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Ballin M, Berglind D, Henriksson P, Neovius M, Nordström A, Ortega FB, Sillanpää E, Nordström P, Ahlqvist VH. Adolescent Cardiorespiratory Fitness and Risk of Cancer in Late Adulthood: Nationwide Sibling-Controlled Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.01.24309761. [PMID: 39006434 PMCID: PMC11245056 DOI: 10.1101/2024.07.01.24309761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Objective To investigate whether the higher risks of certain cancers associated with high cardiorespiratory fitness can be explained by increased detection and unobserved confounders. Design Nationwide sibling-controlled cohort study of adolescents. Setting Sweden. Participants 1 124 049 men of which 477 453 were full siblings, who underwent mandatory military conscription examinations between 1972 and 1995 at a mean age of 18.3 years. Main outcome measures Hazard ratios (HR) and 95% confidence intervals (CI) of overall cancer diagnosis and cancer mortality, and 14 site-specific cancers (diagnosis or death), as recorded in the Swedish National Patient Register or Cause of Death Register until 31 December 2023, modelled using flexible parametric regressions. Results Participants were followed until a median (maximum) age of 55.9 (73.5) years, during which 98 410 were diagnosed with cancer and 16 789 had a cancer-related death (41 293 and 6908 among full siblings respectively). The most common cancers were non-melanoma skin (27 105 diagnoses & 227 deaths) and prostate cancer (24 211 diagnoses & 869 deaths). In cohort analysis, those in the highest quartile of cardiorespiratory fitness had a higher risk of prostate (adjusted HR 1.10; 95% CI: 1.05 to 1.16) and skin cancer (e.g., non-melanoma HR 1.44; 1.37 to 1.50) compared to those in the lowest quartile, which led to a higher risk of any type of cancer diagnosis (HR 1.08; 1.06 to 1.11). However, those in the highest quartile had a lower risk of cancer mortality (HR 0.71; 0.67 to 0.76). When comparing full siblings, and thereby controlling for all behavioural, environmental, and genetic factors they share, the excess risk of prostate (HR 1.01; 0.90 to 1.13) and skin cancer (e.g., non-melanoma HR 1.09; 0.99 to 1.20) attenuated to the null. In contrast, the lower risk of overall cancer mortality was still statistically significant after control for such shared confounders (HR 0.78; 0.68 to 0.89). For other site-specific cancers, the influence of such confounding tended to vary, but none showed the same excess risk as prostate and non-melanoma skin cancer. Conclusions The association between high levels of adolescent cardiorespiratory fitness and excess risk of some cancers, such as prostate and non-melanoma skin cancer, appears to be fully explained by unobserved confounders shared between full siblings. However, the protective association with cancer mortality persists even after control for such confounding.
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Affiliation(s)
- Marcel Ballin
- Department of Public Health and Caring Sciences, Clinical Geriatrics, Uppsala University, Uppsala, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Daniel Berglind
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Center for Wellbeing, Welfare and Happiness, Stockholm School of Economics, Stockholm, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Martin Neovius
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Anna Nordström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- School of Sports Science, UiT The Arctic University of Norway, Tromsø, Norway
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada; CIBEROBN, ISCIII, Granada, Andalucía, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Elina Sillanpää
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Peter Nordström
- Department of Public Health and Caring Sciences, Clinical Geriatrics, Uppsala University, Uppsala, Sweden
| | - Viktor H Ahlqvist
- Department of Public Health and Caring Sciences, Clinical Geriatrics, Uppsala University, Uppsala, Sweden
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Ballin M, Neovius M, Ortega FB, Henriksson P, Nordström A, Berglind D, Nordström P, Ahlqvist VH. Genetic and Environmental Factors and Cardiovascular Disease Risk in Adolescents. JAMA Netw Open 2023; 6:e2343947. [PMID: 37976057 PMCID: PMC10656641 DOI: 10.1001/jamanetworkopen.2023.43947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Cardiovascular risk factors in youth have been associated with future cardiovascular disease (CVD), but conventional observational studies are vulnerable to genetic and environmental confounding. Objective To examine the role of genetic and environmental factors shared by full siblings in the association of adolescent cardiovascular risk factors with future CVD. Design, Setting, and Participants This is a nationwide cohort study with full sibling comparisons. All men who underwent mandatory military conscription examinations in Sweden between 1972 and 1995 were followed up until December 31, 2016. Data analysis was performed from May 1 to November 10, 2022. Exposures Body mass index (BMI), cardiorespiratory fitness, blood pressure, handgrip strength, and a combined risk z score in late adolescence. Main Outcomes and Measures The primary outcome was fatal or nonfatal CVD, as recorded in the National Inpatient Register or the Cause of Death Register before 2017. Results A total of 1 138 833 men (mean [SD] age, 18.3 [0.8] years), of whom 463 995 were full brothers, were followed up for a median (IQR) of 32.1 (26.7-37.7) years, during which 48 606 experienced a CVD outcome (18 598 among full brothers). All risk factors were associated with CVD, but the effect of controlling for unobserved genetic and environmental factors shared by full siblings varied. In the sibling analysis, hazard ratios for CVD (top vs bottom decile) were 2.10 (95% CI, 1.90-2.32) for BMI, 0.77 (95% CI, 0.68-0.88) for cardiorespiratory fitness, 1.45 (95% CI, 1.32-1.60) for systolic blood pressure, 0.90 (95% CI, 0.82-0.99) for handgrip strength, and 2.19 (95% CI, 1.96-2.46) for the combined z score. The percentage attenuation in these hazard ratios in the sibling vs total cohort analysis ranged from 1.1% for handgrip strength to 40.0% for cardiorespiratory fitness. Consequently, in the sibling analysis, the difference in cumulative CVD incidence at age 60 years (top vs bottom decile) was 7.2% (95% CI, 5.9%-8.6%) for BMI and 1.8% (95% CI, 1.0%-2.5%) for cardiorespiratory fitness. Similarly, in the sibling analysis, hypothetically shifting everyone in the worst deciles of BMI to the middle decile would prevent 14.9% of CVD at age 60 years, whereas the corresponding number for cardiorespiratory fitness was 5.3%. Conclusions and Relevance In this Swedish national cohort study, cardiovascular risk factors in late adolescence, especially a high BMI, were important targets for CVD prevention, independently of unobserved genetic and environmental factors shared by full siblings. However, the role of adolescent cardiorespiratory fitness in CVD may have been overstated by conventional observational studies.
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Affiliation(s)
- Marcel Ballin
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Clinical Geriatrics, Uppsala University, Uppsala, Sweden
| | - Martin Neovius
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Francisco B. Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute, University of Granada, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Granada, Spain
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Nordström
- Rehabilitation and Pain Centre, Uppsala University Hospital, Uppsala, Sweden
- School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Health Sciences, The Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden
| | - Daniel Berglind
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter Nordström
- Department of Public Health and Caring Sciences, Clinical Geriatrics, Uppsala University, Uppsala, Sweden
| | - Viktor H. Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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3
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Åberg M, Robertson J, Djekic D, Rosengren A, Schaufelberger M, Kuhn G, Åberg ND, Schiöler L, Lindgren M. Body Weight in Adolescent Men in Sweden and Risk of an Early Acute Coronary Event: A Prospective Population-Based Study. J Am Heart Assoc 2023:e029336. [PMID: 37301742 DOI: 10.1161/jaha.122.029336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/13/2023] [Indexed: 06/12/2023]
Abstract
Background Coronary heart disease remains the dominant cause of death worldwide. To improve cardiovascular disease prevention, knowledge of early key risk factors, especially those that are modifiable, is essential. The ongoing global obesity epidemic is of particular concern. We aimed to determine whether body mass index at conscription predicts early acute coronary events among men in Sweden. Methods and Results This was a population-based Swedish cohort study of conscripts (n=1 668 921; mean age, 18.3 years; 1968-2005), with follow-up through linkage to the nationwide Swedish patient and death registries. Risk of a first acute coronary event (hospitalization for acute myocardial infarction or coronary death) during follow-up (1-48 years) was calculated with generalized additive models. Objective baseline measures of fitness and cognition were included in the models in secondary analyses. During follow-up, there were 51 779 acute coronary events, of which 6457 (12.5%) were fatal within 30 days. Compared with men at the lowest end of the normal body mass index spectrum (body mass index, 18.5 kg/m2), an increasing risk for a first acute coronary event was observed, with hazard ratios (HRs) peaking at 40 years of age. After multivariable adjustments, men with a body mass index of 35 kg/m2 had an HR of 4.84 (95% CI, 4.29-5.46) for an event before the age of 40 years. Conclusions An increased risk of an early acute coronary event was detectable within normal levels of body weight at the age of 18 years, increasing to almost 5-fold in the highest weight category at 40 years of age. Given increasing levels of body weight and prevalence of overweight and obesity in young adults, the current decrease in coronary heart disease incidence in Sweden may flatten or even reverse in the near future.
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Affiliation(s)
- Maria Åberg
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Regionhälsan Gothenburg Sweden
| | - Josefina Robertson
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Demir Djekic
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Cardiology Unit Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland Gothenburg Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Cardiology Unit Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland Gothenburg Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Cardiology Unit Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland Gothenburg Sweden
| | - Georg Kuhn
- Centre for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - N David Åberg
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Cardiology Unit Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland Gothenburg Sweden
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4
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Ortega FB, Leskošek B, Blagus R, Gil-Cosano JJ, Mäestu J, Tomkinson GR, Ruiz JR, Mäestu E, Starc G, Milanovic I, Tammelin TH, Sorić M, Scheuer C, Carraro A, Kaj M, Csányi T, Sardinha LB, Lenoir M, Emeljanovas A, Mieziene B, Sidossis LS, Pihu M, Lovecchio N, Konstabel K, Tambalis KD, Štefan L, Drenowatz C, Rubín L, Gontarev S, Castro-Piñero J, Vanhelst J, O'Keeffe B, Veiga OL, Gisladottir T, Sandercock G, Misigoj-Durakovic M, Niessner C, Riso EM, Popovic S, Kuu S, Chinapaw M, Clavel I, Labayen I, Dobosz J, Colella D, Kriemler S, Salaj S, Noriega MJ, Bös K, Sánchez-López M, Lakka TA, Tabacchi G, Novak D, Ahrens W, Wedderkopp N, Jurak G. European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network. Br J Sports Med 2023; 57:299-310. [PMID: 36623866 PMCID: PMC9985767 DOI: 10.1136/bjsports-2022-106176] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES (1) To develop reference values for health-related fitness in European children and adolescents aged 6-18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries. METHODS This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test-retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method. RESULTS A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online (www.fitbackeurope.eu). CONCLUSION This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.
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Affiliation(s)
- Francisco B Ortega
- Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain .,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Bojan Leskošek
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Blagus
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.,Institute for Biostatistics and Medical Informatics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Faculty of Mathematics, Natural Sciences and Information technologies, University of Primorska, Glagoljaška, Slovenia
| | - José J Gil-Cosano
- Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain.,Department of Communication and Education, Universidad Loyola Andalucía, Dos Hermanas, Spain
| | - Jarek Mäestu
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jonatan R Ruiz
- Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
| | - Evelin Mäestu
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Ivana Milanovic
- University of Belgrade, Faculty of Sport and Physical Education, Belgrade, Serbia
| | - Tuija H Tammelin
- JAMK University of Applied Sciences, School of Health and Social Studies, LIKES, Jyväskylä, Finland
| | - Maroje Sorić
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.,University of Zagreb, The Faculty of Kinesiology, Zagreb, Croatia
| | - Claude Scheuer
- European Physical Education Association (EUPEA).,Department of Education and Social Work, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Attilio Carraro
- Faculty of Education, Free University of Bozen-Bolzano, Brixen, Italy
| | - Mónika Kaj
- Hungarian School Sport Federation, Budapest, Hungary
| | - Tamás Csányi
- Hungarian School Sport Federation, Budapest, Hungary.,Department of Physical Education Theory and Methodology, Hungarian University of Sports Science, Budapest, Hungary.,Department of Physical Education, Faculty of Primary and Pre-School Education, ELTE, Eötvös Loránd University, Budapest, Hungary
| | - Luis B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, 1499-002 Cruz-Quebrada, Portugal
| | - Matthieu Lenoir
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Arunas Emeljanovas
- Lithuanian Sports University, Department of Physical and Social Education, Kaunas, Lithuania
| | - Brigita Mieziene
- Lithuanian Sports University, Department of Physical and Social Education, Kaunas, Lithuania
| | - Labros S Sidossis
- Mediterranean Lifestyle Medicine Institute and Department of Kinesiology and Health, Rutgers University, New Brunswick, USA
| | - Maret Pihu
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Nicola Lovecchio
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy.,Confederation of Italian Associations of Physical Education Teachers (Capdi & LSM), Venezia, Italy
| | - Kenn Konstabel
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia.,Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Konstantinos D Tambalis
- Harokopio University, Department of Nutrition and Dietetics, Athens, Greece.,National and Kapodistrian University of Athens, Department of Physical Education and Sport Science, Athens, Greece
| | - Lovro Štefan
- University of Zagreb, The Faculty of Kinesiology, Zagreb, Croatia.,Faculty of Sports Studies, Masaryk University, Brno, Czech Republic.,Recruitment and Examination (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University of Education Upper Austria, Linz, Austria
| | - Lukáš Rubín
- Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic.,Department of Physical Education and Sport, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Seryozha Gontarev
- Faculty of Physical Education, Sport and Health. Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - José Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, Cadiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Jérémy Vanhelst
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Centre of Research in Epidemiology and Statistics - University of Paris Cité (CRESS), Bobigny, France
| | - Brendan O'Keeffe
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Oscar L Veiga
- EstiLIFE Research Group. Department of Physical Education, Sport and Human Movement, Faculty of Teaching Training and Education, Autonomous University of Madrid, Madrid, Spain
| | - Thordis Gisladottir
- Center of Sport and Health Sciences, School of Education, University of Iceland, Reykjavik Iceland
| | - Gavin Sandercock
- School of Sport Rehabilitation and Exercise Science, University of Essex, Colchester, UK
| | | | - Claudia Niessner
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Eva-Maria Riso
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Stevo Popovic
- University of Montenegro, Faculty for Sport and Physical Education, Niksic, Montenegro.,Western Balkan Sport Innovation Lab, Podgorica, Montenegro
| | - Saima Kuu
- Tallinn University, School of Natural Sciences and Health, Tallinn, Estonia
| | - Mai Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Iván Clavel
- Galician Sport Foundation, General Sport Secretariat, Galician Government, Santiago de Compostela, Spain.,Performance and Health Group, Faculty of Sport Sciences and Physical Education, Department of Physical Education and Sports, University of A Coruña, Coruña, Spain
| | - Idoia Labayen
- Research Institute for Innovation & Sustainable Food Chain Development, Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Janusz Dobosz
- Józef Piłsudski University of Physical Education in Warsaw, Poland
| | - Dario Colella
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sanja Salaj
- University of Zagreb, The Faculty of Kinesiology, Zagreb, Croatia
| | - Maria Jose Noriega
- Department of Physiology & Pharmacology University of Cantabria, Cantabria, Spain
| | - Klaus Bös
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Mairena Sánchez-López
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain
| | - Timo A Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.,Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Garden Tabacchi
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Dario Novak
- University of Zagreb, The Faculty of Kinesiology, Zagreb, Croatia
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Niels Wedderkopp
- The Pediatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gregor Jurak
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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5
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The genetic basis of exercise and cardiorespiratory fitness – Relation to cardiovascular disease. CURRENT OPINION IN PHYSIOLOGY 2023. [DOI: 10.1016/j.cophys.2023.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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6
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Qiu Y, Fernández-García B, Lehmann HI, Li G, Kroemer G, López-Otín C, Xiao J. Exercise sustains the hallmarks of health. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:8-35. [PMID: 36374766 PMCID: PMC9923435 DOI: 10.1016/j.jshs.2022.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 05/23/2023]
Abstract
Exercise has long been known for its active role in improving physical fitness and sustaining health. Regular moderate-intensity exercise improves all aspects of human health and is widely accepted as a preventative and therapeutic strategy for various diseases. It is well-documented that exercise maintains and restores homeostasis at the organismal, tissue, cellular, and molecular levels to stimulate positive physiological adaptations that consequently protect against various pathological conditions. Here we mainly summarize how moderate-intensity exercise affects the major hallmarks of health, including the integrity of barriers, containment of local perturbations, recycling and turnover, integration of circuitries, rhythmic oscillations, homeostatic resilience, hormetic regulation, as well as repair and regeneration. Furthermore, we summarize the current understanding of the mechanisms responsible for beneficial adaptations in response to exercise. This review aimed at providing a comprehensive summary of the vital biological mechanisms through which moderate-intensity exercise maintains health and opens a window for its application in other health interventions. We hope that continuing investigation in this field will further increase our understanding of the processes involved in the positive role of moderate-intensity exercise and thus get us closer to the identification of new therapeutics that improve quality of life.
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Affiliation(s)
- Yan Qiu
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong 226011, China; Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, Shanghai 200444, China
| | - Benjamin Fernández-García
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo 33011, Spain; Department of Morphology and Cell Biology, Anatomy, University of Oviedo, Oviedo 33006, Spain
| | - H Immo Lehmann
- Cardiovascular Division of the Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Guoping Li
- Cardiovascular Division of the Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris Cité, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris 75231, France; Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif 94805, France; Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris 75015, France.
| | - Carlos López-Otín
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo 33006, Spain; Centro de Investigación Biomédica en Red Enfermedades Cáncer (CIBERONC), Oviedo 33006, Spain.
| | - Junjie Xiao
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong 226011, China; Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, Shanghai 200444, China.
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7
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Abstract
Childhood obesity is, according to the WHO, one of the most serious challenges of the 21st century. More than 100 million children have obesity today. Already during childhood, almost all organs are at risk of being affected by obesity. In this review, we present the current knowledge about diseases associated with childhood obesity and how they are affected by weight loss. One major causative factor is obesity-induced low-grade chronic inflammation, which can be observed already in preschool children. This inflammation-together with endocrine, paracrine, and metabolic effects of obesity-increases the long-term risk for several severe diseases. Type 2 diabetes is increasingly prevalent in adolescents and young adults who have had obesity during childhood. When it is diagnosed in young individuals, the morbidity and mortality rate is higher than when it occurs later in life, and more dangerous than type 1 diabetes. Childhood obesity also increases the risk for several autoimmune diseases such as multiple sclerosis, Crohn's disease, arthritis, and type 1 diabetes and it is well established that childhood obesity also increases the risk for cardiovascular disease. Consequently, childhood obesity increases the risk for premature mortality, and the mortality rate is three times higher already before 30 years of age compared with the normal population. The risks associated with childhood obesity are modified by weight loss. However, the risk reduction is affected by the age at which weight loss occurs. In general, early weight loss-that is, before puberty-is more beneficial, but there are marked disease-specific differences.
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Affiliation(s)
- Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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8
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Radulović A, Jurak G, Leskošek B, Starc G, Blagus R. Secular trends in physical fitness of Slovenian boys and girls aged 7 to 15 years from 1989 to 2019: a population-based study. Sci Rep 2022; 12:10495. [PMID: 35729360 PMCID: PMC9213534 DOI: 10.1038/s41598-022-14813-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022] Open
Abstract
Using the population-based data we aim to estimate the general population trends of multiple components of physical fitness of children, identify critical structural changes in these trends, and evaluate the potential changes in differences in the test scores between the children. During the entire study period, 1989-2019, median body mass index and triceps skinfold increased in both genders and all age groups. Muscular fitness, in general, showed negative trends, with some exceptions: during the post-2010 period, children were mostly experiencing the improvement of isometric strength of the upper body. The neuromuscular components of physical fitness showed positive trends, especially in girls. Cardiorespiratory fitness has been declining in all age groups until the last decade, with the largest decreases occurring before 2000. In the last decade, the trends reversed. The flexibility indicator revealed the largest differences between boys and girls, with boys mainly experiencing negative and girls mostly positive trends. The variability of the test scores mostly increased during the study period. This increasing variance suggests that-despite generally favourable trends in the last decade-children in Slovenia have been facing increasing inequalities in their development, which can potentially lead to future inequalities in health.
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Affiliation(s)
- Ana Radulović
- Center for Control and Prevention of Infectious Diseases, Institute of Public Health of Montenegro, Džona Džeksona bb, 81000, Podgorica, Montenegro
| | - Gregor Jurak
- Faculty of Sports, University of Ljubljana, Gortanova ulica 22, 1000, Ljubljana, Slovenia
| | - Bojan Leskošek
- Faculty of Sports, University of Ljubljana, Gortanova ulica 22, 1000, Ljubljana, Slovenia
| | - Gregor Starc
- Faculty of Sports, University of Ljubljana, Gortanova ulica 22, 1000, Ljubljana, Slovenia
| | - Rok Blagus
- Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
- Faculty of Sports, University of Ljubljana, Gortanova ulica 22, 1000, Ljubljana, Slovenia.
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Glagoljaška ulica 8, 6000, Koper, Slovenia.
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9
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Ballin M, Nordström P. Does exercise prevent major non-communicable diseases and premature mortality? A critical review based on results from randomized controlled trials. J Intern Med 2021; 290:1112-1129. [PMID: 34242442 DOI: 10.1111/joim.13353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Observational studies show that physical activity is strongly associated with a reduced risk of premature mortality and major non-communicable diseases. We reviewed to which extent these associations have been confirmed in randomized controlled trials (RCTs) for the outcomes of mortality, cardiovascular disease (CVD), type 2 diabetes (T2D), and fracture. The results show that exercise does not reduce all-cause mortality and incident CVD in older adults or in people with chronic conditions, based on RCTs comprising ∼50,000 participants. The results also indicate a lack of effect on cardiovascular mortality in people with chronic conditions, based on RCTs comprising ∼11,000 participants. Furthermore, there is inconsistent evidence regarding the effect of exercise on fractures in older adults, based on RCTs comprising ∼40,000 participants. Finally, based on RCTs comprising ∼17,000 participants, exercise reduces T2D incidence in people with prediabetes when combined with dietary modification, although evidence for the individual effect of exercise is lacking. Identified shortcomings of the current evidence include risks of publication bias, lack of high-quality studies in certain high-risk populations, and inconstant evidence with respect to some outcomes. Thus, additional large trials would be of value, especially with fracture as the primary outcome. In conclusion, according to current RCT evidence, exercise can prevent T2D assuming it is combined with dietary intervention. However, the current evidence shows that exercise does not prevent premature mortality or CVD, with inconsistent evidence for fractures.
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Affiliation(s)
- Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden
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10
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Tarp J, Grøntved A, Sanchez‐Lastra MA, Dalene KE, Ding D, Ekelund U. Fitness, Fatness, and Mortality in Men and Women From the UK Biobank: Prospective Cohort Study. J Am Heart Assoc 2021; 10:e019605. [PMID: 33715383 PMCID: PMC8174221 DOI: 10.1161/jaha.120.019605] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/19/2021] [Indexed: 12/20/2022]
Abstract
Background Cardiorespiratory fitness may moderate the association between obesity and all-cause mortality (ie, the "fat-but-fit" hypothesis), but unaddressed sources of bias are a concern. Methods and Results Cardiorespiratory fitness was estimated as watts per kilogram from a submaximal bicycle test in 77 169 men and women from the UK Biobank cohort and combined with World Health Organization standard body mass index categories, yielding 9 unique fitness-fatness combinations. We also formed fitness-fatness combinations based on bioimpedance as a direct measure of body composition. All-cause mortality was ascertained from death registries. Multivariable-adjusted Cox regression models were used to estimate hazard ratios and 95% CIs. We examined the association between fitness-fatness combinations and all-cause mortality in models with progressively more conservative approaches for accounting for reverse causation, misclassification of body composition, and confounding. Over a median follow-up of 7.7 years, 1731 participants died. In our base model, unfit men and women had higher risk of premature mortality irrespective of levels of adiposity, compared with the normal weight-fit reference. This pattern was attenuated but maintained with more conservative approaches in men, but not in women. In analysis stratified by sex and excluding individuals with prevalent major chronic disease and short follow-up and using direct measures of body composition, mortality risk was 1.78 (95% CI, 1.17-2.71) times higher in unfit-obese men but not higher in obese-fit men (0.94 [95% CI, 0.60-1.48]). In contrast, there was no increased risk in obese-unfit women (1.09 [95% CI, 0.44-1.05]) as compared with the reference. Conclusions Cardiorespiratory fitness modified the association between obesity and mortality in men, but this pattern appeared susceptible to biases in women.
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Affiliation(s)
- Jakob Tarp
- Department of Sports MedicineNorwegian School of Sports SciencesOsloNorway
| | - Anders Grøntved
- Research Unit for Exercise EpidemiologyCentre of Research in Childhood HealthDepartment of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
| | - Miguel A. Sanchez‐Lastra
- Department of Special DidacticsFaculty of Educational Sciences and SportsUniversity of VigoPontevedraSpain
| | - Knut Eirik Dalene
- Department of Sports MedicineNorwegian School of Sports SciencesOsloNorway
| | - Ding Ding
- Prevention Research CollaborationSydney School of Public HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Ulf Ekelund
- Department of Sports MedicineNorwegian School of Sports SciencesOsloNorway
- Department of Chronic Diseases and AgeingNorwegian Institute of Public HealthOsloNorway
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