Physical activity measured by accelerometry among adolescents participating in sports clubs and non-participating peers

AbstractThe purpose of this descriptive cross-sectional study is to describe the amount and intensity of physical activity (PA) measured by accelerometry among adolescents participating in organized sports (SCP) and age-matched non-participating peers (NP). SCPs (332) and NPs (139) wore an accelerometer on the hip for 7 days. PA was reported using the 1 min exponential moving average. The current moderate-to-vigorous physical activity (MVPA) recommendation of at least an average of 60 minutes of MVPA daily was reached by 85% of SCPs and 45% of NPs (p < 0.001). During training days, the MVPA times among SCPs ranged from 153 ± 39 min in males and 109 ± 35 min in females participating in basketball to 113 ± 33 min in males participating in floorball and 83 ± 32 min in females participating in gymnastics. -Sports participation contributes rather strongly to the accumulation of the recommended amount of MVPA. During training days SCPs, except for females participating in gymnastics, accumulated more MVPA than NPs. During non-training days only males participating in cross country skiing and females participating in track and field accumulated more MVPA than NPs.

Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain

Background

Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP.

Methods

Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0–4 none, 5–9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined.

Results

The internal consistency of the PHQ-9-mFIN was high (Cronbach’s α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson’s correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, − 0.40 to − 0.67 and − 0.64) than for the Physical (range, − 0.08 to − 0.43 and − 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work.

Conclusions

The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work.

Trial registration

NCT01465698.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-020-03832-y.

Performance in dynamic movement tasks and occurrence of low back pain in youth floorball and basketball players

BACKGROUND

Prospective studies investigating risk factors for low back pain (LBP) in youth athletes are limited. The aim of this prospective study was to investigate the association between hip-pelvic kinematics and vertical ground reaction force (vGRF) during landing tasks and LBP in youth floorball and basketball players.

METHODS

Three-hundred-and-eighty-three Finnish youth female and male floorball and basketball players (mean age 15.7 ± 1.8) participated and were followed up on for 3 years. At the beginning of every study year the players were tested with a single-leg vertical drop jump (SLVDJ) and a vertical drop jump (VDJ). Hip-pelvic kinematics, measured as femur-pelvic angle (FPA) during SLVDJ landing, and peak vGRF and side-to-side asymmetry of vGRF during VDJ landing were the investigated risk factors. Individual exposure time and LBP resulting in time-loss were recorded during the follow-up. Cox's proportional hazard models with mixed effects and time-varying risk factors were used for analysis.

RESULTS

We found an increase in the risk for LBP in players with decreased FPA during SLVDJ landing. There was a small increase in risk for LBP with a one-degree decrease in right leg FPA during SLVDJ landing (HR 1.09, 95% CI 1.02 to 1.17, per one-degree decrease of FPA). Our results showed no significant relationship between risk for LBP and left leg FPA (HR 1.04, 95% CI 0.97 to 1.11, per one-degree decrease of FPA), vGRF (HR 1.83, 95% CI 0.95 to 3.51) or vGRF side-to-side difference (HR 1.22, 95% CI 0.65 to 2.27) during landing tasks.

CONCLUSIONS

Our results suggest that there is an association between hip-pelvic kinematics and future LBP. However, we did not find an association between LBP and vGRF. In the future, the association between hip-pelvic kinematics and LBP occurrence should be investigated further with cohort and intervention studies to verify the results from this investigation.

LEVEL OF EVIDENCE

Prognosis, level 1b.

Acute and overuse injuries among sports club members and non-members: the Finnish Health Promoting Sports Club (FHPSC) study

Background

Physical activity in adolescence is promoted for its multi-dimensional health benefits. However, too intensive sports participation is associated with an increased injury risk. Our aim was to compare the occurrence of acute and overuse injuries in Finnish sports club members and non-members and to report training and competing habits associated with a higher injury risk in sports club members.

Methods

In this cross-sectional survey targeted at 14–16-year-old adolescents, a structured questionnaire was completed by 1077 sports club members and 812 non-members. The main outcome measures were self-reported acute and overuse injuries, their location and type.

Results

At least one acute injury in the past year was reported by 44.0% of sports club members and 19.8% of non-members (P < 0.001). The sex-adjusted odds ratio (OR) for acute injury in sports club members compared to non-members was 3.13 (95% confidence interval (95% CI) 2.54–3.87). Thirty-five percent of sports club members and 17.4% of non-members (P < 0.001) reported at least one overuse injury during the past year. The overuse injury OR for sports club members was 2.61 (95% CI 2.09–3.26). Sports club members who trained 7–14 h per week during training (OR 1.61, 95% CI 1.21–2.12, P = 0.001) or competition season (OR 1.55, 95% CI 1.18–2.06, P = 0.002) were more likely to report an injury compared to members who trained 3–6 h per week. Those sports club members who participated in forty competitions or more compared to 7–19 competitions per year were more likely to report an acute injury (OR 1.55, 95% CI 1.05–2.08, P = 0.028) or for an overuse injury (OR 1.53, 95% CI 1.02–2.30, P = 0.038).

Conclusions

Both acute and overuse injuries are common among youth sports club members, and the number increases along with increasing amounts of training and competitions. More effective injury prevention is needed both for adolescents engaging in sports club activities and for other adolescents.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2417-3) contains supplementary material, which is available to authorized users.

High ankle injury rate in adolescent basketball: A 3-year prospective follow-up study

This prospective study investigated the incidence and pattern of acute time-loss injuries in young female and male basketball players. Eight basketball teams (n=201; mean age 14.85±1.5) participated in the follow-up study (2011-2014). The coaches recorded player participation in practices and games on a team diary. A study physician contacted the teams once a week to check new injuries and interviewed the injured players. In total, 158 injuries occurred. The overall rate of injury (per 1000 hours) was 2.64 (95% CI 2.23-3.05). Injury rate was 34.47 (95% CI 26.59-42.34) in basketball games and 1.51 (95% CI 1.19-1.82) in team practices. Incidence rate ratio (IRR) between game and practice was 22.87 (95% CI 16.71-31.29). Seventy-eight percent of the injuries affected the lower limbs. The ankle (48%) and knee (15%) were the most commonly injured body sites. The majority of injuries involved joint or ligaments (67%). Twenty-three percent of the injuries were severe causing more than 28 days absence from sports. Number of recurrent injuries was high (28% of all injuries), and most of them were ankle sprains (35 of 44, 79%). No significant differences were found in injury rates between females and males during games (IRR 0.88, 0.55, to 1.40) and practices (IRR 1.06, 0.69, to 1.62). In conclusion, ankle and knee ligament injuries were the most common injuries in this study. Moreover, the rate of recurrent ankle sprains was alarming.

Low back and neck and shoulder pain in members and non-members of adolescents' sports clubs: the Finnish Health Promoting Sports Club (FHPSC) study

BACKGROUND

The objective of this study was to investigate the prevalence of self-reported low back pain (LBP) and neck and shoulder pain (NSP), and the related factors in members and non-members of adolescents' sports clubs.

METHODS

This cross-sectional study was based on surveys of 14-16-year-olds as a part of the Finnish Health Promoting Sports Club (FHPSC) Study. The surveys on self-reported health behaviours, injuries, and musculoskeletal health were conducted among sports club members (n = 962) and non-members (n = 675). Binary logistic regression analysis was applied to study the associations between dependent variables of LBP and NSP, and the independent factors.

RESULTS

The prevalence of LBP during the preceding 3 months was 35.0 % in girls and 24.5 % in boys (p < 0.05 for sex difference). The prevalence of NSP was 55.9 % in girls and 27.3 % in boys (p < 0.001 for sex difference). Being a sports club member increased the odds for LBP in boys (odds ratio [OR] 2.35, 95 % CI 1.48-3.72). On the other hand, sports club participation was associated with lower odds of frequent NSP in girls (OR 0.52, 95 % CI 0.33-0.82). No associations were found between other leisure-time physical activity and LBP or NSP. Higher screen time (computer games, TV/DVD, phone, Internet) during leisure-time increased the odds of NSP in boys and LBP in boys and girls.

CONCLUSIONS

In this study, self-reported LBP and NSP were already relatively common among adolescents. Girls have a higher risk for reporting LBP and NSP. Measures that are more effective in the prevention of LBP in male sports club members are needed. Excessive screen time is weakly associated with LBP and NSP, which should be taken into account in health promotion among adolescents.

Knee Control and Jump-Landing Technique in Young Basketball and Floorball Players

Poor knee alignment is associated with increased loading of the joints, ligaments and tendons, and may increase the risk of injury. The study purpose was to compare differences in knee kinematics between basketball and floorball players during a vertical drop jump (VDJ) task. We wanted to investigate whether basketball players, whose sport includes frequent jump-landings, exhibited better knee control compared with floorball players, whose sport involves less jumping. Complete data was obtained from 173 basketball and 141 floorball players. Peak knee valgus and flexion angles during the VDJ were analyzed by 3D motion analysis.Larger knee valgus angles were observed among basketball players (- 3.2°, 95%CI -4.5 to - 2.0) compared with floorball players (- 0.9°, 95%CI -2.3 to 0.6) (P=0.022). Basketball players landed with a decreased peak knee flexion angle (83.1°, 95%CI 81.4 to 84.8) compared with floorball players (86.5°, 95%CI 84.6 to 88.4) (P=0.016). There were no significant differences in height, weight or BMI between basketball and floorball players. Female athletes exhibited significantly greater valgus angles than males. This study revealed that proper knee control during jump-landing does not seem to develop in young athletes simply by playing the sport, despite the fact that jump-landings occur frequently in practice and games.

Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010

We determined the current trend in the number and incidence of hip fracture among persons 50 years of age or older in Finland between 1970 and 2010. After a clear rise until the late 1990s, the incidence of hip fracture has continuously declined.

INTRODUCTION

Hip fractures are a major public health issue associated with excess morbidity and mortality. We determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined Caucasian population of 5.4 million people.

METHODS

We took into account all persons 50 years of age or older who were admitted to hospitals for primary treatment of hip fracture between 1970 and 2010.

RESULTS

The number of hip fractures rose sharply till the end of 1990s (from 1,857 in 1970 to 7,122 in 1997), but since then, the rise has leveled off (7,594 fractures in 2010). Similarly, the age-adjusted incidence of hip fracture increased until 1997 but declined thereafter. The decline was especially clear in women whose age-adjusted incidence was 515.7 (per 100,000 persons) in 1997 but only 382.6 in 2010. In men, the corresponding incidence was 245.3 in 1997 and 210.7 in 2010. The number of hip fractures will increase 1.8-fold by 2030 even with the current 2010 incidence rates because the size of the 50-year-old or older population is likely to increase sharply in the near future.

CONCLUSIONS

The declining trend in the incidence of hip fracture in Finland has continued through the entire first decade of the new millennium. Reasons for this development are uncertain, but possible explanations include increased average body weight, improved functional ability among elderly Finns, and specific measures to prevent bone loss and reduce the risk of falling.

Effect of a neuromuscular warm-up programme on muscle power, balance, speed and agility: a randomised controlled study

OBJECTIVE

To investigate whether a 6-month neuromuscular warm-up programme could improve muscle power, balance, speed and agility.

DESIGN

Cluster randomised controlled study.

SETTING

27 top level female floorball teams in Finland.

PARTICIPANTS

222 players (mean age 24 years); 119 in the intervention group and 103 in the control group were followed-up for one league season (6 months).

INTERVENTION

A neuromuscular warm-up programme included sports-specific running technique, balance, jumping and strengthening exercises. The teams were advised to use the programme 1-3 times per week through the league season. One training session took approximately 25 min.

MAIN OUTCOME MEASURES

Performance tests were assessed before and after the 6-month intervention and included static jump, countermovement jump, jumping over a bar, standing on a bar and figure-of-eight running.

RESULTS

At 6 months, significant between-group differences were found in two outcome measures: jumping over a bar (number of jumps in 15 s) and standing on a bar (number of balance losses in 60 s). These differences were 2.3 jumps (95% CI 0.8 to 3.8, p = 0.003), favouring the intervention group, and -0.4 balance losses (95% CI -0.8 to 0.0, p = 0.050), again in favour of the intervention group.

CONCLUSION

A neuromuscular warm-up programme improved the floorball players' sideways jumping speed and static balance. The exercises were also safe to perform and can thus be recommended for weekly training of floorball players.

TRIAL REGISTRATION NUMBER

ISRCTN26550281.

Declining incidence of low-trauma knee fractures in elderly women: nationwide statistics in Finland between 1970 and 2006

The study assessed the recent secular trend in the incidence of low-trauma knee fractures among older Finns in the years 1970-2006. The clear rise in women's fracture incidence from early 1970s until the late 1990s was followed by a declining fracture rate. Exact reasons for the decline are unknown, but a cohort effect toward a healthier female population with improved functionality and reduced risk of injurious slips, trips and falls could partly explain the phenomenon.

INTRODUCTION

Although low-trauma fractures of elderly adults have been recognized as a major public health concern in modern societies with aging populations, fresh nationwide information on their secular trends is sparse.

METHODS

We determined the current trend in the number and incidence (per 100,000 persons) of low-trauma knee fractures among elderly people in Finland, an EU country with a well-defined white population of 5.3 million, by taking into account all persons 60 years of age or older who were admitted to our hospitals for primary treatment of such fractures from 1970 to 2006.

RESULTS

The number and incidence of low-trauma knee fractures among 60-year-old or older Finnish women sharply rose between 1970 and 1997, from 218 (number) and 55 (incidence) in 1970 to 733 and 124 in 1997. However, thereafter both the number and incidence of fractures have continuously declined so that there were only 626 fractures in these women in 2006 (incidence 94). In the age-adjusted fracture incidence, the findings were similar. During 1970-1997, the age-adjusted incidence of low-trauma knee fractures in our elderly women clearly rose (from 60 to 118), but thereafter, this incidence declined to 85 in 2006. In men, the fracture incidence did not show consistent trend changes over time (30 in 1970 and 36 in 2006).

CONCLUSIONS

The sharp rise in the incidence of low-trauma knee fractures in Finnish elderly women from early 1970s until late 1990s has been followed by a declining fracture rate. Exact reasons for this are unknown, but a cohort effect toward a healthier aging female population with improved functional ability and reduced risk of injurious slips, trips and falls cannot be excluded.

Incidence of poisoning deaths in Finland in 1971–2005

Poisonings cause considerable morbidity and mortality worldwide. However, only few countries have published nationwide statistics on poisoning deaths. Based on the Official Cause-of-Death Statistics of Finland, we investigated the incidence and secular trend of poisoning deaths in Finland in 1971–2005. Alcohol poisoning deaths and other poisoning deaths were analyzed separately. During the 35-year study period, other poisoning deaths (non-alcohol) increased from 2.6/100,000 in men and 1.4/100,000 in women in 1971 to 6.8/100,000 and 3.2/100,000 in 2005, respectively. Alcohol poisoning death rates also increased from 9.6/100,000 in men and 0.7/100,000 in women in 1971 to 16.8/100,000 and 4.2/100,000 in 2005, respectively. In the early 1970s, the incidence rates of alcohol deaths were about 10 times higher in men compared with women, whereas in the last few years of observation, men's incidence rate was only about four times higher. Our study showed that alcohol and other poisoning deaths increased in Finland between 1971 and 2005. Men’s risk was markedly higher than women’s risk, but in the later years, women’s risk was increasing. Poisoning death rates among children and adolescents were low throughout the period.

Participation in sports clubs is a strong predictor of injury hospitalization: a prospective cohort study

The aim of this prospective cohort study was to investigate the nature and risk factors of injuries leading to hospitalization. A cohort of 57 407 Finns aged 14-18 years was followed in the Hospital Discharge Register for an average of 10.6 years, totaling 608 990 person-years. We identified 5889 respondents (10.3%) with injury hospitalization. The most common anatomical location was the knee and shin (23.9%), followed by the head and neck (17.8%), and the ankle and foot (16.7%). Fractures (30.4%) and distortions (25.4%) were the most common injury types. The strongest risk factor for injury hospitalization was frequent participation in sports clubs [hazard ratio (HR) in males 1.8; 95% confidence interval (CI): 1.7-2.0 and in females 2.3; 95% CI: 1.9-2.7], followed by recurring drunkenness (HR 1.6; 95% CI: 1.4-2.7 in males and 1.4; 95% CI: 1.2-1.6 in females) and daily smoking (HR 1.4; 95% CI: 1.3-1.5 in males and 1.43 95% CI: 1.2-1.5 in females). The association between injuries and sports clubs participation remained after adjusting for sociodemographic background, health, and health behaviors. Health behavior in adolescence, particularly sports club activity, predicted injury hospitalization. Preventive interventions directed toward adolescents who participate in sports clubs may decrease injury occurrence.

Trend in sports injuries among young people in Finland

The main purpose of this study was to explore how the number of home, sports, and other leisure time injuries among young people aged 15 - 25 years has developed in Finland in 1988 - 2003. In 1988, 2559 people aged 15 - 25 years were interviewed by Statistics Finland. In 1993, 1997 and 2003 those amounts were 751, 1638 and 1382. The subjects were asked in a telephone interview to report the injuries in which they had been involved during the previous 12 months. The crude injury incidence in 2003 was 364 per 1000 person years in men and 246 in women. The total number of injuries increased 49 % between the years 1988 and 2003. The number of sports injuries increased the most. The increase was greater among men than women, and the injury rate was higher among both men and women aged 15 - 19 years than those aged 20 - 25 years. More research is needed on whether and how exercise and time at home have changed and become riskier among young people. It is also essential to find out which prevention methods are the most effective among young people and implement these measures in a well-planned and targeted manner.

Artificial playing surface increases the injury risk in pivoting indoor sports: a prospective one-season follow-up study in Finnish female floorball

OBJECTIVES

To compare the injury risk in pivoting indoor sports between two different surfaces: artificial floors and wooden floors.

METHODS

Female players (n = 331) from 26 top-level Finnish floorball teams were followed for one competitive season (6 months). All traumatic game related time-loss injuries were recorded. Injury incidences were calculated as the number of injuries per 1000 game hours for both surfaces. Incidence rate ratios (IRRs) were obtained from Poisson regression models.

RESULTS

Over the competitive season, 62 traumatic injuries occurred during the games. The injury incidence per 1000 playing hours was 59.9 (95% CI 43.2 to 83.0) on artificial floors and 26.8 (95% CI 18.2 to 39.3) on wooden floors, the adjusted IRR being twofold higher (IRR = 2.1; 95% CI 1.2 to 3.5, p = 0.005) on artificial floors than wooden floors. The risk for non-contact injuries (adjusted IRR = 12.5; 95% CI 2.9 to 54.9, p = 0.001) and severe injuries (adjusted IRR = 3.3; 95% CI 0.9 to 10.9, p = 0.052) was especially high when playing on artificial floors.

CONCLUSIONS

The study attested that the risk of traumatic injury in pivoting indoor sports is higher when playing on artificial floors than wooden floors. The higher shoe-surface friction on the former surface is likely to explain the higher injury risk.

Injury risk in female floorball: a prospective one-season follow-up

The purpose of this prospective study was to examine the incidence, nature, causes, and severity of injuries in female floorball. Three hundred and seventy-four licensed female floorball players from Finnish top leagues were observed prospectively for one season (6 months). The practice and game hours of floorball were recorded on an exercise diary. All injuries were registered with a structured questionnaire and verified by a physician. During the study period, 133 out of the 374 (35%) players sustained 172 injuries. The injury incidence was 1.8 per 1000 practice hours and 40.3 per 1000 game hours. Of all injuries, 70% were traumatic and 30% were from overuse. The most common injury type was joint sprain (27%). The most commonly injured sites were the knee (27%) and ankle (22%). Twenty-one of the knee injuries (46%) were serious including 10 anterior cruciate ligament (ACL) ruptures. Eight of ACL ruptures occurred during floorball games, giving an ACL rupture incidence of 3.6 per 1000 game hours. Eleven injuries (6%) needed hospital admission. The study attested that injury rate in floorball game is very high. Injury prevention strategies in female floorball should be targeted at injuries occurring at the knee and ankle.

Knee Injuries in Leisure-Time Physical Activities: A Prospective One-Year Follow-Up of a Finnish Population Cohort

This prospective one-year follow-up study compared the risks of knee injuries in various commuting and lifestyle activities as well as in recreational and competitive sports in a 15 to 74-year-old Finnish population cohort. A cohort of 3657 persons was randomly selected from the nationwide population register of Finland. Ninety-two percent of them accepted to participate (n = 3363). The subjects were interviewed by telephone three times during the one-year follow-up. The recorded data included all physical activities that lasted 15 minutes or more, and all injuries that were sustained during these activities. Fifteen percent (n = 321) of all reported injuries affected the knee. The individual risk of knee injury per 1000 exposure hours was low in commuting activities (cycling, walking), 0.06 (95 % CI 0.04 to 0.09) and in lifestyle activities (gardening, hunting, fishing, home repair etc.), 0.04 (0.03 - 0.06). In recreational and competitive sports, the knee injury risk was almost ten times higher, 0.44 (0.39 - 0.50). For commuting activities (p = 0.046) and for recreational and competitive sports (p < 0.001), there was a decreasing injury rate with age. In lifestyle activities (p = 0.038), in turn, there was an increasing trend of injuries with aging. In commuting activities (hazard ratio, HR 5.99, 95 % CI 1.40 to 25.6), the risk of knee injury was significantly higher in women than in men. In conclusion, the knee injury risk per exposure hours is almost ten times lower in commuting and lifestyle activities compared to recreational and competitive sports. The knee injury risk is especially high in the age group of 15 to 25 years, especially in various team sports and ball games. At population level, however, widely practiced low-to-moderate intensity activities with relatively low injury risk per exposure hours produce a large absolute number of knee injuries.

Self-guided brisk walking training with or without poles: a randomized-controlled trial in middle-aged women

Walking with poles (Nordic walking, NW) has become popular. We compared training responses of brisk walking (W) or NW on cardiorespiratory and neuromuscular fitness. We randomized 121 non-obese sedentary women (aged 50-60) to an NW or W group (NWG, WG), to train 40 min four times weekly for 13 weeks. Intensity was based on subjective perception of exertion. Cardiorespiratory performance was assessed in four levels corresponding to 50%, 65%, 80% and 100% of peak VO(2). Fifty-four NWG and 53 WG subjects completed the study. The mean intensity was about 50% of heart rate (HR) reserve. The baseline peak VO(2) was 25.8 (SD 3.9) mL/min/kg. Both groups improved peak VO(2) similarly (NWG 2.5 mL/min/kg, 95% confidence interval (CI) 1.9-3.3; WG 2.6, CI 1.9-3.3). In the submaximal stages while walking with or without poles, HR and lactate decreased after training in both groups, but the changes were not statistically significantly different between the groups. Of the neuromuscular tests after training, the only significant difference between the groups was in the leg strength in the one-leg squat, favoring WG. In conclusion, both training modes improved similarly health-enhancing physical fitness, and they were feasible and safe.

Exercise-induced bronchospasm among healthy elite cross country skiers and non-athletic students

Regular exercise in cold, dry air is believed to be a predisposing factor for exercise-induced bronchospasm (EIB). The aim of this study was to compare the occurrence of EIB among previously healthy elite cross country skiers and their non-athletic control subjects. Twenty healthy elite cross country skiers and 18 non-asthmatic controls were challenged by a standardized free exercise test. Thereafter, subjects' respiratory function was followed by flow-volume spirometry up to 30 min. EIB was defined in the post-exercise spirometry as at least one of the following: a >or=10% decrease in forced expiratory volume in 1 s (FEV1), a >or=20% decrease in mean maximal expiratory flow (MMEF) or a >or=25% decrease in peak expiratory flow rate (PEF). EIB was found in two skiers and one control according to FEV1, for seven skiers and two controls according to MMEF. Two skiers and one control had exercise-induced asthma (EIA) according to both parameters. The largest decrease in PEF was 13%, that did not result in additional diagnoses. All nine of the subjects with a positive test result reported asthma-like symptoms (dyspnea, cough or increased mucus excretion) after the exercise challenge. Accordingly, seven previously healthy skiers (35%) and two controls (11%) were diagnosed as having EIB. In addition, three skiers of the original cohort were excluded because of an earlier asthma diagnosis, making the total asthma prevalence 10/23 (42%) among the elite skiers. It was concluded that EIB is more common in elite cross country skiers than in non-athletic controls. The bronchoconstriction induced by exercise is usually mild or moderate, and flow-volume spirometry with sensitive flow parameters is needed for it to be diagnosed. Even a mild asthma decreases minute ventilation and maximal performance of winter sport athletes. Therefore, skiers with long-term respiratory symptoms or decreased performance should be studied for EIA and treated adequately.

Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future

We determined the current trends in the number and incidence of hospital-treated minimal-trauma rib fractures (low- to moderate-energy traumas typically caused by a fall from standing height or less) in Finnish elderly people by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to hospitals in 1970-2001 for primary treatment of such fractures. The number and incidence (per 100,000 persons) of these fractures clearly increased from 268 (number) and 41 (incidence) in 1970 to 737 and 70 in 2001, while in younger patients (aged 20-49 years) the trend was decreasing, the corresponding numbers being 194 and 10 in 1970, and 153 and 7 in 2001. In the elderly Finns, also the age-adjusted incidence of these hospital-admitted rib fractures showed an increase, from 37 (1970) to 51 (2001) in women, and from 63 to 77 in men. In women aged 80 years and over, the age-specific incidence of fracture increased from 88 to 186, while in the other age groups only slight secular changes were found. If the above-described trends continue, the number of elderly Finns admitted to a hospital due to a rib fracture will more than double in next three decades.

Active Living and Injury Risk

The purpose of this study was to get reliable insight into injury risk in various commuting and lifestyle activities, as well as recreational and competitive sports. A cohort of 3 657 persons was randomly selected from the 15- to 74-year-old Finnish population. Ninety-two percent (n = 3 363) of the subjects accepted to participate the one-year follow-up, record all their physical activities that lasted 15 min or more, and register all acute and overuse injuries that occurred during these activities. To collect the information, the study subjects were interviewed by phone by the trained personnel of the Statistics Finland three times in four-month intervals. The individual injury risk per exposure time was relatively low, ranging from 0.19 to 1.5 per 1 000 hours of participation, in commuting and lifestyle activities including walking and cycling to work, gardening, home repair, hunting and fishing, and, in sports such as golf, dancing, swimming, walking, and rowing. The risk was clearly higher in squash, orienteering, and contact and team sports, such as judo, wrestling, karate, rinkball, floorball, basketball, soccer, ice hockey, volleyball, and Finnish baseball ranging from 6.6 to 18.3 per 1 000 hours of participation. However, the highest absolute number of injuries occurred in low-risk activities, such as gardening, walking, home-repair, and cycling, because they are performed so often. In conclusion, individual injury risk per exposure hours is relatively low in commuting and lifestyle activities compared to many recreational and competitive sports. However, at a population level, these low-to-moderate intensity activities are widely practised producing a rather high absolute number of injuries, and thus, preventive efforts are needed in these activities, too.

Basic science and clinical studies coincide: active treatment approach is needed after a sports injury

The basic response to injury at the tissue level is well known and consists of acute inflammatory phase, proliferative phase, and maturation and remodeling phase. Knowing these phases, the treatment and rehabilitation program of athletes' acute musculoskeletal injuries should use a short period of immobilization followed by controlled and progressive mobilization. Both experimental and clinical trials have given systematic and convincing evidence that this program is superior to immobilization - a good example where basic science and clinical studies do coincide - and therefore active approach is needed in the treatment of these injuries.

[Pathophysiology of overuse tendon injury]

Overuse tendon injury is one of the most common injuries in sports. The etiology as well as the pathophysiological mechanisms leading to tendinopathy are of crucial medical importance. At the moment intrinsic and extrinsic factors are assumed as mechanisms of overuse tendon injury. Except for the acute, extrinsic trauma, the chronic overuse tendon injury is a multifactorial process. There are many other factors, such as local hypoxia, less of nutrition, impaired metabolism and local inflammatory that may also contribute to the development of tissue damage. The exact interaction of these factors cannot be explained entirely at the moment. Further studies will be necessary in order to get more information.

Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future

To increase knowledge about recent trends in the number and incidence of various low-trauma injuries among elderly people, we selected, from the National Hospital Discharge Register, all patients > or =60 years of age who were admitted to hospitals in Finland (5 million population) for primary treatment of a first low-trauma ankle fracture during 1970-2000. In each year of the study, the age-adjusted and age-specific incidence of fracture was expressed as the number of patients per 100,000 persons. The predicted numbers and incidence rates of fractures until the year 2030 were calculated using a regression model. For the study period, the number and incidence of low-trauma ankle fractures in Finnish persons > or =60 years of age rose substantially: the total number of fractures increased from 369 in 1970 to 1545 in 2000, a 319% increase, and the crude incidence increased from 57 to 150, a 163% increase. The age-adjusted incidence of these fractures also rose in both women (from 66 in 1970 to 174 in 2000, a 164% increase) and men (from 38 in 1970 to 114 in 2000, a 200% increase). The regression model indicates that, if this trend continues, there will be about three times more low-trauma ankle fractures in Finland in the year 2030 than there was in 2000. In conclusion, the number of low-trauma ankle fractures in elderly Finns is rising rapidly at a rate that cannot be explained simply by demographic changes and, therefore, potentially effective preventive measures, such as prevention of slippings, trippings, and falls in elderly people, and use of ankle supports, should be urgently studied.

Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work

Sports injuries are one of the most common injuries in modern western societies. Treating sports injuries is often difficult, expensive and time consuming, and thus, preventive strategies and activities are justified on medical as well as economic grounds. A successful injury surveillance and prevention requires valid pre- and post-intervention data on the extent of the problem. The aetiology, risk factors and exact mechanisms of injuries need to be identified before initiating a measure or programme for preventing sports injuries, and measurement of the outcome (injury) must include a standardised definition of the injury and its severity, as well as a systematic method of collecting the information. Valid and reliable measurement of the exposure includes exact information about the population at risk and exposure time. The true efficacy of a preventive measure or programme can be best evaluated through a well-planned randomised trial. Until now, 16 randomised, controlled trials (RCT) have been published on prevention of sports injuries. According to these RCT, the general injury rate can be reduced by a multifactorial injury prevention programme in soccer (relative risk 0.25, p < 0.001, in the intervention group), or by ankle disk training, combined with a thorough warm-up, in European team handball [odds ratio 0.17; 95% confidence interval (CI) 0.09 to 0.32, p < 0.01]. Ankle sprains can be prevented by ankle supports (i.e. semirigid orthoses or air-cast braces) in high-risk sporting activities, such as soccer and basketball (Peto odds ratio 0.49; 95% CI 0.37 to 0.66), and stress fractures of the lower limb by the use of shock-absorbing insoles in footwear (Peto odds ratio 0.47; 95% CI 0.30 to 0.76). In future studies, it is extremely important for researches to seek consultation with epidemiologists and statisticians to be certain that the study hypothesis is appropriate and that the methodology can lead to reliable and valid information. Further well-designed randomised studies are needed on preventive actions and devices that are in common use, such as preseason medical screenings, warming up, proprioceptive training, stretching, muscle strengthening, taping, protective equipment, rehabilitation programmes and education interventions (such as increasing general injury awareness among a team). The effect of a planned rule change on the injury risk in a particular sport could be tested via a RCT before execution of the change. The most urgent needs are in commonly practised or high-risk sports, such as soccer, American football, rugby, ice hockey, European team handball, karate, floorball, basketball, downhill skiing and motor sports.

Continuously rising problem of osteoporotic knee fractures in elderly women: nationwide statistics in Finland in 1970-1999 and predictions until the year 2030

We assessed the current trends in the number and incidence of osteoporotic knee fractures in Finland by collecting data from the National Hospital Discharge Register for all patients > or =60 years of age who were admitted to Finnish hospitals in 1970-1999 for primary treatment of such fractures. The knee fracture was defined "osteoporotic" if it was caused by a low-energy trauma only; that is, a fall from standing height or less. We also predicted fracture development until the year 2030 by a regression model, which took into account the predicted changes in the fracture incidences and population at risk. The number and incidence (per 100,000 persons) of osteoporotic knee fractures in Finnish women aged > or =60 years clearly rose during the study period, from 218 (number) and 55 (incidence) in 1970 to 685 and 113 in 1999. Even after age adjustment, the incidence of women's fractures showed a clear increase, from 59 in 1970 to 105 in 1999. If this trend continues, there will be about 2.5 times more osteoporotic knee fractures in Finnish women in the year 2030 than there were in 1999. In Finnish men aged > or =60 years, the annual number of fractures and its changes were clearly smaller (77 in 1970 vs. 138 in 1999), and the fracture incidence did not show consistent trend changes over time (30 in 1970 vs. 34 in 1999). We conclude that in elderly Finnish women the number of osteoporotic knee fractures shows a rise with a rate that cannot be explained merely by demographic changes and, therefore, vigorous preventive measures are needed to control this development.

Sports injuries in floorball: a prospective one-year follow-up study

Two hundred and ninety-five licensed floorball players from Finnish premier to fifth division were observed prospectively for one season to study the incidence, nature, causes and severity of floorball injuries. During the study period, 100 out of the 295 (34 %) players sustained 120 injuries. Thirty-seven percent (73/199) of the male players and 28 % (27/96) of the females suffered from an injury. The injury rate was 1.0 per 1000 practice hours for both sexes. The injury rates per 1000 game hours were 23.7 for men and 15.9 for women. One hundred injuries (83 %) were acute and the remaining 20 (17 %) were overuse injuries. Sprain was the most common type of injury in men while overuse injuries were the most frequent injury type in women. The lower extremity was involved in 62 %, spine or trunk in 19 % and upper extremity in 10 % of the injuries. The most commonly injured sites were the knee and ankle (22 % and 20 % of all injuries), followed by head and neck (8 %). In both sexes the majority of injuries were minor, level II, injuries. Ten of the knee injuries (38 %) were serious, level IV injuries, of which seven were ACL ruptures. In conclusion, the individual risk of injury in floorball is relatively low in game practice while rather high during the game itself. Before initiation of clinical trials on prevention of floorball injuries, an exact knowledge of the risk factors and mechanisms of floorball injuries are needed.

Epidemiology of adulthood injuries: a quickly changing injury profile in Finland

Although developed societies have undergone many profound changes during recent decades, including urbanization, increased traffic and aging of the populations, epidemiologic information on secular trends in profiles of injuries is limited. We investigated such trends in Finland by selecting from the National Hospital Discharge Register all Finns aged 15 years or more who required hospital treatment because of an unintentional injury during 1971-1995. The injury incidences were expressed as the number of patients per 100,000 individuals per year. In Finnish men, road traffic accidents and falls, the two leading causes of injury, produced equal numbers of injuries in 1971 (4935 and 4957), but thereafter the role of the traffic accidents gradually decreased (3512 injuries with unadjusted and age-adjusted incidences of 177 and 183 in 1995) and that of falls clearly increased (13,218 injuries with unadjusted and age-adjusted incidences of 664 and 635 in 1995). Changes in the other injury categories of men were less drastic. In Finnish women, falling was the most common cause of injury in 1971 (5051 injuries), after which its role increased sharply, to 17,250 injuries in 1995 (unadjusted and age-adjusted incidences of 804 and 698, respectively). In 1971, road traffic produced 2369 injuries in women, after which this number somewhat decreased (2160 injuries with unadjusted and age-adjusted incidences of 101 and 101 in 1995). The role of all the other injury categories was small in Finnish women during 1971-1995. We conclude that a quick change in the overall profile of injuries occurred in Finland in 1971-1995, a change in which falls replaced road traffic accidents as the major cause of a serious injury. This epidemiologic change will give a new challenge for injury prevention in the new millennium.

Prevention of hip fracture in elderly people with use of a hip protector

BACKGROUND

Hip fractures are common in frail elderly adults worldwide. We investigated the effect of an anatomically designed external hip protector on the risk of these age-related fractures.

METHODS

We randomly assigned 1801 ambulatory but frail elderly adults (1409 women and 392 men; mean age, 82 years), in a 1:2 ratio, either to a group that wore a hip protector or to a control group. Fractures of the hip and all other fractures were recorded until the end of the first full month after 62 hip fractures had occurred in the control group. The risk of fracture in the two groups was compared, and in the hip-protector group the risk of fracture was also analyzed according to whether the protector had been in use at the time of a fall.

RESULTS

During follow-up, 13 subjects in the hip-protector group had a hip fracture, as compared with 67 subjects in the control group. The respective rates of hip fracture were 21.3 and 46.0 per 1000 person-years (relative hazard in the hip-protector group, 0.4; 95 percent confidence interval, 0.2 to 0.8; P=0.008). The risk of pelvic fracture was slightly but not significantly lower in the hip-protector group than in the control group (2 subjects and 12 subjects, respectively, had pelvic fracture) (relative hazard, 0.4; 95 percent confidence interval, 0.1 to 1.8; P > or = 0.05). The risk of other fractures was similar in the two groups. In the hip-protector group, four subjects had a hip fracture (among 1034 falls) while wearing the protector, and nine subjects had a hip fracture (among 370 falls) while not wearing the protector (relative hazard, 0.2; 95 percent confidence interval, 0.05 to 0.5; P=0.002).

CONCLUSIONS

The risk of hip fracture can be reduced in frail elderly adults by the use of an anatomically designed external hip protector.

Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium

We determined the current trends in the number and incidence of osteoporotic fractures of the proximal humerus in Finland by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to Finnish hospitals in 1970-1998 for primary treatment of such fractures. The fracture was defined osteoporotic if it was caused by a low-energy trauma only, i.e., a fall from standing height or less. The number and incidence (per 10(5) persons) of fractures increased sharply from 208 (number) and 32 (incidence) in 1970 to 1,105 and 110 in 1998. Even after the age-adjustment, the incidence of fractures showed a clear increase: in women from 50 in 1970 to 133 in 1998, and in men from 14 in 1970 to 49 in 1998. If this trend continues, there will be three times more osteoporotic fractures of the proximal humerus in Finland in the year 2030 than there were in 1998.

Unintentional injury deaths in an adult Finnish population from 1971-1997

We investigated the trends in age-standardized rates (per 100,000 persons-years) of unintentional injury deaths in adult Finns from 1971-1997. In 1971, the leading category of unintentional injury resulting in death among Finnish men was road traffic accidents (age-standardized death rate 47 per 100,000 person-years). This rate has declined sharply, reaching 13 per 100,000 person-years in 1997. Simultaneously, the rate of fall-induced death among men gradually increased from 17/100,000 person-years in 1971 to 21/100,000 person-years in 1997. In 1997 the death rate from falls in men was greater than that of any other category of injury. In 1971, traffic caused fewer deaths in women (rate 17/100,000 person-years) than men, and declined from there to a rate of 6/100,000 person-years in 1997. Concurrently the rate of fall-induced deaths in women also decreased, from 27/100,000 person-years in 1971 to 17/100,000 person-years in 1997. Falling, however, was the leading cause of injury-related death in 1997. Thus, in the period 1971-1997, falls replaced road traffic accidents as the leading cause of unintentional injury death in Finland.

A controlled trial of the health benefits of regular walking on a golf course

PURPOSE

To study the effects of regular walking during a golf game on various health and fitness indicators in middle-aged men.

METHODS

Study subjects were 55 healthy male golfers aged 48 to 64 years who had been sedentary during the 7 months before the study, and 55 age-matched, similarly sedentary controls. During the 20-week study, those in the intervention group were encouraged to play golf two to three times a week; the controls were not. Measurements of body composition, cardiorespiratory performance, motor and musculoskeletal fitness, blood pressure, and serum lipid, glucose, and insulin levels were obtained at baseline and after the 20-week study.

RESULTS

Walking during a golf game was a practical and safe form of physical activity with high adherence. It significantly increased aerobic performance and trunk muscle endurance, with a net difference (pretraining to posttraining change between the golfers and controls) of 36 seconds (95% confidence interval [CI]: 19 to 53 seconds, P < 0.001) for treadmill walking time and 13 seconds (95% CI: 2 to 24 seconds, P = 0.02) for static back extension. In addition, regular walking favorably affected body composition, including reductions in weight of 1.4 kg (95% CI: 0.6 to 2.1 kg, P < 0.001), in waist circumference of 2.2 cm (95% CI: 1.0 to 3.3 cm, P < 0.001), and in abdominal skin fold thickness of 2.2 cm (95% CI: 0.9 to 3.4 cm, P = 0.001). Golfers also had significantly greater increases in serum high-density lipoprotein (HDL) cholesterol levels and in the ratio of HDL cholesterol to total cholesterol.

CONCLUSIONS

Regular walking had many positive effects on the health and fitness of sedentary middle-aged men. Walking during a golf game is characterized by high adherence and low risk of injury and is therefore a good form of health-enhancing physical activity.

Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons

BACKGROUND

Although osteoporosis, falls, and fractures among older adults are said to be a continuously increasing public health problem, reliable epidemiological information on their secular trends is very limited.

OBJECTIVE

To determine the current trend in the number and incidence of fall-induced, fracture-associated, spinal cord injuries in a typical white population (Finland, a country with about 5 million inhabitants).

METHODS

All Finns aged 50 years or older who were admitted to hospitals from January 1, 1970, through December 31, 1995, for primary treatment of an acute fall-induced, fracture-associated, spinal cord injury were selected from the National Hospital Discharge Register. Similar patients aged 20 through 39 years served as a reference group. In each year of the study, the number and the age-specific and age-adjusted incidences of injuries were expressed as the number of patients per 100,000 persons.

RESULTS

The total number of fall-induced, fracture-associated, spinal cord injuries of Finnish older adults increased considerably during the study period, from 60 in 1970 to 419 in 1995 (an average increase of 24% annually). The corresponding injury incidence was 5 in 1970 and 27 in 1995. The age-adjusted incidence of these injuries also increased from 1970 to 1995: in women, from 5 to 29, and in men, from 7 to 17 (relative increases were 480% and 143%, respectively). In the reference group, no trend changes by time were observed.

CONCLUSIONS

In Finnish persons aged 50 years or older, the number of fall-induced, fracture-associated, spinal cord injuries shows a rise with a rate that cannot be explained merely by demographic changes. The finding shows an increasing influence of osteoporosis and falls on health and well-being of our older adults, and therefore, vigorous preventive measures are needed to control this development.

Childhood deaths and injuries in Finland in 1971-1995

BACKGROUND

This study examined the recent nationwide trends for the absolute number and the age- and sex-specific incidence rates of the fatal and serious non-fatal injuries among 0-14 year old children in Finland in 1971-1995.

METHODS

We selected from Official Cause-of-Death Statistics and National Hospital Discharge Register children aged 0-14 years who died or required treatment at a hospital department because of an injury in 1971-1995. The number of Finnish children was 1.1 million in 1971, and 1.0 million in 1995.

RESULTS

During the entire study period injuries were the leading cause of death in children aged 1-14 years, but not in infants. However, in these years the incidence (per 100 000 people) of fatal injuries in Finnish children decreased considerably in all age groups and both sexes, in girls from 20.1 in 1971 to 4.6 in 1995, and in boys from 36.7 in 1971 to 9.3 in 1995. In 1995, 41% of all the injurious deaths among 0-14 year old Finnish children were motor vehicle accidents, 12% were drownings, and 24% intentional injuries. The overall number and incidence of serious non-fatal injuries among Finnish children showed no clear trend change in 1971-1995. The mean hospitalization time of injured children shortened between 1971 and 1995, from 7.4 days to 2.7 days.

CONCLUSIONS

We conclude that the number and incidence of fatal childhood injuries have decreased dramatically in Finland between 1971 and 1995. The reasons for this positive development are multifactorial, but improved traffic safety and trauma care are probably very important. In children's serious non-fatal injuries the development has not been so encouraging and therefore children's injury prevention should receive continuous intense attention.

Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970-1997 and alarming projections for the new millennium

The purpose of our epidemiologic study was to determine the current trend in the number and incidence of osteoporotic pelvic fractures in Finland, a country with a Caucasian population of 5 million. Thus, all Finns 60 years of age or older who were admitted to hospitals in 1970-1997 for primary treatment of a first osteoporotic pelvic fracture were selected from The National Hospital Discharge Register. In each year of the study, the number and the age-specific and age-adjusted incidences of fractures were expressed as the number of. patients per 100,000 individuals. The total number of osteoporotic pelvic fractures increased considerably in Finland during the study period, from 128 in 1970 to 913 in 1997, an average increase of 23% a year. The corresponding fracture incidence (per 100,000 persons 60 years of age or older) was 20 in 1970 and 92 in 1997. The mean age of the patients also increased, from 74 years (1970) to 80 years (1997). Despite this, the age-adjusted incidence of osteoporotic pelvic fractures also showed a steady increase from 1970 to 1997: in women, from 31 to 103, and in men, from 13 to 38 (relative increases were 232% and 192%, respectively). If this trend continues, the current number of osteoporotic pelvic fractures in this country (about 900 fractures per year) may treble by the year 2030 (about 2,700 fractures per year). We conclude that the number of osteoporotic pelvic fractures in elderly Finns is increasing at a rate that cannot be explained simply by demographic changes and therefore effective preventive measures should be urgently initiated to control the increasing burden of these age-related fractures.