Educational inequalities in general and mental health: differential contribution of physical activity, smoking, alcohol consumption and diet.

BACKGROUND: Behavioural, material and psychosocial risk factors may explain educational inequalities in general health. To what extent these risk factors have similar or different contributions to educational inequalities in mental health is unknown. METHODS: Data were derived from the Norwegian Survey of Level of Living from 2005, comprising 5791 respondents aged ≥ 25 years. The study objectives were addressed by means of a series of logistic regression analyses in which we examined: (i) educational inequalities in self-reported general and mental health; (ii) the associations between behavioural, material and psychosocial risk factors and general and mental health, controlled for sex, age and education; and (iii) the contribution of risk factors to the observed health gradients. RESULTS: The lower educated were more likely to be in poor health [odds ratio (OR): 3.46 (95% confidence interval, CI: 2.84-4.21)] and to be in poor mental health [OR: 1.41 (95% CI: 1.12-1.78)] than the highest educated. The joint contribution of behavioural, material and psychosocial risk factors explained all the variations of mental health inequalities, whereas these were able to explain ~40% of the inequalities in general health. Both behavioural and material risk factors contributed substantially to the explanation of general and mental health inequalities, whereas the psychosocial risk factor (i.e. having close persons to communicate with) only seemed to make a larger difference for the explanation of mental health inequalities. CONCLUSION: Policies and interventions to reduce health inequalities should have a broad focus. Combined strategies should be applied to improve physical activity, decrease smoking and improve material and psychosocial conditions among lower educated groups, to achieve the true potential of reducing inequalities in both general and mental health.

Factors predicting changes in physical activity through adolescence: the Young-HUNT Study, Norway.

PURPOSE: The purpose of this prospective population-based study was to analyze predictors of changes in physical activity (PA) levels from early to late adolescence. METHODS: Data presented are from 2,348 adolescents and their parents who participated in the Nord-Trøndelag Health study (HUNT 2, 1995-1997) and at follow-up in Young-HUNT 2, 2000-2001 Participants completed a self-reported questionnaire and participated in a clinical examination that included measurements of height and weight. RESULTS: Four patterns of PA emerged in the study: active or inactive at both time points (active maintainers, 13%; inactive maintainers, 59%), inactive and became active (adopters, 12%), active and became inactive (relapsers, 16%). Being overweight, dissatisfied with life, and not actively participating in sports at baseline were significant predictors of change regarding PA among boys at follow-up. For girls, smoking, drinking, low maternal education, and physical inactivity predicted relapsers and inactive maintainers. Higher levels of education and more physically active parents at baseline seemed to protect against decreased PA during follow-up for both genders. CONCLUSION: Predictors of change in, or maintaining PA status during adolescence differed by gender. These results suggest that PA-promoting interventions should be tailored by gender and focus on encouraging activity for inactive adolescents and maintenance of PA in those already active.

Reliability and validity of the international physical activity questionnaire in the Nord-Trøndelag health study (HUNT) population of men.

BACKGROUND: There is no standardized method for the assessment of physical activity (PA). Therefore it is important to investigate the validity and comparability of different measures. The International Physical Activity Questionnaire (IPAQ) has been developed as an instrument for cross-national assessment of PA and has been validated in 12 countries. These instruments have acceptable measurement properties for monitoring population levels of PA among 18-65 year-old adults in diverse settings. However, there are some concerns that IPAQ may over-report PA.The purpose of this study is to evaluate the reliability and validity of IPAQ, short version, last 7-days in the Nord-Trøndelag Health Study (HUNT) population of men. METHODS: The questionnaire was administered twice to a random sample of 108 men aged 20-39 and validity by comparing results with VO2max and ActiReg, an instrument that measures PA and energy expenditure (EE). ActiReg discriminates between the body positions: stand, sit, bend forward and lie and also registers if there is motion or not in each of them or both. RESULTS: Our results for reliability of the IPAQ short version were good for vigorous and fair for moderate activities. Intraclass correlations ranged from a low of 0.30 for moderate activity hours, to a high of 0.80 for sitting hours. Concerning validity, our results suggest that total IPAQ vigorous PA was a moderately good measure of vigorous activity, having moderately strong, significant correlations with VO2max, r = 0.41 (p < or = 0.01), but correlated not with metabolic equivalent (METs) values of 6 or more measured with ActiReg. Only total IPAQ walking was fair correlated with METs 1-3 and METs 3-6, respectively r = -0.27 and 0.26 (p < or = 0.05). The index for IPAQ sitting hours per week was moderate correlated with METs values of 1-3 and negatively correlated with METs values of 3-6. Classification of PA in three levels (low, moderate and high) correlated also most strongly with VO2max (0.31 p < or = 0.01) and METs 3-6 and METs 1-3 from ActiReg (r = 0.32 and -0.31, p < or = 0.01). Classification of BMI in three levels (normal, overweight and obese) correlated most strongly negative with VO2max (-0.42 p < or = 0.01) and MJ from ActiReg (r = 0.31 p < or = 0.01). CONCLUSION: Our results indicate that IPAQ short version for men has acceptable reliability and criterion validity for vigorous activity and sitting. Walking has moderate reliability. Only the IPAQ for walking had a fair correlation with METs 6+. The questions about moderate activity had fair reproducibility and correlated poorly with most comparison measures.

Reliability and validity of two frequently used self-administered physical activity questionnaires in adolescents.

BACKGROUND: To create and find accurate and reliable instruments for the measurement of physical activity has been a challenge in epidemiological studies. We investigated the reliability and validity of two different physical activity questionnaires in 71 adolescents aged 13-18 years; the WHO, Health Behaviour in Schoolchildren (HBSC) questionnaire, and the International Physical Activity Questionnaire (IPAQ, short version). METHODS: The questionnaires were administered twice (8-12 days apart) to measure reliability. Validity was assessed by comparing answers from the questionnaires with a cardiorespiratory fitness test (VO2peak) and seven days activity monitoring with the ActiReg, an instrument measuring physical activity level (PAL) and total energy expenditure (TEE). RESULTS: Intraclass correlation coefficients for reliability for the WHO HBSC questionnaire were 0.71 for frequency and 0.73 for duration. For the frequency question, there was a significant difference between genders; 0.87 for girls and 0.59 for boys (p < 0.05). The intraclass correlation coefficients the IPAQ varied between 0.10 and 0.62 for the reliability. Spearman correlation coefficients for validity for both the WHO HBSC questionnaire and the IPAQ (recoded into low, moderate and high activity) measured against VO2peak were fair, ranging between 0.29 - 0.39. The WHO HBSC questionnaire measured against VO2peak for girls were acceptable, ranging between 0.30 - 0.55. Both questionnaires, except the walking question in IPAQ, showed a low correlation with PAL and TEE, ranging between 0.01 and 0.29. CONCLUSION: These data indicate that the WHO HBSC questionnaire had substantial reliability and were acceptable instrument for measuring cardiorespiratory fitness, especially among girls. None of the questionnaires however seemed to be a valid instrument for measuring physical activity compared to TEE and PAL in adolescents.

Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study: HUNT 1.

BACKGROUND: A large health survey was previously conducted in 1984-86, the Nord-Trøndelag Health Study (HUNT 1), and another was conducted in 1995-97 (HUNT 2). A third, HUNT 3, started in 2006. However, the physical activity (PA) questionnaires have not yet been validated. AIMS: To assess the reliability and validity of the self-reported physical activity questionnaire in the Nord-Trøndelag Health Study (HUNT 1). METHODS: The HUNT 1 questionnaire was administered to a random sample of 108 healthy men aged 20-39 years. Repeatability was assessed with a repeat questionnaire after one week, and validity by comparing results with direct measurement of VO(2) during maximal work on a treadmill, with ActiReg, an instrument that measures PA and energy expenditure (EE) and with the International Physical Activity Questionnaire (IPAQ). ActiReg records the main body positions (stand, sit, bent forward and lie) together with the motion of the trunk and/or one leg each second. RESULTS: The results indicated strong, significant agreement on test-retest (weighted kappa frequency, r=0.80, intensity, r=0.82, and duration, r=0.69). We found a moderate, significant correlation, r=0.48 (p< or =0.01), between the index based on questionnaire responses and VO(2max.) Metabolic equivalent (MET) values of 6 or more from ActiReg and "vigorous activity'' from the IPAQ most strongly correlated with the index (r=0.39, r=0.55, respectively). Associations of other measures obtained from ActiReg with questionnaire responses were weaker. CONCLUSIONS: Our results indicate that the PA questionnaire in HUNT 1 is reproducible and provides a useful measure of leisure-time PA for men. The questionnaire is very short, and compared favourably with much longer instruments for assessment of more vigorous PA. It should be an appropriate tool for use in further epidemiological studies, particularly when the interest is in aspects of PA reflected in fitness or METs greater than 6.

Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study (HUNT 2).

BACKGROUND: To validate the physical activity (PA) questionnaire in Nord-Trøndelag Health Study (HUNT 2). METHODS: The questionnaire was administered twice to a random sample of 108 men aged 20-39 and validity by comparing results with VO(2max) and ActiReg, measuring PA and energy expenditure and with the International Physical Activity Questionnaire (IPAQ). RESULTS: Spearman correlation coefficients indicated poor and moderate significant agreement by test-retest (light activity, r = 0.17, and hard activity, r = 0.50). We found a moderate significant correlation r = 0.46 (p < or = 0.01) between hard PA and VO(2max) and n.s for light activity (r = -03). Metabolic equivalent (METs) values 6+ from ActiReg most strongly correlated with hard PA r = 0.31 (p < or = 0.01), though associations of other measures obtained from ActiReg with questionnaire measures were weaker. Occupational activity was strongest correlated for METs 3-6 r = 0.48 (p < or = 0.01) by ActiReg. CONCLUSIONS: The HUNT 2 question for "hard" LTPA has acceptable repeatability and appears to be a reasonably valid measure of vigorous activity, as reflected in moderate correlations with several other measures including VO(2max), and with corresponding results from IPAQ and ActiReg. The HUNT 2 question on occupational activity had good repeatability and appears to best reflect time spent in moderate activity, with moderate associations with measured time at intermediate intensity levels. The "light" activity question from HUNT 2 had poor reproducibility and did not correlate well with most of the comparison measures. Thus, the "hard" PA and the occupational activity question should be useful measures of vigorous PA, if time and space allow only very brief assessment. The utility of the "light" PA questions remains to be established.

Adolescents with wheeze have increased risk of additional health problems. The Young-HUNT study, Norway.

OBJECTIVE: To explore the hypothesis of an association between current wheeze and other health problems in adolescence and to investigate any sex differences. METHODS: N=8817 adolescents aged 13-19 years completed a self-administered questionnaire including questions on health and lifestyle in Norway (1995-1997). RESULTS: All subjective health problems were significantly more prevalent in current wheezers compared to non-wheezers (frequent headache: girls 18% vs. 9%, boys 8% vs. 3%; frequent neck and shoulder pain: girls 10% vs. 5%, boys 6% vs. 2%; frequent joint and muscle pain: girls 6% vs. 2%, boys 6% vs. 2%; and frequent abdominal pain: girls 10% vs. 3%, boys 3% vs.1%). In both sexes, adjusted for covariates, current wheezers had statistically significant increased risk of reporting frequent headache (girls OR=2.0, boys OR=2.9), frequent neck and shoulder pain (girls OR=1.9, boys OR=3.3), frequent joint and muscle pain (girls OR=2.7, boys OR=3.5) and frequent abdominal pain (girls OR=2.7, boys OR=2.0). CONCLUSIONS: Current adolescent wheezers reported more additional health problems compared to non-wheezers. Even if girls reported more symptoms in general, the associations were stronger in boys. The findings are important for the clinical approach to teenage wheezers and should increase doctors' awareness of coexistence of other health complaints in these patients.

[Fibromyalgia--effect of exercise]. / Fibromyalgi--effekt av fysisk trening.

BACKGROUND: Fibromyalgia is a chronic widespread unexplained musculoskeletal pain syndrome with decreased pain threshold. Because the etiology of fibromyalgia is unknown and the pathogenesis is unidentified, treatment is largely symptomatic and not standardised. The pain and fatigue reported by individuals with fibromyalgia results in a relative sedentary lifestyle, hence also a decrease in the fitness level of skeletal muscles. MATERIAL AND METHODS: In order to assess the effect of exercise in fibromyalgia, the Cochrane Controlled Trials Register was reviewed; 17 studies of exercise interventions on cardiorespiratory endurance, muscle strength and/or flexibility were selected. RESULTS: The results from the studies are inconsistent but low-intensity aerobic exercise regimens were found to be one of the few effective treatments. In these studies, however, subjective pain levels fail to show significant improvement, although improvements are seen on other parameters such as improvement in the number of tender points, in total myalgic scores and reduced tender point tenderness, improved aerobic capacity, physical function, subjective well-being and self-efficacy. INTERPRETATION: The group exercises varied from 1-3 times per week, sessions from 25 minutes to 90 minutes; the duration of the programmes from 6 weeks to 6 month. Most of the programmes were low-intensity dynamic endurance training with a working rate at 50-70 % of maximal heart rate in relation to age.