Changes in Daily Steps and Body Mass Index and Waist to Height

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Author(s): Salin, Kasper; Hirvensalo, Mirja; Magnussen, Costan G.; Telama, Risto; Hutri-Kähönen,
Nina; Viikari, Jorma; Raitakari, Olli; Tammelin, Tuija
Title:
Changes in daily steps and body mass index and waist to height ratio during four year
follow-up in adults : Cardiovascular risk in young Finns study
Year:
2017
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Please cite the original version:
Salin, K., Hirvensalo, M., Magnussen, C. G., Telama, R., Hutri-Kähönen, N., Viikari, J., .
. . , & Tammelin, T. (2017). Changes in daily steps and body mass index and waist to
height ratio during four year follow-up in adults : Cardiovascular risk in young Finns
study. International Journal of Environmental Research and Public Health, 14 (9),
1015. doi:10.3390/ijerph14091015
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International Journal of
Environmental Research
and Public Health
Article
Changes in Daily Steps and Body Mass Index and
Waist to Height Ratio during Four Year Follow-Up in
Adults: Cardiovascular Risk in Young Finns Study
Kasper Salin 1, *, Mirja Hirvensalo 1 , Costan G. Magnussen 2,3 , Risto Telama 1 ,
Nina Hutri-Kähönen 4 , Jorma Viikari 2 , Olli Raitakari 2 and Tuija Tammelin 5
1
2
3
4
5
*
Faculty of Sport & Heath Sciences, University of Jyväskylä, 40014 Jyväskylän, Finland;
mirja.hirvensalo@jyu.fi (M.H.); risto.r.telama@jyu.fi (R.T.)
Research Centre of Applied and Preventive Cardiovascular Medicine and Departments of Clinical
Physiology and Internal Medicine, University of Turku and Turku University Central Hospital, 20500 Turku,
Finland; costan.magnussen@utas.edu.au (C.G.M.); jorma.viikari@utu.fi (J.V.); olli.raitakari@utu.fi (O.R.)
Menzies Institute for Medical Research Hobart, University of Tasmania, Hobart, TAS 7000, Australia
Department of Pediatrics, University of Tampere and Tampere University Hospital, 33100 Tampere, Finland;
nina.hutri-kahonen@uta.fi
LIKES Research Centre for Physical Activity and Health, 40014 Jyväskylä, Finland; tuija.tammelin@likes.fi
Correspondence: kasper.makela@jyu.fi
Received: 30 June 2017; Accepted: 1 September 2017; Published: 5 September 2017
Abstract: Aims: Over the study years, there was a significant increase in body mass index (BMI)
and waist-to-height ratio (WtHR) in middle aged Finnish adults. Methods: Data were obtained from
1033 Finnish adults from the Cardiovascular Risk in Young Finns Study in 2007 and 2011. Cohort
study participants wore an Omron Walking Style One (HJ-152R-E) pedometer for five days and were
grouped into those who increased, maintained and decreased their steps between 2007 and 2011.
Paired samples t-test was used to compare body mass index (BMI) and waist-to-height ratio (WtHR)
change values between the change groups in study years. Results: Among study population BMI
and WtHR increase between study years was statistically significant (p < 0.001). Only those, who
increased their total steps for at least 2000 steps, maintained their BMI in the same level, while people
who decreased or maintained their total steps in the same level, BMI and WtHR increased during
four years follow-up. Conclusions: This data suggests that increasing steps in middle age is associated
with maintaining BMI at the same level.
Keywords: physical activity; pedometer; adults; follow-up; body mass index; waist-to-height ratio
1. Background
In recent decades, physical inactivity has emerged as a major health problem. Recent data show
physical inactivity to be the fourth leading cause of death worldwide [1], with 6–10% of all deaths
from non-communicable diseases worldwide being attributable to physical inactivity [2,3]. Physical
inactivity is also associated with obesity and other major risk factors for chronic disease [2]. Although
leisure time physical activity (PA) has increased, occupational PA has decreased in high income and
rapidly developing countries with current estimates suggesting that 31% of the world’s population
is not meeting PA recommendations [4]. During the 20 years follow-up (1975–2014) of 19.2 million
participants, BMI increased from 21.7 to 24.2 among men and from 22.1 to 24.4 among women [5].
Overall, the worldwide proportion of adults with a BMI of 25 kg/m2 or greater have increased from
28.8% to 36.9% in men and from 29.8% to 38.0% in women between the years 1980 and 2013 [6].
Based on self-reported questionnaires, 48.6% of adults in Finland do not meet the recommendations
for health enhancing physical activity (HEPA) [7]. However, self-reported questionnaires of PA have
Int. J. Environ. Res. Public Health 2017, 14, 1015; doi:10.3390/ijerph14091015
www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2017, 14, 1015
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several limitations when compared with objectively measured PA [8]. Recent data have emerged from
studies with objective measurements of PA [9–12] that suggest a decline of total PA and an increase
of sedentary time among adults in economically developed countries. However, there are signs of
gender and age differences between countries. In some countries, the decline in daily steps have been
observed only among men [9], women [10], or in certain age groups [9].
Obesity is often considered to be a result of either excessive food intake or insufficient physical
activity [13]. High sedentary time is related to higher body weight and increased risk of obesity [14].
In addition, low PA has been found to be a risk factor for higher prevavelnce of adverse cardiometabolic
health indicators [15]. Recent studies using objective measurements of PA have found that short
term changes in daily steps do not influence body mass index (BMI) [16]. Similarly, even though
individuals have increased their PA, the increase has not been enough to prevent weight gain [17].
Likewise among obese individuals, the trend of daily steps is stable or even declining while among
normal and overweight people trend of daily steps is increasing among the adult population in the
USA [18]. In recent studies, it has been stated that alongside BMI, other measures should be used to
measure central obesity, like waist circumference, and waist-to-hip ratio [19] and waist-to-height ratio
(WtHR) [20]. No research has examined the associations between PA change over a longer time period
using objective measurements with BMI, and WtHR in population-based samples. Therefore, the aim
of this study is to evaluate changes in PA during a four years follow-up period among Finnish adults
and explore the associations between changes in daily steps with changes of BMI and WtHR.
2. Methods
2.1. Study Design and Participants
Data was obtained from the ongoing cohort study, Cardiovascular Risk Young Finns Study (YFS)
that began in 1980 [21]. The population of this study consisted of women and men aged 30, 33,
36, 39, 42 and 45 years who participated in the 2007 and 2011 follow-ups. In total, there were 2204
participants who attended clinics in 2007 of which 1874 (85.0%) completed the pedometer study. In
2011, 2005 (55.7% of the baseline participants) participated in study clinics, of whom 1525 completed
the pedometer study (76.1%). Participants who had at least 5 recorded days and at least 8 h per
day of pedometer wear time in both 2007 and 2011 were included. Therefore, step data from 1033
participants was used. From these participants, 1033 also had weight and height data available. The
study participants gave written informed consent in accordance with the Helsinki Declaration and the
study protocol was reviewed and approved by the ethics committee of the participating universities
(Decision number 533/2006).
2.2. Anthropometric Measures
Height, weight, and waist circumference were measured by educated and experienced measurers
(e.g., nurses). Body mass index (BMI) was calculated as weight (kg)/height (m)2 . Waist-to-height ratio
(WtHR) was calculated as waist (cm)/height (cm).
2.3. Measurement of Physical Activity
Participants were issued an Omron Walking Style One (HJ-152R-E) pedometer and were instructed
to attach the pedometer during waking hours on their waistband or belt in the same position for seven
consecutive days and to maintain a pedometer log.
Based on questionnaire data, the level of self-rated PA did not differ significantly between those
who participated and who did not participate in the pedometer study in 2007. The study participants
gave written informed consent and the study protocol was reviewed and approved by the ethics
committee of the participating universities.
Pedometer logs were used to record the time of pedometer removal and at the end of the day to
record the steps taken on the display. Participants were asked to continue with their typical activities
Int. J. Environ. Res. Public Health 2017, 14, 1015
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and to remove the pedometer only while bathing or swimming. Participants could report comments
and problems about their pedometer use in the pedometer log and could contact the study personnel.
On the 8th day, participants were instructed to send their pedometer log and the pedometer to the
study centers using a padded mailbag in a self-addressed, stamped envelope that was provided to
all participants.
The Omron pedometer collects aerobic steps and minutes in addition to total steps. Aerobic steps
are those taken during activities that last for at least ten minutes without interruption at a pace of 60+
steps per minute. We compared Omron Walking Style One pedometers with the steps measured by
ActiGraph accelerometers (GT1M) in a subsample of 45 participants for 6 to 7 successive days (total of
304 days). The Spearman’s rank correlation coefficient was 0.966 (p < 0.001) [22].
All those who had at least five recorded days with a wear time at least 8 h, were included in all
analyses. Sickness or injury status, exceptional step counts reported as an untypical day, or problems
with pedometer use, were considered and compensated by the mean of other days. A daily wear time
was imputed if the participant had reported at least two days wear time for eight hours. Participants
reported several reasons for daily nonparticipation or interruption to pedometer wear. The main
reasons in 2007 were lost (n = 52) or broken pedometer (n = 23), illness (n = 30), or other reasons
such as untypical day (n = 22). The remainder of the participants (n = 203) chose not to participate
in the pedometer study or did not send pedometer information back to the research center. In 2011,
main reasons for nonparticipation were; lost device (n = 1), illness (n = 105, and other reasons such
as untypical day (n = 31). The remainder of the participants (n = 388) chose not to participate in
the pedometer study or did not send pedometer information back to the research center. The final
sample size was 1518 imputed and corrected steps in 2007 and 1359 in 2011. Together, there were
1033 participants who had proper data from both years. There was no seasonal variation in total steps
between summer and winter months neither in 2007 (p = 0.677) nor 2011 (p = 0.059) and wear time was
considered in the analyses.
Total steps and aerobic steps were used as continuous variables in descriptive analysis and in
correlation analyses but as categorical variables when analyzing upward and downward proportions
of change from 2007 to 2011. Changes in daily steps between the follow-up (2007 & 2011) were
categorized to two main categories (increasers and decreasers) and these were divided to three more
subcategories depending on the amount of increase/decrease (>2000/1000–1999/0–999 steps/day).
In further analysis, these groups were merged to three categories increasers (>2000 steps/day or
more), decreasers (>2000 steps/day or more) and maintainers (0–1999 steps/day increase or decrease).
The same categories were also used in the comparison of BMI change among participants. Aerobic
steps were classified in three categories according to change in aerobic steps/day between 2007 and
2011 (1) Maintainers (increase or decrease <1000 steps/day), (2) Decreasers (decline > 1000 steps/day),
and (3) Increasers (increase >1000 steps/day) (Table 1).
Table 1. Changes in daily steps and aerobic steps from 2007 to 2011, N = 1033.
Change in Steps
% of Participants in Each Category
Total Steps/Day
All
Women
Men
Increase ≥ 2000
Maintain
Decrease > 2000
25.3 (261)
56.1 (579)
18.7 (193)
24.8 (130)
59.2 (311)
16.0 (84)
25.8 (131)
52.8 (268)
21.5 (109)
24.7 (255)
47.9 (495)
27.4 (283)
25.1 (132)
44.8 (235)
30.1 (158)
24.2 (123)
51.2 (260)
24.6 (125)
Aerobic Steps */Day
Increase (+1000)
Maintain
Decrease (−1000)
* Aerobic steps are those taken during activities that last for at least ten minutes without interruption at a pace of
60+ steps per minute.
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2.4. Statistical Analysis
Participant descriptives for 2007 and 2011 are shown as mean ± SD for normally distributed
variables and median (25th, 75th percentile) for total and aerobic steps per day owing to right-skewed
distributions. Correlation between step changes and BMI changes (and WtHR change) were calculated
with Pearson’s correlation to find out linear association between PA and BMI and WtHR change.
Pearson’s correlation was used to find whether there are associations between BMI and WtHR changes
and step changes. Proportion of participants in increasers’, maintainers’, and decreasers PA groups
(meeting the three categories described above) are displayed as proportions for males, females and
the total sample. Paired samples t-test was used to compare BMI values among those who decreased,
increased or maintained their steps between 2007 and 2011. All statistical analyses were performed
using SPSS version 22.0 (IBM, New York, NY, USA). Significance level was set to 0.05.
3. Results
Table 1 shows the proportions of participants across the change in step categories. 25.3% of
participants (women = 24.8%, men 25.8%) increased and 18.7% (women = 16.0%, men = 21.5%)
decreased their activity by at least 2000 total steps between 2007 and 2011. There was no difference
in the proportion of men and women between the increase and decrease change groups (p = 0.726).
Totally, 47.9% of the participants (women = 44.8%, men = 51.2%) did not change aerobic steps per day
(±<1000 steps) while about one fourth decreased or increased their aerobic steps. Among women
there were more changes in aerobic steps than among men (p < 0.001). A higher proportion of women
either decreased (30.1%) or increased (25.1%) their aerobic step counts compared with men (decreased,
24.6%; increased, 24.2%).
Table 2 shows the characteristics of the 1033 participants included in the final sample. In 2007,
participants averaged 7713 total steps/day and 1999 aerobic steps/day. In 2011, participants averaged
8112 total steps/day and 1986 aerobic steps/day. Overall, 56.5% of participants had more total
steps/day in 2011 than 2007 and 51.5% had more aerobic steps/day in 2011 than 2007 (p < 0.001).
In 2007, 19.0% of adults were active (more than 10,000 steps daily), while in 2011 the percentage was
24.8, (p < 0.001). In 2007, 48.9% of participants were inactive (<5000 steps per day) compared with
47.3% in 2011. In both years, approximately a quarter of men did not achieve any aerobic steps. BMI
changed among participants from 25.6 to 26.1 during the follow-up period (p < 0.001) and WtHR from
0.51 to 0.53 (p = 0.001). Average weight gain between the study years was 2.6 kg among women and
1.1 kg among men (p < 0.001). BMI change had a significant correlation with step change (r2 = −0.146,
p = 0.001) and aerobic step change (−0.075, p = 0.005). WtHR change had a significant correlation with
step change (r2 = −0.100, p = 0.01) and aerobic step change (r2 = −0.091, p = 0.05).
BMI levels in 2007 and 2011 are shown for increases’, maintainers’, and decreasers’ PA groups
in Figures 1 and 2. Among those who increased their daily steps by more than 2000, BMI stayed at
the same level (p = 0.077). Among those who maintained their daily steps, BMI increased (p < 0.001).
Among those, who decreased their daily steps BMI increased (p < 0.001). Among those who stayed
inactive (n = 67) (<5000 steps in both years), BMI in 2007 (26.9) increased significantly to year 2011
(27.7) (p = 0.003). BMI increased in all aerobic step change groups. WtHR increased among women
(p = 0.029–<0.001) both in total and aerobic step groups, while among men in increasers group WtHR
did not change (p = 0.140–0.229).
Int. J. Environ. Res. Public Health 2017, 14, 1015
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Table 2. Baseline characteristics of the study participants in 2007 and 2011 (N = 1033).
Women
Demographics
Age (years), mean (SD)
Education, years mean (SD)
Weight (kg)
Height (cm)
BMI (kg/m2 ) mean (SD)
WtHR
Pedometer values (steps/day)
Total steps/day
Aerobic steps/day
25th
6045
666
Men
2007 (n = 641)
2011 (n = 641)
38.2 (5.0)
15.8 (3.3)
69.9 (14.7)
165.9 (6.0)
25.1 (4.6)
0.50 (0.07)
42.2 (4.9)
15.7 (3.4)
72.5 (16.3)
165.9 (5.7)
25.8 (5.0)
0.53 (0.08)
Median
7702
2092
75th
9568
3478
25th
6239
498
Median
8029
1820
p-Value
<0.001
<0.001
75th
10,312
3687
25th
5202
0
2007 (n = 392)
2011 (n = 392)
38.1 (5.0)
15.0 (3.4)
86.4 (15.5)
179.6 (6.6)
26.5 (4.0)
0.53 (0.06)
42.0 (5.0)
15.0 (3.5)
87.5 (16.0)
179.8 (6.6)
26.7 (4.1)
0.54 (0.07)
Median
7016
821
75th
9093
2280
25th
5458
0
Median
7049
759
p-Value
<0.001
0.008
<0.001
75th
9397
1940
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Int. J. Environ. Res. Public Health 2017, 14, 1015
Int. J. Environ. Res. Public Health 2017, 14, 1015
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27.50
27.50
27.00
27.00
26.50
26.50
26.00
26.00
25.50
25.50
25.00
25.00
24.50
24.50
24.00
24.00
23.50
23.50
0.001
0.001
0.01
0.01
<0.001
<0.001
0.474
0.474
0.007
0.007
<0.001
<0.001
Increase >2000
Increase >2000
Women 2007
Women 2007
No change
No change
Women 2011
Men 2007
Women 2011
Men 2007
Decrease >2000
Decrease >2000
Men 2011
Men 2011
Figure 1. BMI in 2007 and 2011 in women and men according to change groups (increase, maintain or
Figure 1. BMI in 2007 and 2011 in women and men according to change groups (increase, maintain or
Figure
1. BMI
in 2007
2011
in women
men according
to change
groups
decrease)
of total
stepsand
from
2007
to 2011.and
p-values
for difference
between
2007 (increase,
and 2011. maintain or
decrease) of total steps from 2007 to 2011. p-values for difference between 2007 and 2011.
decrease) of total steps from 2007 to 2011. p-values for difference between 2007 and 2011.
27.5
27.5
27
27
26.5
26.5
26
26
25.5
25.5
25
25
24.5
24.5
24
24
23.5
23.5
0.006
0.006
<0.001
<0.001
0.020
0.020
Increase >1,000 steps
Increase >1,000 steps
Women 2007
Women 2007
<0.001
<0.001
No change
No change
Women 2011
Men 2007
Women 2011
Men 2007
<0.001
<0.001
0.001
0.001
Decrease <1,000 steps
Decrease <1,000 steps
Men 2011
Men 2011
Figure 2. BMI change in the different aerobic step change groups among men and women with pFigure
BMI
among
men
and
women
with
pvalues, 2.
2007–2011.
Figure
2.
BMIchange
changeininthe
thedifferent
differentaerobic
aerobicstep
stepchange
changegroups
groups
among
men
and
women
with
values,
2007–2011.
p-values, 2007–2011.
4. Discussion
4. Discussion
4. Discussion
Unlike in earlier studies [9–11], in this study overall PA measured by daily steps seems to be
Unlikeininmidlife
earlier studiesfour
[9–11],
in follow-up
this study overallEven
PA measured
by daily steps
seems
towas
be
increasing
years
though the
in total
stepsto
Unlike in earlierduring
studies [9–11],
in this studyperiod.
overall PA measured
bychange
daily steps
seems
be
increasing
in midlife
during four
years follow-up
period. Even though
change
total steps
was
not statistically
significant,
direction
is encouraging.
results the
support
thein
results
increasing
in midlife
duringthe
four
years follow-up
period. These
Even though
the
change
inprevious
total steps
was
not
statistically
significant,
the
direction
is
encouraging.
These
results
support
the
previous
results
thatstatistically
BMI tend tosignificant,
increase during
middle-age
[9]. In this study,
it was
found
that increasing
daily
steps
not
the direction
is encouraging.
These
results
support
the previous
results
that
BMI
tend towith
increase
duringin
middle-age
[9].decreasing
In this study,
it was
found that increasing
daily
steps
was
associated
no
change
BMI,
while
steps
or
maintaining
steps
was
associated
that BMI tend to increase during middle-age [9]. In this study, it was found that increasing daily steps
was
associated
with
no change
in BMI,
while
decreasing
steps or maintaining
steps was
associated
withassociated
increases in
BMI.
is in in
line
withwhile
previous
results that
though individuals
increase
their
was
with
noThis
change
BMI,
decreasing
stepseven
or maintaining
steps was
associated
with
increases
in
BMI.
This
is
in
line
with
previous
results
that
even
though
individuals
increase
their
PA, weight
may
[16].
with
increases
in still
BMI.increase
This is in
line with previous results that even though individuals increase their
PA, weight
may still
increase
[16]. previous studies suggesting that higher steps are associated with
These
results
are
in
line
with
PA, weight may still increase [16].
These results
are
insame
line with
previous
studies
suggesting
that
higher steps
are
associated
with
maintaining
BMI inare
thein
levelprevious
[11]. Likewise,
lower
WtHR is
associated
withare
higher
levels ofwith
PA
These results
line with
studies
suggesting
that
higher steps
associated
maintaining
BMI
in
the
same
level
[11].
Likewise,
lower
WtHR
is
associated
with
higher
levels
of
PA
[23].
Generally
in
high-income
countries
leisure-time
PA
has
increased
in
adults,
but
at
the
same
time,
maintaining BMI in the same level [11]. Likewise, lower WtHR is associated with higher levels of
[23].
GenerallyPA
in high-income
countries
leisure-time
PA hassteps
increased
in adults, but
at the
same
time,
occupational
has decreased
[4]. In this
study, aerobic
had decreased
which
may
indicate
occupational
PA
has
decreased
[4].
In
this
study,
aerobic
steps
had
decreased
which
may
indicate
decreases in leisure time PA. The study population may be in a certain episode of life, when there is
decreases in leisure time PA. The study population may be in a certain episode of life, when there is
Int. J. Environ. Res. Public Health 2017, 14, 1015
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PA [23]. Generally in high-income countries leisure-time PA has increased in adults, but at the same
time, occupational PA has decreased [4]. In this study, aerobic steps had decreased which may indicate
decreases in leisure time PA. The study population may be in a certain episode of life, when there is
not so much time for leisure time PA, (e.g., they have family responsibilities). Percentages of inactive
and low active participants in 2011 (47.3%) were a bit higher than in a Danish population (42.8%),
but lower than in Brazilian adults (56.2%) [24]. Likewise, the percentage of those who were active
(24.7%) in 2011 was a bit lower than in the Danish population 29.3%) [10], but clearly higher than in
Brazilian adults (12.9%) [16]. The difference of a higher percentage of active Danish may be explained
by a higher amount of active transport in Denmark. While 19.5% of Finnish people walk or cycle to
work [25], in Denmark the percentage of those who solely cycle to work, is higher (25%) [26].
Even though the mean average of aerobic steps had decreased, the amount of those who had
increased their aerobic steps was 51.5%. In addition, in Finland the proportion of those who were active
(over 10,000 steps) increased from 19.0% (2007) to 24.8% (2011) while in Denmark among 18–75 years
old adults, it decreased from 34.8% (2008) to 28.4% (2012). Likewise, in the Czech Republic, the
amount of those who are defined as very active, are decreasing between 2008 and 2013 [27]. In Finland
importance of PA has highlighted for years, and this may explain the reason why steps have increased
during the follow-up period. It meay be, that in the Western countries same kind of phenomenom will
turn up in recent years.
In the future, more concern should be directed especially to those men, who are inactive, since
they are more likely to maintain a sedentary lifestyle than women. Hence, more efforts should be
directed towards low active men. Among women there were more changes in activity between the
two occasions and steps increased. Recent studies have shown that among low active individuals,
increasing PA from low levels can significantly influence a reduction in the mortality risk [28]. Among
women more efforts should be directed to encouraging maintaining the PA. Even though there were
plenty of women who increased PA, there were especially low active women at baseline who decreased
their PA during the follow-up. On the other hand, more encouragement should be directed to all
participant to maintain their physically active lifestyle and healthy eating habits.
To find out the stability of PA, a rigorous analysis should be done to determine the type of
PA, what kind of sports keep people to be physically active and what kind of sports are more or
less seasonal or occasional PA. Also further examination could be directed to life transitions, e.g.,
parenting, graduating, and moving to another city and how other health habits (e.g., diet) is related to
these changes.
Measuring PA with pedometers includes several limitations. For example, pedometers tend to
under-detect certain activities such as cycling and are taken off during water-based activities, such as
swimming [29]. Likewise, there is the possibility of recording of false steps during the day [30]. Hence,
among some participants, there is the possibility of under-detection of PA. There are also several
strengths in this study. Most of the objectively measured PA among adults rely on cross-sectional data,
follow-up period is short, or study population is small. In this study, same population was followed
four-year period and valid data was obtained from 1033 participants. In addition, usage of different
anthropometric markers gives more reliability for the results. However, lack of diet data as a predictor
of BMI and WtHR changes is a limitation in this study. In the Cardiovascular Risk Study, it has been
found that some dietary habits (e.g., high intake of sweet beverages and high salt among women and
high intake of French fries and milk) are related to weight gain [31]. In the following studies in the
future, confounders, e.g., education, diet and socioeconomic status will be studied as a part of the
study. In the future, step change and BMI and/or WtHR change studies should include data from
eating habits and changes in other health behavior as well.
5. Conclusions
Increasing daily steps during middle age is associated with maintaining BMI at the same level.
In this study, it was found that increasing daily steps to 2000 steps was associated maintain BMI at
Int. J. Environ. Res. Public Health 2017, 14, 1015
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the same level as four years before. Since individuals’ metabolic rate declines with age, PA should be
increased with age to maintain BMI at the same level as previously [32]. Maintaining PA at the same
level as four years before was associated with an increase in BMI. Also, one of the issues emerging
from this study is high stability of PA among men. Those who had low activity in 2007 were likely had
low activity in 2011.
Acknowledgments: This work was supported by Finnish Cultural Foundation, Ministry of Education and Culture
(Major, grant number: 83/626/2014). We wish to thank Harto Hakonen from the LIKES Research Center for
Physical Activity and Health for statistical help with the step data.
Author Contributions: Jorma Viikari contributed the design of the study. Mirja Hirvensalo, and Kasper Salin
performed the statistical analysis, Kasper Salin and Mirja Hirvensalo drafted the manuscript. Mirja Hirvensalo,
Olli Raitakari, Costan G. Magnussen, Nina Hutri-Kähönen, Risto Telama and Tuija Tammelin provided the
databases for the analysis, assisted with the design and aided in the interpretation of data. All authors read and
approved the final manuscript.
Conflicts of Interest: The authors declare no conflict of interest.
Abbreviations
BMI
YFS
HEPA
PA
SD
WtHR
Body mass index
Young Finns Study
Health enhancing physical activity
Physical activity
Standard deviation
Waist-to-height ratio
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