Physical activity and exercise among older adults

172 Pages·2016·3.29 MB·English

by  Hallgeir Viken

Doctoral theses at NTNU, 2016:192
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ISBN 978-82-326-1722-7 (printed ver.)
ISBN 978-82-326-1723-4 (electronic ver.)
ISSN 1503-8181
Doctoral theses at NTNU, 20 NTNUNorwegian University ofScience and TechnologyThesis for the Degree ofPhilosophiae DoctorFaculty of Medicineulation and Medical Imaging
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Hallgeir Viken
Physical activity and exercise
among older adults
- The Generation 100 study
Thesis for the Degree of Philosophiae Doctor
Trondheim, June 2016
Norwegian University of Science and Technology
Faculty of Medicine
Department of Circulation and Medical Imaging
NTNU
Norwegian University of Science and Technology
Thesis for the Degree of Philosophiae Doctor
Faculty of Medicine
Department of Circulation and Medical Imaging
© Hallgeir Viken
ISBN 978-82-326-1722-7 (printed ver.)
ISBN 978-82-326-1723-4 (electronic ver.)
ISSN 1503-8181
Doctoral theses at NTNU, 2016:192
Printed by NTNU Grafisk senter
SAMMENDRAG
De fleste land i verden vil fram mot år 2050 oppleve en demografisk endring, der andelen eldre
personer vil øke sterkt. Denne demografiske endringen er forventet å øke helserelaterte
kostnader, både fra et samfunnsøkonomisk perspektiv og for den enkelte. Fysisk aktivitet har
vist seg å være en nøkkelfaktor for forebygging av livsstilsrelaterte sykdommer, men det er
mindre forskning på fysisk aktivitet blant eldre enn i resten av befolkningen. I tillegg så finnes
det få langvarige, randomiserte treningsstudier med friske eldre.

Avhandlingen bygger på tre forskningsartikler. Artikkel 1 hadde som mål å beskrive design,
metode og initiering av en randomisert kontrollert studie, Generasjon 100, som evaluerer
effekten av langvarig trening på helse, levealder og fysisk aktivitetsnivå hos eldre. Artikkel 2
hadde som mål å beskrive det fysiske aktivitetsnivået blant eldre voksne, ved hjelp av både
relative- og absolutte intensitetsgrenser for akselerometer. Artikkel 3 hadde som mål å øke
kunnskapen om bakgrunnsfaktorer som er assosiert med akselerometer-målt fysisk aktivitet
blant eldre.

Generasjon 100 er beskrevet i detalj i artikkel 1. Den startet opp i år 2012 og vil pågå fram til
2018. Studien inkluderte 1567 personer i alderen 70-77 år, alle bosatt i Trondheim kommune.
Deltakerne gjennomgikk undersøkelser, deriblant måling av fysisk aktivitetsnivå og kondisjon
(maksimalt oksygenopptak). De fylte også ut spørreskjema. Undersøkelsene gjentas etter 1-, 3-
og 5 år av studien. Deltakerne ble tilfeldig trukket ut til en kontrollgruppe eller til en gruppe
som trener utholdenhet med enten moderat- eller høy intensitet, to ganger per uke.

Resultatene fra artikkel 2 viste at aktivitetsnivået blant 1219 norske eldre var høyere enn i andre
land, men svært likt som i en norsk nasjonal kartlegging fra 2008-2009. Kvinner hadde et
høyere totalt aktivitetsnivå, og brukte mer tid i høyere relative intensiteter, sammenlignet med
menn. Totalt aktivitetsnivå og tid i nær-maksimal intensitet avtok med økende alder. Eldre
personer med god kondisjon var mer fysisk aktive enn de med lav- og middels kondisjon. Vi
fant at relative intensitetsgrenser, justert for kjønn og kondisjon, resulterte i at en høyere andel
(79 %) eldre oppfylte myndighetenes anbefalinger for fysisk aktivitet, sammenlignet med bruk
av en tradisjonell absolutt intensitetsgrense (29 %).

Resultatene fra artikkel 3 viste at 9 av 14 bakgrunnsfaktorer var med og forklarte 27 % av
variansen i totalt aktivitetsnivå blant 850 eldre. Aktivitetsnivået var assosiert med
demografiske, miljømessige og biologiske faktorer. Kondisjon, kjønn og årstid var faktorene
som sterkest assosierte med totalt fysisk aktivitetsnivå. Studien er, så langt vi vet, den største
studien av bakgrunnsfaktorer for fysisk aktivitet blant eldre som har kombinert
akselerometermålinger og direkte målt maksimalt oksygenopptak.

Hallgeir Viken
Cardiac Exercise Research Group
Institutt for sirkulasjon og bildediagnostikk, Det medisinske fakultet, NTNU
Veiledere: Professor Ulrik Wisløff og forsker Dorthe Stensvold
Finansiering: Samarbeidsorganet mellom Helse Midt-Norge RHF og NTNU, og K.G. Jebsen
stiftelsen

I
SUMMARY
Most countries in the world will by the year 2050 experience a large demographic change,
leading to an increase in the proportion of older adults. This is expected to increase health
related costs, both societally and individually. Physical activity is shown to be a key factor in
the prevention of lifestyle-related diseases, but there is less research on physical activity among
older adults compared to the general population. In addition, there are few long-term,
randomised exercise intervention studies among healthy older adults.

This thesis is based on three research papers. Paper 1 aimed to describe the design, methodology
and initiation of a randomised controlled trial entitled the Generation 100 study, evaluating the
effect of long-term exercise training on health, longevity and physical activity levels among
older adults. Paper 2 aimed to describe physical activity levels in older adults, using both
relative- and absolute intensity accelerometer thresholds. Paper 3 aimed to increase the
knowledge about the background factors associated with accelerometer-measured physical
activity in older adults.

The Generation 100 is outlined in detail in paper 1. It began in 2012 and will continue until
2018. The study included 1,567 people aged 70-77 years, residing in the municipality of
Trondheim, Norway. Participants underwent examinations, including measurement of physical
activity and cardiorespiratory fitness (maximal oxygen uptake). They also filled out
questionnaires. Participants are followed-up at 1-, 3- and 5 years of the study. Participants were
randomly assigned to a control group or to either a moderate- or high intensity endurance
exercise group required to train two times per week.

The results from paper 2 showed that the activity level in 1219 Norwegian older adults was
higher than in other countries, but very similar to a Norwegian national survey from 2008-2009.
Females had a higher overall activity, and spent more time in higher relative intensities,
compared to males. Overall activity and time in the near-max relative intensity decreased with
age. Older adults with higher levels of cardiorespiratory fitness were also more active than those
with low- and medium cardiorespiratory fitness. We found that the use of relative intensity
thresholds, adjusted for gender and fitness, resulted in higher proportions (79%) of older adults
meeting physical activity recommendations, compared to the use of a traditional absolute
intensity threshold (29%).

The results from paper 3 showed that 9 out of 14 background factors explained 27% of the
variance in overall physical activity among 850 older adults. Activity level was associated with
demographic, environmental and biological factors. Cardiorespiratory fitness, gender and
season were the factors most strongly associated with overall activity. The study was, to our
knowledge, the largest study of background factors for physical activity among older adults that
has combined accelerometry and directly measured maximal oxygen uptake.

Hallgeir Viken
Cardiac Exercise Research Group
Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU
Supervisor: Professor Ulrik Wisløff. Co-supervisor: Researcher Dorthe Stensvold
Funding source: The Liaison Committee between the Central Norway Regional Health
Authority (RHA) and the Norwegian University of Science and Technology (NTNU), and the
K.G. Jebsen Foundation
II
ACKNOWLEDGEMENTS
This PhD project was carried out during the years 2012 -2016 at the Norwegian University of
Science and Technology, the Faculty of Medicine, the Department of Circulation and Medical
Imaging. My PhD project has been financed by the Liaison Committee between the Central
Norway Regional Health Authority and the Norwegian University of Science and
Technology, and the K.G. Jebsen Foundation.

First of all, I would like to thank my supervisors, professor Ulrik Wisløff and researcher
Dorthe Stensvold, for invaluable help and support through my PhD period. Ulrik and Dorthe
must be the perfect supervisors; they allow you to work independently when necessary while
also offering experience and invaluable advice whenever you need the important answers!
Since Dorthe is the Generation 100 project manager I have worked extremely closely with
her, and I can really say that she is a genuinely positive person (cid:1) all the time!

I would also like to thank my fellow first author on paper II and III, PhD student Nils Petter
Aspvik, for all his expertise in statistical analysis and for great collaboration during the
writing of papers. We have worked with the papers together in the same room for countless
days, with lots of scientific discussions, but without any conflicts.

Thanks also to my co-authors PhD student Nina Zisko and amanuensis Jan Erik Ingebrigtsen.
Nina has contributed with invaluable input regarding both English grammar and scientific
content, and Jan Erik with his experience and contributions to study design and interpretations
of results. Equally important, Jan Erik was the person who linked me to Ulrik and his group
and encouraged me to apply for this PhD position.

Furthermore, I would like to thank all the fantastic people who have contributed to the data
collections in the Generation 100 study. This includes all the master students and medical
students, the nurses at the Clinical Research Facility, St. Olavs University Hospital, the
engineers at the Department of Circulation and Medical Imaging, as well as the PhD
candidates, medical doctors and others involved in the study.

The CERG group also deserves an enormous recognition. This research group consists of
entirely hard-working, energetic and positive people. Though I might not be the most visible
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person in the group, I highly appreciate working here, and I think that this group has the best
possible work environment! A special thanks goes to my office colleagues during these years,
both for inspiring me to work even harder and for the pleasant coffee breaks and talks.

I also want to thank my family for all their support. My parents, Asbjørg and Kåre, you have
always supported me in the best possible way, from childhood at home, during my sports
career and education, and now as grandparents and ever present babysitters. Finally, I have to
thank those closest to me: my fiancé Trude, and my two children, Jenny and Martin. You are
the people who know me best and you have supported me through the hardest parts of this
PhD period. When I`m with you, I get to focus on something totally different than work,
which is also necessary and good.

Trondheim, March 2016

IV
LIST OF PAPERS
This thesis is based on the following original research papers, referred to in the text as paper I,
paper II and paper III:

Paper I
Stensvold D, Viken H, Rognmo Ø, Skogvoll E, Steinshamn S, Vatten LJ, Coombes JS,
Anderssen SA, Magnussen J, Ingebrigtsen JE, Fiatarone Singh MA, Langhammer A, Støylen
A, Helbostad JL, Wisløff U. (2015) A randomised controlled study of the long-term effects of
exercise training on mortality in elderly people: study protocol for the Generation 100 study.
BMJ Open 2015;5(2).

Paper II
Aspvik NP*, Viken H*, Zisko N, Ingebrigtsen JE, Wisløff U, Stensvold D. (2016) Physical
activity among older adults (70-77yrs) (cid:1) and consequences of different methodological
approaches: The Generation 100 study. Submitted. *Shared first authorship.

Paper III
Viken H*, Aspvik NP*, Ingebrigtsen JE, Zisko N, Wisløff U, Stensvold D. (2015) Correlates
of objectively measured physical activity among Norwegian older adults: The Generation 100
study. Journal of Aging and Physical Activity. Accepted for publication. *Shared first
authorship.

V
ABBREVIATIONS
ACSM: American College of Sports Medicine
AHA: American Heart Association
BMI: Body mass index
CPM: Counts per minute
CRF: Cardiorespiratory fitness
CVD: Cardiovascular disease
HIIT: High intensity interval training
HR: Heart rate
HR : Maximal heart rate
max
HR : Peak heart rate
peak
HUNT: The Nord-Trøndelag Health Study
Kan1: The Physical Activity among Adults and Older People Study
MCT: Continuous moderate intensity training
MPA: Moderate intensity physical activity
MVPA: Moderate-to-vigorous physical activity
PA: Physical activity
RCT: Randomised controlled trial
SD: Standard deviation
VO : Maximal oxygen uptake
2max
VO : Peak oxygen uptake
2peak
VPA: Vigorous intensity physical activity
WHO: World Health Organization

VI
DEFINITIONS
Cardiorespiratory fitness:
The maximal ability of the circulatory and respiratory systems to supply fuel during dynamical
work involving large muscle mass, and to eliminate fatigue products after supplying fuel.

Exercise:
A subset of physical activity that is planned, structured, and repetitive and has as a final or an
intermediate objective the improvement or maintenance of physical fitness.

Physical activity:
Any bodily movement produced by skeletal muscles that results in energy expenditure.

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