A cross-sectional study of low physical fitness, self-rated fitness and psychosocial factors in a sample of Finnish 18- to 64-year-old men

This is an elec onic ep in o he o iginal a icle. This ep in may di e om he o iginal in pagina ion and ypog aphic de ail. Au ho (s): Ti le: Yea : Ve sion: Please ci e he o iginal e sion: All ma e ial supplied ia JYX is p o ec ed by copy igh and o he in ellec ual p ope y igh s, and duplica ion o sale o all o pa o any o he eposi o y collec ions is no pe mi ed, excep ha ma e ial may be duplica ed by you o you esea ch use o educa ional pu poses in elec onic o p in o m. You mus ob ain pe mission o any o he use. Elec onic o p in copies may no be o e ed, whe he o sale o o he wise o anyone who is no an au ho ised use . A c oss-sec ional s udy o low physical i ness, sel - a ed i ness and psychosocial ac o s in a sample o Finnish 18- o 64-yea -old men Kaasalainen, Ka oliina; Kasila, Ki s i; Villbe g, Ja i; Komulainen, Jy ki; Poskipa a, Ma i a Kaasalainen, K., Kasila, K., Villbe g, J., Komulainen, J., & Poskipa a, M. (2013). A c oss-sec ional s udy o low physical i ness, sel - a ed i ness and psychosocial ac o s in a sample o Finnish 18- o 64-yea -old men. BMC Public Heal h, 13(1113), 1-10. h ps://doi.o g/10.1186/1471-2458-13-1113 2013 RESEARCH ARTICLE Open Access A c oss-sec ional s udy o low physical i ness, sel - a ed i ness and psychosocial ac o s in a sample o Finnish 18- o 64-yea -old men Ka oliina S Kaasalainen 1* , Ki s i Kasila 1† , Ja i Villbe g 1† , Jy ki Komulainen 2† and Ma i a Poskipa a 1† Abs ac Backg ound: The biological isk ac o s o inac i i y and poo ca dio espi a o y i ness a e well es ablished. Howe e , isk g oups a e ha d o each and hey may ha e mispe cep ions o hei need o change. This s udy explo ed sel - a ings o physical i ness (PF) and he ela ionship be ween objec i ely es ima ed physical i ness (PFI) and psychosocial ac o s among Finnish men o wo king-age. Me hods: C oss-sec ional da a on 899 Finnish men (aged 18–64) we e collec ed in 2011. Heal h- ela ed physical i ness was e alua ed wi h a physical i ness index calcula ed om he esul s o selec ed i ness es s. The men we e subsequen ly classi ied in o h ee g oups: low, mode a e and high PFI. Psychosocial ac o s and sel - a ed i ness we e elici ed in he ques ionnai e. The da a we e analysed wi h c oss abula ions, chi squa e- es and logis ic eg ession analysis. Resul s: One- i h o he pa icipan s had low PFI. Fo y- i e pe cen o he low- i middle-aged (35–49 yea s) men sel - epo ed poo PF, while 80 pe cen o he younge (18–34 yea s) low- i men sel - epo ed mode a e o good PF. The heal h bene i s and ecommended dose o physical ac i i y we e well known in all he PFI ca ego ies. The low- i men we e heal h conscious, bu lacked adequa e exe cise skills, sel -e icacy and social suppo . Howe e , logis ic eg essions e ealed ha , in he younge men, likelihood o be e knowledge was no ela ed o highe PFI. Among he 50- o-64-yea -old men, high PFI was no associa ed wi h a highe social suppo . Conclusions: Poo exe cise skills, sel -e icacy and social suppo we e ela ed o low PFI. Physical ac i i y p omo ion o low- i men should ake in o accoun age di e ences in he ela ionship be ween psychosocial ac o s and physical i ness. Thus, new and e ec i e ways o es ablish social suppo and mo i a ion o physical ac i i y among low- i men in all wo king-age g oups a e needed. Fu he esea ch is also wa an ed on whe he es ima ion o PFI could be used as a p ac ical heal h counselling ool. Keywo ds: Physical i ness, Physical ac i i y, Mo i a ion, Psychosocial ac o s, Middle-aged, Men Backg ound The heal h isks o inac i i y, poo ca dio espi a o y i - ness and obesi y a e well es ablished [1-4]. Only one-hal o wo king-aged (18–64 yea s) men in Eu ope a e su i- cien ly ac i e [5] and up o 70 a e o e weigh o obese [6]. Bo h poo ca dio espi a o y i ness and abdominal obesi y a e associa ed wi h ele a ed isk o me abolic diseases and mo ali y among men [7]. Physical ac i i y (PA) and a heal hy die a e p edic o s o good physical i ness and a ou able body composi ion. Heal h- ela ed physical i - ness (PF) desc ibes an indi idual’s ae obic capaci y, skel- e al muscle s eng h and body composi ion [8]. The dec easing end in PA and inc easing obesi y among wo king-aged men a e public heal h issues [5]. Finnish s udies ha e also exp essed conce n abou poo ca dio e- spi a o y i ness in young and wo king-aged men [9,10]. Al hough only 10 pe cen o wo king-aged Finnish men ha e a ed hei PF as poo in popula ion-based su ey [11], he o e all size o he low i ness popula ion may be g ea e . People end o o e es ima e hei PA, while many * Co espondence: [email p o ec ed] † Equal con ibu o s 1 Facul y o Spo and Heal h Sciences, Uni e si y o Jy äskylä, P.O.Box 35 (L) FI-40014, Jy äskylä, Finland Full lis o au ho in o ma ion is a ailable a he end o he a icle © 2013 Kaasalainen e al.; licensee BioMed Cen al L d. This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/2.0), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. Kaasalainen e al. BMC Public Heal h 2013, 13:1113 h p://www.biomedcen al.com/1471-2458/13/1113 s udies ha e ec ui ed pa icipan s om a mo i a ed and physically ac i e popula ion [12,13]. To da e, only a ew physical ac i i y in e en ions ha e been a ge ed a inac i e men and mos o hese p o- g ammes ha e had poo eachabili y and only sho - e m e ec s [12,14]. Men a e awa e o he heal h bene i s o adequa e PA, bu knowledge is a poo mo i a o o changes in heal h beha iou . Mispe cep ions o one’s own isk may be one explana ion o he low in e es in a ending PA in e en ions. In p e ious s udies up o 60 pe cen o inac i e people ha e o e es ima ed hei le el o PA [13,15,16]. Physical i ness es ing and indi idual- ized eedback ha e been used in heal h counselling in o de o inc ease awa eness o cu en PF and mo i - a ion o heal h beha iou changes [17-19]. Howe e , comp ehensi e i ness es s ha e no imp o ed counsel- ling ou comes [17-19]. The esul s sugges s ha PF es s and eedback a e no likely o con ibu e o he desi ed beha iou change p ocess i indi iduals a e al eady well awa e o hei cu en PF s a us o lack he con idence o implemen he a ge beha iou al change [18]. Hence, he easons o low PF and inac i i y do no eside in knowledge alone. Mos o people ha e he in en ion o be physically ac- i e, bu less han a hal o all a emp s o main ain egu- la PA a e success ul [20]. Psychosocial ac o s, including knowledge, a i udes, in en ion, mo i a ion social sup- po and sel -e icacy, a ec PA adop ion and main en- ance [21,22]. Recen s udies ha e concluded ha al hough in en ion p edic s PA, he la e can be also based on habi ual and non-in en ional beha iou [4,21,23-26]. A mo e e iden mode a o o beha iou al change is sel -e icacy, which is also included in mos o he heal h beha iou heo ies [26]. Sel -e icacy is a pe - sonal belie in one’s abili y o engage in a desi ed beha - iou [27]. The success ul adop ion o egula PA is a gued o be in luenced by an imp o emen in sel - e icacy and educ ion in he pe cei ed ba ie s [22]. Ba ie s o PA can be en i onmen al, and hence o some ex en modi iable (e.g. social suppo , lack o exe cise a- cili ies), o indi idual and less likely o be modi iable (e.g. poo skills, lack o mo i a ion) [28-30]. Modi iable and non-modi iable ac o s bo h ha e an in luence on indi iduals’enjoymen o physical ac i i ies and exe cise. Gene ics is a cen al non-modi iable ac o de e mining PF, al hough PA his o y and heal h beha iou also ha e a conside able impac on PF [21]. Fu he unde s anding o he psychosocial ac o s ha de e mine he adop ion and main enance o PA among low i ness men is needed. The aims in his s udy we e o examine: 1) he ela ionship be ween sel - a ed phys- ical i ness and objec i ely es ima ed physical i ness (PFI) and 2) he ela ionship be ween a low PFI and se- lec ed psychosocial ac o s. Me hods Sample and s udy design The s udy sample comp ised 899 Finnish men who pa icipa ed in a heal h p omo ion campaign, “The Ad en u es o Joe Finn”, du ing Sep embe 2011. The campaign was held in he ma ke squa es o 15 Finnish municipali ies and was o ganized by he Fi o Li e P og am. The campaign o e ed all pa icipan s PF es s ee o cha ge and pe sonal eedback on he es esul s. The es s we e conduc ed in a mobile es lab by ained pe sonnel. Comple ion o all es s ook abou 15 minu es pe pa icipan . The inclusion c i e ia in o he s udy we e gende (male), age (18–64) and comple ion bo h i ness es s and he heal h beha iou ques ionnai e. Pa - icipa ion in he s udy was olun a y and all pa icipan s ga e hei w i en consen . The s udy was app o ed by he Uni e si y o Jy äskylä E hical Commi ee. Physical i ness index The i ness es s included hand g ip s eng h (Saehan dynamome e ), he Pola Fi ness Tes (Pola Elec o, Kempele, Finland) and a body composi ion analysis (InBody 720- analyse ). To ou knowledge, his is he i s ime ha his combina ion o i ness es s has been used o e alua e heal h- ela ed PF. These i ness es s we e chosen, as he aim o he campaign was o encou - age seden a y men o pa icipa e in he es s and help hem o become amilia wi h hei PF. Exe cise es s de- manding s enuous physical e o we e no deemed sui - able o heal h counselling pu poses. P e ious s udies sugges ha hand g ip-s eng h, Pola Fi ness Tes and body composi ion analysis by bioelec ical impedance (BIA) a e easible es s o popula ion-based s udies and he esul s co ela e s ongly wi h o he assessmen me hods [1,31]. Hand g ip s eng h desc ibes he gene al i ness o he skele al muscles and also p edic s unc ional abili y and isk o ch onic diseases in he las yea s o li e [32]. Hand g ip s eng h was measu ed wi h a Saehan dyna- mome e and he esul s we e compa ed wi h age and gende speci ic e e ence alues. The e e ences we e based on i ness es da a on wo king-aged Finnish men collec ed by he LIKES Resea ch Cen e o Spo and Heal h Sciences be ween he yea s 2007-2011 [33]. Ae obic i ness was measu ed wi h he Pola Fi - ness Tes , which p edic s a pe son’s ae obic capaci y (VO 2 max) [34]. Es ima ion o VO 2 max was based on es ing hea a e, hea a e a iabili y, gende , age, heigh , body weigh and sel - epo ed le el o long- e m physical ac i i y. The esul ing alue was compa ed o in e na ional e e ence s anda ds o ae obic capaci y o gende and age g oup, and he indi idual was subse- quen ly assigned o one o he i ness ca ego ies, which anged om 1 o 7 [35]. Al hough VO 2 max was assessed Kaasalainen e al. BMC Public Heal h 2013, 13:1113 Page 2 o 10 h p://www.biomedcen al.com/1471-2458/13/1113 indi ec ly, he Pola Fi ness Tes has been shown o be a eliable es o ae obic i ness in popula ion-based s ud- ies [36]. The mean e o be ween he Pola Fi ness Tes and labo a o y-measu ed maximal oxygen up ake has a ied be ween 6.5 and 8.2 pe cen [37]. Body composi ion was measu ed by using an InBody 720 analyse . The body composi ion analysis es ima es body weigh , pe cen age o o al body a ( a %), isce al a a ea (VFA) (cm 2 ) and skele al muscle mass (SMM) (kg/m). VFA desc ibes abdominal obesi y, which has been associa ed wi h inc eased isk o mo ali y and me abolic diseases [2,7]. Obese indi iduals wi h good PF ha e had less in e nal a han obese and un i indi id- uals [1,38]. SSM desc ibes a - ee mass, which has posi- i e associa ions wi h unc ional abili y and ene gy me abolism [39]. In compa ison o he o he body com- posi ion assessmen me hods (e.g. DEXA and MRI), he BIA has easonable alidi y [31]. The inal physical i ness index (PFI) desc ibed heal h- ela ed i ness wi h a nume ic scale. The PFI was com- pu ed om he esul s o he ollowing i ness es a i- ables: es ima ed ae obic capaci y (VO 2 max), hang g ip s eng h (kg/kg), pe cen age o o al body a ( a %), SSM (kg/m) and VFA (cm 2 ). All he es esul s we e con e ed o s anda dized poin s and hen weigh ed wi h he ollow- ing equa ions: Ae obic i ness (VO 2 max), poin s = 0,5 × [10 × (ml/kg/min - (−0,2835 × age + 50,307)) / 30], body a (%), poin s = 0,1 × [ −(10 × a % - (0,143 × age + 15,264))/ 24], VFA (cm 2 ), poin s = 0,15 × [ −(10 × (cm2 - (1,326 × age + 56,031))) / 140], Hand g ip s eng h (kg/kg), poin s=0,15×[10×(kg/kg–(−0,036 × age + 22,33)) / 10], SSM (kg/m), poin s = 0,1 × [10 × (kg/m - (−0,0037 × age + 0,83)) / 0,5]. The inal PFI anges om ′-5, +5′, whe e < −3 = e y poo , < −1 = poo , < +1 = accep able, < +3 = good and > +3 = e y good PF. Fo he s a is ical analyses, he PFI was ecoded in o low PF (PFI ≤−1), mode a e PF (PFI <1) and high PFI (PFI ≥1) classes. Sel - a ed physical i ness and su iciency o physical ac i i y Sel - a ed PF was elici ed wi h he ques ion “Wha do you hink abou you cu en le el o physical i ness?” The esponse al e na i es we e gi en on a 5-poin scale (1 = e y good…5 = e y poo ). Fo he s a is ical ana- lyses, sel - a ed PF was ecoded in o h ee classes (good, mode a e and poo ). Fu he mo e, pe cei ed su iciency o PA was elici ed wi h he s a emen “I am su icien ly physically ac i e”. The esponse al e na i es we e gi en on a 5-poin scale (1 = o ally ag ee…4 = o ally disag ee, 5 = I don’ know). The esponses we e assigned o one o h ee classes (1 = ag ee, 2 = disag ee and 0 = I don’ know). The ca ego ies we e dicho omised o he s a is- ical analyses in o wo classes (1 = ag ee, 2 = disag ee o I don’ know). Heal h, physical ac i i y and eadiness o physical ac i i y change Gene al heal h s a us was elici ed in he ques ionnai e by e e ence o a lis o ch onic diseases [11]. Pa ici- pan s sel -e alua ed hei le el o PA, which was la e assigned o one o 4 ca ego ies (1 = o e 5 h/week (wk), 2 =3-5 h/wk, 3 = 1-3 h/wk and 4 = 1 o 0 h/wk). The classi ica ion was cons uc ed on he basis o he an- swe s gi en on he Pola Fi ness Tes backg ound o m. The PA assessmen included desc ip ions o he e- quency, du a ion and in ensi y o PA, including bo h condi ioning and non-condi ioning PA. Commu ing ac- i i y o wo k and equency o gym/s eng h aining we e also elici ed in he heal h beha iou ques ionnai e. Readiness o PA change was elici ed wi h he ques ion “Ha e you inc eased you le el o PA du ing he pas yea ?”(1 = No, and I ha e no in en ion o inc ease i , 2 = No, bu I in end o inc ease i in he nea u u e, 3 = I ha e ied o inc ease i , 4 = I ha e inc eased i conside - ably, and 5 = I ha e been physically ac i e on egula basis”). Psychosocial ac o s The heal h beha iou ques ionnai e included 19 s a e- men s (C onbach’s al a 0.90) on psychosocial ac o s (Table 1). The i ems conce ned knowledge on he heal h bene i s o PA, pe cei ed PA skills, goal se ing, social suppo and sel -e icacy. The psychosocial i ems we e selec ed on he basis o p e ious s udies [40-43]. Pa ici- pan s we e asked o assess how well he s a emen s ma ched hei si ua ion. The o iginal esponse al e na- i es we e gi en on a 5-poin scale (1 = o ally ag ee, 2 = somewha ag ee, 3 = somewha disag ee, 4 = o ally dis- ag ee 5 = I don’ know). The esponses we e subse- quen ly assigned o h ee classes (1 = ag ee, 2 = disag ee and 0 = I don’ know). The ca ego ies we e dicho omised o he s a is ical analyses in o wo classes (1 = ag ee, 2 = disag ee o I do no know). In he u he analysis, he psychosocial i ems we e di ided in o i e sub- dimensions (knowledge, skills, goal se ing, social sup- po and sel -e icacy). Those who ag eed wi h all he sco e- ela ed i ems o med he high-sco e g oup. S a is ical analyses Da a we e analysed using SPSS o Windows 18.0. Basic desc ip i e da a equencies and c oss- abula ion wi h chi squa e- es we e calcula ed o demog aphics (educa- ion, ma i al s a us, employmen , age, BMI, ch onic dis- eases), physical ac i i y ( o al PA le el, gym aining and commu ing ac i i y) and he psychosocial a iables. Bi- a ia e and mul i a ia e logis ic eg essions we e used o es associa ions be ween he psychosocial a iables and PFI in h ee age ca ego ies (18–34, 35–49 and 50–64). Main e ec s o he psychosocial a iables we e analysed Kaasalainen e al. BMC Public Heal h 2013, 13:1113 Page 3 o 10 h p://www.biomedcen al.com/1471-2458/13/1113 in logis ic eg ession analyses. The psychosocial a iables we e en e ed in he models i s indi idually and subse- quen ly by he s epwise me hod. Only s a is ically signi i- can esul s o he s epwise models we e epo ed. The esul s o he logis ic eg ession analyses a e p esen ed as odds a ios (OR) and 95% con idence in e als (CI). Low- i men we e used as a e e ence g oup in all models. Resul s The esponden s’(N = 899) mean age was 43.9 (SD = 12.7). The majo i y o he s udy pa icipan s we e employed (69%) and ma ied o cohabi ing (66%). Nine- een pe cen o he men we e loca ed in he low- i ness class (low- i ), 42 pe cen in he mode a e i ness class (mod- i ) and 38 pe cen in he high i ness class (high- i ). The low- i men we e less educa ed and hey e- po ed mo e diseases han he high- i men. Almos all he low- i men we e o e weigh o obese, and one- i h engaged in physical ac i i ies a leas h ee hou s pe week (Table 2). Also among he low- i men, one- i h epo ed ha hey had ei he inc eased PA du ing he pas yea o we e pe manen ly ac i e. When sel - epo ed and measu ed PFI we e compa ed in he di e en age-g oups, poo PF was mos equen ly epo ed by he middle-aged men. Almos 80 pe cen o he low- i men in he younges g oup sel -es ima ed mode a e o good PF. The younges low- i men also he mos o en epo ed engaging su icien ly in PA (Table 3). One- hi d (29%) o he younges low- i men sel - epo ed less han one hou o PA pe week, while among he middle-aged and oldes g oup he co e- sponding pe cen ages we e 50 and 41. Psychosocial ac o s and physical i ness The heal h bene i s and ecommended dose o PA we e well known. Howe e , 40 pe cen o he low- i men did no know whe e o ob ain social suppo (Table 1). Only hal o he low- i men epo ed seeking in o ma ion on exe cise o se ing exe cise goals. The low- i men we e also less con iden han mod- and high- i men o hei abili y o be physically ac i e in di e en li e si ua ions. Table 1 Scale o psychosocial ac o s and associa ions wi h physical i ness index Low (n = 172) Mode a e (n = 386) High (n = 341) p 1 (%) (%) (%) Knowledge (Ch onbach’sα= 0.80) I know heal h bene i s o PA 95 98 97 0.201 I know how o en I should exe cise 90 94 95 0.165 I know how many hou s in a week I should exe cise 85 86 90 0.115 I know he in ensi y a which I should exe cise 76 77 83 0.042 I know whe e I can ge social suppo o exe cise 59 72 77 <0.001 Skills (Ch onbach’sα= 0.71) I ha e sough in o ma ion on exe cise 52 63 75 <0.001 I can seek exe cise al e na i es 75 85 90 <0.001 I ha e ound an ag eeable way o exe cise 67 85 95 <0.001 I ha e good exe cise skills 63 82 93 <0.001 Goal se ing (Ch onbach’sα= 0.76) I ha e se goals o exe cise 50 64 78 <0.001 I can achie e my exe cise goals 61 77 86 <0.001 Sel -e icacy ( Ch onbach’sα= 0.80) I am able o exe cise when I am i ed 51 55 76 <0.001 I am able o exe cise when I am bad empe ed 62 78 86 <0.001 I am able o exe cise when I am busy 38 52 67 <0.001 I am able o exe cise al hough people close o me do no ega d highly PA 71 87 90 <0.001 I am able o es a exe cise a e an inac i e pe iod 80 88 95 <0.001 Social suppo (Ch onbach’sα=0.75) People close o me suppo my PA 70 82 88 <0.001 People close o me ha e a high ega d o PA 75 87 90 <0.001 I belie e ha by being ac i e I can con ibu e o PA by people close o me 75 82 88 0.001 p 1 = signi icance es ed by chi squa e- es . Kaasalainen e al. BMC Public Heal h 2013, 13:1113 Page 4 o 10 h p://www.biomedcen al.com/1471-2458/13/1113 The esul s o he logis ic eg ession analyses e ealed se e al age-speci ic di e ences in he odd a ios o high sco es in he psychosocial a iables (Table 4). In bo h lo- gis ic eg ession models, he esul s showed ha , in he younges g oup, he mode a e- i men we e mo e likely o ha e a highe knowledge sco e han he low- i men. Al hough he younges mode a e- i men did no epo be e skills han hei low- i pee s, among he middle- aged and he oldes g oups he likelihood o ha ing good skills was highe in he mode a e and high PFI classes. Also in he s epwise model, he ORs o a high sco e in skills ac oss ages 35–64 emained s a is ically signi ican be ween he low and high- i men. The mode a e- i younge men sco ed highe in goal se ing han hei younges low- i coun e pa s, while among he middle-aged and olde men only he high- i we e likely o ha e a high goal-sco e. In he s epwise model, goals showed no s a is ically signi ican associ- a ion wi h high PFI in any age g oup. The e we e sel - e icacy di e ences be ween he low- and high- i men in he younges g oup and di e ences in all he PFI ca - ego ies in he middle-age and oldes g oups. Mode a e Table 2 Associa ions be ween Physical Fi ness Index, demog aphics and Physical Ac i i y beha iou Low PFI (N = 172) Mode a e PFI (N = 386) High PFI (N = 341) To al (N = 899) p 1 (%) (%) (%) (%) (Χ 2 ) Age 18-34 48 (27.9) 103 (26.7) 106 (31.1) 257 (28.6) ns 35-49 65 (37.8) 140 (36.3) 120 (35.2) 325 (36.2) 50-64 59 (34.3) 143 (37.0) 115 (33.7) 325 (36.2) Educa ion Low (−9 yea ) 16 (9.8) 37 (10.2) 29 (8.8) 82 (9.6) 0.003 Medium (9–12 yea ) 88 (53.7) 202 (56.0) 140 (42.9) 430 (50.5) (16.4) High (12- yea ) 60 (36.6) 123 (33.8) 88 (48.3) 213 (39.9) Ch onic diseases No o no epo ed 129 (75.0) 309 (80.9) 292 (85.9) 731(81.8) 0.009 a leas one 43 (25.0) 73 (18.9) 48 (14.1) 164(18.2) (9.4) BMI <25 14 (8.1) 130 (33.8) 231 (67.7) 375 (41.8) <0.001 25-29,9 60 (34.9) 215 (57.2) 109 (32.0) 386 (43.0) (389.5) ≥30 98 (57.0) 38 (9.9) 1 (0.3) 137 (15.3) Ac i i y le el <1 h/week 70 (40.7) 68 (17.6) 1 (0.3) 139 (15.6) <0.001 1-3 h/week 71 (41.3) 224 (58.0) 115 (33.7) 410 (45.4) (251.6) >3 h/week 31 (18.0) 94 (24.4) 225 (66.0) 350 (38.9) F equency o s eng h aining a leas 3 imes/wk 32 (18.5) 116 (30.4) 146 (42.9) 294 (32.8) <0.001 1-2 imes/wk 55 (31.6) 139 (36.4) 129 (37.9) 323 (36.1) (45.4) less han once a week 86 (49.7) 127 (33.2) 65 (19.1) 278 (31.1) Commu ing o wo k by walking o cycling/ week ≤1 h /wk 143 (83.1) 284 (73.6) 192 (56.3) 619 (68.9) <0.001 > 1 h/wk 29 (16.9) 102 (26.4) 149 (43.7) 280 (31.1) (44.7) Mo i a ional eadiness No in en ion o inc ease PA 8 (4.7) 42 (11.0) 58 (17.2) 108 (12.1) <0.001 In en ion o inc ease PA 56 (32.6) 91 (23.9) 41 (12.1) 188 (21.1) (114.1) T ied o inc ease PA 75 (43.6) 146 (38.3) 89 (26.3) 310 (34.8) Inc eased PA du ing he pas yea 30 (17.4) 69 (18.1) 62 (18.3) 161 (18.1) PA on egula basis 3 (1.7) 33 (8.7) 88 (26.0) 124 (13.9) F = equencies,% = pe cen age, p 1 = signi icance es ed by chi squa e- es , Χ 2 = chi squa e, ns = no signi ican . Kaasalainen e al. BMC Public Heal h 2013, 13:1113 Page 5 o 10 h p://www.biomedcen al.com/1471-2458/13/1113 Table 3 Pe cen ages o Sel - a ed physical i ness and su icien physical ac i i y in di e en PFI-ca ego ies and age g oups Low (n = 172) Mode a e (n = 386) High (n = 341) p Sel - a ed PF (%) (%) (%) (Χ 2 ) Age 18-34 good 6 (12.5) 45 (43.7) 81 (76.4) <0.001 mode a e 31 (64.6) 47 (45.6) 22 (20.8) 60.4 poo 11 (22.9) 11 (10.7) 3 (2.8) Age 35-49 good 3 (4.6) 29 (20.7) 86 (71.7) <0.001 mode a e 33 (50.8) 97 (69.3) 33 (27.5) 153.2 poo 29 (44.6) 14 (10.0) 1 (0.8) Age 50-64 good 8 (13.6) 38 (26.6) 76 (66.1) <0.001 mode a e 28 (47.5) 89 (62.2) 37 (32.2) 91.9 poo 23 (39.0) 16 (11.2) 2 (1.7) I engage su icien ly in PA 18-34 18 (37.5) 56 (54.4) 84 (79.2) <0.001 35-49 13 (20.0) 64 (45.7) 98 (81.7) <0.001 50-64 11 (18.6) 71 (49.7) 98 (85.2) <0.001 F = equencies,% = pe cen age, p = signi icance es ed by chi squa e- es , Χ 2 = chi squa e. Table 4 Odds a ios (OR) o selec ed psychosocial ac o s ac oss di e en i ness ca ego ies and age g oups Low Mode a e (model 1) Mode a e (model 2) High (model 1) High (model 2) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Knowledge 18-34 1.00 2.84 (1.40-5.76)* 2.59 (1.25-5.36)* 1.84 (0.92-3.69) ns 35-49 1.00 1.52 (0.84-2.74) ns 2.58 (1.39-4.80)* ns 50-64 1.00 1.66 (0.90-3.05) ns 3.07 (1.58-5.95)* ns Skills 18-34 1.00 1.95 (0.98-3.91) ns 2.72 (1.35-5.49)* ns 35-49 1.00 2.19 (1.17-4.07)* ns 7.39 (83.36-14.53)** 5.35 (2.34-10.85)** 50-64 1.00 2.49 (1.23-5.00)* 2.49 (1.23-5.00)* 6.15 (2.98-12.68)** 6.15 (2.98-12.68)** Goal se ing 18-34 1.00 2.51 (1.40-5.06)* ns 3.46 (1.69-7.08)* ns 35-49 1.00 1.48 (0.82-2.68) ns 4.55 (2.37-8.73)** ns 50-64 1.00 1.66 (0.90-3.06) ns 3.44 (1.78-6.65)** ns Sel -e icacy 18-34 1.00 1.52 (0.73-3.10) ns 3.22 (1.56-6.64)** 2.36 (1.10-5.09)* 35-49 1.00 1.97 (1.01-3.85)* ns 3.83 (2.44-9.56)** 2.90 (1.40-6.00)** 50-64 1.00 2.48 (1.15-5.31)* ns 4.04 (1.87-8.76)* ns Social suppo 18-34 1.00 2.51 (1.22-5.15)* 2.22 (1.04-4.74)* 3.64 (1.72-7.69)* 2.74 (1.25-5.98)* 35-49 1.00 1.86 (1.02-3.37)* ns 3.55 (1.86-6.79)** ns 50-64 1.00 1.70 (0.80-3.23) ns 1.90 (0.97-3.71) ns *p < 0.05, **p < 0.001, OR = odds a io, CI = con idence in e al, ns = no signi ican , Model 1 = ORs o single psychosocial sco es, Model 2 = s epwise model o psychosocial sco es. Kaasalainen e al. BMC Public Heal h 2013, 13:1113 Page 6 o 10 h p://www.biomedcen al.com/1471-2458/13/1113 i ness was no ela ed o be e sel -e icacy in he youn- ges g oup. The younges men in he mode a e and high PFI g oups we e likely o sco e well on social suppo , bu no s a is ically signi ican di e ences be ween he PFI ca ego ies we e ound in he oldes g oup. Discussion Resul s indica ed ha he majo i y o he low- i men who pa icipa ed in his s udy we e heal h conscious and had in en ions o inc ease hei PA. Howe e , he e we e age-g oup di e ences in sel - a ed PF and psychosocial ac o s. A g ea e p opo ion o he middle-aged (35– 49 yea s) low- i men sel - epo ed poo i ness han ei- he hei younge (18–34 yea s) o olde (50–64 yea s) coun e pa s. A hal o he middle-aged low- i men we e inac i e. Age di e ences we e also ound when psy- chosocial sco es we e compa ed wi h sco es in he o he PFI ca ego ies. Low i ness was ela ed o lowe sco es in skills, goal se ing and sel -e icacy, ega dless o age. Howe e , knowledge was no ela ed o high PFI in he younges g oup and social suppo was no ela ed o be e PFI in he men aged 50–64. Sel -es ima ed physical i ness P e ious s udies ha e ound ha 50–60 pe cen o he inac i e popula ion o e es ima e hei PA [13,16,44]. In his s udy, almos 80 pe cen o he young low- i men epo ed mode a e o good PF. A ecen s udy epo ed ha PA o e es ima o s ended o compa e hei ac i i y le el o people who we e e en mo e seden a y han hemsel es [15]. Simila ly, low- i ness men may use a downwa d compa ison wi h mo e un i people. Howe e , in his s udy, he p opo ion o PF o e es ima o s should be in e p e ed wi h cau ion. Sel - a ed i ness was com- pa ed wi h PFI, which has no been es ablished as a measu e o PF in p e ious s udies. Thus, PFI may be ai ly accu a e measu e o men aged 35–49, bu unde - es ima e PF in younge o olde men. The pe cen age o men aged 35–64, who sel -es i- ma ed su icien PA, was almos he same as he pe - cen age who epo ed a leas 3 hou s PA pe week. Al hough o e es ima ion may be an obs acle o PA change [13,15,44], he p esen esul s sugges ha mos low- i men ha e a ealis ic pe cep ion o hei need o inc ease hei PA. Ne e heless he possibili y emains ha , among he low- i popula ion, a seden a y li es yle is he no m, blu ing a clea pe cep ion o wha cons i- u es su icien PA o good PF [15]. Rhodes & Dean (2009) poin ed ou ha inac i i y is a he e ogeneous phenomenon [45]. Seden a y beha iou may be as in en ional as is pa icipa ion in PA [45]. They sugges ha a he han ying o ad ise seden a y people o in- c ease hei PA, i may be mo e ui ul o ecommend hem o plan how o cu down on seden a y ime [45]. Psychosocial ac o s Good PA knowledge was ela ed o mode a e i ness in he younges men. This may e lec di e en alues and a i udes o PA among young men. Bo h seden a y be- ha iou and egula PA aining may be habi ual and e- la ed o he social en i onmen . Be ge e al. (2012) ound ha young men we e mo e likely o engage in PA o e 3.5 h/week, when hei signi ican o he s had posi- i e a i udes o heal hy beha iou s [46]. Social suppo was also highe in he younges mode a e and high- i men han low- i men. Mode a ely i young men may ha e a g ea e endency o ci e heal h bene i s and eel- ing e eshed as easons o hei engagemen in PA han hose who a e ei he seden a y o a hle ic. The mode a e- i younges men we e also mo e likely o ha e se hemsel es exe cise goals han hei low- i pee s. This esul indica es ha mode a ely- i young men in- es e o in planning hei engagemen in PA, which also se es o unde line he impo ance o social and en- i onmen al suppo in p omo ing PA. P e ious s udies sugges ha poo exe cise skills may lead o nega i e expe iences o PA, educed sel -e icacy and wi hd awal om in ended exe cise ac i i ies [47]. Sel - e icacy is he la ges de e minan o PA, and i is e- la ed bo h o he abili y o o e come ba ie s and he con- idence o engage in PA beha iou i sel [26]. Howe e , in he younges low- i age g oup, skills and sel -e icacy ended o di e en ia e only he low- and high- i , bu no low- and mode a e- i men. Skills and sel -e icacy a e im- po an long- e m p edic o s o PA main enance [26,48,49], and he e o e gene ics may ha e a s onge ole in de e mining low PF han long- e m PA in young adul s. The likelihood o adop ing PA habi s inc eases i one has good mo o skills o exe cise ac i i ies o a gene ic p e- disposi ion o good ae obic capaci y and muscula s eng h [50,51]. The in luence o PA his o y, o e weigh and ch onic diseases b oadens he gap be ween he i and un i du ing middle-age and he la e wo king yea s [2,48]. Social suppo is a key ac o o success ul PA change [14]. Howe e , social suppo was no ela ed o be e PFI in he oldes men. A ecen e iew also concluded ha social suppo is no a de e minan o PA [21]. The p esen esul s sugges ha social suppo appea s o ha e mo e impac on PA in younge han olde men. Lack o sel -e icacy, mo i a ion o PA skills may be mo e no able obs acles o engagemen in PA in he la e han ea lie wo king yea s, and hence ela ed o poo PA his o y. P e ious esea ch indica es ha a posi i e social en i onmen inc eases sel -e icacy owa ds beha iou and media es PA changes [12,16]. Social ac o s ha e been emphasized as an impo an componen o PA p o- g ams o middle-aged men [12]. Howe e , he speci ic o m o social suppo should be a ge ed o low and mode a ely i men di e en ly. Kaasalainen e al. BMC Public Heal h 2013, 13:1113 Page 7 o 10 h p://www.biomedcen al.com/1471-2458/13/1113 O e all, he low- i men we e mos ly o e weigh , pe - cei ed hei exe cise skills as poo , and we e no e y con iden o hei abili y o achie e hei exe cise goals. A p e ious e iew concluded ha in e en ion me hods like ac ion planning, sel -moni o ing and social suppo can inc ease sel -e icacy and media e PA change in a non-obese popula ion [52]. Howe e , in an obese popu- la ion, e ec i e in e en ion echniques may lie mo e in ac ion i sel . I has been sugges ed ha planning does no p omo e PA i one’s con idence in ac ualizing he be- ha iou is low [47]. Compa ed o o he heal h beha iou changes, egula PA equi es mo e ime and also, o some ex en , special skills [23,26]. Good physical i ness may be ela ed o one so o physical ac i i y capi al ha p omo es engagemen in PA and p o ides he abili y o ob ain social suppo om he en i onmen [42]. While easy access o exe cise g oups and good spo a- cili ies could be enough o inc ease PA in mode a ely- i men, low- i men may need mo e indi idual counseling, social suppo and PA al e na i es ha a e pe cei ed as ag eeable and un. Fu he esea ch is needed o de e - mine whe he he PFI used he e could o m one compo- nen o a p ac ical ool-ki in heal h counselling. S eng hs and limi a ions This s udy has limi a ions ha es ic he gene- alizabili y o he indings. Fi s , he pa icipan s we e wo king-aged men who olun a ily engaged in he es - ing e en s. I is p obable, he e o e, ha he s udy did no include men wi h he lowes i ness s a us. Un i and inac i e popula ions do no usually engage in PF s udies owing o he challenging na u e o he i ness es s used and lack o mo i a ion [12]. Howe e , he p esen da a we e ob ained in public e en s ha we e ee o cha ge and he i ness es s we e easy o pe o m. No wi h- s anding, he da a we e es ic ed o mo i a ed men, as only 16 pe cen o he pa icipan s we e seden a y. Sec- ond, he s udy was c oss-sec ional in na u e. Gene a ion and age coho di e ences in PA pa e ns and a i udes may in luence he di e ences in he esul s o PF and he psychosocial ac o s. Thi d, psychosocial ac o s we e assessed by using cons uc s d awn om se e al heal h beha iou heo ies (e.g. he heo y o planned beha iou and he T ans- heo e hical model) [22,25,26]. Rhodes & Nigg (2011) p oposed ha simply picking and choosing cons uc s om heo ies and models wi hou making a ull a emp o alida e a heo y may lead o p oblems in ad ancing PA esea ch [26]. Howe e , Glanz & Bishop sugges ed ha he s onges in e en ions may be buil om mul- iple heo ies [22]. The psychosocial measu es used in his s udy had been alida ed o pilo ed in p e ious s u- dies [40-43] among he a ge popula ion, which s eng hens he eliabili y o he esul s. The ou h limi a ion conce ns sel - epo ed a iables. Fo he psychosocial ac o s and physical ac i i y, sel - e alua ions ha e had sa is ac o y alidi y [25,53]. Sel - epo ed PF co ela es mode a ely wi h objec i ely mea- su ed PF, al hough he mos inac i e g oups end o o e es ima e hei PF [54]. I is ecommended ha o he assessmen me hods be used oge he wi h sel - epo s [54]. This s udy included bo h e alua ion o PF wi h ob- jec i e i ness es s and sel - a ed PF. Physical i ness was used as an ou come measu e ins ead o PA, because i has been sugges ed ha PF may mo e accu a ely de- sc ibe peoples’gene al endency o PA han sel - epo ed PA [55]. Howe e , ch onic diseases o gene ics may be he p ima y easons o low PF, and no inac i i y [3,21,50]. Assessing peoples’PA in ee-li ing condi ions is chal- lenging. The e o e, PF is a be e p edic o o heal h s a- us han PA. PF was assessed in he p esen s udy wi h a PFI ha comp ised se e al dimensions o heal h- ela ed i ness. The PFI did no indica e unc ional abili y alone, bu also isk o ad e se heal h condi ions. The PFI de- sc ibed PF (ae obic capaci y and skele al muscle s eng h) and indica ed isk ac o s o unc ional dis- abili y and ch onic diseases ( a % and VFA). Howe e , his was he i s ime ha his PFI has been used o e- sea ch pu poses. The e e ence alues o he PFI es s we e adjus ed o he popula ion o Finnish middle-aged men, which es ic s i s use in o he popula ions. Fu he esea ch should examine he alidi y o he p esen PFI in di e en age g oups and on di e en i ness le els. Conclusions Poo exe cise skills, sel -e icacy and social suppo we e ela ed o low PFI. Physical ac i i y p omo ion o low- i men should ake in o accoun age di e ences in he ela ionship be ween psychosocial ac o s and physical i ness. Thus, new and e ec i e ways o es ablish social suppo and mo i a ion o physical ac i i y among low- i men in all wo king-age g oups a e needed. Fu he e- sea ch is also wa an ed on whe he es ima ion o PFI could be used as a p ac ical heal h counselling ool. Compe ing in e es s The au ho s decla e ha hey ha e no compe ing in e es s. Au ho s’con ibu ions KSK analysed he da a and w o e he manusc ip . JK, KK and MP con ibu ed o he s udy design, da a collec ion and c i ical e iew o d a manusc ip s. JV assis ed wi h he s a is ical analysis, in e p e a ion o da a and c i ical e iew o d a manusc ip s. All he au ho s ead and app o ed he inal manusc ip . Acknowledgemen s This s udy has been suppo ed by a esea ch g an o he i s au ho om U heiluopis osää iö ( he Spo s Ins i u e Founda ion). We acknowledge he LIKES Resea ch Cen e and pe sonnel o he Fi o Li e P og am o hei con ibu ion and suppo du ing ieldwo k. We a e especially g a e ul o all Kaasalainen e al. BMC Public Heal h 2013, 13:1113 Page 8 o 10 h p://www.biomedcen al.com/1471-2458/13/1113