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Scandina ian Jou nal o P ima y Heal h Ca e
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Exe cise in e en ion and heal h checks o
middle-aged men wi h ele a ed ca dio ascula
isk: A andomized con olled ial
Helena Lii a, Elina Engbe g, Jenni Leppä uo i, S e lana F om, Hannu
Kau iainen, Juha Lii a, Taina Remes-Lyly, Heikki Tikkanen & Kaisu Pi kälä
To ci e his a icle: Helena Lii a, Elina Engbe g, Jenni Leppä uo i, S e lana F om, Hannu
Kau iainen, Juha Lii a, Taina Remes-Lyly, Heikki Tikkanen & Kaisu Pi kälä (2014) Exe cise
in e en ion and heal h checks o middle-aged men wi h ele a ed ca dio ascula isk: A
andomized con olled ial, Scandina ian Jou nal o P ima y Heal h Ca e, 32:4, 156-162, DOI:
10.3109/02813432.2014.984967
To link o his a icle: h p://dx.doi.o g/10.3109/02813432.2014.984967
© 2014 The Au ho (s) Published online: 01 Dec 2014.
Submi you a icle o his jou nal A icle iews: 483
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Scandina ian Jou nal o P ima y Heal h Ca e, 2014; 32: 156–162
ISSN 0281-3432 p in /ISSN 1502-7724 online © 2014 The Au ho (s)
DOI: 10.3109/02813432.2014.984967
ORIGINAL ARTICLE
Exe cise in e en ion and heal h checks o middle-aged men wi h
ele a ed ca dio ascula isk: A andomized con olled ial
HELENA LIIRA
1,4 , ELINA ENGBERG
2,3 , JENNI LEPP Ä VUORI
2,3 ,
SVETLANA FROM
4 , HANNU KAUTIAINEN
5 , JUHA LIIRA
6 , TAINA REMES-LYLY
7 ,
HEIKKI TIKKANEN
2,3 & KAISU PITK Ä L Ä
4
1 Depa men o Gene al P ac ice, School o Medicine, Uni e si y o Tampe e,
2 Depa men o Spo s and Exe cise Medicine,
Ins i u e o Clinical Medicine, Uni e si y o Helsinki,
3 Founda ion o Spo s and Exe cise Medicine, Clinic o Spo s and
Exe cise Medicine, Helsinki,
4 Uni o P ima y Heal h Ca e, Helsinki Uni e si y Cen al Hospi al and Depa men o
Gene al P ac ice, Uni e si y o Helsinki,
5 Medca e Founda ion, Ä ä nekoski,
6 Finnish Ins i u e o Occupa ional Heal h,
Helsinki, and
7 Ki kkonummi Heal h Cen e
Abs ac
Objec i e. To s udy he e ec s o a heal h check by a nu se alone o combined wi h an exe cise in e en ion in middle-aged
men a inc eased ca dio ascula isk. Design. A andomized con olled ial. Se ing and in e en ion. P ima y ca e in Ki k-
konummi municipali y wi h 36 000 inhabi an s. A heal h check by a nu se alone o combined wi h an exe cise in e en ion
o con ols wi h no in e en ion was compa ed. Subjec s. A o al o 168 men aged 35 o 45 yea s wi h a leas wo ca dio-
ascula isk ac o s and physical ac i i y (PA) equency ⬍ 3 imes a week. Main ou come measu es. Me abolic synd ome
(Me S) as de i ned by In e na ional Diabe es Fede a ion/Ame ican Hea Associa ion and sel - epo ed PA equency. Resul s.
O e all, ocusing on heal h inc eased physical ac i i y equency in middle-aged men. A e one yea , 19% had inc eased
PA o ⱖ 3 imes a week (95% CI 12 – 26). All s udy g oups inc eased PA o ⱖ 3 imes: 26% o men in he exe cise in e en-
ion g oup, 15% o men in he heal h check g oup, and 16% o con ols. The di e ences be ween he g oups we e no
s a is ically signi i can . The in e en ion did no ha e any meaning ul impac on Me S o o he ca dio ascula ou comes a
one-yea ollow up. Conclusions. Physical ac i i y inc eased in all s udy g oups o middle-aged men in his heal h-p omo ion
ial. The in e en ions had no e ec on me abolic synd ome o o he ca dio ascula ou comes in he pa icipan s. The ial
inc eased awa eness and collabo a ion in physical ac i i y p omo ion among municipal heal h ca e and exe cise se ices.
Key Wo ds: Ca dio ascula isk , exe cise in e en ion , Finland , gene al p ac ice , heal h check , me abolic synd ome
wi h die a y changes, i dec eases he incidence o
ype 2 diabe es melli us in high- isk g oups [3],
imp o es he Me S in gene al [4], and educes HbA1c
le els in pa ien s wi h ype 2 diabe es [5]. The
challenge is ha people do no adhe e o PA ecom-
menda ions. The main easons o his in he middle-
aged include economic ac o s, lack o ime, and
low mo i a ion [6].
Al hough he e ec i eness o such in e en ions
on mo bidi y may now be ques ionable [7], he e was
a end in Finland o conduc heal h checks o
40-yea -old men o imp o e hei li es yle habi s.
Also in Ki kkonummi municipali y, he heal h ca e
In oduc ion
Middle-aged men s a o p esen symp oms o me -
abolic synd ome (Me S), which makes hem a ele-
an a ge o heal h p omo ion. In Finland, he
No h Ka elia p ojec ocused mos ly on nu i ion
and se es as a model o an e ec i e heal h-p omo-
ion in e en ion o educe ca dio ascula isk [1].
Nowadays, a seden a y li es yle has become p e a-
len and i appea s ha inc easing physical ac i i y
(PA) may be one o he mos e ec i e means o con-
ol ca dio ascula isk.
The posi i e e ec s o PA a e well s udied: i p o-
mo es weigh loss [2], especially when combined
Co espondence: Helena Lii a, Kuninkaan ie 4, 02400 Ki kkonummi, Finland. E-mail: [email p o ec ed]
This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-Non-Comme cial License
(h p://c ea i ecommons.o g/licenses/by-nc/3.0)
(Recei ed 9 Ap il 2014 ; accep ed 10 Oc obe 2014 )
Heal h checks and exe cise in e en ion o men wi h ca dio ascula isk 157
policy-make s wan ed o commence a p og amme o
heal h checks. Howe e , in addi ion o heal h checks
we we e able o s a a andomized con olled ial
s udying he e ec i eness o heal h checks alone o
in combina ion wi h an exe cise in e en ion.
Because an indi idual app oach may no be su -
i cien o li es yle changes, we added a g oup-based
exe cise in e en ion o he ial. This was especially
impo an as Ki kkonummi is a commu e own in
he Helsinki a ea whe e mos inhabi an s mo e o
wo k in he capi al egion and as a esul o his men
end up lacking hei na u al g oups o pee s o exe -
cise. The e o e, as one o he communi y a ge s wi h
his ial we aimed o es ablish g oups o men exe cis-
ing oge he . We also wan ed o c ea e coope a ion
be ween he heal h cen e and o he municipal ac i -
i ies, such as adul educa ion and exe cise se ices in
heal h p omo ion.
Al hough he e is e idence o he e ec s o exe -
cise plus die in indi iduals al eady p esen ing wi h
impai ed glucose ole ance [3] and o he clinical
mani es a ions [4,5], he e is s ill a need o s udies
on exe cise alone in p ima y heal h ca e a ge ed a
isk g oups. Ou aim was o a ge he isk g oup o
middle-aged men wi h ca dio ascula isk ac o s
wi h wo in e en ions: heal h checks and an exe cise
in e en ion, and o s udy he e ec s in a andomized
con olled ial. In his pape , we p esen he i ndings
o he ial wi h ega d o i s main ou comes: me a-
bolic synd ome and physical ac i i y.
Ma e ial and me hods
Gene al design
We planned a h ee-a med one-cen e andomized
con olled ial (see Figu e 1). The me hods ha e
been desc ibed in de ail ea lie [8]. Men we e
ec ui ed by h ee me hods: by in i a ion le e s o
40-yea -olds, by mass media and local campaigning,
and by a ge ed ec ui ing in he heal h se ices.
A e sc eening and andomiza ion, he i s s udy
a m ecei ed a 1 ½ -hou heal h check in e en ion by
a public heal h nu se. The second in e en ion a m
ecei ed, in addi ion o he heal h check, a guided
g oup exe cise in e en ion o 12 weeks. The hi d
g oup se ed as a con ol g oup, and men in his
g oup had he oppo uni y o pa icipa e in he heal h
checks and exe cise in e en ions a e one yea .
Pa icipan s
Inclusion c i e ia we e p ede i ned as ollows: men
aged 35 o 45 wi h a leas wo ca dio ascula isk
ac o s. These included BMI 27 – 34 kg/m
2 , wais ci -
cum e ence ⬎ 94 cm, as ing glucose ⬎ 6.1 mmol/l,
o al plasma choles e ol ⬎ 5.0 mmol/l, LDL-choles-
e ol ⬎ 3.0 mmol/l, iglyce ides ⬎ 2.0 mmol/l, sys-
olic blood p essu e ⬎ 140 mmHg, dias olic blood
p essu e ⬎ 90 mmHg and cu en ly ei he smoking
o on choles e ol-lowe ing o blood p essu e-lowe -
ing medica ion.
Exclusion c i e ia we e as ollows: BMI o e 34
(o any o he physical ba ie p e en ing pa icipa-
ion in he exe cise in e en ion) o ac i e exe cise
(exe cising o a leas 30 minu es h ee imes a week
o mo e) o ha ing an immedia e heal h p oblem
equi ing ea men o a se e e isk ac o , o exam-
ple, ecen ly diagnosed o uncon olled ype I diabe-
es, o symp oma ic co ona y a e y disease.
Randomiza ion
Once he men had consen ed o pa icipa e in he
s udy and he baseline measu emen s we e ca ied ou ,
hey we e andomly alloca ed o one o he h ee s udy
g oups. A andomiza ion lis based on andom num-
be s was made and ans e ed o sequen ially num-
be ed, sealed en elopes. The s udy coo dina o (SF)
opened he en elopes in numbe ed o de and in o med
pa icipan s o hei s udy a m and p ocedu es.
S udy in e en ions
Heal h check in e en ion by a nu se . Public heal h
nu ses used s anda d p ac ices in hei heal h-p o-
mo ion in e en ion. P io o he onse o he ial,
hey a ended a aining session a anged by he
Finnish Hea Associa ion. In hei in e en ions,
he nu ses used he ype 2 diabe es disease isk
assessmen o m (Finnish Diabe es Associa ion)
[9], and he ca dio ascula isk assessmen cha
( he Finnish Hea Associa ion). The in e en ion
I is known ha p omo ion o physical ac i i y in
p ima y ca e o seden a y adul s leads o a small
o medium imp o emen in sel - epo ed physi-
cal ac i i y a 12 mon hs.
A 19% inc ease was obse ed a one yea in •
o e all sel - epo ed physical ac i i y in mid-
dle-aged men who pa icipa ed in a heal h-
p omo ion ial.
The change in physical ac i i y did no ha e •
an e ec on he heal h ou comes a one-yea
ollow-up.
The ial had communi y e ec s: g oups o •
men con inued exe cising oge he and he
ial inc eased collabo a ion be ween heal h
and exe cise se ices in he municipali y.
158 H. Lii a e al.
included assessmen s o indi idual isks, die a y
habi s, PA, and a mo i a ional alk abou hese hab-
i s. The in e en ion las ed up o 90 minu es and
did no include a ollow-up.
Exe cise in e en ion. In addi ion o he heal h checks,
he second in e en ion g oup was also in i ed o a
g oup exe cise in e en ion. The size o hese g oups
a ied om 10 o 20 people. The exe cise in e en-
ion g oup me once a week and was guided by a
physical educa ion counsello and consis ed o a i-
ous ypes o basic physical aining. The exe cise ses-
sions las ed 60 minu es each. Du ing he 12 weekly
mee ings se e al sa e exe cise ac i i ies o a leas
mode a e in ensi y we e in oduced, such as No dic
walking, i ness ci cle, olleyball, swimming, ci cui
aining, gym, boxing, zumba, e c.
In addi ion o he s udy in e en ions, all g oups
ecei ed, i necessa y, s anda d ea men a Ki kkon-
ummi Heal h Cen e, a municipal public p ima y
ca e uni . I a pa icipan showed any need o medical
ea men , o his medica ions equi ed medical a en-
ion, he was e e ed o a p ima y ca e physician.
Ou come measu es
The ou comes we e measu ed a e h ee and 12
mon hs o he andomiza ion. The blood es s we e
aken a mon hs 0, 3, and 12. O he ou comes we e
measu ed by In e ne su eys and, i he pa icipan
did no espond, by elephone su eys.
We had wo p ima y ou come measu es. Fi s ,
Me S as de i ned by he In e na ional Diabe es
Fede a ion/Ame ican Hea Associa ion [10], i.e.
436 eligible o
labo a o y es ing and
isk assessmen
A = Heal h check by a
nu se
n = 60
168 men ga e consen
and we e andomized
B = Exe cise
in e en ion and
heal hcheck
n = 54
C = Con ols
n = 54
665 men sc eened
Excluded:
39 wi h BMI >34
190 exe cised a leas 3
imes e week
3 mon h ollow up
n = 47
3 mon h ollow up
n = 32
3 mon h ollow up
n = 46
12 mon h ollow up
n = 42
12 mon h ollow up
n = 46
12 mon h ollow up
n = 43
Figu e 1. Pa icipan l ow diag am.
Heal h checks and exe cise in e en ion o men wi h ca dio ascula isk 159
checking whe he h ee o mo e o he ollowing c i-
e ia we e ul i lled: (i) sys olic blood p essu e ⱖ 130
o dias olic blood p essu e ⱖ 85 o speci i c medica-
ion; (ii) iglyce ides ⱖ 1.7 mmol/L o speci i c
medica ion; (iii) HDL choles e ol ⬍ 1.0 mmol/L o
speci i c medica ion; (i ) as ing plasma glucose
ⱖ 5.6 mmol/L o speci i c medica ion; o ( ) wais
ci cum e ence ⬎ 94 cm. We chose me abolic syn-
d ome as ou main ou come measu e as we expec ed
ha in his g oup o men wi h ele a ed ca dio ascu-
la isk i could be modi i ed by ou in e en ions.
The second p ima y ou come measu e was sel -
epo ed PA assessed by asking how many imes pe
week a pa icipan pe o med any exe cise ha
induced swea ing and go he pe son a leas sligh ly
ou o b ea h, i.e. was a leas o mode a e in ensi y,
o a leas 30 minu es.
S a is ical analyses
The esul s a e exp essed as p opo ions o means
and s anda d de ia ions (SD). S a is ical compa i-
sons be ween he g oups wi h con inuous a iables
in baseline cha ac e is ics we e pe o med using
analysis o a iance o he K uskall-Wallis es
and wi h a chi-squa ed es o Fishe ’ s exac es
o dicho omous a iables. The di e ences be ween
g oups in PA and Me S we e es ed by using boo -
s ap echniques. Boo s apping is a e-sampling
me hod, in which no assump ions on dis ibu ion
a e made [11]. The α -le el was se a 0.05. All
s a is ical analyses we e pe o med using STATA
( o Windows), e sion 10 (S a a Co p, College S a-
ion, TX, USA).
Resul s
Th ee age coho s we e in i ed o he s udy, he 1969
bo n (n ⫽ 313 and 122 esponded), he 1970 bo n
(n ⫽ 330 and 110 esponded), and he 1971 bo n
(n ⫽ 303 and 88 esponded). O e all, 320 o 946
in i ed men (34%) esponded and pa icipa ed in he
sc eening. An addi ional 345 men became in e es ed
in he ial ia he mass media, campaigning, o a -
ge ed in i a ions. Be ween 2009 and 2011, a o al o
665 men aged be ween 35 and 45 yea s esponded
o he sc eening ques ionnai e o he ial. The pa -
icipan l ow diag am is p esen ed in Figu e 1. A e
labo a o y es ing and isk assessmen , al oge he
168 men consen ed and we e andomized in o he
ial. The baseline cha ac e is ics o he men a e p e-
sen ed in Table I.
Physical ac i i y
O e all, he men in he ial inc eased hei PA e-
quency. Since men who exe cised a leas h ee imes
pe week we e excluded om he ial, none o he
pa icipan s exe cised h ee imes pe week a baseline.
All s udy g oups inc eased hei PA (Figu e 2), and
o all pa icipan s, 19% (95% CI 12 – 26) con inued
Table I. Baseline pa icipan cha ac e is ics: mean (and s anda d de ia ion).
All (n ⫽ 168)
Heal h check
(n ⫽ 60)
Exe cise
in e en ion
(n ⫽ 54)
Con ols
(n ⫽ 54) P
1
Mean age, yea s (SD) 40.3 (2.9) 40.2 (2.5) 40.4 (2.8) 40.3 (3.5) 0.95 (NS)
Weigh , kg (SD) 88.4 (11.9) 89.3 (12.9) 89.6 (11.1) 86.2 (11.4) 0.26 (NS)
Heigh , cm (SD) 180.8 (6.4) 181.3 (6.6) 180.5 (6.3) 180.7 (6.2) 0.79 (NS)
Wais ci cum e ence, cm (SD) 99 (13.4) 99 (11.6) 101 (18.0) 98 (10.2) 0.55 (NS)
Sys olic blood p essu e, mmHg (SD) 134 (12.9) 132 (14.3) 135 (10.2) 136 (13.9) 0.28 (NS)
Dias olic blood p essu e, mmHg (SD) 84 (9.0) 82 (9.5) 86 (7.6) 84 (9.7) 0.09 (NS)
RR medica ion (%) 8 3 11 9 0.27 (NS)
Glucose, mmol/l (SD) 5.7 (0.7) 5.8 (0.9) 5.7 (0.6) 5.6 (0.4) 0.67 (NS)
Choles e ol, mmol/l (SD) 5.4 (0.8) 5.5 (0.8) 5.3 (0.8) 5.2 (0.8) 0.05 (NS)
LDL, mmol/l (SD) 3.6 (0.7) 3.7 (0.7) 3.5 (0.7) 3.5 (0.7) 0.10 (NS)
HDL, mmol/l (SD) 1.4 (0.4) 1.3 (0.4) 1.4 (0.4) 1.4 (0.3) 0.90 (NS)
T iglyce ides, mmol/l (SD) 1.4 (0.7) 1.6 (0.9) 1.4 (0.7) 1.2 (0.5) 0.01 (
* )
Me abolic synd ome, n (%) 45 (7) 59 (13) 42 (13) 35 (13) 0.03 (
* )
F equency o physical ac i i y (a leas mode a e
in ensi y, ⱖ 30 minu es), n (%)
2
Some imes o ne e
1 – 2 imes/week
58 (35)
110 (65)
21 (35)
39 (65)
21 (31)
33 (69)
16 (40)
38 (60)
0.07 (NS)
No es:
1
S a is ical compa isons be ween he g oups we e pe o med using analysis o a iance o K uskall – Wallis es o con inuous
a iables and chi-squa ed es o Fishe ’ s exac es o ca ego ical a iables.
2 The men who exe cised ⱖ 3 imes/week we e excluded om
he ial and he e o e no one exe cised his much a baseline.

160 H. Lii a e al.
exe cising a leas h ee imes a week a 12 mon hs. In
he exe cise in e en ion g oup, 26% (95% CI 11 – 40)
o men pu sued exe cising a leas h ee imes a week,
in he heal h check g oup 16% (95% CI 5 – 27) and in
he con ol g oup 17% (95% CI 5 – 29); howe e he
di e ences be ween he g oups we e no s a is ically
signi i can (Figu e 2).
Me abolic synd ome
A baseline, 45% o men ul i lled he c i e ia o
Me S. Al hough he e was a end owa ds a dec eased
p opo ion o men wi h Me S a h ee mon hs, a e
12 mon hs he p e alence o Me S had e u ned o
he o iginal le el o abo e (Figu e 3). The e we e no
di e ences be ween he in e en ion g oups and he
con ol g oup in he p e alence o Me S.
O he ou comes
The ca dio ascula ou comes a e p esen ed in
Table II. The in e en ions had no s a is ically sig-
ni i can e ec s on hese ou comes a h ee mon hs
o a 12 mon hs.
Discussion
Ou p agma ic ial o an exe cise in e en ion and
heal h checks in a municipal heal h cen e was able
o change he exe cise habi s o middle-aged men in
all s udy g oups. We ec ui ed men wi h a leas wo
ca dio ascula isk ac o s and low le els o PA.
A e one yea , 19% o hese seden a y men had
inc eased hei PA equency o a leas h ee imes
a week. The e we e no di e ences be ween he s udy
g oups in PA.
Ou esul s a e simila o p e ious s udies on
heal h p omo ion in p ima y ca e. A sys ema ic
e iew published in 2012 [12] obse ed small
e ec s wi h physical ac i i y p omo ion o pa ien s
ec ui ed in p ima y ca e. I p o ided an es ima ion
o a numbe needed o ea (NNT) o 12, which
means ha 12 pa ien s need o be a ge ed wi h
physical ac i i y p omo ion o one o become
ac i e. This can be compa ed wi h smoking cessa-
ion ad ice, whe e NNTs o 50 o 120 ha e been
epo ed [13].
Al hough men inc eased he equency o exe cise,
we ound no e ec s on heal h ou comes, me abolic
synd ome, o indi idual ca dio ascula ou comes. Fo
subs an ial heal h bene i s, adul s should do a leas
150 minu es a week o mode a e in ensi y, o 75 min-
u es a week o igo ous-in ensi y ae obic physical
ac i i y, o an equi alen combina ion o hese [14,15].
Ou ou come measu e, sel - epo ed physical ac i i y,
is somewha c ude and does no ake in o accoun he
in ensi y o he exe cise o he po en ial exe cise du -
ing wo king hou s. Howe e , in a p agma ic p ima y
heal h ca e ial i was he mos easible me hod.
Time, mon hs
312
Physical ac i i y ≥3 imes pe week, %
0
6
12
18
24
30
36
42
48
54
60 Heal h
Exe cise
Con ol
p=0.51 p=0.42
Key: Heal h = heal h check.
Exe cise = exe cise in e en ion and heal h check.
Figu e 2. Pe cen age o men who pe o med physical ac i i y a
leas h ee imes a week a h ee and 12 mon hs in s udy g oups.
Time, mon hs
03 12
Pe cen age o Me S
0
10
20
30
40
50
60
70
80
90
100
p=0.013 p=0.19 p=0.33
Heal h
Exe cise
Con ol
Key: Me S = me abolic synd ome. Heal h = heal h check.
Exe cise = exe cise in e en ion and heal h check.
Figu e 3. Pe cen age o men wi h 95% con i dence in e als wi h
me abolic synd ome a h ee and 12 mon hs in s udy g oups.
Heal h checks and exe cise in e en ion o men wi h ca dio ascula isk 161
The changes in exe cise habi s did no ha e
e ec s on he p e alence o me abolic synd ome in
he pa icipan s. Ei he he change in ac i i y was no
la ge enough, he ollow-up was no long enough o
obse e he e ec s, o o he li es yle changes such as
die ing would ha e been equi ed. I also appea s
ha me abolic synd ome is di i cul o al e and may
no be an op imal ou come measu e. The choice o
he ou come measu es mus be conside ed as a lim-
i a ion o his ial.
Randomized con olled ials a e no commonly
conduc ed in p ima y ca e in Finland. This e o
augh us se e al lessons. Using mass media and
local campaigning was e ec i e o ec ui men bu
i also con amina ed he ial as he p ojec was
e y isible in he local newspape and e en s,
which led o he con ol men also ecei ing some
o he in e en ion.
The weakness o ou s udy is ha i lacks powe .
I was designed o 300 men, and we we e able o
ec ui and andomize only 168 men. Al hough he
ial ecei ed much a en ion in he communi y and
men eage ly ook pa in he sc eening su ey, i was
di i cul o mo i a e hem o a end o labo a o y
es ing and o pa icipa e in he ollow-up. Middle-aged
men li e busy li es wi h wo k and amilies and i is
challenging o hem o commi hemsel es o a weekly
in e en ion. Acco ding o he g oup counsello s, he
pa icipa ion a es in he exe cise g oups a ied
be ween 50% and 80%.
Pa icipan s in he con ol g oup we e in i ed o
comple e an online ques ionnai e wi h heal h- and
li es yle- ela ed ques ions a baseline and a h ee
and 12 mon hs. Fu he mo e, hey we e p omised
heal h counselling and g oup exe cise aining a e
he 12-mon h s udy pe iod. The ques ionnai es,
keeping in con ac wi h he s udy coo dina o , and
u u e heal h counselling and exe cise aining may
ha e mo i a ed hem o inc ease hei PA.
Ou esul s a e consis en wi h p e ious p ima y
ca e s udies epo ing inc eases in PA le els also
among he con ol g oup. In a Du ch s udy, a ailo ed
PA in e en ion inc eased PA le els bu no mo e
han in he con ol g oup [16]. I appea ed ha he
physical ac i i y measu emen s independen ly
a ec ed pa icipan s ’ beha iou [17].
The communi y a ge s in ou s udy we e suc-
cess ul. Some men in he exe cise in e en ion g oups
con inued exe cising oge he a e he ial, which
was one o ou communi y aims. In addi ion, he ial
also inc eased collabo a ion be ween he heal h and
exe cise se ices in he municipali y. An exe cise
counsello s a ed consul a ions a he heal h cen e,
and physicians lea n o be e e e hei pa ien s o
he municipal exe cise se ices. Since amily medi-
cine is no only o indi iduals bu also o communi-
Table II. Ca dio ascula ou comes h ee mon hs and 12 mon hs a e he in e en ion: Mean
(and s anda d de ia ion).
1.
All
Heal h
check
Exe cise
in e en ion Con ols
Weigh , kg
3 m
12 m
87.3 (11.8)
88.3 (11.8)
90.0 (12.8)
89.6 (11.3)
87.9 (12.1)
89.9 (10.9)
84.7 (10.3)
85.5 (13.0)
Sys olic blood p essu e, mmHg (SD)
3 m
12 m
135 (13.0)
136 (11.9)
131 (8.0)
135 (11.8)
138 (14.1)
139 (11.7)
136 (14.8)
134 (12.2)
Dias olic blood p essu e, mmHg (SD)
3 m
12 m
83 (8.7)
85 (9.4)
81 (8.3)
83 (10.2)
86 (8.6)
87 (8.2)
80 (9.1)
83 (9.7)
Glucose, mmol/l (SD)
3 m
12 m
5.6 (0.6)
5.7 (0.6)
5.5 (0.5)
5.6 (0.6)
5.6 (0.8)
5.7 (0.6)
5.6 (0.5)
5.7 (0.6)
Choles e ol, mmol/l (SD)
3 m
12 m
5.2 (0.8)
5.4 (0.9)
5.4 (0.8)
5.5 (0.8)
5.1 (0.9)
5.3 (0.9)
5.1 (0.8)
5.2 (0.8)
LDL, mmol/l (SD)
3 m
12 m
3.5 (0.7)
3.5 (0.7)
3.6 (0.7)
3.7 (0.7)
3.4 (0.8)
3.5 (0.8)
3.4 (0.7)
3.4 (0.7)
HDL, mmol/l (SD)
3 m
12 m
1.4 (0.3)
1.4 (0.4)
1.3 (0.3)
1.4 (0.3)
1.4 (0.3)
1.4 (0.4)
1.4 (0.3)
1.5 (0.4)
T iglyce ides, mmol/l (SD)
3 m
12 m
1.3 (0.6)
1.4 (0.7)
1.4 (0.7)
1.5 (0.8)
1.2 (0.5)
1.4 (0.7)
1.1 (0.4)
1.2 (0.5)
No e:
1 Di e ences a e s a is ically non-signi i can .
162 H. Lii a e al.
ies, i is impo an o pu he ocus on communi y
consequences o ials [18].
In conclusion, ou ial led o small changes in
he physical ac i i y o middle-aged men bu we
obse ed no changes in ca dio ascula heal h. We
we e, howe e , able o inc ease awa eness and col-
labo a ion in he municipali y on physical ac i i y
heal h p omo ion.
E hics app o al
The ial was app o ed by he municipal au ho i ies
and by he Coo dina ing E hics Commi ee a
Helsinki Uni e si y Hospi al on 8 June, 2009
( e : 4/13/03/00/09). The s udy was egis e ed a
Con olled T ials (h p://www.con olled- ials.com).
T ial numbe : ISRCTN80672011.
Acknowledgemen s
The au ho s would like o hank Ms Ma ia Te ä ä inen
o help wi h he s udy ma e ial, and he public heal h
nu ses ha pe o med he heal h checks as well as
he employees a he municipal adul educa ion and
exe cise se ices o excellen collabo a ion.
Decla a ion o in e es
The au ho s epo no con l ic s o in e es . The
au ho s alone a e esponsible o he con en and
w i ing o he pape .
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