Associa ion o Physical Ac i i y in Childhood and Ea ly Adul hood
Wi h Ca o id A e y Elas ici y 21 Yea s La e : The Ca dio ascula Risk
in Young Finns S udy
K is iina S. P€
al e, MD; Ka ja Pahkala, PhD; Cos an G. Magnussen, PhD; Teemu Koi is oinen, MD, MSc; Ma kus Juonala, MD, PhD;
Mika K€
ah€
onen, MD, PhD; Te ho Leh im€
aki, MD, PhD; Tapani R€
onnemaa, MD, PhD; Jo ma S. A. Viika i, MD, PhD; Olli T. Rai aka i, MD, PhD
Backg ound-—Dec eased a e ial elas ici y is a isk ac o o se e al ca dio ascula ou comes. Longi udinal da a on he e ec o
physical ac i i y in you h on adul a e ial elas ici y a e limi ed. The aim o his s udy was o de e mine he long- e m e ec s
o physical ac i i y in child en and young adul s on ca o id a e y elas ici y a e 21 yea s o ollow-up.
Me hods and Resul s-—Pa icipan s we e 1417 child en (aged 9 o 15 yea s) and 999 young adul s (aged 18 o 24 yea s) om he
p ospec i e Ca dio ascula Risk in Young Finns S udy. Pa icipan s had ques ionnai e measu es o leisu e- ime physical ac i i y
a ailable om 1986 and ul asound-de i ed indices o ca o id a e y elas ici y measu ed in 2007. Ca o id a e y elas ici y indices
we e dis ensibili y (%/10 mm Hg), Young’s elas ic modulus (kPa), and s i ness index (uni less). Physical ac i i y a age 18 o
24 yea s was di ec ly associa ed wi h dis ensibili y (b=0.068, P=0.014) and in e sely wi h Young’s elas ic modulus (b=0.057,
P=0.0037) and indi ec ly wi h s i ness index (b=0.050, P=0.0028) 21 yea s la e in males and emales. The associa ions
emained a e adjus men o age, sex, body mass index, smoking, sys olic blood p essu e, se um lipids and insulin, and 21-yea
change in physical ac i i y. A age 9 o 15 yea s, he a o able associa ion, emaining a e adjus men , was ound in males
(dis ensibili y [b=0.097, P=0.010], Young’s elas ic modulus [b=0.060, P=0.028], and s i ness index [b=0.062, P=0.007]) bu
no in emales (P=0.70, P=0.85, and P=0.91, espec i ely).
Conclusions-—Leisu e- ime physical ac i i y in boys and young adul s is associa ed wi h ca o id a e y elas ici y la e in li e,
sugges ing ha highe le els o physical ac i i y in you h may benefi u u e ca dio ascula heal h. (J Am Hea Assoc. 2014;3:
e000594 doi: 10.1161/JAHA.113.000594)
Key Wo ds: a he oscle osis •exe cise •p e en ion
Cen al a e ies, such as he ao a and ca o id, lose hei
elas ici y wi h age.
1–3
Dec eased a e ial elas ici y is a
isk ac o o se e al ca dio ascula ou comes: hype en-
sion, a he oscle osis, and co ona y hea disease.
4
I has
been shown in c oss-sec ional s udies ha high le els o
habi ual physical ac i i y is associa ed wi h inc eased a e ial
elas ici y, such as imp o ed ca o id a e y compliance
5,6
and educed a e ial s i ening in olde adul s.
6,7
Howe e ,
longi udinal da a on he e ec o physical ac i i y in child en
and young adul s on la e ascula heal h a e limi ed. Van de
Laa e al ha e shown ha li e ime igo ous, bu no ligh - o-
mode a e, habi ual physical ac i i y is a o ably associa ed
wi h b achial and emo al a e y compliance among 373
pa icipan s, aged 13 yea s a baseline, du ing 24 yea s o
ollow-up.
8
Chen e al ha e shown ha a dec ease in
physical ac i i y in males aged 14 yea s a baseline is
associa ed wi h inc eased a e ial s i ness a e 3 yea s o
ollow-up.
9
We
10–12
and o he s
13–15
ha e p e iously shown in adul s
ha habi ual physical ac i i y is ela ed o inc eased insulin
sensi i i y, a mo e a o able lipid p ofile, dec eased p e a-
lence o he me abolic synd ome, and lowe blood p essu e
and educed isk o he de elopmen o hype ension.
F om he Resea ch Cen e o Applied and P e en i e Ca dio ascula Medicine,
Uni e si y o Tu ku, Tu ku, Finland (K.S.P., K.P., C.G.M., M.J.); Loimaa Dis ic
Hospi al, Loimaa, Finland (K.S.P.); Depa men s o Clinical Physiology (T.K.,
M.K.) and Clinical Chemis y (T.L.), Fimlab Labo a o ies, Tampe e Uni e si y
Hospi al and School o Medicine, Uni e si y o Tampe e, Tampe e, Finland;
Menzies Resea ch Ins i u e Tasmania, Uni e si y o Tasmania, Hoba , Tasma-
nia, Aus alia (C.G.M.); Paa o Nu mi Cen e, Spo s & Exe cise Medicine Uni ,
Depa men o Physical Ac i i y and Heal h (K.P.), Depa men s o Medicine
(M.J., T.R., J.S.A.V.), and Clinical Physiology and Nuclea Medicine (O.T.R.),
Uni e si y o Tu ku and Tu ku Uni e si y Hospi al, Tu ku, Finland.
Co espondence o: K is iina P€
al e, MD, Resea ch Cen e o Applied and
P e en i e Ca dio ascula Medicine, Uni e si y o Tu ku, Kiinamyllynka u 10,
20520 Tu ku, Finland. E-mail: k soma@u u.fi
Recei ed Decembe 5, 2013; accep ed Feb ua y 28, 2014.
ª2014 The Au ho s. Published on behal o he Ame ican Hea Associa ion,
Inc., by Wiley Blackwell. This is an open access a icle unde he e ms o he
C ea i e Commons A ibu ion-NonComme cial License, which pe mi s 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 and is no used o comme cial pu poses.
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All hese cha ac e is ics may ha e a posi i e e ec on a e ial
wall s uc u e and unc ion.
16–18
The pu pose o his s udy was o examine he e ec o
physical ac i i y in >2000 child en and young adul s on
ca o id a e y elas ici y measu ed 21 yea s la e .
Ma e ial and Me hods
Subjec s
The Ca dio ascula Risk in Young Finns S udy is a p ospec i e
ollow-up o a he oscle osis isk ac o s om you h. The fi s
c oss-sec ional su ey was conduc ed in 1980. The o iginal
sample size was 4320 child en and adolescen s aged 3, 6, 9,
12, 15, and 18 yea s. O hese, 3596 pa icipa ed (83.2% o
hose in i ed) in 1980. Full de ails o he s udy design ha e
been published.
19
The en i e coho was ollowed in 1983,
1986, 2001, and 2007. Vascula ul asound measu emen s
we e pe o med in 2001 and 2007. The sample o his
analysis included hose subjec s who ook pa in he s udy in
1986 and in 2007 (N=2416). Due o missing da a o some o
he analysis co a ia es, such as se um lipids, he numbe o
subjec s a ied be ween 1603 and 2416 in he analyses.
Pa icipan s we e aged 9 o 24 yea s a baseline and 30 o
45 yea s a ollow-up. The 1986 s udy was chosen as baseline
because his was he fi s yea ha physical ac i i y was
inqui ed using he same ques ionnai e o all pa icipan s.
Clinical measu emen s and physical ac i i y da a collec ions
we e pe o med simul aneously o each ollow-up, du ing
win e mon hs, o minimize seasonal a ia ion. Pa icipan s
ga e w i en in o med consen , and he s udy was app o ed
by local e hics commi ees.
Physical Ac i i y
Physical ac i i y was assessed by using a sel -adminis e ed
ques ionnai e in 1986 and in 2007.
10,20
The pa icipan s we e
asked o epo hei habi ual leisu e- ime physical ac i i y
in ensi y, equency, and du a ion. A me abolic equi alen
(MET) index o leisu e- ime physical ac i i y (la e called
“MET-index”) was calcula ed om he p oduc o in en-
si y9 equency9du a ion (MET h/wk) o bo h s udy yea s.
The coe ficien s o he in ensi y o physical ac i i y we e
es ima ed om he exis ing ables.
21
One MET is he
consump ion o 1 kcal o a pe son pe weigh kilog am pe
hou in es . The MET-index anged be ween 0 and 52 MET
h/wk in 1986 and be ween 0 and 93 MET h/wk in 2007.
The alida ion o he ques ionnai e is published p e i-
ously.
10
In b ie , we pe o med an expe imen al s udy
including 45 adul s (age ange 23 o 55 yea s, 48% emales).
The pa icipan s filled in he ques ionnai e, and hei physical
ac i i y was measu ed wi h accele ome e s and pedome e s
o a pe iod o 1 week. The MET-index and i s componen s
(ie, in ensi y, equency, and du a ion o physical ac i i y)
co ela ed significan ly wi h da a assessed using accele om-
e e s ( =0.26 o 0.40) and pedome e s ( =0.30 o 0.39).
These co ela ion coe ficien s we e o simila magni ude o
hose demons a ed in o he s udies.
22
We also collec ed
physical ac i i y da a in 2007 using alida ed pedome e s in
1934 indi iduals om he en i e s udy popula ion. Pa ici-
pan s wo e an Om on Walking S yle One (HJ-152R-E; Om on
Heal hca e Eu ope) pedome e o a pe iod o 1 week. The
co ela ion be ween he numbe o s eps measu ed wi h
pedome e s and he amoun o mo emen measu ed wi h
Ac iG aph accele ome e s (GT1M) was =0.97 (P<0.001,
n=45).
Ca o id A e y Ul asound
The le common ca o id a e y was scanned by ul asound
echnicians ollowing a simila , s anda dized p o ocol in 5
s udy cen e s.
3
A high- esolu ion ul asound imaging de ice
(Sequoia 512; Acuson) wi h a 13-MHz linea -a ay ans-
duce was used o assess a e ial elas ici y and in ima-
media hickness (IMT). The image was ocused on he
pos e io ( a ) wall, and gain se ings we e used o op imize
image quali y. Measu emen s we e made o fline om s o ed
digi al images. All ul asound scans we e analyzed by 1
eade blinded o he subjec s’de ails. To assess ca o id
a e y elas ici y indices and IMT, he bes -quali y ca diac
cycle was selec ed om a con inuous 5-second image file.
F om his image, a leas 4 measu emen s o he common
ca o id a wall we e aken 10 mm p oximal o he
bi u ca ion o de i e mean ca o id IMT. The common ca o id
diame e was measu ed a leas wice du ing end dias ole
and end sys ole. The means o he measu emen s we e
used as he end-dias olic and end-sys olic diame e s. The
me hods ha e been desc ibed in de ail p e iously.
23,24
Ul asound and concomi an b achial blood p essu e mea-
su emen s we e used o calcula e he ollowing indices o
a e ial elas ici y: ca o id a e y dis ensibili y (Cdis
[%/10 mm Hg]=[(D
s
D
d
)/D
d
]/(P
s
P
d
), Young’s elas ic mod-
ulus (YEM [kPa]=[(P
s
P
d
)D
d
2
]/[2(D
s
D
d
)IMT], and s i ness
index [SI]=ln(P
s
/P
d
)/[(D
s
D
d
)/D
d
], whe e D
d
is dias olic
diame e , D
s
is sys olic diame e , P
s
is sys olic blood
p essu e, and P
d
is dias olic blood p essu e.
25
No e ha
highe le els o bo h he YEM and SI ep esen dec eased
a e ial elas ici y, while a highe Cdis alue ep esen s a
be e a e ial elas ici y.
Clinical Cha ac e is ics and Labo a o y Me hods
Weigh was measu ed in ligh clo hing wi hou shoes wi h a
digi al scale o he nea es 0.1 kg, and heigh was measu ed
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wi h a wall-moun ed s adiome e o he nea es 0.1 cm. Body
mass index (BMI) was calcula ed as BMI=weigh (kg)/[heigh
(m)]
2
. Blood p essu e was measu ed wi h a andom ze o
sphygmomanome e . Ko o ko ’sfi h sound was used as a
sign o dias olic blood p essu e (DBP), and fi s sound was
used as he sign o sys olic blood p essu e (SBP). Readings o
he nea es e en numbe o millime e s o me cu y we e
pe o med a leas 3 imes on each subjec . The a e age o
hese measu emen s was used in he analyses. Mean a e ial
p essu e was calcula ed as mean a e ial p essu e=
[(29DBP)+SBP]/3. To al ene gy in ake was assessed by a
ood equency ques ionnai e in 2007. Alcohol consump ion,
es ima ed as numbe o s anda d d inks pe day du ing he
p e ious week, was assessed using a ques ionnai e in 2007.
Smoking habi s we e assessed by a sel -adminis e ed ques-
ionnai e beginning a age 12 yea s. Those smoking daily
we e conside ed as smoke s. Pack-yea s o smoking we e
calcula ed in 2007. Socioeconomic s a us was assessed by
he le el o educa ion ( o al school yea s) in 2007. The use o
medica ions we e assessed by using sel -adminis e ed ques-
ionnai e in 2007; 152 subjec s epo ed he use o an ihy-
pe ensi e medica ion, 46 subjec s used choles e ol-lowe ing
medica ion, 14 subjec s used insulin, and 11 subjec s used
o al an idiabe ic medica ion.
Venous blood samples we e d awn a e an o e nigh as .
All lipid and lipop o ein de e mina ions we e pe o med using
s anda d me hods, as desc ibed p e iously.
26,27
Se um low-
densi y lipop o ein (LDL) choles e ol was calcula ed using he
F iedewald o mula
28
in subjec s wi h iglyce ides <4 mmol/
L. Se um insulin was measu ed by mic opa icle enzyme
immunoassay ki (Abbo Labo a o ies, Diagnos ic Di ision,
Dainabo ). Se um glucose concen a ions we e analyzed
enzyma ically (Olympus Diagnos ica GmbH).
S a is ical Me hods
Sex di e ence in he a iables was s udied by using es ,
nonpa ame ic median es o
2
es , as app op ia e. Due o
he discon inui y o he 1986 MET-index, i could no be
no malized; he e o e, i was ca ego ized in o e iles ha
eflec meaning ul di e ences in ac i i y le els o ease he
in e p e a ion o he eg ession coe ficien s.
10
Howe e ,
simila ela ions we e ob ained when he con inued MET-
index was used in he eg ession models in place o he
ca ego ized index. The e ile cu -poin s we e 3 MET h/wk
and 12 MET h/wk―3 MET h/wk co esponds o mode a e-
in ensi y physical ac i i y o 60 minu es once a week, such
as walking o 1 hou a he speed o 4 km/h, and 12 MET h/
wk co esponds o 4 h/wk o mode a e in ensi y physical
ac i i y o 1 o 2 h/wk o igo ous physical ac i i y (eg,
unning o 1.5 hou a he speed o 8 km/h). Males and
emales aged 9 o 15 yea s we e analyzed sepa a ely
because he e was an in e ac ion be ween sex and MET-
index e iles when Cdis measu ed in 2007 (P=0.047) was
he explana o y a iable. In young adul s, he e was no
sex9MET-index in e ac ion (P=0.23), and, hus, males and
emales we e analyzed combined. The associa ion be ween
1986 MET-index e iles and ca o id a e y elas ici y indices
and IMT we e examined sepa a ely o child en (aged 9 o
15 yea s) and young adul s (aged 18 o 24 yea s) using
mul i a ia e eg ession analysis. Age in 2007, sex, BMI in
1986 and in 2007, SBP in 1986 and in 2007, smoking in
1986 and in 2007, high-densi y lipop o ein (HDL) choles e ol
in 1986 and in 2007, LDL choles e ol in 1986 and in 2007,
iglyce ides in 1986 and in 2007, insulin in 1986 and in
2007, glucose in 1986 and in 2007, 21-yea change in MET-
indexes (DMET), and MET-index in 2007 we e used o adjus
he analyses. We calcula ed 6-yea change in elas ici y
indices (DCdis , DYEM, and DSI). We also used mean a e ial
p essu e, alcohol in ake, pack-yea s o smoking, o al ene gy
in ake, socioeconomic s a us, an ihype ensi e medica ion,
lipid-lowe ing medica ion, insulin, and o al an idiabe ic med-
ica ion as co a ia es and co a ia es om 1986 only, bu his
did no change he esul s (da a no shown). We also
calcula ed he 21-yea change in BMI, SBP, smoking, HDL
choles e ol, LDL choles e ol, iglyce ides, insulin, and glu-
cose and used hese as co a ia es, bu his did no change
he esul s (da a no shown). Due o skewness o iglyce ide
and insulin le els, YEM and SI, a na u al loga i hm ans o -
ma ion was calcula ed. To illus a e he associa ions be ween
MET-index e iles and Cdis 2007 (Figu es 1 and 2), we
calcula ed he adjus ed means (SE) by using ANCOVA wi h
Tukey–K ame adjus ed mul iple compa ison. We addi ionally
explo ed he possibili y o a nonlinea ela ion be ween
ascula measu emen s and MET-index e iles wi h mul i a -
ia e models ha included ascula measu emen as he
dependen a iable and MET-index e ile, age, and highe -
o de MET-index e ile e ms as independen a iables bu
did no find consis en e idence o suppo nonlinea
ela ions (da a no shown). These analyses we e pe o med
sepa a ely o males and emales among 9- o 15-yea -olds
and 18- o 24-yea -olds.
As a seconda y analysis, we used longi udinal mixed
modeling. As he exposu e a iable, we used a con inuous
physical ac i i y index ha has been collec ed using wi h
simila ques ions in 1980, 1983, and 1986 in all pa icipan s
aged ≥9 yea s. This index co ela es s ongly ( 0.8) wi h he
MET-index ha was a ailable om s udy yea 1986 and was
used in he p ima y analysis. The mean exposu e o physical
ac i i y in childhood and ea ly adul hood du ing in 1980,
1983, and 1986 was calcula ed o each pa icipan aged
≥9 yea s. As he ou come a iable, we modeled adul hood
ca o id a e y elas ici y measu ed a 2 ime poin s in 2001
and 2007. The co a ia es included age, sex, se um lipids, BMI,
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and insulin measu ed a each ollow-up, as well as physical
ac i i y index in adul hood.
S a is ical analyses we e made using he S a is ical
Analysis Sys em so wa e e sion 9.2, and s a is ical signi -
icance was in e ed a a 2- ailed p obabili y alue <0.05.
Resul s
Pa icipan Cha ac e is ics
Pa icipan cha ac e is ics in 1986 and 2007 a e shown in
Table 1 o hose aged 9 o 15 yea s a baseline and in Table
2 o hose aged 18 o 24 yea s a baseline. Among hose
aged 9 o 15 yea s a baseline, males we e physically mo e
ac i e han emales in 1986 (P<0.0001) bu no in 2007
(P=0.4). Among hose aged 18 o 24 yea s a baseline, males
and emales we e equally ac i e in bo h s udy yea s (P=0.5
and P=0.4). Wi h he excep ion o age in 1986 and 2007, BMI
in 1986, HDL choles e ol in 1986, and insulin le els in 2007,
he emaining a iables di e ed significan ly be ween males
and emales (Table 1). The e was a significan sex di e ence
among hose aged 18 o 24 yea s o all a iables excep age
in 1986 and 2007, LDL choles e ol in 1986, iglyce ides in
1986, and insulin le els in 1986 and 2007 (Table 2).
Associa ion Be ween Physical Ac i i y in
Childhood and Adul A e ial Elas ici y
Measu ed 21 Yea s La e
Among 9- o 15-yea -old males, physical ac i i y was di ec ly
associa ed wi h adul Cdis (b=0.097 pe e ile inc ease in
MET-index, SE=0.038, P=0.010) and in e sely wi h adul YEM
(b=0.060, SE=0.027, P=0.028) and SI (b=0.062,
SE=0.023, P=0.007). In mul i a ia e analyses, physical ac i -
i y emained a significan de e minan o adul Cdis , YEM,
and SI a e adjus men s o co a ia es (Table 3) (Figu e 1).
Adul Cdis , YEM, and SI we e measu ed in 2007.
Among 9- o 15-yea -old emales, we ound no associa ion
be ween physical ac i i y in childhood and adul Cdis
(b=0.016, SE=0.042, P=0.70), YEM (b=0.005, SE=0.026,
P=0.85), o SI (b=0.003, SE=0.024, P=0.91). We did no
find an associa ion be ween physical ac i i y and ca o id
a e y elas ici y indices measu ed in 2001 (Cdis
[b=0.00002, SE=0.00003, P=0.47], YEM [b=0.02,
SE=0.02, P=0.28], o SI [b=0.007, SE=0.01, P=0.57]) o
be ween physical ac i i y and DCdis (b=0.03, SE=0.03,
P=0.39) o DYEM (b=13.07, SE=9.72, P=0.18) o DSI
(b=0.22, SE=0.13, P=0.09). The e o e, hese ou comes
we e no u he examined.
Figu e 2. Associa ion o ca o id a e y dis ensibili y (Cdis ) wi h
me abolic equi alen (MET) index e iles in young adul s aged 18
o 24 yea s in 1986. P- alues shown a e om ANCOVA wi h
Tukey–K ame mul iple compa ison. Desc ip i e da a a e gi en as
es ima ed ma ginal means (SE) adjus ed o age in 2007, sex, BMI
in 1986 and in 2007, SBP in 1986 and in 2007, smoking in 1986
and in 2007, HDL choles e ol measu ed in 1986 and in 2007, LDL
choles e ol measu ed in 1986 and in 2007, iglyce ides
measu ed in 1986 and in 2007, insulin measu ed in 1986 and
in 2007, glucose measu ed in 1986 and in 2007, and DMET. BMI
indica es body mass index; HDL, high-densi y lipop o ein; LDL,
low-densi y lipop o ein; SBP, sys olic blood p essu e.
Figu e 1. Associa ion o ca o id a e y dis ensibili y (Cdis ) wi h
me abolic equi alen (MET) index e iles in males aged 9 o
15 yea s in 1986. P- alues shown a e om ANCOVA wi h Tukey–
K ame mul iple compa ison. Desc ip i e da a a e gi en as
es ima ed means (SE) adjus ed o age in 2007, BMI in 1986
and in 2007, SBP in 1986 and in 2007, smoking in 1986 and in
2007, HDL choles e ol measu ed in 1986 and in 2007, LDL
choles e ol measu ed in 1986 and in 2007, iglyce ides
measu ed in 1986 and in 2007, insulin measu ed in 1986 and
in 2007, glucose measu ed in 1986 and in 2007, and DMET. BMI
indica es body mass index; HDL, high-densi y lipop o ein; LDL,
low-densi y lipop o ein; SBP, sys olic blood p essu e.
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Associa ion Be ween Young Adul Physical Ac i i y
and A e ial Elas ici y Measu ed 21 Yea s La e
Physical ac i i y o young adul s aged 18 o 24 yea s was
di ec ly associa ed wi h u u e Cdis (b=0.068, SE=0.027,
P=0.014) and in e sely wi h YEM (b=0.057, SE=0.020,
P=0.004) and SI (b=0.050, SE=0.017, P=0.003). In mul i-
a iable analyses, physical ac i i y in 1986 emained a
significan de e minan o Cdis , YEM, and SI 21 yea s la e
a e adjus men s o co a ia es (Table 4, Figu e 2). Adul
Cdis , YEM, and SI we e measu ed in 2007. We did no
find associa ion be ween physical ac i i y and ca o id a e y
indices measu ed in 2001 (Cdis [b=0.00003, SE=0.00003,
P=0.29], YEM [b=0.02, SE=0.02, P=0.29], o SI [b=0.02,
SE=0.01, P=0.14]. The e o e, hese ou comes we e no
u he examined. Physical ac i i y was di ec ly associa ed
wi h DCdis (b=0.084, SE=0.028, P=0.0032) and in e sely
wi h DYEM (b=53.41, SE=13.34, P<0.0001) and DSI
(b=0.79, SE=0.19, P<0.0001). These esul s emained
significan a e adjus men s o co a ia es (da a no shown).
Associa ion Be ween Physical Ac i i y and
Ca o id A e y IMT Measu ed 21 Yea s La e
Among 9- o 15-yea -old males, physical ac i i y was no
associa ed wi h adul IMT (b=0.0007 pe e ile inc ease in
Table 1. Cha ac e is ics o S udy Pa icipan s a Baseline (1986) and Follow-up (2007) in Females and Males Aged 9 o 15 Yea s
Females Males
Mean (SD) N Mean (SD) N
1986
MET-index (MET h/wk) (median, in e qua ile ange) 12 (3 o 18) 719 12 (3 o 21) 698
Age, y 12.0 (2.5) 744 12.0 (2.5) 731
BMI, kg/m
2
18.6 (3.0) 734 18.5 (3.2) 717
SBP, mm Hg 108 (10) 734 109 (12) 717
DBP, mm Hg 62 (10) 731 61 (10) 715
Daily smoke s, % 2 (–) 1218 4 (–) 1274
HDL-chol, mmol/L 1.5 (0.2) 726 1.5 (0.3) 715
LDL-chol, mmol/L 3.0 (0.8) 717 2.9 (0.7) 705
T iglyce ides, mmol/L 0.8 (0.3) 725 0.8 (0.4) 714
Insulin, mU/L 10.9 (10.2) 724 9.6 (6.7) 720
Glucose, mmol/L 4.6 (1.2) 710 4.6 (0.5) 689
2007
MET-index, MET h/wk (median, in e qua ile ange) 8 (3 o 20) 737 8 (1 o 31) 629
Cdis , %/10 mm Hg 2.1 (0.7) 735 1.8 (0.6) 632
YEM, kPa 386 (1299) 735 417 (246) 632
SI, uni less 6.6 (22.4) 735 6.2 (3.0) 632
Age, y 35.4 (4.6) 1218 35.7 (4.7) 1274
BMI, kg/m
2
25.0 (5.1) 717 26.6 (4.4) 636
SBP, mm Hg 115 (13) 735 125 (12) 640
DBP, mm Hg 72 (11) 735 78 (11) 638
Daily smoke s, % 16 (–) 749 25 (–) 643
HDL-chol, mmol/L 1.5 (0.3) 738 1.2 (0.3) 635
LDL-chol, mmol/L 2.9 (0.7) 734 3.2 (0.8) 617
T iglyce ides, mmol/L 1.2 (0.7) 739 1.6 (1.1) 640
Insulin, mU/L 8.6 (8.5) 739 9.2 (8.8) 639
Glucose, mmol/L 5.1 (0.9) 739 5.5 (1.0) 640
All di e ences be ween sexes we e significan (P<0.05) excep age in 1986 and 2007, BMI in 1986, HDL le els in 1986, insulin le els in 2007, and MET-index in 2007. Values a e mean
(SD) unless s a ed o he wise. MET indica es me abolic equi alen ; BMI, body mass index; SBP, sys olic blood p essu e; DBP, dias olic blood p essu e; HDL-chol, high-densi y lipop o ein
choles e ol; LDL-chol, low-densi y lipop o ein choles e ol; Cdis , ca o id a e y dis ensibili y; YEM, Young’s elas ic modulus; SI, s i ness index.
DOI: 10.1161/JAHA.113.000594 Jou nal o he Ame ican Hea Associa ion 5
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MET-index, SE=0.006, P=0.9). The same was ue among 9- o
15-yea -old emales and 18- o 24-yea -old young adul s
(b=0.007, SE=0.004, P=0.1, and b=0.004, SE=0.004,
P=0.4, espec i ely).
Seconda y Analyses Using Longi udinal Modeling
A gene al physical ac i i y index a ailable om pa icipan s
aged ≥9 yea s om s udy yea s 1980, 1983, and 1986 was
used as a exposu e a iable in longi udinal model wi h he
adul hood ca o id a e y elas ici y measu ed a 2 ime poin s in
2001 and 2007 as he ou come a iable. This index has no mal
a dis ibu ion wi h a mean o 9.0, SD o 1.6, and ange om 5
o 14. In he longi udinal mixed model including da a om all
indi iduals be ween ages 9 and 24 yea s, 1-SD inc ease in he
index was associa ed wi h 0.026-uni (%/10 mm Hg) inc ease
in Cdis in he model adjus ed o age, sex, se um lipids, BMI,
and insulin measu ed a each ollow-up, as well as physical
ac i i y index in adul hood (P=0.026). The e ec was s onge
in males (b=0.045, P=0.005) han in emales (b=0.009,
P=0.66), bu no e idence o significan sex in e ac ion was
de ec ed (in e ac ion P=0.40).
Table 2. Cha ac e is ics o S udy Pa icipan s a Baseline (1986) and Follow-up (2007) in Females and Males Aged 18 o 24 Yea s
Females Males
Mean (SD) N Mean (SD) N
1986
MET-index (MET h/wk)
(median, in e qua ile ange)
5 (2 o 12) 561 5 (2 o 20) 438
Age, y 20.7 (2.4) 614 20.6 (2.4) 490
BMI, kg/m
2
21.9 (2.8) 581 22.3 (2.8) 468
SBP, mm Hg 116 (11) 581 126 (11) 468
DBP, mm Hg 68 (9) 581 71 (10) 467
Daily smoke s, % 22 (–) 614 31 (–) 490
HDL-chol, mmol/L 1.5 (0.3) 581 1.3 (0.2) 467
LDL-chol, mmol/L 3.0 (0.9) 577 2.9 (0.9) 461
T iglyce ides, mmol/L 0.9 (0.4) 582 1 (0.5) 465
Insulin, mU/L 9.9 (5.2) 586 9.6 (5.9) 475
Glucose, mmol/L 4.3 (0.4) 569 4.6 (0.7) 454
2007
MET-index (MET h/wk)
(median, in e qua ile ange)
12 (3 o 20) 469 8 (1 o 21) 344
Cdis , %/10 mm Hg 1.8 (0.7) 470 1.6 (0.5) 350
YEM, kPa 368 (222) 470 446 (299) 350
SI, uni less 6.5 (3.8) 470 7.0 (3.8) 350
Age, y 41.7 (2.4) 614 41.6 (2.4) 490
BMI, kg/m
2
26 (5) 466 27 (4) 351
SBP, mm Hg 119 (15) 472 127 (14) 352
DBP, mm Hg 75 (11) 472 81 (11) 352
Daily smoke s, % 13 (–) 476 19 (–) 356
HDL-chol, mmol/L 1.4 (0.3) 471 1.2 (0.3) 349
LDL-chol, mmol/L 3.0 (0.8) 469 3.4 (0.8) 338
T iglyce ides, mmol/L 1.2 (0.6) 471 1.7 (1.2) 354
Insulin, mU/L 8.5 (6.3) 471 10.2 (11.4) 354
Glucose, mmol/L 5.2 (0.7) 471 5.6 (0.9) 354
All di e ences be ween sexes we e significan (P<0.05) excep age in 1986 and 2007, LDL le els in 1986, iglyce ides le els in 1986, insulin le els in 1986 and 2007, and MET-index in
1986 and 2007. Values a e mean (SD) unless s a ed o he wise. MET indica es me abolic equi alen ; BMI, body mass index; SBP, sys olic blood p essu e; DBP, dias olic blood p essu e;
HDL-chol, high-densi y lipop o ein choles e ol; LDL-chol, low-densi y lipop o ein choles e ol; Cdis , ca o id a e y dis ensibili y; YEM, Young’s elas ic modulus; SI, s i ness index.
DOI: 10.1161/JAHA.113.000594 Jou nal o he Ame ican Hea Associa ion 6
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Discussion
We obse ed in his p ospec i e, longi udinal s udy ha
physical ac i i y in child en and young adul s is associa ed
wi h inc eased ca o id a e y elas ici y, a ma ke o a e ial
heal h, a age 30 o 45 yea s. This a o able e ec was
independen o se e al o he ca diome abolic isk ac o s.
P e ious longi udinal s udies on he associa ion o physical
ac i i y and ca o id a e y elas ici y a e sca ce. A s udy wi h
377 (196 emales) pa icipan s aged 13 yea s a baseline
Table 3. Associa ion Be ween Physical Ac i i y in Males Aged 9 o 15 Yea s and Ca o id A e y Elas ici y Indices in Adul hood
Model
Males
Cdis * lnYEM* lnSI*
bSE PValue bSE PValue bSE PValue
A: Age adjus ed 1986 MET-index e iles 0.091 0.038 0.02 0.059 0.027 0.03 0.060 0.023 0.010
B: A+BMI
†
in 1986 and in 2007 0.084 0.036 0.02 0.054 0.027 0.05 0.058 0.023 0.01
C: B+SBP in 1986 and in 2007 0.088 0.036 0.02 0.056 0.027 0.04 0.058 0.023 0.01
D: C+smoking in 1986 and in 2007 0.090 0.036 0.01 0.061 0.027 0.02 0.061 0.022 0.007
E: D+HDL-chol in 1986 and in 2007 0.091 0.037 0.01 0.063 0.027 0.02 0.062 0.023 0.007
F: E+LDL-chol in 1986 and in 2007 0.095 0.037 0.01 0.064 0.027 0.02 0.063 0.023 0.006
G: F+ iglyce ides in 1986 and in 2007 0.103 0.038 0.007 0.069 0.027 0.01 0.070 0.023 0.003
H: G+insulin in 1986 and in 2007 0.097 0.038 0.01 0.066 0.027 0.02 0.068 0.023 0.004
I: H+glucose in 1986 and in 2007 0.092 0.039 0.02 0.061 0.028 0.03 0.066 0.024 0.007
J: I+DMET 0.102 0.042 0.02 0.076 0.030 0.01 0.075 0.026 0.005
K: I+MET-index in 2007 0.087 0.040 0.03 0.052 0.029 0.07 0.061 0.025 0.01
Cdis , YEM, and SI we e measu ed in 2007. band SE a e o a 1- e ile inc ease in 1986 MET-index. Cdis indica es ca o id a e y dis ensibili y; ln, na u al loga i hm; YEM, Young’s elas ic
modulus; SI, s i ness index; b, eg ession coe ficien ; MET, me abolic equi alen ; BMI, body mass index; SBP, sys olic blood p essu e; HDL-chol, high-densi y lipop o ein choles e ol;
LDL-chol, low-densi y lipop o ein choles e ol; DMET, 21-yea change in MET-indexes.
*N a ies be ween 450 and 387.
†
The esul emained simila when weigh o heigh we e sepa a ely used as a co a ia e in place o BMI.
Table 4. Associa ion Be ween Physical Ac i i y in Young Adul s Aged 18 o 24 Yea s and Ca o id A e y Elas ici y Indices in Adul hood
Model
Young Adul s
Cdis * lnYEM* lnSI*
bSE PValue bSE PValue bSE PValue
A: Age- and sex-adjus ed 1986 MET-index e iles 0.076 0.027 0.005 0.065 0.019 0.001 0.053 0.017 0.002
B: A+BMI
†
in 1986 and in 2007 0.056 0.026 0.03 0.053 0.019 0.005 0.044 0.017 0.008
C: B+SBP in 1986 and in 2007 0.055 0.026 0.03 0.052 0.019 0.006 0.044 0.017 0.008
D: C+smoking in 1986 and in 2007 0.064 0.026 0.01 0.059 0.019 0.002 0.051 0.017 0.003
E: D+HDL-chol in 1986 and in 2007 0.061 0.026 0.02 0.060 0.019 0.002 0.052 0.017 0.003
F: E+LDL-chol in 1986 and in 2007 0.062 0.027 0.02 0.059 0.020 0.003 0.053 0.018 0.003
G: F+ iglyce ides in 1986 and in 2007 0.061 0.027 0.02 0.056 0.020 0.004 0.052 0.018 0.003
H: G+insulin in 1986 and in 2007 0.063 0.027 0.02 0.057 0.020 0.004 0.053 0.018 0.003
I: H+glucose in 1986 and in 2007 0.063 0.027 0.02 0.058 0.020 0.004 0.053 0.018 0.003
J: I+DMET 0.065 0.030 0.03 0.054 0.022 0.01 0.054 0.020 0.006
K: I+MET-index in 2007 0.064 0.028 0.02 0.062 0.021 0.003 0.054 0.019 0.004
Cdis , YEM, and SI we e measu ed in 2007. band SE a e o a 1- e ile inc ease in 1986 MET-index. Cdis indica es ca o id a e y dis ensibili y; ln, na u al loga i hm; YEM, Young’s elas ic
modulus; SI, s i ness index; b, eg ession coe ficien ; MET, me abolic equi alen ; BMI, body mass index; SBP, sys olic blood p essu e; HDL-chol, high-densi y lipop o ein choles e ol;
LDL-chol, low-densi y lipop o ein choles e ol; DMET, 21-yea change in MET-indexes.
*N a ies be ween 746 and 655.
†
The esul emained simila when weigh o heigh we e sepa a ely used as a co a ia e in place o BMI.
DOI: 10.1161/JAHA.113.000594 Jou nal o he Ame ican Hea Associa ion 7
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showed ha li e ime igo ous, bu no ligh - o-mode a e,
in ensi y habi ual physical ac i i y is a o ably associa ed wi h
u u e ca o id a e y elas ici y measu ed wi h he SI. This
associa ion pe sis ed a e adjus men o sex, heigh , ime
spen in physical ac i i ies, alcohol consump ion, smoking,
and ene gy in ake.
29
We did no find o he publica ions o
longi udinal s udies on he associa ion be ween physical
ac i i y and enhanced ca o id a e y elas ici y.
In a c oss-sec ional s udy o 135 (67 emales) heal hy
adul s aged 20 o 40 yea s, seden a y indi iduals we e
cha ac e ized by educ ions in a e ial compliance ela i e o
hei endu ance- ained pee s, independen o changes in
con en ional isk ac o s o ca dio ascula disease.
30
In
ano he c oss-sec ional s udy o 102 (59 emales) child en
aged 8 o 11 yea s, physical ac i i y was associa ed wi h
small, bu no la ge, a e y compliance.
31
The e a e se e al possible mechanisms ha migh explain
he associa ion o physical ac i i y in child en and young
adul s wi h enhanced ca o id a e y elas ici y. In a s, physical
ac i i y inc eases he elas in con en o he ao ic wall and
p obably enhances a e ial dila a ion and dis ensibili y.
32
Sugawa a e al ound ha endu ance aining enhances
ca o id a e y compliance in middle-aged and olde adul s
and ha he e ec is media ed h ough educ ion in a-
ad ene gic ecep o –media ed ascula one (ie, sympa he ic
ne ous sys em ac i i y is educed wi h endu ance aining).
33
Mo eo e , ae obic physical ac i i y aining enhances he
elease o ni ic oxide ia inc eased shea s ess du ing o
immedia ely a e physical ac i i y bou s.
34
I is also sug-
ges ed ha egula physical ac i i y migh delay he age-
associa ed educ ion o ac ion o elas ic lamellae in he
a e ial wall.
35
A e 3 mon hs o ae obic exe cise aining,
common ca o id a e y compliance was enhanced and
co esponded wi h a educ ion in plasma endo helin-1 con-
cen a ion.
36
Endo helin-1 is he mos po en asocons ic o
pep ide sec e ed by ascula endo helial cells
37
; he e o e, i s
educ ion may be an impo an ac o o ascula elas ici y.
The s eng hs o his s udy include a la ge numbe o
pa icipan s ollowed o 21 yea s who ha e been well
pheno yped using es ablished me hods since a young age.
The s udy subjec s ha e been closely ollowed wi h well-
es ablished me hods since a young age o adul hood. A
limi a ion is ha we did no use applana ion onome y, a
pu a i e gold s anda d, o measu e ao ic pulse wa e eloci y
as a ma ke o a e ial elas ici y. Al e na i ely, we used
ul asound o measu e changes in ca o id a e y diame e
du ing he ca diac cycle and we calcula ed elas ici y indices
(dis ensibili y). This me hod is ano he commonly used
measu e o a e ial elas ici y, and i shows simila ela ions
wi h ca dio ascula isk ma ke s as he pulse-wa e
eloci y.
38,39
A po en ial sou ce o inaccu acy, howe e , in
his me hod is ha i uses pe iphe al blood p essu e
measu emen s in he calcula ion o dis ensibili y. I would
be ideal o s udy he pulse p essu e om he a e y in
ques ion, because he use o b achial p essu es o e es i-
ma es pulse p essu e in cen al a e ies.
40
Howe e , he
di e ence be ween cen al and pe iphe al pulse p essu es is
likely o be simila be ween s udy subjec s wi hin a na ow
age ange, as in ou s udy. Mo eo e , Bo ow and Newbu ge
demons a ed a s ong co ela ion be ween SBP ( =0.98) and
DBP ( =0.97) measu ed in cen al and pe iphe al a e ies.
41
One limi a ion is ha physical ac i i y was measu ed using
ques ionnai es and no objec i e measu es, such as s ep-
coun e s, we e a ailable in childhood and ea ly adul hood in
he 1986 s udy. Howe e , we ha e collec ed s ep da a
collec ed in adul hood in 2007 and ha e shown ha we see
simila highly significan co ela ions be ween ques ionnai e
da a and s ep da a ha ha e been epo ed in se e al o he
s udies.
10
Addi ionally, we ha e demons a ed ha physical
ac i i y measu ed wi h ou ques ionnai e shows significan
ela ions be ween epea ed measu emen s in childhood,
adolescence, and ea ly adul hood. App oxima ely hal o he
indi iduals classified as ac i e o seden a y emained in he
same ca ego y in a 6-yea ollow-up.
20
We ha e also ecen ly
shown ha a physically ac i e li es yle s a s o de elop ea ly
in childhood and ha he s abili y o physical ac i i y is
mode a e o high along he li e-cou se om you h o adul hood
o e pe iod o 30 yea s.
42
The e o e, he da a sugges ha
he ques ionnai e me hod easonably well cha ac e izes he
pa icipan s acco ding o hei long- e m ac i i y le el.
Al hough physical ac i i y was ela ed o a e ial elas ici y,
we ound no link be ween you h physical ac i i y and adul
ca o id IMT, a s uc u al ma ke o ea ly a he oscle osis. We
ha e p e iously obse ed an indi ec associa ion be ween
physical ac i i y and ao ic IMT in adolescen s pa icipa ing in
he Special Tu ku Co ona y Risk Fac o In e en ion P ojec
s udy. Howe e , ao ic IMT may be a mo e sensi i e ma ke o
ea ly a he oscle osis han ca o id IMT.
43
In adul s, he
majo i y o c oss-sec ional s udies ha e epo ed in e se
associa ions be ween physical inac i i y and ca o id IMT, bu
many s udies ha e also ailed o demons a e his ela ion. Fo
example, K onenbe g e al did no find an associa ion be ween
physical ac i i y and ca o id IMT in 1778 indi iduals pa ic-
ipa ing he Na ional Hea , Lung, and Blood Ins i u e Family
Hea S udy.
44
Tanaka e al ound no di e ence in ca o id IMT
be ween seden a y and endu ance- ained subjec s.
45
A
e iew by Kadoglou e al sugges ed ha a possible explana-
ion o he di e ing esul s de i es om he wide a iabili y o
s udy popula ions. The influence o physical ac i i y on ca o id
IMT seems especially inconsis en among heal hy subjec s.
46
In ou s udy, we did no find associa ion in he younge age
g oup o 9- o 15-yea -old emales be ween physical ac i i y in
childhood and adul ca o id a e y elas ici y. Po en ial expla-
na ions may in ol e sex di e ences in he esponsi eness o
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he exposu e due o di e ences in physiology (eg, ho monal
di e ences) and/o o he possible di e ences in he quali y
o quan i y o he exposu e dose, such as he amoun o
igo ous physical ac i i y. Fo example, es ogen may p o ec
a e ies agains a he ogenesis.
47
In 2007, he emales in he
younge age g oup we e 30 o 36 yea s old and he p o ec i e
e ec o es ogen may ha e masked a weake e ec
associa ed wi h ea ly physical ac i i y exposu e. O he
explana ion migh be ha he e is a di e ence in quali y o
physical ac i i y in 9- o 15-yea -old males and emales.
Finally, we we e unable o con ol o he e ec o you h wais
ci cum e ence because his measu emen was no a ailable
om 1986. Beneficial e ec s o physical ac i i y on a e ial
elas ici y may be media ed by changes adiposi y ha could
po en ially be be e cap u ed by wais ci cum e ence mea-
su emen s han by BMI. Howe e , adjus men o adul wais
ci cum e ence did no dilu e he e ec o you h physical
ac i i y on elas ici y.
Ou da a p o ide suppo o he po en ially independen
benefi s o physical ac i i y on u u e ca dio ascula heal h.
Wha ou da a add ha is unique o p e ious wo k is ha he
po en ial benefi o physical ac i i y o ca dio ascula heal h
may be maximized only i an indi idual is ac i e om ea ly li e,
ex ending e en o childhood.
Acknowledgmen s
I ina Lisinen and Ville Aal o a e acknowledged o skill ul da a
managemen and analysis.
Sou ces o Funding
This s udy was financially suppo ed by he Academy o
Finland (g an s 126925, 124282, 77841, 210283, 121584,
and 34316), he Social Insu ance Ins i u ion o Finland, he
Tu ku Uni e si y Founda ion, he Juho Vainio Founda ion, Emil
Aal onen Founda ion (D Leh im€
aki) Finnish Founda ion o
Ca dio ascula Resea ch (D Leh im€
aki), esea ch unds om
he Tampe e (9N035 o D Leh im€
aki), and Tu ku Uni e si y
Hospi als, he Resea ch Founda ion o O ion Co po a ion,
and he Finnish Cul u al Founda ion. D Magnussen holds a
Na ional Heal h and Medical Resea ch Council Ea ly Ca ee
Fellowship (Public Heal h Fellowship, APP1037559).
Disclosu es
None.
Re e ences
1. Vai ke icius PV, Fleg JL, Engel JH, O’Conno FC, W igh JG, Laka a LE, Yin FC,
Laka a EG. E ec s o age and ae obic capaci y on a e ial s i ness in heal hy
adul s. Ci cula ion. 1993;88:1456–1462.
2. Tanaka H, DeSouza CA, Seals DR. Absence o age- ela ed inc ease in cen al
a e ial s i ness in physically ac i e women. A e ioscle Th omb Vasc Biol.
1998;18:127–132.
3. Juonala M, K€
ah€
onen M, Lai inen T, Hu i-K€
ah€
onen N, Jokinen E, Tai onen L,
Pie ik€
ainen M, Helenius H, Viika i JS, Rai aka i OT. E ec o age and sex on
ca o id in ima-media hickness, elas ici y and b achial endo helial unc ion in
heal hy adul s: he Ca dio ascula Risk in Young Finns S udy. Eu Hea J.
2008;29:1198–1206.
4. A ne DK, E ans GW, Riley WA. A e ial s i ness: a new ca dio ascula isk
ac o ? Am J Epidemiol. 1994;140:669–682.
5. Mo eau KL, Dona o AJ, Seals DR, DeSouza CA, Tanaka H. Regula exe cise,
ho mone eplacemen he apy and he age- ela ed decline in ca o id a e ial
compliance in heal hy women. Ca dio asc Res. 2003;57:861–868.
6. Nualnim N, Ba nes JN, Ta umi T, Renzi CP, Tanaka H. Compa ison o cen al
a e y elas ici y in swimme s, unne s, and he seden a y. Am J Ca diol.
2011;107:783–787.
7. Gando Y, Yamamo o K, Mu akami H, Ohmo i Y, Kawakami R, Sanada K, Higuchi
M, Taba a I, Miyachi M. Longe ime spen in ligh physical ac i i y is
associa ed wi h educed a e ial s i ness in olde adul s. Hype ension.
2010;56:540–546.
8. an de Laa RJ, Fe ei a I, an Mechelen W, P ins MH, Twisk JW, S ehouwe CD.
Habi ual physical ac i i y and pe iphe al a e ial compliance in young adul s:
The Ams e dam g ow h and heal h longi udinal s udy. Am J Hype ens.
2011;24:200–208.
9. Chen Y, Danga d F, Osika W, Be gg en K, G onowi z E, F ibe g P. Age- and
sex- ela ed di e ences in ascula unc ion and ascula esponse o men al
s ess. Longi udinal and c oss-sec ional s udies in a coho o heal hy child en
and adolescen s. A he oscle osis. 2012;220:269–274.
10. Mansikkaniemi K, Juonala M, Taimela S, Hi ensalo M, Telama R, Huupponen
R, Saa ikoski L, Hu me M, Malla Z, Benessiano J, Jula A, Tai onen L, Ma niemi
J, K€
ah€
onen M, Leh im€
aki T, R€
onnemaa T, Viika i J, Rai aka i OT. C oss-sec ional
associa ions be ween physical ac i i y and selec ed co ona y hea disease
isk ac o s in young adul s. The Ca dio ascula Risk in Young Finns S udy. Ann
Med. 2012;44:733–744.
11. Yang X, Telama R, Hi ensalo M, Viika i JS, Rai aka i OT. Sus ained
pa icipa ion in you h spo dec eases me abolic synd ome in adul hood. In
J Obes (Lond). 2009;33:1219–1226.
12. Rai aka i OT, Taimela S, Po kka KV, Viika i JS. E ec o leisu e- ime physical
ac i i y change on high-densi y lipop o ein choles e ol in adolescen s and
young adul s. Ann Med. 1996;28:259–263.
13. Rizzo NS, Ruiz JR, Oja L, Veidebaum T, Sj€
os €
om M. Associa ions be ween
physical ac i i y, body a , and insulin esis ance (homeos asis model
assessmen ) in adolescen s: he Eu opean You h Hea S udy. Am J Clin Nu .
2008;87:586–592.
14. Ha dman AE. Physical ac i i y, obesi y and blood lipids. In J Obes Rela Me ab
Diso d. 1999;23(suppl 3):S64–S71.
15. Schmid MD, Cleland VJ, Thomson RJ, Dwye T, Venn AJ. A compa ison o
subjec i e and objec i e measu es o physical ac i i y and fi ness in iden i ying
associa ions wi h ca diome abolic isk ac o s. Ann Epidemiol. 2008;18:378–
386.
16. Koi is oinen T, Hu i-K€
ah€
onen N, Juonala M, Aa ola H, K€
o€
obi T, Leh im€
aki T,
Viika i JS, Rai aka i OT, K€
ah€
onen M. Me abolic synd ome in childhood and
inc eased a e ial s i ness in adul hood: he Ca dio ascula Risk in Young
Finns S udy. Ann Med. 2011;43:312–319.
17. Ma sson N, Magnussen CG, R€
onnemaa T, Malla Z, Benessiano J, Jula A,
Tai onen L, K€
ah€
onen M, Juonala M, Viika i JS, Rai aka i OT. Me abolic
synd ome and ca o id in ima-media hickness in young adul s: oles o
apolipop o ein B, apolipop o ein A-I, C- eac i e p o ein, and sec e o y
phospholipase A2: he Ca dio ascula Risk in Young Finns s udy. A e ioscle
Th omb Vasc Biol. 2010;30:1861–1866.
18. Juonala M, Viika i JS, K€
ah€
onen M, Tai onen L, Lai inen T, Hu i-K€
ah€
onen N,
Leh im€
aki T, Jula A, Pie ik€
ainen M, Jokinen E, Telama R, R€
as€
anen L, Mikkil€
aV,
Helenius H, Ki im€
aki M, Rai aka i OT. Li e- ime isk ac o s and p og ession o
ca o id a he oscle osis in young adul s: he Ca dio ascula Risk in Young Finns
s udy. Eu Hea J. 2010;31:1745–1751.
19. Rai aka i OT, Juonala M, R€
onnemaa T, Kel ikangas-J€
a inen L, R€
as€
anen L,
Pie ik€
ainen M, Hu i-K€
ah€
onen N, Tai onen L, Jokinen E, Ma niemi J, Jula A,
Telama R, K€
ah€
onen M, Leh im€
aki T,

Ake blom HK, Viika i JS. Coho p ofile: he
Ca dio ascula Risk in Young Finns S udy. In J Epidemiol. 2008;37:1220–1226.
20. Rai aka i O, Po kka K, Taimela S, Telama R, R€
as€
anen L, Viika i J. E ec s o
pe sis en physical ac i i y and in ac i i y on co ona y isk ac o s in child en
and young adul s. Am J Epidemiol. 1994;140:195–205.
21. Ainswo h BE, Haskell WL, Leon AS, Jacobs DR J , Mon oye HJ, Sallis JF,
Pa enba ge RS J . Compendium o physical ac i i ies: classifica ion o ene gy
cos s o human physical ac i i ies. Med Sci Spo s Exe c. 1993;25:71–80.
DOI: 10.1161/JAHA.113.000594 Jou nal o he Ame ican Hea Associa ion 9
Physical Ac i i y and A e y Elas ici y P€
al e e al
ORIGINAL RESEARCH
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