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      Association between education and future leisure-time physical inactivity: a study of Finnish twins over a 35-year follow-up

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          Abstract

          Background

          Education is associated with health related lifestyle choices including leisure-time physical inactivity. However, the longitudinal associations between education and inactivity merit further studies. We investigated the association between education and leisure-time physical inactivity over a 35-year follow-up with four time points controlling for multiple covariates including familial confounding.

          Methods

          This study of the population-based Finnish Twin Cohort consisted of 5254 twin individuals born in 1945–1957 (59 % women), of which 1604 were complete same-sexed twin pairs. Data on leisure-time physical activity and multiple covariates was available from four surveys conducted in 1975, 1981, 1990 and 2011 (response rates 72 to 89 %). The association between years of education and leisure-time physical inactivity (<1.5 metabolic equivalent hours/day) was first analysed for each survey. Then, the role of education was investigated for 15-year and 35-year inactivity periods in the longitudinal analyses. The co-twin control design was used to analyse the potential familial confounding of the effects. All analyses were conducted with and without multiple covariates. Odds Ratios (OR) with 95 % Confidence Intervals (CI) were calculated using logistic and conditional (fixed-effects) regression models.

          Results

          Each additional year of education was associated with less inactivity (OR 0.94 to 0.95, 95 % CI 0.92, 0.99) in the cross-sectional age- and sex-adjusted analyses. The associations of education with inactivity in the 15- and 35-year follow-ups showed a similar trend: OR 0.97 (95 % CI 0.93, 1.00) and OR 0.94 (95 % CI 0.91, 0.98), respectively. In all co-twin control analyses, each year of higher education was associated with a reduced likelihood of inactivity suggesting direct effect (i.e. independent from familial confounding) of education on inactivity. However, the point estimates were lower than in the individual-level analyses. Adjustment for multiple covariates did not change these associations.

          Conclusions

          Higher education is associated with lower odds of leisure-time physical inactivity during the three-decade follow-up. The association was found after adjusting for several confounders, including familial factors. Hence, the results point to the conclusion that education has an independent role in the development of long-term physical inactivity and tailored efforts to promote physical activity among lower educated people would be needed throughout adulthood.

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          Most cited references44

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Lack of exercise is a major cause of chronic diseases.

            Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life. © 2012 American Physiological Society. Compr Physiol 2:1143-1211, 2012.
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              Understanding differences in health behaviors by education.

              Using a variety of data sets from two countries, we examine possible explanations for the relationship between education and health behaviors, known as the education gradient. We show that income, health insurance, and family background can account for about 30 percent of the gradient. Knowledge and measures of cognitive ability explain an additional 30 percent. Social networks account for another 10 percent. Our proxies for discounting, risk aversion, or the value of future do not account for any of the education gradient, and neither do personality factors such as a sense of control of oneself or over one's life. Copyright 2009 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                +358 50 448 0010 , maarit.piirtola@helsinki.fi
                jaakko.kaprio@helsinki.fi
                urho.m.kujala@jyu.fi
                kauko.heikkila@helsinki.fi
                markku.koskenvuo@helsinki.fi
                pia.svedberg@ki.se
                karri.silventoinen@helsinki.fi
                annina.ropponen@ttl.fi
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                4 August 2016
                4 August 2016
                2016
                : 16
                : 720
                Affiliations
                [1 ]Department of Public Health, University of Helsinki, PO Box 41 (Tukholmankatu 8, 2B), FI-00014 Helsinki, Finland
                [2 ]Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
                [3 ]Department of Health, National Institute for Health and Welfare, Helsinki, Finland
                [4 ]Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
                [5 ]Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
                [6 ]Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland
                [7 ]Finnish Institute of Occupational Health, Helsinki, Finland
                Author information
                http://orcid.org/0000-0001-7270-6676
                Article
                3410
                10.1186/s12889-016-3410-5
                4973543
                27492437
                a10e3e8e-de14-421f-b690-a2268a9950e5
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 March 2016
                : 29 July 2016
                Funding
                Funded by: Academy of Finland Center of Execelence in Complex Disease Genetics
                Award ID: 213506
                Award Recipient :
                Funded by: Academy of Finland Center of Excellence in Complex Disease Genetics
                Award ID: 129680
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100002341, Suomen Akatemia;
                Award ID: 265240
                Award ID: 263278
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/501100003126, Opetus- ja Kulttuuriministeriö;
                Funded by: FundRef http://dx.doi.org/10.13039/501100004037, Juho Vainion Säätiö;
                Award ID: 266592
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Public health
                adult,behavioral genetics,cohort studies,educational status,exercise,follow-up studies,twins
                Public health
                adult, behavioral genetics, cohort studies, educational status, exercise, follow-up studies, twins

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