Timo Törmäkangas | University of Jyväskylä (original) (raw)

Papers by Timo Törmäkangas

Journal of the American Geriatrics Society, 2016

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2006

We examined the effect of life satisfaction on survival over 10 years among 80-year-old and older... more We examined the effect of life satisfaction on survival over 10 years among 80-year-old and older same-sex twins of whom 320 individuals responded to the Life Satisfaction Index Z questionnaire in connection with the OCTO-Twin study. We treated participants as individuals in semiparametric Cox regression mixed-effects models (frailty) by adjusting the similarity of mortality risk within twin pairs by modeling it as a random variable. An exploratory factor analysis yielded three factors: Zest and Mood represented satisfaction with present life and Congruence represented satisfaction with past life. Those in the lowest quartile of factors of satisfaction with present life had an almost twofold risk for mortality compared with those in the highest quartile, even after adjustment for multiple confounders. Satisfaction with past life satisfaction showed no association with mortality.

PloS one, 2015

There is some evidence linking sub-optimal prenatal development to an increased risk of disabilit... more There is some evidence linking sub-optimal prenatal development to an increased risk of disability pension (DP). Our aim was to investigate whether body size at birth was associated with transitioning into all-cause and cause-specific DP during the adult work career. 10 682 people born in 1934-44 belonging to the Helsinki Birth Cohort Study had data on birth weight extracted from birth records, and on time, type and reason of retirement between 1971 and 2011 extracted from the Finnish Centre for Pensions. Altogether 21.3% transitioned into DP during the 40-year follow-up, mainly due to mental disorders, musculoskeletal disorders and cardiovascular disease. Average age of transitioning into DP was 51.3 (SD 8.4) for men and 52.2 (SD 7.6) for women. Cohort members who did not transition into DP retired 10 years later on average. Among men, higher birth weight was associated with a lower hazard of transitioning into DP, adjusted hazard ratio (HR) being 0.94 (95% confidence interval [CI]...

Hallym International Journal of Aging, 2003

PloS one, 2014

The purpose of the study was to examine the effects of exercise on total leukocyte count and subs... more The purpose of the study was to examine the effects of exercise on total leukocyte count and subsets, as well as hormone and cytokine responses in a thermoneutral and cold environment, with and without an individualized pre-cooling protocol inducing low-intensity shivering. Nine healthy young men participated in six experimental trials wearing shorts and t-shirts. Participants exercised for 60 min on a treadmill at low (LOW: 50% of peak VO2) and moderate (MOD: 70% VO2peak) exercise intensities in a climatic chamber set at 22°C (NT), and in 0°C (COLD) with and without a pre-exercise low-intensity shivering protocol (SHIV). Core and skin temperature, heart rate and oxygen consumption were collected continuously. Blood samples were collected before and at the end of exercise to assess endocrine and immunological changes. Core temperature in NT was greater than COLD and SHIV by 0.4±0.2°C whereas skin temperature in NT was also greater than COLD and SHIV by 8.5±1.4°C and 9.3±2.5°C respec...

Aging Clin Exp Res, 2006

An acute illness may place older frail people at increased risk of losing independence in functio... more An acute illness may place older frail people at increased risk of losing independence in functional abilities. Physical exercise may reduce the risk by improving muscle strength and balance. However, the effects of physical training on functional abilities have not been studied among frail, very old people recovering from an acute illness. The aim of this study was to determine the effects of a group-based exercise program on their ability to carry out self-care (ADL) and instrumental activities (IADL) relevant to daily life after discharge from hospital. This randomized controlled trial examined 68 community-dwelling women aged 75 years or older (mean age 83.0, SD 3.9) who were hospitalized due to an acute illness, and were mobility-impaired at admission. Participants were recruited from the geriatric ward of a primary-care health-center hospital, and were randomized into group-based strength training (n=34) and control (n=34) groups. The 10-week group-based intervention included strength training and functional exercises. The control group received instructions for a home exercise training program, including functional exercises but no further encouragement to exercise. The level of independence in ADL and IADL was evaluated, using a 13-item scale with stepwise grading from fully independent to fully dependent. Measurements took place immediately before and after the intervention, and three and nine months later. The intervention did not have any significant main effect (p = 0.407), nor was there any significant interaction between follow-up time and intervention (p = 0.854). The multicomponent outpatient strength training program did not improve autonomy in expert-evaluated ADL/IADL functions.

Scandinavian Journal of Medicine & Science in Sports, 2008

The aim of this study was to analyze social welfare and healthcare costs and fall-related healthc... more The aim of this study was to analyze social welfare and healthcare costs and fall-related healthcare costs after a group-based exercise program. The 10-week exercise program, which started after discharge from the hospital, was designed to improve physical fitness, mood, and functional abilities in frail elderly women. Sixty-eight acutely hospitalized and mobility-impaired women (mean age 83.0, SD 3.9 years) were randomized into either group-based (intervention) or home exercise (control) groups. Information on costs was collected during 1 year after hospital discharge. There were no differences between the intervention and control groups in the mean individual healthcare costs: 4381 euros (SD 3829 euros) vs 3539 euros (SD 3967 euros), P=0.477, in the social welfare costs: 3336 euros (SD 4418 euros) vs 4073 euros (SD 5973 euros), P=0.770, or in the fall-related healthcare costs: 996 euros (SD 2612 euros) vs 306 euros (SD 915), P=0.314, respectively. This exercise intervention, which has earlier proved to be effective in improving physical fitness and mood, did not result in any financial savings in municipal costs. These results serve as a pilot study and further studies are needed to establish the cost-effectiveness of this exercise intervention for elderly people.

PLoS ONE, 2013

Vitamin D is well known for its regulatory role in calcium and phosphate homeostasis, but its rol... more Vitamin D is well known for its regulatory role in calcium and phosphate homeostasis, but its role in muscle mass and strength during growth remains inconclusive. We explored the association of serum 25-hydroxyvitamin D (25(OH)D) with muscle development in girls from 11 to 18-years old. Whole body lean tissue mass (LM WB ), appendicular lean mass (aLM), muscle cross-sectional area at the lower leg (mCSA), maximal voluntary contraction of elbow flexors (MVC elbow ) and knee extensors (MVC knee ) were assessed in 217 girls aged 10-13 years (at baseline), 215 in 2-year and 226 in 7.5-year follow-up. Serum concentration of 25(OH)D and intact parathyroid hormone (PTH) were analyzed retrospectively and girls were categorized according to their 25(OH)D levels (consistently insufficient 25(OH)D G LL ,50 nmol/l and consistently sufficient G HH .50 nmol/l from baseline to 7-year follow-up). We found that 25(OH)D level declined until menarche (p,0.05) while LM WB , aLM, mCSA, MVC elbow and MVC knee continued to increase (p,0.001 for all) post menarche. At pre-menarche, the G LL (n = 34) had higher LM WB and aLM than the G HH (n = 21, p,0.05), while post-menarche the G HH (n = 15) had a greater catchup gain in LM WB (p = 0.004), aLM (p = 0.001) and mCSA (p = 0.027) compared to the G LL (n = 65) over the first 2-year period. At the age of 18, no differences in muscle mass/strength between the low (n = 151) and high (n = 77) levels of 25(OH)D groups were found. This finding was independent of vitamin D receptor genotype and other confounders. In conclusion, our results showed that levels of 25(OH)D have no significant negative influence on the development of muscle mass and strength during pubertal growth both with longitudinal and cross-sectional comparison. On the contrary, our results suggest that the temporary negative association between 25(OH)D and muscle mass arises as a consequence of fast growth prior to menarche, and this negative association is diminished through catch-up growth after menarche.

Ophthalmic Epidemiology, 2008

To examine vision as a predictor of mortality in older people and the role of mobility, depressed... more To examine vision as a predictor of mortality in older people and the role of mobility, depressed mood, chronic diseases, body mass index, physical activity and injurious accidents in this possible association. 223 persons aged 75 and 193 persons aged 80 years at the baseline participated in visual acuity measurements. Visual acuity (VA) of < 0.3 in the better eye was defined as visual impairment, VA of > or = 0.3 but < or = 0.5 as lowered vision and VA > 0.5 as normal VA. Death dates were received from the official register. Cox regression models were used to determine the relative risks of mortality and to study what factors lie on the pathway from poor vision to mortality. Over the 10-year follow-up, 107 (48%) persons aged 75 years and 138 (72%) aged 80 years at the baseline died. The risk for mortality among the 75-year-olds with lowered vision was 1.98 (95 % CI 1.25-3.13) and with visual impairment 1.90 (95% CI 1.12-3.20) compared to those with normal VA. Lower walking speed, physical inactivity, cardiovascular diseases, injurious accidents, diabetes and depressed mood each attenuated the risk markedly. Nevertheless, lowered vision remained a significant predictor of mortality even after including all these variables in the model. Among the 80-year-olds vision did not correlate with mortality. Lowered vision and severe visual impairment predicted mortality in the 75-year-old but not 80-year-old population. The increased risk was partially explained by lower walking speed, physical inactivity, cardiovascular diseases, depressed mood, diabetes and injurious accidents.

Journal of the American Geriatrics Society, 2000

OBJECTIVES: To study which individual characteristics and environmental factors correlate with fe... more OBJECTIVES: To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation. DESIGN: Observational prospective cohort study and cross-sectional analyses. SETTING: Community and research center. PARTICIPANTS: Seven hundred twenty-seven communityliving people aged 75 to 81 were interviewed at baseline, of whom 314 took part in a 3.5-year follow-up. MEASUREMENTS: Fear of moving outdoors and its potential individual and environmental correlates were assessed at baseline. Perceived difficulties in walking 0.5 km and 2 km were assessed twice a year over a 3.5-year period. RESULTS: At baseline, 65% of the women and 29% of the men reported fear of moving outdoors. Poor socioeconomic status; musculoskeletal diseases; slow walking speed; and the presence of poor street conditions, hills in the nearby environment, and noisy traffic correlated with fear of moving outdoors. At the first 6-month follow-up, participants with fear of moving outdoors had more than four times the adjusted risk (odds ratio (OR) 5 4.6, 95% confidence interval (CI) 5 1.92-11.00) of developing difficulties in walking 0.5 km and a three times greater adjusted risk (OR 5 3.10, 95% CI 5 1.49-6.46) for developing difficulty in walking 2 km compared with those without fear. The difference in the prevalence of walking difficulties remained statistically significant over the 3.5-year follow-up (P 5.02 and P 5.009, respectively). CONCLUSION: Fear of moving outdoors is common in older adults and increases the risk of developing selfreported difficulties in walking 0.5 km and 2 km. Knowl-edge about individual and environmental factors underlying fear of moving outdoors and finding ways to alleviate fear of moving outdoors are important for community planning and prevention of disability. J Am Geriatr Soc 57: 634-640, 2009.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009

Background. Physical activity counseling increases physical activity among older people, but its ... more Background. Physical activity counseling increases physical activity among older people, but its effectiveness on mobility, that is, maintaining the ability to move independently, is unknown. We studied the effect of physical activity counseling on mobility among older people and evaluated whether counseling-induced benefi ts persist after cessation of the intervention.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008

Background. Inability to maintain balance while standing increases risk of falls in older people.... more Background. Inability to maintain balance while standing increases risk of falls in older people. The present study assessed whether center of pressure (COP) movement measured with force platform technology predicts risk for falls among older people with no manifest deficiency in standing balance.

BMC Public Health, 2013

Background: Environmental barriers are associated with disability-related outcomes in older peopl... more Background: Environmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80-to 89-year-old single-living people. Methods: This longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002-2003, and 393 were followed up for mortality until May 15, 2012. Environmental barriers and functional limitations were assessed with the Housing Enabler instrument, which is intended for objective assessments of Person-Environment (P-E) fit problems in housing and the immediate outdoor environment. Mortality data were gathered from the public national register. Cox regression models were used for the analyses. Results: A total of 264 (67%) participants died during follow-up. Functional limitations increased mortality risk. Among the specific environmental barriers that generate the most P-E fit problems, lack of handrails in stairs at entrances was associated with the highest mortality risk (adjusted RR 1.55, 95% CI 1.14-2.10), whereas the total number of environmental barriers at entrances and outdoors was not associated with mortality. A higher number of environmental barriers indoors showed a slight protective effect against mortality even after adjustment for functional limitations (RR 0.98, 95% CI 0.96-1.00). Conclusion: Specific environmental problems may increase mortality risk among very-old single-living people. However, the association may be confounded by individuals' health status which is difficult to fully control for. Further studies are called for.

BMC Medicine, 2009

Background: Understanding how bone (BM), lean (LM) and fat mass (FM) develop through childhood, p... more Background: Understanding how bone (BM), lean (LM) and fat mass (FM) develop through childhood, puberty and adolescence is vital since it holds key information regarding current and future health. Our study aimed to determine how BM, LM and FM track from prepuberty to early adulthood in girls and what factors are associated with intra-and inter-individual variation in these three tissues.

Archives of Physical Medicine and Rehabilitation, 2007

Mänty M, Heinonen A, Leinonen R, Törmäkangas T, Sakari-Rantala R, Hirvensalo M, von Bonsdorff MB,... more Mänty M, Heinonen A, Leinonen R, Törmäkangas T, Sakari-Rantala R, Hirvensalo M, von Bonsdorff MB, Rantanen T. Construct and predictive validity of a self-reported measure of preclinical mobility limitation. Arch Phys Med Rehabil 2007;88:1108-13.

Age and Ageing, 2013

Background: high job strain increases the risk of health decline, but little is known about the s... more Background: high job strain increases the risk of health decline, but little is known about the specific consequences and longterm effects of job strain on old age health. Objectives: purpose was to investigate whether physical and mental job strain in midlife was associated with hospital care use in old age. Methods: study population included 5,625 Finnish public sector employees aged 44-58 years who worked in blue-and whitecollar professions in 1981. The number of in-patient hospital care days was collected from the Finnish Hospital Discharge Register for the 28-year follow-up period. Results: rates of hospital care days per 1,000 person-years for men were 7.78 (95% confidence interval [CI] 7.71-7.84) for low, 9.68 (95% CI 9.50-9.74) for intermediate and 12.56 (95% CI 12.47-12.66) for high physical job strain in midlife. The corresponding rates for women were 6.63 (95% CI 6.57-6.68), 7.91 (95% CI 7.87-7.95) and 10.35 (95% CI 10.25-10.42), respectively. Rates were parallel but lower for mental job strain. Reporting high physical job strain in midlife increased the risk of hospital care in old age compared with those who reported low job strain, fully adjusted incidence rate ratio 1.17 (95% CI 1.00-1.38) for men and 1.42 (95% CI 1.25-1.61) for women. These associations were robust in analyses confined to hospital care that took place after the employees had turned 65 years.

AGE, 2010

At the moment, there is no clear molecular explanation for the steeper decline in muscle performa... more At the moment, there is no clear molecular explanation for the steeper decline in muscle performance after menopause or the mechanisms of counteractive treatments. The goal of this genome-wide study was to identify the genes and gene clusters through which power training (PT) comprising jumping activities or estrogen containing hormone replacement therapy (HRT) may affect skeletal muscle properties after menopause. We used musculus vastus lateralis samples from early stage postmenopausal (50-57 years old) women participating in a yearlong randomized double-blind placebo-controlled trial with PT and HRT interventions. Using microarray platform with over 24,000 probes, we identified 665 differentially expressed genes. The hierarchical clustering method was used to assort the genes. Additionally, enrichment analysis of gene ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways was carried out to clarify whether assorted gene clusters are enriched with particular functional categories. The analysis revealed transcriptional regulation of 49 GO/ KEGG categories. PT upregulated transcription in "response to contraction"-category revealing novel candidate genes for contraction-related regulation of muscle function while HRT upregulated gene expression related to functionality of mitochondria. Moreover, several functional categories tightly related to muscle energy metabolism, development, and function were affected regardless of the treatment. Our results emphasize that during the early stages of the postmenopause, muscle properties are under transcriptional modulation, which both PT and HRT partially counteract leading to preservation of muscle power and potentially reducing the risk for aging-related muscle weakness. More specifically, PT and HRT may function through improving energy metabolism, response to contraction as well as by preserving functionality of the mitochondria.

Journal of the American Geriatrics Society, 2016

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2006

We examined the effect of life satisfaction on survival over 10 years among 80-year-old and older... more We examined the effect of life satisfaction on survival over 10 years among 80-year-old and older same-sex twins of whom 320 individuals responded to the Life Satisfaction Index Z questionnaire in connection with the OCTO-Twin study. We treated participants as individuals in semiparametric Cox regression mixed-effects models (frailty) by adjusting the similarity of mortality risk within twin pairs by modeling it as a random variable. An exploratory factor analysis yielded three factors: Zest and Mood represented satisfaction with present life and Congruence represented satisfaction with past life. Those in the lowest quartile of factors of satisfaction with present life had an almost twofold risk for mortality compared with those in the highest quartile, even after adjustment for multiple confounders. Satisfaction with past life satisfaction showed no association with mortality.

PloS one, 2015

There is some evidence linking sub-optimal prenatal development to an increased risk of disabilit... more There is some evidence linking sub-optimal prenatal development to an increased risk of disability pension (DP). Our aim was to investigate whether body size at birth was associated with transitioning into all-cause and cause-specific DP during the adult work career. 10 682 people born in 1934-44 belonging to the Helsinki Birth Cohort Study had data on birth weight extracted from birth records, and on time, type and reason of retirement between 1971 and 2011 extracted from the Finnish Centre for Pensions. Altogether 21.3% transitioned into DP during the 40-year follow-up, mainly due to mental disorders, musculoskeletal disorders and cardiovascular disease. Average age of transitioning into DP was 51.3 (SD 8.4) for men and 52.2 (SD 7.6) for women. Cohort members who did not transition into DP retired 10 years later on average. Among men, higher birth weight was associated with a lower hazard of transitioning into DP, adjusted hazard ratio (HR) being 0.94 (95% confidence interval [CI]...

Hallym International Journal of Aging, 2003

PloS one, 2014

The purpose of the study was to examine the effects of exercise on total leukocyte count and subs... more The purpose of the study was to examine the effects of exercise on total leukocyte count and subsets, as well as hormone and cytokine responses in a thermoneutral and cold environment, with and without an individualized pre-cooling protocol inducing low-intensity shivering. Nine healthy young men participated in six experimental trials wearing shorts and t-shirts. Participants exercised for 60 min on a treadmill at low (LOW: 50% of peak VO2) and moderate (MOD: 70% VO2peak) exercise intensities in a climatic chamber set at 22°C (NT), and in 0°C (COLD) with and without a pre-exercise low-intensity shivering protocol (SHIV). Core and skin temperature, heart rate and oxygen consumption were collected continuously. Blood samples were collected before and at the end of exercise to assess endocrine and immunological changes. Core temperature in NT was greater than COLD and SHIV by 0.4±0.2°C whereas skin temperature in NT was also greater than COLD and SHIV by 8.5±1.4°C and 9.3±2.5°C respec...

Aging Clin Exp Res, 2006

An acute illness may place older frail people at increased risk of losing independence in functio... more An acute illness may place older frail people at increased risk of losing independence in functional abilities. Physical exercise may reduce the risk by improving muscle strength and balance. However, the effects of physical training on functional abilities have not been studied among frail, very old people recovering from an acute illness. The aim of this study was to determine the effects of a group-based exercise program on their ability to carry out self-care (ADL) and instrumental activities (IADL) relevant to daily life after discharge from hospital. This randomized controlled trial examined 68 community-dwelling women aged 75 years or older (mean age 83.0, SD 3.9) who were hospitalized due to an acute illness, and were mobility-impaired at admission. Participants were recruited from the geriatric ward of a primary-care health-center hospital, and were randomized into group-based strength training (n=34) and control (n=34) groups. The 10-week group-based intervention included strength training and functional exercises. The control group received instructions for a home exercise training program, including functional exercises but no further encouragement to exercise. The level of independence in ADL and IADL was evaluated, using a 13-item scale with stepwise grading from fully independent to fully dependent. Measurements took place immediately before and after the intervention, and three and nine months later. The intervention did not have any significant main effect (p = 0.407), nor was there any significant interaction between follow-up time and intervention (p = 0.854). The multicomponent outpatient strength training program did not improve autonomy in expert-evaluated ADL/IADL functions.

Scandinavian Journal of Medicine & Science in Sports, 2008

The aim of this study was to analyze social welfare and healthcare costs and fall-related healthc... more The aim of this study was to analyze social welfare and healthcare costs and fall-related healthcare costs after a group-based exercise program. The 10-week exercise program, which started after discharge from the hospital, was designed to improve physical fitness, mood, and functional abilities in frail elderly women. Sixty-eight acutely hospitalized and mobility-impaired women (mean age 83.0, SD 3.9 years) were randomized into either group-based (intervention) or home exercise (control) groups. Information on costs was collected during 1 year after hospital discharge. There were no differences between the intervention and control groups in the mean individual healthcare costs: 4381 euros (SD 3829 euros) vs 3539 euros (SD 3967 euros), P=0.477, in the social welfare costs: 3336 euros (SD 4418 euros) vs 4073 euros (SD 5973 euros), P=0.770, or in the fall-related healthcare costs: 996 euros (SD 2612 euros) vs 306 euros (SD 915), P=0.314, respectively. This exercise intervention, which has earlier proved to be effective in improving physical fitness and mood, did not result in any financial savings in municipal costs. These results serve as a pilot study and further studies are needed to establish the cost-effectiveness of this exercise intervention for elderly people.

PLoS ONE, 2013

Vitamin D is well known for its regulatory role in calcium and phosphate homeostasis, but its rol... more Vitamin D is well known for its regulatory role in calcium and phosphate homeostasis, but its role in muscle mass and strength during growth remains inconclusive. We explored the association of serum 25-hydroxyvitamin D (25(OH)D) with muscle development in girls from 11 to 18-years old. Whole body lean tissue mass (LM WB ), appendicular lean mass (aLM), muscle cross-sectional area at the lower leg (mCSA), maximal voluntary contraction of elbow flexors (MVC elbow ) and knee extensors (MVC knee ) were assessed in 217 girls aged 10-13 years (at baseline), 215 in 2-year and 226 in 7.5-year follow-up. Serum concentration of 25(OH)D and intact parathyroid hormone (PTH) were analyzed retrospectively and girls were categorized according to their 25(OH)D levels (consistently insufficient 25(OH)D G LL ,50 nmol/l and consistently sufficient G HH .50 nmol/l from baseline to 7-year follow-up). We found that 25(OH)D level declined until menarche (p,0.05) while LM WB , aLM, mCSA, MVC elbow and MVC knee continued to increase (p,0.001 for all) post menarche. At pre-menarche, the G LL (n = 34) had higher LM WB and aLM than the G HH (n = 21, p,0.05), while post-menarche the G HH (n = 15) had a greater catchup gain in LM WB (p = 0.004), aLM (p = 0.001) and mCSA (p = 0.027) compared to the G LL (n = 65) over the first 2-year period. At the age of 18, no differences in muscle mass/strength between the low (n = 151) and high (n = 77) levels of 25(OH)D groups were found. This finding was independent of vitamin D receptor genotype and other confounders. In conclusion, our results showed that levels of 25(OH)D have no significant negative influence on the development of muscle mass and strength during pubertal growth both with longitudinal and cross-sectional comparison. On the contrary, our results suggest that the temporary negative association between 25(OH)D and muscle mass arises as a consequence of fast growth prior to menarche, and this negative association is diminished through catch-up growth after menarche.

Ophthalmic Epidemiology, 2008

To examine vision as a predictor of mortality in older people and the role of mobility, depressed... more To examine vision as a predictor of mortality in older people and the role of mobility, depressed mood, chronic diseases, body mass index, physical activity and injurious accidents in this possible association. 223 persons aged 75 and 193 persons aged 80 years at the baseline participated in visual acuity measurements. Visual acuity (VA) of < 0.3 in the better eye was defined as visual impairment, VA of > or = 0.3 but < or = 0.5 as lowered vision and VA > 0.5 as normal VA. Death dates were received from the official register. Cox regression models were used to determine the relative risks of mortality and to study what factors lie on the pathway from poor vision to mortality. Over the 10-year follow-up, 107 (48%) persons aged 75 years and 138 (72%) aged 80 years at the baseline died. The risk for mortality among the 75-year-olds with lowered vision was 1.98 (95 % CI 1.25-3.13) and with visual impairment 1.90 (95% CI 1.12-3.20) compared to those with normal VA. Lower walking speed, physical inactivity, cardiovascular diseases, injurious accidents, diabetes and depressed mood each attenuated the risk markedly. Nevertheless, lowered vision remained a significant predictor of mortality even after including all these variables in the model. Among the 80-year-olds vision did not correlate with mortality. Lowered vision and severe visual impairment predicted mortality in the 75-year-old but not 80-year-old population. The increased risk was partially explained by lower walking speed, physical inactivity, cardiovascular diseases, depressed mood, diabetes and injurious accidents.

Journal of the American Geriatrics Society, 2000

OBJECTIVES: To study which individual characteristics and environmental factors correlate with fe... more OBJECTIVES: To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation. DESIGN: Observational prospective cohort study and cross-sectional analyses. SETTING: Community and research center. PARTICIPANTS: Seven hundred twenty-seven communityliving people aged 75 to 81 were interviewed at baseline, of whom 314 took part in a 3.5-year follow-up. MEASUREMENTS: Fear of moving outdoors and its potential individual and environmental correlates were assessed at baseline. Perceived difficulties in walking 0.5 km and 2 km were assessed twice a year over a 3.5-year period. RESULTS: At baseline, 65% of the women and 29% of the men reported fear of moving outdoors. Poor socioeconomic status; musculoskeletal diseases; slow walking speed; and the presence of poor street conditions, hills in the nearby environment, and noisy traffic correlated with fear of moving outdoors. At the first 6-month follow-up, participants with fear of moving outdoors had more than four times the adjusted risk (odds ratio (OR) 5 4.6, 95% confidence interval (CI) 5 1.92-11.00) of developing difficulties in walking 0.5 km and a three times greater adjusted risk (OR 5 3.10, 95% CI 5 1.49-6.46) for developing difficulty in walking 2 km compared with those without fear. The difference in the prevalence of walking difficulties remained statistically significant over the 3.5-year follow-up (P 5.02 and P 5.009, respectively). CONCLUSION: Fear of moving outdoors is common in older adults and increases the risk of developing selfreported difficulties in walking 0.5 km and 2 km. Knowl-edge about individual and environmental factors underlying fear of moving outdoors and finding ways to alleviate fear of moving outdoors are important for community planning and prevention of disability. J Am Geriatr Soc 57: 634-640, 2009.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009

Background. Physical activity counseling increases physical activity among older people, but its ... more Background. Physical activity counseling increases physical activity among older people, but its effectiveness on mobility, that is, maintaining the ability to move independently, is unknown. We studied the effect of physical activity counseling on mobility among older people and evaluated whether counseling-induced benefi ts persist after cessation of the intervention.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008

Background. Inability to maintain balance while standing increases risk of falls in older people.... more Background. Inability to maintain balance while standing increases risk of falls in older people. The present study assessed whether center of pressure (COP) movement measured with force platform technology predicts risk for falls among older people with no manifest deficiency in standing balance.

BMC Public Health, 2013

Background: Environmental barriers are associated with disability-related outcomes in older peopl... more Background: Environmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80-to 89-year-old single-living people. Methods: This longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002-2003, and 393 were followed up for mortality until May 15, 2012. Environmental barriers and functional limitations were assessed with the Housing Enabler instrument, which is intended for objective assessments of Person-Environment (P-E) fit problems in housing and the immediate outdoor environment. Mortality data were gathered from the public national register. Cox regression models were used for the analyses. Results: A total of 264 (67%) participants died during follow-up. Functional limitations increased mortality risk. Among the specific environmental barriers that generate the most P-E fit problems, lack of handrails in stairs at entrances was associated with the highest mortality risk (adjusted RR 1.55, 95% CI 1.14-2.10), whereas the total number of environmental barriers at entrances and outdoors was not associated with mortality. A higher number of environmental barriers indoors showed a slight protective effect against mortality even after adjustment for functional limitations (RR 0.98, 95% CI 0.96-1.00). Conclusion: Specific environmental problems may increase mortality risk among very-old single-living people. However, the association may be confounded by individuals' health status which is difficult to fully control for. Further studies are called for.

BMC Medicine, 2009

Background: Understanding how bone (BM), lean (LM) and fat mass (FM) develop through childhood, p... more Background: Understanding how bone (BM), lean (LM) and fat mass (FM) develop through childhood, puberty and adolescence is vital since it holds key information regarding current and future health. Our study aimed to determine how BM, LM and FM track from prepuberty to early adulthood in girls and what factors are associated with intra-and inter-individual variation in these three tissues.

Archives of Physical Medicine and Rehabilitation, 2007

Mänty M, Heinonen A, Leinonen R, Törmäkangas T, Sakari-Rantala R, Hirvensalo M, von Bonsdorff MB,... more Mänty M, Heinonen A, Leinonen R, Törmäkangas T, Sakari-Rantala R, Hirvensalo M, von Bonsdorff MB, Rantanen T. Construct and predictive validity of a self-reported measure of preclinical mobility limitation. Arch Phys Med Rehabil 2007;88:1108-13.

Age and Ageing, 2013

Background: high job strain increases the risk of health decline, but little is known about the s... more Background: high job strain increases the risk of health decline, but little is known about the specific consequences and longterm effects of job strain on old age health. Objectives: purpose was to investigate whether physical and mental job strain in midlife was associated with hospital care use in old age. Methods: study population included 5,625 Finnish public sector employees aged 44-58 years who worked in blue-and whitecollar professions in 1981. The number of in-patient hospital care days was collected from the Finnish Hospital Discharge Register for the 28-year follow-up period. Results: rates of hospital care days per 1,000 person-years for men were 7.78 (95% confidence interval [CI] 7.71-7.84) for low, 9.68 (95% CI 9.50-9.74) for intermediate and 12.56 (95% CI 12.47-12.66) for high physical job strain in midlife. The corresponding rates for women were 6.63 (95% CI 6.57-6.68), 7.91 (95% CI 7.87-7.95) and 10.35 (95% CI 10.25-10.42), respectively. Rates were parallel but lower for mental job strain. Reporting high physical job strain in midlife increased the risk of hospital care in old age compared with those who reported low job strain, fully adjusted incidence rate ratio 1.17 (95% CI 1.00-1.38) for men and 1.42 (95% CI 1.25-1.61) for women. These associations were robust in analyses confined to hospital care that took place after the employees had turned 65 years.

AGE, 2010

At the moment, there is no clear molecular explanation for the steeper decline in muscle performa... more At the moment, there is no clear molecular explanation for the steeper decline in muscle performance after menopause or the mechanisms of counteractive treatments. The goal of this genome-wide study was to identify the genes and gene clusters through which power training (PT) comprising jumping activities or estrogen containing hormone replacement therapy (HRT) may affect skeletal muscle properties after menopause. We used musculus vastus lateralis samples from early stage postmenopausal (50-57 years old) women participating in a yearlong randomized double-blind placebo-controlled trial with PT and HRT interventions. Using microarray platform with over 24,000 probes, we identified 665 differentially expressed genes. The hierarchical clustering method was used to assort the genes. Additionally, enrichment analysis of gene ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways was carried out to clarify whether assorted gene clusters are enriched with particular functional categories. The analysis revealed transcriptional regulation of 49 GO/ KEGG categories. PT upregulated transcription in "response to contraction"-category revealing novel candidate genes for contraction-related regulation of muscle function while HRT upregulated gene expression related to functionality of mitochondria. Moreover, several functional categories tightly related to muscle energy metabolism, development, and function were affected regardless of the treatment. Our results emphasize that during the early stages of the postmenopause, muscle properties are under transcriptional modulation, which both PT and HRT partially counteract leading to preservation of muscle power and potentially reducing the risk for aging-related muscle weakness. More specifically, PT and HRT may function through improving energy metabolism, response to contraction as well as by preserving functionality of the mitochondria.