Article Text

Increase in physical activity and cardiometabolic risk profile change during lifestyle intervention in primary healthcare: 1-year follow-up study among individuals at high risk for type 2 diabetes
  1. Urho M Kujala1,
  2. Jari Jokelainen2,3,
  3. Heikki Oksa4,
  4. Timo Saaristo4,5,
  5. Nina Rautio4,
  6. Leena Moilanen6,
  7. Eeva Korpi-Hyövälti7,
  8. Juha Saltevo8,
  9. Mauno Vanhala9,10,11,
  10. Leo Niskanen8,12,
  11. Markku Peltonen13,
  12. Jaakko Tuomilehto14,
  13. Matti Uusitupa15,16,
  14. Sirkka Keinänen-Kiukaannemi2,3,17
  1. 1Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
  2. 2Institute of Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
  3. 3Unit of General Practice, Oulu University Hospital, Oulu, Finland
  4. 4Pirkanmaa Hospital District, Tampere, Finland
  5. 5Finnish Diabetes Association, Tampere, Finland
  6. 6Department of Medicine, Kuopio University Hospital, Kuopio, Finland
  7. 7Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
  8. 8Department of Internal Medicine, Central Finland Hospital District, Jyväskylä, Finland
  9. 9Unit of Family Practice, Central Finland Hospital District, Jyväskylä, Finland
  10. 10Kuopio University Hospital, Kuopio, Finland
  11. 11University of Eastern Finland, Kuopio, Finland
  12. 12Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
  13. 13National Institute for Health and Welfare, Helsinki, Finland
  14. 14Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
  15. 15Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
  16. 16Research Unit, Kuopio University Hospital, Finland
  17. 17Unit of General Practice, Oulu University Hospital District, Oulu, Finland
  1. Correspondence to Professor Urho M Kujala; urho.m.kujala{at}


Objectives To investigate the association between increase in physical activity and changes in cardiometabolic risk factors during a lifestyle intervention programme in routine clinical settings.

Design Prospective follow-up.

Setting 400 primary healthcare centres and occupational healthcare outpatient clinics in Finland.

Participants Individuals at high risk for type 2 diabetes identified in the implementation project of the national diabetes prevention programme (FIN-D2D) and participating in baseline and 1-year follow-up visits. Final study group comprised the 1871 non-diabetic participants who responded at follow-up visit to a question on stability versus increase of physical activity.

Interventions Lifestyle intervention.

Primary outcome measures Cardiometabolic risk factors (body composition, blood pressure and those measured from fasting venous blood samples) measured at baseline and follow-up visits.

Results Of the participants, 310 (16.6% of all responders) reported at follow-up having clearly increased their physical activity during the past year, while 1380 (73.8%) had been unable to increase their physical activity. Those who increased their activity decreased their weight by 3.6 kg (95% CI 2.9 to 4.3, age and sex adjusted, p<0.001) and waist circumference by 3.6 cm (95% CI 2.9 to 4.3, p<0.001) more than those who did not increase their activity. Similarly, those who increased their physical activity had greater reductions in total cholesterol (group difference in reduction 0.17 mmol/l, 95% CI 0.06 to 0.28, p=0.002), low-density lipoprotein cholesterol (0.16 mmol/l, 95% CI 0.06 to 0.26, p=0.001), low-density lipoprotein/high-density lipoprotein ratio (0.17, 95% CI 0.08 to 0.25, p<0.001) as well as fasting glucose (0.09 mmol/l, 95% CI 0.03 to 0.15, p=0.004) and 2 h glucose levels (0.36 mmol/l, 95% CI 0.17 to 0.55, p=0.023) than those who did not increase their physical activity.

Conclusion Increasing physical activity seems to be an important feature of cardiometabolic risk reduction among individuals at high risk for type 2 diabetes participating in preventive interventions in routine clinical settings.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Kujala UM, Jokelainen J, Oksa H, et al. Increase in physical activity and cardiometabolic risk profile change during lifestyle intervention in primary healthcare: 1-year follow-up study among individuals at high risk for type 2 diabetes. BMJ Open 2011;1:e000292. doi:10.1136/bmjopen-2011-000292

  • Funding FIN-D2D was supported by hospital districts of Pirkanmaa, Southern Ostrobothnia, Northern Ostrobothnia, Central Finland and Northern Savo, the Finnish National Public Health Institute, the Finnish Diabetes Association, the Ministry of Social Affairs and Health in Finland, Finland's Slottery Machine Association, the Academy of Finland (grant number 129293) and Commission of the European Communities, Directorate of Public Health (grant agreement number 2004310) in cooperation with the FIN-D2D Study Group and the Steering Committee: Huttunen J, Kesäniemi A, Kiuru S, Niskanen L, Oksa H, Pihlajamäki J, Puolakka J, Puska P, Saaristo T, Vanhala M and Uusitupa M. Role of study sponsors: the funding organisations (except for the hospital districts) had no role in the design and conduct of the study; the collection, management, analysis and interpretation of data; and the writing of the manuscript for publication.

  • Competing interests None.

  • Ethics approval Ministry of Social Affairs and Health in Finland gave the permission to collect the data from healthcare units specifically for scientific evaluation purposes including scientific publication of data to National Public Health Institute.

  • Contributors UMK designed this post hoc substudy, drafted the manuscript and is the guarantor. JJ analysed the data. All authors contributed to the study design, collection and interpretation of data and writing of the manuscript. All authors declare that they accept full responsibility for the conduct of the study, had access to the data and controlled the decision to publish.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.