The purpose of this dissertation was to test the utility of theories across the development, implementation, and evaluation of three nationwide knowledge translation (KT) interventions in the physical disability community. Using a theory-based evaluation guided by the Theory of Planned Behaviour (TPB), Study 1 evaluates the effectiveness of an evidence-based, continuing education module designed to increase emergency health care professionals’ (HCPs) knowledge and use of clinical practice guidelines for managing patients with spinal cord injury (SCI) who present with autonomic dysrefexia. Findings suggest that behaviour change theory should be integrated into the intervention to change theory-based determinants of behaviour, and that information about intervention implementation may help explain observed outcomes. Study 2 examined the use of theory across three phases of research in the Canadian Paralympic Committee’s Changing Minds, Changing Lives (CMCL) intervention. Study 2.1 describes the restructuring of the CMCL curriculum to include research evidence and theory. Study 2.2 evaluates the short- and long-term effects of the CMCL intervention on HCPs’ social cognitions for discussing leisure-time physical activity (LTPA), and explores key implementation variables that predict changes in HCPs’ social cognitions. Overall Study 2 results suggest that: (1) using a KT framework and integrating stakeholders throughout intervention development increases the likelihood that interventionists will adopt and implement the intervention, and (2) real-world implementation is important to understanding intervention effectiveness. Study 3 examines the effectiveness, and its implementation correlates, of Get in Motion (GIM), a nationwide, LTPA-enhancing telephone counseling service for adults with SCI. Study 3 furthers our understanding of the relationship between implementation and effectiveness, and suggests key implementation ingredients that could be targeted in future refinements of GIM. Together, the dissertation studies contribute to our understanding of how to use theory when developing, implementing, and evaluating behaviour change interventions targeting HCPs and other end-users in the physical disability community. / Dissertation / Doctor of Philosophy (PhD)

Participation in leisure-time physical activity (LTPA) is vital to ensure adequate physical work capacity for the demands of daily living and job performance. Due to work demand, most top and middle (executive) managerial employees become physically inactive and experience psychological and other health problems which may lead to hypokinetic diseases and even premature death. The purpose of this study was twofold: to determine leisure-time physical activity and psychological well-being status of executive employees; and to determine the relationship between leisure-time physical activity and psychological well-being status of executive employees in selected African countries. A cross-sectional study design was carried out on a group of 156 (mean age 41.22±10.17) available executive employees from selected African countries. Participants were grouped according to age (≤35 years; 36–46 years and ≥ 46 years). Standardised questionnaires were used to collect the data. Subsequently, total scores were calculated for all variables. Out of 156 participants in the study, 42.9% occupied top level management and 57.1% middle level management positions. When data was analysed according to age groups, 31.4% and 68.6% in the less than 35 years age group were in the top and the middle level management positions respectively. In the age group 36 to 46 years, 47.2% occupied the top level management position and 52.8% occupied the middle level management position. With regard to LTPA, top level managers (71.6%) scored low LTPA compared to the middle level managers (62.9%). In addition, both the top and middle level managers reported bad emotional index (49.3%; 56.2%) and happiness index (41.8%; 37.1%) respectively. Though not significant, LTPA was positively associated with psychological well-being parameters amongst top level managers. The study concluded that both top and middle level managers exhibited low LTPA, and with no participation in high physical activity among top level managers. In addition, more middle level managers reported bad emotional stage than the top level managers, while the top level managers were less happy than the middle level managers. The study therefore recommends urgent strategic intervention programmes for leisure-time physical activity and psychological well-being. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2014

Age, male sex, hypertension, smoking, diabetes, dyslipidaemia, and obesity are considered as established risk factors for cardiovascular diseases. Several of these established cardiovascular risk factors are strongly influenced by lifestyle. Novel biomarkers from different mechanistic pathways have been associated with cardiovascular risk, but their clinical utility is still uncertain. The overall objective of the thesis was to evaluate the associations between certain lifestyle factors (physical activity and snuff use), biomarkers reflecting the haemostatic and the inflammatory systems and risk of a future first-ever myocardial infarction.  A prospective incident nested case-control study design was used with a total of 651 cases of myocardial infarction and 2238 matched controls from the population-based Northern Sweden Health and Disease Study.  The effects of commuting activity, occupational and leisure time physical activity on risk of myocardial infarction were studied. A clearly increased risk of myocardial infarction was found for car commuting compared to active commuting (walking, cycling or going by bus). High versus low leisure time physical activity was associated with decreased risk of myocardial infarction. Low occupational physical activity was associated with risk of myocardial infarction in men.  The risk of myocardial infarction or sudden cardiac death was studied in male snuff users compared to non-tobacco users. No increased risk was found for myocardial infarction or sudden cardiac death among snuff users without a previous history of smoking. However, for sudden cardiac death the study did not have statistical power to detect small differences in risk.  Plasma levels of haemostatic markers have previously shown to be associated with risk of myocardial infarction, but as haemostatic markers are also acute-phase reactants, it is not clear if their association with myocardial infarction is independent of inflammatory markers. In the present study, the haemostatic markers D-dimer, von Willebrand factor (VWF), tissue plasminogen activator (t-PA), and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (t-PA/PAI-1 complex) were associated with risk of myocardial infarction after adjustment for established risk factors and the inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6). Furthermore, the addition of eight haemostatic and inflammatory markers could improve the predictive ability for future myocardial infarction beyond that of a model utilizing only established risk factors.  Established risk factors and novel biomarkers were explored as potential mediators of the reduced risk of myocardial infarction related to active commuting. A combination of established risk factors, haemostatic and inflammatory markers appeared to explain a substantial proportion (40%) of the difference in risk for myocardial infarction between active commuters and car commuters. IL-6, t-PA, t-PA/PAI-1 complex, apo B/apo A-1 ratio, and BMI seemed to be the largest potential mediators when tested individually. In conclusion, regular physical activity such as active commuting is associated with reduced risk of a first-ever myocardial infarction. This effect could in part be mediated through a beneficial influence on haemostasis and inflammation, as well as a positive impact on established risk factors. Several haemostatic markers are associated with risk of myocardial infarction independent of established risk factors and inflammatory markers. The combination of haemostatic and inflammatory markers may enhance predictive ability beyond established risk factors. Our findings do not support the hypothesis that snuff use increases the risk of myocardial infarction.

Leisure-time physical inactivity is a global public health concern affecting all people in different walks of life, including employees. This inactivity is associated with chronic diseases of lifestyle as well as low work capacity. The purpose of this study was two-fold: to determine leisure-time physical activity (LTPAI), coronary risk- (CRI), health status (HSI) and lifestyle (LSI) indexes of some executive employees in selected African countries; and to determine the effect of leisure-time physical activity (LTPA) on the coronary risk-, health status- and lifestyle- indexes of some executive employees in selected African countries.A cross-sectional study design was followed on a group of 156 (mean age 41.22±10.17) executive employees. Participants were grouped according to age (<35 years; 36–46 years and > 46 years). Standardized questionnaires were used to collect data. Out of 156 participants in the study, 43% occupied top level management and 57% middle level management positions. When data were analyzed according to age groups, 31% and 69% in the less than 35 years age group were in the top and the middle level management, respectively. In the age group 36 to 46 years of age, 47% were in the top level of management and 52.8% middle level management. With regard to LTPA, top level managers (71.6%) scored low LTPA as compared to middle level managers (62.9%). Top level managers scored higher percentages (14.9%) for developing the risk of coronary heart disease. The results show a negative effect of physical activity on selected health parameters, with significant negative relationships between low LTPA and daily lifestyle index (r= -0.52; p=0.01), and moderate LTPA and daily lifestyle index (r= -0.71; p<0.001) for middle managers. It can be concluded that both top and middle level managers exhibited low LTPA and high risk for developing coronary heart disease. It was apparent that the managers in low LTPA are prone to bad stages of life style, health status and coronary risk- indexes compared to the ones with moderate and high LTPA. Additionally, low and moderate LTPA inversely affected selected health parameters of executive employees. No significant association was found for high LTPA with selected health parameters. The study therefore recommends a strategic intervention programme geared towards improving the present state of affairs among the managers in the corporate environment. / Thesis (MA (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

Participation in leisure-time physical activity (LTPA) is vital to ensure adequate physical work capacity for the demands of daily living and job performance. Due to work demand, most top and middle (executive) managerial employees become physically inactive and experience psychological and other health problems which may lead to hypokinetic diseases and even premature death. The purpose of this study was twofold: to determine leisure-time physical activity and psychological well-being status of executive employees; and to determine the relationship between leisure-time physical activity and psychological well-being status of executive employees in selected African countries. A cross-sectional study design was carried out on a group of 156 (mean age 41.22±10.17) available executive employees from selected African countries. Participants were grouped according to age (≤35 years; 36–46 years and ≥ 46 years). Standardised questionnaires were used to collect the data. Subsequently, total scores were calculated for all variables. Out of 156 participants in the study, 42.9% occupied top level management and 57.1% middle level management positions. When data was analysed according to age groups, 31.4% and 68.6% in the less than 35 years age group were in the top and the middle level management positions respectively. In the age group 36 to 46 years, 47.2% occupied the top level management position and 52.8% occupied the middle level management position. With regard to LTPA, top level managers (71.6%) scored low LTPA compared to the middle level managers (62.9%). In addition, both the top and middle level managers reported bad emotional index (49.3%; 56.2%) and happiness index (41.8%; 37.1%) respectively. Though not significant, LTPA was positively associated with psychological well-being parameters amongst top level managers. The study concluded that both top and middle level managers exhibited low LTPA, and with no participation in high physical activity among top level managers. In addition, more middle level managers reported bad emotional stage than the top level managers, while the top level managers were less happy than the middle level managers. The study therefore recommends urgent strategic intervention programmes for leisure-time physical activity and psychological well-being. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2014

Leisure-time physical inactivity is a global public health concern affecting all people in different walks of life, including employees. This inactivity is associated with chronic diseases of lifestyle as well as low work capacity. The purpose of this study was two-fold: to determine leisure-time physical activity (LTPAI), coronary risk- (CRI), health status (HSI) and lifestyle (LSI) indexes of some executive employees in selected African countries; and to determine the effect of leisure-time physical activity (LTPA) on the coronary risk-, health status- and lifestyle- indexes of some executive employees in selected African countries.A cross-sectional study design was followed on a group of 156 (mean age 41.22±10.17) executive employees. Participants were grouped according to age (<35 years; 36–46 years and > 46 years). Standardized questionnaires were used to collect data. Out of 156 participants in the study, 43% occupied top level management and 57% middle level management positions. When data were analyzed according to age groups, 31% and 69% in the less than 35 years age group were in the top and the middle level management, respectively. In the age group 36 to 46 years of age, 47% were in the top level of management and 52.8% middle level management. With regard to LTPA, top level managers (71.6%) scored low LTPA as compared to middle level managers (62.9%). Top level managers scored higher percentages (14.9%) for developing the risk of coronary heart disease. The results show a negative effect of physical activity on selected health parameters, with significant negative relationships between low LTPA and daily lifestyle index (r= -0.52; p=0.01), and moderate LTPA and daily lifestyle index (r= -0.71; p<0.001) for middle managers. It can be concluded that both top and middle level managers exhibited low LTPA and high risk for developing coronary heart disease. It was apparent that the managers in low LTPA are prone to bad stages of life style, health status and coronary risk- indexes compared to the ones with moderate and high LTPA. Additionally, low and moderate LTPA inversely affected selected health parameters of executive employees. No significant association was found for high LTPA with selected health parameters. The study therefore recommends a strategic intervention programme geared towards improving the present state of affairs among the managers in the corporate environment. / Thesis (MA (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

Abstract Physical activity with regular physical exercise (PE) has long been advocated because it lowers morbidity and mortality. However, there have been concerns about a transiently increased risk of adverse cardiac events such as sudden cardiac death (SCD) during PE. Our aim was to identify risk factors related to SCD during PE and clarify the effect of PE on cardiovascular well-being in the general population. In study I we found out that male gender as well as coronary artery disease (CAD), cardiac hypertrophy and myocardial scarring as autopsy-findings were clearly more common among exercise-related SCD. Typical northern activities in skiing and snow shoveling were among the three most common types of PE alongside cycling. In study II we analyzed the previously recorded electrocardiograms (ECG) of victims of SCD. Fragmented QRS complex (fQRS) in anterior leads was a common finding among subjects who died during exercise, especially among subjects with a prior diagnosis of CAD. In study III, we collected retrospectively out-of-hospital sudden cardiac arrest (SCA) data in Northern Ostrobothnia between the years 2007 and 2012. The subjects who suffered SCA in relation to PE were younger and previously healthier, and they had more often a shockable rhythm as the initial rhythm. There was a markedly better prognosis for hospital discharge when SCA occurred during PE. In study IV, we noticed a decrease in cardiac mortality in subjects who were physically active or became active during follow-up in a population of 1,746 stable CAD patients. A similar effect could be seen affecting SCD mortality. No increase in cardiac mortality could be seen among those with the highest levels of habitual PE. In conclusion, ischemic heart disease and male gender, especially when fQRS is present in anterior leads, are characteristics related to exercise-related SCD. On the other hand, when SCA takes place during PE, the prognosis is markedly better compared to SCA occurring at rest. An active lifestyle is also linked to decreased cardiac mortality. / Tiivistelmä Säännöllinen aktiivinen elämäntapa on yhteydessä pienempään fyysisten ja psyykkisten sairauksien riskiin. Tutkimuksissa on kuitenkin havaittu raskaampaan liikuntaan liittyvä väliaikaisesti lisääntynyt akuutin sydäntapahtuman, kuten äkkikuoleman, riski. Väitöskirjatutkimuksessa tutkitaan rasitukseen liittyvän sydänperäisen äkkikuoleman erityispiirteitä ja fyysisen aktiivisuuden merkitystä hyvinvoinnille. Ensimmäisessä osajulkaisussa havaittiin, että rasitukseen liittyvissä kuolemissa oli ruumiinavauslöydöksenä merkittävästi enemmän sepelvaltimotautia, sydänlihaksen arpeutumista ja sydänlihaksen liikakasvua verrattuna äkkikuolemiin levossa. Miessukupuoli oli selkeästi yliedustettuna rasituspopulaatiossa, sillä peräti 94 % oli miehiä. Yleisimmät rasitusmuodot olivat hiihto, pyöräily ja lumenluonti. Toisessa osatutkimuksessa tutkittiin edeltävien EKG-muutosten yhteyttä rasitusperäisiin äkkikuolemiin. Havaitsimme, että QRS-kompleksin pirstoutuminen etuseinäkytkennöissä oli selkeästi yleisempi löydös rasitusryhmässä. Tämä löydös oli erityisen merkittävä sepelvaltimotautipotilailla. Kolmas julkaisu sisältää tiedot sairaalan ulkopuolisista sydänpysähdyksistä Pohjois-Pohjanmaalla vuosina 2007–2012. Tässä aineistossa havaitsimme, että rasitukseen liittyvän sydänpysähdyksen alkurytmi oli useammin defibrilloitava, potilaat olivat nuorempia ja terveempiä, ja maallikkoelvytys aloitettiin useammin. Rasituksessa elottomaksi menneillä oli suhteellisen hyvä selviämisennuste. Neljännessä tutkimuksessa havaitsimme selkeästi paremman ennusteen niillä stabiilia sepelvaltimotautia sairastaneilla, jotka olivat liikunnallisesti aktiivisia. Sydänperäinen kuolleisuus oli pienempi myös niillä potilailla, jotka onnistuivat lisäämään liikunnallista aktiivisuuttaan. Samankaltainen tulos todettiin sydänperäisten äkkikuolemien osalta. Sepelvaltimotauti ja miessukupuoli ovat hyvin yleisiä löydöksiä, kun sydänperäinen äkkikuolema tapahtuu rasituksessa. Myös QRS-kompleksin pirstoutuminen etuseinäkytkennöissä liittyi rasitusperäisiin kuolemiin. Toisaalta potilaan ennuste selvitä on selkeästi parempi sydänpysähdyksen tapahtuessa rasituksessa. Osoitimme myös, että liikunnallinen aktiivisuus ja sen pienikin lisäys parantavat sepelvaltimotautipotilaiden ennustetta.

Made available in DSpace on 2014-06-11T19:22:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-17Bitstream added on 2014-06-13T20:09:59Z : No. of bitstreams: 1 papini_cb_me_rcla.pdf: 533751 bytes, checksum: 947e39c2977772360b0d7ec58b683ba9 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo desse estudo foi investigar associações entre nível, oferta de Atividade Física (AF) no trabalho e AF de lazer. Foi realizado um estudo transversal de base populacional. Participaram do estudo 864 trabalhadores com idade média e desviopadrão de 41 (± 13,4) anos, sendo 451 homens e 413 mulheres e eles responderam o Questionário Internacional de AF (versão longa– classificados em ativos e sedentários de acordo com o nível de AF de lazer), o Questionário baseado no modelo Transteorético (Estágios de Prontidão – classificados em fase de adoção e fase antecedentes), o Questionário sobre convênios e instalações para a prática de AF pela empresa e o Questionário sócio-demográfico. Para verificar as associações foi realizada a Regressão de Poisson no programa STATASE.10, obtendo a Razão de Prevalência (RP) com Intervalo de Confiança (IC - 95%). Como variáveis dependentes utilizamos o sedentarismo (nível de AF de lazer) e fase antecedentes (participação em AF de lazer). Para as variáveis independentes utilizamos: sexo, idade, índice de massa corporal (IMC), escolaridade, nível sócio-econômico, nível de AF no trabalho, oferta de ginástica laboral, participação na ginástica laboral e oferta de programas de condicionamento físico (PCF) através de convênios e instalações no local de trabalho. Os resultados indicam que os trabalhadores do sexo masculino são menos sedentários quando comparados com as trabalhadoras do sexo feminino. Para o sexo masculino, menor nível sócio-econômico está associado ao sedentarismo e a oferta de PCF oferecidos através de convênios está associada a níveis mais elevadosl de AF de lazer. Para o sexo feminino, maior IMC e menor nível sócio-econômico foram associados ao sedentarismo. Com relação a participação em AF de lazer o sexo feminino tem menos chances de estarem na fase de adoção... / The aim of this study was to investigate the associations between Physical Activity’s (PA) level and PA’s offer at worksite and Leisure time PA. The Population-based cross-sectional study was realized with 864 workers with average age and standard deviation 41 (± 13,4) years old, being 451 men and 413 women. They answered the International PA Questionnaire (long version – classified in activity and sedentary according to leisure time PA’s level), the Questionnaire based on Transteorethic Model (Stages of change – classified in adoption and antecedents phases), the Questionnaire about facilities and installations PA’s practice in the worksite and the demographic-status Questionnaire. The Poisson Regression in the STATASE.10 program, getting the Prevalence Ratio (PR) with Confident Interval (CI - 95%) was conducted to verify the associations between the variables. The dependents variables were the sedentarism (leisure time PA’s level) and antecedents phase (leisure time PA’s participation). For the independents variables were used: sex, age, body mass index (BMI), schooling level, social status, PA’s level in work, stretchbreak’s offer, stretch-break’s participation and fitness program’s (FP) through facilities and installations PA’s practice in the worksite. The results indicated that the male workers are less sedentary than female. For men the lower social status was associated with sedentarism and the FP facilities was associated with bigger leisure time PA’s level. For female, bigger IMC and lower social status were associates with sedentarism. About leisure time PA’s participation, the female has less chance to be in the adoption phase than male. The variables associated to leisure time PA’s participation for male are: bigger schooling and social status... (Complete abstract click electronic access below)

Population ageing and the tendency for older adults to have poorer health status than younger adults have raised concerns about potential increases in the number of elderly suffering disease and disability. Significantly, many health problems experienced in later life are associated with the onset of a more sedentary lifestyle. Increasing older adults' participation in leisure time physical activity (henceforth LTPA) offers an opportunity to reduce the prevalence of preventable morbidity in later life and offset a potential burden of ageing on the public health sector. As a forerunner to the development of strategies to increase older adults' LTPA participation, researchers have investigated the intrapersonal, interpersonal and, to a lesser extent, environmental influences on this health behaviour. Recent findings from studies of the adult population have suggested that neighbourhood deprivation, a measure of the socioeconomic conditions of small areas, may significantly influence LTPA participation. Extending previous findings, this research investigated how neighbourhood deprivation influenced older adults' LTPA participation. A total of 63 older adults were recruited from high- and low-deprivation neighbourhoods in Christchurch, New Zealand. Neighbourhoods were selected because of their relative positions on the New Zealand Deprivation Index and were characterised by the researcher as "East-town", a neighbourhood of high deprivation, and "West-town", a neighbourhood of low deprivation. The research incorporated a cross-sectional, comparative and mixed-methods approach. The methods of enquiry employed in this research included a recall survey, Q method, and semi-structured interviewing. Each method addressed a different aspect of the primary research question and provided data that was used in the creation of an integrated model depicting the influence of neighbourhood deprivation on older adults' LTPA participation. The results derived from the three research methods showed that older adults from the low-deprivation neighbourhood of West-town participated in LTPA more frequently than older adults from the high-deprivation neighbourhood of East-town. East-town was identified as having many physical and social environmental constraints to LTPA and comparatively few facilitators. Alternatively, West-town was found to have many physical and social environmental facilitators to LTPA and relatively few constraints. Neighbourhood attributes which appeared to influence older adults' LTPA participation included appropriateness of leisure provision, neighbourhood attractiveness, walkability, traffic, and perceptions of crime and antisocial behaviour. One implication of this research is that environmental interventions should be considered in attempts to engage older adults in LTPA for health purposes, particularly in high-deprivation neighbourhoods.

Abstract Despite advances in treatment of cardiovascular diseases, coronary heart disease (CHD) remains the most common cause of death in the Western countries; and its first manifestation is often sudden cardiac death (SCD). The development of CHD is a lifelong process, the pace of which is governed by the burden of several risk factors. The purpose of this study was to investigate the association of levels of cardiorespiratory fitness (CRF), exercise-induced myocardial ischemia and physical activity with the risk of CHD-related death, including SCD events among men with different risk factor profiles. This study is based on the population of the Kuopio Ischaemic Heart Disease Risk Factor Study, which recruited a sample of 2682 men aged 42–60 years. Their CRF was assessed with a maximal exercise test using respiratory gas analysis. Exercise-induced ST segment depression was defined as a ≥1 mm ST segment depression on the electrocardiogram. Anthropometric measurements, blood sample analyzes and questionnaires regarding leisure-time physical activity (LTPA) and smoking were performed at baseline. Men with both low CRF and exercise-induced ST segment depression were at higher risk of death from CHD and SCD than men with high CRF without ST segment depressions. Men with low CRF and low LTPA were at higher risk of SCD than men with low CRF and high LTPA. The amount of LTPA did not alter the incidence on SCD among men with high CRF. These findings were adjusted for age, type 2 diabetes and CHD, smoking, alcohol consumption, body mass index, systolic blood pressure, serum low density lipoprotein cholesterol, and serum C-reactive protein level. These findings emphasize the importance of physical activity and treatment of other modifiable risk factors, especially among the men with low CRF. / Tiivistelmä Sydän- ja verisuonisairauksien ennaltaehkäisystä ja hoidon edistysaskeleista huolimatta sepelvaltimotauti on edelleen kehittyneiden maiden yleisin kuolinsyy, sydänperäisen äkkikuoleman ollessa usein taudin ensimmäinen ilmentymä. Sepelvaltimotaudin syntyminen on pitkäaikainen prosessi, jossa riskitekijät määrittävät suurelta osin taudin etenemisen nopeuden. Tämän tutkimuksen tavoitteena oli selvittää kliinisessä rasituskokeessa todetun aerobisen suorituskyvyn, sydänlihasiskemian sekä fyysisen aktiivisuuden yhteyttä sepelvaltimotautikuolemiin ja sydänperäisiin äkkikuolemiin eri sydän- ja verisuonisairauksien riskitekijäyhdistelmien omaavien miesten keskuudessa. Tämä tutkimus perustuu Kuopio Ischaemic Heart Disease Risk Factor Study- aineistoon, johon kuuluu 2682 42–60 vuotiasta miestä. Tutkittavien aerobista suorituskykyä arvioitiin kliinisessä rasituskokeessa mittaamalla hapenkulutus suoraan hengityskaasuista. Sydänlihasiskemian merkkinä pidettiin rasituksen provosoimaa ≥1 mm ST-välin laskua tutkittavien EKG:ssa. Tutkittavilta kartoitettiin alussa antropometriset mittaukset, verikokeet sekä kyselylomakkeilla selvitettiin mm. vapaa-ajan liikunnan määrää ja tupakointia. Miehet, joilla todettiin huono suorituskyky sekä samanaikainen rasituksen aiheuttama sydänlihasiskemia olivat suuremmassa vaarassa menehtyä sepelvaltimotautiin ja sydänperäiseen äkkikuolemaan verrattuna miehiin, joilla todettiin hyvä suorituskyky eikä rasituksen aiheuttamaa sydänlihasiskemiaa. Miehet joilla todettiin huono suorituskyky, mutta harrastivat enemmän liikuntaa vapaa-ajalla, olivat pienemmässä vaarassa sydänperäiseen äkkikuolemaan kuin huonokuntoiset miehet, jotka harrastivat vähemmän liikuntaa vapaa-ajallaan. Vapaa-ajan liikunnan määrä ei muuttanut sydänperäisen äkkikuoleman esiintyvyyttä hyväkuntoisten miesten keskuudessa. Nämä tulokset vakioitiin iän, tyypin 2-diabeteksen, todetun sepelvaltimotaudin, tupakoinnin, alkoholin kulutuksen, painoindeksin, systolisen verenpaineen, seerumin LDL-kolesterolin ja C-reaktiivisen proteiinin suhteen. Nämä löydökset korostavat liikunnan harrastamisen tärkeyttä muiden riskitekijöiden hoidon ohessa, erityisesti lähtötasoltaan huonokuntoisilla miehillä.