Aslaug Angelsen

Background: Physical activity is a key component in public health frameworks to maintain functional ability through ageing. In Norway, healthcare services such as home health nursing and long-term institutional stays for older adults account for a significant amount of healthcare expenditures, but little is known about the association between physical activity levels through adulthood and utilisation of these services later in life. To this end, we wanted to explore an association between physical activity and the use of these specific healthcare services. Methods: We used data from three waves of the Trøndelag Health Study, that surveyed physical activity levels through questions about physical activity frequency, duration and intensity (HUNT1, 3 and 4). These questions allowed the calculation of minutes per week of moderate intensity physical activity, in addition to assessment of weekly physical activity frequencies (low-high). We included all who were either ≥ 65 years in HUNT3 or took part in all three surveys. Time-series of home health nursing and long-term institutional stays was collected from the combined Individual-based Statistics for Nursing and Care Services (IPLOS) and the Norwegian Registry for Primary Health Care (NRPHC) between 2007 and 2022. Multiple Cox proportional hazard models were built to assess the association between time to healthcare utilisation and physical activity levels. Results: Of the 15,737 participants who took part in HUNT1 and HUNT3, 9318 also participated in HUNT4. Moderate-intensity physical activity could be calculated for 8882 participants aged ≥ 65 years in HUNT3 (53% women), of whom 42.7% achieved the recommended ≥ 150 min per week. Physical activity frequency analysis included all 15,737 participants (55.7% women), of whom 43.4% increased their physical activity frequency between their first and last HUNT survey. Of the 9318 participants who took part in all three surveys, 40.8% received home health nursing care during follow-up, and 16.3% received long-term institutional stays. For participants who did not take part in HUNT4, the corresponding proportions were 76.5% and 41.8%. A potential dose-response relationship was seen between physical activity levels and healthcare utilisation, although not all comparisons were statistically significant. Conclusion: Individuals who partake in higher levels of leisure time physical activity had lower utilisation of home health nursing and long-term institutional stays. As most of the participants in our study did not comply with the nationally recommended ≥ 150 min of moderate physical activity per week, understanding what enables physical activity throughout life could help enable healthy ageing and reduce need for healthcare. Clinical trial number: Not applicable. Trial registration: Not applicable.

Background: With the global population growing older, there is a need for more knowledge of how to improve and/or maintain functional capacities to promote healthy ageing. In this study we aimed to assess the effect of several known health-promoting behaviors in old age with intrinsic capacity ten years later. Methods: This was a prospective cohort study looking at participants that were ≥ 65 years at the time of the third wave of the Trøndelag Health Study (HUNT3, 2006–2008) who also took part in the 70 + sub-study of the fourth wave (HUNT4 70+, 2017–2019). Self-reported behavior data from short questionnaires, including diet and physical activity, were collected in HUNT3, and data on the five domains of intrinsic capacity defined by the World Health Organization were collected in HUNT4 70+. A composite index was created for both healthy life and intrinsic capacity, awarding points for how well participants adhered to guidelines for healthy living and their level of functional impairment, respectively. Ordinal logistic regression was used to assess the relationship between health-promoting behaviors and intrinsic capacity. Results: Of 12,361 participants in HUNT3 ≥ 65 years, 4699 (56.5% women) also participated in HUNT4 70+. On the health-promoting behaviors, lowest adherence to healthy living guidelines were seen for fruit and vegetables intake (47.2%), milk intake (46.7%) and physical activity (31.1%). On intrinsic capacity domains, highest impairment was seen in the domains of locomotion (29.7%), hearing (11.1%) and vitality (8.3%). A higher adherence to guidelines for healthy living was associated with higher intrinsic capacity 10 years later. A one-point increase in the healthy life index was associated with a 1.15 (95% confidence interval 1.10–1.21) times increased odds of being in a higher intrinsic capacity category. Conclusion: Health-promoting behaviors in old age are associated with better intrinsic capacity ten years later. In clinical settings assessment of health-promoting behaviors could potentially be done using short questionnaires.

Contrary to food ingredients, little is known about recipes’ healthiness or environmental impact. Here we examine 600 dinner recipes from Norway, the UK and the USA retrieved from cookbooks and the Internet. Recipe healthiness was assessed by adherence to dietary guidelines and aggregate health indicators based on front-of-pack nutrient labels, while environmental impact was assessed through greenhouse gas emissions and land use. Our results reveal that recipe healthiness strongly depends on the healthiness indicator used, with more than 70% of the recipes being classified as healthy for at least one front-of-pack label, but less than 1% comply with all dietary guidelines. All healthiness indicators correlated positively with each other and negatively with environmental impact. Recipes from the USA, found to use more red meat, have a higher environmental impact than those from Norway and the UK.