Häkkinen et al.

Health and Quality of Life Outcomes 2010, 8:15

http://www.hqlo.com/content/8/1/15

RESEARCH Open Access

Association of physical fitness with health-related

quality of life in Finnish young men
Arja Häkkinen1,2*, Marjo Rinne3, Tommi Vasankari3,4, Matti Santtila5, Keijo Häkkinen6, Heikki Kyröläinen6

Abstract
Background: Currently, there is insufficient evidence available regarding the relationship between level of physical
fitness and health-related quality of life (HRQoL) in younger adults. Therefore, the aim of the present study was to
investigate the impact of measured cardiovascular and musculoskeletal physical fitness level on HRQoL in Finnish
young men.
Methods: In a cross-sectional study, we collected data regarding the physical fitness index, including aerobic
endurance and muscle fitness, leisure-time physical activity (LTPA), body composition, health, and HRQoL (RAND
36) for 727 men [mean (SD) age 25 (5) years]. Associations between HRQoL and the explanatory parameters were
analyzed using the logistic regression analysis model.
Results: Of the 727 participants who took part in the study, 45% were in the poor category of the physical fitness,
while 37% and 18% were in the satisfactory and good fitness categories, respectively. A higher frequency of LTPA
was associated with higher fitness (p < 0.001). Better HRQoL in terms of general health, physical functioning,
mental health, and vitality were associated with better physical fitness. When the HRQoL of the study participants
were compared with that of the age- and gender-weighted Finnish general population, both the good and
satisfactory fitness groups had higher HRQoL in all areas other than bodily pain. In a regression analysis, higher
LTPA was associated with three dimensions of HRQoL, higher physical fitness with two, and lower number of
morbidities with all dimensions, while the effect of age was contradictory.
Conclusions: Our study of Finnish young men indicates that higher physical fitness and leisure-time physical
activity level promotes certain dimensions of HRQoL, while morbidities impair them all. The results highlight the
importance of health related physical fitness while promoting HRQoL.

Background physical activity at work [3]. The decrease in occupa-

The sedentary lifestyle presents a major public health tional and commuting physical activities should be com-
challenge that must be met in order to prevent obesity pensated by an increase in LTPA as there is strong
and thus enhance health and well-being [1]. For sub- evidence regarding the protective effects of regular
stantial health benefits, current guidelines for adults LTPA and a high level of physical fitness against major
recommend at least 2.5 hours of moderate-intensity or chronic diseases such as coronary heart disease, hyper-
1.25 hours of vigorous-intensity aerobic physical activity tension, stroke, noninsulin-dependent diabetes mellitus,
per week. Futher, moderate- or high-intensity muscle- osteoporosis, depression, and anxiety among others
strengthening activities for all major muscle groups two [4-7].
or more days a week provide additional health benefits A systematic review has reported a consistent associa-
[2]. According to the 2005 Eurobarometer on Health tion of higher health-related quality of life (HRQoL)
and Food, 41% of adults in EU-15 countries reported no scores with higher PA levels among healthy adults [1].
moderate level physical activity in the past week and Physical activity has enhanced well-being and increasing
over half (59%) of the EU population get little or no physical functioning also in people with poor health [8]
or of advanced age [9]. Also higher physical fitness level
* Correspondence: [email protected] has been shown to be associated with higher levels of
1
Department of Physical Medicine and Rehabilitation, Central Hospital,
Jyväskylä, Finland HRQoL in the older and chronically diseased

© 2010 Häkkinen et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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populations [10-12]. However, there is insufficient evi- Finnish general population was used as a reference
dence regarding the relationship between physical fitness study group [14].
level and HRQoL in younger adults. One recent study Physical fitness index (PFI)
has reported associations between cardiorespiratory fit- Oxygen uptake (VO2max) was indirectly measured using
ness and HRQoL in young males in United States navy. a bicycle ergometer test (Ergoline 800 S, Ergoselect 100
They found a positive relationship between submaximal K or 200 K, Bitz, Germany) [15]. The handlebars and
fitness test and mental and physical components of seats were individually adjusted. After a 5-min warm up,
HRQoL [13]. There is still limited evidence on relation- the test began with a power output of 75 W, which was
ships of objectively measured fitness and individual increased by 25 W after every other minute. The pedal-
domains of HRQoL. Therefore, the aim of the present ling rate of 60 rpm was maintained throughout the test.
study was to investigate the impact of measured cardio- The heart rate (HR) was recorded continuously (Polar
vascular and musculoskeletal physical fitness level on Vantage NV or S610, S710 or S810, Kempele, Finland).
HRQoL in Finnish young men. The test was terminated at volitional exhaustion, includ-
ing a decrease in the pedalling rate to below 50 rpm.
Methods Predicted VO 2 max was determined from the HR and
The study participants were enrolled from April 2008 to power (Fitware, Mikkeli, Finland), as follows: VO2max
November 2008 during eighth refresher course orga- (ml·kg -1 ·min -1 ) = [(P max * 12.48) + 217]/body mass,
nized in different counties around the country; thus, where Pmax is maximal power. The test-retest repeat-
they geographically represent the entire country. Of ability was r = 0.89 and 0.96 for women and men,
1,155 invited reservists, 922 participated in the courses respectively [16].
and 845 men volunteered for the present study. During Muscle fitness was measured by four consecutive
the analysis phase, a further 118 participants were tests: grip strength, push-ups, sit-ups, and repeated
excluded because they had missed physical fitness tests squats [14]. Before testing commenced, supervisors
(if any of the endurance or muscle fitness test results demonstrated the technically correct way to perform
were missing, the physical fitness index [PFI] could not each test; they also controlled the performance techni-
be calculated). Thus, the final study group consisted of que of each person. Isometric grip strength was mea-
727 men with mean (SD) age of 25 (5) years. The parti- sured in a sitting position (90° elbow angle) by a
cipants signed a written consent form indicating that dynamometer (Saehan Corporation, Masan, South
they were aware of the risks and benefits of the study. Korea). The test was repeated twice separately for both
The study was approved by the ethical committees of hands; the best results for the right and left hands were
the University of Jyväskylä and the Central Finland averaged for the outcome [17]. Sit-ups, which measure
Health Care District, as well as the Headquarters of the performance of abdominal and hip-flexor muscles, were
Finnish Defence Forces. done with each subject lying supine on the floor with
his hands behind the neck and directing his elbows for-
Measurements ward. The knees were flexed at an angle of 90°, the legs
HRQoL were slightly apart, and the assistant supported the
In public health and in medicine, the concept of health- ankles. During the movement, the each subject lifted his
related quality of life refers to a person’s or group’s per- upper body and touched his elbows to the knees. Push-
ceived physical and mental health over time. In this ups, which measure performance of arm- and shoulder-
study HRQoL data were collected using the Finnish extensor muscles, were started from the lowest face-
Rand 36-item health survey 1.0, which was developed down position. Each subject’s hands were kept
from the original 36-Item Short Form Health Survey shoulder-wide and level. The fingers were directed for-
(SF-36) [14]. RAND-36 measures eight dimensions: gen- ward, and the legs were kept parallel and close to each
eral health, physical functioning, role limitation physical, other. During the movement, the arms were fully
role limitation emotional, vitality, mental health, social extended and the torso was straightly tensed. In the sec-
functioning, and bodily pain. There is a 0-100 range in ond phase, the torso was lowered down to an elbow
each subscale, with higher scores indicating higher angle of 90°. Repetitive squats measure the strength of
HRQoL. The reliability and validity of the scale has the knee extensors. The subject was standing with feet
reported to be good (Cronbach’s alpha coefficients for 8 just inside shoulder width apart and squat was per-
dimensions varied between 0.80 and 0.94), but ceiling formed until the thighs were horizontal. The results of
effects were detected for physical functioning, role lim- the push-ups, sit-ups, and repeated squats were
itation physical and social functioning dimensions and expressed as the number of correctly performed repeti-
floor effect for role limitation physical, role limitation tions within 60 s. The recovery time between each of
emotional dimensions [14]. The age- and sex-weighted the tests was 5-10 min.
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In PFI calculations the absolute results for each mus- were discovered by asking the respondents if they had
cle fitness test were scored to corresponding fitness pulmonary or heart disease, hypertension, inflammatory
categories from poor (1.0-1.9) to excellent (5.0-5.9). The joint disease, or musculoskeletal disease. Self-perceived
total muscle fitness index was the sum of 4 muscle fit- general health was assessed using a visual analogue
ness tests. Finally PFI was determined utilizing an scale, and self-perceived physical fitness compared to
adjusted nomogram” where aerobic fitness and muscle age mates was asked using five categories (highly lower,
fitness are equally important (50 and 50%). Accordingly, somewhat lower, equal, somewhat better, highly better).
the PFI also had five different categories: excellent (5.0-
5.9), good (4.0-4.9), satisfactory (3.0-3.9), fair (2.0-2.9), Statistics
and poor (1.0-1.9). For statistical analyses, the PFI was The results are provided as means with standard devia-
categorized as poor (combination of categories fair and tion (SD) or 95% confidence level (CI). The normality of
poor), satisfactory, or good (good and excellent) [17]. variables was evaluated by Kolmogorov-Smirnoff test
The reference values are based on the results of 3635 and by means of histograms. The statistical significance
civilians and include 5 year age-specific categories [18]. of characteristics among the groups was evaluated by
These VO2max and muscle fitness tests have been used analysis of variance (ANOVA). If the variables did not
during this past decade (2000-2009) in the Finnish fill normality assumptions, Kruskal-Wallis nonpara-
Defense Forces in order to follow-up the fitness compo- metric test with appropriate pair-wise comparisons or
nents of professional soldiers and reservists and, in addi- chi-square test was used. The Finnish population values
tion, to find out the general population based trends in for the eight dimensions were weighted to match the
fitness changes. age distribution of the study population. Associations
LTPA between HRQoL and the explanatory parameters (age,
The frequency and intensity of weekly LTPA was deter- LTPA, BMI, tobacco use, and morbidities) were ana-
mined from responses to a single question with six cate- lyzed using the logistic regression analysis model. Before
gories: (1) no physical activity at all, (2) some physical regression analysis Spearman’s Rank correlation coeffi-
activity without feeling out of breath or sweating, (3) cient was used to give an indication of the magnitude of
physical activity with feeling out of breath or sweating association (collinearity) between explanatory variables
once a week, (4) physical activity with feeling out of and they were considered highly associated if their cor-
breath or sweating twice a week, (5) physical activity relation coefficient was greater than 0.7.
with feeling out of breath or sweating three times a
week, and (6) physical activity with feeling out of breath Results
or sweating at least four times a week. In the analysis, When the participants were grouped according their
the participants were recorded to three groups accord- objectively measured physical fitness indices (PFI) 45%
ing their physical activity level: low (combination of of them belong to the poor, 37% to the satisfactory and
LTPA categories 1 and 2), moderate (categories 3 and 18% to the good fitness category. The mean (SD) PFIs
4), or high (categories 5 and 6) [16]. were 2.44 (0.35), 3.43 (0.28), and 4.61 (0.47), respec-
Health examination tively. The mean (SD) age of all of the participants was
Height and weight were measured while the participants 25 (5) years (range 20-47). Mean (SD) BMI was 25 (4)
were wearing lightweight clothing. Body mass index (range 16.8-43.1); 60% of the participants had a normal
(BMI) was classified in five categories: severe obesity, BMI, 31% were overweight, and 9% were obese. Men in
≥35.0; obesity, 30.0-34.9; overweight, 25.0-29.9; normal higher PFI categories had a lower BMI and a lower pro-
19.0-24.9; and underweight, ≤18.9. Body fat and lean portion of body fat (Table 1). The correlation between
mass percentages were recorded using the eight-polar BMI and body fat was 0.81 (0.79 to 0.84). The lean body
bioimpedance method with multifrequency current mass proportion did not differ among the PFI groups.
(InBody 720; Biospace Company, Seoul, Korea). Bioim- The proportion of tobacco use increased with decreas-
pedance was performed in the postabsorbtive state after ing PFI. Self-perceived general health was lower in the
a 12-hour overnight fast and the day preceding the mea- poor PFI group. The number of other morbidities did
surement day was a rest day from intensive exercise. For not differ among the groups. The most commonly
men the test-retest reliability of the device has shown to reported morbidities were musculoskeletal disease (n =
be high (ICC 0.9995) and no significant mean (SD) dif- 171), pulmonary or heart disease (n = 45), and hyperten-
ference was found for body fat between two trials [20.98 sion (n = 34).
(8.88)% and 21.00 (8.83)% [18]. In the poor objectively measured PFI group, 45% of
Alcohol and tobacco product use was determined by a the participants graded their self-perceived physical fit-
questionnaire. In addition, a number of self-reported ness as lower compared to age mates, while 9% graded
morbidities that had been diagnosed by medical doctors it as higher (Table 1). In the good PFI group, the
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Table 1 Sample characteristics by physical fitness index

Variable Physical fitness index P-value between
the groups
Poor Satisfactory Good
(n = 328) (n = 271) (n = 128)
Age in years, mean (SD) 25 (3) 25 (5) 27 (7) 0.29
Weight, kg, mean (SD) 85 (15) 78 (10) 73 (9) < .0.001
Height, cm, mean (SD) 180 (6) 180 (6) 179 (6) 0.19
Body mass index, n (%) < .0.001 *
<19 8 (3) 8 (3) 3 (2)
19-24.9 138 (42) 173 (64) 106 (83)
25-29.9 127 (39) 79 (29) 18 (14)
≥30 53 (16) 11 (4) 1 (1)
Body fat, mean (SD) 21.3 (6.9) 16.1 (5.7) 12.0 (4.5) < 0.001
Lean body mass, mean (SD) 65.9 (8.2) 65.3 (7.1) 64.3 (6.6) 0.19
Alcohol users ≥ once a week, n (%) 219 (67) 175 (65) 74 (58) 0.20
Tobacco users, n (%) 161 (49) 85 (32) 20 (16) < 0.001
Snuff users, n (%) 12 (4) 20 (7) 4 (3) 0.062
Self perceived general health, mean(SD) 25 (19) 21 (18) 18 (15) < 0.001
Self-reported morbidities, n (%) 110 (33) 82 (30) 40 (31) 0.72 *
Self perceived physical fitness compared to age mates, n (%) < 0.001 *
Highly lower 6 (2) 3 (1) 0(0)
Somewhat lower 141 (43) 23 (9) 2 (1)
Equal 152 (46) 128 (47) 41 (32)
Somewhat better 27 (8) 96 (35) 61 (48)
Highly better 2 (1) 21 (8) 24 (19)
Self-reported leisure time physical activity, n (%) < 0.001
Low 159 (48) 53 (20) 8 (6)
Moderate 134 (41) 109 (40) 44 (34)
High 36 (11) 108 (40) 76 (59)
ANOVA or it’s nonparametric equivalent Kruskall-Wallis-test
* Chi-square

respective proportions were 1% and 67%. A higher fre- was associated with better physical functioning, while
quency of LTPA was associated with a higher PFI. The higher age with better role limitation emotional, vitality,
correlation between PFI and LTPA was 0.49 (95% CI and mental health.
0.44-0.55).
A higher HRQoL score in the general health, physical Discussion
functioning, vitality and mental health, dimensions was Results of the present study showed in a relatively large
associated with a higher PFI (Table 2). When the sample of Finnish men that higher PFI was associated
HRQoL of the participants was compared with that of with more favorable scores in the general health, physi-
the age- and gender-weighted Finnish population both cal functioning, mental health, and vitality dimensions
the good and the satisfactory PFI participants had a of HRQoL. The importance of PFI was supported by
higher HRQoL than the general population in all of the our finding that the good and satisfactory PFI groups
dimensions except for bodily pain (Figure 1). In the had a higher HRQoL score in all of the dimensions
poor physical fitness group, role limitation physical, except for bodily pain, compared to the reference values
mental health and social functioning dimensions were of the age- and gender-weighted Finnish population.
on a higher level compared to the general population. The lack of difference in the bodily pain dimension may
Regression analysis revealed that a lower number of reflect the fact that the number of morbidities did not
morbidities was related to a higher HRQoL in all eight differ among the fitness categories. Previous studies
dimensions (Table 3). Both higher PFI and LTPA were have shown that cardiorespiratory fitness is associated
associated with general health and physical functioning with physical functioning in 40-65-year-old participants
and higher LTPA with the vitality dimension. Lower age with diabetes [19] and 40-60-year-old Finnish men
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Table 2 Health related quality of life (RAND-36) in 727 Finnish young men according to their physical fitness index
(PFI)
PFI-groups P-value between the groups*
Low Satisfactory High
Mean (95% Cl) Mean (95% Cl) Mean (95% Cl)
General health perception 70.0 (67.4 to 72.5) 74.5 (72.4 to 76.7) 74.2 (72.2 to 76.3) < 0.001
Physical functioning 95.2 (94.0 to 96.3) 95.5 (94.6 to 96.4) 97.6 (96.3 to 98.9) < 0.001
Role limitation physical 93.9 (91.1 to 96.8) 92.4 (89.1 to 95.8) 91.9 (88.9 to 94.7) 0.98
Role limitation emotional 87.9 (83.6 to 92.2) 89.5 (85.4 to 93.6) 93.9 (90.8 to 97.0) 0.78
Vitality 68.5 (65.6 to 71.5) 74.5 (72.2 to 76.7) 71.3 (69.3 to 73.3) 0.034
Mental health 78.8 (76.5 to 81.1) 81.179.0 to 83.1) 78.6 (76.8 to 80.4) 0.029
Social functioning 90.9 (88.4 to 93.5) 88.8 (86.4 to 91.1) 92.8 (90.9 to 94.7) 0.32
Bodily pain 80.6 (77.7 to 83.4) 81.6 (79.3 to 83.9) 79.3 (76.8 to 81.8) 0.35
* Kruskall-Wallis test

working in blue-collar occupations [6]. When we higher levels of LTPA were associated with certain
repeated regression analysis of our study group and HRQoL dimensions [20-22]. Vuillemin et al. (2005)
entered VO2max and muscle fitness index separately in reported that in men, LTPA was related to all of the
the model, instead of combined PFI, VO2max was asso- other dimensions except for emotional role functioning
ciated with general health perception and muscle fitness [20]. Wendel-Vos et al. (2004) showed that meeting
index was associated with physical functioning and gen- recommended levels of physical activity (at least 30 min-
eral health perception (data not shown). A recent study utes of moderate LTPA per day) was associated with
including healthy 18-49 years old men from United higher HRQoL scores in all dimension [22]. When inter-
States navy showed a positive relationship between sub- preting our results and the results of others, it is impor-
maximal exercise test and mental and physical health tant to note that some participants may under- or
components of HRQoL [13]. overestimate the intensity of their LTPA. In the present
The results presented here provide support for earlier study, over half of the participants in the poor PFI cate-
findings of cross-sectional studies, which showed that gory reported that their LTPA was moderate or high,

Figure 1 Health-related quality of life dimensions (SF-36) of Finnish young men compared to age-matched male population. (means
with 95 percent confidence intervals). Line shows age adjusted values of general population.
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Table 3 Logistic regression analysis of eight HRQoL dimensions (RAND-36).

General health Physical Role limitation Role limitation Vitality Mental Social Bodily pain
perception functioning physical emotional health functioning
Age 0.98 (0.94 to 1.01) 0.96(0.92 to 1.00(0.95 to 1.04) 1.05(1.00 to 1.10)* 1.08(1.03 to 1.05(1.01 to 1.02(0.98 to 0.98(0.94 to
0.99)* 1.12)* 1.09)* 1.06) 1.01)
PFI 1.63 (1.27 to 2.09)* 1.56(1.19 to 1.05(0.77 to 1.43) 1.09(0.84 to 1.42) 1.15(0.91 to 1.01(0.80 to 1.09(0.87 to 1.09(0.86 to
2.05)* 1.45) 1.28) 1.37) 1.39)
LTPA 1.27 (1.12 to 1.43)* 1.28(1.12 to 0.99(0.85 to 1.16) 1.03(0.90 to 1.17) 1.12(1.00 to 1.01(0.90 to 1.05(0.93 to 1.08(0.96 to
1.46)* 1.26)* 1.14) 1.17) 1.22)
BMI 1.01 (0.96 to 1.06) 0.98(0.93 to 1.01(0.95 to 1.08) 1.01(0.96 to 1.07) 1.04(0.99 to 1.02(0.97 to 1.05(1.00 to 1.00(0.96 to
1.03) 1.09) 1.07) 1.10) 1.06)
Morbidities 0.47 (0.33 to 0.65)* 0.30(0.21 to 0.39(0.26 to 0.59) 0.60(0.42 to 0.85)* 0.61(0.44 to 0.62(0.45 to 0.56(0.41 to 0.24(0.17 to
0.43)* * 0.84)* 0.86)* 0.77)* 0.34)*
Only those variables are shown which were entered into model.

while some of the participants in the good PFI category even in late adolescent college students thus increasing
reported that it was low. Some respondents may not the risk of chronic diseases later in life [27].
perceive their activity as sufficiently moderate or vigor- Morbidities were an important explanatory variable of
ous, and may have underestimated their LTPA level. the impairments found in all eight HRQoL dimensions.
Likewise, some respondents may have misreported their The diseases that were reported decreased the physical,
PA levels to reflect the socially desirable nature of PA mental, and social functioning of the participants. A
participation; thus, they may have overestimated their previous study showed that musculoskeletal pain has a
LTPA level [23]. However, we found that both self- negative effect on the HRQoL of elderly people living in
reported LTPA levels and measured PFIs were asso- Turkey [28]. A German study found that general prac-
ciated with the general health perception and physical tice patients with chronic diseases had impaired quality
functioning dimension. Our finding that LTPA was also of life, particularly with regard to physical health [29].
associated with vitality dimension is supported by a The independent effects of the morbidities on HRQoL
review by Puetz (2006) showing that people who are varied depending upon the type of chronic disease:
physically active in their leisure time have about a 40% HRQoL appeared to be more affected by diseases such
reduced risk of experiencing feelings of low energy and as depression, back pain, osteoarthritis of the knee, and
fatigue compared to sedentary people [24]. cancer than by hypertension and diabetes [30]. Asymp-
In the good PFI group, we found that the proportion tomatic status and health risks such as hypertension or
of body fat was lower than in the low PFI group. How- MBO were reported to be less likely to affect quality of
ever, the amount of lean body mass did not differ life [29,31], while study participants were more con-
among the PFI groups, although BMI increased with scious of and thus affected by physical medical symp-
decreasing PFI. BMI was not associated with HRQoL. toms leading to a discernable limitation in performance
Further, when the percentage of body fat was entered [32,33].
into the regression model instead of BMI, the only sta- In Finland a universal male conscription is in place,
tistically significant association we found was that a high under which all men above 18 years of age serve for 6, 9
body fat percentage was associated with the better men- or 12 months, these reservists which are invited to the
tal health dimension (data not shown). The findings of refresher courses represent rather well Finnish young
previous studies of the effect of body weight on HRQoL men. Some of the reservists from which we drew our
are controversial. Some studies have reported that obese study participants were unable to attend the courses
adolescents have a poorer HRQoL than lean individuals because of personal or social reasons or health condi-
[25]. On the other hand, in accordance with our results, tions, or because they were living abroad. Thus, a limita-
other studies did not find a significant relationship tion of the present study is that we do not know the
between BMI and HRQoL [26]. These confounding characteristics of those reservists who did not enter the
results of different studies may be partly explained by courses. It was previously suggested that males may
differences in the gender, sample size, age, and range of underestimate problems of functional capacity and pain
BMI of the participants. Furthermore, it is possible for a on questionnaires [32,34], which may also have affected
healthy, well-trained muscular individual with very low the data regarding our study participants. The range of
body fat to be classified as obese using the BMI formula. the age was 20-47 years. Increasing age does not neces-
However, higher body fatness and lower physical fitness sarily cause a reduction in the quality of life, but it may
has reported to be associated with metabolic risk factors shift the emphasis of it as shown with the present data.
Although 32% of the participants had self-reported
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This work was supported by The Scientific Committee for National Defense 17. Kyröläinen H, Häkkinen K, Kautiainen H, Santtila M, Pihlainen K, Häkkinen A:
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Author details Occup Med (Lond) 2008, 58:251-256.
1
Department of Physical Medicine and Rehabilitation, Central Hospital, 18. Kyröläinen H, Häkkinen A, Kautiainen H, Santtila M, Pihlainen K, Häkkinen K:
Jyväskylä, Finland. 2Department of Health Sciences, University of Jyväskylä, Puolustusvoimien palkatun henkilöstön fyysistä suorituskykyä mittaavan
Jyväskylä, Finland. 3UKK-Institute for Health Promotion Research, Tampere, testimenetelmän viitearvoluokittelun ja kuntoindeksin validointitutkimus.
Finland. 4The National Institute for Health and Welfare, Helsinki, Finland. Fyysisen kunnon, painoindeksin ja sairauspoissaolojen väliset yhteydet.
5
Defence Command, Personnel Division, Finnish Defence Forces, Finland. Pääesikunta, Koulutusosasto 2006, ISBN 951-25-1677-2.
6
Department of Biology of Physical Activity, University of Jyväskylä, Jyväskylä, 19. Bennett WL, Ouyang P, Wu AW, Barone BB, Stewart KJ: Fatness and fitness:
Finland. How do they influence health-related quality of life in type 2 diabetes
mellitus?. Health Qual Life Outcomes 2008, 6:110.
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Mokdad AH: Associations between short- and long-term unemployment
Competing interests and frequent mental distress among a national sample of men and
The authors declare that they have no competing interests. women. J Occup Environ Med 2003, 45:1159-1166.
22. Wendel-Vos GC, Schuit AJ, Tijhuis MA, Kromhout D: Leisure time physical
Received: 8 July 2009 activity and health-related quality of life: Cross-sectional and
Accepted: 29 January 2010 Published: 29 January 2010 longitudinal associations. Qual Life Res 2004, 13:667-677.
23. Brown DW, Balluz LS, Giles WH, Beckles GL, Moriarty DG, Ford ES,
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doi:10.1186/1477-7525-8-15
Cite this article as: Häkkinen et al.: Association of physical fitness with
health-related quality of life in Finnish young men. Health and Quality of
Life Outcomes 2010 8:15.

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