Article
Physical activity, fatness, educational level and snuff consumption as determinants of semen quality: findings of the ActiART study

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Abstract

In this study, the association between physical activity and other potential determinants, objectively measured by accelerometry, was examined. Sixty-two men attending an infertility clinic participated in the study. Obese men (body mass index ≥ 30) and those with a waist circumference 102 cm or more had lower semen volume than the other men (P < 0.05). Higher values in sperm parameters were observed in participants who completed university studies and those who did not consume snuff, compared with the other participants (P < 0.05). Finally, men who spent an average number of 10 min-bouts of moderate-to-vigorous physical activity had significantly better semen quality than those who engaged in low or high numbers of bouts of activity (P < 0.05). No associations were found for sedentary or moderate-to-vigorous physical activity time when it was not sustained over 10 min, i.e. not in bouts. Men who have average levels of physical activity over sustained periods of 10 min are likely to have better semen quality than men who engage in low or high levels of such activity. Similarly, high levels of total and central adiposity, low educational level and snuff consumption are negatively related to semen quality.

Introduction

Infertility is an increasing public health problem, affecting about 15% of couples of fertile age (Boivin et al., 2007). Although reproductive abnormalities in the male partner are identified in about one-half of these cases, few risk factors for abnormal semen quality have been identified (Juul et al, 1999, Kovac et al, 2013). Emerging evidence suggests that lifestyle factors such as smoking (Ramlau-Hansen et al, 2007, Wegner et al, 2010), diet (Afeiche et al., 2014), physical activity (Hajizadeh Maleki et al, 2013, Vaamonde et al, 2006, Wise et al, 2011), overweight and obesity (Crujeiras, Casanueva, 2014, Sermondade et al, 2013), stress (Janevic et al., 2014), and sexual activity habits among others seem to have a cumulative effect on sperm quality (Wogatzky et al., 2012).

Physical activity is an efficient method for preventing weight gain, and has a broad and positive systemic influence, such as reducing the risk for cardiovascular diseases, stroke, type 2-diabetes, cancer and metabolic syndrome (US Department of Health and Human Services, 2008), and could therefore be potentially related to sperm quality. Closely related to physical activity is physical fitness, and particularly cardiorespiratory and muscular strength are considered powerful markers of health, as well as strong predictors of morbidity and mortality for cardiovascular disease and for all causes (Kodama et al, 2009, Ortega et al, 2012, Ruiz et al, 2008). Little information is available on whether fitness levels, e.g. cardiorespiratory fitness and muscular strength, are related to sperm quality.

As often happens in human physiology, too much or too little of something is not good. This is the case for body mass index (BMI) and semen quality, for which an inverted U-shape relationship has been proposed, i.e. too low or too high values of BMI are related to a poorer sperm quality (Jensen et al., 2004). This could also be the case for physical activity, as inactivity and sedentary lifestyle have a well-known harmful effect on many health outcomes (Pate et al., 2008), whereas too much physical activity has been negatively associated with semen quality (De Souza et al, 1994, Safarinejad et al, 2009, Vaamonde et al, 2006). In this context, recent studies support that recreationally active men have a healthier semen production than non-active men, but also than elite athletes, suggesting a U-shape relationship (Hajizadeh Maleki et al, 2013, Vaamonde et al, 2012).

The few studies analysing the association between regular physical activity and semen quality have shown inconclusive results (Braga et al, 2012, De Souza et al, 1994, Hajizadeh Maleki et al, 2013, Safarinejad et al, 2009, Vaamonde et al, 2006, Vaamonde et al, 2012, Wise et al, 2011, Wogatzky et al, 2012). Most of these studies have used self-report methods to assess physical activity, i.e. questionnaires. Therefore, new empirical and objective data about physical activity and sperm quality are needed to better understand the role of physical activity in male reproductive health.

In the present study, the association of objectively measured physical activity was analysed using accelerometry, with semen quality indicators among men attending an infertility clinic. In addition, the effect of other potentially related factors, such as fatness markers, educational level, television watching, consumption of smokeless tobacco (snuff, which is highly consumed in Nordic countries), handgrip strength and self-reported fitness were studied.

Section snippets

Study sample and design

Male participants from the Physical Activity and Assisted Reproductive Technology (ActiART) project were enrolled in the present study. Data were collected from the Centre for Reproduction at Uppsala University Hospital, Sweden between February 2011 and January 2014. As couples undergoing infertility treatment might change their everyday physical activity levels during the treatment period (Kucuk et al., 2010), only participants who were attending the clinic for the first time were recruited,

Characteristics

Characteristics of the study sample are shown in Table 1. A total of 53.2% (n = 33) of participants were overweight or obese (12.9%, n = 8, of them obese) and 18% (n = 11) had a waist circumference above the recommended limit of 102 cm. Mean time spent in MVPA was 53.2 min/d and in sedentary time was 11.7 h/d. The mean value of each semen parameter was above the WHO reference value for semen characteristics (36), whereas 27.4% (n = 17) of the participants had one parameter or more below these

Discussion

This study analysed the relationship of objectively measured physical activity, muscular strength, self-reported fitness, total and central adiposity and lifestyle variables such as educational level, employment status, snuff consumption, and television-watching, with semen quality parameters among men attending an infertility clinic. Several major findings were obtained: (i) higher BMI and waist circumference were related with semen volume, but not with the rest of semen parameters studied;

Acknowledgements

The authors thank all individuals for their participation. This work was supported by Karolinska Institutet Foundation grants [Refs: 2011FoBi1184]; Estonian National Kristjan Jaak scholarship program, implemented by the Archimedes Foundation [Refs: 16-3.5/1080]; Spanish Ministry of Economy and Competitiveness [RYC-2010-05957; RYC-2011-09011]; European Research Council, Marie Curie Actions, Intra-European Fellowships (IEF) [FP7-PEOPLE-2012-IEF, Ref. No. 329812]; grants from Uppsala University;

Signe Altmäe is a post-doctoral fellow at the University of Granada, School of Medicine and a part-time researcher at the Competence Centre on Health Technologies. Her research interests are female and male infertility, endometrial receptivity, early pregnancy establishment and supplementation during pregnancy.

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    Signe Altmäe is a post-doctoral fellow at the University of Granada, School of Medicine and a part-time researcher at the Competence Centre on Health Technologies. Her research interests are female and male infertility, endometrial receptivity, early pregnancy establishment and supplementation during pregnancy.

    1

    TP and RGR contributed equally to this work.

    2

    FBO and SA contributed equally to this work.

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