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Ekblom Bak, E., Ekblom, Ö., Andersson, G., Wallin, P., Söderling, J., Hemmingsson, E. & Ekblom, B. (2019). Decline in cardiorespiratory fitness in the Swedish working force between 1995 and 2017.. Scandinavian Journal of Medicine and Science in Sports, 29(2), 232-239
Open this publication in new window or tab >>Decline in cardiorespiratory fitness in the Swedish working force between 1995 and 2017.
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2019 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, no 2, p. 232-239Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Long-term trend analyses of cardiorespiratory fitness (VO2 max) in the general population are limited.

OBJECTIVES: To describe trends in VO2 max from 1995 to 2017 in the Swedish working force and to study developments across categories of sex, age, education, and geographic regions.

METHODS: 354.277 participants (44% women, 18-74 years) who participated in a nationwide occupational health service screening between 1995 and 2017 were included. Changes in standardized mean values of absolute (L·min-1 ) and relative (ml·min-1 ·kg-1 ) VO2 max, and the proportion with low (<32) relative VO2 max are reported. VO2 max was estimated using a submaximal cycle test.

RESULTS: Absolute VO2 max decreased by -6.7% (-0.19 L·min-1 ) in the total population. Relative VO2 max decreased by -10.8% (-4.2 ml·min-1 ·kg-1 ) with approximately one-third explained by a simultaneous increase in body mass. Decreases in absolute fitness were more pronounced in men vs. women (8.7% vs. 5.3%), in younger vs. older (6.5% vs 2.3%), in short (11.4%) vs. long (4.5%) education, and in rural vs. urban regions (6.5% vs 3.5%), all p<0.001. The proportions with low VO2 max increased from 27% to 46% (p<0.001).

CONCLUSION: Between 1995 and 2017, there was a steady and pronounced decline in mean cardiorespiratory fitness in Swedish adults. Male gender, young age, short education and living in a rural area were predictive of greater reductions. The proportion with low cardiorespiratory fitness almost doubled. Given the strong associations between cardiorespiratory fitness and multiple morbidities and mortality, preventing further decreases is a clear public health priority, especially for vulnerable groups. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Maximal oxygen consumption, VO2max, aerobic capacity, population, secular trend
National Category
Physiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5460 (URN)10.1111/sms.13328 (DOI)30351472 (PubMedID)
Projects
HPI-gruppen
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2019-01-18Bibliographically approved
Holmlund, T., Ekblom Bak, E., Franzén, E., Hultling, C. & Wahman, K. (2019). Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.. Spinal Cord
Open this publication in new window or tab >>Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.
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2019 (English)In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624Article in journal (Refereed) Epub ahead of print
Abstract [en]

STUDY DESIGN: Descriptive.

OBJECTIVE: The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP).

SETTINGS: Rehabilitation facility in Sweden.

METHODS: The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses.

RESULTS: The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP.

CONCLUSION: This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.

Place, publisher, year, edition, pages
Nature Publishing Group, 2019
National Category
Physiotherapy
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5806 (URN)10.1038/s41393-019-0308-y (DOI)31243318 (PubMedID)
Projects
Energiomsättning hos ryggmärgsskadade
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved
Fridolfsson, J., Börjesson, M., Buck, C., Ekblom, Ö., Ekblom Bak, E., Hunsberger, M., . . . Arvidsson, D. (2019). Effects of Frequency Filtering on Intensity and Noise in Accelerometer-Based Physical Activity Measurements.. Sensors, 19(9), Article ID E2186.
Open this publication in new window or tab >>Effects of Frequency Filtering on Intensity and Noise in Accelerometer-Based Physical Activity Measurements.
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2019 (English)In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 19, no 9, article id E2186Article in journal (Refereed) Published
Abstract [en]

In objective physical activity (PA) measurements, applying wider frequency filters than the most commonly used ActiGraph (AG) filter may be beneficial when processing accelerometry data. However, the vulnerability of wider filters to noise has not been investigated previously. This study explored the effect of wider frequency filters on measurements of PA, sedentary behavior (SED), and capturing of noise. Apart from the standard AG band-pass filter (0.29-1.63 Hz), modified filters with low-pass component cutoffs at 4 Hz, 10 Hz, or removed were analyzed. Calibrations against energy expenditure were performed with lab data from children and adults to generate filter-specific intensity cut-points. Free-living accelerometer data from children and adults were processed using the different filters and intensity cut-points. There was a contribution of acceleration related to PA at frequencies up to 10 Hz. The contribution was more pronounced at moderate and vigorous PA levels, although additional acceleration also occurred at SED. The classification discrepancy between AG and the wider filters was small at SED (1-2%) but very large at the highest intensities (>90%). The present study suggests an optimal low-pass frequency filter with a cutoff at 10 Hz to include all acceleration relevant to PA with minimal effect of noise.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
ActiGraph, Axivity, I.Family, LIV-2013, adults, calibration, children
National Category
Medical Laboratory and Measurements Technologies Sport and Fitness Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5745 (URN)10.3390/s19092186 (DOI)000469766800230 ()31083538 (PubMedID)
Projects
Mätning av det dagliga aktivitetsmönstret
Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-08-20
Lidin, M., Hellénius, M.-L., Ekblom Bak, E. & Rydell Karlsson, M. (2019). Experiences from individuals with increased cardiovascular risk participating in a one-year lifestyle program.. European Journal of Cardiovascular Nursing, Article ID 1474515119848967.
Open this publication in new window or tab >>Experiences from individuals with increased cardiovascular risk participating in a one-year lifestyle program.
2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id 1474515119848967Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: The purpose of the current study was to describe the participants' experiences of a structured lifestyle program for persons with high cardiovascular risk.

METHOD: Sixteen participants with high cardiovascular risk participating in a one-year structured lifestyle intervention program were interviewed regarding their experiences of the program. The interviews were analyzed using content analyses.

RESULTS: The participants' (mean age 58 ± 9) experiences were categorized into three categories: "How to know," based on the participants' experience from both individual counselling and group sessions with tools to strengthen self-care; "Staff who know how," based on experience from the meeting with, and the importance of, competent health professionals; "Why feedback is essential," based on the participants' experience and effects of person-centered feedback. Several factors were deemed important in the structure of the program: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful health professional who gives continuous feedback, and the right tools to support self-care at home between visits.

CONCLUSION: Individuals participating in a structured lifestyle program experienced several factors as important: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful healthcare professional who gives continuous feedback, and the right tools to support self-care at home between visits.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Structured lifestyle program, cardiovascular risk, experience, feedback, health professionals, self-care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5749 (URN)10.1177/1474515119848967 (DOI)31067978 (PubMedID)
Projects
Livsstilsmottagningen på Karolinska universitetssjukhuset, Solna
Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-08-14Bibliographically approved
Lönnberg, L., Ekblom Bak, E. & Damberg, M. (2019). Improved unhealthy lifestyle habits in patients with high cardiovascular risk: results from a structured lifestyle programme in primary care. Upsala Journal of Medical Sciences
Open this publication in new window or tab >>Improved unhealthy lifestyle habits in patients with high cardiovascular risk: results from a structured lifestyle programme in primary care
2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background. Physical activity, healthful dietary habits, and not smoking are associated with reduced cardiovascular morbidity and mortality. However, few studies have examined how counselling to improve poor lifestyle habits might be carried out in clinical practice. In Swedish primary care, structured lifestyle counselling is still not integrated into everyday clinical practice. The aim of the present study was two-fold: (1) to describe a novel lifestyle intervention programme in primary care; and (2) to evaluate change in unhealthy lifestyle habits over 1 year in men and women with high cardiovascular risk who participated in the lifestyle intervention programme. Method. A single-group study with a 1-year follow-up was carried out. A total of 417 people was enrolled, median age 62 years (54% women), with either hypertension (69%), type 2 diabetes mellitus, or impaired glucose tolerance. The 1-year intervention included five counselling sessions that focused on lifestyle habits, delivered by a district nurse with postgraduate credits in diabetes care and the metabolic syndrome. All patients were offered in-depth counselling for one or more lifestyle habits when needed. Lifestyle habits were assessed by a questionnaire at baseline and 1-year follow-up. Total change was assessed using a nine-factor unhealthy lifestyle habit index. Results. Favourable, significant changes were observed for physical activity, dietary habits, smoking, and stress over 1 year. Similar improvements were seen for both sexes and type of diagnosis. Conclusions. The results support the utility of a multifactorial, structured approach to change unhealthy lifestyle habits for cardiovascular risk prevention in a primary care setting.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Cardiovascular prevention, general practice, hypertension, lifestyle habits, structured lifestyle programme, type 2 diabetes mellitus
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5800 (URN)10.1080/03009734.2019.1602088 (DOI)000470479000001 ()31063003 (PubMedID)
Projects
Livsstilsmottagningen på Citypraktiken, Västerås
Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2019-08-13
Arvidsson, D., Fridolfsson, J., Buck, C., Ekblom, Ö., Ekblom Bak, E., Lissner, L., . . . Börjesson, M. (2019). Reexamination of Accelerometer Calibration with Energy Expenditure as Criterion: VO2net Instead of MET for Age-Equivalent Physical Activity Intensity.. Sensors, 19(15), Article ID E3377.
Open this publication in new window or tab >>Reexamination of Accelerometer Calibration with Energy Expenditure as Criterion: VO2net Instead of MET for Age-Equivalent Physical Activity Intensity.
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2019 (English)In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 19, no 15, article id E3377Article in journal (Refereed) Published
Abstract [en]

Accelerometer calibration for physical activity (PA) intensity is commonly performed using Metabolic Equivalent of Task (MET) as criterion. However, MET is not an age-equivalent measure of PA intensity, which limits the use of MET-calibrated accelerometers for age-related PA investigations. We investigated calibration using VO2net (VO2gross - VO2stand; mL⋅min-1⋅kg-1) as criterion compared to MET (VO2gross/VO2rest) and the effect on assessment of free-living PA in children, adolescents and adults. Oxygen consumption and hip/thigh accelerometer data were collected during rest, stand and treadmill walk and run. Equivalent speed (Speedeq) was used as indicator of the absolute speed (Speedabs) performed with the same effort in individuals of different body size/age. The results showed that VO2net was higher in younger age-groups for Speedabs, but was similar in the three age-groups for Speedeq. MET was lower in younger age-groups for both Speedabs and Speedeq. The same VO2net-values respective MET-values were applied to all age-groups to develop accelerometer PA intensity cut-points. Free-living moderate-and-vigorous PA was 216, 115, 74 and 71 min/d in children, adolescents, younger and older adults with VO2net-calibration, but 140, 83, 74 and 41 min/d with MET-calibration, respectively. In conclusion, VO2net calibration of accelerometers may provide age-equivalent measures of PA intensity/effort for more accurate age-related investigations of PA in epidemiological research.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
MET, VO2, VO2net, accelerometer, adolescents, adults, calibration, children, equivalent speed, free-living, physical activity, speed
National Category
Sport and Fitness Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5804 (URN)10.3390/s19153377 (DOI)000483198900132 ()31374854 (PubMedID)
Projects
Mätning av det dagliga aktivitetsmönstret
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-09-24
Ekblom Bak, E., Ekblom, B., Söderling, J., Börjesson, M., Blom, V., Kallings, L., . . . Ekblom, Ö. (2019). Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 266.109 adults.. Preventive Medicine, 127, Article ID 105799.
Open this publication in new window or tab >>Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 266.109 adults.
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2019 (English)In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 127, article id 105799Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate sex- and age-specific associations between cardiorespiratory fitness, all-cause and cause-specific mortality, and cardiovascular disease (CVD) morbidity. 266.109 participants (47% women, 18-74 years) free from CVD, participating in occupational health service screenings in 1995-2015 were included. CRF was assessed as estimated maximal oxygen consumption (estVO2max) using a submaximal cycle test. Incident cases of first-time CVD event and death from any cause were ascertained through national registers. There were 4244 CVD events and 2750 cases of all-cause mortality during mean 7.6 years follow-up. Male gender, higher age and lower estVO2max were associated with higher all-cause mortality and CVD morbidity incidence rates. Risk reductions with increasing estVO2max were present in all age-groups of men and women. No obvious levelling off in risk was identified in the total cohort. However, women and older age-groups showed no further reduction in higher aggregated estVO2max levels. CVD specific mortality was more associated with estVO2max compared to tumor specific mortality. The risk for all-cause mortality and CVD morbidity decreased by 2.3% and 2.6% per increase in 1 ml·min-1·kg-1 with no significant sex-differences but more pronounced in the three lower estVO2max categories for all-cause mortality (9.1%, 3.8% and 3.3%, respectively). High compared to lower levels of estVO2max was not related to a significantly elevated mortality or morbidity. In this large cohort study, CVD morbidity and all-cause mortality were inversely related to estVO2max in both men and women of all age-groups. Increasing cardiorespiratory fitness is a clear public health priority.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Aerobic capacity, Cancer, Cardiovascular disease, Population, Risk, VO(2)max
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5834 (URN)10.1016/j.ypmed.2019.105799 (DOI)000485788400010 ()31454664 (PubMedID)
Projects
HPI-gruppen
Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2019-10-11
Holmlund, T., Ekblom Bak, E., Franzén, E., Hultling, C. & Wahman, K. (2018). Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia.. Spinal Cord, 56(3), 274-283
Open this publication in new window or tab >>Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia.
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2018 (English)In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 56, no 3, p. 274-283Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: Cross-sectional.

OBJECTIVES: This study aimed to describe and compare VO2 and energy expenditure at rest (REE) and during standardized sedentary, non-exercise physical activity, and exercise activities, in people with motor-complete tetraplegia (C5-C8). Further, REE and energy expenditure (EE) for the different activities were compared to data from a reference group of people with motor-complete paraplegia (T7-T12).

SETTING: Sweden.

METHODS: The sample of people with motor-complete tetraplegia consisted of 26 adults (seven women) with SCI, C5-C8 AIS A-B. REE and EE for the different activities were measured with indirect calorimetry. The results were further compared to people with motor-complete paraplegia.

RESULTS: Resting VO2 was 2.57 ml O2 kg-1 min-1, 2.54 for men and 2.60 for women. The VO2 or activity energy expenditure related to body weight increased three to four times during non-exercise physical activity compared to sedentary activities for the people with motor-complete tetraplegia, and up to six times during exercise activity. No significant differences were seen in resting or sedentary activity VO2 between the people with motor-complete tetraplegia and those with motor-complete paraplegia. Activities of daily life revealed no or small differences in VO2, except for setting a table, while the people with tetraplegia had ∼50% lower VO2 during exercise activities.

CONCLUSIONS: Non-exercise physical activities of daily life may be significant for increasing total daily EE in people with motor-complete tetraplegia. This might act to motivate the individual, and might be clinically important when designing adapted lifestyle intervention programs for the target group.

National Category
Physiotherapy
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5139 (URN)10.1038/s41393-017-0024-4 (DOI)000426748900013 ()29238094 (PubMedID)
Projects
Energiomsättning hos ryggmärgsskadade
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-05-23Bibliographically approved
Lidin, M., Hellénius, M.-L., Rydell-Karlsson, M. & Ekblom Bak, E. (2018). Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice.. BMC Cardiovascular Disorders, 18(1), Article ID 59.
Open this publication in new window or tab >>Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice.
2018 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, no 1, article id 59Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiovascular disease is still the leading cause of premature death world-wide with factors like abdominal obesity, hypertension and dyslipidemia being central risk factors in the etiology. The aim of the present study was to investigate the effects on cardiovascular risk factors and cardiovascular risk after 6 months and 1 year, in individuals with increased cardiovascular risk enrolled in a lifestyle multidisciplinary program in a clinical setting.

METHOD: Individuals with increased cardiovascular risk were referred from primary health care and hospitals to a program at an outpatient clinic at a department of cardiology. The program consisted of three individual visits including a health check-up with a physical examination and blood sampling, and a person-centered dialogue for support in behavioural change of unhealthy lifestyle habits (at baseline, 6 months and 1 year). Furthermore, five educational group sessions were given at baseline. Cardiovascular risk was assessed according to Framingham cardiovascular risk predicting model.

RESULTS: One hundred individuals (mean age 59 years, 64% women) enrolled between 2008 and 2014 were included in the study. Waist circumference, systolic and diastolic blood pressure and total cholesterol decreased significantly over 1 year. In parallel, cardiovascular risk according to the cardiovascular risk profile based on Framingham 10-year risk prediction model, decreased with 15%. The risk reduction was seen in both men and women, and in participants with or without previous cardiovascular disease.

CONCLUSION: Participating in a structured lifestyle program over a year was associated with significant improvement in multiple cardiovascular risk factors and decreased overall cardiovascular risk.

TRIAL REGISTRATION: The study is registered at www.clinicaltrials.gov (ClinicalTrial.gov ID: NCT02744157 ).

Keywords
Cardiovascular, Lifestyle, Multidisciplinary, Program, Risk factor
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5254 (URN)10.1186/s12872-018-0792-6 (DOI)29609555 (PubMedID)
Projects
Livsstilsmottagningen på Karolinska universitetssjukhuset, Solna
Available from: 2018-05-17 Created: 2018-05-17 Last updated: 2018-05-17
Ekblom Bak, E. (2018). Medverkan i skolidrotten ger bättre vanor och hälsa. Idrott & hälsa (4), 6-9
Open this publication in new window or tab >>Medverkan i skolidrotten ger bättre vanor och hälsa
2018 (Swedish)In: Idrott & hälsa, ISSN 1653-1124, no 4, p. 6-9Article in journal (Other (popular science, discussion, etc.)) Published
National Category
Educational Sciences
Research subject
Social Sciences/Humanities
Identifiers
urn:nbn:se:gih:diva-5465 (URN)
Projects
HPI-gruppen
Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2018-11-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3901-7833

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