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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. (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
Ekblom Bak, E., Ekblom, Ö., Andersson, G., Wallin, P. & Ekblom, B. (2018). Physical Education and Leisure-Time Physical Activity in Youth Are Both Important for Adulthood Activity, Physical Performance, and Health.. Journal of Physical Activity and Health, 15(9), 661-670
Open this publication in new window or tab >>Physical Education and Leisure-Time Physical Activity in Youth Are Both Important for Adulthood Activity, Physical Performance, and Health.
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2018 (English)In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, no 9, p. 661-670Article in journal (Refereed) Published
Abstract [en]

Background: The importance of youth physical activity (PA) for adulthood PA, performance, and health was retrospectively evaluated. Methods: A total of 258,146 participants (49% women), aged 19–70, with a first-time health-profile assessment between 1982 and 2015, provided self-reported data on current perceived health, PA, lifestyle, and physical education class participation, and PA outside school hours before age 20. Data on anthropometrics, blood pressure, and estimated maximal oxygen consumption (VO2max) were obtained. Results: Women participating in physical education class, compared with those who did not, had significantly lower OR (range: 0.81–0.87) for perceiving poor overall health, general obesity, and high diastolic blood pressure after adjustment for potential confounders, and increased OR (range: 1.17–1.23) for exercising regularly and a normal/high VO2max in adulthood. For men, the ORs were significantly lower (range: 0.66–0.86) for poor perceived overall health, general, and abdominal obesity. These associations were seen for participants up to 70 years. Increased PA outside school hours revealed even stronger beneficial associations. In joint analyses, both youth and current PA were important for lower OR of poor health and being obese in adulthood. Conclusions: Physical education class participation and additional PA after school hours were both important for perceived health, PA, VO2max, and metabolic health in adulthood up to 70 years.

Keywords
VO2max, adolescent, epidemiology, physical fitness, public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5253 (URN)10.1123/jpah.2017-0083 (DOI)000441442900004 ()29706117 (PubMedID)
Projects
HPI-gruppen
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-09-04Bibliographically approved
Ekblom Bak, E. (2018). Stor försämring av svenskars kondition. Idrottsforskning.se, Article ID 20 november.
Open this publication in new window or tab >>Stor försämring av svenskars kondition
2018 (Swedish)In: Idrottsforskning.se, article id 20 novemberArticle in journal (Other (popular science, discussion, etc.)) Published
Abstract [sv]

En ny studie visar alarmerande resultat om folkhälsan. Närmare hälften av 350 000 undersökta svenskar har så dålig kondition att sjukdomsrisken är kraftigt ökad.

Place, publisher, year, edition, pages
Centrum för idrottsforskning, 2018
National Category
Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5548 (URN)
Available from: 2019-01-16 Created: 2019-01-16 Last updated: 2019-01-16Bibliographically approved
Holmlund, T., Ekblom-Bak, E., Franzén, E., Hultling, C., Wikmar, L. N. & Wahman, K. (2017). Energy expenditure in people with motor-complete paraplegia.. Spinal Cord, 55(8), 774-781
Open this publication in new window or tab >>Energy expenditure in people with motor-complete paraplegia.
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2017 (English)In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 55, no 8, p. 774-781Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: The present descriptive clinical and laboratory study is cross-sectional in design.

OBJECTIVES: The primary aim is to describe and compare resting energy expenditure (REE) and energy expenditure (EE) during different standardized sedentary, non-exercise and exercise activities in people with motor-complete paraplegia (Th7 to Th12.). A secondary aim was to compare men and women.

METHODS: Thirty-eight adults (10 women) with SCI, T7-T12 AIS A-B, were recruited. All the data were collected through indirect calorimetry. REE was measured in supine for 30 min after 8 h of overnight fasting. Activity energy expenditure (AEE) for activities was measured for seven minutes during sedentary, non-exercise physical activity (NEPA) and exercise activities.

RESULTS: AEE increased four to eight times when engaging in NEPA compared to that in sedentary activities. Men had significantly higher resting oxygen uptake compared to women, 0.19 vs 0.15 l min(-1) (P=0.005), REE per 24 h, 1286 vs 1030 kcal (P=0.003) and EE during weight-bearing activities. However, these became nonsignificant after adjustment for body weight and speed of movement, with a mean resting oxygen uptake of 2.47 ml O2 per kg min(-1) for the whole group (women 2.43 and men 2.57 ml O2 kg(-1) min(-1), P=0.49).

CONCLUSIONS: NEPA increases AEE up to eight times compared to sedentary activities. Gender differences in oxygen uptake during both rest and weight-bearing activities were diminished after adjustment for body weight. The mean resting oxygen uptake for the whole group was 2.47 ml O2 kg(-1) min(-1). These results highlight the importance, especially of NEPA, for increasing total daily EE in the target population.

National Category
Physiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4851 (URN)10.1038/sc.2017.27 (DOI)000407265700011 ()28374809 (PubMedID)
Projects
Energiomsättning hos ryggmärgsskadade
Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-05-23Bibliographically approved
Ekblom-Bak, E., Ekblom, Ö., Bergström, G. & Börjesson, M. (2016). Isotemporal substitution of sedentary time by physical activity of different intensities and bout lengths, and its associations with metabolic risk.. European Journal of Preventive Cardiology, 23(9), 967-974
Open this publication in new window or tab >>Isotemporal substitution of sedentary time by physical activity of different intensities and bout lengths, and its associations with metabolic risk.
2016 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 9, p. 967-974Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Time spent being sedentary, regardless of time in exercise, has been associated with metabolic risk using regression modelling. By using isotemporal substitution modelling, the effect of replacing sedentary time with an equal amount of time in physical activity (PA) of different intensities can be considered. The present study aims to investigate the effect of replacing sedentary time with time in light, moderate and vigorous PA to the prevalence of the metabolic syndrome (MetS). Also, replacement of sedentary time by PA of different bout lengths was studied.

METHODS: In total, 836 participants (52% women), aged 50-64 years, from the SCAPIS pilot study were included. Daily time spent sedentary and in PA of different intensities was assessed using hip-worn accelerometers.

RESULTS: In this cross-sectional study, replacing 10 minutes of sedentary time with the same amount of light PA was associated with significant lower MetS prevalence, odds ratio (OR) 0.96 (95% confidence interval 0.93-0.98). Replacement with moderate PA resulted in even lower OR, 0.89 (0.82-0.97), with the lowest OR for vigorous PA, 0.41 (0.26-0.66). Participants with high energy intake and high daily sedentary time benefitted more from the replacement of sedentary time with light PA. Significant associations were seen for all bout lengths of light, moderate and vigorous PA in a stepwise-like fashion from one minute to up to 120 minute bouts.

CONCLUSION: Theoretical substitutions of sedentary time with PA of any intensity and of as little as one minute were associated with significantly lower ORs for MetS. This may be an easily communicable message in clinical practice and for public health purposes.

National Category
Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4246 (URN)10.1177/2047487315619734 (DOI)000376288500008 ()26635358 (PubMedID)
Projects
SCAPIS
Available from: 2015-12-08 Created: 2015-12-08 Last updated: 2018-04-26Bibliographically approved
Ekblom-Bak, E., Ekblom, Ö., Bolam, K., Ekblom, B., Bergström, G. & Börjesson, M. (2016). SCAPIS Pilot Study: Sitness, Fitness and Fatness - Is Sedentary Time Substitution by Physical Activity Equally Important for Everyone's Markers of Glucose Regulation?. Journal of Physical Activity and Health, 13(7), 697-703
Open this publication in new window or tab >>SCAPIS Pilot Study: Sitness, Fitness and Fatness - Is Sedentary Time Substitution by Physical Activity Equally Important for Everyone's Markers of Glucose Regulation?
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2016 (English)In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 13, no 7, p. 697-703Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although moderate-to-vigorous physical activity (MVPA) is mainly recommended for glucose control, light physical activity (LIPA) may also have the potential to induce favorable changes. We investigated sedentary time (SED) substitution with equal time in LIPA and MVPA, and the association with markers of glucose regulation and insulin sensitivity after stratification by waist circumference, fitness and fasting glucose levels.

METHODS: A total of 654 men and women, 50-64 years, from the SCAPIS pilot study were included. Daily SED, LIPA and MVPA were assessed using hip-worn accelerometers. Fasting plasma glucose, insulin and HOMA-IR were determined.

RESULTS: Substituting 30 min of SED with LIPA was significantly associated with 3.0% lower fasting insulin values and 3.1% lower HOMA-IR values, with even lower levels when substituting SED with MVPA. Participants with lower fitness and participants with high fasting glucose levels benefited significantly more from substituting 30 min of SED with LIPA compared to participants with normal to high fitness levels and participants with normal glucose levels, respectively.

CONCLUSIONS: LIPA, and not only MVPA, may have beneficial associations with glucose regulation. This is of great clinical and public health importance, not least because it may confer a higher compliance rate to regular PA.

Keywords
Isotemporal substitution, sedentary, light physical activity, moderate physical activity, insulin resistance
National Category
Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4378 (URN)10.1123/jpah.2015-0611 (DOI)000381244300001 ()26900674 (PubMedID)
Projects
SCAPIS
Available from: 2016-03-14 Created: 2016-03-14 Last updated: 2018-04-26Bibliographically approved
Mijwel, S., Cardinale, D., Ekblom-Bak, E., Sundberg, C. J., Wengström, Y. & Rundqvist, H. (2016). Validation of 2 Submaximal Cardiorespiratory Fitness Tests in Patients With Breast Cancer Undergoing Chemotherapy.. Rehabilitation oncology (American Physical Therapy Association. Oncology Section), 34(4), 137-143
Open this publication in new window or tab >>Validation of 2 Submaximal Cardiorespiratory Fitness Tests in Patients With Breast Cancer Undergoing Chemotherapy.
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2016 (English)In: Rehabilitation oncology (American Physical Therapy Association. Oncology Section), ISSN 2168-3808, Vol. 34, no 4, p. 137-143Article in journal (Refereed) Published
Abstract [en]

Patients with breast cancer have an impaired cardiorespiratory fitness, in part, due to the toxic effects of anticancer therapy. Physical exercise as a means of rehabilitation for patients with cancer is an emerging area of research and treatment, emphasizing the need for accurate and feasible physical capacity measurements. The purpose of this study was to evaluate the validity of peak oxygen consumption (o2peak) predicted by the Ekblom-Bak test (E-B) and the Åstrand-Rhyming prediction model (A-R).

METHODS: Eight patients with breast cancer undergoing chemotherapy participated in the study. Submaximal exercise tests were performed at 2 different submaximal workloads. Estimated o2peak values were obtained by inserting the heart rate (HR) from the 2 workloads into the E-B prediction model and the HR of only the higher workload into the Åstrand nomogram. A 20-W incremental cycle test-to-peak effort was performed to obtain o2peak values.

RESULTS: Results from A-R overestimated o2peak by 6% (coefficient of variation = 7%), whereas results from E-B overestimated o2peak with 42% (coefficient of variation = 21%) compared with measured o2peak. Pearson's correlation coefficient revealed a significant strong relationship between the estimated o2peak from A-R and the measured o2peak (r = 0.86; P < .05), whereas the relationship between the estimated o2peak from E-B and the measured o2peak resulted in a nonsignificant weak correlation (r = 0.21).

CONCLUSION: In a situation where maximal exercise testing is not practical or undesirable from a patient safety perspective, submaximal exercise testing provides an alternative way of estimating o2peak. The A-R prediction model appears to be a valid submaximal exercise test for determining cardiorespiratory fitness in this population.

National Category
Cancer and Oncology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4634 (URN)10.1097/01.REO.0000000000000030 (DOI)000390116700005 ()27812433 (PubMedID)
Available from: 2016-11-09 Created: 2016-11-09 Last updated: 2017-01-12
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3901-7833

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