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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
Christenson, A., Johansson, E., Reynisdottir, S., Torgerson, J. & Hemmingsson, E. (2019). “…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study.. PLoS ONE, 14(9), 1-17
Open this publication in new window or tab >>“…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study.
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 9, p. 1-17Article in journal (Refereed) Published
Abstract [en]

Introduction: The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. Methods: Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19–39 y) with obesity. Thematic analysis was used to analyze the data. Results: We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives’ approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. Conclusions: A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients’ background, have a non-judgmental approach and refrain from giving unsolicited advice. 

Place, publisher, year, edition, pages
Public Library of Science, 2019
Keywords
Biology and life sciences, Body mass index, Body weight, Emotions, Maternal health, Medical personnel, Medicine and health sciences, Midwives, Obesity, Obstetrics and gynecology, People and places, Physiological parameters, Physiology, Population groupings, Pregnancy, Professions, Psychology, Research, Article, Social sciences, Weight gain, Women's health
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5851 (URN)10.1371/journal.pone.0222543 (DOI)
Available from: 2019-09-24 Created: 2019-09-24 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
Hemmingsson, E. (2018). Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication.. Current Obesity Reports, 7(2), 204-209
Open this publication in new window or tab >>Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication.
2018 (English)In: Current Obesity Reports, E-ISSN 2162-4968, Vol. 7, no 2, p. 204-209Article in journal (Refereed) Published
Abstract [en]

PURPOSE OF REVIEW: To explore the sequence and interaction of infancy and early childhood risk factors, particularly relating to disturbances in the social environment, and how the consequences of such exposures can promote weight gain and obesity.

RECENT FINDINGS: This review will argue that socioeconomic adversity is a key upstream catalyst that sets the stage for critical midstream risk factors such as family strain and dysfunction, offspring insecurity, stress, emotional turmoil, low self-esteem, and poor mental health. These midstream risk factors, particularly stress and emotional turmoil, create a more or less perfect foil for calorie-dense junk food self-medication and subtle addiction, to alleviate uncomfortable psychological and emotional states. Disturbances in the social environment during infancy and early childhood appear to play a critical role in weight gain and obesity, through such mechanisms as insecurity, stress, and emotional turmoil, eventually leading to junk food self-medication and subtle addiction.

Keywords
Affective states, Emotion regulation, Family environment, Food addiction, Infancy, Obesity etiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5264 (URN)10.1007/s13679-018-0310-2 (DOI)000432628100013 ()29704182 (PubMedID)
Available from: 2018-05-25 Created: 2018-05-25 Last updated: 2018-06-07
Christenson, A., Johansson, E., Reynisdottir, S., Torgerson, J. & Hemmingsson, E. (2018). Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study. Midwifery, 63, 1-7
Open this publication in new window or tab >>Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study
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2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 63, p. 1-7Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Excessive gestational weight gain, regardless of initial BMI, is associated with perinatal risks for both mother and offspring and contributes to obesity in women. Studies report that healthcare professionals find it difficult to communicate about weight and pregnant women perceive healthcare professionals as unconcerned, leaving many women uninformed about weight recommendations and risks. We aimed to explore how midwives approach communication about gestational weight gain recommendations, and to characterize communication barriers and facilitators.

METHODS:

Seventeen midwives from different areas in Sweden were interviewed by a therapist using semi-structured interviews. Interviews were transcribed verbatim and analysed by three researchers using latent content analysis. Recurrent themes were identified and formulated.

RESULTS:

The main theme identified in the latent part of the analysis was "midwives use avoidant behaviours to cope with fear of inflicting worries, shame or feelings of guilt in pregnant women". Avoidant behaviours include: adjusting weight recommendations, toning down risks and avoid talking about weight. Subthemes identified were (I) Conflicting responsibilities in midwives' professional identity (II) Perceived deficiencies in the working situation.

CONCLUSION:

Midwives' empathy and awareness of weight stigma strongly affects communication about weight with pregnant women, and midwives' use of avoidant behaviours constitutes salient information barriers. More research is needed on whether gestational weightguidelines and weighing routines for all women, resources for extra visits, training in specific communication skills and backup access to other professions can facilitate for midwives to initiate and communicate about healthy gestational weight development, enabling more pregnant women to make well-informed lifestyle choices.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5282 (URN)10.1016/j.midw.2018.04.020 (DOI)000436780500002 ()
Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2018-08-17Bibliographically approved
Hemmingsson, E. (2018). Slutbantat: förstå din kropp och få en vikt som håller livet ut. Stockholm: Bonnier Fakta
Open this publication in new window or tab >>Slutbantat: förstå din kropp och få en vikt som håller livet ut
2018 (Swedish)Book (Other (popular science, discussion, etc.))
Abstract [sv]

Förlagets text:

Har du också kämpat med vikten i många år? Ibland har det kanske gått åt det håll du vill, men ofta hamnar du förr eller senare tillbaka till ursprungsläget med några eller många kilo fler än du önskar. Självrannsakan och en känsla av misslyckande ligger nära till hands men Erik Hemmingsson, med över tjugo års erfarenhet av forskning på övervikt, menar att det är inte din karaktär det är fel på. Vi föds med olika fysiologiska förutsättningar, vissa har lätt att gå upp i vikt medan andra kan äta i princip vad som helst och ändå håller sig trådsmala genom hela livet. Kroppen motarbetar dessutom viktminskning på olika sätt, och forskning visar att övervikt är starkt kopplat till vårt inre. Visste du att övervikt kan bero på hur du hade det när du var liten, i vilket område du är född, om du har stressat mycket under ditt liv, vilka föräldrar du växte upp med eller om du haft svåra livshändelser? Allt detta påverkar vad vi äter, hur vi äter och inte minst varför vi äter.Vi behöver alla lära oss mer om vår aptit och mättnad, som många aldrig riktigt lärt sig lyssna på, och som heller inte fungerar speciellt bra hos många överviktiga. I Slutbantat finns verktygslådan där du få olika verktyg att förstå dig själv och ditt ätbeteende bättre men också hållbara strategier och en genomgång av vilken mat som du ska satsa på.

Place, publisher, year, edition, pages
Stockholm: Bonnier Fakta, 2018. p. 207
National Category
Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5525 (URN)9789174249453 (ISBN)
Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-01-09
Dreber, H., Thorell, A., Torgerson, J., Reynisdottir, S. & Hemmingsson, E. (2018). Weight loss, adverse events, and loss to follow-up after gastric bypass in young versus older adults: A Scandinavian Obesity Surgery Registry study.. Surgery for Obesity and Related Diseases, 14(9), 1319-1326, Article ID S1550-7289(18)30324-1.
Open this publication in new window or tab >>Weight loss, adverse events, and loss to follow-up after gastric bypass in young versus older adults: A Scandinavian Obesity Surgery Registry study.
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2018 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, no 9, p. 1319-1326, article id S1550-7289(18)30324-1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Young adults display particularly poor weight loss in behavioral obesity treatment; nonetheless, they have seldom been included in bariatric research.

OBJECTIVES: To compare weight loss, adverse events, and loss to follow-up in young (18-25 yr) versus older (≥26 yr) adults up to 5 years after Roux-en-Y gastric bypass.

SETTING: Nationwide, register-based study, Sweden.

METHODS: Prospective registry data (Scandinavian Obesity Surgery Register) were analyzed in young (22.2 yr [standard deviation (SD): 2.1], 81.6% women, mean body mass index 43.7 kg/m2 [SD: 5.4]) and older (42.6 years [SD: 9.6], 82.0% women, mean body mass index 43.4 kg/m2 [SD: 5.0]) adults undergoing Roux-en-Y gastric bypass. Groups were matched for body mass index, sex, and year of surgery. Regression analyses and mixed models were used to compare outcomes between groups.

RESULTS: A total of 369 young (37.0% of eligible) and 2210 older (46.1%) adults attended the 5-year follow-up. At this time, weight loss was 31.8% in young and 28.2% in older adults (P < .001), with a serious adverse event (Clavien-Dindo ≥3b) being reported in 52 (14.1%) young and 153 (6.9%) older adults (odds ratio = 2.06, 95% confidence interval: 1.45-2.92, P < .001). Loss to follow-up was higher in young versus older adults throughout the study period (range of relative risk = 1.16-1.89, P < .001).

CONCLUSIONS: While young adults displayed at least equal weight loss as older adults, rates of adverse events were approximately doubled, and loss to follow-up rates were higher. Future studies on the significance of and the etiology behind the higher incidence of serious adverse events are needed. Intensified clinical contact post Roux-en-Y gastric bypass should have the potential to further improve outcomes in young adults.

Keywords
Adverse event, Loss to follow-up, RYGB, Weight loss, Young adult
National Category
Surgery
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5394 (URN)10.1016/j.soard.2018.06.012 (DOI)000448491100019 ()30056048 (PubMedID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-11-16Bibliographically approved
Dreber, H., Reynisdottir, S., Angelin, B., Tynelius, P., Rasmussen, F. & Hemmingsson, E. (2017). Mental distress in treatment seeking young adults (18-25 years) with severe obesity compared with population controls of different body mass index levels: cohort study.. Clinical Obesity, 7(1), 1-10
Open this publication in new window or tab >>Mental distress in treatment seeking young adults (18-25 years) with severe obesity compared with population controls of different body mass index levels: cohort study.
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2017 (English)In: Clinical Obesity, ISSN 1758-8103, E-ISSN 1758-8111, Vol. 7, no 1, p. 1-10Article in journal (Refereed) Published
Abstract [en]

Young adults (18-25) with severe obesity constitute a challenging patient group, and there is limited evidence about their mental health status compared to population controls. Mental distress in treatment seeking young adults with severe obesity (n = 121, mean body mass index [BMI] = 39.8 kg m(-2) ) was compared with matched (1:3 for age, gender and socioeconomic status) population controls of normal weight (n = 363, mean BMI = 22.4 kg m(-2) ), as well as unmatched population controls with class I obesity (n = 105, mean BMI = 32.1 kg m(-2) ) or severe obesity (n = 41, mean BMI = 39.7 kg m(-2) ). Mental distress was measured by the General Health Questionnaire-12 (GHQ-12), and we quantified physician-diagnosed depression, present anxiety and suicide attempts. Poisson regression and linear regression analysis were used for analysing differences in mental distress between groups. Treatment seekers experienced more mental distress than normal weight controls as measured by continuous (adjusted mean: 3.9 vs. 2.2 points, P <0.001) and categorical (cut-off for mental distress ≥3 points, RR: 1.76, P <0.001) GHQ-12 scores, depression (RR: 2.18, P < 0.001), anxiety (RR: 1.97, P < 0.001) and suicide attempts (RR: 2.04; P = 0.034). Treatment seekers also experienced more mental distress as measured by continuous GHQ-12 than controls with class I obesity (adjusted mean: 2.3 points) or severe obesity (adjusted mean: 2.1; both, P < 0.001). Young adult treatment seekers with severe obesity constitute a risk group for mental distress compared to population controls of different BMI levels.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:gih:diva-4734 (URN)10.1111/cob.12170 (DOI)28058812 (PubMedID)
Available from: 2017-01-31 Created: 2017-01-26 Last updated: 2017-11-29Bibliographically approved
Christenson, A., Johansson, E., Reynisdottir, S., Torgerson, J. & Hemmingsson, E. (2016). Women's Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study.. PLoS ONE, 11(12), Article ID e0167731.
Open this publication in new window or tab >>Women's Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study.
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 12, article id e0167731Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Obesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions.

METHODS: Qualitative interview study (semi-structured) using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories.

RESULTS: Participants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss.

CONCLUSION: There is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:gih:diva-4735 (URN)10.1371/journal.pone.0167731 (DOI)27936110 (PubMedID)
Note

Available from: 2017-01-31 Created: 2017-01-26 Last updated: 2017-11-29Bibliographically approved
Olsson, S. J., Börjesson, M., Ekblom Bak, E., Hemmingsson, E., Hellénius, M.-L. & Kallings, L. (2015). Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial. BMC Public Health, 15, Article ID 687.
Open this publication in new window or tab >>Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial
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2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 687Article in journal (Refereed) Published
Abstract [en]

Background

The effects of physical activity on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear. We therefore aimed to explore the effects of the Swedish PAP model on HRQoL in overweight older adults.

Methods

Participants were recruited from a cohort of men and women born between 1937 and 1938, and living in Stockholm County. Inclusion criteria were; insufficiently physically active, i.e. <30 min of at least moderate intensity physical activity (PA) per day; body mass index >25 kg/m 2 ; and waist circumference ≥102 cm (men) or ≥88 cm (women). Altogether, 101 individuals, aged 67 years, were randomly assigned to two parallel groups: intervention group (n = 47) receiving individualised PAP or control group (n = 54). The 36-item Short Form Health Survey (SF-36) was administered before and after the six months intervention. Main outcomes were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Intention to treat analysis was utilised. Regression analysis was performed to assess whether changes in PA and body weight affected changes in HRQoL.

Results

At the six months follow-up, regarding the MCS score, the intervention group had improved significantly more (median: 4.4 [interquartile range (IQR): −2.4 to 23.3]) vs (median: 0.0 [IQR: −4.0 to 4.9]); p < 0.05) and a higher proportion of participants had attained relevant improvements (OR 2.43 (95 % CI 1.00–5.88) p < 0.05) compared to the controls. A within group improvement in the PCS score (median: 3.8 [IQR: −1.9 to 19.5] p < 0.05) was found in the intervention group. Changes in PA and body weight had a small, but significant, mediating effect on the changes in HRQoL.

Conclusions

PAP had a positive effect on HRQoL, measured by the SF-36 MCS, but no significant between group effect was seen on the PCS in overweight older adults. These effects were, to some extent, mediated by changes in PA and body weight. Our findings support clinical use of the Swedish PAP model.

Trial registration

ClinicalTrials.gov NCT02320760.

Keywords
Clinical research; Health promotion; Intervention study; Older adults; Prescribed physical activity; Health related quality of life; Overweight
National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-3957 (URN)10.1186/s12889-015-2036-3 (DOI)26193882 (PubMedID)
Available from: 2015-08-04 Created: 2015-08-04 Last updated: 2017-12-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7335-3796

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