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  • 1.
    Adlard, Kirsten N.
    et al.
    Univ Queensland, Sch Human Movement & Nutr Sci, Brisbane, Qld, Australia..
    Devin, James L.
    Univ Queensland, Sch Human Movement & Nutr Sci, Brisbane, Qld, Australia..
    Jenkins, David G.
    Univ Queensland, Sch Human Movement & Nutr Sci, Brisbane, Qld, Australia..
    Bolam, Kate A.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet. Univ Queensland, Sch Human Movement & Nutr Sci, Brisbane, Qld, Australia..
    Aitken, Joanne F.
    Griffith Univ, Menzies Hlth Inst Queensland, Gold Coast, Qld, Australia.;Canc Council Queensland, Canc Res Ctr, Brisbane, Qld, Australia..
    Chambers, Suzanne K.
    Griffith Univ, Menzies Hlth Inst Queensland, Gold Coast, Qld, Australia.;Canc Council Queensland, Canc Res Ctr, Brisbane, Qld, Australia.;Prostate Canc Fdn Australia, Sydney, NSW, Australia.;Edith Cowan Univ, Hlth & Wellness Inst, Perth, WA, Australia.;Univ Queensland, Clin Res Ctr, Brisbane, Qld, Australia..
    Dunn, Jeffrey C.
    Griffith Univ, Menzies Hlth Inst Queensland, Gold Coast, Qld, Australia.;Canc Council Queensland, Canc Res Ctr, Brisbane, Qld, Australia.;Univ Queensland, Sch Social Sci, Brisbane, Qld, Australia..
    Skinner, Tina L.
    Univ Queensland, Sch Human Movement & Nutr Sci, Brisbane, Qld, Australia..
    THE INFLUENCE OF EXERCISE INTENSITY ON FATIGUE IN COLORECTAL CANCER SURVIVORS: A RANDOMIZED CONTROLLED TRIAL2016Inngår i: Asia-Pacific Journal of Clinical Oncology, ISSN 1743-7555, E-ISSN 1743-7563, Vol. 12, nr S5, s. 78-78, artikkel-id 44Artikkel i tidsskrift (Annet vitenskapelig)
  • 2. Adlard, Kirsten N
    et al.
    Jenkins, David G
    Salisbury, Chloe E
    Bolam, Kate
    Karolinska Institute, Stockholm, Sweden.
    Gomersall, Sjaan R
    Aitken, Joanne F
    Chambers, Suzanne K
    Dunn, Jeff C
    Courneya, Kerry S
    Skinner, Tina L
    Peer support for the maintenance of physical activity and health in cancer survivors: the PEER trial - a study protocol of a randomised controlled trial.2019Inngår i: BMC Cancer, E-ISSN 1471-2407, Vol. 19, nr 1, s. 656-, artikkel-id 656Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Despite an overwhelming body of evidence showing the benefits of physical activity (PA) and exercise for cancer survivors, few survivors meet the exercise oncology guidelines. Moreover, initiating, let alone maintaining exercise programs with cancer survivors continues to have limited success. The aim of this trial is to evaluate the influence of peer support on moderate-to-vigorous PA (MVPA) and various markers of health 12 months following a brief supervised exercise intervention in cancer survivors.

    METHODS: Men and women previously diagnosed with histologically-confirmed breast, colorectal or prostate cancer (n = 226), who are >1-month post-treatment, will be invited to participate in this trial. Once enrolled, participants will complete 4 weeks (12 sessions) of supervised high intensity interval training (HIIT). On completion of the supervised phase, both groups will be provided with written recommendations and verbally encouraged to achieve three HIIT sessions per week, or equivalent exercise that meets the exercise oncology guidelines. Participants will be randomly assigned to receive 12 months of peer support, or no peer support (control). Primary and secondary outcomes will be assessed at baseline, after the 4-week supervised HIIT phase and at 3-, 6- and 12-months. Primary outcomes will include accelerometry-derived MVPA and prescribed HIIT session adherence; whilst secondary outcomes will include cardiorespiratory fitness ([Formula: see text]), body composition, quality of life and select cytokines, myokines and inflammatory markers. Random effects mixed modelling will be used to compare mean changes in outcomes between groups at each time point. A group x time interaction will be used to formally test for differences between groups (alpha =0.05); utilising intention-to-treat analyses.

    DISCUSSION: If successful, peer support may be proposed, adopted and implemented as a strategy to encourage cancer survivors to maintain exercise beyond the duration of a short-term, supervised intervention. A peer support-exercise model has the long-term potential to reduce comorbidities, improve physical and mental wellbeing, and significantly reduce the burden of disease in cancer survivors.

    ETHICS: Human Research Ethics Committee of Bellberry Ltd. (#2015-12-840).

    TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry 12618001855213 . Retrospectively registered 14 November 2018. Trial registration includes all components of the WHO Trial Registration Data Set, as recommended by the ICMJE.

  • 3.
    Adler, Dana
    et al.
    Bar Ilan University, Israel.
    Shapira, Zehavit
    Bar Ilan University, Israel.
    Weiss, Shimon
    Bar Ilan University, Israel ; University of California, Los Angeles, USA..
    Shainberg, Asher
    Bar Ilan University, Israel.
    Katz, Abram
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Weak Electromagnetic Fields Accelerate Fusion of Myoblasts.2021Inngår i: International Journal of Molecular Sciences, ISSN 1661-6596, E-ISSN 1422-0067, Vol. 22, nr 9, artikkel-id 4407Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Weak electromagnetic fields (WEF) alter Ca2+ handling in skeletal muscle myotubes. Owing to the involvement of Ca2+ in muscle development, we investigated whether WEF affects fusion of myoblasts in culture. Rat primary myoblast cultures were exposed to WEF (1.75 µT, 16 Hz) for up to six days. Under control conditions, cell fusion and creatine kinase (CK) activity increased in parallel and peaked at 4-6 days. WEF enhanced the extent of fusion after one and two days (by ~40%) vs. control, but not thereafter. Exposure to WEF also enhanced CK activity after two days (almost four-fold), but not afterwards. Incorporation of 3H-thymidine into DNA was enhanced by one-day exposure to WEF (~40%), indicating increased cell replication. Using the potentiometric fluorescent dye di-8-ANEPPS, we found that exposure of cells to 150 mM KCl resulted in depolarization of the cell membrane. However, prior exposure of cells to WEF for one day followed by addition of KCl resulted in hyperpolarization of the cell membrane. Acute exposure of cells to WEF also resulted in hyperpolarization of the cell membrane. Twenty-four hour incubation of myoblasts with gambogic acid, an inhibitor of the inward rectifying K+ channel 2.1 (Kir2.1), did not affect cell fusion, WEF-mediated acceleration of fusion or hyperpolarization. These data demonstrate that WEF accelerates fusion of myoblasts, resulting in myotube formation. The WEF effect is associated with hyperpolarization but WEF does not appear to mediate its effects on fusion by activating Kir2.1 channels.

    Fulltekst (pdf)
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  • 4.
    Alfvén, G
    et al.
    Karolinska institutet, Stockholm.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Karolinska institutet, Department of Neuroscience, Stockholm.
    The Dangerous Staircase of Stress2021Inngår i: Anesthesia & Pain Research, ISSN 2639-846X, Vol. 5, nr 2, s. 1-6Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Chronic negative stress may be the start of a progress of illness, that may end in serious troubles for the affected. In this Perspective we highlight the steps in such a progress, what we call a staircase of stress. This underlines the importance of recognition, understanding and therapeutic measures at an early stage of the stress disorders. 

    Fulltekst (pdf)
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  • 5.
    Alfvén, Gösta
    et al.
    Clintec, Karolinska Institutet.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC). Institutionen för Neurovetenskap, Karolinska Institutet.
    Barn med stressutlöst smärta hade kraftigare startle-reflex2017Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, artikkel-id 114:ERZXArtikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Återkommande stressutlöst smärta är ett närmast vardagligt fenomen. Avsaknaden av enkla test inom sjukvården för att diagnostisera stressutlöst smärta medför diagnostiska svårigheter och därmed svårigheter med handläggning. Ett grundläggande problem är att förståelse för den patofysiologiska processen bakom långvarig stressutlöst smärta saknas.

    Tidigare studier från samma forskare har visat att barn och tonåringar med långvarig stressutlöst smärta diagnostiserad enligt fastställda kriterier utvecklar ett karakteristiskt mönster av ömma punkter (tender points) i muskler på platser för bland annat huvudvärk, skuldersmärtor och buksmärtor nära naveln. Dessa muskler ingår i startle-reflexen, en neuromuskulär försvarsreaktion som utlöses från en kärna i hjärnstammen. Startle-reflexen startar med en blinkreflex och följs på mindre än en tiondels sekund av framåtböjning av huvudet och en nedstigande böjningsreaktion av kroppen, som sträcker sig ned till benen. Stress kan bland annat via amygdala leda till förstärkt och lättare utlöst startle-reflex.

    Vår hypotes var att startle-reflexen hos individer med stressutlöst smärta är mer lättutlöst och ger ett högre svar än hos friska. I en kontrollerad studie ingick 19 individer i åldern 10–17 år som hade stressutlöst återkommande smärta enligt fastställda kriterier. Gruppen jämfördes med 23 friska i jämförbar ålder, av motsvarande kön och utan smärtbesvär. Under likvärdiga, lugna förhållanden utlöstes startle-reflex vid upprepade starka auditiva signaler på 105 dB via hörlurar, och EMG registrerades från ögonblinkningsmuskeln (orbicularis oculi), tinningmuskel (temporalis), nacknära skuldermuskel (trapezius), stora bröstmuskeln (pectoralis major), bukmuskel (rectus abdominis) samt ryggmuskel (lumbala erector spinae).

    I smärtgruppen var muskelspänningen signifikant förhöjd i ovan nämnda muskler. Startle-reflexen utlöstes också lättare och tidigare, var kraftigare och varade längre. Muskel­aktivitetsgraden efter ljudstimuli visade i smärtgruppen signifikant högre medelamplitud än i kontrollgruppen för alla sex muskler och de åtta upprepade startle-responserna sammantagna. Aktuell forskning om möjliga muskulära och centralnervösa smärtmekanismer presenteras i artikeln.

    För första gången har ökad muskelspänning och förstärkt startle-reaktion påvisats med EMG hos barn/ungdomar med återkommande stressutlöst smärta i ett mönster som sammanfaller med mönstret av ömma punkter och smärtlokalisation. Vår förhoppning är att dessa fynd ska stimulera till fortsatt forskning och förbättra klinisk praxis.

    Alfvén, G, Grillner, S, Andersson E. Eur J Pain. Epub 4 maj 2017. doi: 10.1002/ejp.1057

  • 6.
    Alfvén, Gösta
    et al.
    Department of Clintec, Karolinska Institute, Stockholm, Sweden.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    New Understanding of Psychosomatic Pain2021Inngår i: Journal of Pain Management & Medicine, ISSN 2684-1320, Vol. 7, nr 3, s. 1-4, artikkel-id 154Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    For better understanding and better care of psychosomatic pain valid and reliable diagnostic criteria is a prerequisite. The startle reflex is of importance for the understanding of the stress induced pain and the increased excitability in several muscles. The pattern of increased muscle tension and tenderness that can be found in these patterns can be of valuable diagnostic support. Decreased oxytocin and increased cortisol is a sign of right brain dominance in stress and indicate psuchosomatic pain. The omega-3 and omega-6 changes are in indication metabolic pain mechanism of interest for future study. Treatment is reccomended to be guided by the knowledge here described.

    Fulltekst (pdf)
    fulltext
  • 7.
    Alfvén, Gösta
    et al.
    Clintec, Karolinska Institute, Stockholm, Sweden..
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Stress and recurrent abdominal pain.2023Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, nr 11, s. 2312-2316Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We discuss the aetiology of recurrent abdominal pain of non-organic origin, according to the Rome Criteria for Functional Gastrointestinal Disorders and a psychogenic hypothesis. Stress activates the brain-gut axis, which is important for local gut symptoms, such as abdominal pain, but it also causes pain in other areas, including the head, back and chest. Our research has indicated that the startle reflex plays a dominant role in this stress-induced pain pattern, which is manifested in the whole body. Localised abdominal pain can be part of a general negative stress reaction that causes multiple pains in other areas of the body.

  • 8.
    Alfvén, Gösta
    et al.
    Clintec, Karolinska Institutet.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Understanding pain of stress etiology, comprising changes in muscle excitability, hormones and the nervous system.2020Konferansepaper (Fagfellevurdert)
    Abstract [en]

    G. Alfvén1, E. Andersson2, 3

    1. Clintec, Karolinska Institute, Stockholm, Sweden. 2. The Department of Neuroscience, Karolinska institute, Stockholm, Sweden. 3. The Swedish School of Sport and Health Sciences, Stockholm, Sweden.

    Corresponding author:  G Alfvén (gosta.alfven@slmk.org) Karolinska Institute, Sweden

    ABSTRACT 

    Background: Recurrent pain of stress etiology is a common, worldwide problem with impaired quality of life and decreased school attendance. Research show that pain of stress etiology, often called psychosomatic pain, often is a complex of multiple pains, other symptoms and augmented widespread muscular tension with a specific pattern of tender points (1). 

    Objective and Method: We will in a clinical context present electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple pain. 

    Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 23 matched controls. Also, higher resting muscle activity was shown. We will also present data showing increased cortisol and decreased oxytocin and increased risk for developing fibromyalgia in children with psychosomatic pain. 

    Conclusion. Stressors potentiated the startle reaction with increased muscle activity in rest and increased excitability. These reactions and increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of recurrent pain and must be heeded in the treatment of patients with pain related to stress.  

    1. Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019; Jun4.doi:10.1111/apa.14884.

    2. Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.

    3. Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. 

    Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).

  • 9.
    Alfvén, Gösta
    et al.
    Department of Clintec, Karolinska Institute, Stockholm, Sweden.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Understanding pain of stress etiology, comprising changes in muscle excitability, hormones and the nervous system.2021Konferansepaper (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 10.
    Alfvén, Gösta
    et al.
    Clintec, Karolinska Institutet.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Understanding stress comprising changes in muscle excitability, hormones and the nervous system.2020Konferansepaper (Fagfellevurdert)
    Abstract [en]

    G. Alfvén1, E. Andersson2, 3

    1. Clintec, Karolinska Institute 2. Department of Neuroscience, Karolinska institute, 3. Swedish School of Sport and Health Sciences, -all Stockholm, Sweden.

    Corresponding author:  G Alfvén (gosta.alfven@slmk.org) 

    ABSTRACT 

    Background: Negative stress is very common, always affecting brain and body resulting in different symptoms often called psychosomatic. To better understand stress, it is important to overcome the mind-body dichotomy and explore how they are connected. 

    Objective and Method: We will present in children with recurrent stress related pain, some hormonal changes and electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple psychosomatic pain (1).  

    Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 21 matched controls. Also, higher resting muscle activity was found in these children as well as increased cortisol and decreased oxytocin. 

    Conclusion. Stressors evoke stress response for example in the amygdala, which can trigger and potentiate the startle reaction with amplified muscle excitability and tonus. These reactions and the increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of psychosomatic pain and must be heeded in the treatment of patients with pain related to stress.  

    1.Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019;Jun4.doi:10.1111/apa.14884.

    2.Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.

    3.Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. 

    Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).

     

     

  • 11.
    Alfvén, Gösta
    et al.
    Department of Clintec, Karolinska Institute, Stockholm, Sweden.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Understanding stress comprising changes in muscle excitability, hormones and the nervous system.2021Konferansepaper (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 12.
    Anandavadivelan, Poorna
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Cardinale, Daniele A.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Blomhoff, Rune
    Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway..
    Sunde, Berit
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Solna, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden..
    Lassen, Kristoffer
    Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway.
    Kleive, Dyre
    Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway.
    Sturesson, Christian
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Solna, Sweden; Department of HPB Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Gilg, Stefan
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Solna, Sweden; Department of HPB Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Raastad, Truls
    Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway..
    Mijwel, Sara
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden; Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway..
    Blood flow restriction Exercise in the perioperative setting to Prevent loss of muscle mass in patients with pancreatic, biliary tract, and liver cancer: study protocol for the PREV-Ex randomized controlled trial.2024Inngår i: Trials, E-ISSN 1745-6215, Vol. 25, nr 1, artikkel-id 356Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Patients diagnosed with pancreatic, biliary tract, and liver cancer often suffer from a progressive loss of muscle mass. Given the considerable functional impairments in these patients, high musculoskeletal weight loads may not be well tolerated by all individuals. The use of blood-flow restricted resistance training (BFR-T) which only requires low training loads may allow for a faster recovery of muscle due to avoidance of high levels of mechanical muscle stress associated with high-load resistance exercise. This study aims to investigate whether BFR-T can prevent or slow down the loss of skeletal muscle mass and enhance the functional capacity and mental health of patients with pancreatic, biliary tract, and liver cancer.

    METHODS: The PREV-Ex exercise trial is a multicenter two-armed randomized controlled trial. Patients will be randomized to an exercise program consisting of home-based low-load BFR-T during a combined pre- and postoperative period for a total of 6-10 weeks (prehabilitation and rehabilitation), or to a control group. Protein supplementation will be given to both groups to ensure adequate protein intake. The primary outcomes, skeletal muscle thickness and muscle cross-sectional area, will be assessed by ultrasound. Secondary outcomes include the following: (i) muscle catabolism-related and inflammatory bio-markers (molecular characteristics will be assessed from a vastus lateralis biopsy and blood samples will be obtained from a sub-sample of patients); (ii) patient-reported outcome measures (self-reported fatigue, health-related quality of life, and nutritional status will be assessed through validated questionnaires); (iii) physical fitness/performance/activity (validated tests will be used to evaluate physical function, cardiorespiratory fitness and maximal isometric muscle strength. Physical activity and sedentary behavior (assessed using an activity monitor); (iv) clinical outcomes: hospitalization rates and blood status will be recorded from the patients' medical records; (v) explorative outcomes of patients' experience of the exercise program which will be evaluated using focus group/individual interviews.

    DISCUSSION: It is worthwhile to investigate new strategies that have the potential to counteract the deterioration of skeletal muscle mass, muscle function, strength, and physical function, all of which have debilitating consequences for patients with pancreatic, biliary tract, and liver cancer. The expected findings could improve prognosis, help patients stay independent for longer, and possibly reduce treatment-related costs.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT05044065. Registered on September 14, 2021.

    Fulltekst (pdf)
    fulltext
  • 13.
    Anborg, Robyn
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Estetisk kirurgi: En kvantitativ studie om hur subjektiva upplevelser kring familj påverkar intresse av estetisk kirurgi2011Independent thesis Basic level (degree of Bachelor), 15 poäng / 22,5 hpOppgave
    Abstract [sv]

    Syfte och frågeställningar

    Syftet med denna studie är att förklara hur subjektiva upplevelser runt familj påverkar intresse av estetisk kirurgi. Specifika frågeställningar har formulerats för att undersöka detta:

    – Hur påverkas intresse av estetisk kirurgi av familjemedlemmar som pratat om att utföra eller som har utfört estetisk kirurgi?

    – Hur påverkas intresse av estetisk kirurgi av upplevd skilsmässa under uppväxt och uppväxt med en ensamstående förälder?

    – Hur påverkas intresse av estetisk kirurgi av fysisk eller psykisk frånvaro av mamma eller pappa under uppväxt?

    – Hur påverkas intresse av estetisk kirurgi av att minst en person gett stöd och varit älskande under uppväxt?

    – Hur påverkas intresse av estetisk kirurgi av ouppnådda familjefunktioner?

    – Hur påverkas intresse av estetisk kirurgi av en upplevd familjekris?

    Metod

    Denna uppsats har använts sig av en kvantitativ forskningsmetod med enkät. En egen enkät komponerades och delades ut i Stockholms län. 60 enkäter delades ut, varav 58 av dessa besvarades. Enkäterna hanterades anonymt och sammanställdes först i Excel-ark för att sedan analyseras i SPSS genom Mann-Whitney och Chi-2 test, samt logistisk regression.

    Resultat

    Prediktorer för intresse för estetisk kirurgi är föräldrar som pratat om att utföra estetisk kirurgi (P=0,049), lägre skattning av psykisk närvaro av mamma (P=0,029), lägre skattning av psykisk närvaro av pappa (P=0,042), lägre skattning av att pappa ingivit respekt kring den egna personens värde (P=0,001) och vid lägre skattning av att familj gett en god grund för en stabil och harmonisk uppväxt (P=0,003). Ingen av dessa kunde enskilt förklara den beroende variabelns variation, utan alla samvarierade. Genom att stegvis exkludera prediktorer i en logistisk regression kunde den viktigaste prediktorn till intresse av estetisk kirurgi identifieras, vilket var, den sistnämnda.

    Slutsats

    Slutsatsen är att vissa subjektiva upplevelser runt familj påverkar intresse av estetisk kirurgi medan påverkan av andra inte gett signifikanta skillnader.

     

    Fulltekst (pdf)
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  • 14.
    Andersson, Eva
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Alfvén, Gösta
    Clintec, Karolinska Institutet, Stockholm, Sweden.
    Increased muscle activity in acoustic startle response among children with recurrent pain in the head, neck and abdomen due to chronic stress.2021Konferansepaper (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 15.
    Andersson, Eva
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Hovland, Anders
    Kjellman, Bengt
    Taube, Jill
    Martinsen, Egil W.
    Fysisk aktivitet är lika bra som läkemedel eller samtalsterapi vid depression2016Inngår i: Idrottsmedicin, ISSN 2001-3302, Vol. 35, nr 1, s. 4-7Artikkel i tidsskrift (Annet vitenskapelig)
  • 16.
    Andersson, M. J.
    et al.
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Kenttä, Göran
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Moesch, K.
    Malmö Univ, Dept Sports Sci, Malmö, Sweden..
    Borg, E.
    Stockholm Univ, Dept Psychol Percept & Psychophys, Stockholm, Sweden..
    Claesdotter-Knutsson, E.
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Håkansson, A.
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Symptoms of Depression and Anxiety Among Elite High School Student-Athletes in Sweden During the COVID-19 Pandemic: A Longitudinal Study2023Inngår i: European Psychiatry 66(2023):Suppl. 1, Cambridge University Press, 2023, Vol. 66, s. S593-S594, artikkel-id EPP0961Konferansepaper (Annet vitenskapelig)
  • 17.
    Andersson, Mitchell J
    et al.
    Malmö Addiction Center, Region Skåne, Clinical Sports and Mental Health Unit, Malmö, Sweden.; Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden..
    Kenttä, Göran
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik. Swedish Sports Confederation, Stockholm, Sweden; School of Human Kinetics, University of Ottawa, Ottawa, Canada.
    Moesch, Karin
    Swedish Sports Confederation, Stockholm, Sweden.; Department of Sports Science, Malmö University, Malmö, Sweden.
    Borg, Elisabet
    Faculty of Social Sciences, Department of Psychology - Perception and Psychophysics, Stockholm University, Stockholm, Sweden..
    Claesdotter-Knutsson, Emma
    Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden..
    Håkansson, Anders
    Malmö Addiction Center, Region Skåne, Clinical Sports and Mental Health Unit, Malmö, Sweden.; Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden..
    Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study.2023Inngår i: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447X, Vol. 41, nr 9, s. 874-883Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one's career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

    Fulltekst (pdf)
    fulltext
  • 18. Angenete, E
    et al.
    Angerås, U
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Ekelund, J
    Gellerstedt, M
    Thorsteinsdottir, T
    Steineck, G
    Haglind, E
    Physical activity before radical prostatectomy reduces sick leave after surgery - results from a prospective, non-randomized controlled clinical trial (LAPPRO).2016Inngår i: BMC Urology, E-ISSN 1471-2490, Vol. 16, nr 1, artikkel-id 50Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Studies have reported that early physical rehabilitation after surgical procedures is associated with improved outcome measured as shorter hospital stay and enhanced recovery. The aim of this study was to explore the relationship between the preoperative physical activity level and subsequent postoperative complications, sick-leave and hospital stay after radical prostatectomy for prostate cancer in the setting of the LAPPRO trial (LAParoscopic Prostatectomy Robot Open).

    METHODS: LAPPRO is a prospective controlled trial, comparing robot-assisted laparoscopic and open surgery for localized prostate cancer between 2008 and 2011. 1569 patients aged 64 or less with an occupation were included in this sub-study. The Gleason score was <7 in 52 % of the patients. Demographics and the level of self-assessed preoperative physical activity, length of hospital stay, complications, quality of life, recovery and sick-leave were extracted from clinical record forms and questionnaires. Multivariable logistic regression, with log-link and logit-link functions, was used to adjust for potential confounding variables.

    RESULTS: The patients were divided into four groups based on their level of activity. As the group with lowest engagement of physical activity was found to be significantly different in base line characteristics from the other groups they were excluded from further analysis. Among patients that were physically active preoperativelly (n = 1467) there was no significant difference between the physical activity-groups regarding hospital stay, recovery or complications. However, in the group with the highest self-assessed level of physical activity, 5-7 times per week, 13 % required no sick leave, compared to 6.3 % in the group with a physical activity level of 1-2 times per week only (p < 0.0001).

    CONCLUSIONS: In our study of med operated with radical prostatectomy, a high level of physical activity preoperatively was associated with reduced need for sick leave after radical prostatectomy compared to men with lower physical activity.

    TRIAL REGISTRATION: The trial is registered at the ISCRTN register. ISRCTN06393679 .

    Fulltekst (pdf)
    fulltext
  • 19. Ansund, Josefin
    et al.
    Mijwel, Sara
    Bolam, Kate
    Karolinska Institute, Stockholm, Sweden.
    Altena, Renske
    Wengström, Yvonne
    Rullman, Eric
    Rundqvist, Helene
    High intensity exercise during breast cancer chemotherapy - effects on long-term myocardial damage and physical capacity - data from the OptiTrain RCT.2021Inngår i: Cardio-oncology (London, England), ISSN 2057-3804, Vol. 7, nr 1, s. 7-, artikkel-id 7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Adjuvant systemic breast cancer treatment improves disease specific outcomes, but also presents with cardiac toxicity. In this post-hoc exploratory analysis of the OptiTrain trial, the effects of exercise on cardiotoxicity were monitored by assessing fitness and biomarkers over the intervention and into survivorship. Methods; Women starting chemotherapy were randomized to 16-weeks of resistance and high-intensity interval training (RT-HIIT), moderate-intensity aerobic and high-intensity interval training (AT-HIIT), or usual care (UC). Outcome measures included plasma troponin-T (cTnT), Nt-pro-BNP and peak oxygen uptake (VO2peak), assessed at baseline, post-intervention, and at 1- and 2-years.

    RESULTS: For this per-protocol analysis, 88 women met criteria for inclusion. Plasma cTnT increased in all groups post-intervention. At the 1-year follow-up, Nt-pro-BNP was lower in the exercise groups compared to UC. At 2-years there was a drop in VO2peak for patients with high cTnT and Nt-pro-BNP. Fewer patients in the RT-HIIT group fulfilled biomarker risk criteria compared to UC (OR 0.200; 95% CI = 0.055-0.734).

    CONCLUSIONS: In this cohort, high-intensity exercise was associated with lower levels of NT-proBNP 1-year post-baseline, but not with cTnT directly after treatment completion. This may, together with the preserved VO2peak in patients with low levels of biomarkers, indicate a long-term cardioprotective effect of exercise.

    TRIAL REGISTRATION: Clinicaltrials. govNCT02522260 , Registered 13th of august 2015 - Retrospectively Registered.

  • 20.
    Askling, Carl
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Akut hamstringsskada vanlig inom svensk elitfotboll2013Inngår i: Idrottsmedicin, ISSN 2001-3302, nr 2, s. 26-27Artikkel i tidsskrift (Annet vitenskapelig)
  • 21.
    Askling, Carl
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Are exercises the best medicine?2017Konferansepaper (Fagfellevurdert)
  • 22.
    Askling, Carl
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Nilsson, Johnny
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Thorstensson, Alf
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    A new hamstring test to complement the common clinical examination before return to sport after injury2010Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 18, nr 12, s. 1788-1803Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The aim was to introduce and evaluate the reliability and validity of an active hamstring flexibility test as a complement to common clinical examination when determining safe return to sport after hamstring injury.

    METHODS: Eleven healthy subjects (28 years) were tested on repeated occasions, and 11 athletes (21 years) with MRI-verified acute hamstring strain were tested when common clinical examination revealed no signs of remaining injury, i.e. there was no differences between the legs in palpation pain, manual strength tests, and passive straight leg raise. Flexibility, i.e. highest range of motion of three consecutive trials, was calculated from electrogoniometer data during active ballistic hip flexions and conventional passive slow hip-flexions in a supine position. A VAS-scale (0-100) was used to estimate experience of insecurity during active tests.

    RESULTS: No significant test-retest differences were observed. Intra-class correlation coefficients ranged 0.94-0.99 and coefficients of variation 1.52-4.53%. Active flexibility was greater (23%) than passive flexibility. In the athletes, the injured leg showed smaller (8%) active, but not passive, flexibility than the uninjured leg. Average insecurity estimation was 52 (range 28-98) for the injured and 0 for the uninjured leg, respectively.

    CONCLUSION: The new test showed high reliability and construct validity; furthermore, it seems to be sensitive enough to detect differences both in active flexibility and in insecurity after acute hamstring strains at a point in time when the commonly used clinical examination fails to reveal injury signs. Thus, the test could be a complement to the common clinical examination before the final decision to return to sport is made.

  • 23. Baguley, Brenton J
    et al.
    Bolam, Kate
    Karolinska Institute, Stockholm, Sweden.
    Wright, Olivia R L
    Skinner, Tina L
    The Effect of Nutrition Therapy and Exercise on Cancer-Related Fatigue and Quality of Life in Men with Prostate Cancer: A Systematic Review.2017Inngår i: Nutrients, E-ISSN 2072-6643, Vol. 9, nr 9, artikkel-id 1003Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Improvements in diet and/or exercise are often advocated during prostate cancer treatment, yet the efficacy of, and optimal nutrition and exercise prescription for managing cancer-related fatigue and quality of life remains elusive. The aim of this study is to systematically review the effects of nutrition and/or exercise on cancer-related fatigue and/or quality of life.

    METHODS: A literature search was conducted in six electronic databases. The Delphi quality assessment list was used to evaluate the methodological quality of the literature. The study characteristics and results were summarized in accordance with the review's Population, Intervention, Control, Outcome (PICO) criteria.

    RESULTS: A total of 20 articles (one diet only, two combined diet and exercise, and seventeen exercise only studies) were included in the review. Soy supplementation improved quality of life, but resulted in several adverse effects. Prescribing healthy eating guidelines with combined resistance training and aerobic exercise improved cancer-related fatigue, yet its effect on quality of life was inconclusive. Combined resistance training with aerobic exercise showed improvements in cancer-related fatigue and quality of life. In isolation, resistance training appears to be more effective in improving cancer-related fatigue and quality of life than aerobic exercise. Studies that utilised an exercise professional to supervise the exercise sessions were more likely to report improvements in both cancer-related fatigue and quality of life than those prescribing unsupervised or partially supervised sessions. Neither exercise frequency nor duration appeared to influence cancer-related fatigue or quality of life, with further research required to explore the potential dose-response effect of exercise intensity.

    CONCLUSION: Supervised moderate-hard resistance training with or without moderate-vigorous aerobic exercise appears to improve cancer-related fatigue and quality of life. Targeted physiological pathways suggest dietary intervention may alleviate cancer-related fatigue and improve quality of life, however the efficacy of nutrition management with or without exercise prescription requires further exploration.

  • 24.
    Bakkman, Linda
    et al.
    Karolinska institutet.
    Fernström, Maria
    Karolinska institutet.
    Loogna, Peter
    Sophiahemmet.
    Rooyackers, Olav
    Brandt, Lena
    Karolinska institutet.
    Lagerros, Ylva Trolle
    Karolinska institutet.
    Reduced respiratory capacity in muscle mitochondria of obese subjects.2010Inngår i: Obesity Facts, ISSN 1662-4025, E-ISSN 1662-4033, Vol. 3, nr 6, s. 371-5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND/AIMS: The extent of weight gain varies among individuals despite equal calorie overconsumption. Furthermore, weight gain is often less than expected from energy excess. This suggests differences in metabolic efficiency and basal metabolism. Since mitochondrial uncoupling accounts for a substantial portion of the basal metabolic rate, we compared skeletal muscle mitochondrial respiration in obese subjects to normal-weight reference groups with various degrees of physical activity.

    METHODS: Muscle biopsies were taken from the vastus lateralis muscle of 9 healthy obese subjects (BMI 40 ± 3). Mitochondria were isolated and analyzed for coupled (state 3) and uncoupled (state 4) respirations as well as mitochondrial efficiency (P/O ratio) using pyruvate as a substrate. Respiratory data were compared to reference groups A, normal-weight untrained (BMI 24 ± 0.7), and B, normal-weight trained (BMI 24 ± 0.6).

    RESULTS: Obese subjects had a decreased respiratory capacity per mitochondrial volume compared to the reference groups: this was evident in state 4 (65% and 35% of reference group A and B, respectively) and state 3 (53% and 29% of A and B, respectively) (p < 0.05).

    CONCLUSION: Obese subjects had a low capacity for fuel oxidation, which may play a role in the predisposition of obesity. However, whether lower mitochondrial capacity is a cause or a consequence of obesity requires further research.

  • 25.
    Bendrik, R., Jr.
    et al.
    Uppsala Univ, Deparment Publ Hlth & Caring Sci, Uppsala, Sweden.;Uppsala Univ, Ctr Res & Dev, Gavle, Sweden.;Reg Gavleborg, Gavle, Sweden..
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp. Uppsala Univ, Deparment Publ Hlth & Caring Sci, Uppsala, Sweden..
    Broms, K., Sr.
    Uppsala Univ, Deparment Publ Hlth & Caring Sci, Uppsala, Sweden.;Uppsala Univ, Ctr Res & Dev, Gavle, Sweden.;Reg Gavleborg, Gavle, Sweden..
    Emtner, M., Sr.
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    MAXIMAL STEP-UP TEST A NEW FUNCTIONAL TEST IN HIP OR KNEE OSTEOARTHRITIS2016Inngår i: Osteoarthritis and Cartilage, ISSN 1522-9653, Vol. 24, nr S1, s. S471-S471Artikkel i tidsskrift (Fagfellevurdert)
  • 26.
    Bendrik, Regina
    et al.
    Uppsala University, Sweden.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Uppsala University, Sweden.
    Bröms, Kristina
    Uppsala University, Sweden.
    Kunanusornchai, Wanlop
    Mahidol University, Bangkok, Thailand.
    Emtner, Margareta
    Uppsala University, Sweden.
    Physical activity on prescription in patients with hip or knee osteoarthritis: A randomized controlled trial.2021Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 35, nr 10, s. 1465-1477Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate whether physical activity on prescription, comprising five sessions, was more effective in increasing physical activity than a one-hour advice session after six months.

    DESIGN: Randomized, assessor-blinded, controlled trial.

    SETTING: Primary care.

    SUBJECTS: Patients with clinically verified osteoarthritis of the hip or knee who undertook less than 150 minute/week of moderate physical activity, and were aged 40-74 years.

    INTERVENTIONS: The advice group (n = 69) received a one-hour session with individually tailored advice about physical activity. The physical activity on prescription group (n = 72) received individually tailored physical activity recommendations with written prescription, and four follow-ups during six months.

    MAIN MEASURES: Patients were assessed at baseline and six months: physical activity (accelerometer, questionnaires); fitness (six-minute walk test, 30-second chair-stand test, maximal step-up test, one-leg rise test); pain after walking (VAS); symptoms (HOOS/KOOS); and health-related quality of life (EQ-5D).

    RESULTS: One hundred four patients had knee osteoarthritis, 102 were women, and mean age was 60.3 ± 8.3 years. Pain after walking decreased significantly more in the prescription group, from VAS 31 ± 22 to 18 ± 23. There was no other between groups difference. Both groups increased self-reported activity minutes significantly, from 105 (95% CI 75-120) to 165 (95% CI 135-218) minute/week in the prescription group versus 75 (95% CI 75-105) to 150 (95% CI 120-225) in the advice group. Also symptoms and quality of life improved significantly in both groups.

    CONCLUSION: Individually tailored physical activity with written prescription and four follow-ups does not materially improve physical activity level more than advice about osteoarthritis and physical activity.

    TRIAL REGISTRATION: ClinicalTrials.gov (NCT02387034).

    Fulltekst (pdf)
    fulltext
  • 27.
    Bendrik, Regina
    et al.
    Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden.; Centre for Research and Development, Uppsala University/ Region Gävleborg, Gävle, Sweden.
    Kallings, Lena V
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden..
    Bröms, Kristina
    Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden..
    Emtner, Margareta
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden..
    Follow-up of individualised physical activity on prescription and individualised advice in patients with hip or knee osteoarthritis: A randomised controlled trial.2024Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 38, nr 6, s. 770-782Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients.

    DESIGN: Randomised, assessor-blinded, controlled trial.

    SETTING: Primary care.

    SUBJECTS: Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40-74.

    INTERVENTION: The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups.

    MAIN MEASURES: Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months.

    RESULTS: There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74-130) minutes/week at baseline to 214 (95% CI 183-245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103-157) to 176 (95% CI 145-207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by -514 (95% CI -567-462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was -852 (95% CI -900-804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5-8.2) and in the prescription group by 14.7 points (95% CI 14.3-15.1) from baseline to 24 months (p = 0.024 between groups).

    CONCLUSIONS: There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis.

    Fulltekst (pdf)
    fulltext
  • 28.
    Bendrik, Regina
    et al.
    Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Sundström, Björn
    Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden; Department of Public health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden..
    Bröms, Kristina
    Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden..
    Emtner, Margareta
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kallings, Lena V
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden.
    Peterson, Magnus
    Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden; Academic Primary Health Care, Region Uppsala, Sweden.
    One leg testing in hip and knee osteoarthritis: A comparison with a two-leg oriented functional outcome measure and self-reported functional measures.2024Inngår i: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 32, nr 7, s. 937-942Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To compare the responsiveness of two unilateral lower-limb performance-based tests, the one-leg rise test and the maximal step-up test, with the bilateral 30-second chair-stand test and the self-reported measure of physical function (HOOS/KOOS). Specific aims were to evaluate responsiveness, floor/ceiling effect and association between the instruments.

    METHOD: Data was included from 111 participants, mean age 61.3 years (8.3), with clinically verified hip or knee osteoarthritis, who reported less than 150 minutes/week of moderate or vigorous intensity physical activity. Responsiveness, how well the instruments captured improvements, was measured as Cohen's standardised mean difference for effect size, and was assessed from baseline to 12 months following a physical activity intervention. Other assessments were floor and ceiling effects, and correlations between tests.

    RESULTS: The maximal step-up test had an effect size of 0.57 (95% CI 0.37, 0.77), the 30-second chair-stand 0.48 (95% CI 0.29, 0.68) and the one-leg rise test 0.12 (95% CI 0.60, 0.31). The one-leg rise test had a floor effect as 72% of the participants scored zero at baseline and 63% at 12 months. The correlation between performance-based tests and questionnaires was considered to be minor (r = 0.188 to 0.226) (p = 0.018 to 0.048).

    CONCLUSION: The unilateral maximal step-up test seems more responsive to change in physical function compared to the bilateral 30-second chair-stand test, although the tests did not differ statistically in effect size. The maximal step-up test provides specific information about each leg for the individual and allows for comparison between the legs.

    Fulltekst (pdf)
    fulltext
  • 29.
    Bergström, Göran
    et al.
    Göteborgs universitet.
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms och Mats Börjessons forskningsgrupp.
    Schmidt, Caroline
    Göteborgs universitet.
    Self-efficacy regarding physical activity is superior to self-assessed activity level, in long-term prediction of cardiovascular events in middle-aged men2015Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikkel-id 820Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Self-efficacy has been determined to be a strong predictor of who will engage in physical activity. We aimed to evaluate the associations between self-efficacy to perform physical activity, self-reported leisure-time physical activity and cardiovascular events in a population-based cohort of middle-aged Swedish men with no previous cardiovascular disease, or treatment with cardiovascular drugs.

    Methods

    Analyses are based on 377 men randomly selected and stratified for weight and insulin sensitivity from a population sample of 58-year-old men (n = 1728) and who had answered a question about their competence to perform exercise (as an assessment of physical self-efficacy). The Saltin-Grimby Physical Activity Level Scale was used to assess self-reported levels of leisure-time physical activity. Cardiovascular events were recorded during 13-years of follow-up.

    Results

    The group with poor self-efficacy to perform physical activity had a significantly higher incidence of cardiovascular events compared with the group with good physical self-efficacy (32.1 % vs 17.1 %, p < 0.01). Multivariate analyses showed that poor physical self-efficacy was associated with an increased relative risk of 2.0 (95 % CI 1.2 to 3.0), of having a cardiovascular event during follow-up also after adjustments for co-variates such as waist to hip ratio, heart rate, fasting plasma glucose, serum triglycerides, systolic blood pressure, apoB/apoA-I ratio and leisure-time physical activity.

    Conclusion

    Self-efficacy to perform physical activity was strongly and independently associated with cardiovascular events and was superior to self-assessed physical activity in predicting cardiovascular events during 13-years of follow-up in a group of middle-aged men, without known CVD or treatment with cardiovascular drugs.

    Fulltekst (pdf)
    fulltext
  • 30.
    Bergström, Göran
    et al.
    Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.;Departments of Clinical Physiology (G. Bergström, O.H.), Region Västra Götaland, Gothenburg, Sweden..
    Persson, Margaretha
    Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.;Departments of Internal Medicine (M.P.), Skåne University Hospital, Malmö, Sweden..
    Adiels, Martin
    Sahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden..
    Björnson, Elias
    Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden..
    Bonander, Carl
    Sahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden..
    Ahlström, Håkan
    Section of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden..
    Alfredsson, Joakim
    Departments of Cardiology (J.A., E.S.), Linköping University, Sweden.;Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden..
    Angerås, Oskar
    Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.;Cardiology (O.A.), Region Västra Götaland, Gothenburg, Sweden..
    Berglund, Göran
    Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden..
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden..
    Brandberg, John
    Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.;Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden..
    Börjesson, Mats
    Institute of Medicine (M.B.), University of Gothenburg, Sweden.;Center for Health and Performance (M.B.), University of Gothenburg, Sweden.;Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden..
    Cederlund, Kerstin
    Department of Clinical Science, Intervention and Technology (K.C.), Karolinska Institutet, Stockholm, Sweden..
    de Faire, Ulf
    Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine (U.d.F.), Karolinska Institutet, Stockholm, Sweden..
    Duvernoy, Olov
    Section of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden..
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Engström, Gunnar
    Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden..
    Engvall, Jan E.
    Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.;Clinical Physiology (J.E.E.), Linköping University, Sweden.;CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden..
    Fagman, Erika
    Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.;Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden..
    Eriksson, Mats
    Department of Endocrinology, Metabolism &amp; Diabetes and Clinical Research Center, Karolinska University Hospital Huddinge, Stockholm, Sweden (M.E.)..
    Erlinge, David
    Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.)..
    Fagerberg, Björn
    Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.;Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden..
    Flinck, Agneta
    Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.;Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden..
    Gonçalves, Isabel
    Department of Clinical Sciences Malmö (I.G.), Lund University and Skåne University Hospital, Lund, Sweden..
    Hagström, Emil
    Cardiology (E.H.), Uppsala University, Sweden.;Department of Medical Sciences, and Uppsala Clinical Research Center (E.H.), Uppsala University, Sweden..
    Hjelmgren, Ola
    Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.;Departments of Clinical Physiology (G. Bergström, O.H.), Region Västra Götaland, Gothenburg, Sweden..
    Lind, Lars
    Clinical Epidemiology (L.L., J.S.), Uppsala University, Sweden..
    Lindberg, Eva
    Respiratory, Allergy and Sleep Research (E.L.), Uppsala University, Sweden..
    Lindqvist, Per
    Department of Surgical and Perioperative Sciences (P.L.), Umeå University, Sweden..
    Ljungberg, Johan
    Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden..
    Magnusson, Martin
    Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.;Cardiology (M. Magnusson), Skåne University Hospital, Malmö, Sweden.;Wallenberg Center for Molecular Medicine, Lund University, Sweden (M. Magnusson).;North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa (M. Magnusson)..
    Mannila, Maria
    Heart and Vascular Theme, Department of Cardiology, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden (M. Mannila)..
    Markstad, Hanna
    Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences Malmö (H.M.), Lund University, Malmö, Sweden.;Center for Medical Imaging and Physiology (H.M.), Lund University and Skåne University Hospital, Lund, Sweden..
    Mohammad, Moman A.
    Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.)..
    Nystrom, Fredrik H.
    Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden..
    Ostenfeld, Ellen
    Department of Clinical Sciences Lund, Clinical Physiology (E.O.), Lund University and Skåne University Hospital, Lund, Sweden..
    Persson, Anders
    Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.;Radiology (A.P.), Linköping University, Sweden.;CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden..
    Rosengren, Annika
    Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.;Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden..
    Sandström, Anette
    Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden..
    Själander, Anders
    Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden..
    Sköld, Magnus C.
    Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine (M.C.S.), Karolinska Institutet, Stockholm, Sweden.;Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden (M.C.S.)..
    Sundström, Johan
    Clinical Epidemiology (L.L., J.S.), Uppsala University, Sweden.;The George Institute for Global Health, University of New South Wales, Sydney, Australia (J.S.)..
    Swahn, Eva
    Departments of Cardiology (J.A., E.S.), Linköping University, Sweden.;Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden..
    Söderberg, Stefan
    Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden..
    Torén, Kjell
    Occupational and Environmental Medicine/School of Public Health and Community Medicine (K.T.), University of Gothenburg, Sweden.;Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden..
    Östgren, Carl Johan
    Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.;CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden..
    Jernberg, Tomas
    Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institutet, Stockholm, Sweden..
    Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population2021Inngår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 144, nr 12, s. 916-929Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.

    Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.

    Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.

    Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

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  • 31.
    Birgegard, Andreas
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Abbaspour, Afrouz
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Borg, Stina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Forsén Mantilla, Emma
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Savva, Androula
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Termorshuizen, Jet D.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bulik, Cynthia M.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ N Carolina, Dept Psychiat, Chapel Hill, NC 27515 USA.;Univ N Carolina, Dept Nutr, Chapel Hill, NC 27515 USA..
    Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden2021Inngår i: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 30, nr 6, s. 602-617Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The study aimed to document the impact of the COVID-19 pandemic on the health and well-being of individuals with past and current eating disorders (ED) in Sweden. We re-contacted participants with a known lifetime history of ED from two previous Swedish studies. Participants completed an online survey about health and functioning at baseline early in the pandemic (Wave 1 ca May/June 2020; N= 982) and six months later (Wave 2 Dec/Jan 2020/21; N= 646). Three important patterns emerged: 1) higher current ED symptoms were associated with greater anxiety, worry, and pandemic-related ED symptom increase; 2) patterns were fairly stable across time, although a concerning percentage (23%) who were symptom-free at Wave 1 reported the re-emergence of symptoms at Wave 2; and 3) only a minority of participants (<50%) with a current ED were in treatment, and of those in treatment, many reported fewer treatment sessions and decreased quality of care. The COVID-19 pandemic appears to pose serious health challenges for individuals with an ED, whether currently symptomatic or in remission. We encourage health service providers and patient advocates to be alert to the needs of individuals with ED and to take active measures to ensure access to appropriate evidence-based care both during and following the pandemic.

  • 32.
    Birgegard, Andreas
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Karolinska Inst, MEB, Nobels Vag 12A, SE-17177 Stockholm, Sweden..
    Forsén Mantilla, Emma
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Breithaupt, Lauren E.
    Massachusetts Gen Hosp, Eating Disorders Clin & Res Program, Boston, MA USA.;Harvard Med Sch, Dept Psychiat, Boston, MA USA..
    Borg, Stina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Sanzari, Christina M.
    SUNY Albany, Dept Psychol, Albany, NY USA.;Univ North Carolina Chapel Hill, Dept Psychiat, Chapel Hill, NC USA..
    Padalecki, Sophie
    Univ North Carolina Chapel Hill, Dept Psychiat, Chapel Hill, NC USA.;Elon Univ, Coll Arts & Sci, Dept Publ Hlth, Elon, NC USA..
    Hedlund, Elin
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bulik, Cynthia M.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ North Carolina Chapel Hill, Dept Psychiat, Chapel Hill, NC USA.;Univ North Carolina Chapel Hill, Dept Nutr, Chapel Hill, NC USA..
    Proposal for increasing diagnostic clarity in research and clinical practice by renaming and reframing atypical anorexia nervosa as "Restrictive Eating Disorder" (RED)2023Inngår i: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 50, artikkel-id 101750Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Atypical anorexia nervosa (AAN) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5), is characterized by meeting all criteria for anorexia nervosa (AN) except for weight being within or above the "normal" range despite significant weight loss. The current definition is plagued by several problems, resulting in widely heterogeneous operationalizations in research and clinical practice. As such, the poorly defined diagnosis of AAN negatively impacts affected individuals and frustrates research attempts to better understand the syndrome. We consider conceptual flaws in the AAN description and contend that the undefined weight range and nature of weight loss renders these two factors functionally inapplicable in research and practice. They also represent a departure from the originally intended use of the AAN category, i.e., arresting a negative weight trajectory likely to result in AN, making the target population, and the application of the label, unclear. We propose revised criteria and a new name, restrictive eating disorder (RED), intended to reduce stigma and encompass a wide but better-defined range of presentations. The RED criteria focus on clinically significant restrictive behavior that disrupts normal living (i.e., impairment), and cognitive symptoms of overevaluation, disturbed experience, and lack of recognition of illness seriousness. We believe that RED may enable more appropriate clinical application, but also inspire coordinated research toward a more valid psychiatric nosology in the eating disorders field.

  • 33.
    Birgegard, Andreas
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Forsén Mantilla, Emma
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Dinkler, Lisa
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Hedlund, Elin
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Savva, Androula
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Larsson, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Bulik, Cynthia M.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Validity of eating disorder diagnoses in the Swedish national patient register2022Inngår i: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 150, s. 227-230Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Swedish National Patient Register (NPR) includes population-level longitudinal data, and determining the validity of NPR diagnoses is critical to undergirding the research and policy recommendations they inform. Sweden also has the integrated "Riksa & BULL;t " and "Stepwise " National Quality Registers (QR), with data from specialized eating disorder (ED) treatment based on structured, valid assessment methods. To validate NPR ED diagnoses, we compared ICD-10-based anorexia nervosa (AN), bulimia nervosa (BN), and unspecified ED in NPR to DSM-IV-based AN, BN, and ED not otherwise specified category (EDNOS) in QR. Patients' first diagnoses registered in QR between February 2008 and August 2013 were compared with NPR diagnoses entered within & PLUSMN;1 month (N = 2074). QR registration includes the semi-structured DSM-IV-based Structured ED Interview. Each ED diagnosis was analyzed separately for degree of match using several indices: overall agreement, sensitivity, positive predictive value, specificity, negative predictive value, area under the curve, and Cohen's kappa. Results showed moderate to excellent agreement depending on estimate (e.g. positive predictive values AN: 0.747; BN:.836; EDNOS: 0.761), except for a somewhat low sensitivity for BN, and EDNOS agreement was overall the lowest. Case prevalence in the NPR and QR was highly similar for AN, and within five percentage points for BN and EDNOS. Generalizability is hampered by limited age range and diagnostic resolution as well as few males. Available data precluded study of presence/absence of ED, and complementary approaches are considered for future research. We conclude that NPR ED diagnoses have acceptable validity and are appropriate for use in research.

  • 34.
    Bjerkefors, Anna
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Squair, J W
    Malik, R
    Lam, T
    Chen, Z
    Carpenter, M G
    Diagnostic accuracy of common clinical tests for assessing abdominal muscle function after motor-complete spinal cord injury above T6.2015Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 53, s. 114-119Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study design:Diagnostic study.Objectives:The objective of this study was to compare patterns of electromyography (EMG) recordings of abdominal muscle function in persons with motor-complete spinal cord injury (SCI) above T6 and in able-bodied controls, and to determine whether manual examination or ultrasound measures of muscle activation can be accurate alternatives to EMG.Setting:Research center focused on SCI and University laboratory, Vancouver, Canada.Methods:Thirteen people with SCI (11 with American Spinal Injury Association Impairment Scale (AIS) A and 2 AIS B; C4-T5), and 13 matched able-bodied participants volunteered for the study. Participants completed trunk tasks during manual examination of the abdominal muscles and then performed maximal voluntary isometric contractions, while EMG activity and muscle thickness changes were recorded. The frequency of muscle responses detected by manual examination and ultrasound were compared with detection by EMG (sensitivity and specificity).Results:All individuals with SCI were able to elicit EMG activity above resting levels in at least one abdominal muscle during one task. In general, the activation pattern was task specific, confirming voluntary control of the muscles. Ultrasound, when compared with EMG, showed low sensitivity but was highly specific in its ability to detect preserved abdominal muscle function in persons with SCI. Conversely, manual examination was more sensitive than ultrasound but showed lower specificity.Conclusion:The results from this study confirm preserved voluntary abdominal muscle function in individuals classified with motor-complete SCI above T6 and highlight the need for further research in developing more accurate clinical measures to diagnose the level of trunk muscle preservation in individuals with SCI.Spinal Cord advance online publication, 25 November 2014; doi:10.1038/sc.2014.202.

  • 35.
    Bjerkefors, Anna
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Squair, J W
    Malik, R
    Lam, T
    Chen, Z
    Carpenter, M G
    Response to 'Diagnostic accuracy of common clinical tests for assessing abdominal muscle function after motor-complete spinal cord injury above T6'.2015Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 53, nr 12, s. 892-892Artikkel i tidsskrift (Annet vitenskapelig)
  • 36.
    Bjerkefors, Anna
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Squair, Jordan W
    Chua, Romeo
    Lam, Tania
    Chen, Zhen
    Carpenter, Mark G
    Assessment of abdominal muscle function in individuals with motor-complete spinal cord injury above T6 in response to transcranial magnetic stimulation.2015Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 2, s. 138-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To use transcranial magnetic stimulation and electromyography to assess the potential for preserved function in the abdominal muscles in individuals classified with motor-complete spinal cord injury above T6. Subjects: Five individuals with spinal cord injury (C5-T3) and 5 able-bodied individuals. Methods: Transcranial magnetic stimulation was delivered over the abdominal region of primary motor cortex during resting and sub-maximal (or attempted) contractions. Surface electromyography was used to record motor-evoked potentials as well as maximal voluntary (or attempted) contractions in the abdominal muscles and the diaphragm. Results: Responses to transcranial magnetic stimulation in the abdominal muscles occurred in all spinal cord injury subjects. Latencies of muscle response onsets were similar in both groups; however, peak-to-peak amplitudes were smaller in the spinal cord injury group. During maximal voluntary (or attempted) contractions all spinal cord injury subjects were able to elicit electromyography activity above resting levels in more than one abdominal muscle across tasks. Conclusion: Individuals with motor-complete spinal cord injury above T6 were able to activate abdominal muscles in response to transcranial magnetic stimulation and during maximal voluntary (or attempted) contractions. The activation was induced directly through corticospinal pathways, and not indirectly by stretch reflex activations of the diaphragm. Transcranial magnetic stimulation and electromyography measurements provide a useful method to assess motor preservation of abdominal muscles in persons with spinal cord injury.

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  • 37.
    Björkman, Frida
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Physical Exercise as Treatment for PTSD: A Systematic Review and Meta-Analysis.2022Inngår i: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 187, nr 9-10, s. 1103-e1113Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Post-traumatic stress disorder (PTSD) is a cluster of physical and psychiatric symptoms following military or civilian trauma. The effect of exercise on PTSD symptoms has previously been investigated in several studies. However, it has not been fully determined what type of exercise most impacts PTSD symptoms. The aim of the present study was to systematically review the effects of different types of exercise on PTSD symptom severity and symptoms of coexisting conditions in adults.

    MATERIALS AND METHODS: Electronic searches were conducted in the databases PubMed, APA PsycInfo, and SportDiscus, from database inception up until February 1, 2021. Inclusion criteria were randomized controlled trials published in English, participants having a PTSD diagnosis or clinically relevant symptoms, and participants randomly allocated to either a non-exercising control group or an exercise group. Data concerning the number of participants, age, exercise type and duration, PTSD symptom severity (primary outcome), and symptoms of coexisting conditions (secondary outcomes) were extracted. The subgroup analysis included high or low training dose, military trauma versus non-military trauma, the type of intervention (yoga versus other exercise), active or passive control condition, group training versus individual exercise, and study quality. The study quality and risk of bias were assessed using grading of recommendation assessment, development and evaluation (GRADE) guidelines. A meta-analysis was performed with a mixed-effects model and restricted maximum likelihood as model estimator, and effect size was calculated as the standardized difference in mean and 95% CI.

    RESULTS: Eleven studies were included in the present review. Results showed a main random effect of exercise intervention (0.46; 95% CI: 0.18 to 0.74) and a borderline significant interaction between more voluminous (>20 hours in total) and less voluminous (≤20 hours in total) exercise interventions (P = .07). No significant findings from the subgroup analysis were reported. The secondary outcome analysis showed a small but significant effect of exercise on depressive symptoms (0.20, 95% CI: 0.01 to 0.38), and a larger effect on sleep (0.51, 95% CI: 0.29 to 0.73). For substance use (alcohol and drugs combined) and quality of life, we found significant effects of 0.52 (95% CI: 0.06 to 0.98) and 0.51 (95% CI: 0.34 to 0.69), respectively. No significant effect was found for anxiety (0.18, 95% CI: -0.15 to 0.51), and no sign of publication bias was found.

    CONCLUSIONS: Exercise can be an effective addition to PTSD treatment, and greater amounts of exercise may provide more benefits. However, as there were no differences found between exercise type, possibly due to the inclusion of a low number of studies using different methodologies, further research should aim to investigate the optimal type, dose, and duration of activity that are most beneficial to persons with PTSD.

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  • 38.
    Björkman, Frida
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Holm, Karin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Fysisk status hos pojkar med typ 1 diabetes2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [en]

    Aim

    The aim of this study was to survey the physical fitness in boys with type 1 diabetes (IDDM). The results were compared to a control group with healthy boys that have preformed the same tests in other studies. Our questions were:

    1. How does BMI relate between IDDM-children and healthy peers?

    2. How does physical activity level relate between IDDM-children and healthy peers?

    3. How does aerobic fitness (VO2max), grip strength and balance relate between IDDM-children and healthy peers?

    Method

    Subjects were recruited in cooperation with Astrid Lindgrens Barnsjukhus. Height, body mass, VO2max, grip strength, balance and measurement of physical activity level with accelerometry were data collected from five boys with type 1 diabetes. The results were compared to data found in healthy subjects. The collected data were presented as z scores.

    Results

    Two subjects showed a main difference in their test results compared to the mean value of healthy boys. The subjects that were deviated from mean values performed poor results in some or all of the tests. Only two subjects provided sufficiently registration of physical activity level for comparison with the control group. Data showed a lower activity level in one subject compared to healthy controls and a higher activity level in the other subject.

    Conclusions

    The examined group cannot be proven to be a representative selection, and no general conclusion regarding children with type 1 diabetes and their physical status could be drawn. No statistic significant differences could be found based on the data of this study. One notable tendency was that the subjects that differs a lot from mean values in some test also show the same discrepancy in the other tests.

    Fulltekst (pdf)
    FULLTEXT01
  • 39.
    Björkman, Frida
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Björn Ekbloms forskningsgrupp.
    Mattsson, C. Mikael
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Björn Ekbloms forskningsgrupp.
    Hur farlig är multisport?2011Inngår i: Svensk IdrottsMedicin, ISSN 1103-7652, Vol. 30, nr 4, s. 8-11Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Den övervägande delen av deltagarna i större multisporttävlingar drabbas av någon typ av skada som i de flesta fall är lindrig. Men det är ändå ingen tvekan om att multisport kan vara farligt. Det ställs höga krav på medicinsk personal att kunna hantera en mångfald av skador och sjukdomar.

  • 40.
    Blackwood, Sarah J
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Horwath, Oscar
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Moberg, Marcus
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Pontén, Marjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Apro, William
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden..
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden..
    Larsen, Filip J
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Katz, Abram
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Extreme Variations in Muscle Fiber Composition Enable Detection of Insulin Resistance and Excessive Insulin Secretion.2022Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 107, nr 7, s. e2729-e2737, artikkel-id dgac221Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    CONTEXT: Muscle fiber composition is associated with peripheral insulin action.

    OBJECTIVE: We investigated whether extreme differences in muscle fiber composition are associated with alterations in peripheral insulin action and secretion in young, healthy subjects who exhibit normal fasting glycemia and insulinemia.

    METHODS: Relaxation time following a tetanic contraction was used to identify subjects with a high or low expression of type I muscle fibers: group I (n=11), area occupied by type I muscle fibers = 61.0 ± 11.8%; group II (n=8), type I area = 36.0 ± 4.9% (P<0.001). Biopsies were obtained from the vastus lateralis muscle and analyzed for mitochondrial respiration on permeabilized fibers, muscle fiber composition and capillary density. An intravenous glucose tolerance test was performed and indices of glucose tolerance, insulin sensitivity and secretion were determined.

    RESULTS: Glucose tolerance was similar between groups, whereas whole-body insulin sensitivity was decreased by ~50% in group II vs group I (P=0.019). First phase insulin release (area under the insulin curve during 10 min after glucose infusion) was increased by almost 4-fold in group II vs I (P=0.01). Whole-body insulin sensitivity was correlated with % area occupied by type I fibers (r=0.54; P=0.018) and capillary density in muscle (r=0.61; P=0.005), but not with mitochondrial respiration. Insulin release was strongly related to % area occupied by type II fibers (r=0.93; P<0.001).

    CONCLUSIONS: Assessment of muscle contractile function in young healthy subjects may prove useful in identifying individuals with insulin resistance and enhanced glucose stimulated insulin secretion prior to onset of clinical manifestations.

  • 41.
    Blackwood, Sarah J
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Horwath, Oscar
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Moberg, Marcus
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden..
    Pontén, Marjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Apro, William
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden..
    Larsen, Filip J
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Katz, Abram
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Insulin resistance after a 3-day fast is associated with an increased capacity of skeletal muscle to oxidize lipids.2023Inngår i: American Journal of Physiology. Endocrinology and Metabolism, ISSN 0193-1849, E-ISSN 1522-1555, Vol. 324, nr 5, s. E390-E401Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There is a debate on whether lipid-mediated insulin resistance derives from an increased or decreased capacity of muscle to oxidize fats. Here we examine the involvement of muscle fiber composition in the metabolic responses to a 3-day fast (starvation, which results in increases in plasma lipids and insulin resistance) in two groups of healthy young subjects: 1, area occupied by type I fibers = 61.0 ± 11.8%; 2, type I area = 36.0 ± 4.9% (P<0.001). Muscle biopsies and intravenous glucose tolerance tests were performed after an overnight fast and after starvation. Biopsies were analyzed for muscle fiber composition and mitochondrial respiration. Indices of glucose tolerance and insulin sensitivity were determined. Glucose tolerance was similar in both groups after an overnight fast and deteriorated to a similar degree in both groups after starvation. In contrast, whole-body insulin sensitivity decreased markedly after starvation in group 1 (P<0.01), whereas the decrease in group 2 was substantially smaller (P=0.06). Non-esterified fatty acids and β-hydroxybutyrate levels in plasma after an overnight fast were similar between groups and increased markedly and comparably in both groups after starvation, demonstrating similar degrees of lipid load. The capacity of permeabilized muscle fibers to oxidize lipids was significantly higher in group 1 vs. 2, whereas there was no significant difference in pyruvate oxidation between groups. The data demonstrate that loss of whole-body insulin sensitivity after short-term starvation is a function of muscle fiber composition and is associated with an elevated rather than a diminished capacity of muscle to oxidize lipids.

  • 42.
    Bolam, Kate
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Bojsen-Møller, Emil
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Wallin, Peter
    Research Department, HPI Health Profile Institute, Stockholm, Sweden..
    Paulsson, Sofia
    Research Department, HPI Health Profile Institute, Stockholm, Sweden..
    Lindwall, Magnus
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Psychology, University of Gothenburg, Goteborg, Sweden..
    Rundqvist, Helene
    Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden..
    Ekblom Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Association between change in cardiorespiratory fitness and prostate cancer incidence and mortality in 57 652 Swedish men.2024Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 58, nr 7, s. 366-372Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To examine the associations between changes in cardiorespiratory fitness (CRF) in adulthood and prostate cancer incidence and mortality.

    METHODS: In this prospective study, men who completed an occupational health profile assessment including at least two valid submaximal CRF tests, performed on a cycle ergometer, were included in the study. Data on prostate cancer incidence and mortality were derived from national registers. HRs and CIs were calculated using Cox proportional hazard regression with inverse probability treatment weights of time-varying covariates.

    RESULTS: During a mean follow-up time of 6.7 years (SD 4.9), 592 (1%) of the 57 652 men were diagnosed with prostate cancer, and 46 (0.08%) died with prostate cancer as the primary cause of death. An increase in absolute CRF (as % of L/min) was associated with a reduced risk of prostate cancer incidence (HR 0.98, 95% CI 0.96 to 0.99) but not mortality, in the fully adjusted model. When participants were grouped as having increased (+3%), stable (±3%) or decreased (-3%) CRF, those with increased fitness also had a reduced risk of prostate cancer incidence compared with those with decreased fitness (HR 0.65, 95% CI 0.49 to 0.86), in the fully adjusted model.

    CONCLUSION: In this study of employed Swedish men, change in CRF was inversely associated with risk of prostate cancer incidence, but not mortality. Change in CRF appears to be important for reducing the risk of prostate cancer.

    Fulltekst (pdf)
    fulltext
  • 43.
    Bolam, Kate
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Mijwel, Sara
    Rundqvist, Helene
    Wengström, Yvonne
    Two-year follow-up of the OptiTrain randomised controlled exercise trial.2019Inngår i: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 175, nr 3, s. 637-648Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The aim of this study was to determine if there were any differences in health-related outcomes and physical activity (PA) between the two OptiTrain exercise groups and usual care (UC), 2 years post-baseline.

    METHODS: The OptiTrain study was a three-arm randomised controlled trial comparing 16 weeks of concurrent aerobic high-intensity interval training (HIIT) and progressive resistance exercise (RT-HIIT) or concurrent HIIT and continuous moderate-intensity aerobic exercise (AT-HIIT) to UC in 206 patients with breast cancer undergoing chemotherapy. Eligible participants were approached 2 years following baseline to assess cancer-related fatigue, quality of life, symptoms, muscle strength, cardiorespiratory fitness, body mass, PA, sedentary behaviour, and sick leave.

    RESULTS: The RT-HIIT group reported lower total cancer-related fatigue, (- 1.37, 95% CI - 2.70, - 0.04, ES = - 0.06) and cognitive cancer-related fatigue (- 1.47, 95% CI - 2.75, - 0.18, ES = - 0.28), and had higher lower limb muscle strength (12.09, 95% CI 3.77, 20.40, ES = 0.52) than UC at 2 years. The AT-HIIT group reported lower total symptoms (- 0.23, 95% CI - 0.42, - 0.03, ES = - 0.15), symptom burden (- 0.30, 95% CI - 0.60, - 0.01, ES = - 0.19), and body mass - 2.15 (- 3.71, - 0.60, ES = - 0.28) than UC at 2 years.

    CONCLUSION: At 2 years, the exercise groups were generally experiencing positive differences in cancer-related fatigue (RT-HIIT), symptoms (AT-HIIT), and muscle strength (RT-HIIT) to UC. The findings provide novel evidence that being involved in an exercise program during chemotherapy can have long-term benefits for women with breast cancer, but that strategies are needed to create better pathways to support patients to maintain physical activity levels.

    TRIAL REGISTRATION: Clinicaltrials.gov registration number: NCT02522260. Trial registered on 9 June 2015. https://clinicaltrials.gov/ct2/show/NCT02522260 . Retrospectively registered.

  • 44.
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms och Mats Börjessons forskningsgrupp.
    The Role Of The Ecg In Cardiovascular Screening Of Athletes2015Inngår i: European Journal of Sports Medicine, 3(2015):Suppl. 1 / [ed] Konstantinos Natsis, 2015, Vol. 3, s. 27-28Konferansepaper (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Sudden cardiac arrest (SCA) in an athlete, is an uncommon event (1/50 000), caused by inherited/congenital cardiovascular disease (in younger athletes, >35 years), while in the older athletes, the cause is most often  underlying coronary artery disease (CAD). Cardiac societies, Sports Medicine Associations and subsequently international sporting bodies have developed cardiac screening programmes to prevent SCA in athletes. In addition, increased  awareness and recommendations regarding arena safety procedures (external automated defibrillators, medical action plans), have been introduced in recent years, to increase the chance of survival in case of a SCA. However, the most appropriate cardiac screening protocol and specifically, the role of the ECG in cardiovascular screening of athletes, is still debated.

    AIM: This talk will discuss the sensitivity and specificity issues, connected with using the ECG or not, as part of cardiovascular screening of athletes.

    MATERIALS AND METHODS: Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) (1) as well as the International Olympic Committee (IOC) recommend regular screening of competitive athletes, including personal and family history and physical examination. However, the AHA does not recommend the routine use of the ECG in screening. In recent years, more evidence has emerged, making it possible to scrutinize the literature regarding sensitivity/specificity for screening with/without ECG.

    RESULTS: Firstly, the available literature show that cardiovascular screening including an ECG will have much superior sensitivity for finding underlying relevant cardiac abnormalities. Traditionally, ECG has been found to also have a large number of false-positives, making the specificity of including the ECG low. However, in recent years, the international consensus-statements on ECG interpretation in athletes, have been repeatedly updated, due to scientific progress, making the specificity of cardiac screening with the ECG much higher, with unchanged high sensitivity (2). On the contrary, cardiac screening without the ECG has been shown to have a very low sensitivity, but more importantly will probably have also a low specificity, since many athletes do have a variety of often diffuse symptoms, which will necessitate further investigation, most readily an ECG. The few available cost-effectiveness studies worldwide, have shown that screening with the ECG is more cost-effective than screening without, but more high quality studies, are needed on cost-effectiveness.

    CONCLUSION: Cardiovascular screening of athletes aims to prevent sudden cardiac arrest (and death) of athletes. The inclusion of an ECG in regular screening, will be accompanied by higher sensitivity, while the specificity using this approach has increased considerably in recent years. All in all, ECG should be an integral part of cardiovascular screening of athletes, and is also recommended by EFSMA in its latest statement on pre-participation examination in sports (3).

  • 45.
    Börjesson, Mats
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Onerup, Aron
    Sahlgrenska universitetssjukhuset, Göteborg.
    Lundqvist, Stefan
    Primärvården Göteborg.
    Dahlöf, Björn
    Sahlgrenska akademin, Göteborg.
    Fysisk aktivitet vid hypertoni2016Inngår i: FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, Läkartidningen förlag , 2016, s. 412-425Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    Sammanfattande rekommendation

    Personer med hypertoni bör rekommenderas aerob fysisk aktivitet för att sänka blodtrycket. Måttligt starkt vetenskapligt underlag (evidensstyrka +++).

    Personer med hypertoni kan som tillägg rekommenderas isometrisk träning för att sänka blodtrycket. Begränsat vetenskapligt underlag (evidensstyrka ++).

    Personer med hypertoni bör även rekommenderas muskelstärkande fysisk aktivitet enligt de allmänna rekommendationerna om fysisk aktivitet.

    Personer med hypertoni bör rekommenderas regelbunden fysisk aktivitet som en av flera åtgärder för att sänka blodtrycket.

  • 46.
    Börjesson, Mats
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Solberg, Erik Ekker
    Diakonhjemmets sykehus, Oslo.
    Nylander, Eva
    Universitetssjukhuset Linköping.
    Plötslig hjärtdöd vid fysisk aktivitet2016Inngår i: FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, Läkartidningen förlag , 2016, s. 241-249Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    Sammanfattning

    Regelbunden fysisk aktivitet har positiva effekter på såväl riskfaktorer för hjärtkärlsjukdom som etablerad hjärt-kärlsjukdom. Aerob fysisk aktivitet på måttlig intensitet rekommenderas allmänt. Mer fysisk aktivitet på hög intensitet har potentiellt ännu större effekt, men kan också medföra ökade risker för personer med bakomliggande hjärt-kärlsjukdom.

    Plötslig hjärtdöd i samband med fysisk aktivitet bland individer > 35 år orsakas nästan uteslutande av kranskärlssjukdom. För äldre idrottare (> 35 år), liksom för icke elitaktiva, saknas i dag svenska rekommendationer om hjärtscreening. Självskattningsformulär, i utvalda fall kompletterat med hjärtundersökning hos ordinarie läkare, har föreslagits kunna minska risken i denna grupp.

    Plötsliga dödsfall under idrottsutövning bland unga (< 35 år) beror vanligen på tidigare odiagnostiserade medfödda eller ärftliga hjärtsjukdomar. Riksidrottsförbundet (RF) och Socialstyrelsen rekommenderar riktade hjärtkontroller av unga elitidrottare från 16 års ålder, bestående av familjehistoria, symtom, fysikalisk undersökning och vilo-EKG.

  • 47.
    Börjesson, Mats
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms och Mats Börjessons forskningsgrupp.
    Vanhees, Luc
    Leuven University.
    Cardiovascular evaluation of middle-aged/senior leisure time athletes2013Inngår i: Cardiac Electrophysiology Clinics, ISSN 1877-9182, Vol. 5, nr 1, s. 33-42Artikkel, forskningsoversikt (Fagfellevurdert)
  • 48. Calbet, J A L
    et al.
    Mortensen, S P
    Munch, G D W
    Curtelin, D
    Boushel, Robert
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Constant infusion transpulmonary thermodilution for the assessment of cardiac output in exercising humans.2016Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, nr 5, s. 518-527Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To determine the accuracy and precision of constant infusion transpulmonary thermodilution cardiac output (CITT-Q) assessment during exercise in humans, using indocyanine green (ICG) dilution and bolus transpulmonary thermodilution (BTD) as reference methods, cardiac output (Q) was determined at rest and during incremental one- and two-legged pedaling on a cycle ergometer, and combined arm cranking with leg pedaling to exhaustion in 15 healthy men. Continuous infusions of iced saline in the femoral vein (n = 41) or simultaneously in the femoral and axillary (n = 66) veins with determination of temperature in the femoral artery were used for CITT-Q assessment. CITT-Q was linearly related to ICG-Q (r = 0.82, CITT-Q = 0.876 × ICG-Q + 3.638, P < 0.001; limits of agreement ranging from -1.43 to 3.07 L/min) and BTD-Q (r = 0.91, CITT-Q = 0.822 × BTD + 4.481 L/min, P < 0.001; limits of agreement ranging from -1.01 to 2.63 L/min). Compared with ICG-Q and BTD-Q, CITT-Q overestimated cardiac output by 1.6 L/min (≈ 10% of the mean ICG and BTD-Q values, P < 0.05). For Q between 20 and 28 L/min, we estimated an overestimation < 5%. The coefficient of variation of 23 repeated CITT-Q measurements was 6.0% (CI: 6.1-11.1%). In conclusion, cardiac output can be precisely and accurately determined with constant infusion transpulmonary thermodilution in exercising humans.

  • 49. Calbet, Jose A L
    et al.
    Boushel, Robert C
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Assessment of cardiac output with transpulmonary thermodilution during exercise in humans.2015Inngår i: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 118, nr 1, s. 1-10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The accuracy and reproducibility of transpulmonary thermodilution (TPTd) to assess cardiac output (Q) in exercising men was determined using indocyanine green (ICG) dilution as a reference method. TPTd has been utilized for the assessment of Q and preload indices of global end-diastolic volume (GEDV) and intrathoracic blood volume (ITBV), as well as extravascular lung water (EVLW) in resting humans. It remains unknown if this technique is also accurate and reproducible during exercise. Sixteen healthy men underwent catheterization of the right femoral vein (for iced saline injection), an antecubital vein (ICG injection) and femoral artery (thermistor) to determine their Q by TPTd and [ICG] during incremental 1 and 2-legged pedaling on a cycle ergometer, and combined arm cranking with leg pedaling to exhaustion. There was a close relationship between Td-Q and ICG-Q (r=0.95, n=151, SEE: 1.452 L/min, P<0.001; mean difference of 0.06 L/min; limits of agreement -2.98 to 2.86 L/min), and TPTd-Q and ICG-Q increased linearly with VO2 with similar intercepts and slopes. Both methods had mean coefficients of variation (CV) close to 5% for Q, GEDV and ITBV. The mean CV of EVLW, assessed with both indicators (ICG and thermal) was 17%, and was sensitive enough as to detect a reduction in EVLW of 107 ml when changing from resting supine to upright exercise. In summary, transpulmonary thermodilution with bolus injection into the femoral vein is an accurate and reproducible method to assess cardiac output during exercise in humans.

  • 50. Campbell, Kristin L
    et al.
    Cormie, Prue
    Weller, Sarah
    Alibhai, Shabbir M H
    Bolam, Kate
    Karolinska institutet, Stockholm, Sweden.
    Campbell, Anna
    Cheville, Andrea L
    Dalzell, Mary-Ann
    Hart, Nicolas H
    Higano, Celestia S
    Lane, Kirstin
    Mansfield, Sami
    McNeely, Margaret L
    Newton, Robert U
    Quist, Morten
    Rauw, Jennifer
    Rosenberger, Friederike
    Santa Mina, Daniel
    Schmitz, Kathryn H
    Winters-Stone, Kerri M
    Wiskemann, Joachim
    Goulart, Jennifer
    Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals.2022Inngår i: JCO oncology practice, ISSN 2688-1535, Vol. 18, nr 5, s. e697-e709Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion.

    METHODS: The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement.

    RESULTS: Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment-related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential.

    CONCLUSION: Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.

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