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  • 1.
    Andersson, Eva
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Laboratory for Biomechanics and Motor Control.
    Hovland, Anders
    Kjellman, Bengt
    Taube, Jill
    Martinsen, Egil W.
    Fysisk aktivitet är lika bra som läkemedel eller samtalsterapi vid depression2016In: Idrottsmedicin, ISSN 2001-3302, Vol. 35, no 1, p. 4-7Article in journal (Other academic)
  • 2. Hallgren, Mats
    et al.
    Herring, Matthew P
    Owen, Neville
    Dunstan, David
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.
    Helgadottir, Björg
    Nakitanda, Olivia Aya
    Forsell, Yvonne
    Exercise, Physical Activity, and Sedentary Behavior in the Treatment of Depression: Broadening the Scientific Perspectives and Clinical Opportunities.2016In: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 7, article id 36Article in journal (Refereed)
    Abstract [en]

    Research exploring links between exercise and depression now span several decades, yet several clinically relevant research questions remain unanswered. This opinion article briefly describes the status of selected research issues from the exercise depression literature and offer insights into research areas that are currently lacking. We draw particular attention to the potential of research exploring links between sedentary behavior and depression.

  • 3.
    Helgadóttir, Björg
    et al.
    Karolinska institutet.
    Forsell, Y
    Karolinska institutet.
    Hallgren, M
    Karolinska institutet.
    Möller, J
    Karolinska institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Exercise for depression: What are the long-term effects of different exercise intensities?2017In: European Journal of Public Health, Volume 27, Issue suppl_3, 1 November 2017, 2017, Vol. 27, no Suppl. 3, article id ckx187.168Conference paper (Refereed)
    Abstract [en]

    Key messages:

    • As all exercise conditions had at least a comparable effect to treatment as usual, exercise at any intensity can be recommended as treatment for mild-to-moderate depression.
    • Light intensity exercise should be emphasised more in treatment guidelines than it currently is, as its effects are potentially even greater than that of treatment as usual.
  • 4.
    Helgadóttir, Björg
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Forsell, Yvonne
    Karolinska Institutet, Stockholm, Sweden.
    Hallgren, Mats
    Karolinska Institutet, Stockholm, Sweden.
    Möller, Jette
    Karolinska Institutet, Stockholm, Sweden.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Long-term effects of exercise at different intensity levels on depression: A randomized controlled trial.2017In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 105, p. 37-46, article id S0091-7435(17)30294-3Article in journal (Refereed)
    Abstract [en]

    Previous research has shown positive effects of exercise on depression but studies have mainly focused on the short-term effects; few have examined the long-term effect, especially with regard to differences in intensity. The aim of this study was to examine the long-term effects of prescribed exercise on depression, performed at three intensity levels. People aged 18-67years with mild to moderate depression (Patient Health Questionnaire-9 score of ≥10) participated in a single-blind, parallel randomized control trial lasting 12weeks (Sweden 2011-2013). Four arms were included: Treatment as usual (TAU, n=310), light (n=106), moderate (n=105) and vigorous exercise (n=99). Severity of depression was measured at baseline, post-treatment and 12-month follow-up using the Montgomery-Åsberg Depression Rating Scale (MADRS). Coefficients (β) and odds ratios were estimated using linear mixed models with time×group interactions. The results showed that at the 12month follow-up the light exercise group had significantly lower depression severity scores than the TAU (-1.9, 95% CI: -3.7, -0.04) and the moderate exercise group (-2.94 95% CI: -5.2, -0.7). The vigorous exercise group had significantly lower scores than the moderate exercise group only (-2.7, 95% CI: -4.9, -0.4). In conclusion, compared to usual care for depression, only light exercise resulted in significantly lower depression severity at 12-month follow-up. Both light and vigorous exercise was more effective than moderate exercise.

    TRIAL REGISTRATION: The study was registered with the German Clinical Trial Register (DRKS study ID: DRKS00008745).

  • 5.
    Helgadóttir, Björg
    et al.
    Karolinska Institutet.
    Hallgren, Mats
    Karolinska Institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Forsell, Yvonne
    Karolinska Institutet.
    Training fast or slow? Exercise for depression: A randomized controlled trial2016In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 91, p. 123-131Article in journal (Refereed)
    Abstract [en]

    Exercise can be used to treat depression but there is a lack of evidence regarding the optimal intensity and mode. Our aim was to compare the effects of different exercise intensities on post-treatment depression severity. People aged 18–67years with mild-to-moderate depression (Patient Health Questionnaire-9 score of ≥10) participated in a single-blind, parallel randomized control trial lasting 12-weeks (Sweden 2011–2013). Four treatment arms were included: treatment as usual (TAU) (n=310), light exercise (yoga or similar n=106), moderate exercise (aerobic conditioning, n=105) and vigorous exercise (aerobic conditioning, n=99). Depression severity was measured at baseline and post-treatment using the Montgomery-Åsberg Depression Rating Scale (MADRS). Differences between the groups in depression severity at post-treatment were analysed using linear regression. Differences in exercise intensity were confirmed by heart rate monitoring. At post-treatment, the light (−4.05 Confidence Interval (CI)=−5.94, −2.17), moderate (−2.08 CI=−3.98, −0.18) and vigorous exercise groups (−3.13 CI=−5.07, −1.19) had reduced their MADRS scores significantly more than TAU. No significant differences were found between the exercise groups, and no significant interaction effect was observed between group and gender. In conclusion, exercise, whether performed at a low (yoga or similar), moderate or vigorous intensity (aerobic training) is effective in treating mild-to-moderate depression and is at least as effective as treatment as usual by a physician.

  • 6. Helgadóttir, Björg
    et al.
    Owen, Neville
    Dunstan, David W.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Hallgren, Mats
    Forsell, Yvonne
    Changes in physical activity and sedentary behavior associated with an exercise intervention in depressed adults2017In: Psychology of Sport And Exercise, ISSN 1469-0292, E-ISSN 1878-5476, Vol. 30, p. 10-18Article in journal (Refereed)
    Abstract [en]

    Background Exercise is beneficial for depression, but less is known about its impact on post-intervention physical activity and sedentary behavior. The aim of this paper was to determine the extent to which participation in light-, moderate- and vigorous-intensity exercise intervention influenced habitual physical activity and sedentary behavior patterns in depressed adults. Methods Accelerometer data was collected pre- and post-intervention from depressed participants randomized to one of three 12-week intervention groups: light (n = 21), moderate (n = 25) and vigorous (n = 22) exercise. Mixed models examined changes in time spent sedentary and in light and moderate-to-vigorous physical activity (MVPA); time accumulated in sedentary and MVPA bouts; and, number of MVPA bouts and interruptions in sedentary time. Results Overall sedentary time decreased while light activity time increased across all intervention groups but not significantly so. The light exercise intervention group reduced MVPA minutes (−8.22, 95% CI: −16.44, −0.01), time in MVPA bouts (−8.44, 95% CI: −14.27, −2.62), and number of activity bouts (−0.43, 95% CI: −0.77, −0.09). The moderate exercise intervention group reduced time in MVPA bouts (−6.27, 95% CI: −11.71, −0.82) and number of sedentary interruptions (−6.07, 95% CI: −9.30, −2.84). No changes were observed for the vigorous exercise intervention group. Conclusions The exercise intervention led to an increase in overall light physical activity and decrease in sedentary time, though neither change was statistically significant. Participation in the light and moderate exercise intervention groups was associated with reductions of time in MVPA bouts, but this was not evident for the vigorous exercise intervention group.

  • 7.
    Hovland, Anders
    et al.
    Universitet i Bergen.
    Martinsen, Egil W.
    Oslo universitetssykehus.
    Taube, Jill
    Landstinget i Värmland.
    Andersson, Eva
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Laboratory for Biomechanics and Motor Control.
    Kjellman, Bengt
    Karolinska institutet.
    Fysisk aktivitet vid ångestsyndrom2016In: FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, Läkartidningen förlag , 2016, p. 632-643Chapter in book (Other academic)
    Abstract [sv]

    Sammanfattande rekommendation

    Personer med panikångest bör rekommenderas aerob fysisk aktivitet för att minska ångest. Måttligt starkt vetenskapligt underlag (evidensstyrka +++).

    Ett enstaka aerobt träningspass på hög intensitet minskar risken att utlösa panikångest. Måttligt starkt vetenskapligt underlag (evidensstyrka +++).

    Fysisk aktivitet kan användas som kompletterande behandling vid all form av ångest, då det finns grund för att förvänta en viss symtomreduktion både akut och på längre sikt.

    Den fysiska aktiviteten bör utformas och individanpassas av medicinskt utbildad personal i samråd med individen.

    Personer med ångest, oavsett typ, bör även rekommenderas muskelstärkande fysisk aktivitet enligt de allmänna rekommendationerna om fysisk aktivitet.

  • 8.
    Johansson, Leonard
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Nilsson, Jenny
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Uppfattningar om betydelsen av motorisk träning för barn med ADHD/DAMP2005Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [sv]

    Syfte

    Syftet med denna studie har varit att med hjälp av intervjuer undersöka hur skolpersonal och föräldrar uppfattar betydelsen av motorisk träning för barn med ADHD/DAMP. I detta ligger att undersöka på vilket sätt barnens motorik, koncentrationsförmåga samt sociala förmåga påverkas av fysisk aktivitet, och på vilket sätt diagnosen ADHD/DAMP ställer krav på pedagogiska förhållningssätt.

    Metod

    Vi har gjort en litteraturgenomgång och en kvalitativ intervjustudiestudie. Urvalsgruppen från St: Örjans skolor har bestått av två pedagoger, en idrottslärare, en assistent och en förälder. Samtliga inom skolpersonalsgruppen hade många års erfarenhet inom området. Vi har använt oss av halvstrukturerande intervjuer som lagts upp utifrån följande temaområden: skolpersonal och förälders syn på fysisk aktivitet/motorisk träning för barn med ADHD/DAMP, den fysiska aktivitetens påverkan på barnen, förhållningssätt och bemötande samt barnet/barnens anpassningsförmåga till aktivitet.

    Resultat och slutsats

    Vad man kan urskönja av resultatet är att samtliga intervjupersoner i denna studie är ense om att fysisk aktivitet och motorisk träning är av stor betydelse för barn med ADHD/DAMP.

    Något som de intervjuade tryckte på var den fysiska aktivitetens betydelse för barnens sociala utveckling, här sågs idrotten som en viktig arena. Genom idrott och fysisk aktivitet får barnen lära sig att umgås med andra, visa hänsyn, respekt, empati och förstå att andra människor har känslor. Den sistnämnda förmågan saknas ofta hos dessa barn.

    Vad det gäller motoriken behöver dessa barn mycket träning och enligt litteraturen kan denna träning på sikt ge goda resultat. Noterbart i studien är dock att det råder delade meningar om att koncentrationsförmågan kan påverkas av fysisk aktivitet. Även intervjupersonerna menar att det inte med säkerhet går att säga att koncentrationen förbättras av fysisk aktivitet. Trots att vi har kommit i kontakt med erfarna personer inom detta område, anser vi inte riktigt att vi fått ut det vi förväntat oss. Detta kan bero på att våra och de intervjuades praktiskt pedagogiska kunskaper skiljer sig åt. I resultatet framträder det att de intervjuade har svårt att i mer preciserad form tala om motorisk träning, vilket gör att den röda tråden i deras beskrivningar är svår att läsa av. Slutsatsen är att de intervjuade anser att fysisk aktivitet och motorisk träning har en påtaglig betydelse för barn med ADHD/DAMP i relation till barnens sociala, emotionella och motoriska utveckling samt till viss del deras koncentrationsförmåga.

  • 9.
    Kaldo, Viktor
    et al.
    Huddinge Hospital, Stockholm, Sweden..
    Lundin, Andreas
    Karolinska Institutet, Stockholm, Sweden.
    Hallgren, Mats
    Karolinska Institutet, Stockholm, Sweden.
    Kraepelien, Martin
    Huddinge Hospital, Stockholm, Sweden..
    Strid, Catharina
    Lund University, Lund, Sweden.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Lavebratt, Catharina
    Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Huddinge Hospital, Stockholm, Sweden..
    Öjehagen, Agneta
    Lund University, Lund, Sweden.
    Forsell, Yvonne
    Karolinska Institutet, Stockholm, Sweden.
    Effects of internet-based cognitive behavioural therapy and physical exercise on sick leave and employment in primary care patients with depression: two subgroup analyses.2018In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 75, no 1, p. 52-58, article id oemed-2017-104326Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Depression can negatively impact work capacity, but treatment effects on sick leave and employment are unclear. This study evaluates if internet-based cognitive behavioural therapy (ICBT) or physical exercise (PE), with already reported positive effects on clinical outcome and short-term work ability, has better effects on employment, sick leave and long-term work ability compared with treatment as usual (TAU) for depressed primary care patients (German clinical trials: DRKS00008745).

    METHODS: After randomisation and exclusion of patients not relevant for work-related analysis, patients were divided into two subgroups: initially unemployed (total n=118) evaluated on employment, and employed (total n=703) evaluated on long-term sick leave. Secondary outcomes were self-rated work ability and average number of sick days per month evaluated for both subgroups. Assessments (self-reports) were made at baseline and follow-up at 3 and 12 months.

    RESULTS: For the initially unemployed subgroup, 52.6% were employed after 1 year (response rate 82%). Both PE (risk ratio (RR)=0.44; 95% CI 0.23 to 0.87) and ICBT (RR=0.37; 95% CI 0.16 to 0.84) showed lower rates compared with TAU after 3 months, but no difference was found after 1 year (PE: RR=0.97; 95% CI 0.69 to 1.57; ICBT: RR=1.23; 95% CI 0.72 to 2.13). For those with initial employment, long-term sick leave (response rate 75%) decreased from 7.8% to 6.5%, but neither PE (RR=1.4; 95% CI 0.52 to 3.74) nor ICBT (RR=0.99; 95% CI 0.39 to 2.46) decreased more than TAU, although a temporary positive effect for PE was found. All groups increased self-rated work ability with no differences found.

    CONCLUSIONS: No long-term effects were found for the initially unemployed on employment status or for the initially employed on sick leave. New types of interventions need to be explored.

  • 10. Lindegård, Agneta
    et al.
    Jonsdottir, Ingibjörg H
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.
    Lindwall, Magnus
    Gerber, Markus
    Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion.2015In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 15, article id 272Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a lack of research regarding the long-lasting effects of a more physically active lifestyle in patients with mental disorders. In the present study, clinical data were analysed to examine if initially physically inactive patients, clinically diagnosed with stress-related exhaustion, taking part in 12-month multimodal treatment (MMT), differ at the 18-month follow-up regarding mental health, depending on whether they did or did not comply with the physical activity (PA) recommendations resembling those of the American College of Sports Medicine.

    METHODS: The study population consisted of 69 patients (65 % women) who were referred to a stress clinic due to stress-related exhaustion. All patients received MMT. A major goal was to increase patients' PA levels. The patients received general comprehensive instructions including personal advice regarding the positive effects of PA on mental health and could self-select for an 18-week coached exercise program. Changes in mental health symptoms over an 18-month period were compared between non-compliers (n = 26), mild compliers (n = 22) and strong compliers (n = 21) with the PA recommendations included in the MMT.

    RESULTS: Non-compliers, mild and strong compliers did not differ regarding burnout, depression and anxiety at baseline. Although substantial improvements occurred in all groups, mild and strong compliers reported significantly lower burnout and depression levels at the 18-month follow-up than the non-complying group (p < .05). The general pattern of findings was corroborated, if standard cut-off criteria for clinical burnout were used.

    CONCLUSIONS: Compliance with PA recommendations is associated with decreased levels of burnout and depression in patients with stress-related exhaustion. Thus, the promotion of a more active lifestyle among patients with stress-related exhaustion should be implemented as a part of MMT, to achieve a more sustainable decrease of symptoms of burnout and depression.

    TRIAL REGISTRATION: This is not a clinical trial.

  • 11.
    Martinsen, Egil W
    et al.
    Oslo universitetssjukhus.
    Hovland, Anders
    Universitetet i Bergen.
    Kjellman, Bengt
    Karolinska institutet.
    Taube, Jill
    Landstinget i Värmland.
    Andersson, Eva
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Laboratory for Biomechanics and Motor Control.
    Fysisk aktivitet vid depression2016In: FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, Läkartidningen förlag , 2016, p. 362-370Chapter in book (Other academic)
    Abstract [sv]

    Sammanfattande rekommendation

    Personer med depression bör rekommenderas aerob eller muskelstärkande fysisk aktivitet för att minska depressiva symtom, måttligt starkt vetenskapligt underlag (evidensstyrka +++), och förbättra livskvalitet, begränsat vetenskapligt underlag (evidensstyrka ++).

    Vid lindrig eller måttlig depression reducerar fysisk aktivitet depressiva symtom i liknande grad som antidepressiva läkemedel eller kognitiv beteendeterapi (KBT). Måttligt starkt vetenskapligt underlag (evidensstyrka +++).

    Om enbart muskelstärkande fysisk aktivitet väljs i syfte att behandla depression, bör den kompletteras med aerob fysisk aktivitet för att minska risken för hjärt-kärlsjukdom, eftersom denna risk är förhöjd vid depression.

  • 12.
    Martinsen, Egil W.
    et al.
    Oslo universitetssjukhus.
    Hovland, Anders
    Universitet i Bergen.
    Kjellman, Bengt
    Karolinska insitutet.
    Taube, Jill
    Landstinget i Värmland.
    Andersson, Eva
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Laboratory for Biomechanics and Motor Control. Karolinska institutet.
    Fysisk aktivitet vid depression: Forskning pågår2017In: Fysioterapi, ISSN 1653-5804, no 5, p. 34-39Article in journal (Other academic)
    Abstract [sv]

    Vi har nöjet att publicera kapitel 2.8 Fysisk aktivitet vid depression ur  Fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, FYSS 2017  med tillstånd av Yrkesföreningar för Fysisk Aktivitet (YFA). Detta kapitel samt  ytterligare drygt 30 kapitel ur FYSS 2017 kan laddas ner från www.fyss.se.  Samtliga 53 kapitel är samlade i boken FYSS 2017 utgiven av Läkartidningen förlag AB.

    SAMMANFATTANDE REKOMMENDATION •  Personer med depression bör rekommenderas aerob eller muskelstärkande fysisk aktivitet för att minska depressiva symtom. Måttligt starkt vetenskapligt underlag (evidensstyrka +++). •  Fysisk aktivitet reducerar depressiva symtom i liknande grad som antidepressiva läkemedel eller KBT vid lindrig och måttlig depression. Måttligt starkt vetenskapligt underlag (evidensstyrka +++). •  Om enbart muskelstärkande fysisk aktivitet väljs i syfte att behandla depression, bör den kompletteras med aerob fysisk aktivitet för att minska risken för kardiovaskulär sjukdom, eftersom denna risk är förhöjd vid depression.

  • 13. Mather, Lisa
    et al.
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group.
    Bergström, Gunnar
    Svedberg, Pia
    An Underlying Common Factor, Influenced by Genetics and Unique Environment, Explains the Covariation Between Major Depressive Disorder, Generalized Anxiety Disorder, and Burnout: A Swedish Twin Study.2016In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 19, no 6, p. 619-627Article in journal (Refereed)
    Abstract [en]

    Depression and anxiety are highly comorbid due to shared genetic risk factors, but less is known about whether burnout shares these risk factors. We aimed to examine whether the covariation between major depressive disorder (MDD), generalized anxiety disorder (GAD), and burnout is explained by common genetic and/or environmental factors. This cross-sectional study included 25,378 Swedish twins responding to a survey in 2005-2006. Structural equation models were used to analyze whether the trait variances and covariances were due to additive genetics, non-additive genetics, shared environment, and unique environment. Univariate analyses tested sex limitation models and multivariate analysis tested Cholesky, independent pathway, and common pathway models. The phenotypic correlations were 0.71 (0.69-0.74) between MDD and GAD, 0.58 (0.56-0.60) between MDD and burnout, and 0.53 (0.50-0.56) between GAD and burnout. Heritabilities were 45% for MDD, 49% for GAD, and 38% for burnout; no statistically significant sex differences were found. A common pathway model was chosen as the final model. The common factor was influenced by genetics (58%) and unique environment (42%), and explained 77% of the variation in MDD, 69% in GAD, and 44% in burnout. GAD and burnout had additive genetic factors unique to the phenotypes (11% each), while MDD did not. Unique environment explained 23% of the variability in MDD, 20% in GAD, and 45% in burnout. In conclusion, the covariation was explained by an underlying common factor, largely influenced by genetics. Burnout was to a large degree influenced by unique environmental factors not shared with MDD and GAD.

  • 14.
    Mather, Lisa
    et al.
    Karolinska Institutet.
    Narusyte, J
    Karolinska Institutet.
    Ropponen, A
    Karolinska Institutet.
    Bergström, G
    Karolinska Institutet.
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group. Karolinska Institutet.
    Helgadóttir, B
    Karolinska Institutet.
    Svedberg, P
    Karolinska Institutet.
    Sick leave due to mental disorders, morbidity and mortality: a prospective study of discordant twin pairs.2019In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate if sick leave due to mental disorders increases the risk of morbidity measured by inpatient and specialized outpatient care, and mortality among women and men, independent of familial factors.

    METHODS: An open cohort study of 4979 twin pairs discordant for sick leave due to mental disorders was conducted in 2005-2013. Twins were followed up in the cause of death and national patient registries until the end of study, emigration, death, and inpatient and specialized outpatient care. Conditional Cox proportional hazard regression, adjusting for the familial factors shared by the twins, was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In case of non-proportional hazards, time-varying covariates were used.

    RESULTS: Sick leave due to mental disorders increased the risk for inpatient care among men (HR: 1.90, CI 1.66-2.17) and women (HR: 1.39, CI 1.27-1.51). For men, the risk of outpatient care was higher the first 2 years (HR: 2.08, CI 1.87-2.31), after which it was attenuated (HR: 1.32, CI 1.02-1.70). For women, the HR was 1.57 (CI 1.47-1.68) for the whole study time. There was an increased risk of death among men (HR: 2.91, CI 1.70-4.99), but not among women (HR: 0.84, CI 0.53-1.35).

    CONCLUSIONS: Sick leave due to mental disorders was a risk factor for mortality for men only, and increased the risk of inpatient and specialized outpatient care among both women and men, but the risks were higher for men when stratifying for sex.

  • 15.
    Millischer, Vincent
    et al.
    Karolinska institutet.
    Erhardt, Sophie
    Karolinska institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Forsell, Yvonne
    Karolinska institutet.
    Lavebratt, Catharina
    Karolinska institutet.
    Twelve-week physical exercise does not have a long-lasting effect on kynurenines in plasma of depressed patients2017In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 13, p. 967-972Article in journal (Refereed)
    Abstract [en]

    Background: Physical exercise has well-characterized positive effects on depressive symptoms. The underlying biologic mechanisms are, however, far from established. A recently discovered mechanism has linked the enhanced conversion of kynurenine to kynurenic acid (KYNA) to an increased resilience toward stress-induced depression in mice. The aim of this study was to translate these findings to humans.

    Materials and methods: Kynurenine and KYNA levels were measured by high-performance liquid chromatography in plasma samples from 117 patients affected by mild-to-moderate depression before and within a week after a 12-week training period at three different intensities. The patients were part of the Regassa study.

    Results: No differences in plasma levels of kynurenine and KYNA or in their ratio could be detected between before and after training. No effect of the intensity group could be observed. No correlation with the improvement in cardiovascular fitness (Åstrand score) or the improvement in mood (Montgomery Åsberg Depression Rating Scale score) could be observed.

    Limitations: As the Regassa study is based on an intention-to-treat protocol, the exact time and the exact intensity of the physical exercise are not known. Analyses of pulse data as well as personal interviews, however, were used to control the exercise protocols. Furthermore, the observations reflect chronic changes.

    Conclusion: Physical exercise positively affects mood and cardiovascular fitness, but does not lead to long-lasting changes in plasma levels of kynurenine and KYNA in patients affected by mild-to-moderate depression.

  • 16.
    Näslund, Anja
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Att hjälpa eller stjälpa: kan hälsopedagoger vara en resurs i arbetet med självhjälpsgrupper?2005Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [en]

    Aim

    The aim with this study was to find out which role self-help groups have today in our community in different health fields. The aim was also to see how self-help groups think that their work is possible to combine with professional social service and then especially if and how a health educationist can work together with self-help groups.

    Methods

    The study started with reading to find out what earlier researchers think about professionals’ work with self-help groups. Through Internet and www.msn.se appropriate self-help groups to study has been selected. The selection is based on those health subjects that are included in the health education programme at Stockholm University College of physical education and sport during 2002-2005. From all groups one or two person’s choosed by the organizations have been interviewed. All of them have worked for their self-help group or their coordinate. The interview has been in unstructured form with just supportive questions to get answers corresponding to the aim. After the interviews the answers are put together and red through by the interviewee.

    Results

    All studied groups/organizations belong to the health area, especially to physical health and alcoholic problems. The groups have a united opinion that professionals do not belong in self-help groups. One of the studied groups, PersonalDialog, is separate from this though they already include professional help. None of the studied groups work with health educationists today.

    Conclusions

    Today it is almost impossible to find cooperation between health educationists and self-help groups although we all have the same aim to promote health and strengthen the self-esteem with these persons. It is important as a health educationist to know that self-help groups exist. Which role to choose must be one own´s decision based on interests and knowledge. My recommendation is that professionals as well as self-help groups keep on supporting and developing a good cooperation between them.

  • 17.
    Rahman, Md Shafiqur
    et al.
    Karolinska Institutet.
    Helgadóttir, Björg
    Karolinska Institutet.
    Hallgren, Mats
    Karolinska Institutet.
    Forsell, Yvonne
    Karolinska Institutet.
    Stubbs, Brendon
    King's College London, UK..
    Vancampfort, Davy
    KU Leuven, Belgium.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Cardiorespiratory fitness and response to exercise treatment in depression.2018In: BJPsych open, ISSN 2056-4724, Vol. 4, no 5, p. 346-351Article in journal (Refereed)
    Abstract [en]

    Background: Exercise improves cardiorespiratory fitness (CRF) and reduces depressive symptoms in people with depression. It is unclear if changes in CRF are a predictor of the antidepressant effect of exercise in people with depression.

    Aims: To investigate whether an increase in CRF is a predictor of depression severity reduction after 12 weeks of exercise (trial registration: DRKS study ID, DRKS00008745).

    Method: The present study includes participants who took part in vigorous (n = 33), moderate (n = 38) and light (n = 39) intensity exercise and had CRF information (as predicted maximal oxygen uptake, O2max) collected before and after the intervention. Depression severity was measured with the Montgomery-Åsberg Depression Rating Scale (MADRS). O2max (L/min) was assessed with the Åstrand-Rhyming submaximal cycle ergometry test. The main analysis was conducted pooling all exercise intensity groups together.

    Results: All exercise intensities improved O2max in people with depression. Regardless of frequency and intensity of exercise, an increase in post-treatment O2max was significantly associated with reduced depression severity at follow-up (B = -3.52, 95% CI -6.08 to -0.96); adjusting for intensity of exercise, age and body mass index made the association stronger (B = -3.89, 95% CI -6.53 to -1.26). Similarly, increased O2max was associated with higher odds (odds ratio = 3.73, 95% CI 1.22-11.43) of exercise treatment response (≥50% reduction in MADRS score) at follow-up.

    Conclusions: Our data suggest that improvements in O2max predict a greater reduction in depression severity among individuals who were clinically depressed. This finding indicates that improvements in O2max may be a marker for the underpinning biological pathways for the antidepressant effect of exercise.

    Declaration of interest: None.

  • 18.
    Svedberg, Pia
    et al.
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, Stockholm, Sweden..
    Mather, L.
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, Stockholm, Sweden..
    Bergstrom, G.
    Karolinska Inst, Inst Environm Med, Div Intervent & Implementat Res, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Lindfors, P.
    Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group. Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    A twin study of work-home interference and the risk of future sickness absence with mental diagnoses2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl 1Article in journal (Refereed)
  • 19.
    Zou, Ding
    et al.
    University of Gothenburg.
    Wennman, Heini
    National Institute for Health and Welfare, Helsinki, Finland.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Grote, Ludger
    University of Gothenburg.
    Arvidsson, Daniel
    University of Gothenburg.
    Blomberg, Anders
    Umeå University.
    Torén, Kjell
    University of Gothenburg.
    Bergström, Göran
    University of Gothenburg.
    Börjesson, Mats
    University of Gothenburg.
    Hedner, Jan
    University of Gothenburg.
    Insomnia and cardiorespiratory fitness in a middle-aged population: the SCAPIS pilot study.2019In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, no 1, p. 319-326Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We aimed to assess the independent association between insomnia and CRF in a population-based cohort of subjects aged 50 to 64 years.

    METHODS: Subjects participating in the Swedish CArdioPulmonary bioImaging Study (SCAPIS) pilot cohort (n = 603, men 47.9%) underwent a submaximal cycle ergometer test for estimation of maximal oxygen consumption (VO2max). Data on physical activity and sedentary time were collected via waist-worn accelerometers. An insomnia severity index score ≥ 10 was used to define insomnia.

    RESULTS: Insomnia was identified in 31.8% of the population. The VO2max was significantly lower in insomnia subjects compared with the non-insomnia group (31.2 ± 6.3 vs. 32.4 ± 6.5 ml* kg-1 *min-1, p = 0.028). There was no difference in objectively assessed physical activity or time spent sedentary between the groups. In a multivariate generalized linear model adjusting for confounders, an independent association between insomnia status and lower VO2max was found in men, but not in women (β = - 1.15 [95% CI - 2.23-- 0.06] and - 0.09 [- 1.09-0.92], p = 0.038 and 0.866, respectively).

    CONCLUSIONS: We found a modest, but significant, association between insomnia and lower CRF in middle-aged men, but not in women. Our results suggest that insomnia may link to cardiovascular disease via reduced CRF. Insomnia may require a specific focus in the context of health campaigns addressing CRF.

  • 20.
    Zuidersma, Marij
    et al.
    University of Groningen, The Netherlands.
    Sjöberg, Linnea
    Karolinska institutet.
    Pantzar, Alexandra
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Fratiglioni, Laura
    Karolinska institutet.
    Wang, Hui-Xin
    Karolinska institutet.
    A bi-factor model of the Montgomery Åsberg depression rating scale and future cognitive impairments in older adults: A 6-year follow-up study.2019In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 109, p. 1-9, article id S0022-3956(18)30418-7Article in journal (Refereed)
    Abstract [en]

    Depression has been found to be associated with cognitive decline. This study evaluated the association of general depressive symptoms and motivational-related symptoms with cognitive impairment 6 years later and to explore the role of potential underlying mechanisms. In 2690 cognitively healthy persons aged ≥60 from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) depressive symptoms were derived from the Montgomery Åsberg Depression Rating Scale (MADRS). Cognitive performance was assessed at baseline and 6 years later in 1810 persons with the Mini Mental State Examination (global cognition), Digit Span Forward (short-term memory), Digit Span Backward (working memory), Clock-test (visuospatial construction), and the 5-item test (immediate and delayed recall). Bi-factor analysis on the MADRS yielded a General Depression factor and an unrelated Motivational factor. After adjusting for demographics, the General Depression factor was only associated with 6-year impairment in delayed recall (OR (95% CI): 1.18 (1.04-1.34)). This association was no longer significant after adjusting for demographics, cardiovascular risk, lifestyle factors and medication use. The Motivational factor was not significantly associated with future cognitive impairments after adjusting for demographics. Concluding, almost all associations of general depressive symptoms and motivational-related symptoms with future cognitive impairments appeared to be confounded by demographics. Only the association of general depressive symptoms with future memory impairments appeared to be explained by a combination of demographics, cardiovascular risk, lifestyle and medication use.

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