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  • 1.
    Andermo, Susanne
    et al.
    Karolinska institutet, Sweden.
    Hellénius, Mai-Lis
    Karolinska institutet, Sweden.
    Lidin, Matthias
    Karolinska institutet, Sweden.
    Hedby, Ulrika
    Karolinska institutet, Sweden.
    Nordenfelt, Anja
    The Foundation A Healthy Generation, Sweden.
    Nyberg, Gisela
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap. Karolinska institutet, Sweden.
    Effectiveness of a family intervention on health-related quality of life-a healthy generation, a controlled pilot trial.2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 809Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Physical activity is associated with better health, but knowledge about health promoting interventions, including physical activity for families in disadvantaged areas and the impact on health-related quality of life (HRQOL) is sparse. The aim of this study was to assess HRQOL in children and their parents after participation in the programme "A Healthy Generation".

    METHODS: The programme is delivered in socioeconomically disadvantaged areas in Sweden and offers physical activity and a healthy meal or fruit twice a week from August to May to families with children in grade 2. Children (n = 67), aged 8-9 years, and their parents (n = 90) participated in this controlled study conducted in four schools, two control and two intervention schools. HRQOL of children and adults was assessed at baseline and follow-up after the intervention with the Pediatric Quality of Life Inventory (PedsQL) 4.0 and the Gothenburg Quality of Life scale, respectively. Analyses of covariance (ANCOVAs), linear regression and Pearson's correlation were conducted.

    RESULTS: There were no significant differences between intervention and control in HRQOL among children or adults after the intervention. However, in a subgroup of children (n = 20) and adults (n = 29) with initial low HRQOL scores at baseline, there was a significant difference between the intervention group and control group after the intervention (children (total score): p = 0.02; adults (social domain) p = 0.04). Furthermore, within the intervention group, there was a significant relationship between level of participation in "A Healthy Generation" and the physical domain of HRQOL among girls (r = 0.44, p = 0.01), but not boys (r = - 0.07, p = 0.58).

    CONCLUSION: Participation in the programme "A Healthy Generation" did not show a significant intervention effect on HRQOL in general. However, the findings suggest that HRQOL may be increased for children and adults with low HRQOL in disadvantaged areas. This knowledge can contribute to the development of health promoting interventions in such areas, and to more equitable health.

    TRIAL REGISTRATION: ISRCTN ISRCTN11660938. Retrospectively registered 23 September 2019.

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  • 2.
    Andermo, Susanne
    et al.
    Karolinska Institutet, Stockholm, Sweden..
    Lidin, Matthias
    Karolinska Institutet, Stockholm, Sweden..
    Hellenius, Mai-Lis
    Karolinska Institutet, Stockholm, Sweden..
    Nordenfelt, Anja
    The Foundation A Healthy Generation, Stockholm, Sweden..
    Nyberg, Gisela
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Karolinska Institutet, Stockholm, Sweden..
    "We were all together"- families' experiences of the health-promoting programme - A Healthy Generation.2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1911Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Healthy lifestyle habits, including physical activity (PA), are associated with a broad range of positive psychosocial and physical health benefits. However, there are challenges involved in reaching vulnerable groups in socioeconomically disadvantaged areas. There is a lack of research on family-based PA interventions, specifically considering psychosocial health. The purpose of this study was to explore how families experienced psychosocial aspects of health after participation in a family-based programme, A Healthy Generation.

    METHODS: A Healthy Generation is a health-promoting, family-based programme delivered in collaboration with local municipalities and sport associations in socioeconomically disadvantaged areas in Sweden. Families with children in grade 2 (8-9 years), including siblings, participate in health-promoting activities, including activity sessions, healthy meals, health information and parental support groups. Data was collected through interviews with parents and children (n = 23) from a controlled pilot trial of the programme. Interviews were audio recorded, transcribed and analysed using a phenomenological hermeneutical method.

    RESULTS: Three themes and seven sub-themes emerged. The themes were: "A sense of belonging", "Awareness of one's role as a parent" and "Inspiration towards new and healthier behaviours". In terms of A sense of belonging, participation in the programme was the families own free zone, where they also had the opportunity of being together with other families in the programme. For participants that were isolated and lacked a social network, their participation helped them towards social participation. During the programme, parents created an Awareness of one's role as a parent, with new insights on how to act as a parent and they also negotiated differences between each other. Participation in the programme contributed to Inspiration towards new and healthier behaviours such as experience-based insights and healthy lifestyle changes.

    CONCLUSIONS: This study highlights the importance of co-participation in family-based health-promoting programmes to enhance psychosocial health among families in socioeconomically disadvantaged areas. The results give new insights into participants' experiences of psychosocial aspects of health after participation in a family-based PA programme. This knowledge can contribute to the understanding of how to design health-promoting, family-based interventions to promote psychosocial health in socioeconomically disadvantaged areas.

    TRIAL REGISTRATION: ISRCTN ISRCTN11660938 . Retrospectively registered 23 September 2019.

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  • 3. Arvidson, Elin
    et al.
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Ahlborg, Gunnar
    Lindegård, Agneta
    Jonsdottir, Ingibjörg H
    The level of leisure time physical activity is associated with work ability-a cross sectional and prospective study of health care workers.2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, s. 855-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: With increasing age, physical capacity decreases, while the need and time for recovery increases. At the same time, the demands of work usually do not change with age. In the near future, an aging and physically changing workforce risks reduced work ability. Therefore, the impact of different factors, such as physical activity, on work ability is of interest. Thus, the aim of this study was to evaluate the association between physical activity and work ability using both cross sectional and prospective analyses.

    METHODS: This study was based on an extensive questionnaire survey. The number of participants included in the analysis at baseline in 2004 was 2.783, of whom 2.597 were also included in the follow-up in 2006. The primary outcome measure was the Work Ability Index (WAI), and the level of physical activity was measured using a single-item question. In the cross-sectional analysis we calculated the level of physical activity and the prevalence of poor or moderate work ability as reported by the participants. In the prospective analysis we calculated different levels of physical activity and the prevalence of positive changes in WAI-category from baseline to follow-up. In both the cross sectional and the prospective analyses the prevalence ratio was calculated using Generalized Linear Models.

    RESULTS: The cross-sectional analysis showed that with an increased level of physical activity, the reporting of poor or moderate work ability decreased. In the prospective analysis, participants reporting a higher level of physical activity were more likely to have made an improvement in WAI from 2004 to 2006.

    CONCLUSIONS: The level of physical activity seems to be related to work ability. Assessment of physical activity may also be useful as a predictive tool, potentially making it possible to prevent poor work ability and improve future work ability. For employers, the main implications of this study are the importance of promoting and facilitating the employees' engagement in physical activity, and the importance of the employees' maintaining a physically active lifestyle.

  • 4.
    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 men2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 820Artikel i tidskrift (Refereegranskat)
    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.

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  • 5. Bergström, Helena
    et al.
    Haggård, Ulrika
    Norman, Åsa
    Sundblom, Elinor
    Schäfer Elinder, Liselotte
    Nyberg, Gisela
    Centre for Epidemiology and Community Medicine, Stockholm County Council, and Karolinska Institutet, Stockholm, Sweden.
    Factors influencing the implementation of a school-based parental support programme to promote health-related behaviours--interviews with teachers and parents.2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 541Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The 'Healthy School Start' programme was developed to promote healthy dietary habits and physical activity, targeting parents of 6-year-old children in pre-school class. Knowledge of barriers and facilitators of implementation is crucial before introducing this kind of programme on a larger scale. The aim of this study was to explore the views of teachers and parents regarding factors influencing the implementation of a school-based parental support programme to promote physical activity and healthy diet.

    METHODS: An inductive qualitative method was used to explore the experiences and views of teachers and parents involved in the programme. A group discussion was held with three teachers, and semi-structured interviews were conducted with 14 parents. Data were analysed using qualitative content analysis.

    RESULTS: Clear communication on roles and responsibilities was identified as an overarching theme, emphasising the importance of clear information and well-functioning cooperation between project management, schools and parents when implementing the programme in a school setting. Five categories at a manifest level described aspects influencing the implementation: 1) 'The programme' underlining the importance of flexibility and feed-back; 2) 'the school' referring to management and work routines; 3) 'family conditions', implying various life situations; 4) 'group dynamics' dealing with attitudes among children and parents; and 5) 'the surrounding community' including accessibility and attitudes within society.

    CONCLUSIONS: When implementing a parental support programme in a school setting it is important to facilitate communication and clearly define the division of responsibilities between project management, schools and parents. This emphasises the need for managerial support, and a professional prevention support system.

  • 6.
    Blom, Victoria
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Karolinska institutet, Stockholm, Sweden ; Stockholm University, Sweden.
    Drake, Emma
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Nooijen, Carla F J
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    The effects on self-efficacy, motivation and perceived barriers of an intervention targeting physical activity and sedentary behaviours in office workers: a cluster randomized control trial.2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 1048Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The importance of physical activity on health is clear, but changing behaviour is difficult. Successful interventions aiming to improve physical activity and reduce sedentary behaviour is therefore of importance. The aim of this study was to evaluate effects on motivation, self-efficacy and barriers to change behaviour from two different behavioural intervention focusing either on reducing sedentary behaviour or on increasing physical activity as compared to a waiting list control group.

    METHODS: The study was designed as a cluster randomized control trial (RCT) within two private companies. Self-efficacy, motivation and perceived barriers were together with demographic variables assessed before and after a 6-month intervention. Participant cluster teams were randomly allocated to either the physical activity intervention (iPA), the sedentary behaviour intervention (iSED), or control group. The intervention was multi componential and included motivational counselling based on Cognitive behaviour therapy and Motivational interviewing, group activities and management involvement. Group differences were determined using Bayesian multilevel modelling (parameter estimate; credible interval (CI)), analysing complete cases and those who adhered to the protocol by adhering to at least 3 out of 5 intervention sessions.

    RESULTS: After the intervention, the complete cases analysis showed that the iPA group had significantly higher autonomous motivation (0.33, CI: 0.05-0.61) and controlled motivation (0.27, CI: 0.04-0.51) for physical activity compared with the control group. The iSED group scored less autonomous and controlled motivation compared to the iPA group (0.38, CI: - 0.69- -0.087 respectively - 0.32, CI: - 0.57-0.07) but no significant differences compared with the control group. Among individuals that adhered to the protocol, the results showed higher scores on Exercise (3.03, CI: 0.28-6.02) and Sedentary self-efficacy (3.59, CI: 0.35-7.15) for individuals in the iPA group and on Sedentary self-efficacy (4.77, CI: 0.59-9.44) for the iSED group compared to the control group.

    CONCLUSION: These findings indicate that the interventions were successful in increasing self-efficacy in each intervention group and autonomous motivation for exercise in the iPA group, in particular when actively participating in the motivational counselling sessions.

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  • 7.
    Bojsen-Møller, Emil
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Wang, Rui
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden..
    Nilsson, Jonna
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Heiland, Emerald G
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Surgical Sciences, Medical Epidemiology, University of Uppsala, Uppsala, Sweden..
    Boraxbekk, Carl-Johan
    Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.; Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden.; Institute of Sports Medicine Copenhagen (ISMC) and Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark..
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The effect of two multi-component behavior change interventions on cognitive functions.2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikel-id 1082Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: We previously reported the effects of two cluster-randomized 6-month multi-component workplace interventions, targeting reducing sedentary behavior or increasing physical activity among office workers, on movement behaviors and cardiorespiratory fitness. The primary aim of this study was to investigate the effects of these interventions on cognitive functions compared to a wait-list control group. The secondary aims were to examine if changes in cognition were related to change in cardiorespiratory fitness or movement behaviors and if age, sex, or cardiorespiratory fitness moderated these associations.

    METHODS: Both interventions encompassed multi-components acting on the individual, environmental, and organizational levels and aimed to change physical activity patterns to improve mental health and cognitive function. Out of 263 included participants, 139 (mean age 43 years, 76% females) completed a neuropsychological test battery and wore accelerometers at baseline and 6-month follow-up. The intervention effect (aim 1) on cognitive composite scores (i.e., Executive Functions, Episodic Memory, Processing Speed, and Global Cognition) was investigated. Additionally, associations between changes in movement behaviors and cardiorespiratory fitness, and changes in cognition were examined (aim 2). Moreover, age, sex, and cardiorespiratory fitness level were investigated as possible moderators of change associations (aim 3).

    RESULTS: Overall, cognitive performance improved from baseline to follow-up, but the change did not differ between the intervention groups and the control group. Changes in cardiorespiratory fitness or any movement behavior category did not predict changes in cognitive functions. The association between changes in time in bed and changes in both Executive Function and Global Cognition were moderated by age, such that a more positive relation was seen with increasing age. A less positive association was seen between changes in sedentary behavior and Processing Speed for men vs. women, whereas higher cardiorespiratory fitness was related to a more positive association between changes in moderate-intensity physical activity and Global Cognition.

    CONCLUSION: The lack of an intervention effect on cognitive functions was expected since the intervention did not change movement behavior or fitness. Age, sex, and cardiorespiratory fitness level might moderate the relationships between movement behaviors and cognitive functions changes.

    TRIAL REGISTRATION: ISRCTN92968402 . Registered 09/04/2018.

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  • 8.
    Dahlstrand, Johan
    et al.
    University of Gothenburg, Gothenburg, Sweden. ; The Swedish Institute for Global Health Transformation (SIGHT), Royal Swedish Academy of Sciences, Stockholm, Sweden..
    Friberg, Peter
    University of Gothenburg, Gothenburg, Sweden. ; The Swedish Institute for Global Health Transformation (SIGHT), Royal Swedish Academy of Sciences, Stockholm, Sweden..
    Fridolfsson, Jonatan
    University of Gothenburg, Gothenburg, Sweden.
    Börjesson, Mats
    University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Arvidsson, Daniel
    University of Gothenburg, Gothenburg, Sweden.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Chen, Yun
    University of Gothenburg, Gothenburg, Sweden.
    The use of coping strategies "shift-persist" mediates associations between physical activity and mental health problems in adolescents: a cross-sectional study.2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 1104Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Self-perceived mental health problems among adolescents has had an upward trend. Concurrently, adolescents' physical activity (PA) has been falling whilst sedentary time (SED) has increased. There is a lack of research using accelerometer measured PA and SED to study their relationships to perceived stress and psychosomatic symptoms, both frequently observed mental health problems among adolescents. Whether coping strategies is one of the mechanisms underlying such relationship is less clear.

    METHODS: A total of 2283 13-year olds were enrolled in the baseline examination of the STARS (STudy of Adolescence Resilience and Stress) study in Western Sweden. Light-, moderate-, vigorous-intensity PA (LPA, MPA and VPA) and SED were measured using hip-worn ActiGraph GT3X+ accelerometer. A total of 1284 adolescents provided valid accelerometer data (at least 4 days with ≥10 h per day). PA and SED during school-time and leisure-time were analysed separately. Surveys were utilized to monitor perceived stress, psychosomatic symptoms and the use of coping strategies "shift-persist". Logistic regression and mediation analyses were performed adjusting for gender, ethnicity, socioeconomic status and puberty development.

    RESULTS: We observed that more time spent in PA was associated with less stress in adolescents. The associations were observed for LPA (Odds ratio for LPA per 60 min: 0.557 (95% CI 0.399-0.776), VPA (Odds ratio for VPA per 15 min: 0.688 (95% CI 0.588-0.806) and MVPA (Odds ratio for MVPA per 15 min: 0.795 (95%CI 0.718-0.879) during leisure time, but not during school time. Similar associations were observed between leisure time PA and psychosomatic symptoms. The associations remained statistically significant even after adjusting for the confounders. Further, our data showed that adolescents who engaged more time in PA during leisure time were more likely to adopt the coping strategies of "shift-persist". Mediation analysis showed that the use of "shift-persist" mediated the associations between leisure time PA and stress/psychosomatic symptoms.

    CONCLUSIONS: Leisure time physical activity, irrespective of intensity, may facilitate successful coping with stress and stress-related mental health problems in adolescents.

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  • 9.
    Delisle Nyström, Christine
    et al.
    Department of Biosciences and Nutrition, Karolinska institutet, Huddinge, Sweden.
    Henström, Maria
    Department of Biosciences and Nutrition, Karolinska institutet, Huddinge, Sweden.
    Andermo, Susanne
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Huddinge, Sweden ; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Almquist-Tangen, Gerd
    The Sahlgrenska Academy, University of Gothenburg, Sweden. ; Child Health Care Unit, Region Halland, Halmstad, Sweden.
    Thomas, Kristin
    Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Sweden..
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden. ; Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Sweden..
    Study protocol for an effectiveness-implementation hybrid trial to evaluate a health promotion intervention in parents and their 5-year-old child: Saga Stories in health talks in Swedish child healthcare.2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, s. 2184-, artikel-id 2184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Unhealthy lifestyle behaviours such as a poor diet, inadequate physical activity, and excessive screen time have been shown to be established in childhood and track into adulthood, demonstrating the need for health promotion interventions in the pre-school years. The overall aim of this project is to: (i) evaluate the effectiveness of `Saga Stories in health talks´ within child healthcare (CHC) on parental self-efficacy to promote healthy diet, physical activity, and screen time behaviours in their child; children's intake of key dietary indicators and screen time and (ii) evaluate and explore the implementation of `Saga Stories in health talks´ with regards to acceptability, appropriateness, feasibility, fidelity, adoption, sustainability, satisfaction, and usage.

    METHODS: A hybrid type I effectiveness-implementation trial will be conducted. A cluster randomized controlled trial will be used to assess the effectiveness of `Saga Stories in health talks´ in 42 CHC centers across six regions in Sweden. `Saga Stories in health talks´ consists of material for CHC nurses to use to facilitate the health talk with both the child and parent(s) and is complemented with take-home material. Parent and child dyads are recruited (n = 450) from participating CHC centers when they attend their 5-year routine visit. The intervention group receives the health talk using Saga Stories and take-home material, whereas the control group receives the standard health talk. The primary outcome is parental self-efficacy to promote healthy diet, physical activity, and screen time behaviours in their child and secondary outcomes include children's intake of key dietary indicators and screen time. All outcomes are assessed at baseline and 2-months post-intervention. The implementation outcomes that will be assessed are: acceptability, appropriateness, feasibility, satisfaction, usage, fidelity, adoption, and sustainability (assessed quantitatively and qualitatively).

    DISCUSSION: The Swedish National Board of Health and Welfare have identified the need of more material, education, and working methods for promoting healthy lifestyle behaviours in CHC. Following this trial `Saga Stories in health talks´ has great potential to be implemented in CHC across Sweden to aid nurses to promote and support healthy lifestyle behaviours in pre-school children and their families.

    TRIAL REGISTRATION: ClinicalTrials.gov , NCT05237362 . Registered 2 February 2022.

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  • 10.
    Ding, Lijie
    et al.
    Shandong Sport University, China.
    Liang, Yajun
    Karolinska institutet, Sweden.
    Tan, Edwin C K
    School of Pharmacy, Sydney, New South Wales, Australia.
    Hu, Yin
    Södertälje Hospital, Sweden.
    Zhang, Chi
    Royal Institute of Technology, Stockholm, Sweden.
    Liu, Yanxun
    Shandong University, China.
    Xue, Fuzhong
    Shandong University, China.
    Wang, Rui
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap. Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Smoking, heavy drinking, physical inactivity, and obesity among middle-aged and older adults in China: cross-sectional findings from the baseline survey of CHARLS 2011-2012.2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1062Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Prevention and control of cardiometabolic conditions and cardiovascular disease (CVD) in China may contribute to sustainable CVD reduction globally, given the fact that one-fifth of the worldwide population is in China. Knowing the distribution of behavioral risk factors (e.g., smoking and physical inactivity), especially at a national level in China, would be extremely relevant to the field of public health and CVD prevention. The objectives of this study were to investigate the nationwide prevalence of obesity, smoking, heavy drinking, and physical inactivity in Chinese adults, and further explore whether cardiometabolic conditions would modify the distribution of behavioral risk factors.

    METHODS: This population-based study is based on the China Health and Retirement Longitudinal Study (2011-2012), including 17,302 adults (≥45 years, mean age 59.67 years, female 51.66%) from 25 provinces in China. Data on demographics, lifestyle factors, health status and history of diseases were collected via structured interviews and laboratory tests. Smoking, heavy drinking, obesity, and physical inactivity were defined following standard guidelines. We performed descriptive analysis and logistic regressions in this study.

    RESULTS: The overall prevalence of heavy drinking, obesity, current smoking, and physical inactivity among middle-aged and older adults was 7.23% (95% confidence interval 6.53-7.29%), 11.53% (10.43-12.62%), 27.46% (26.30-28.62%), and 44.06% (41.19-46.92%), respectively. The prevalence varied between rural and urban areas as well as among geographic areas, with higher prevalence in the Northern and Northeastern regions. Heavy drinking and obesity were significantly associated with incident hypertension, diabetes, and high cholesterol; while current smoking was significantly associated with incident hypertension. Compared with healthy individuals, participants who self-reported a diagnosis of hypertension, high cholesterol, or diabetes were less likely to smoke currently and drink alcohol heavily, but more likely to be physically inactive and obese.

    CONCLUSIONS: Among Chinese middle-aged and older adults, the prevalence of behavioral risk factors varies by geographic region. Further effort is required to improve physical activity and fitness for Chinese adults, especially those with cardiometabolic conditions.

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  • 11.
    Ekblom, Örjan
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Ekblom-Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Bolam, Kate A
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Ekblom, Björn
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Schmidt, Caroline
    Söderberg, Caroline
    Bergström, Göran
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Concurrent and predictive validity of physical activity measurement items commonly used in clinical settings- data from SCAPIS pilot study.2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 978Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    As the understanding of how different aspects of the physical activity (PA) pattern relate to health and disease, proper assessment is increasingly important. In clinical care, self-reports are the most commonly used assessment technique. However, systematic comparisons between questions regarding concurrent or criterion validity are rare, as are measures of predictive validity. The aim of the study was to examine the concurrent (using accelerometry as reference) and predictive validity (for metabolic syndrome) of five PA questions.

    METHODS:

    A sample of 948 middle-aged Swedish men and women reported their PA patterns via five different questions and wore an accelerometer (Actigraph GT3X) for a minimum of 4 days. Concurrent validity was assessed as correlations and ROC-analyses. Predictive validity was assessed using logistic regression, controlling for potential confounders.

    RESULTS:

    Concurrent validity was low-to-moderate (r <0.35 and ROC AUC <0.7) with large misclassifications regarding time spent sitting/sedentary and in moderate-to vigorous PA. The predictive validity of the questions was good, and one question (PHAS) showed an 80 % decreased odds-ratio of having metabolic syndrome, after taking potential confounders into consideration.

    DISCUSSION:

    In this mixed sample of adults, both concurrent and predictive validity vaired between items and between measures of the physical activity pattern. The PHAS and WALK items are proposed for assessment of adherence to PA recommendations.

    CONCLUSION:

    Assessing PA patterns using self-report measures results in methodological problems when trying to predict individual risk for the metabolic syndrome, as the concurrent validity generally was low. However, several of the investigated questions may be useful for assessing risk at a group level, showing better predictive validity.

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  • 12. Elinder, Liselotte Schäfer
    et al.
    Patterson, Emma
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden and Centre for Epidemiology and Community Medicine, Stockholm County Council.
    Norman, Åsa
    A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial.2018Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 18, nr 1, artikel-id 459Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children's health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through parental support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study.

    METHODS: Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context.

    DISCUSSION: The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health.

    TRIAL REGISTRATION: The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 .

  • 13.
    Elinder, Liselotte Schäfer
    et al.
    Karolinska Institutet, Stockholm, Sweden; Region Stockholm, Stockholm, Sweden..
    Wiklund, Camilla
    Karolinska Institutet, Stockholm, Sweden..
    Norman, Åsa
    Karolinska Institutet, Stockholm, Sweden..
    Stattin, Nouha Saleh
    Region Stockholm, Stockholm, Sweden; Karolinska Institutet, Huddinge, Sweden..
    Andermo, Susanne
    Karolinska Institutet, Stockholm, Sweden..
    Patterson, Emma
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Cook, Clayton
    University of Minnesota, Minneapolis, MN, USA..
    Raposo, Sara
    Karolinska Institutet, Stockholm, Sweden; Region Stockholm, Stockholm, Sweden.
    Kwak, Lydia
    Karolinska Institutet, Stockholm, Sweden..
    IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) - study protocol for a cluster-randomized trial.2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 1630Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5-7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents' risk of developing type 2 diabetes.

    METHODS: IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents' feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability.

    DISCUSSION: This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools.

    TRIAL REGISTRATION: Registered prospectively at ClinicalTrials.gov ID: NCT04984421 , registered July 30, 2021.

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  • 14.
    Farias, Lisette
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Nyberg, Gisela
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Helgadóttir, Björg
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Andermo, Susanne
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Adolescents' experiences of a school-based health promotion intervention in socioeconomically advantaged and disadvantaged areas in Sweden: a qualitative process evaluation study.2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 1631Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Adolescence is a transition period in which positive experiences of physical activity have the potential to last into later adulthood. These experiences are influenced by socioeconomic determinants, leading to health inequalities. This study aims to explore adolescents' experiences and participation in a multi-component school-based intervention in schools located in socioeconomically advantaged and disadvantaged areas in Sweden.

    METHODS: A qualitative design was used to evaluate how participants experienced the intervention. The intervention was a multi-component school-based intervention. It was conducted in six schools (four control and two intervention schools) with a total of 193 students and lasted one school year. It was teacher-led and consisted of three 60-minute group sessions per week: varied physical activities, homework support with activity breaks, and walks while listening to audiobooks. In total, 23 participant observations were conducted over eight months and 27 students participated in focus groups. A content analysis was conducted.

    RESULTS: The results describe a main category 'Engaging in activities depending on socioeconomic status' and three generic categories: 1. Variations in participation in PA together with classmates and teachers; 2. Variations in engagement in PA after school; and 3. Differences in time and place allocated to do homework and listen to audiobooks. These categories illustrate how participants looked forward to the physical activities but used the time spent during the walks and homework support differently depending on how busy they were after school. Frequently, those who were busiest after school were also those from the advantaged area, and those who had little to do after school were from the disadvantaged area.

    CONCLUSION: Socioeconomic factors influence participants' possibilities to engage in the intervention activities as well as how they use their time in the activities. This study showed that it is crucial to support adolescents' participation in physical activities by providing structure and engaging well-known teachers in the activities, especially in schools located in disadvantaged areas.

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  • 15.
    Fernström, Maria
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Fernberg, Ulrika
    Örebro University, Sweden .
    Hurtig-Wennlöf, Anita
    Örebro University, Sweden.
    The importance of cardiorespiratory fitness and sleep duration in early CVD prevention: BMI, resting heart rate and questions about sleep patterns are suggested in risk assessment of young adults, 18–25 years: The cross-sectional lifestyle, biomarkers and atherosclerosis (LBA) study.2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, artikel-id 1715Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Cardiorespiratory fitness (CRF) and sleep habits are lifestyle factors with potential to prevent cardiovascular disease (CVD). CVD is the leading cause of death worldwide. It is therefore important to establish a healthy lifestyle at a young age. In the Lifestyle, Biomarkers and Atherosclerosis (LBA) study we have examined 834 healthy non-smoking adults, aged 18–25 years. The general purpose of the LBA study was to study the effect of lifestyle on traditional biomarkers known to influence CVD risk. The aims of the present study were to evaluate sleep habits of young adult women and men participating in the LBA study, and to compare the importance of sleep and other lifestyle habits on clinically relevant biomarkers for CVD. An additional aim was to find easy and reliable non-invasive biomarkers to detect young adults with increased risk of developing CVD later in life.

    Methods

    The participants had previously been examined for lifestyle factors, biomarkers and CVD risk score. They filled in a validated computerized questionnaire about their general physical and mental health. The questionnaire included questions on sleep duration and experienced quality of sleep.

    Results

    In total 27% of the young adult participants reported difficulties falling asleep or experienced troubled sleep with frequent awakenings per night. The experienced troubled sleep was not related to a higher CVD risk score, but sleep quality and duration were correlated. Shorter sleep duration was significantly associated to higher body mass index (BMI), body fat (%), homeostasis model assessment of insulin resistance (HOMA-IR) and CVD risk. The modifiable lifestyle factor with the highest odds ratio (OR) for CVD risk was CRF. Sleep duration was the second most influential lifestyle factor, more important than moderate- and vigorous physical activity (MVPA) and food habits. Correlations between CRF and heart rate (HR), (P < 0.01) and HOMA-IR and BMI (P < 0.01) were observed, indicating that BMI and resting HR in combination with questions about sleep patterns are easy and reliable non-invasive biomarkers to detect young adults who need counselling on a healthy lifestyle.

    Conclusion

    Decreased sleep duration in combination with decreased CRF, in young adults, is a serious health issue.

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  • 16.
    Fridolfsson, Jonatan
    et al.
    Center for Health and Performance, Department of Food and Nutrition and Sport Science, Faculty of Education, University of Gothenburg, Sweden.
    Arvidsson, Daniel
    Center for Health and Performance, Department of Food and Nutrition and Sport Science, Faculty of Education, University of Gothenburg, Sweden.
    Ekblom Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Bergström, Göran
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ; Department of Clinical Physiology, Region Västra Götaland, Gothenburg, Sweden.
    Börjesson, Mats
    Center for Lifestyle Intervention, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ; Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden..
    Accelerometer-measured absolute versus relative physical activity intensity: cross-sectional associations with cardiometabolic health in midlife.2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 2322Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Observational studies investigating the association between accelerometer-measured physical activity and health all use absolute measures of physical activity intensity. However, intervention studies suggest that the physical activity intensity required to improve health is relative to individual fitness. The aim of this study was to investigate the associations between accelerometer-measured absolute and relative physical activity intensity and cardiometabolic health, and what implications these associations may have on the interpretation of health-associated physical activity.

    METHODS: A sample of the cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS) consisting of 4,234 men and women aged 55-64 years was studied. Physical activity intensity was measured by accelerometry and expressed as absolute (e.g., metabolic equivalents of task) or relative (percentage of maximal oxygen consumption). Fitness was estimated by the submaximal Ekblom-Bak test. A composite ('metabolic syndrome') score combined measures of waist circumference, systolic blood pressure, high-density lipoprotein, triglycerides, and glycated hemoglobin. Associations of absolute and relative physical activity intensity with the health indicators (i.e., fitness and metabolic syndrome score) were studied by partial least squares regression. Analyses were stratified by fitness level.

    RESULTS: Both absolute and relative physical activity intensity associated with the health indicators. However, the strongest associations for absolute intensity varied depending on fitness levels, whereas the associations for relative intensity were more synchronized across fitness groups. The dose-response relationship between moderate-to-vigorous intensity and the health indicators was stronger for relative than for absolute intensity. The absolute and relative moderate-to-vigorous intensity cut-offs intersected at the 5th fitness percentile, indicating that the absolute intensity cut-off is too low for 95% of individuals in this sample. While 99% of individuals fulfilled the general physical activity recommendations based on absolute intensity measures, only 21% fulfilled the recommendations based on relative intensity measures. In relation to a "sufficient" fitness level, 9% fulfilled the recommendations.

    CONCLUSIONS: Accelerometer-measured relative physical activity intensity represents the intensity related to health benefits regardless of fitness level. Traditional absolute moderate intensity accelerometer cut-offs are too low for most individuals and should be adapted to the fitness level in the sample studied. Absolute and relative physical activity intensity cannot be used interchangeably.

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  • 17.
    Helgadóttir, Björg
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Instituten, Stockholm, Sweden.
    Fröberg, Andreas
    University of Gothenburg, Sweden.
    Kjellenberg, Karin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Nyberg, Gisela
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    COVID-19 induced changes in physical activity patterns, screen time and sleep among Swedish adolescents - a cohort study.2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 380Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had a huge impact on daily life, even in countries such as Sweden where the restrictions were relatively mild. This paper assesses the effects of the COVID-19 pandemic restrictions on physical activity (PA) patterns, screen time, and sleep among Swedish adolescents. The exposures explored include gender, parental education, anthropometrics, and cardiovascular fitness (CVF).

    METHODS: Cohort data were collected from September 26th to December 6th, 2019, and from April 12th to June 9th, 2021. Participants were 13-14 years-old (7th graders) at baseline with 585 participating at both baseline and follow-up. At both baseline and follow-up PA and sedentary time were measured with accelerometers, and sleep and screen time with questionnaires. The exposure variables (gender, parental education, anthropometrics and CVF) were collected at baseline. Multilevel linear regression analyses were performed.

    RESULTS: Moderate-to-vigorous-physical activity (MVPA) remained unchanged while light physical activity (LiPA) decreased and sedentary time increased. Sleep duration decreased and screen time increased. Girls, adolescents with overweight/obesity (BMI and percent body fat), and those with lower CVF at baseline had less favourable changes in PA patterns, sleep and screen time.

    CONCLUSIONS: Although no significant (α = 0.05) changes were seen in MVPA, both LiPA and sedentary time as well as sleep and screen time changed in unfavourable ways. More intense activities are often organised and seem to have withstood the pandemic, while less intense activities decreased. Some groups were more vulnerable and will need directed intervention in the post-pandemic period as well as when future pandemics hit.

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  • 18.
    Kallings, Lena
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Uppsala University, Sweden.
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Ekblom, Björn
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysiologi, nutrition och biomekanik.
    Holmlund, Tobias
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Salier Eriksson, Jane
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Andersson, Gunnar
    HPI, Health Profile Institute, Stockholm, Sweden..
    Wallin, Peter
    HPI, Health Profile Institute, Stockholm, Sweden..
    Ekblom Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Workplace sitting is associated with self-reported general health and back/neck pain: a cross-sectional analysis in 44,978 employees.2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 875Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Total sitting time is associated with a higher risk for cardio metabolic disease and mortality, while breaks in prolonged sitting attenuate these effects. However, less is known about associations of different specific domains and breaks of sitting on general health, back/neck pain and if physical activity could influence these associations. The aim was to investigate how workplace sitting and frequency of breaking up workplace sitting is associated with self-reported general health and self-reported back/neck pain.

    METHODS: 44,978 participants (42% women) from the Swedish working population, who participated in a nationwide occupational health service screening 2014-2019, were included in this cross-sectional study. Self-reported sitting duration and frequency of breaks from sitting at work, general health, back/neck pain, exercise, leisure time sitting, diet, smoking, stress and body mass index were assessed. Occupation was classified as requiring higher education qualifications or not. Logistic regression modelling was used to assess the association between workplace sitting/frequency of breaks in workplace sitting and poor general health and back/neck pain, respectively.

    RESULTS: Compared to sitting all the time at work, sitting ≤75% of the time showed significantly lower risks for poor general health (OR range 0.50-0.65), and sitting between 25 and 75% of the time showed significantly lower risks (OR 0.82-0.87) for often reported back/neck pain. For participants reporting sitting half of their working time or more, breaking up workplace sitting occasionally or more often showed significantly lower OR than seldom breaking up workplace sitting; OR ranged 0.40-0.50 for poor health and 0.74-0.81 for back/neck pain.

    CONCLUSIONS: Sitting almost all the time at work and not taking breaks is associated with an increased risk for self-reported poor general health and back/neck pain. People sitting almost all their time at work are recommended to take breaks from prolonged sitting, exercise regularly and decrease their leisure time sitting to reduce the risk for poor health.

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  • 19.
    Larisch, Lisa-Marie
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden..
    Hagströmer, Maria
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden..
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Nilsson, Jonna
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Division of Family Medicine and Preventive Medicine, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden..
    Improving movement behavior in office workers: effects of two multi-level cluster-RCT interventions on mental health2024Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 24, nr 1, artikel-id 127Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period.

    Methods: Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models.

    Results: Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (β = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (β = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress.

    Conclusions: The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components.

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  • 20.
    Larsson, Kristina
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Forskningsgruppen för idrottspsykologi.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Criterion validity and test-retest reliability of SED-GIH, a single item question for assessment of daily sitting time.2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, nr 1, artikel-id 19:17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sedentary behaviour has been closely linked to metabolic and cardiovascular health and is therefore of importance in disease prevention. A user-friendly tool for assessment of sitting time is thus needed. Previous studies concluded that the present tools used to assess a number of sedentary behaviours are more likely to overestimate sitting than single-item questions which often underestimate sitting time, and that categorical answering options are recommended. In line with this, the single-item question with categorical answering options, SED-GIH, was developed. The aim of this study was to investigate the criterion validity of the SED-GIH question using activPAL3 micro as the criterion measure. The second aim was to evaluate the test-retest reliability of the SED-GIH questionnaire.

    METHOD: In the validity section of this study, 284 middle-aged adults answered a web questionnaire, which included SED-GIH, wore activPAL and filled in a diary log for one week. Spearman's rho assessed the relationship between the SED-GIH answers and the daily average sitting time as monitored by the activPAL (activPAL-SIT), a Weighted Kappa assessed the agreement, ANOVA assessed differences in activPAL-SIT between the SED-GIH answer categories, and a Chi2 compared the proportions of hazardous sitters between the different SED-GIH answer categories. In the reliability section, 95 elderly participants answered the SED-GIH question twice, with a mean interval of 5.2 days. The reliability was assessed with ICC and a weighted Kappa.

    RESULTS: The SED-GIH question correlated moderately with activPAL-SIT (rho = 0.31), with a poor agreement (weighted Kappa 0.12). In total, 40.8% underestimated and 22.2% overestimated their sitting time. The ANOVA showed significant differences in activPAL-SIT between the different SED-GIH answer categories (p < 0.001). The Chi2 showed a significant difference in proportion of individuals sitting more than 10 h per day within each SED-GIH answer category. ICC for the test-retest reliability of SED-GIH was excellent with ICC = 0.86, and the weighted Kappa showed an agreement of 0.77.

    CONCLUSIONS: The unanchored single item SED-GIH question showed excellent reliability but poor validity in the investigated populations. Validity and reliability of SED-GIH is in line with other questionnaires that are commonly used when assessing sitting time.

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  • 21.
    Malek, Mahnoush Etminan
    et al.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Andermo, Susanne
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Global Public Health and Department of Neurobiology, Care Sciences and Society,, Karolinska Institutet, Stockholm, Sweden.
    Nyberg, Gisela
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Elinder, Liselotte Schäfer
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Sweden.
    Patterson, Emma
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Section for Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden.
    Norman, Åsa
    Department of Global Public Health and Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden.
    Parents' experiences of participating in the Healthy School Start Plus programme - a qualitative study.2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 646Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The rise in overweight and obesity among children is a global problem and effective prevention interventions are urgently required. Parents play an important role in children's lifestyle behaviours and body weight development and therefore there is a great need to investigate how to involve parents effectively in health promotion and prevention programmes. The aim of the study was to describe parents' experiences of barriers and facilitators of participating in the Healthy School Start Plus (HSSP) intervention study.

    METHODS: HSSP is a parental support programme, conducted in Sweden, with the aim to promote a healthy diet, physical activity and preventing obesity in 5-7-year-old children starting school. In total 20 parents from 7 schools participated in semi-structured telephone-based interviews. The data was analysed using qualitative content analysis, with a deductive approach based on the Consolidated Framework for Implementation Research (CFIR).

    RESULTS: Parental experiences of barriers and facilitators informing the implementation of the HSSP intervention were identified within all five domains of the CFIR. Two additional constructs, not included in the CFIR were identified: Social factors and Cooperation. The findings of parental experiences of barriers and facilitators related to the importance of (1) adaptation of the intervention to fit the abilities of the parents with different social and cultural backgrounds; (2) the need for continuous delivery of information related to healthy behaviours; (3) the commitment and efforts of the deliverers of the intervention; (4) the need for repetition of information related to healthy behaviours given by the deliverers of the intervention; (5) encouragement and facilitation of the involvement of the family and key people around them through the intervention activities and by the deliverers of the intervention; (6) awareness of unexpected impacts and social and cultural conditions complicating the execution of the intervention and; (7) cooperation and a well-functioning interaction between parents and school staff.

    CONCLUSIONS: Barriers and facilitators indicated by the parents highlighted that interventions like the HSSP need to be adapted to fit the parents' abilities, with reminders, follow-ups and delivery of relevant information. Variations in social and cultural conditions need to be taken into consideration. The commitment of the school and the interaction between the school staff and the family as well as key people around them appears to be important.

    TRIAL REGISTRATION: The Healthy School Start Plus trial was retrospectively registered in the International Standard Randomised Controlled Trial Number Registry on January 4, 2018 and available online at ClinicalTrials.gov: No. NCT03390725.

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  • 22.
    Nooijen, Carla F J
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Forskningsgruppen för idrottspsykologi.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Improving office workers' mental health and cognition: a 3-arm cluster randomized controlled trial targeting physical activity and sedentary behavior in multi-component interventions2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, artikel-id 266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Physically inactive and sedentary lifestyles are negatively related to both mental health and cognition. For office-workers, who spend two-thirds of their workday sitting, it is important to improve these lifestyles. The aim of this study is to assess the effectiveness of multi-component interventions, incorporating individual, environmental and organizational changes, to increase physical activity or reduce sedentary behavior among office-workers in order to improve mental health and cognition.

    Methods

    a 3-arm, clustered randomized controlled trial (RCT) with waiting list control group amongst adult office-workers of two large Swedish companies. Cluster teams will be randomized into 6-month interventions or to a passive waiting list control group which will receive the allocated intervention with a 6-month delay. Two multicomponent interventions will be studied of which one focuses on improving physical activity and the other on reducing sedentary behavior. Both interventions include 5 sessions of motivational counselling. In the physical activity intervention persons also get access to a gym and team leaders will organize lunch walks and encourage to exercise. In the sedentary behavior intervention standing- and walking meetings will be implemented and team leaders will encourage to reduce sitting. The recruitment target is 110 office-workers per arm (330 in total). Measurements will be repeated every 6months for a total intended duration of 24months. Proximal main outcomes are physical activity measured with accelerometers and sedentary behavior with inclinometers. Distal outcomes are self-reported mental health and a cognition test battery. Additional outcomes will include cardiovascular fitness, body composition, sleep, self-reported physical activity and sedentary behavior, other health habits, physical health, and working mechanisms from blood samples and questionnaires.

    Discussion

    This cluster RCT will contribute to the currently available evidence by comparing the effectiveness of multi-component interventions targeting physical activity or sedentary behavior with the end goal of improving mental health and cognition. This study is strong in its cluster randomized design, numerous objective outcome measures and long-term follow-up. The exact content of the interventions has been defined by combining theory with results from a larger research project as well as having a continuous dialogue with the involved companies.

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  • 23.
    Nooijen, Carla F J
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap. Karolinska Institutet, Stockholm, Sweden.
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Forskningsgruppen för idrottspsykologi. Karolinska Institutet, Stockholm, Sweden.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Heiland, Emerald G
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Larisch, Lisa-Marie
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Bojsen-Møller, Emil
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Ekblom, Maria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Laboratoriet för biomekanik och motorisk kontroll (BMC). Karolinska Institutet, Stockholm, Sweden.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet. Uppsala University, Sweden.
    The effectiveness of multi-component interventions targeting physical activity or sedentary behaviour amongst office workers: a three-arm cluster randomised controlled trial.2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1329Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Interventions to increase physical activity or reduce sedentary behaviour within the workplace setting have shown mixed effects. This cluster randomised controlled trial assessed whether multi-component interventions, focusing on changes at the individual, environmental, and organisational levels, either increased physical activity or reduced sedentary behaviour, compared to a passive control group.

    METHODS: Teams of office-workers from two companies participated in one of two interventions (iPA: targeting physical activity; or iSED: targeting sedentary behaviour), or wait-list control group (C). Exclusion criterion was very high physical activity level (MVPA ≥30 min/day in ≥10 min bouts every day). Randomisation occurred at the level of workplace cluster, and groups were randomly allocated (1:1) with stratification for company and cluster size. Personnel involved in data collection and processing were blinded to group allocation. Both interventions included five sessions of cognitive behavioural therapy counselling for 6 months. iPA included counselling focused on physical activity, access to a gym, and encouragement to exercise, and go for lunch walks. iSED included counselling on sedentary behaviour and encouragement to reduce sitting and increase engagement in standing- and walking-meetings. At baseline and the 6-month mark accelerometers were worn on the hip and thigh for 7 days. The primary outcomes were group differences in time spent in moderate-to-vigorous intensity physical activity (%MVPA) and in sedentary behaviour (%), analysed using Bayesian multilevel modelling for those with complete data.

    RESULTS: Two-hundred and sixty three office workers (73% women, mean age 42 ± 9 years, education 15 ± 2 years) were randomised into 23 cluster teams (iPA n = 84, 8 clusters; iSED n = 87, 7 clusters; C n = 92, 7 clusters). No significant group differences (posterior mean ratios: 95% credible interval) were found after the intervention for %MVPA or for %Sedentary. %MVPA: iPA vs C (0·04: - 0·80-0·82); iSED vs C (0·47: - 0·41-1·32); iPA vs iSED (0·43: - 0·42-1·27). %Sedentary: iPA vs C (1·16: - 1·66-4·02); iSED vs C (- 0·44: - 3·50-2·64); iPA vs iSED (- 1·60: - 4·72-1·47).

    CONCLUSIONS: The multi-component interventions focusing on either physical activity or sedentary behaviour were unsuccessful at increasing device-measured physical activity or reducing sedentary behaviour compared to a control group.

    TRIAL REGISTRATION: ISRCTN, ISRCTN92968402 . Registered 27/2/2018, recruitment started 15/03/2018.

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  • 24. Norman, Åsa
    et al.
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden and Centre for Epidemiology and Community Medicine, Stockholm County Council.
    Elinder, Liselotte Schäfer
    Berlin, Anita
    One size does not fit all-qualitative process evaluation of the Healthy School Start parental support programme to prevent overweight and obesity among children in disadvantaged areas in Sweden.2016Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 16, artikel-id 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Parental support interventions have shown some effectiveness in improving children's dietary and physical activity habits and preventing overweight and obesity. To date, there is limited research on barriers and facilitators of school-based parental support interventions targeting overweight and obesity. This study aimed to describe barriers and facilitators influencing implementation of the Healthy School Start (HSS) intervention in disadvantaged areas in Stockholm, Sweden, from the perspective of parents and teachers.

    METHODS: Focus groups and individual interviews with teachers (n = 10) and focus groups with parents (n = 14) in the intervention group of the HSS were undertaken, guided by the Consolidated Framework for Implementation Research (CFIR). Transcriptions were analysed using qualitative content analysis in two steps: deductive sorting in two domains of the CFIR (intervention characteristics and process), and subsequent inductive analysis.

    RESULTS: The overarching theme "tailoring the intervention to increase participant engagement" was found. Among teachers, barriers and facilitators were related to how the intervention was introduced, perceptions of the usefulness of the classroom material, preparation ahead of the start of the intervention, cooperation between home and school and children's and parents' active engagement in the intervention activities. For parents, barriers and facilitators were related to the perceived relevance of the intervention, usefulness of the material, experiences of the Motivational Interviewing (MI) sessions, the family member targeted by the intervention, cooperation between home and school and parents' ability to act as good role models.

    CONCLUSION: It seems important to tailor the intervention to the abilities of the target group in order to increase participant engagement. Including activities that focus on parents as role models and cooperation between parents seems important to bring about changes in the home environment. It also appears important to include activities that target cooperation between home and school.

  • 25.
    Nyberg, Gisela
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Sundblom, Elinor
    Norman, Asa
    Elinder, Liselotte Schäfer
    A healthy school start - parental support to promote healthy dietary habits and physical activity in children: design and evaluation of a cluster-randomised intervention.2011Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 11, artikel-id 185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Childhood obesity is multi-factorial and determined to a large extent by dietary habits, physical activity and sedentary behaviours. Previous research has shown that school-based programmes are effective but that their effectiveness can be improved by including a parental component. At present, there is a lack of effective parental support programmes for improvement of diet and physical activity and prevention of obesity in children.

    METHODS/DESIGN: This paper describes the rationale and design of a parental support programme to promote healthy dietary habits and physical activity in six-year-old children starting school. The study is performed in close collaboration with the school health care and is designed as a cluster-randomised controlled trial with a mixed methods approach. In total, 14 pre-school classes are included from a municipality in Stockholm county where there is large variation in socio-economic status between the families. The school classes are randomised to intervention (n = 7) and control (n = 7) groups including a total of 242 children. The intervention is based on social cognitive theory and consists of three main components: 1) a health information brochure; 2) two motivational interviewing sessions with the parents; and 3) teacher-led classroom activities with the children. The primary outcomes are physical activity in the children measured objectively by accelerometry, children's dietary and physical activity habits measured with a parent-proxy questionnaire and parents' self-efficacy measured by a questionnaire. Secondary outcomes are height, weight and waist circumference in the children. The duration of the intervention is six months and includes baseline, post intervention and six months follow-up measurements. Linear and logistic regression models will be used to analyse differences between intervention and control groups in the outcome variables. Mediator and moderator analysis will be performed. Participants will be interviewed.

    DISCUSSION: The results from this study will show if it is possible to promote a healthy lifestyle and a normal weight development among children from low-income districts with relatively limited efforts involving parents. Hopefully the study will provide new insights to the further development of effective programmes to prevent overweight and obesity in children.

    TRIAL REGISTRATION: ISRCTN: ISRCTN32750699.

  • 26.
    Olsson, Sven Johan Gustav
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Ekblom Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Hemmingsson, Erik
    Karolinska Institutet.
    Hellénius, Mai-Lis
    Karolinska Institutet.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 687Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusions

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

    Trial registration

    ClinicalTrials.gov NCT02320760.

  • 27.
    Ropponen, Annina
    et al.
    Karolinska institutet, Stockholm, Sweden ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Wang, Mo
    Karolinska institutet, Stockholm, Sweden.
    Narusyte, Jurgita
    Karolinska Institutet, Stockholm, Sweden..
    Kärkkäinen, Sanna
    Karolinska Institutet, Stockholm, Sweden..
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Karolinska Institutet, Stockholm, Sweden..
    Svedberg, Pia
    Karolinska Institutet, Stockholm, Sweden..
    The role of sickness absence diagnosis for the risk of future inpatient- or specialized outpatient care in a Swedish population-based twin sample.2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 957Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Studies of consequences of sickness absence such as health and well-being have been rare whereas risk factors for sickness absence have been studied extensively. This study assumed the consequences of sickness absence would differ by diagnostic group or by patient care type. The aim was to investigate sickness absence due to various diagnosis groups as a predictor for subsequent inpatient- and specialized outpatient care while controlling for familial confounding.

    METHODS: We utilized the register data of 69,552 twin individuals between 16 and 80 years of age (48% women). The first incident sickness absence spell, from baseline year 2005, including diagnosis of sickness absence was our primary exposure of interest and we followed them until the first incident inpatient- and specialized outpatient care episode with main diagnosis code or until 31.12.2013.

    RESULTS: A total of 7464 incident sickness absence spells took place (11%), 42% had inpatient care and 83% specialized outpatient care (mean follow-up time 3.2 years, SD 3.1 years). All the main sickness absence diagnosis groups were associated with increased risk of future care in comparison to no sickness absence. Controlling for confounders attenuated the associations in magnitude but with retaining direction, and we could not confirm an effect of familial factors.

    CONCLUSIONS: Sickness absence predicts both inpatient- and specialized outpatient care and the association is universal across diagnosis groups. The lower survival time and incidence rates of inpatient than specialized outpatient care point towards severity of diseases assumption. This finding was also universal across sickness absence diagnosis groups.

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  • 28. Rödjer, Lars
    et al.
    Jonsdottir, Ingibjörg H
    Rosengren, Annika
    Björck, Lena
    Grimby, Gunnar
    Thelle, Dag S
    Lappas, Georgios
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Self-reported leisure time physical activity: a useful assessment tool in everyday health care.2012Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 12, nr 1, s. 693-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The individual physical activity level is an independent risk factor for cardiovascular disease and death, as well as a possible target for improving health outcome. However, today's widely adopted risk score charts, typically do not include the level of physical activity. There is a need for a simple risk assessment tool, which includes a reliable assessment of the level of physical activity. The aim of this study was therefore, to analyse the association between the self-reported levels of physical activity, according to the Saltin-Grimby Physical Activity Level Scale (SGPALS) questionnaire, and cardiovascular risk factors, specifically focusing on the group of individuals with the lowest level of self-reported PA.

    METHODS: We used cross sectional data from the Intergene study, a random sample of inhabitants from the western part of Sweden, totalling 3588 (1685 men and 1903 women, mean age 52 and 51). Metabolic measurements, including serum-cholesterol, serum-triglycerides, fasting plasma-glucose, waist circumference, blood pressure and resting heart rate, as well as smoking and self-reported stress were related to the self-reported physical activity level, according to the modernized version of the SGPALS 4-level scale.

    RESULTS: There was a strong negative association between the self-reported physical activity level, and smoking, weight, waist circumference, resting heart rate, as well as to the levels of fasting plasma-glucose, serum-triglycerides, low-density lipoproteins (LDL), and self-reported stress and a positive association with the levels of high-density lipoproteins (HDL). The individuals reporting the lowest level of PA (SGPALS, level 1) had the highest odds-ratios (OR) for having pre-defined levels of abnormal risk factors, such as being overweight (men OR 2.19, 95% CI: 1.51-3.19; women OR 2.57, 95 % CI: 1.78-3.73), having an increased waist circumference (men OR 3.76, 95 % CI: 2.61-5.43; women OR 2.91, 95% CI: 1.94-4.35) and for reporting stress (men OR 3.59, 95 % CI: 2.34-5.49; women OR 1.25, 95% CI: 0.79-1.98), compared to the most active individuals, but also showed increased OR for most other risk factors analyzed above.

    CONCLUSION: The self-reported PA-level according to the modernized Saltin-Grimby Physical Activity Level Scale, SGPALS, is associated with the presence of many cardiovascular risk factors, with the most inactive individuals having the highest risk factor profile, including self-reported stress. We propose that the present SGPALS may be used as an additional, simple tool in a routine risk assessment in e.g. primary care, to identify inactive individuals, with a higher risk profile.

  • 29. Sundblad, Gunilla M Brun
    et al.
    Saartok, Tönu
    Engström, Lars-Magnus T
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Forskningsgruppen för pedagogik, idrott och fritidskultur.
    Child-parent agreement on reports of disease, injury and pain.2006Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 6, s. 276-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Studies on school students are indicating that somatic complaints and pain have increased during the past decades. Throughout this period there has been a change in methodology from proxy reports by parents to having the students themselves act as the respondents, possible explaining some of the increase in prevalence. The aim of this study was to compare the agreement of answers from students with answers given by their parents regarding the students' medical background and subjective rating of perceived health with specific focus on frequency of headache, musculoskeletal pain and tiredness. METHODS: The participating students came from eleven different schools in Sweden. The schools were a sub sample of randomly selected schools originally participating in a larger multidisciplinary base study. Those 8th grade students present at school on the test date became the subjects of the investigation. A total of 232 students answered, assisted by the test leader, a specially designed self-complete questionnaire at school. Their parents were, at the same time, contacted and 200 answered a similar mailed-out questionnaire. One hundred and eighty-six (186) corresponding student-same parent questionnaires were registered for which comparisons of answers could be made and analysis conducted. RESULTS: When a child is in good health, in absence of diseases, pain and injuries, his or her assessment matches up with their parent. Children and parents also showed agreement in cases of severe injuries and frequent (daily) complaints of knee pain. Less frequent headaches, back- and musculoskeletal pain and other complaints of minor injuries and less wellbeing, such as students' tiredness, were all under-reported and under-rated by their parents. CONCLUSION: When assessing the perceived health and wellbeing of students, their own expressions should be the basis for the data collection and analysis rather than relying entirely on parental reports.

  • 30.
    Väisänen, Daniel
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Andersson, Gunnar
    HPI Health Profile Institute, Stockholm, Sweden.
    Wallin, Peter
    HPI Health Profile Institute, Stockholm, Sweden.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Ekblom Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa.
    Lifestyle-associated health risk indicators across a wide range of occupational groups: a cross-sectional analysis in 72,855 workers.2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1656Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Identify and compare health risk indicators for common chronic diseases between different occupational groups.

    METHODS: A total of 72,855 participants (41% women) participating in an occupational health service screening in 2014-2019 were included. Occupation was defined by the Swedish Standard Classification of Occupation, and divided into nine major and additionally eight sub-major groups. These were analysed separately, as white- and blue-collar occupations and as low- and high-skilled occupations. Seven health risk indicators were self-reported: exercise, physical work situation, sitting at work and leisure, smoking, diet, and perceived health, whereas cardiorespiratory fitness, BMI and blood pressure were measured. These were further dichotomized (yes/no) and as clustering of risk indicators (≥3 vs. <3).

    RESULTS: The greatest variation in OR across sub-major and major occupational groups were seen for daily smoking (OR = 0.68 to OR = 5.12), physically demanding work (OR = 0.55 to OR = 45.74) and high sitting at work (OR = 0.04 to OR = 1.86). For clustering of health risk indicators, blue-collar workers had significantly higher clustering of health risks (OR: 1.80; 95% CI 1.71-1.90) compared to white-collar workers (reference). Compared to high-skilled white-collar workers, low-skilled white-collar workers had similar OR (2.00; 1.88-2.13) as high-skilled blue-collar workers (1.98; 1.86-2.12), with low-skilled blue-collar workers having the highest clustered risk (2.32; 2.17-2.48).

    CONCLUSION: There were large differences in health risk indicators across occupational groups, mainly between high-skilled white-collar occupations and the other occupations, with important variations also between major and sub-major occupational groups. Future health interventions should target the occupational groups identified with the highest risk for effective disease prevention.

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  • 31.
    Wahlgren, Lina
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, FoU-gruppen för rörelse, hälsa och miljö.
    Schantz, Peter
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, FoU-gruppen för rörelse, hälsa och miljö.
    Exploring bikeability in a metropolitan setting: stimulating and hindering factors in commuting route environments2012Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 12, nr 168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Route environments may influence people’s active commuting positively and thereby contribute to public health. Assessments of route environments are, however, needed in order to better understand the possible relationship between active commuting and the route environment. The aim of this study was, therefore, to assess the potential associations between perceptions of whether the route environment on the whole hinders or stimulates bicycle commuting and perceptions of environmental factors.

    Methods

    The Active Commuting Route Environment Scale (ACRES) was used for the assessment of bicycle commuters’ perceptions of their route environments in the inner urban parts of Greater Stockholm, Sweden. Bicycle commuters (n = 827) were recruited by advertisements in newspapers. Simultaneous multiple regression analyses were used to assess the relation between predictor variables (such as levels of exhaust fumes, noise, traffic speed, traffic congestion and greenery) and the outcome variable (hindering – stimulating route environments). Two models were run, (Model 1) without and (Model 2) with the item traffic: unsafe or safe included as a predictor.

    Results

    Overall, about 40% of the variance of hindering – stimulating route environments was explained by the environmental predictors in our models (Model 1, = 0.415, and Model 2, = 0.435). The regression equation for Model 1 was: y = 8.53 + 0.33 ugly or beautiful + 0.14 greenery + (−0.14) course of the route + (−0.13) exhaust fumes + (−0.09) congestion: all types of vehicles (p ≤ 0.019). The regression equation for Model 2 was y = 6.55 + 0.31 ugly or beautiful + 0.16 traffic: unsafe or safe + (−0.13) exhaust fumes + 0.12 greenery + (−0.12) course of the route (p ≤ 0.001).

    Conclusions

    The main results indicate that beautiful, green and safe route environments seem to be, independently of each other, stimulating factors for bicycle commuting in inner urban areas. On the other hand, exhaust fumes, traffic congestion and low ‘directness’ of the route seem to be hindering factors. Furthermore, the overall results illustrate the complexity of a research area at the beginning of exploration.

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  • 32.
    Wallman-Sperlich, Birgit
    et al.
    Institute of Health Promotion and Clinical Movement Science, German Sports University Cologne, Germany.
    Buksch, Jens
    WHO Collaborating Centre for Child and Adolescent Health Promotion, School of Public Health, Bielefeld University, Germany.
    Hansen, Sylvia
    Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.
    Schantz, Peter
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, FoU-gruppen för rörelse, hälsa och miljö.
    Froboese, Ingo
    Institute of Health Promotion and Clinical Movement Science, German Sports University Cologne, Germany.
    Sitting Time in Germany: An Analysis of Socio-demographic and Environmental Correlates2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 196, nr 13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Sedentary behaviour in general and sitting time in particular is an emerging global health concern. The aim of this study was to provide data on the prevalence of sitting time in German adults and to examine socio-demographic and environmental correlates of sitting time.

    Methods: A representative sample of German adjults (n = 2000; 967 men, 1033 women; 49.3 ±17.6 years of age) filled in the Global Physical Activity Questionnaire, including one question on overall sitting time and answered questions about the neighbourhood environment, as well as concerning demographics. Daily sitting time was stratified by gender, age group, BMI, educational and income level, as well as physical activity (PA). To identify socio-demographic and environmental correlates of sitting time, we used a series of linear regressions.

    Results: The overall median was 5 hours (299 minutes) of sitting time/day and men sat longer than women (5 vs. 4 hours/day; p < 0.05). In both genders age and PA were negatively and the educational level positively associated with sitting time. The level of income was not a correlate of sitting time in multivariate analyses. Sitting time was significantly positively associated with higher neighbourhood safety for women. The variance ranged from 16.5% for men to 8.9% for women.

    Conclusions: The overall sitting time was unequally distributed in the German adult population. Our findings suggest implementing specific interventions to reduce sitting time for subgroups such as men, younger aged adults and adults with a higher education and lower PA. Future studies should enhance our understanding of the specific correlates of different types and domains of sitting in order to guide the development of effective public health strategies.

     

     

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  • 33.
    Wang, Mo
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ropponen, Annina
    Karolinska Institutet, Stockholm, Sweden .
    Narusyte, Jurgita
    Karolinska Institutet, Stockholm, Sweden.
    Helgadóttir, Björg
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap. Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Karolinska Institutet, Stockholm, Sweden.
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Forskningsgruppen för idrottspsykologi. Karolinska Institutet, Stockholm, Sweden.
    Svedberg, Pia
    Karolinska Institutet, Stockholm, Sweden.
    Adverse outcomes of chronic widespread pain and common mental disorders in individuals with sickness absence - a prospective study of Swedish twins.2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1301Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Chronic widespread pain (CWP) and common mental disorders (CMDs) are common public health problems, but little is known about the role of CWP and CMDs on future adverse outcomes among work disabled individuals. The aims of the study were to investigate the associations between CWP and CMDs with subsequent disability pension (DP), long-term unemployment (> 90 days) and all-cause mortality in individuals with sickness absence (SA) and whether the associations were explained by familial factors.

    METHODS: In this prospective cohort study, 7884 Swedish twins born between 1933 and 1985 were included and baseline data were gathered from a questionnaire in 1998 to 2006. Register data were used for obtaining information regarding demographics, SA, DP, unemployment and mortality. Cox proportional hazards regressions were used to calculate Hazard Ratios (HR) with 95% Confidence Intervals (CI) for the associations between CWP and/or CMDs with DP, unemployment and mortality, while conditional Cox models for twin pairs provided control for familial confounding.

    RESULTS: Having either CWP or CMDs among those with a history of SA was associated with a higher risk of DP and all-cause mortality than individuals without CWP and CMDs after controlling for socio-demographic and health factors. Moreover, sick-listed individuals with both CWP and CMDs had a higher risk of DP while those who only had CMDs had a higher risk of long-term unemployment compared to those without CWP and CMDs. The association between CMDs with DP and long-term unemployment was no longer significant when controlling for familial factors.

    CONCLUSIONS: CMDs was a risk factor for DP, unemployment and mortality among individuals with SA, while CWP seems to be important in relation to future DP and mortality. Familial factors played a role in the associations between CMDs and DP and CMDs and unemployment.

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