Gymnastik- och idrottshögskolan, GIH

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  • 1.
    Andermo, Susanne
    et al.
    Karolinska institutet.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Extra schemalagd fysisk aktivitet i högstadiet: en väg framåt?2021In: Svensk idrottsmedicin 2021:3, 2021Conference paper (Other academic)
  • 2.
    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
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska institutet, Sweden.
    Effectiveness of a family intervention on health-related quality of life-a healthy generation, a controlled pilot trial.2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 809Article in journal (Refereed)
    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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  • 3.
    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
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Institutet, Stockholm, Sweden..
    "We were all together"- families' experiences of the health-promoting programme - A Healthy Generation.2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 1911Article in journal (Refereed)
    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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  • 4.
    Andermo, Susanne
    et al.
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Olin, Susanna
    Karolinska Inst, STAD, Ctr Psychiat Res, Stockholm, Sweden.;Stockholm Cty Council, Stockholm, Sweden..
    Hellenius, Mai-Lis
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Nordenfelt, Anja
    Fdn A Hlth Generat, Stockholm, Sweden..
    Lidin, Matthias
    Karolinska Inst, Dept Med, Stockholm, Sweden.;Karolinska Univ Hosp, Theme Heart & Vessels, Stockholm, Sweden..
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden.
    O9-2 Participants' and leaders' experiences of a family-based health promotion programme: A Healthy Generation2022In: EUROPEAN JOURNAL OF PUBLIC HEALTH, vol. 32, S2, Oxford University Press, 2022, Vol. 32, no S2Conference paper (Other academic)
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  • 5. Beckvid Henriksson, Gabriella
    et al.
    Franzén, Sofie
    Elinder, Liselotte Schäfer
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden and Centre for Epidemiology and Community Medicine, Stockholm County Council.
    Low socio-economic status associated with unhealthy weight in six-year-old Swedish children despite higher levels of physical activity.2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 10, p. 1204-10Article in journal (Refereed)
    Abstract [en]

    AIM: Socio-economic status is an important determinant of physical activity, sedentary behaviour and body mass index, but these associations are contradictory in younger children. We investigated the associations between parental socio-economic status, physical activity, sedentary behaviour and body mass index in six-year-old children, to identify possible differences in physical activity between socio-economic groups.

    METHODS: The study comprised 621 children from Stockholm suburbs, recruited from, A healthy school start, a cluster-randomised controlled intervention study. A cross-sectional study was performed using baseline data. Physical activity and sedentary behaviour were assessed by accelerometry, body weight and height were measured, and body mass index was calculated. Sedentary behaviour was also assessed using a questionnaire.

    RESULTS: We found that 12% of the study population were overweight and 9% were obese. Children from families with low socio-economic status were more physically active and slightly less sedentary, but were almost twice as likely to be overweight or obese than children from high socio-economic status, irrespective of the child's sex.

    CONCLUSION: Low socio-economic status was associated with higher physical activity, lower sedentary behaviour and an unhealthier weight status compared to high socio-economic status, suggesting a role of diet as a cause of the higher overweight and obesity prevalence.

  • 6. Berglind, Daniel
    et al.
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    Persson, Margareta
    Wells, Michael
    Forsell, Yvonne
    An eHealth program versus a standard care supervised health program and associated health outcomes in individuals with mobility disability: study protocol for a randomized controlled trial.2018In: Trials, E-ISSN 1745-6215, Vol. 19, no 1, article id 258Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Young adults with mobility disability (MD) are less likely to engage in regular physical activity (PA) compared with their able-bodied peers and inactive adults with a MD are more likely to report one or more chronic diseases compared to those who are physically active. Despite the vast amount of research published in the field of PA interventions over the past decades, little attention has been focused on interventions aiming to increase PA among individuals with MD. Thus, we propose to compare the effects of an eHealth program compared to a usual care supervised health program on levels of PA and other health behaviors.

    METHODS: The current intervention will use a randomized controlled trial (RCT) design with two treatment groups (an eHealth program and a usual care supervised health program) in young adults with newly acquired MD. In total, 110 young adults (aged 18-40 years) with a MD, acquired within the past 3 years, will be recruited to participate in a 12-week intervention. The primary study outcome is accelerometer-measured time spent in moderate to vigorous PA. Secondary outcomes includes health-related quality of life, depression, stress, fitness, body composition, diet, musculoskeletal pain, motivation to exercise and work ability.

    DISCUSSION: There is a lack of RCTs investigating effective ways to increase levels of PA in young adults with MD. Increased levels of PA among this physically inactive population have the potential to substantially improve health-related outcomes, possibly more so than in the general population. The trial will put strong emphasis on optimizing exercise adherence and investigating feasibility in the two treatment programs. The Ethical Review Board (EPN) at Karolinska Institutet has approved the study (2017/1206-31/1).

    TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN), reference number ISRCTN22387524 . Prospectively registered February 4, 2018.

  • 7. 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.2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, article id 541Article in journal (Refereed)
    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.

  • 8.
    Bergström, Helena
    et al.
    Karolinska Institutet.
    Sundblom, Elinor
    Region Stockholm.
    Elinder, Liselotte Schäfer
    Karolinska institutet.
    Norman, Åsa
    Karolinska institutet.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska institutet.
    Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study.2020In: Journal of Primary Prevention, ISSN 0278-095X, E-ISSN 1573-6547, Vol. 41, no 3, p. 191-209Article in journal (Refereed)
    Abstract [en]

    Health-related behaviours in children can be influenced by parental support programmes. The aim of this study was to explore barriers to and facilitators for the implementation of a parental support programme to promote physical activity and healthy dietary habits in a school context. We explored the views and experiences of 17 coordinating school nurses, non-coordinating school nurses, and school principals. We based the interview guide on the Consolidated Framework for Implementation Research. We held four focus group discussions with coordinating and non-coordinating school nurses, and conducted three individual interviews with school principals. We analysed data inductively using qualitative content analysis. We identified "Creating commitment in an overburdened work situation" as an overarching theme, emphasising the high workload in schools and the importance of creating commitment, by giving support to and including staff in the implementation process. We also identified barriers to and facilitators of implementation within four categories: (1) community and organisational factors, (2) a matter of priority, (3) implementation support, and (4) implementation process. When implementing a parental support programme to promote physical activity and healthy dietary habits for 5- to 7-year-old children in the school context, it is important to create commitment among school staff and school nurses. The implementation can be facilitated by political support and additional funding, external guidance, use of pre-existing resources, integration of the programme into school routines, a clearly structured manual, and appointment of a multidisciplinary team. The results of this study should provide useful guidance for the implementation of similar health promotion interventions in the school context.

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  • 9. Bohman, Benjamin
    et al.
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden.
    Sundblom, Elinor
    Elinder, Liselotte Schäfer
    Validity and Reliability of a Parental Self-Efficacy Instrument in the Healthy School Start Prevention Trial of Childhood Obesity.2014In: Health Education & Behavior, ISSN 1090-1981, E-ISSN 1552-6127, Vol. 41, no 4, p. 392-6Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Measures of parental self-efficacy (PSE) for healthy dietary or physical activity (PA) behaviors in children have been used in several studies; however, further psychometric validation of PSE for these behaviors is needed. The purpose of the present study was to evaluate the psychometric properties of a new PSE instrument.

    METHODS: Mothers (n = 162) of 6-year-old children in the Healthy School Start prevention trial of childhood obesity responded to the instrument and a parent-report questionnaire on diet and PA in children. In addition, PA was objectively assessed by accelerometry.

    RESULTS: Exploratory factor analysis yielded a structure composed of three factors of PSE for dietary and PA behaviors in children, and PSE was associated with parent-report of these behaviors. Internal consistency was good.

    DISCUSSION: Preliminary support of the validity and reliability of the PSE instrument was provided. The measure may be useful in prevention and treatment trials of childhood obesity.

  • 10.
    Danielsson, Pernilla
    et al.
    Karolinska Institutet.
    Svensson, Viktoria
    Karolinska Institutet.
    Kowalski, Jan
    Karolinska Institutet.
    Nyberg, Gisela
    Karolinska Institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Marcus, Claude
    Karolinska Institutet.
    Importance of age for 3-year continuous behavioral obesity treatment success and dropout rate.2012In: Obesity Facts, ISSN 1662-4025, E-ISSN 1662-4033, Vol. 5, no 1, p. 34-44Article in journal (Refereed)
    Abstract [en]

    Abstract

    Objective: To assess whether first year weight loss, age, and socioeconomic background correlate with the success rate of continuous long-term behavioral obesity treatment. Methods: In a 3-year longitudinal study, obese children (n = 684) were divided into three groups based on age at the start of treatment, age 6-9 years, 10-13 years, and 14-16 years. Results: The mean BMI standard deviation score (BMI-SDS) decline was age-dependent (p = 0.001), independently of adjustment for missing data: -1.8 BMI-SDS units in the youngest, -1.3 in the middle age group, and -0.5 in the oldest age group. SES and parental BMI status did not affect the results. 30% of the adolescents remained in treatment at year 3. There was only a weak correlation between BMI-SDS change after 1 and 3 years: r = 0.51 (p < 0.001). Among children with no BMI-SDS reduction during year 1 (n = 46), 40% had a clinically significantly reduced BMI-SDS after year 3. Conclusion: Behavioral treatment should be initiated at an early age to increase the chance for good results. Childhood obesity treatment should be continued for at least 3 years, regardless of the initial change in BMI-SDS. Copyright © 2012 S. Karger GmbH, Freiburg.

  • 11. Delisle Nyström, Christine
    et al.
    Larsson, Christel
    Alexandrou, Christina
    Ehrenblad, Bettina
    Eriksson, Ulf
    Friberg, Marita
    Hagströmer, Maria
    Lindroos, Anna Karin
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden.
    Löf, Marie
    Results from Sweden's 2018 Report Card on Physical Activity for Children and Youth.2018In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, no S2, p. S413-S414, article id jpah.2018-0519Article in journal (Refereed)
  • 12.
    Ekblom, Maria
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Institutionen för Neurovetenskap, KI.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Selinus, Eva Noren
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Fysisk aktivitet och hjärnhälsa: En bok för skolan2021 (ed. 1)Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Fysisk aktivitet gynnar förutsättningarna för lärande och psykiskt välbefinnande, men ungdomar rör sig mindre än någonsin och fysisk aktivitet har blivit allt mer av en klassfråga. Detta har lett till orättvisa villkor för barns hälsa och lärande, en orättvisa som skolan kan bidra till att jämna ut.

    Boken Fysisk aktivitet och hjärnhälsa går konkret igenom hur skolor kan främja fysisk aktivitet inom ramen för skolvardagen och vilka effekter detta kan ge. Här beskrivs vad vi idag faktiskt vet om sambanden mellan fysisk aktivitet och hjärnhälsa med fokus på barn och ungdomar, men också vad vi behöver mer kunskap om. Med ett kritiskt förhållningssätt gör författarna en evidensbaserad genomgång av centrala begrepp inom området fysisk aktivitet med koppling till effekter på hjärnhälsa och lärande.

    Barn och ungdomar i skolåldern bör röra sig minst 60 minuter om dagen och eftersom eleverna spenderar en så stor del av sin vakna tid i skolan behöver gynnsamma förutsättningar skapas i skolmiljön då inte enbart inom skolämnet Idrott och hälsa.

    Fysisk aktivitet och hjärnhälsa vänder sig till alla lärare, lärarstudenter, skolledare och elevhälsoteam som vill bidra till ökad fysisk aktivitet, hjärnhälsa och goda vanor för livet.

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  • 13.
    Ekblom, Örjan
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Nyberg, Gisela
    Karolinska Institutet.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Ekelund, Ulf
    Cambridge University.
    Marcus, Claude
    Karolinska Institutet.
    Validity and comparability of a wrist-worn accelerometer in children.2012In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 9, no 3, p. 389-393Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Wrist-worn accelerometers may provide an alternative to hip-worn monitors for assessing physical activity as they are easier to wear and may thus facilitate long-term recordings. The current study aimed at a) assessing the validity of the Actiwatch (wrist-worn) for estimating energy expenditure, b) determining cut-off values for light, moderate, and vigorous activities, c) studying the comparability between the Actiwatch and the Actigraph (hip-worn), and d) assessing reliability.

    METHODS:

    For validity, indirect calorimetry was used as criterion measure. ROC-analyses were applied to identify cut-off values. Comparability was tested by simultaneously wearing of the 2 accelerometers during free-living condition. Reliability was tested in a mechanical shaker.

    RESULTS:

    All-over correlation between accelerometer output and energy expenditure were found to be 0.80 (P < .001).Based on ROC-analysis, cut-off values for 1.5, 3, and 6 METs were found to be 80, 262, and 406 counts per 15 s, respectively. Energy expenditure estimates differed between the Actiwatch and the Actigraph (P < .05). The intra- and interinstrument coefficient of variation of the Actiwatch ranged between 0.72% and 8.4%.

    CONCLUSION:

    The wrist-worn Actiwatch appears to be valid and reliable for estimating energy expenditure and physical activity intensity in children aged 8 to 10 years.

  • 14.
    Ekstedt, Mirjam
    et al.
    KTH.
    Nyberg, Gisela
    Karolinska Institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Ingre, Mikael
    Stockholms Universitet.
    Marcus, Claude
    Karolinska Insitutete.
    Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: a cross-sectional study.2013In: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 22, no 10, p. 82-89Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described.

    METHOD:

    We conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary (<1.5 METS), light (1.5 to 3 METS) and moderate-to-vigorous (> 3 METS); and Body Mass Index standard deviations score, BMIsds.

    RESULTS:

    Total sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -.23, P < .01). A negative association between BMIsds and sleep duration was found (-.10, p < .01).

    CONCLUSIONS:

    Short sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.

  • 15. 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.2018In: BMC Public Health, E-ISSN 1471-2458, Vol. 18, no 1, article id 459Article in journal (Refereed)
    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 .

  • 16. Elinder, Liselotte Schäfer
    et al.
    Patterson, Emma
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden.
    Säfsten, Eleonore
    Sundblom, Elinor
    [Sweden needs a national strategy for nutrition and physical activity].2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DFSEArticle in journal (Other (popular science, discussion, etc.))
  • 17.
    Farias, Lisette
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Andermo, Susanne
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. 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.2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 1631Article in journal (Refereed)
    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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  • 18.
    Fernström, Maria
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Heiland, Emerald G
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Surgical Sciences, Medical Epidemiology, Uppsala University Uppsala Sweden.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Pontén, Marjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Tarassova, Olga
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Ekblom, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Effects of prolonged sitting and physical activity breaks on measures of arterial stiffness and cortisol in adolescents2023In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 5, p. 1011-1018Article in journal (Refereed)
    Abstract [en]

    Aim

    In adults, prolonged periods of sitting have been linked to acute negative effects on vascular structure and function. The aim of this study was to evaluate the acute effects of physical activity (PA) breaks during prolonged sitting on arterial stiffness, cortisol and psychological factors in adolescents.

    Methods

    Adolescents underwent different short (3-min) breaks starting every 20 min, during 80 min of sitting on three separate days. Breaks were (A) social seated breaks (SOC), (B) low-intensity simple resistance activity PA breaks (SRA) and (C) moderate-intensity step-up PA breaks (STEP). The arterial stiffness measures were augmentation index (AIx), AIx@75 and pulse wave velocity (PWV). Cortisol was measured from saliva. Psychological factors were self-reported.

    Results

    Eleven girls and six boys (average age 13.6 ± 0.7 years) participated, with average baseline heart rates of 72 ± 11 bpm, systolic/diastolic blood pressure 111 ± 7/64 ± 6 mmHg and cortisol 10.9 ± 5.8 nmoL/L. PWV, cortisol and psychological factors did not change after any of the conditions. AIx@75 increased significantly (4.9 ± 8.7–9.2 ± 13.2) after the STEP intervention compared with SOC and SRA (time × condition p < 0.05).

    Conclusion

    Arterial stiffness increased after prolonged sitting with frequent, short step-up activity breaks. The results indicate potential important intensity-dependent effects of physical activity on vascular regulation in youth.

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  • 19.
    Fröberg, Andreas
    et al.
    University of Gothenburg, Sweden.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Lindroos, Anna Karin
    University of Gothenburg, Sweden; Karolinska Institute, Sweden.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Institute, Sweden.
    Self-reported physical activity and sedentary behaviour among adolescents in Sweden vary depending on sex, age and parental education.2021In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, no 11, p. 3097-3104Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate self-reported physical activity and sedentary behaviour by sex, age and parental education in a large representative sample of Swedish adolescents.

    METHODS: This study is based on data from the national dietary survey Riksmaten Adolescents that was conducted by the Swedish Food Agency in 2016-2017. In total, 3477 students in grade five (11-12 years), eight (14-15 years), and eleven (17-18 years) were included. A web questionnaire was used to collect information about physical activity and sedentary behaviour.

    RESULTS: In total, 53% reported active transport to and from school, 93% that they usually participate in the physical education, 76% reported a physically active leisure time, and 66% that they participated in organised physical activities. In addition, 12% and 6% reported two hours or less of screen time on weekdays and weekends, respectively. Participation in physical activity was generally lower among girls, older adolescents and for those from families with low parental education.

    CONCLUSION: This study provide reference values for self-reported physical activities and sedentary behaviours among adolescents in Sweden. Strategies to increase physical activity and reduce screen time are needed, particularly among girls, older adolescents and among those with low parental education.

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  • 20.
    Fröberg, Andreas
    et al.
    University of Gothenburg, Sweden.
    Lindroos, Anna-Karin
    Swedish Food Agency, Uppsala, Sweden.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Organised physical activity during leisure time is associated with more objectively measured physical activity among Swedish adolescents.2020In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, no 9, p. 1815-1824Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate associations between participation in organised physical activity (PA), such as sport and exercise during leisure time, and objectively measured PA and sedentary time in a large representative sample of Swedish adolescents.

    METHODS: This study was part of the school-based cross-sectional Swedish national dietary survey Riksmaten Adolescents 2016-17. Data from 3477 adolescents aged 11-12, 14-15 and 17-18 years were used in the analyses. Participation in organised PA and parental education were reported in questionnaires. PA and sedentary time were objectively measured through accelerometry during seven consecutive days.

    RESULTS: Adolescents who participated in organised PA had significantly higher total PA (14%, p<0.001), more time spent on moderate-to-vigorous PA (MVPA) (eight minutes, p<0.001) and had less sedentary time (15 minutes, p<0.001). Those who participated in organised PA were more likely to reach recommended PA levels. Total PA and MVPA did not differ by parental education among those who participated in organised PA.

    CONCLUSION: Adolescents who participated in organised PA were more physically active, less sedentary and more likely to reach PA recommendations than those who did not.

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  • 21.
    Fröberg, Andreas
    et al.
    Department of Food and Nutrition and Sport Science, University of Gothenburg, Sweden.
    Lindroos, Anna-Karin
    Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Moraeus, Lotta
    Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; .
    Patterson, Emma
    Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden..
    Warensjö Lemming, Eva
    Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; .
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden..
    Leisure-time organised physical activity and dietary intake among Swedish adolescents.2022In: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447X, Vol. 40, no 11, p. 1198-1205Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate associations between participation in leisure-time organised physical activity (LTOPA) and dietary intake in a large representative sample of Swedish adolescents participating in the national dietary survey Riksmaten Adolescents 2016-2017. A sample of 2807 participants aged 11-12, 14-15 and 17-18 years were included. Information about LTOPA and dietary intake were collected through questionnaires and two 24-hour recalls on the web (RiksmatenFlex). For dietary intake, overall healthy eating index, intake of fruit, vegetables, candy, sugar-sweetened beverages, and the proportion of added sugar to total energy intake were analysed. Significance-testing for associations was performed with analysis of covariance. LTOPA was associated with lower sugar-sweetened beverages intake among adolescent boys (p < 0.001, ηp2 = 0.012) and girls (p = 0.007, ηp2 = 0.005), higher fruit intake among boys (p = 0.043, ηp2 = 0.003), and lower vegetable intake among girls (p < 0.001, ηp2 = 0.009). However, LTOPA was unrelated to the overall healthy eating index, candy intake, and the proportion of added sugar to total energy intake (p > 0.05). LTOPA was only associated with some healthy eating behaviours, and there is much room for improvement in the diets of Swedish adolescents.

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  • 22.
    Heiland, Emerald G
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Uppsala University, Sweden.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Tarassova, Olga
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Fernström, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska institutet, Stockholm, Sweden.
    Ekblom, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska institutet, Stockholm, Sweden.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska institutet, Stockholm, Sweden.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    ABBaH teens: Activity Breaks for Brain Health in adolescents2022In: Trials, E-ISSN 1745-6215, Vol. 23, no 1, article id 22Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity breaks are widely being implemented in school settings as a solution to increase academic performance and reduce sitting time. However, the underlying physiological mechanisms suggested to improve cognitive function from physical activity and the frequency, intensity, and duration of the breaks remain unknown. This study will investigate the effects of frequent, short physical activity breaks during prolonged sitting on task-related prefrontal cerebral blood flow, cognitive performance, and psychological factors. Additionally, the moderating and mediating effects of arterial stiffness on changes in cerebral blood flow will be tested.

    METHODS: This is a protocol for a randomized crossover study that will recruit 16 adolescents (13-14 years old). Participants will undergo three different conditions in a randomized order, on three separate days, involving sitting 80 min with a different type of break every 17 min for 3 min. The breaks will consist of (1) seated social breaks, (2) simple resistance activities, and (3) step-up activities. Before and after the 80-min conditions, prefrontal cerebral blood flow changes will be measured using functional near-infrared spectroscopy (primary outcome), while performing working memory tasks (1-, 2-, and 3-back tests). Arterial stiffness (augmentation index and pulse wave velocity) and psychological factors will also be assessed pre and post the 80-min interventions.

    DISCUSSION: Publication of this protocol will help to increase rigor in science. The results will inform regarding the underlying mechanisms driving the association between physical activity breaks and cognitive performance. This information can be used for designing effective and feasible interventions to be implemented in schools.

    TRIAL REGISTRATION: www.ClinicalTrials.gov , NCT04552626 . Retrospectively registered on September 21, 2020.

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  • 23.
    Heiland, Emerald G.
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Tarassova, Olga
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Acute effects of nitrate and breakfast on working memory and cerebral blood flow in adolescents: a randomized crossover trial2023Conference paper (Other academic)
    Abstract [en]

    Purpose: Beneficial acute effects of dietary nitrate have been demonstrated on working memory in adults, with changes in cerebral blood flow (CBF) being a potential mechanism. However, these effects have not been studied in adolescents. Moreover, having breakfast compared to skipping may also exhibit positive effects on working memory. Therefore, this randomized crossover trial investigated the acute effects of nitrate and breakfast on working memory and changes in task-related CBF in adolescents.  Methods: This trial will recruit at least 43 adolescents (13–15 years old). There were three experimental breakfast conditions: (1) none, (2) regular, and (3) regular breakfast with high nitrate in the form of concentrated beetroot juice. Working memory (1-, 2-, 3-back tests) and task-related CBF (prefrontal cortex oxygenated and deoxygenated-hemoglobin changes estimated using functional near-infrared spectroscopy) were measured immediately after breakfast and 130 min later. The data collection for this study is ongoing, thus results for 35 adolescents are presented here and due to blinding of the researcher we are unable to report at this time in which condition these effects occurred, but will be revealed by the time of the conference, as well as for the results on changes in CBF.  Results: Preliminary results from the ongoing study showed that from pretest to posttest there was a statistically significant improvement in reaction time in all three conditions for all three n-back tests, but no intervention effects. Accuracy, however, improved from pretest to posttest in only one condition, for all three nback tests (β [95% confidence interval] from linear mixed-effects models with subject as random effect: 1-back 2.8[1.2-4.3], 2-back 2.6[0.9-4.2], 3-back 3.6[2.2-5.0]), and there was a tendency towards an intervention effect between this breakfast condition and another on the accuracy of the 3-back test (P for time-by-condition interaction 0.07).   Conclusions: The results from this study will increase our understanding into the effects of breakfast and its composition (i.e., nitrate-rich) on acutely improving working memory in adolescents and the potential mechanisms. In turn, the results will inform on whether policies on providing breakfast in schools should be considered to improve students' cognitive performance.

  • 24.
    Helgadóttir, Björg
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Institutet, Stockholm, Sweden.
    Baurén, Hanna
    Karolinska Institutet, Stockholm, Sweden.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Institutet, Stockholm, Sweden.
    Breakfast Habits and Associations with Fruit and Vegetable Intake, Physical Activity, Sedentary Time, and Screen Time among Swedish 13–14-Year-Old Girls and Boys2021In: Nutrients, E-ISSN 2072-6643, Vol. 13, no 12, article id 4467Article in journal (Refereed)
    Abstract [en]

    This study explored whether breakfast habits were associated with intake of fruits and vegetables, minutes in moderate-to-vigorous physical activity (MVPA), minutes spent sedentary, and screen time among adolescents. Cross-sectional data were collected among 13&ndash;14-year-old boys and girls (n = 1139). Breakfast habits and screen time were determined via questionnaire, fruit and vegetable intake were determined through dietary recall, and physical activity and sedentary time were determined via accelerometers. Multilevel mixed models and general estimation equation models were applied. Almost 40% of participants skipped breakfast at least one day of the week. Participants with irregular breakfast habits on weekdays had lower fruit and vegetable consumption by 26.7 g (95% CI = &minus;49.3, &minus;5.9) while irregular breakfast habits during the whole week were associated with higher levels of screen time (OR = 1.5, 95% CI = 1.1, 2.1) compared to regular breakfast habits. Girls with irregular breakfast habits on weekdays had 7.7 min more sedentary time (95% CI = 0.8, 15.7) than girls with regular breakfast habits, while the opposite was found in boys (&beta; = &minus;13.3, 95% CI = &minus;25.3, &minus;2.6)). No significant associations were found for MVPA. Regular breakfast habits should be encouraged, as they might contribute to a higher intake of fruit and vegetables and are associated with lower levels of screen time, although further studies are necessary to establish causation.

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  • 25.
    Helgadóttir, Björg
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Instituten, Stockholm, Sweden.
    Fröberg, Andreas
    University of Gothenburg, Sweden.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. 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.2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 380Article in journal (Refereed)
    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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  • 26.
    Helgadóttir, Björg
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Fröberg, Andreas
    Göteborgs universitet.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Has COVID-19 led to changes in physical activity patterns, screen time and sleep among Swedish adolescents?: A cohort study2023Conference paper (Other academic)
    Abstract [en]

    Purpose: The COVID-19 pandemic has had an impact on daily life around the world though in Sweden the restrictions have been rather mild. The aim is to explore whether the pandemic has led to changes in physical activity (PA) patterns, including sedentary time, Light Physical Activity (LiPA) and Moderate-to-Vigorous-Physical Activity (MVPA) during weekdays and weekends, as well as screen time and sleep. The potential predictors explored include gender, parental education, anthropometrics, and cardiovascular fitness (CVF).

    Methods: Data were collected in the fall of 2019 and the spring of 2021. The participants were 13-14 years-old at baseline and lived in the Stockholm area. In total 585 participated at both baseline and follow-up. PA and sedentary time were measured with accelerometers and sleep and screen time with questionnaires at baseline and follow-up. The exposure variables were collected at baseline: gender and parental education via questionnaire, anthropometrics (BMI and body fat percentage measured with standard methods by researchers) and CVF with a submaximal test. Multilevel linear regression analyses were performed.

    Results: MVPA remained unchanged while LiPA decreased by 25.5 minutes on weekdays and 10.3 minutes on weekends (both p<0.001) and sedentary time increased by 9.4 minutes on weekdays (p=0.023). Sleep duration decreased by 27.4 minutes on weekdays and 19.1 minutes on weekends (both p<0.001) and screentime increased by around 45 minutes both on weekdays and weekends (p<0.001). 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: Previous self-reported data seems to suggest a decrease in physical activity due to the pandemic; this study only found such changes to be present in the lower intensity levels of physical activity but not in the MVPA. It is possible that more strenuous physical activity is more often part of organized sport which seems to have prevailed in Sweden despite the pandemic while habitual less intense activity decreased. Some groups were found to be more vulnerable and might need more support to maintain their physical activity levels, both now in the post-pandemic periods and during future pandemics.

  • 27.
    Hoy, Sara
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Movement, Culture and Society.
    Larsson, Håkan
    Swedish School of Sport and Health Sciences, GIH, Department of Movement, Culture and Society. Department of Teacher Education and Outdoor Studies, The Norwegian School of Sport Sciences (NIH), Oslo, Norway.
    Kjellenberg, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Gendered relations? Associations between Swedish parents, siblings, and adolescents' time spent sedentary and physically active2024In: Frontiers in Sports and Active Living, E-ISSN 2624-9367, Vol. 6, article id 1236848Article in journal (Refereed)
    Abstract [en]

    Introduction

    The family is assumed to be fundamental in youth socialization processes and development, connected to social and cultural practices such as healthy lifestyles and physical activity. However, gender patterns in physical activity among adolescents and the structural drivers of gender inequality (e.g., parentage and siblingship) are poorly understood. The aim of this study was to explore further how gender structures relate to adolescents' time spent being sedentary and physically active, using contemporary gender theory.

    Methods

    This cross-sectional study involved 1,139 adolescents aged 13-14 and their parents, including 815 mothers and 572 fathers. Physical activity and time spent sedentary were assessed through accelerometry among adolescents and through a self-report questionnaire for parents validated against accelerometry.

    Results

    The results showed significant relationships between mothers' moderate-to-vigorous physical activity (MVPA) and girls' MVPA on weekdays and weekends, and fathers' MVPA was significantly related to girls' MVPA on weekdays. Our results imply that the relationship between Swedish parents' and adolescent girls' physical activity in higher intensities are to some extent gendered practices. However, time spent sedentary does not seem to show any patterns of being performed according to binary ideas of gender. Further, our exploratory analyses suggest that these results somewhat intersect with parents' educational level and relate to intra-categorical aspects of doing gender. The results also indicate slight gendered patterns in the “doing” of brotherhood for time spent sedentary, however, for boys only on weekends.

    Discussion 

    The study contributes to the understanding of gender norms as constraints and enablers for adolescents' participation in physical activity. The results can spur public health and physical activity research to apply a contemporary gender theory approach, and to expand the research agenda connected to what relates to gender inequalities in physical activity practices.

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  • 28.
    Kjellenberg, Karin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Fysisk aktivitet och hjärnhälsa.
    Ahlen, Johan
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden..
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Cross-sectional associations between physical activity pattern, sports participation, screen time and mental health in Swedish adolescents.2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 8, article id e061929Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the associations between physical activity pattern, sports participation, screen time and mental health in Swedish adolescents.

    DESIGN, SETTING AND PARTICIPANTS: A total of 1139 Swedish adolescents (mean age 13.4) from 34 schools participated in the cross-sectional study 'Physical Activity for Healthy Brain Functions in School Youth' in 2019.

    METHODS: Time spent sedentary and in moderate-to-vigorous physical activity (MVPA) was measured using accelerometers for seven consecutive days. Screen time and sports participation were self-reported. Anxiety and health-related quality of life (HRQoL) were assessed using a Short version of the Spence Children's Anxiety Scale and Kidscreen-10.

    RESULTS: MVPA was positively associated (95% CI 0.01 to 0.05 in girls and 0.02 to 0.07 in boys) whereas screen time on weekdays was inversely associated with HRQoL (-4.79 to -2.22 in girls and -2.66 to -0.41 in boys). The largest effect sizes were observed between the high/low MVPA group in boys (Cohen's d=0.51) and screen time groups in girls (Cohen's d=0.59 on weekdays). With regards to anxiety, high compared with lower time spent in MVPA during leisure time on weekdays was associated with lower anxiety scores (95% CI -0.13 to -0.05 in girls and -0.07 to -0.01 in boys). Gender differences were observed, boys who participated in organised sports had low anxiety scores (95% CI -3.49 to -0.13) whereas girls who reported 5 hours or more of screen time had high scores (95% CI 1.94 to 6.18 on weekdays and 1.39 to 5.29 on weekend days).

    CONCLUSIONS: This study showed that MVPA was associated with better mental health, whereas the opposite was seen for screen time. These associations were not consistently significant throughout all time domains, between the genders and mental health outcomes. Our results could create a paradigm for future studies to decide which types of PA patterns and time domains to target in intervention studies with the aim improve mental health among adolescents.

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  • 29.
    Kjellenberg, Karin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ahlen, Johan
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden..
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden..
    P03-09 Cross-sectional associations between physical activity pattern, sports participation, screen time and mental health in Swedish adolescents2022In: EUROPEAN JOURNAL OF PUBLIC HEALTH, vol. 32, S2, Oxford University Press, 2022, Vol. 32Conference paper (Other academic)
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  • 30.
    Kjellenberg, Karin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Stålman, Cecilia
    Swedish School of Sport and Health Sciences, GIH, Department of Movement, Culture and Society.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Associations between Physical Activity Patterns, Screen Time and Cardiovascular Fitness Levels in Swedish Adolescents2021In: Children, E-ISSN 2227-9067, Vol. 8, no 11, article id 998Article in journal (Refereed)
    Abstract [en]

    Cardiovascular fitness (CVF) has been associated with cardiovascular risk factors in adolescents. CVF levels are determined by non-modifiable and modifiable factors; one modifiable factor is physical activity (PA). There is a lack of studies investigating the associations between PA patterns and CVF and how gender, parental education, BMI status and country of birth are associated with CVF. The aim of this study was to explore the cross-sectional associations between PA patterns and CVF in Swedish 13–14-year-old adolescents. CVF was estimated using the Ekblom-Bak submaximal test, data on PA patterns were collected using hip-worn accelerometers and a questionnaire. The mean CVF was 44.8 mL/kg/min in girls (n = 569) and 55.5 mL/kg/min in boys (n = 451) p < 0.01. The results showed a significant association between participation in organised sports (β = 3.32 CI: 2.14, 4.51, β = 4.38, CI: 2.80, 5.96), MVPA (β = 0.07, CI: 0.04, 0.11, β = 0.07, CI: 0.03, 0.11), a high proportion of SED (β = −0.47, CI: −0.70, −0.25, β = −0.41, CI: −0.64, −0.18) and CVF in girls and boys, respectively. More than five hours of screen time on weekdays was associated with lower CVF (β = −2.32 CI: −3.92, −0.71 in girls and boys β = −2.82, CI: −5.14, −0.50). While causal relations remain unknown, these findings could be relevant when designing future interventions with the aim to improve CVF.

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  • 31.
    Kjellenberg, Karin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Åhlen, Johan
    Karolinska institutet.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    High levels of physical activity were associated with better mental health in Swedish adolescents2021In: Svensk idrottsmedicin 2021:3, 2021, p. 43-Conference paper (Other academic)
  • 32.
    Kjellenberg, Karin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Heiland, Emerald G.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Tarassova, Olga
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Fernström, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Effects of physical activity breaks on working memory and oxygenated hemoglobin in adolescents: Results from the AbbaH teen study2023Conference paper (Other academic)
  • 33.
    Kjellenberg, Karin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Heiland, Emerald G.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Tarassova, Olga
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Fernström, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Maria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Helgadóttir, Björg
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Short, frequent physical activity breaks improve working memory in adolescents during prolonged sitting (AbbaH teen study)2023Conference paper (Other academic)
    Abstract [en]

    Purpose: Physical activity breaks in schools have been suggested as a promising strategy to acutely improve cognitive performance in children and adolescents. Most previous studies have explored the effects of single physical activity bouts, but they are infeasible in a school setting (e.g. long duration/high-intensity or requiring equipment/space). Further, studies investigating the underlying physiological mechanisms in adolescents arel acking. Therefore, the aim of this study was to investigate the effects of short, frequent physical activity breaks of different intensities on adolescents’ working memory (WM) and cerebral blood flow (CBF) during prolonged sitting.

    Methods: This randomized crossover study was performed in adolescents (13-15 years of age). In 80-minute sessions, one of the following types of breaks was performed four times in three minutes durations on three different days: simple resistance training (SRA), step-up at a pre-determined pace (STEP), or remaining seated (SOCIAL). Before and after each session, WM (accuracy and reaction time during the 1,2,3-back test) were measured, with simultaneous measurement of task-related CBF (assessed by prefrontal oxygenation using functional near-infrared spectroscopy). Analysis of CBF is ongoing and will be presented at the conference.

    Results: A total of 17 students participated (mean age 13.6 years, 11 girls). In the most demanding task (3-back) the following results were seen: improvement in reaction time following SRA (-30.1, p=0.04) and STEP (-34.3 ms, p=0.05) and no improvement following prolonged sitting. We also found a moderating effect (p <0.01) of WM performance at baseline (using a mean split), such that students with poor WM significantly improved their accuracy and reaction time following the higher-intensity breaks (STEP) while students with high performance did not.

    Conclusion: We found that implementing physical activity breaks of both moderate and high intensities was beneficial for WM performance. For students with low WM performance, high-intensity breaks were more beneficial. Implementing physical activity breaks during periods of prolonged sitting, such as long school classes could improve the students’ cognitive performance. However, future studies should investigate if these breaks are feasible, acceptable, and beneficial to implement in the school setting.

  • 34. Lindroos, Anna Karin
    et al.
    Petrelius Sipinen, Jessica
    Axelsson, Cecilia
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden.
    Landberg, Rikard
    Leanderson, Per
    Arnemo, Marianne
    Warensjö Lemming, Eva
    Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study.2019In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 21, no 10, article id e12572Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A Web-based dietary assessment tool-RiksmatenFlex-was developed for the national dietary survey of adolescents in Sweden.

    OBJECTIVE: This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers.

    METHODS: Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively.

    RESULTS: The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02).

    CONCLUSIONS: RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases.

  • 35.
    Malek, Mahnoush Etminan
    et al.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Andermo, Susanne
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Global Public Health and Department of Neurobiology, Care Sciences and Society,, Karolinska Institutet, Stockholm, Sweden.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. 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.2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 646Article in journal (Refereed)
    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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  • 36.
    Malek, Mahnoush Etminan
    et al.
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden..
    Norman, Åsa
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden..
    Elinder, Liselotte Schäfer
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden.;Region Stockholm, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Patterson, Emma
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden.;Region Stockholm, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Inst, Global Publ Hlth, Stockholm, Sweden.
    O3-6 The Healthy School Start Plus Study - A parental support programme to promote healthy behaviours and prevent childhood obesity in disadvantaged areas2022In: EUROPEAN JOURNAL OF PUBLIC HEALTH, vol. 32, S2, Oxford University Press, 2022, Vol. 32Conference paper (Other academic)
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  • 37.
    Malek, Mahnoush Etminan
    et al.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Norman, Åsa
    Department of Global Public Health / Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, 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; Swedish Food Agency, Uppsala, Sweden.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Relationships between Physical Activity Parenting Practices and Children’s Activity Measured by Accelerometry with Children’s Activity Style as a Moderator: A Cross Sectional Study2022In: Children, E-ISSN 2227-9067, Vol. 9, no 2, article id 248Article in journal (Refereed)
    Abstract [en]

    The objective was to examine the associations between physical activity parenting practices (PAPP) and children's levels of moderate-to-vigorous physical activity (MVPA), and time spent sedentary (SED) during non-school time in weekdays and weekends when children's activity style was taken into account. Study participants were 88 children (mean age 6.3 (SD 0.3) years); 51.0% girls) and their parents who took part in A Healthy School Start Plus in Sweden. The independent variables included PAPPs Structure, Neglect/control, and Autonomy promotion and children's activity style as moderator, assessed through validated parent questionnaires. Dependent variables were the MVPA and SED in minutes, measured by accelerometry. Structural equation modeling was used to examine the associations between PAPPs and children's MVPA and SED with children's activity style as a moderator. No significant associations between the PAPPs Structure, Neglect/control, and Autonomy promotion and measures of physical activity were found (p > 0.13). The moderating role of activity style improved the model fit and the final model had a reasonable fit to the data. Our results suggest that in future studies, with the aim to explore the relationship between PAPP and children's physical activity, the activity style of the children should be included as a moderator.

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  • 38.
    Malek, Mahnoush Etminan
    et al.
    Karolinska institutet.
    Norman, Åsa
    Karolinska institutet.
    Patterson, Emma
    Karolinska institutet.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Schäfer Elinder, Liselotte
    Karolinska institutet.
    En frisk skolstart plus - visar positiva resultat gällande barns fysiska aktivitet2021In: Svensk idrottsmedicin 2021:3, 2021, p. 44-Conference paper (Other academic)
  • 39.
    Malek, Mahnoush Etminan
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Institutet, Stockholm, Sweden.
    Elinder, Liselotte Schäfer
    Karolinska Institutet, Stockholm, Sweden.
    Patterson, Emma
    Karolinska Institutet, Stockholm, Sweden.
    Norman, Åsa
    Karolinska Institutet, Stockholm, Sweden.
    Children's experiences of participating in a school-based health promotion parental support programme - a qualitative study.2021In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 21, no 1, article id 228Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Children's voices are seldom heard in process evaluations concerning health promotion programmes. A Healthy School Start Plus (HSSP) is a parental support programme, conducted in Sweden, with the aim of promoting healthy diet, physical activity and preventing obesity in preschool class children. The 6-month programme includes: (1) Health information to parents; (2) Motivational Interviewing with parents by school nurses; (3) Classroom activities and home assignments for children; (4) A self-test of type-2 diabetes risk for parents. We aimed to describe children's experiences of the third component regarding barriers and facilitators of participating in and learning from the classroom activities in the HSSP.

    METHODS: In total 36 children from 7 schools in Sweden, mean age 6 years, participated in 7 focus group discussions. Purposeful sampling with maximum variation was used to collect the data. The focus groups were audio-recorded, transcribed and analysed using qualitative content analysis.

    RESULTS: Four categories were identified; (1) Time available to work on intervention activities; (2) Others' interest; (3) Abilities and interests in intervention activities; and (4) Practicing the concept of health.

    CONCLUSIONS: The findings may improve the HSSP and other similar interventions that include classroom-based learning regarding health by highlighting the following points to consider: aiming for homework to be an integrated part of the school-setting to enhance parental involvement; using flexible material, tailored to the children's abilities and giving children adequate time to finish the intervention activities; and making teachers and parents aware of the importance of verbal and body language regarding intervention activities.

    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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  • 40.
    Milerad, Josef
    et al.
    Karolinska Institutet, Stockholm, Sweden..
    Runesson, Bo
    Karolinska Institutet, Stockholm, Sweden..
    Fernell, Elisabeth
    Göteborgs universitet, Gothenburg, Sweden.
    Ekblom, Örjan (Contributor)
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nyberg, Gisela (Contributor)
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Kraftsamling för ungas psykiska hälsa: Kunskapssammanfattning och förslag till interventioner från Svenska Läkaresällskapet arbetsgrupp 20212021Report (Other academic)
    Abstract [sv]

    Utvecklingen från mitten av 1960-talet och framåt har kännetecknats av ökad materiell levnadsstandard, stärkt rättskydd för barn, minskande somatisk ohälsa, och en kraftigt sjunkande barnadödlighet. Denna positiva utveckling i Sverige och andra höginkomstländer har inte lett till en minskning av psykiska symptom hos unga. Att barn rapporterar mer stress och psykiska symptom trots bättre levnadsförhållanden, ”välfärdsparadoxen”, har varit tydligt i Sverige. Utgångspunkten för denna översikthar varit att lyfta fram vilka livsstils- och omgivningsfaktorer som har visat sig kunna bromsa eller vända denna utveckling.

    Folkhälsomyndighetens undersökning “Skolbarns hälsovanor”, och liknande rapporter från WHO, Unicef samt USA:s och Kanadas folkhälsomyndigheter har påtalat tydliga samband mellan psykiska symptom hos unga i skolåldern och fysisk inaktivitet. Låg fysisk aktivitet har i sin tur ofta ett samband med att tid på digitala medier tar utrymme från sömn och hälsofrämjande aktiviteter. Det finns även belägg för att program som stärker ungas förmåga att hantera känslor, sociala relationer och fatta ansvarsfulla beslutleder till bättre skolresultat, anpassning till vuxenlivet och bidrar till bättre psykisk hälsa. Ett omfattandekunskapsunderlag talar för att skolan har en central roll när det gäller att främja psykisk hälsa. Samma gäller vikten av tidiga insatser till unga med individuella svårigheter eller problem som beror på ogynnsamma eller socialt belastade uppväxtmiljöer.

    Utifrån publicerade samband mellan psykiska symptom och livsstil eller livsomständigheter föreslår Svenska Läkarsällskapets arbetsgrupp fem konkreta interventioner där vi ser skolan som en viktig arena där man når alla unga i skolåldern.

    5 konkreta interventioner för förbättrad psykisk hälsa bland barn och unga:

    • Regelbunden strukturerad fysisk aktivitet – gärna i anslutning till skoltid.
    • Hjälpa unga att nå en balans mellan tid ägnad åt digitala medier och hälsofrämjande aktiviteter.
    • “Livskunskapsprogram” som hjälp till ungdomar att stärka självkänslan, hantera stress och skapa positiva förändringar.
    • Främja psykisk hälsa i skolmiljön genom att anpassa kunskaps- och betygskrav till ungas utveckling och förutsättningar.
    • Satsa på program för tidig upptäckt och stöd till unga med ökad risk för sämre psykisk hälsa.

    För att kunna genomföra dessa insatser krävs ett nära samarbete mellan alla som verkar för ungas hälsa; professioner inom hälso- och sjukvård, elevhälsa, socialtjänst men även föräldra- och elevorganisationer. När det gäller samhällsfunktioner som hälso- och sjukvård, skola och socialtjänst behöver man undanröja organisatoriska hinder för samverkan. Olika huvudmän för samhällsfunktioner har skilda ansvarsområden och ibland olika syn på sitt uppdrag. Vi vill även understryka vikten av fler kontaktytor mellan akademisk forskning som utvärderar hälsofrämjande program och verksamheter som ska tillämpa dessa.

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  • 41.
    Nooijen, Carla F J
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska institutet.
    Del Pozo-Cruz, Borja
    Australian Catholic University, Sydney.
    Nyberg, Gisela
    Karolinska institutet.
    Sanders, Taren
    Australian Catholic University, Sydney.
    Galanti, Maria R
    Karolinska institutet.
    Forsell, Yvonne
    Karolinska institutet.
    Are changes in occupational physical activity level compensated by changes in exercise behavior?2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 5, p. 940-943Article in journal (Refereed)
    Abstract [en]

    Background: Physically active occupations with high-energy expenditure may lead to lower motivation to exercise during leisure time, while the reverse can be hypothesized for sedentary occupations. The aim of this study was to investigate the impact of changing occupational activity level on exercise behavior.

    Methods: Data on occupational physical activity and leisure time exercise were taken from a population-based cohort, with surveys completed in 2010 and 2014. Using data on those employed in both years, two trajectories were analyzed: (i) participants who changed from sedentary to active occupations and (ii) participants who changed from active to sedentary occupations. Exercise was reported in hours per week and changes from 2010 to 2014 were categorized as decreased, increased or stable. Associations were expressed as ORs and 95% CIs adjusting for age, gender and education.

    Results: Data were available for 12 969 participants (57% women, aged 45 ± 9 years, 57% highly educated). Relative to participants whose occupational activity was stable, participants who changed to active occupations (n = 549) were more likely to decrease exercise (OR = 1.22, 95% CI = 1.02-1.47) and those who changed to sedentary occupations (n = 373) more likely to increase exercise levels (OR = 1.21, 95% CI = 0.97-1.52).

    Conclusion: People changing from sedentary to active occupations compensate by exercising less, and those changing from physically active to sedentary occupations seem to compensate by exercising more in their leisure time. When developing and evaluating interventions to reduce occupational sedentary behavior or to promote exercise, mutual influences on physical activity of different contexts should be considered.

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  • 42. Norman, Åsa
    et al.
    Berlin, Anita
    Sundblom, Elinor
    Elinder, Liselotte Schäfer
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden.
    Stuck in a vicious circle of stress. Parental concerns and barriers to changing children's dietary and physical activity habits.2015In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 87, p. 137-42, article id S0195-6663(14)00769-7Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Dietary habits and physical activity are often the focus of obesity prevention programmes and involving parents in such programmes has proven to be effective. The aims of this study were to describe parents' concerns about their children's diet and physical activity habits and to describe barriers to change.

    RESULTS: The study used archival data gathered unobtrusively in the form of memos taken after sessions of Motivational Interviewing as part of the parental support programme, A Healthy School Start. The 74 MI-sessions were conducted from October 2010 to April 2011 with either a mother or father or both, all with children in pre-school class. Thematic analysis was applied. Three themes were identified regarding children's dietary habits: amount of food consumed influenced by behaviour in the family, eating situations influenced by stressful everyday life and family interplay, and food choices influenced by stressful everyday life and family interplay. One theme appeared regarding physical activity: physical activity influenced by stressful everyday life and family interplay.

    CONCLUSION: Family interplay appears to be an important link between the work-life stress perceived by parents and less healthy food and physical activity habits in the home. Both lack of parental cooperation and negative parent-child interactions may act as barriers to healthy eating and physical activity and should be addressed in future intervention studies on health-related behaviours of children.

  • 43. Norman, Åsa
    et al.
    Bohman, Benjamin
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden and Centre for Epidemiology and Community Medicine, Stockholm County Council.
    Schäfer Elinder, Liselotte
    Psychometric Properties of a Scale to Assess Parental Self-Efficacy for Influencing Children's Dietary, Physical Activity, Sedentary, and Screen Time Behaviors in Disadvantaged Areas.2018In: Health Education & Behavior, ISSN 1090-1981, E-ISSN 1552-6127, Vol. 45, no 1, p. 132-140Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: According to social cognitive theory, self-efficacy is central to behavior change. Consequently, parental self-efficacy (PSE) for influencing children's dietary, physical activity (PA), sedentary, and screen time behaviors is important for child obesity prevention. The aim of this study was to evaluate the psychometric properties of an instrument to measure PSE regarding these behaviors in disadvantaged areas.

    METHOD: Parents ( n = 229) of whom 47% had completed secondary school or less, and who participated in the Healthy School Start trial, responded to a 15-item PSE instrument. Children's diet and screen time were measured through parent reports. PA and sedentary behaviors were measured using accelerometers. Construct validity was assessed using exploratory factor analysis (EFA), criterion validity by correlations with child behaviors, and internal consistency by Cronbach's alpha.

    RESULTS: The EFA yielded three factors: (a) PSE for promoting PA; (b) PSE for limiting intake of unhealthy foods, unhealthy drinks, and screen time; and (c) PSE for promoting intake of fruits and vegetables, all with acceptable to good internal consistency (α = .77-.81). Significant correlations ( p < .01) were found between children's dietary ( rs = -.19 to -.29) and screen time ( r = -.29) behaviors and Factor 2, and dietary behaviors and Factor 3 ( rs = .20-.39) but not regarding PA and sedentary behaviors and Factor 1.

    CONCLUSION: The instrument demonstrated good construct validity and acceptable to good internal consistency regarding all but PA behaviors. It may be useful for assessing PSE in child obesity prevention interventions in disadvantaged settings after some refinement.

  • 44.
    Norman, Åsa
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska institutet, Stockholm, Sweden.
    Sedentary activity bout length was associated with BMI and waist circumference in Swedish children aged 5-7 years.2021In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, no 7, p. 2157-2163Article in journal (Refereed)
    Abstract [en]

    AIM: This study examined the pattern of sedentary behaviour during the week and on weekends, and associations with health outcomes among children aged 5-7 years in Sweden.

    METHODS: This cross-sectional study used data from 342 children, many of whom had at least one parent born outside the Nordic region. Physical activity and sedentary time were measured by accelerometry. A sedentary bout was defined as 1-4 and 5-9 minutes. Diet, time in front of television or computer screen, sleep and physical activity behaviour were measured via parental reports, and anthropometric data by research staff.

    RESULTS: The number of sedentary bouts was higher on weekends than on weekdays. Compared to girls, boys had more 1-4 minute bouts on both weekdays and weekend days, and more 5-9 minute bouts on weekends. A higher number of 5-9 minute bouts was associated with a higher body mass index and waist circumference.

    CONCLUSION: This study showed an association between sedentary activity and weight status in children as young as 5-7 years. Reducing time, especially longer bouts, spent in sedentary activities may encourage healthy weight development in children.

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  • 45.
    Norman, Åsa
    et al.
    Karolinska institutet.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska institutet.
    Berlin, Anita
    Karolinska institutet.
    School-based obesity prevention for busy low-income families: Organisational and personal barriers and facilitators to implementation.2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 11, article id e0224512Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Little research has targeted multiple-level barriers and facilitators in school-based parental support programmes. BackgroundLittle research has targeted multiple-level barriers and facilitators in school-based parental support programmes. This qualitative study aims to describe barriers and facilitators, at organisational and personal levels, that teachers and parents in disadvantaged settings in Sweden perceived as influencing the implementation of the Healthy School Start II (HSS II) intervention.MethodsData collection, analysis and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups and interviews were conducted with 14 parents and ten teachers within the HSS II trial. Data were analysed using qualitative content analysis in a deductive step using the three CFIR domains-inner and outer setting, and personal characteristics-followed by an inductive analysis.ResultsThe theme 'being on the same page-getting burdened teachers and parents to work on common ground' was found. Among teachers, barriers and facilitators were related to the structure of the schoolwork and curriculum, involvement from other staff and school management, the practical school workday, perception of high family needs but low parental interest, insufficient resources in the families, and teacher's personal knowledge, interests, and opinions about health and food. For parents, barriers and facilitators were related to the perceived family needs and resources, parents' health knowledge, consensus about healthy behaviours and ability to cooperate, and school involvement in health issues and the intervention.ConclusionInterventions should facilitate parents' and teachers' work on common ground, with activities suitable for a stressful and burdensome workday and everyday life. This could be achieved by integrating evidence-based practices within school routines, and including activities that are practicable despite parents' stressful lives, and that increase parental consensus about promoting health. Strategies to increase involvement of parents in families with high needs are necessary. Also, this study suggests an expansion of the CFIR to capture the interface between different micro-level organisations, and account for several delivering/receiving organisations.This qualitative study aims to describe barriers and facilitators, at organisational and personal levels, that teachers and parents in disadvantaged settings in Sweden perceived as influencing the implementation of the Healthy School Start II (HSS II) intervention.

    METHODS: Data collection, analysis and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups and interviews were conducted with 14 parents and ten teachers within the HSS II trial. Data were analysed using qualitative content analysis in a deductive step using the three CFIR domains-inner and outer setting, and personal characteristics-followed by an inductive analysis.

    RESULTS: The theme 'being on the same page-getting burdened teachers and parents to work on common ground' was found. Among teachers, barriers and facilitators were related to the structure of the schoolwork and curriculum, involvement from other staff and school management, the practical school workday, perception of high family needs but low parental interest, insufficient resources in the families, and teacher's personal knowledge, interests, and opinions about health and food. For parents, barriers and facilitators were related to the perceived family needs and resources, parents' health knowledge, consensus about healthy behaviours and ability to cooperate, and school involvement in health issues and the intervention.

    CONCLUSION: Interventions should facilitate parents' and teachers' work on common ground, with activities suitable for a stressful and burdensome workday and everyday life. This could be achieved by integrating evidence-based practices within school routines, and including activities that are practicable despite parents' stressful lives, and that increase parental consensus about promoting health. Strategies to increase involvement of parents in families with high needs are necessary. Also, this study suggests an expansion of the CFIR to capture the interface between different micro-level organisations, and account for several delivering/receiving organisations.

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  • 46. 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.2016In: BMC Public Health, E-ISSN 1471-2458, Vol. 16, article id 37Article in journal (Refereed)
    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.

  • 47. Norman, Åsa
    et al.
    Nyberg, Gisela
    Karolinska Institutet, Stockholm, Sweden.
    Elinder, Liselotte Schäfer
    Berlin, Anita
    Parental strategies for influencing the diet of their children - A qualitative study from disadvantaged areas.2018In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 125, p. 502-511, article id S0195-6663(16)30580-3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A social gradient is evident in the prevalence of childhood overweight and obesity, to the disadvantage of children with low socioeconomic status (SES). Parents have a substantial influence on their children's dietary behaviours and weight development through the way they interact with the children around food. This study aims to explore the variation of how parents with low SES influence their child's dietary behaviours.

    METHODS: A phenomenographic design and analysis was used on 29 sessions of motivational interviewing with mothers and fathers participating in the Healthy School Start intervention study in 2012. The parents had a maximum of 12 years of education and resided in areas targeted for socioeconomic development. In the sessions, parents explored changes that they wanted to make in the home environment regarding their child's dietary behaviours.

    RESULTS: Five categories of guidance of children's dietary habits were found ranging from silently guiding to enforcement. The categories of guidance were structurally related to each other through positive to negative impact of parental recognition of responsibility for the child's behaviours, level of trust in the child's satiety response, and level of parental emotional distress.

    CONCLUSION: The results suggest that parents use situation-specific guidance with both negative and positive impacts on child behaviours. Depending on the type of guidance used, parents are in need of different supporting strategies to enhance positive parent-child interplay. Suggestions for intervention strategies are provided where specific focus on parental responsibility recognition, emotional self-regulation, increased responsiveness, and cooperation between parents are highlighted.

  • 48.
    Norman, Åsa
    et al.
    Karolinska institutet.
    Zeebari, Zangin
    Karolinska institutet.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska institutet.
    Elinder, Liselotte Schäfer
    Karolinska institutet.
    Parental support in promoting children's health behaviours and preventing overweight and obesity - a long-term follow-up of the cluster-randomised healthy school start study II trial.2019In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 19, no 1, article id 104Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Effects of obesity prevention interventions in early childhood are only meaningful if they are sustained over time, but long-term follow-up studies are rare. The school-based cluster-randomised Healthy School Start (HSS) trial aimed at child health promotion and obesity prevention through parental support was carried out in 31 pre-school classes (378 families) in disadvantaged areas in Sweden during 2012-2013. Post-intervention results showed intervention effects on intake of unhealthy foods and drinks, and lower BMI-sds in children with obesity at baseline. This study aimed to evaluate the long-term effectiveness 4 years post-intervention.

    METHODS: Data were collected from 215 children in March-June 2017. Child dietary intake, screen time, and physical activity were measured through parental-proxy questionnaires. Child height and weight were measured by the research group. Group effects were examined using Poisson, linear, logistic, and quantile regression for data on different levels. Analyses were done by intention to treat, per protocol, and sensitivity analyses using multiple imputation.

    RESULTS: No between-group effects on dietary intake, screen time, physical activity, or BMI-sds were found for the entire group at the four-year follow-up. In girls, a significant subgroup-effect was found favouring intervention compared to controls with a lower intake of unhealthy foods, but this was not sustained in the sensitivity analysis. In boys, a significant sub-group effect was found where the boys in the intervention group beyond the 95th percentile had significantly higher BMI-sds compared to boys in the control group. This effect was sustained in the sensitivity analysis. Analyses per protocol showed significant intervention effects regarding a lower intake of unhealthy foods and drinks in the children with a high intervention dose compared to controls.

    CONCLUSIONS: Four years after the intervention, only sub-group effects were found, and it is unlikely that the HSS intervention had clinically meaningful effects on the children. These results suggest that school-based prevention programmes need to be extended for greater long-term effectiveness by e.g. integration into school routine practice. In addition, results showed that children with a high intervention dose had better long-term outcomes compared to controls, which emphasises the need for further work to increase family engagement in interventions.

    TRIAL REGISTRATION: ISRCTN, ISRCTN39690370, retrospectively registered March 1, 2013, http://www.isrctn.com/ISRCTN39690370 .

  • 49.
    Nyberg, Gisela
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    It is time to get a move on and tackle worrying health behaviour patterns in children and adolescents.2021In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, no 9, p. 2499-2500Article in journal (Other academic)
  • 50.
    Nyberg, Gisela
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska institutet, Sweden.
    Andermo, Susanne
    Karolinska institutet, Sweden.
    Nordenfelt, Anja
    The Foundation A Healthy Generation, Sweden.
    Lidin, Matthias
    Karolinska institutet, Sweden.
    Hellénius, Mai-Lis
    Karolinska institutet, Sweden.
    Effectiveness of a Family Intervention to Increase Physical Activity in Disadvantaged Areas-A Healthy Generation, a Controlled Pilot Study.2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 11, article id E3794Article in journal (Refereed)
    Abstract [en]

    There are large social inequalities in health. The purpose of this study was to evaluate the effects of a family intervention on physical activity (PA) and sedentary time (ST) in children and their parents. In this controlled pilot study, all 8-9-year-old children from four schools from a socioeconomically disadvantaged area in Sweden were invited and 67 children and 94 parents were included. The intervention was run by a foundation in co-operation with the municipality. The 9-month program included: (1) activity sessions, (2) healthy meals, (3) health information and (4) parental support groups. PA was primary outcome and ST was secondary outcome, measured by accelerometry. In total, 40 of the children (60%) and 45 of the adults (50%) had at least one day of valid accelerometer data at both baseline and follow-up. Significant intervention effects for the whole group were found in total PA (p = 0.048, mean difference (MD) intervention/control 150 counts per minute) and in vigorous PA (p = 0.02, MD 8 min/day) during the weekends. There were no differences between groups in the other PA variables or ST. This pilot study shows that it is possible to influence PA in families from a disadvantaged area through a family program.

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