Gymnastik- och idrottshögskolan, GIH

Objectives: We investigated changes in weight, exercise frequency, and perceived health from the first to last health profile assessment (HPA) and between the number of tests within five years. We examined whether sociodemographic factors, or baseline values influenced these changes.

Methods: Data from 106 005 employees with ≥2 HPA (1990-2021) were included. Change between the first and last HPA within a five-year period was analyzed. Baseline age, sex, education, occupation, and baseline values of each outcome were included as predictors. XGBoost models assessed changes in the outcomes, and performance was evaluated via root mean squared error, mean absolute error, and R-squared. We employed Shapley Additive Explanations and forward marginal effects to interpret dose-response relationships and subgroup differences.

Results: Predictive performance was low, suggesting that the included variables only partially explained observed changes. Nonetheless, longer intervals between the first and last HPA correlated with greater weight gain, while a higher number of tests predicted slightly lower weight gain and modest improvements in perceived health and exercise frequency, compared to the average change. Younger participants had larger weight increases, whereas those with higher education showed smaller declines in exercise frequency.

Conclusions: Infrequent HPA alone did not appear to substantially influence the lifestyle-related factors studied. However, more frequent HPA, coupled with enhanced feedback and support, may yield small improvements in weight, perceived health, and exercise frequency compared to the average change.

BACKGROUND: Digital interventions offering behaviour change support are warranted to prevent and treat non-communicable diseases, and have been evaluated rigorously in controlled settings. Effectivenss, factors influencing the uptake of scaled-up interventions-such as reach, received dose, usability and acceptability- and predictors and mediators of efficiency are rarely explored in research. The study described herein aims to evaluate the effectiveness of a personally tailored digital intervention (the app EviBody®), intended to support healthy and sustained lifestyle behaviours among the adult population, on well-being and behaviour change. Further aims are to explore context and uptake factors, predictors and mediators for behaviour change over 24 months.

METHODS: This is a real-world study, employing a quasi-experimental design and a process evaluation. EviBody® will be marketed and managed by its owner. A four-armed design will allow for comparison between three levels of intervention (basic, standard and premium) and a control group. Adults who sign up for the app will be invited to the research study including sharing app data and answering questionnaires at 0, 1, 3, 6, 12, 18, and 24 months. Study start is Autumn 2025. Controls (n = 200 to evaluate the primary endpoint well-being at 6 months) will be recruited through advertisements on social media and asked to answer the same questionnaires at 0 and 6 months provided by email. For predicting and mediating analyses the intention is to recruit 1500 app users. Well-being (measured with the WHO-5 Well-Being Index), goal achievement, physical activity, eating habits, mental health, mediators (motivation, self-efficacy, and perceived barriers), and demographics will be self-reported. Uptake will be collected using analytics and ratings of usability and acceptability, and described by demographics. Mixed models for repeated measures and structural equation modelling will be employed for data analysis.

DISCUSSION: Besides evaluating the effectivenss of a digital intervention, this study also applies a theory-based evaluation to understand which mediators are effective, for whom they are effective, and the specific conditions under which they are most beneficial.

TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT05973383 on 8 July 2023.

BACKGROUND: Unhealthy lifestyle behaviours, including unhealthy alcohol consumption, physical inactivity, smoking, and nonadherence to dietary recommendations, are major contributors to non-communicable diseases and mortality. While adopting healthy behaviours can reduce these risks in middle-aged adults, research is limited. Therefore, the aim of this study was to assess the distribution of unhealthy lifestyle behaviours in middle-aged adults and their associations with socioeconomic factors, social support, and history of disease.

METHOD: This was a cross-sectional study of the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort (2013-2018) at six Swedish university hospitals. Multilevel regression models were estimated using Bayesian inference with priors shrinking covariate estimates towards the null.

RESULTS: In total, 59 909 participants, aged 50-64 years old were invited to SCAPIS, of which 30 154 (50.3%) decided to participate. The mean age of participants was 58 (SD = 4) years old, and 51% were women (n = 15 508). Men had higher unhealthy alcohol consumption and were less adherent to dietary recommendations compared to women. Older participants were more physically inactive compared to younger participants. Low education and financial difficulties were associated with smoking, physical inactivity, and poor diet adherence. Financial difficulties were also associated with unhealthy alcohol consumption. Having more people to turn to in difficulties was associated with lower alcohol consumption. Lack of appreciation and comfort support was associated with smoking and poor diet adherence. Diabetes was associated with lower alcohol consumption. Diabetes and lung diseases were associated with smoking and inactivity.

CONCLUSIONS: Middle-aged adults with lower socioeconomic status, less quality social support, and a history of disease were more likely to engage in unhealthy behaviours. This study helps to identify groups of middle-aged adults who may require additional attention when it comes to prioritizing the development of preventive measures.

Objective: To evaluate which form and type of physical activity individuals with hip or knee osteoarthritis choose and maintain one and two years after an individualised intervention for physical activity and further to evaluate whether there were differences in the most chosen physical activity with regard to patient characteristics. Method: Patients with hip or knee osteoarthritis from a previous randomised controlled trial, where they received individualised patient-centred counselling about physical activity and registered self-selected sessions of physical activity in a 7-day diary, were included. Sessions lasting more than 10 ​min and rated at least light effort were categorized, and differences were evaluated. Results: Of the 94 patients included, 72.3 ​% were female, 72.0 ​% had knee osteoarthritis and mean age was 62.0 (SD 8.2) years. Women and men who preferred walking, walked on average ​> ​4 times/week and 3–4 times/week, respectively. Everyday activities and cycling were performed 2–3 times/week by both women and men. The proportions of individuals maintaining the same activity after one and two years were 50 ​% for walking and 2 ​% for strength training. Men more often choose different activities and after two years they performed everyday activities and cycling to the same extent as walking. Individuals who chose walking were significantly older, of female gender and had lower muscle strength in the affected leg. Conclusion: Walking is the form of physical activity patients with osteoarthritis most often choose, perform and maintain. Knowledge about preferred activities among patients is crucial for maintaining physical activity in the long term. © 2025 The Authors

Increasing levels of physical inactivity is a global burden for mankind and is also an emerging problem in companion dogs. In both humans and dogs, insufficient physical activity is associated with increased risk for noncommunicable diseases and impaired quality of life (QoL). The aim of the current pilot study was to evaluate effects of a joint outdoor exercise program for dog owners (n = 22) and dogs (n = 22) with focus on QoL and body measurements. Results indicate that an eight-week exercise intervention alone, with a target distance of at least 2 km twice a week, may be sufficient to significantly increase self-reported QoL and acceptance of bodily appearance in dog owners despite no reductions in body measurements. In dogs, a significantly reduced body condition score (BCS) was registered, despite no considerable changes in feeding. The increased owner motivation for continued joint exercise suggests potential for lifestyle changes, which could be investigated in future studies including control groups and long-term follow-ups. The importance of the human-animal bond as a success factor for increased mutual physical activity and health benefits in both dog owners and dogs is recommended to be studied in a more in-depth manner.

Middle-aged adults engaging in unhealthy lifestyle behaviors are at higher risk of chronic diseases. However, little is known about the co-occurrence of these behaviors and their determinants. This cohort study examined the co-occurrence of unhealthy lifestyle behaviors (alcohol consumption, diet, physical inactivity, and smoking) in 30,154 middle-aged adults and their associations with sociodemographic factors, social support, and disease history. Alcohol use was measured by the AUDIT, diet by the MiniMeal-Q, and physical inactivity and smoking by single questions. Participants had a mean age of 58 years, with 51% being female. Of them, 14% had no unhealthy behaviors, 38% had one, 36% had two, 10% had three, and 2% had all four. The most common co-occurrence was between physical inactivity and poor diet (38%). Higher education decreased the likelihood of having three or four unhealthy behaviors, while financial difficulties, having no one around who appreciated one's efforts, and suffering of a lung disease increased it. In conclusion, middle-aged adults exhibit varying levels of unhealthy lifestyle behaviors. Higher education is linked to reduced engagement in multiple unhealthy behaviors, whereas financial strain, lower quality of social support, and lung disease increase the risk.

OBJECTIVES: To elucidate physical activity in the first year after myocardial infarction (MI), and to explore differences in various subgroups, delineated by age, participation in exercise-based cardiac rehabilitation (exCR), or restrictions due to the covid-19 pandemic. Secondly, to explore associations between changes in physical activity variables with blood pressure and lipid levels.

METHODS: A longitudinal study in 2017-2023. Physical activity variables were assessed via accelerometers at two- and twelve months post-MI. The intensity was divided into, sedentary, light, moderate, and vigorous-intensity physical activity, according to established cut-offs. Blood pressure and lipids were measured by standardized procedures at the same time points.

RESULTS: There were 178 patients included at baseline, 81% male, mean age of 64 (9 SD) years. Patients spent 72% of their time sedentary, followed by light (19%), moderate (8%), and vigorous physical activity (1%). Patients included during covid-19 restrictions and younger patients had a higher level of moderate-intensity physical activity compared to patients included during non-pandemic restrictions and older patients. At 12-month follow-up, patients overall increased time (1%) in sedentary behavior (p = 0.03) and decreased time (0.6%) in moderate-intensity physical activity (p = 0.04), regardless of participation in exCR or age. There was a positive association between the change in mean physical activity intensity and HDL-cholesterol (p = 0.047).

CONCLUSIONS: Participants had a low fraction of time in moderate-to-vigorous-intensity physical activity two months post-MI, which deteriorated during the first year. This emphasizes the need for improved implementation of evidence-based interventions to support and motivate patients to perform regular physical activity.

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

DESIGN: Randomised, assessor-blinded, controlled trial.

SETTING: Primary care.

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

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

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

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

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

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

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

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

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

OBJECTIVES: This study aimed to investigate the reach of a large-scale health assessment delivered by the occupational health service in Sweden for almost 30 years.

METHODS: A total of 418 286 individuals who participated in a health assessment (Health Profile Assessment, HPA) between 1995-2021 were included. A comparative sample was obtained from Statistics Sweden, comprising the entire working population for each year (4 962 127-6 011 829 unique individuals per time period). Sociodemographic and work organization characteristics were compared between the HPA and comparative population for six different periods. Under- and overrepresented groups in the private and public sectors were identified using the most recent data (2015-2021).

RESULTS: With negative per cent indicating underrepresentation, the most notable changes over time in representation in the HPA population compared to the comparative were observed for women (-1.2% to -12.8%), private sector employees (-9.4% to 14.9%), individuals with ≥3 years of employment (14.5% to 0.9%), in personal care (0.8% to -8.8%) and manufacturing (0.7% to 6.4%) occupations. Consistently overrepresented groups (median representation across periods) included individuals who had a single income source (6.3%) and were middle-aged (10.8%), born in Sweden (5.9%), associate professionals (8.7%), and employed in companies with high operating profit (17.9%) and low staff turnover (14.3%). Conversely, individuals with low income (-34.0%) and employed in small companies/organizations (-10.9%) were consistently underrepresented. Middle-aged women in education occupations were most underrepresented in the public sector, while in the private sector, it was young women in service and shop sales occupations.

CONCLUSIONS: This health assessment has reached many professionals, including hard-to-reach groups, but did not fully represents the Swedish workforce throughout the years.