Gymnastik- och idrottshögskolan, GIH

OBJECTIVE: The aims were to investigate the association between youth physical activity and the risk of cardiovascular disease (CVD) later in life in men and women and whether mid-life lifestyle-associated factors, including exercise, smoking, Body Mass Index (BMI), and cardiorespiratory fitness (VO₂max), mediate this association.

METHODS: Data from 269,431 Swedish participants (52 % men) who participated in occupational health profile assessments between 1995 and 2023 were included. Youth physical activity was self-reported as overall participation in school-based physical education and physical activity outside school before age 20. CVD incidence was obtained from national registers. Mediation analyses assessed mid-life lifestyle-associated factors' influence on the association.

RESULTS: Compared to those reporting no physical education participation, participation in only physical education was associated with a 18 % lower risk for CVD later in life (HR = 0.82, 95 % CI 0.70,0.95). Participating in additional physical activity outside school yielded varying risk estimates (HR = 0.78, 95 % CI 0.67,0.90 for one to two times/week; HR = 0.84, 95 % CI 0.73,0.97 for three to five times/week). VO₂max, BMI, and smoking mediated 16 %-32 % of the association. In the single mediation model, cardiorespiratory fitness explicitly mediated the association in those who participated in physical education and at least one weekly sessions of physical activity outside school.

CONCLUSION: Youth refraining from participating in physical education class could be considered a risk group for later-life CVD. Mediation analyses suggest that engaging in only physical education or with additional physical activity outside school in youth, may confer more healthy behaviour in mid-life, which explain the lower CVD risk.

AIM: To investigate the association between change in cardiorespiratory fitness (CRF) and cardiovascular disease (CVD)-related and all-cause hospital admission, and explore if the association varies dependent on prior admission, baseline CRF, sex, and age.

METHODS: 91,140 adult participants (41.5% women) with two examinations from occupational health profile assessments between 1986 and 2019 were included (mean 3.2-years between examinations). CRF was assessed as maximal oxygen consumption and estimated through a submaximal cycle test. CRF change was defined as annual percentage change in relative CRF (mL*min-1*kg-1) and further divided into "decliners" (<-1%), "maintainers" (-1%; 1%), and "increasers" (>1%). Hospital admissions were followed over a mean of 7-years. Natural cubic splines and Cox's proportional hazards model were applied. Additionally, prevented fraction for the population was calculated.

RESULTS: Increase in CRF was associated with lower risk of CVD [HR = 0.99] and all-cause hospital admission [HR = 0.99], after multilevel-adjustment for confounders and change in smoking, diet, and stress. Compared to a decline, maintenance of CRF was associated with 9% and 7% lower risk of CVD and all-cause admission, respectively. Increase in CRF reduced the risk with 13% and 11%, and for individuals with prior admission, with 20% and 14%. The burden of CVD and all-cause admission was 6% and 5% lower than if the whole cohort had declined CRF, with large potential cost-savings.

CONCLUSIONS: Efforts to maintain or improve CRF should be included in disease preventive strategies, regardless of change in other lifestyle-related risk factors. Preventing the age-associated decline in CRF can lessen healthcare utilization and costs.

BACKGROUND: Healthy lifestyle habits are recommended in prevention of cardiovascular disease (CVD). However, there is limited knowledge concerning the change in lifestyle-related factors from before to after a CVD event. Thus, this study aimed to explore if and how lifestyle habits and other lifestyle-related factors changed between two health assessments in individuals experiencing a CVD event between the assessments, and if changes varied between subgroups of sex, age, educational level, duration from CVD event to second assessment and type of CVD event.

METHODS: Among 115,504 Swedish employees with data from two assessments of occupational health screenings between 1992 and 2020, a total of 637 individuals (74% men, mean age 47 ± SD 9 years) were identified having had a CVD event (ischemic heart disease, cardiac arrythmia or stroke) between the assessments. Cases were matched with controls without an event between assessments from the same database (ratio 1:3, matching with replacement) by sex, age, and time between assessment (n = 1911 controls). Lifestyle habits included smoking, active commuting, exercise, diet, alcohol intake, and were self-rated. Lifestyle-related factors included overall stress, overall health (both self-rated), physical capacity (estimated by submaximal cycling), body mass index and resting blood pressure. Differences in lifestyle habits and lifestyle-related factors between cases and controls, and changes over time, were analysed with parametric and non-parametric tests. Multiple logistic regression, OR (95% CI) was used to analyse differences in change between subgroups.

RESULTS: Cases had, in general, a higher prevalence of unhealthy lifestyle habits as well as negative life-style related factors prior to the event compared to controls. Nevertheless, cases improved their lifestyle habits and lifestyle factors to a higher degree than controls, especially their amount of active commuting (p = 0.025), exercise (p = 0.009) and non-smoking (p < 0.001). However, BMI and overall health deteriorated to a greater extent (p < 0.001) among cases, while physical capacity (p < 0.001) decreased in both groups.

CONCLUSION: The results indicate that a CVD event may increase motivation to improve lifestyle habits. Nonetheless, the prevalence of unhealthy lifestyle habits was still high, emphasizing the need to improve implementation of primary and secondary CVD prevention.

BACKGROUND: The impact of cardiorespiratory fitness (CRF) and other lifestyle-related factors on severe COVID-19 risk is understudied. The present study aims to investigate lifestyle-related and socioeconomic factors as possible predictors of COVID-19, with special focus on CRF, and to further study whether these factors may attenuate obesity- and hypertension-related risks, as well as mediate associations between socioeconomic factors and severe COVID-19 risk.

METHODS: Out of initially 407,131 participants who participated in nationwide occupational health service screening between 1992 and 2020, n = 857 cases (70% men, mean age 49.9 years) of severe COVID-19 were identified. CRF was estimated using a sub-maximum cycle test, and other lifestyle variables were self-reported. Analyses were performed including both unmatched, n = 278,598, and sex-and age-matched, n = 3426, controls. Severe COVID-19 included hospitalization, intensive care or death due to COVID-19.

RESULTS: Patients with more severe COVID-19 had significantly lower CRF, higher BMI, a greater presence of comorbidities and were more often daily smokers. In matched analyses, there was a graded decrease in odds for severe COVID-19 with each ml in CRF (OR = 0.98, 95% CI 0.970 to 0.998), and a two-fold increase in odds between the lowest and highest (< 32 vs. ≥ 46 ml·min^-1·kg^-1) CRF group. Higher BMI (per unit increase, OR = 1.09, 1.06 to 1.12), larger waist circumference (per cm, OR = 1.04, 1.02 to 1.06), daily smoking (OR = 0.60, 0.41 to 0.89) and high overall stress (OR = 1.36, 1.001 to 1.84) also remained significantly associated with severe COVID-19 risk. Obesity- and blood pressure-related risks were attenuated by adjustment for CRF and lifestyle variables. Mediation through CRF, BMI and smoking accounted for 9% to 54% of the associations between low education, low income and blue collar/low skilled occupations and severe COVID-19 risk. The results were consistent using either matched or unmatched controls.

CONCLUSIONS: Both lifestyle-related and socioeconomic factors were associated with risk of severe COVID-19. However, higher CRF attenuated the risk associated with obesity and high blood pressure, and mediated the risk associated with various socioeconomic factors. This emphasises the importance of interventions to maintain or increase CRF in the general population to strengthen the resilience to severe COVID-19, especially in high-risk individuals.

The COVID-19 pandemic has become a public health emergency of international concern, which may have affected lifestyle habits and mental health. Based on national health profile assessments, this study investigated perceived changes of lifestyle habits in response to the COVID-19 pandemic and associations between perceived lifestyle changes and mental health in Swedish working adults. Among 5599 individuals (50% women, 46.3 years), the majority reported no change (sitting 77%, daily physical activity 71%, exercise 69%, diet 87%, alcohol 90%, and smoking 97%) due to the pandemic. Changes were more pronounced during the first wave (April–June) compared to the second (October–December). Women, individuals &lt;60 years, those with a university degree, white-collar workers, and those with unhealthy lifestyle habits at baseline had higher odds of changing lifestyle habits compared to their counterparts. Negative changes in lifestyle habits and more time in a mentally passive state sitting at home were associated with higher odds of mental ill-health (including health anxiety regarding one’s own and relatives’ health, generalized anxiety and depression symptoms, and concerns regarding employment and economy). The results emphasize the need to support healthy lifestyle habits to strengthen the resilience in vulnerable groups of individuals to future viral pandemics and prevent health inequalities in society.