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  • 1.
    Ek, Amanda
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology. Karolinska University Hospital.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Hambraeus, Kristina
    Falun Hospital.
    Cider, Åsa
    Gothenburg University and Sahlgrenska University Hospital.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology. Uppsala University.
    Börjesson, Mats
    Gothenburg University and Sahlgrenska University Hospital.
    Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry.2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 3, p. 324-332Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality.

    METHODS: A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions.

    RESULTS: During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission.

    CONCLUSIONS: The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.

  • 2.
    Ekblom, Örjan
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ek, Amanda
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Cider, Åsa
    University of Gothenburg.
    Hambraeus, Kristina
    Falun Hospital.
    Börjesson, Mats
    University of Gothenburg.
    Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 24, article id e010108Article in journal (Refereed)
    Abstract [en]

    Background

    With increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI.

    Methods and Results

    Data from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status.

    Conclusions

    The present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.

  • 3.
    Ek, Amanda
    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.
    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.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Hambraeus, Kristina
    Cardiologkliniken, Falu lasarett.
    Börjesson, Mats
    Göteborgs Universitet.
    Association between physical activity level and risk of all-cause mortality after myocardial infarction2017In: European Journal of Preventive Cardiology, Vol 24, Issue 1 Suppl, April 2017: Abstract Book EuroPrevent 2017 Malaga, Spain, 2017, Vol. 24, article id 45Conference paper (Refereed)
    Abstract [en]

    Background/Introduction: There is little knowledge of the association between physical activity (PA) level and the mortality risk post myocardial infarction (MI). Steffen/Batey et al (2000), concluded in a smaller study, that individuals who remained active or increased their level of PA after MI had a lower risk of death. However, in order to confirm this and adjust for confounders larger studies are needed.

    Purpose: Explore any association between PA level after MI and all-cause mortality during follow-up in a large MI-cohort.

    Methods: A national cohort study including all patients <75 years of age, with a diagnosis of MI between 1991-2014 (Swedish MI register SWEDEHEART). From the register self-reported PA, 6-10 weeks post MI, (i.e. number of sessions during the past seven days with moderate and/or vigorous PA lasting ≥30 minutes) was obtained. The answers were grouped into 0-1 sessions (inactive), 2-4 sessions (moderately active) and 5-7 sessions (regularly active). Associations were first assessed unadjusted, stratified by potential confounders (sex, age, smoking status, ejection fraction, ST-elevation and quality of life). Thereafter, a multiple logistic regression was performed to control for possible confounders.

    Results: Complete data was obtained from 37 655 individuals (median 63 years, 74 % men). A total of 2512 deaths occurred during a mean of 4.1 years of follow-up. The mortality rate was 17.0 cases/1000 person-years. Moderate and regular activity, was associated with a lower risk of all-cause mortality (OR 0,356 95 %, CI 0,320-0,396 and OR 0,334, 95 % CI 0,305-0,366) compared to being physically inactive. The OR´s remained largely unchanged when stratifying for age, sex, NSTEM/STEMI and ejection fraction. However, active smokers had a lower OR, for subsequent death, as had patients with a low EQ5D. The associations persisted in the multiple logistic regression, after adjustment for confounders (Figure 1).

    Conclusion(s): A higher level of physical activity seems to be associated with a lower risk of all-cause mortality. These results suggest that physical activity assessment is important post MI, not least as an important predictor.

     

  • 4.
    Ek, Amanda
    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.
    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.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Hambraeus, Kristina
    Cardiologkliniken, Falu lasarett.
    Börjesson, Mats
    Göteborgs Universitet.
    Samband mellan fysisk aktivitetsnivå efter hjärtinfarkt och risken för mortalitet: Association between physical activity level and risk of all-cause mortality after myocardial infarction2017In: Fria föredrag, nr 025, 2017, article id 025Conference paper (Refereed)
    Abstract [en]

    Background: There is little knowledge of the association between physical activity (PA) level and the mortality risk post myocardial infarction (MI)Steffen/Batey et al (2000), concluded in a smaller study, that individuals who remained active or increased their level of PA post-MI had a lower risk of death. This study aimed to explore any association between PA level post-MI and all-cause mortality during follow-up in a large MI-cohort.

    Methods: A national cohort study including patients <75 years of age, with a diagnosis of MI between 2005-2014 (SWEDEHEART, SEPHIA-register). Self-reported PA, 6-10 weeks post-MI, (i.e. number of sessions during the past seven days with moderate and/or vigorous PA lasting ≥30 minutes) was obtained. The answers were grouped into 0-1 sessions (inactive), 2-4 sessions (moderately active) and 5-7 sessions (regularly active). First, stratified unadjusted associations were investigated. Thereafter, a multiple logistic regression was performed to control for possible confounders.

    Results: Complete data was obtained from 37 655 individuals (median age 63 years, 74 % men). A total of 2512 deaths occurred during a mean of 4.1 years of follow-up. The mortality rate was 17.0 cases/1000 person-years. Moderate and regular activity, was associated with a lower risk of all-cause mortality (OR 0.36, 95 % CI: 0.32-0.40 and OR 0.33, 95 % CI: 0.31-0.37) compared to being physically inactive. The OR´s remained largely unchanged when stratifying for age, gender, NSTEM/STEMI and ejection fraction. However, compared to inactive patients, physically active smokers and patients with ≤ 0.85 Eq5D had a higher OR, for subsequent death. The associations persisted in the multiple logistic regression, after adjustment for confounders (Figure 1).

    Conclusions: A higher level of PA, post-MI was associated with a lower risk of all-cause mortality. These results suggest that PA assessment is important post-MI, not least as an important predictor for risk of death.

  • 5.
    Ek, Amanda
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.
    Promoting physical activity - an established part of the clinical practice?2015In: 23rd International Conference on Health Promoting Hospitals and Health Services: "Person-oriented health promotion in a rapidly changing world:Co-production – continuity – new media & technologies", 2015Conference paper (Refereed)
    Abstract [en]

    Introduction

    Insufficient physical activity is a considerable risk factor for mortality and premature death. The healthcare has a unique role in health promotion as they reach a large part of the population. The evidence based recommendation is that the healthcare sector should offer “counseling with the adjunct of exercise on prescription or a pedometer, as well as special follow-up” to promote patients physical activity. Despite this, physical activity is underutilized in prevention and treatment of disease, for reasons not fully known.

     

     

    Purpose/Method

    We aimed to study the attitudes of different healthcare professionals in the hospital setting, towards the importance of physical activity and its clinical use at different levels.

    The study comprised 264 (78% women) health care professionals at the cardiac department/outpatient cardiac center in Stockholm (response rate 91%). Data was obtained in 2013, by questionnaire. Containing 28 multiple choice questions on participants attitudes towards physical activity behavior change, the perceived importance of such measures, practical implementation and possible barriers for implementation.

     

    Results

    All participants stated importance of physical activity promotion within healthcare. Forty-seven percent reported that they promoted physical activity in clinical practice, however only a minority fulfilled the evidence based recommendations (n=65), as brief advice (n=165) or counseling (n=111) were most common. Sixty-one percent aimed to improve the use of physical activity promotion, factors hampering were inadequate knowledge, follow-up possibilities and length of patient visits. Less than half group reported insufficient routines (46%), goals (37%) and lack of management support (42%).

     

    Conclusion         

    Although health professionals generally are positive towards promoting physical activity, just a small proportion actually use the evidence based methods in clinical practice. To improve the promotion of physical activity in patients there is need for further implementation strategies at all levels to create a well-functioning structure, clear goals and routines. Our study suggests, that implementation should focus at education, logistics for follow-up and increased amount of time with direct patient care. 

     

1 - 5 of 5
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