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  • 1.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Andersson, Gunnar
    HPI Health Profile Institute.
    Wallin, Peter
    HPI Health Profile Institute.
    Söderling, Jonas
    Karolinska Institutet.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska Institutet.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Decline in cardiorespiratory fitness in the Swedish working force between 1995 and 2017.2019In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, no 2, p. 232-239Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Long-term trend analyses of cardiorespiratory fitness (VO2 max) in the general population are limited.

    OBJECTIVES: To describe trends in VO2 max from 1995 to 2017 in the Swedish working force and to study developments across categories of sex, age, education, and geographic regions.

    METHODS: 354.277 participants (44% women, 18-74 years) who participated in a nationwide occupational health service screening between 1995 and 2017 were included. Changes in standardized mean values of absolute (L·min-1 ) and relative (ml·min-1 ·kg-1 ) VO2 max, and the proportion with low (<32) relative VO2 max are reported. VO2 max was estimated using a submaximal cycle test.

    RESULTS: Absolute VO2 max decreased by -6.7% (-0.19 L·min-1 ) in the total population. Relative VO2 max decreased by -10.8% (-4.2 ml·min-1 ·kg-1 ) with approximately one-third explained by a simultaneous increase in body mass. Decreases in absolute fitness were more pronounced in men vs. women (8.7% vs. 5.3%), in younger vs. older (6.5% vs 2.3%), in short (11.4%) vs. long (4.5%) education, and in rural vs. urban regions (6.5% vs 3.5%), all p<0.001. The proportions with low VO2 max increased from 27% to 46% (p<0.001).

    CONCLUSION: Between 1995 and 2017, there was a steady and pronounced decline in mean cardiorespiratory fitness in Swedish adults. Male gender, young age, short education and living in a rural area were predictive of greater reductions. The proportion with low cardiorespiratory fitness almost doubled. Given the strong associations between cardiorespiratory fitness and multiple morbidities and mortality, preventing further decreases is a clear public health priority, especially for vulnerable groups. This article is protected by copyright. All rights reserved.

  • 2.
    Holmlund, Tobias
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Franzén, Erika
    Karolinska Institutet, Stockholm, Sweden.
    Hultling, Claes
    Karolinska Institutet, Stockholm, Sweden.
    Wahman, Kerstin
    Karolinska Institutet, Stockholm, Sweden.
    Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.2019In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Descriptive.

    OBJECTIVE: The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP).

    SETTINGS: Rehabilitation facility in Sweden.

    METHODS: The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses.

    RESULTS: The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP.

    CONCLUSION: This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.

  • 3.
    Fridolfsson, Jonatan
    et al.
    University of Gothenburg.
    Börjesson, Mats
    University of Gothenburg.
    Buck, Christoph
    Leibniz Institute for Prevention Research and epidemiology (BIPS), Bremen, Germany.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Hunsberger, Monica
    University of Gothenburg.
    Lissner, Lauren
    University of Gothenburg.
    Arvidsson, Daniel
    University of Gothenburg.
    Effects of Frequency Filtering on Intensity and Noise in Accelerometer-Based Physical Activity Measurements.2019In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 19, no 9, article id E2186Article in journal (Refereed)
    Abstract [en]

    In objective physical activity (PA) measurements, applying wider frequency filters than the most commonly used ActiGraph (AG) filter may be beneficial when processing accelerometry data. However, the vulnerability of wider filters to noise has not been investigated previously. This study explored the effect of wider frequency filters on measurements of PA, sedentary behavior (SED), and capturing of noise. Apart from the standard AG band-pass filter (0.29-1.63 Hz), modified filters with low-pass component cutoffs at 4 Hz, 10 Hz, or removed were analyzed. Calibrations against energy expenditure were performed with lab data from children and adults to generate filter-specific intensity cut-points. Free-living accelerometer data from children and adults were processed using the different filters and intensity cut-points. There was a contribution of acceleration related to PA at frequencies up to 10 Hz. The contribution was more pronounced at moderate and vigorous PA levels, although additional acceleration also occurred at SED. The classification discrepancy between AG and the wider filters was small at SED (1-2%) but very large at the highest intensities (>90%). The present study suggests an optimal low-pass frequency filter with a cutoff at 10 Hz to include all acceleration relevant to PA with minimal effect of noise.

  • 4.
    Lidin, Matthias
    et al.
    Karolinska Institutet.
    Hellénius, Mai-Lis
    Karolinska Institutet.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Rydell Karlsson, Monica
    Karolinska Institutet.
    Experiences from individuals with increased cardiovascular risk participating in a one-year lifestyle program.2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id 1474515119848967Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of the current study was to describe the participants' experiences of a structured lifestyle program for persons with high cardiovascular risk.

    METHOD: Sixteen participants with high cardiovascular risk participating in a one-year structured lifestyle intervention program were interviewed regarding their experiences of the program. The interviews were analyzed using content analyses.

    RESULTS: The participants' (mean age 58 ± 9) experiences were categorized into three categories: "How to know," based on the participants' experience from both individual counselling and group sessions with tools to strengthen self-care; "Staff who know how," based on experience from the meeting with, and the importance of, competent health professionals; "Why feedback is essential," based on the participants' experience and effects of person-centered feedback. Several factors were deemed important in the structure of the program: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful health professional who gives continuous feedback, and the right tools to support self-care at home between visits.

    CONCLUSION: Individuals participating in a structured lifestyle program experienced several factors as important: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful healthcare professional who gives continuous feedback, and the right tools to support self-care at home between visits.

  • 5.
    Lönnberg, Lena
    et al.
    Uppsala University, Sweden..
    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.
    Damberg, Mattias
    Uppsala University, Sweden..
    Improved unhealthy lifestyle habits in patients with high cardiovascular risk: results from a structured lifestyle programme in primary care2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967Article in journal (Refereed)
    Abstract [en]

    Background. Physical activity, healthful dietary habits, and not smoking are associated with reduced cardiovascular morbidity and mortality. However, few studies have examined how counselling to improve poor lifestyle habits might be carried out in clinical practice. In Swedish primary care, structured lifestyle counselling is still not integrated into everyday clinical practice. The aim of the present study was two-fold: (1) to describe a novel lifestyle intervention programme in primary care; and (2) to evaluate change in unhealthy lifestyle habits over 1 year in men and women with high cardiovascular risk who participated in the lifestyle intervention programme. Method. A single-group study with a 1-year follow-up was carried out. A total of 417 people was enrolled, median age 62 years (54% women), with either hypertension (69%), type 2 diabetes mellitus, or impaired glucose tolerance. The 1-year intervention included five counselling sessions that focused on lifestyle habits, delivered by a district nurse with postgraduate credits in diabetes care and the metabolic syndrome. All patients were offered in-depth counselling for one or more lifestyle habits when needed. Lifestyle habits were assessed by a questionnaire at baseline and 1-year follow-up. Total change was assessed using a nine-factor unhealthy lifestyle habit index. Results. Favourable, significant changes were observed for physical activity, dietary habits, smoking, and stress over 1 year. Similar improvements were seen for both sexes and type of diagnosis. Conclusions. The results support the utility of a multifactorial, structured approach to change unhealthy lifestyle habits for cardiovascular risk prevention in a primary care setting.

  • 6.
    Arvidsson, Daniel
    et al.
    University of Gothenburg, Sweden.
    Fridolfsson, Jonatan
    University of Gothenburg, Sweden.
    Buck, Christoph
    Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany..
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Lissner, Lauren
    University of Gothenburg, Sweden.
    Hunsberger, Monica
    University of Gothenburg, Sweden.
    Börjesson, Mats
    University of Gothenburg, Sweden.
    Reexamination of Accelerometer Calibration with Energy Expenditure as Criterion: VO2net Instead of MET for Age-Equivalent Physical Activity Intensity.2019In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 19, no 15, article id E3377Article in journal (Refereed)
    Abstract [en]

    Accelerometer calibration for physical activity (PA) intensity is commonly performed using Metabolic Equivalent of Task (MET) as criterion. However, MET is not an age-equivalent measure of PA intensity, which limits the use of MET-calibrated accelerometers for age-related PA investigations. We investigated calibration using VO2net (VO2gross - VO2stand; mL⋅min-1⋅kg-1) as criterion compared to MET (VO2gross/VO2rest) and the effect on assessment of free-living PA in children, adolescents and adults. Oxygen consumption and hip/thigh accelerometer data were collected during rest, stand and treadmill walk and run. Equivalent speed (Speedeq) was used as indicator of the absolute speed (Speedabs) performed with the same effort in individuals of different body size/age. The results showed that VO2net was higher in younger age-groups for Speedabs, but was similar in the three age-groups for Speedeq. MET was lower in younger age-groups for both Speedabs and Speedeq. The same VO2net-values respective MET-values were applied to all age-groups to develop accelerometer PA intensity cut-points. Free-living moderate-and-vigorous PA was 216, 115, 74 and 71 min/d in children, adolescents, younger and older adults with VO2net-calibration, but 140, 83, 74 and 41 min/d with MET-calibration, respectively. In conclusion, VO2net calibration of accelerometers may provide age-equivalent measures of PA intensity/effort for more accurate age-related investigations of PA in epidemiological research.

  • 7.
    Olsson, Sven Johan Gustav
    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-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.
    Ekblom, Björn
    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 V
    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.
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology. Göteborg University.
    Association of perceived physical health and physical fitness in two Swedish national samples from 1990 and 2015.2018In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 28, no 2, p. 717-724Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Perceived health and physical fitness have been shown to correlate, and low levels of either variable increase the risk for future illness and mortality. However, risk factors and their interrelationship may vary between societies and over time. In this study, the associations of physical fitness and perceived health were therefore assessed in two Swedish national samples 25 years apart.

    METHODS: Perceived physical health, dichotomized as "good" or "bad", maximal oxygen uptake (VO2 max), counter movement jump (CMJ), balance (one-legged 60 second stance), and self-reported demographics and lifestyle were recorded in two cross-sectional samples (sample size, number of eligible participants) of Swedish adults, aged 20 - 65 years, in 1990 - 1991 (2203, 1365), and 2013 - 2015 (3357, 422).

    RESULTS: The odds for good perceived physical health increased by 5% per mL · kg(-1) · min(-1) of VO2 max, 3% per cm CMJ height, and decreased by 4% per 1 time of overbalancing, in both samples. Mutually adjusted regression models showed that perceived physical health was best predicted by VO2 max and chronic illness in 1990 and by age, BMI, and educational level in 2015.

    CONCLUSION: Perceived physical health was related to physical fitness in two samples of Swedish adults from 1990 and 2015. However, multivariate, and mutually adjusted models, indicate that the most important covariates of perceived physical health may have changed from VO2 max and chronic illness in 1990, to age, BMI, and educational level in 2015. This article is protected by copyright. All rights reserved.

  • 8.
    Holmlund, Tobias
    et al.
    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.
    Franzén, Erika
    Karolinska institutet.
    Hultling, Claes
    Karolinska institutet.
    Wahman, Kerstin
    Karolinska institutet.
    Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia.2018In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 56, no 3, p. 274-283Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Cross-sectional.

    OBJECTIVES: This study aimed to describe and compare VO2 and energy expenditure at rest (REE) and during standardized sedentary, non-exercise physical activity, and exercise activities, in people with motor-complete tetraplegia (C5-C8). Further, REE and energy expenditure (EE) for the different activities were compared to data from a reference group of people with motor-complete paraplegia (T7-T12).

    SETTING: Sweden.

    METHODS: The sample of people with motor-complete tetraplegia consisted of 26 adults (seven women) with SCI, C5-C8 AIS A-B. REE and EE for the different activities were measured with indirect calorimetry. The results were further compared to people with motor-complete paraplegia.

    RESULTS: Resting VO2 was 2.57 ml O2 kg-1 min-1, 2.54 for men and 2.60 for women. The VO2 or activity energy expenditure related to body weight increased three to four times during non-exercise physical activity compared to sedentary activities for the people with motor-complete tetraplegia, and up to six times during exercise activity. No significant differences were seen in resting or sedentary activity VO2 between the people with motor-complete tetraplegia and those with motor-complete paraplegia. Activities of daily life revealed no or small differences in VO2, except for setting a table, while the people with tetraplegia had ∼50% lower VO2 during exercise activities.

    CONCLUSIONS: Non-exercise physical activities of daily life may be significant for increasing total daily EE in people with motor-complete tetraplegia. This might act to motivate the individual, and might be clinically important when designing adapted lifestyle intervention programs for the target group.

  • 9.
    Ekblom-Bak, Elin
    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.
    Fagman, Erika
    Göteborgs universitet.
    Angerås, Oskar
    Göteborgs universitet.
    Schmidt, Caroline
    Göteborgs universitet.
    Rosengren, Annika
    Göteborgs universitet.
    Börjesson, Mats
    Göteborgs universitet.
    Bergström, Göran
    Göteborgs universitet.
    Fitness attenuates the prevalence of increased coronary artery calcium in individuals with metabolic syndrome.2018In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, no 3, p. 309-316, article id 2047487317745177Article in journal (Refereed)
    Abstract [en]

    Background The association between cardiorespiratory fitness, physical activity and coronary artery calcium (CAC) is unclear, and whether higher levels of fitness attenuate CAC prevalence in subjects with metabolic syndrome is not fully elucidated. The present study aims to: a) investigate the independent association of fitness on the prevalence of CAC, after adjustment for moderate-to-vigorous physical activity and sedentary time, and b) study the possible attenuation of increased CAC by higher fitness, in participants with metabolic syndrome. Design Cross-sectional. Methods In total 678 participants (52% women), 50-65 years old, from the SCAPIS pilot study were included. Fitness (VO2max) was estimated by submaximal cycle ergometer test and moderate-to-vigorous physical activity and sedentary time were assessed using hip-worn accelerometers. CAC score (CACS) was quantified using the Agatston score. Results The odds of having a significant CACS (≥100) was half in participants with moderate/high fitness compared with their low fitness counterparts. Further consideration of moderate-to-vigorous physical activity, sedentary time and number of components of the metabolic syndrome did only slightly alter the effect size. Those with metabolic syndrome had 47% higher odds for significant CAC compared with those without metabolic syndrome. However, moderate/high fitness seems to partially attenuate this risk, as further joint analysis indicated an increased odds for having significant CAC only in the unfit metabolic syndrome participants. Conclusions Being fit is associated with a reduced risk of having significant CAC in individuals with metabolic syndrome. While still very much underutilized, fitness should be taken into consideration in everyday clinical risk prediction in addition to the traditional risk factors of the metabolic syndrome.

  • 10.
    Lidin, Matthias
    et al.
    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.
    Rydell Karlsson, Monica
    Karolinska institutet.
    Hellénius, Mai-Lis
    Karolinska institutet.
    Long-term effects of a Swedish lifestyle intervention programme on lifestyle habits and quality of life in people with increased cardiovascular risk.2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 6, p. 613-622, article id 1403494817746536Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of this study was to evaluate the effects of a structured intervention programme on lifestyle habits and quality of life after six months and one year in participants with increased cardiovascular risk.

    METHODS: Participants aged ≥18 years with increased cardiovascular risk were referred from primary health care and hospitals. The programme was launched at an outpatient clinic in a department of cardiology at a university hospital. It consisted of individual visits to a nurse for a health check-up and lifestyle counselling at baseline, after six months and at one year. In addition, five group sessions - focusing on nicotine, alcohol, physical activity, eating habits, stress, sleep and behavioural change - were offered to the participants and their relatives or friends. Lifestyle habits and quality of life were assessed with questionnaires at baseline, after six months and at one year.

    RESULTS: One hundred participants (64 women, 36 men, age 58±11 years) were included in the programme. Compared with the baseline, significant and favourable changes in reported lifestyle habits were noted. Exercise levels were higher after one year and sedentary time decreased from 7.4 to 6.3 h/day. Dietary habits improved and the number of participants with a high consumption of alcohol decreased. Quality of life improved after one year.

    CONCLUSIONS: Participating in a structured lifestyle programme resulted in improved lifestyle habits and quality of life over one year in people with increased cardiovascular risk. Components such as an inter-professional teamwork, a focus on lifestyle rather than the disease, and combining individual visits and group sessions, might be central to the positive outcome of the programme.

  • 11.
    Lidin, Matthias
    et al.
    Karolinska institutet.
    Hellénius, Mai-Lis
    Karolinska institutet.
    Rydell-Karlsson, Monica
    Karolinska institutet.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice.2018In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, no 1, article id 59Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiovascular disease is still the leading cause of premature death world-wide with factors like abdominal obesity, hypertension and dyslipidemia being central risk factors in the etiology. The aim of the present study was to investigate the effects on cardiovascular risk factors and cardiovascular risk after 6 months and 1 year, in individuals with increased cardiovascular risk enrolled in a lifestyle multidisciplinary program in a clinical setting.

    METHOD: Individuals with increased cardiovascular risk were referred from primary health care and hospitals to a program at an outpatient clinic at a department of cardiology. The program consisted of three individual visits including a health check-up with a physical examination and blood sampling, and a person-centered dialogue for support in behavioural change of unhealthy lifestyle habits (at baseline, 6 months and 1 year). Furthermore, five educational group sessions were given at baseline. Cardiovascular risk was assessed according to Framingham cardiovascular risk predicting model.

    RESULTS: One hundred individuals (mean age 59 years, 64% women) enrolled between 2008 and 2014 were included in the study. Waist circumference, systolic and diastolic blood pressure and total cholesterol decreased significantly over 1 year. In parallel, cardiovascular risk according to the cardiovascular risk profile based on Framingham 10-year risk prediction model, decreased with 15%. The risk reduction was seen in both men and women, and in participants with or without previous cardiovascular disease.

    CONCLUSION: Participating in a structured lifestyle program over a year was associated with significant improvement in multiple cardiovascular risk factors and decreased overall cardiovascular risk.

    TRIAL REGISTRATION: The study is registered at www.clinicaltrials.gov (ClinicalTrial.gov ID: NCT02744157 ).

  • 12.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Medverkan i skolidrotten ger bättre vanor och hälsa2018In: Idrott & hälsa, ISSN 1653-1124, no 4, p. 6-9Article in journal (Other (popular science, discussion, etc.))
  • 13.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Andersson, Gunnar
    HPI Health Profile Institute AB.
    Wallin, Peter
    HPI Health Profile Institute AB.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Physical Education and Leisure-Time Physical Activity in Youth Are Both Important for Adulthood Activity, Physical Performance, and Health.2018In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, no 9, p. 661-670Article in journal (Refereed)
    Abstract [en]

    Background: The importance of youth physical activity (PA) for adulthood PA, performance, and health was retrospectively evaluated. Methods: A total of 258,146 participants (49% women), aged 19–70, with a first-time health-profile assessment between 1982 and 2015, provided self-reported data on current perceived health, PA, lifestyle, and physical education class participation, and PA outside school hours before age 20. Data on anthropometrics, blood pressure, and estimated maximal oxygen consumption (VO2max) were obtained. Results: Women participating in physical education class, compared with those who did not, had significantly lower OR (range: 0.81–0.87) for perceiving poor overall health, general obesity, and high diastolic blood pressure after adjustment for potential confounders, and increased OR (range: 1.17–1.23) for exercising regularly and a normal/high VO2max in adulthood. For men, the ORs were significantly lower (range: 0.66–0.86) for poor perceived overall health, general, and abdominal obesity. These associations were seen for participants up to 70 years. Increased PA outside school hours revealed even stronger beneficial associations. In joint analyses, both youth and current PA were important for lower OR of poor health and being obese in adulthood. Conclusions: Physical education class participation and additional PA after school hours were both important for perceived health, PA, VO2max, and metabolic health in adulthood up to 70 years.

  • 14.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Stor försämring av svenskars kondition2018In: Idrottsforskning.se, article id 20 novemberArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    En ny studie visar alarmerande resultat om folkhälsan. Närmare hälften av 350 000 undersökta svenskar har så dålig kondition att sjukdomsrisken är kraftigt ökad.

  • 15.
    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.
    Det riskfyllda stillasittandet2017In: Blå boken: årsbok, ISSN 2000-7272, Vol. 110, p. 224-235Article in journal (Other (popular science, discussion, etc.))
  • 16.
    Holmlund, Tobias
    et al.
    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.
    Franzén, E
    Karolinska institutet.
    Hultling, C
    Karolinska institutet.
    Wikmar, L Nilsson
    Karolinska institutet.
    Wahman, K
    Karolinska institutet.
    Energy expenditure in people with motor-complete paraplegia.2017In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 55, no 8, p. 774-781Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: The present descriptive clinical and laboratory study is cross-sectional in design.

    OBJECTIVES: The primary aim is to describe and compare resting energy expenditure (REE) and energy expenditure (EE) during different standardized sedentary, non-exercise and exercise activities in people with motor-complete paraplegia (Th7 to Th12.). A secondary aim was to compare men and women.

    METHODS: Thirty-eight adults (10 women) with SCI, T7-T12 AIS A-B, were recruited. All the data were collected through indirect calorimetry. REE was measured in supine for 30 min after 8 h of overnight fasting. Activity energy expenditure (AEE) for activities was measured for seven minutes during sedentary, non-exercise physical activity (NEPA) and exercise activities.

    RESULTS: AEE increased four to eight times when engaging in NEPA compared to that in sedentary activities. Men had significantly higher resting oxygen uptake compared to women, 0.19 vs 0.15 l min(-1) (P=0.005), REE per 24 h, 1286 vs 1030 kcal (P=0.003) and EE during weight-bearing activities. However, these became nonsignificant after adjustment for body weight and speed of movement, with a mean resting oxygen uptake of 2.47 ml O2 per kg min(-1) for the whole group (women 2.43 and men 2.57 ml O2 kg(-1) min(-1), P=0.49).

    CONCLUSIONS: NEPA increases AEE up to eight times compared to sedentary activities. Gender differences in oxygen uptake during both rest and weight-bearing activities were diminished after adjustment for body weight. The mean resting oxygen uptake for the whole group was 2.47 ml O2 kg(-1) min(-1). These results highlight the importance, especially of NEPA, for increasing total daily EE in the target population.

  • 17.
    Moberg, Marcus
    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.
    Hendo, Gina
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Jakobsson, Madelene
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Mattsson, C Mikael
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom-Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Flockhart, Mikael
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Research group for Mitokondriell funktion och metabolisk kontroll.
    Pontén, Marjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Söderlund, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Increased autophagy signaling but not proteasome activity in human skeletal muscle after prolonged low-intensity exercise with negative energy balance2017In: Physiological Reports, E-ISSN 2051-817X, Vol. 5, no 23, article id e13518Article in journal (Refereed)
    Abstract [en]

    Little is known about the molecular regulation of skeletal muscle protein turnover during exercise in field conditions where energy is intake inadequate. Here, 17 male and 7 female soldiers performed an 8 day long field based military operation. Vastus lateralis muscle biopsies, in which autophagy, the ubiquitin-proteasome system and the mTORC1 signaling pathway where studied, were collected before and after the operation. The 187 h long operation resulted in a 15% and 29% negative energy balance as well as a 4.1% and 4.6% loss of body mass in women and men respectively. After the operation protein levels of ULK1 as well as the phosphorylation of ULK1Ser317 and ULK1Ser555 had increased by 11%, 39% and 13%, respectively, and this was supported by a 17% increased phosphorylation of AMPKThr172 (P<0.05). The LC3b-I/II ratio was 3-fold higher after compared to before the operation (P<0.05), whereas protein levels of p62/SQSTM1 were unchanged. The β1, β2, and β5 activity of the proteasome and protein levels of MAFbx did not change, while levels of MuRF-1 were slightly reduced (6%, P<0.05). Protein levels and phosphorylation status of key components in the mTORC1 signaling pathway remained at basal levels after the operation. Muscle levels of glycogen decreased from 269±12 to 181±9 mmol ∙ kg dry muscle-1 after the exercise period (P<0.05). In conclusion, the 8 days of field based exercise resulted in induction of autophagy without any increase in proteasome activity or protein ubiquitination. Simultaneously, the regulation of protein synthesis through the mTORC1 signaling pathway was maintained.

  • 18.
    Moberg, Marcus
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Eva Blomstrand's research group.
    Hendo, Gina
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Jakobsson, Madeleine
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Mattsson, C. Mikael
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    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.
    Flockhart, Mikael
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Pontén, Marjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Söderlund, Karin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Increased autophagy signalling but not proteasome activity in human skeletal muscle after prolonged low-intensity exercise with negative energy balance2017In: ICSPP Abstracts: Journal of Science and Medicine in Sport, Volume 20, Supplement 2, November 2017, Pages S166, 2017, Vol. 20, no Supplement 2, p. S166-, article id 287Conference paper (Other academic)
  • 19.
    Ekblom-Bak, Elin
    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.
    Bergström, Göran
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Isotemporal substitution of sedentary time by physical activity of different intensities and bout lengths, and its associations with metabolic risk.2016In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 9, p. 967-974Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Time spent being sedentary, regardless of time in exercise, has been associated with metabolic risk using regression modelling. By using isotemporal substitution modelling, the effect of replacing sedentary time with an equal amount of time in physical activity (PA) of different intensities can be considered. The present study aims to investigate the effect of replacing sedentary time with time in light, moderate and vigorous PA to the prevalence of the metabolic syndrome (MetS). Also, replacement of sedentary time by PA of different bout lengths was studied.

    METHODS: In total, 836 participants (52% women), aged 50-64 years, from the SCAPIS pilot study were included. Daily time spent sedentary and in PA of different intensities was assessed using hip-worn accelerometers.

    RESULTS: In this cross-sectional study, replacing 10 minutes of sedentary time with the same amount of light PA was associated with significant lower MetS prevalence, odds ratio (OR) 0.96 (95% confidence interval 0.93-0.98). Replacement with moderate PA resulted in even lower OR, 0.89 (0.82-0.97), with the lowest OR for vigorous PA, 0.41 (0.26-0.66). Participants with high energy intake and high daily sedentary time benefitted more from the replacement of sedentary time with light PA. Significant associations were seen for all bout lengths of light, moderate and vigorous PA in a stepwise-like fashion from one minute to up to 120 minute bouts.

    CONCLUSION: Theoretical substitutions of sedentary time with PA of any intensity and of as little as one minute were associated with significantly lower ORs for MetS. This may be an easily communicable message in clinical practice and for public health purposes.

  • 20.
    Ekblom-Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Bolam, Kate
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Bergström, Göran
    Börjesson, Mats
    SCAPIS Pilot Study: Sitness, Fitness and Fatness - Is Sedentary Time Substitution by Physical Activity Equally Important for Everyone's Markers of Glucose Regulation?2016In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 13, no 7, p. 697-703Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although moderate-to-vigorous physical activity (MVPA) is mainly recommended for glucose control, light physical activity (LIPA) may also have the potential to induce favorable changes. We investigated sedentary time (SED) substitution with equal time in LIPA and MVPA, and the association with markers of glucose regulation and insulin sensitivity after stratification by waist circumference, fitness and fasting glucose levels.

    METHODS: A total of 654 men and women, 50-64 years, from the SCAPIS pilot study were included. Daily SED, LIPA and MVPA were assessed using hip-worn accelerometers. Fasting plasma glucose, insulin and HOMA-IR were determined.

    RESULTS: Substituting 30 min of SED with LIPA was significantly associated with 3.0% lower fasting insulin values and 3.1% lower HOMA-IR values, with even lower levels when substituting SED with MVPA. Participants with lower fitness and participants with high fasting glucose levels benefited significantly more from substituting 30 min of SED with LIPA compared to participants with normal to high fitness levels and participants with normal glucose levels, respectively.

    CONCLUSIONS: LIPA, and not only MVPA, may have beneficial associations with glucose regulation. This is of great clinical and public health importance, not least because it may confer a higher compliance rate to regular PA.

  • 21. Mijwel, Sara
    et al.
    Cardinale, Daniele
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Research group for Mitokondriell funktion och metabolisk kontroll.
    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.
    Sundberg, Carl Johan
    Wengström, Yvonne
    Rundqvist, Helene
    Validation of 2 Submaximal Cardiorespiratory Fitness Tests in Patients With Breast Cancer Undergoing Chemotherapy.2016In: Rehabilitation oncology (American Physical Therapy Association. Oncology Section), ISSN 2168-3808, Vol. 34, no 4, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Patients with breast cancer have an impaired cardiorespiratory fitness, in part, due to the toxic effects of anticancer therapy. Physical exercise as a means of rehabilitation for patients with cancer is an emerging area of research and treatment, emphasizing the need for accurate and feasible physical capacity measurements. The purpose of this study was to evaluate the validity of peak oxygen consumption (o2peak) predicted by the Ekblom-Bak test (E-B) and the Åstrand-Rhyming prediction model (A-R).

    METHODS: Eight patients with breast cancer undergoing chemotherapy participated in the study. Submaximal exercise tests were performed at 2 different submaximal workloads. Estimated o2peak values were obtained by inserting the heart rate (HR) from the 2 workloads into the E-B prediction model and the HR of only the higher workload into the Åstrand nomogram. A 20-W incremental cycle test-to-peak effort was performed to obtain o2peak values.

    RESULTS: Results from A-R overestimated o2peak by 6% (coefficient of variation = 7%), whereas results from E-B overestimated o2peak with 42% (coefficient of variation = 21%) compared with measured o2peak. Pearson's correlation coefficient revealed a significant strong relationship between the estimated o2peak from A-R and the measured o2peak (r = 0.86; P < .05), whereas the relationship between the estimated o2peak from E-B and the measured o2peak resulted in a nonsignificant weak correlation (r = 0.21).

    CONCLUSION: In a situation where maximal exercise testing is not practical or undesirable from a patient safety perspective, submaximal exercise testing provides an alternative way of estimating o2peak. The A-R prediction model appears to be a valid submaximal exercise test for determining cardiorespiratory fitness in this population.

  • 22.
    Björkman, Frida
    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-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.
    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.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Validity of the revised Ekblom Bak cycle ergometer test in adults.2016In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 116, no 9, p. 1627-1638Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To further develop the Ekblom Bak-test prediction equation for estimation of VO2max from submaximal cycle ergometry.

    METHODS: The model group (117 men and 100 women, aged 48.3 ± 15.7 and 46.1 ± 16.8 years, VO2max 46.6 ± 11.1 and 40.4 ± 9.6 mL kg(-1) min(-1), respectively) and the cross-validation group (60 men and 55 women, aged 40.6 ± 17.1 and 41.6 ± 16.7 years, VO2max 49.0 ± 12.1 and 43.2 ± 8.9 mL min(-1) kg(-1), respectively) performed 4 min of cycling on a standard work rate (30 W) directly followed by 4 min on a higher work rate. Heart rate (HR) at each work rate was recorded. Thereafter, participants completed a graded maximal treadmill test for direct measurement of oxygen uptake. The new prediction equation was cross-validated and accuracy compared with the original Ekblom Bak equation as well as by the Åstrand test method.

    RESULTS: The final sex-specific regression models included age, change in HR per-unit change in power (ΔHR/ΔPO), the difference in work rates (ΔPO), and HR at standard work rate as independent variables. The adjusted R (2) for the final models were 0.86 in men and 0.83 in women. The coefficient of variation (CV) was 8.7 % and SEE 0.28 L min(-1). The corresponding CV and SEE values for the EB-test2012 and the Åstrand tests were 10.9 and 18.1 % and 0.35 and 0.48 L min(-1), respectively.

    CONCLUSION: The new EB-test prediction equation provides an easy administered and valid estimation of VO2max for a wide variety of ages (20-86 years) and fitness levels (19-76 mL kg(-1) min(-1)).

  • 23.
    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.
    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.
    Rosengren, Annika
    Hallsten, Mattias
    Bergström, Göran
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Cardiorespiratory Fitness, Sedentary Behaviour and Physical Activity Are Independently Associated with the Metabolic Syndrome, Results from the SCAPIS Pilot Study.2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 6, article id e0131586Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: 

    Previous studies on the relation between lifestyle and the metabolic syndrome lack one or several aspects of the physical activity pattern in the analyses or cardiorespiratory fitness. Likewise, both uni- and triaxial accelerometry have been used, though, the predictive validity of these two modes has not been compared.

    OBJECTIVES: 

    The aims of the present study were firstly to investigate the independent relation between cardiorespiratory fitness and physical activity pattern to the metabolic syndrome (MetS) and secondly to examine the predictive validity of uni- and triaxial accelerometry, respectively.

    METHODS: 

    Data was extracted from the SCAPIS pilot study (n=930, mean age 57.7 yrs). Physical activity pattern was assessed by accelerometry. Cardiorespiratory fitness was estimated using cycle ergometry. MetS was defined per the Adult Treatment Panel III from the National Cholesterol Education Program definition.

    RESULTS: 

    Time spent sedentary (OR: 2.38, 95% CI: 1.54-4.24 for T3 vs T1), in light intensity (OR: 0.50, 95% CI: 0.28-0.90) and in moderate-to-vigorous activity (OR: 0.33, 95% CI: 0.18-0.61), as well as cardiorespiratory fitness (OR: 0.24, 95% CI:0.12-0.48), were all independently related to the prevalence of MetS after adjustment for potential confounders, fitness and/or the other aspects of the physical activity pattern. In addition, we found that triaxial analyses were more discriminant, with ORs farther away from the reference group and additional significant ORs.

    CONCLUSION: 

    The finding that several aspects of the physical activity pattern reveal independent relations to the MetS makes new possible targets for behaviour change of interest, focusing on both exercise and everyday life. When assessing the risk status of a patient, it is advised that triaxial accelerometry is used.

  • 24.
    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.
    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.
    Bolam, Kate A
    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, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Schmidt, Caroline
    Söderberg, Caroline
    Bergström, Göran
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Concurrent and predictive validity of physical activity measurement items commonly used in clinical settings- data from SCAPIS pilot study.2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 978Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    DISCUSSION:

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

    CONCLUSION:

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

  • 25.
    Olsson, Sven Johan Gustav
    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.
    Börjesson, Mats
    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 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.
    Hemmingsson, Erik
    Karolinska Institutet.
    Hellénius, Mai-Lis
    Karolinska Institutet.
    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.
    Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 687Article in journal (Refereed)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusions

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

    Trial registration

    ClinicalTrials.gov NCT02320760.

  • 26.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Pettersson, Tobbe
    Lunds universitet.
    Flockhart, Mikael
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Mattsson, Mikael C
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    F17 – Flygvapenövning 20142015Report (Other academic)
    Abstract [sv]

    På uppdrag av Försvarsmakten genomförde Militärmedicinska forskningsgruppen vid Åstandlaboratoriet vid Gymnastik- och idrottshögskolan Stockholm (GIH), en observationsstudie gällande fysiologisk/medicinsk belastning på 14 flygplatsjägare under en fältövning med beteckningen "F 17 - Flygvapenövning 2014".

    Övningen var indelad i tre etapper, varav den första (c:a 42 tim) och sista (c:a 59 tim) planerades vara mer fysiskt och psykiskt krävande än den mellersta (c:a 114 tim). Registrering av hjärtfrekvens gjordes under hela övningen. Fysiologiska mätningar samt blodprov togs före och efter varje etapp samt efter c:a 12 timmars vila med sedvanliga kost efter övningens avslutande.

    Beräkningar av energiomsättningen för de tre etapperna inklusive viloperioder var c:a 308, 185 respektive 369 kcal/tim, resulterande i totalt c:a 13 000, 21 100 respektive 21 600 kcal per etapp eller totalt c:a 55 700 kcal för hela övningen. De höga fysiska belastningarna i etapp ett och tre är klart högre än tidigare uppmätta data i svenska och utländska militära operationer. Vissa delar av etapp tre resulterade i fysiska belastningar som var på ungefär samma nivå som vid tävlingar i längre uthållighetsidrotter.

    Den höga belastningen resulterade i stora förändringar i fysiologiska parametrar och medicinska markörer. Vissa mätningar av muskelstyrka i armar och ben liksom maximal syreupptagning försämrades. Testosteron sjönk under hela övningen kraftigt. Dessa och andra uppmätta data talar för att fysiska arbetsförmågan – i förlängningen "stridsvärdet" – blev klart försämrat under övningen.

    Mätningen 12 timmar efter övningens avslut visade oväntade resultat. Den subjektiva ansträngningskänslan under standardiserat cykelarbete var klart förbättrat av 12-timmarsvilan efter övningen. Däremot var flertalet medicinska och fysiologiska värden oförändrade jämfört med värden vid testerna 12 timmar tidigare och därmed var de klart lägre än vid testet innan övningens start. Det är uppenbart att återhämtning av stridsvärdet inte kan bedömas subjektivt utan måste avgöras genom reliabla psykologiska och fysiologiska mätningar.

    Undersökningen har gett underlag för fortsatta studier rörande bland annat typer av energitillskott under övning, olika strategier för snabb återhämtning samt försök att finna markörer för individuella reaktionsmönster på "stridsvärde" under långvariga militära operationer.

  • 27.
    Cardinale, Daniele
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Research group for Mitokondriell funktion och metabolisk kontroll.
    Boushel, Robert
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Research group for Mitokondriell funktion och metabolisk kontroll.
    Ekblom-Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, The Research Unit for Movement, Health and Environment.
    Is the Ekblom-Bak Test a valid screening tool for Vo2peak in highly active individuals?2015Conference paper (Refereed)
    Abstract [en]

    Introduction

    Maximal oxygen consumption testing is suggested to be regularly included between training blocks of athletes in order to monitor changes in fitness throughout the season. However, despite the good reliability and validity of this physiological test, an expensive metabolic chart, and expert personnel are needed. Further, the maximal effort needed by the athlete makes this test difficult to be performed routinely. Therefore, it is important to develop valid tools that are also feasible for the estimation of the maximal oxygen consumption. The aim of this study was to validate the Ekblom-Bak test (EBT) (Ekblom-Bak et al., 2014) against an incremental test measuring peak VO2 by gas exchange on a cycle ergometer in well-trained individuals.

    Methods

    33 highly active individuals aged 34.5±6.6yrs (mean ± standard deviation (SD)) body mass 74.5±12kg, and height; 178± 9.3m) participated in the study. The EBT test was performed prior to the incremental exercise test to peak effort on a cycle ergometer for VO2peak assessment. Oxygen uptake was determined by an automated measuring system for oxygen uptake with a mixing chamber (OxygenPro, Jaeger GmbH, Germany) validated against the Douglas bag method resulting in a typical error of 2%. The mean difference and standard deviation of the differences between the EBT and measured VO2peak was calculated with Bland-Altman analysis.

    Results

    The measured mean and SD VO2peak was 4.1±0.8 L•min-1 for the whole group (male 4.4±0.6 L•min-1 and female 2.9±0.5 L•min-1). The mean differences between measured and estimated (EBT) VO2peak was 0.05 L•min-1 (95% CI; -0.15 to 0.25). CV was 13.2% in the whole group with no significant differences between sexes. For individuals with a VO2peak within the valid range of the EBT (VO2max 1.56 to 4.49 L•min-1, n=23), the mean differences between measured and estimate VO2peak was -0.22 L•min-1 (95% CI; -0.36 to -0.08), resulting in a CV of 8.2%. For individuals above the valid limit (n=10), the mean difference was 0.68L•min-1(95% CI; 0.47 to 0.98) with a CV of 6.9%. Discussion The Ekblom-Bak test is an easily applied and inexpensive screening tool for a population of highly active individuals within the current validity range, and may be used routinely in monitoring fitness.

    References

    Ekblom-Bak E, Björkman F, Hellenius ML, Ekblom B (2014). Scand J Med Sci Sports, 24(2), 319-326

  • 28.
    Ekblom Bak, Elin
    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.
    Ekblom, Örjan
    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.
    Stillasittandets effekter på barns hälsa är underbeforskat: Svårt att definiera säker gräns för ökad risk för ohälsa2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 25-26Article in journal (Other academic)
    Abstract [sv]

    Sammanfattat:

    De få studier som gjorts om stillasittande hos barn har fokuserat på övervikt och metabola risker.

    Den svaga kopplingen mellan stillasittande och metabola effekter kan bero på att dessa tillstånd inte har hunnit manifesteras hos barn.

    Fler longitudinella studier med upprepade mätpunkter och objektiv mätmetodik behövs.

    Andra utfall, t ex kognition, bör studeras.

  • 29.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    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.
    Olsson, Gustav
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Bolan, Kate
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    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.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Svenskar rör sig för lite2015In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 24, no 2, p. 30-31Article in journal (Other academic)
    Abstract [sv]

    För den som betraktar svenskarna som ett aktivt folk är det dags att tänka om. Bara sju procent av 50-65 åringarna är tillräckligt fysiskt aktiva, visar  resultat från den stora SCAPIS-studien.

  • 30.
    Ekblom-Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Olsson, Gustav
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Bergström, Göran
    Göteborgs universitet.
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    The Daily Movement Pattern and Fulfilment of Physical Activity Recommendations in Swedish Middle-Aged Adults: The SCAPIS Pilot Study.2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126336Article in journal (Refereed)
    Abstract [en]

    Different aspects of the daily movement pattern-sitting, light intensity physical activity, and moderate- and vigorous intensity physical activity-have each independently been associated with health and longevity. Previous knowledge of the amount and distribution of these aspects in the general Swedish population, as well as the fulfilment rate of physical activity recommendations, mainly relies on self-reported data. More detailed data assessed with objective methods is needed. The aim of the study was to present descriptive data on the daily movement pattern in a middle-aged Swedish population assessed by hip-worn accelerometers. The cohort consisted of 948 participants (51% women), aged 50 to 64 years, from the Swedish CArdioPulmonary bioImage pilot Study. In the total sample, 60.5% of accelerometer wear time was spent sitting, 35.2% in light physical activity and 3.9% in moderate- and vigorous physical activity. Men and participants with high educational level spent a larger proportion of time sitting, compared to women and participants with low educational level. Men and participants with a high educational level spent more time, and the oldest age-group spent less time, in moderate- and vigorous physical activity. Only 7.1% of the study population met the current national physical activity recommendations, with no gender, age or education level differences. Assessment of all three components of the daily movement pattern is of high clinical relevance and should be included in future research. As the fulfilment of national physical activity recommendations is very low and sitting time is very high in our middle-aged population, the great challenge remains to enhance the implementation of methods to increase the level of physical activity in this population.

  • 31.
    Mijwel, S.
    et al.
    Karolinska Institutet.
    Cardinale, Daniele A.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Sundberg, C. J.
    Karolinska Institutet.
    Wengstrom, Y.
    Karolinska Institutet.
    Rundqvist, H.
    Karolinska Institutet.
    Validation of two submaximal exercise tests in breast cancer patients undergoing chemotherapy treatment2015In: European Journal of Cancer (ISSN 0959-8049), 2015, Vol. 51, p. S300-S301Conference paper (Other academic)
  • 32.
    Ekblom-Bak, Elin
    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.
    Björkman, Frida
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Hellenius, Maj-Lis
    Karolinska Institutet.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    A new submaximal cycle ergometer test for prediction of VO(2max).2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 2, p. 319-326Article in journal (Refereed)
    Abstract [en]

    Maximal oxygen uptake (VO(2max) ) is an important, independent predictor of cardiovascular health and mortality. Despite this, it is rarely measured in clinical practice. The aim of this study was to create and evaluate a submaximal cycle ergometry test based on change in heart rate (HR) between a lower standard work rate and an individually chosen higher work rate. In a mixed population (n = 143) with regard to sex (55% women), age (21-65 years), and activity status (inactive to highly active), a model included change in HR per unit change in power, sex, and age for the best estimate of VO(2max) . The association between estimated and observed VO(2max) for the mixed sample was r = 0.91, standard error of estimate = 0.302 L/min, and mean measured VO(2max)  = 3.23 L/min. The corresponding coefficient of variation was 9.3%, a significantly improved precision compared with one of the most commonly used submaximal exercise tests, the Åstrand test, which in the present study was estimated to be 18.1%. Test-retest reliability analysis over 1 week revealed no mean difference in the estimated VO(2max) (-0.02 L/min, 95% confidence interval: -0.07-0.03). The new test is low-risk, easily administered, and valid for a wide capacity range, and is therefore suitable in situations as health evaluations in the general population.

  • 33.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    All aktivitet är bra aktivitet2014In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 23, no 1, p. 16-19Article in journal (Other academic)
    Abstract [sv]

    Alla vet att motion är bra för hälsan. Men en aktiv vardag är lika viktig, inte minst för äldre vuxna som inte kan röra sig lika lätt. Mindre stillasittande skulle ha stor betydelse för hjärt-kärlhälsan hos enskilda individer och för samhället i stort. Det visar en ny avhandling.

  • 34.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Det farliga midjemåttet: ny avhandling: Physical activity, cardiorespiratory fitness, and abdominal obesity in relation to cardiovascular disease risk: epidemiological studies2014In: Svensk idrottsmedicin, ISSN 1103-7652, Vol. 33, no 2, p. 20-23Article in journal (Other academic)
    Abstract [sv]

    Olika aspekter av fysisk aktivitet, alltifrån lågintensiv vardaglig aktivitet, till motion och en god kondition, är var och en viktiga för vår hjärt-kärlhälsa, till och med för hur länge vi lever. Detta visar en nyligen framlagd doktorsavhandling vid Karolinska institutet/Gymnastik- och idrottshögskolan. Dessutom presenteras i avhandlingen ett nytt submaximalt konditionstest på cykel.

  • 35. Hendo, Gina
    et al.
    Jakobsson, Madeleine
    Mattsson, C. Mikael
    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 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.
    Flockhart, Mikael
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Pontén, Marjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Slutövning GMU: "Aldrig ge upp", Amf1, Berga örlogsbas: Muskelfysiologiska resultat2014Report (Other academic)
    Abstract [sv]

    Energistatus, muskelfysiologiska data och fysiskt stridsvärde studerades före och efter en 8 dygn långa grundmilitär slutövning (GMU) vid AMF-1 Berga Örlogsskolor i månadsskiftet oktober november 2013.

    Totalt deltog 105 soldater i övningen, fördelat på 3 plutoner om vardera 35 soldater. En subgrupp på 24 soldater (8 kvinnor) bestående av 8 soldater från vardera pluton studerades mer ingående.

    Medelhjärtfrekvensen för de 6 soldater (2 kvinnor) som hade i stort sett kompletta mätningar från den 187 timmar långa övningen, inklusive viloperioder, var 88 ± 7 slag/minut. Utifrån hjärtfrekvensdata beräknades den totala energiomsättningen till i genomsnitt 44 000 ± 6 600 kcal, vilket motsvarar 5 600 ± 840 kcal per dygn och 235 ± 35 kcal/tim. Total energiförbrukning var i genomsnitt 39 000 kcal för kvinnorna och 46 500 kcal för männen. I övrigt noterades inte några betydande skillnader mellan kvinnor och män. Däremot var det stora individuella variationer i energiutgift, vilka till ca hälften berodde på skillnader i kroppsvikt. Med hänsyn till kroppsvikt och buren vikt var energiförbrukningen ca 3,1 ± 0,23 kcal per timme per kg totalvikt. Den individuella variationen beror på skillnad i buren vikt, på olika uppgifter och på individuella fysiologiska skillnader.

    Utifrån beräknat energiintag blev det totala energiunderskottet under övningen 12 000-15 000 kcal, vilket är ca 1 500-2 000 kcal per dygn. Viktminskningen under övningen var 2,9 kg för kvinnor och 3,7 kg för män. Denna viktminskning på >4 % leder troligen till försämrad uthållighetsförmåga.

    Den maximala muskelstyrkan i armar och ben var i stort sett oförändrade efter övningen, liksom den beräknade maximala syreupptagningsförmågan. Däremot upplevdes ett lågintensivt cykelarbete som betydligt tyngre efter övningen. Muskeluthållighet mättes inte i denna studie.

    Ett skjutprov om 5 skott i liggande på 100 m mot en tredjedelsfigur visade 64 deltagande soldater på en försämrad träffprocent från 90,5% före till 79,4 % efter övningen. Alla soldater hade minst en träff före medan 6 soldater hade alla bom efter övningen.

    Slutsatsen från studien är att GMU-övningen resulterade i ett stort energiunderskott. Stridsvärdet, bedömt från skjutprovet var klart försämrat. Maximala fysiologiska parametrar var i stort sett oförändrade, medan skattad ansträngning och därmed uthållighetsförmåga, försämrades.

  • 36.
    Flockhart, Mikael
    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. Militärmedicinska forskningsgruppen, Åstrand laboratoriet.
    Mattsson, C. Mikael
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Militärmedicinska forskningsgruppen, Åstrand laboratoriet.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology. Militärmedicinska forskningsgruppen, Åstrand laboratoriet.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group. Militärmedicinska forskningsgruppen, Åstrand laboratoriet.
    Slutövning GMU: ”Aldrig ge upp”, Amf1, Berga örlogsbas.: Rapport 4.2014Report (Other academic)
    Abstract [sv]

    Energistatus och förändring i fysiskt stridsvärde studerades i samband med en nästan 8 dygn långa grundmilitär slutövning (GMU) vid AMF-1 Berga Örlogsskolor i månadsskiftet oktober november 2013.

    Totalt deltog 105 soldater i övningen, fördelat på 3 plutoner om vardera 35 soldater. En subgrupp på 24 soldater (8 kvinnor) bestående av 8 soldater från vardera pluton studerades mer ingående.

    Medelhjärtfrekvensen för de 6 soldater (2 kvinnor) som hade i stort sett kompletta mätningar från den 187 timmar långa övningen, inklusive viloperioder, var 88 ± 7 slag/minut. Utifrån hjärtfrekvensdata beräknades den totala energiomsättningen till i genomsnitt 44 000 ± 6 600 kcal, vilket motsvarar 5 600 ± 840 kcal per dygn och 235 ± 35 kcal/tim. Total energiförbrukning var i genomsnitt 39 000 kcal för kvinnorna och 46 500 kcal för männen. I övrigt noterades inte några betydande skillnader mellan kvinnor och män. Däremot var det stora individuella variationer i energiutgift, vilka till ca hälften berodde på skillnader i kroppsvikt. Med hänsyn till kroppsvikt och buren vikt var energiförbrukningen ca 3,1 ± 0,23 kcal per timme per kg totalvikt. Den individuella variationen beror på skillnad i buren vikt, på olika uppgifter och på individuella fysiologiska skillnader.

    Utifrån beräknat energiintag blev det totala energiunderskottet under övningen 12 000-15 000 kcal, vilket är ca 1 500-2 000 kcal per dygn. Viktminskningen under övningen var 2,9 kg för kvinnor och 3,7 kg för män. Denna viktminskning på >4 % leder troligen till försämrad uthållighetsförmåga.

    Den maximala muskelstyrkan i armar och ben var i stort sett oförändrade efter övningen, liksom den beräknade maximala syreupptagningsförmågan. Däremot upplevdes ett lågintensivt cykelarbete som betydligt tyngre efter övningen. Muskeluthållighet mättes inte i denna studie.

    Ett skjutprov om 5 skott i liggande på 100 m mot en tredjedelsfigur visade 64 deltagande soldater på en försämrad träffprocent från 90,5% före till 79,4 % efter övningen. Alla soldater hade minst en träff före medan 6 soldater hade alla bom efter övningen.

    Slutsatsen från studien är att GMU-övningen resulterade i ett stort energiunderskott. Stridsvärdet, bedömt från skjutprovet var klart försämrat. Maximala fysiologiska parametrar var i stort sett oförändrade, medan skattad ansträngning och därmed uthållighetsförmåga, försämrades.

  • 37.
    Ekblom-Bak, Elin
    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. Karolinska institutet.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Vikström, M
    de Faire, U
    Hellénius, Mai-Lis
    Karolinska institutet.
    The importance of non-exercise physical activity for cardiovascular health and longevity.2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, p. 233-238Article in journal (Refereed)
    Abstract [en]

    Background Sedentary time is increasing in all societies and results in limited non-exercise physical activity (NEPA) of daily life. The importance of low NEPA for cardiovascular health and longevity is limited, especially in elderly.                                

    Aim To examine the association between NEPA and cardiovascular health at baseline as well as the risk of a first cardiovascular disease (CVD) event and total mortality after 12.5 years.

    Study design Cohort study.                                

    Material and methods Every third 60-year-old man and woman in Stockholm County was invited to a health screening study; 4232 individuals participated (78% response rate). At baseline, NEPA and exercise habits were assessed from a self-administrated questionnaire and cardiovascular health was established through physical examinations and laboratory tests. The participants were followed for an average of 12.5 years for the assessment of CVD events and mortality.                                

    Results At baseline, high NEPA was, regardless of regular exercise and compared with low NEPA, associated with more preferable waist circumference, high-density lipoprotein cholesterol and triglycerides in both sexes and with lower insulin, glucose and fibrinogen levels in men. Moreover, the occurrence of the metabolic syndrome was significantly lower in those with higher NEPA levels in non-exercising and regularly exercising individuals. Furthermore, reporting a high NEPA level, compared with low, was associated with a lower risk of a first CVD event (HR=0.73; 95% CI 0.57 to 0.94) and lower all-cause mortality (0.70; 0.53 to 0.98).                                

    Conclusions A generally active daily life was, regardless of exercising regularly or not, associated with cardiovascular health and longevity in older adults.                                

  • 38.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Att mäta stillasittande2013In: Långvarigt stillasittande: en hälsofara i tiden / [ed] Elin Ekblom Bak, Studentlitteratur, 2013, p. 79-102Chapter in book (Other academic)
  • 39.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Långvarigt stillasittande - ett riskbeteende2013In: Idrottsmedicin, ISSN 2001-3302, no 2, p. 14-17Article in journal (Other academic)
    Abstract [sv]

    Stillasittande innebär en hälsorisk som är skiljd från den risk som otillräcklig fysisk aktivitet utgör. Långvarig inaktivitet är alltså ett eget område med tidigare endast delvis kända riskfaktorer som kräver egna insatser för att motverka ohälsa.

  • 40.
    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.
    Långvarigt stillasittande: En hälsofara i tiden2013Collection (editor) (Other academic)
    Abstract [sv]

    Vetenskaplig evidens visar att långvarigt dagligt stillasittande, oberoende av övrig fysisk aktivitet och motion, innebär en ökad risk för flertalet av de stora folksjukdomarna samt förtida död. Stillasittande är således inte samma sak som brist på motion, utan de bör ses som två separata beteenden med delvis oberoende betydelse för utfallet hälsa och sjukdom.

    Stillasittande innebär frånvaro av muskelkontraktioner, muskulär inaktivitet, i de större muskelgrupperna i kroppen och karaktäriseras av en mycket låg energiomsättning. Långvarigt stillasittande ersätter framför allt den lågintensiva vardagliga aktiviteten, och genom att öka denna kan ett stillasittande beteende motverkas. I dag finns stora möjligheter, men också krav, på att vara stilla­sittande stora delar av den vakna tiden. Att arbeta med det stillasittande beteendet är således relevant för många olika professioner och yrkeskategorier; alltifrån den som möter individen i det enskilda samtalet, till samhällsplaneraren och beslutsfattaren.

    I denna bok beskrivs för första gången det stillasittande beteendet och bl.a. berörs den epidemiologiska forskningsgrunden hos såväl vuxna som barn, föreslagna mekanismer samt metoder för att mäta och motverka stillasittande. Dessutom ger fyra olika professioner sin syn på saken och hur dom har arbetat med det i sin yrkesroll.

    Innehåll

    • Epidemiologi och mekanismer
    • Stillasittande och psykisk ohälsa
    • Stillasittande hos barn och ungdomar
    • Att mäta stillasittande
    • Sambands- och bestämningsfaktorer för stillasittande
    • Metoder för att reducera ett stillasittande beteende
    • Allmänläkarens perspektiv på stillasittande
    • Sjuksköterskans perspektiv på stillasittande
    • Sjukgymnastens perspektiv på stillasittande
    • Hälsopedagogens perspektiv på stillasittande
  • 41.
    Ekblom-Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Nytt cykeltest för att mäta konditionen2013In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 22, no 1, p. 33-35Article in journal (Other academic)
    Abstract [sv]

    Sedan 1960-talet har Åstrandstestet varit ett av världens vanligaste sätt att mäta maximal syreupptagningsförmåga. Det nya Ekblom-Baktestet är lika enkelt och tidseffektivt, men  betydligt mer tillförlitligt. Felmarginalen på individnivå är halverad jämfört med Åstrandtestet.

  • 42.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Nytt submaximalt test för beräkning av maximal syreupptagning.2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 6, p. 271-Article in journal (Other academic)
  • 43.
    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 and Mats Börjesson's research group.
    Physical activity, cardiorespiratory fitness, and abdominal obesity in relation to cardiovascular disease risk: epidemiological studies2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Although Sweden saw a decline in death rates related to cardiovascular disease (CVD) between 1987 and 2011, it is still the most common cause of death for both women and men. Lifestyle-related factors such as inadequate physical activity (PA), poor cardiorespiratory fitness (CF), and excess body fat are all recognised as important predictors of CVD morbidity and mortality. More recently, studies have highlighted the possible detrimental effects of prolonged sitting, which mainly substitutes for daily non-exercise PA (NEPA). Conversely, more preferable levels of these lifestyle factors are associated with lower CVD risk and increased life expectancy. Despite the extensive research performed within this field, there is still no consensus.

    The main objective of this thesis was therefore to examine the interrelationship between different levels of PA, CF, and abdominal adiposity and their association with CVD risk factors, CVD morbidity, and longevity in population-based samples of Swedish men and women of different ages. A second objective was to develop a new and more precise method for estimation of CF in a mixed, healthy, population.

    The main findings were

    - In a cross-sectional population based random sample of Swedish men (n=781) and women (n=890) aged 20 to 65 years were CF and abdominal obesity each independently and strongly beneficially associated with individual CVD risk factors, as well as to a clustered CVD risk factor profile. For the clustered risk, each unit of fitness (ml·kg-1·min-1) was associated with a 5% decrease in risk and each unit of waist circumference (cm) with a 5% increase in risk. This was seen in women as well as men, younger as well as older people, and daily smokers as well as non-smokers; however, there were some differences within the subgroups.

    - In the same population, higher levels of self-reported PA and CF, but mainly the latter, were independently associated in a beneficial way with both individual and clustered CVD risk factors. Furthermore, a notable interaction of excess clustered CVD risk was shown for being insufficiently physical active according to general guidelines in combination with not being fit.

    - In a representative cohort of 60-year-old men (n=2039) and women (n=2193) in Stockholm County, a generally active daily life was associated with beneficial metabolic health at baseline and an approximately 30% lower risk for a first-time cardiovascular event and all-cause mortality, respectively, after 12.5 years. These relationships were independent of regular exercise.

    - A new submaximal cycle ergometer test for estimation of maximal oxygen uptake was developed. The test is simple, low-risk, and easily administered, and does not require laboratory equipment or expertise. In a mixed population (in terms of age, activity status, and gender), the test showed a significantly increased precision compared with one of the most commonly used submaximal exercise tests today.

    In conclusion, these results indicate that in clinical practice it is important to evaluate both PA and CF as well as abdominal obesity status. Regarding PA, it is important to highlight the separate beneficial associations of a daily active life including NEPA on the one hand, and intentional regular exercise on the other.

  • 44.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Engström, Lars-Magnus
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Forskningsgruppen för pedagogik, idrott och fritidskultur.
    Sambands- och bestämningsfaktorer för stillasittande2013In: Långvarigt stillasittande: en hälsofara i tiden / [ed] Elin Ekblom Bak, Studentlitteratur, 2013, p. 103-111Chapter in book (Other academic)
  • 45. Taube, Jill
    et al.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Hellénius, Mai-Lis
    Karolinska institutet.
    Stillasittande och psykisk ohälsa2013In: Långvarigt stillasittande: en hälsofara i tiden / [ed] Elin Ekblom Bak, Studentlitteratur, 2013, p. 47-55Chapter in book (Other academic)
  • 46.
    Ekblom Bak, Elin
    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.
    Börjesson, Mats
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Ekblom, Örjan
    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.
    Ekblom, Björn
    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.
    Större studier vid GIH2013In: Idrottsmedicin, ISSN 2001-3302, no 2, p. 5-10Article in journal (Other academic)
    Abstract [sv]

    På Åstrandslaboratoriet vid Gymnastik- och idrotthögskolan i Stockholm finns tradition och erfarenhet av att göra populationsundersökningar. För närvarande finns tre pågående projekt av populationskaraktär; Skola-Idrott-Hälsa (SIH), SCAPIS-undersökningen samt LIV-studierna.

  • 47.
    Ekblom, Björn
    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-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.
    Långvarigt stillasittande är en metabol riskfaktor2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 34-35, p. 1467-1470Article in journal (Other academic)
    Abstract [sv]

    Längre stunder av stillasittande, oberoende av övrig medel- och högintensiv fysisk aktivitet, ökar risken för flertalet av de stora folksjukdomarna och förtida död.

    Stillasittande innebär frånvaro av kontraktioner i de stora muskelgrupperna, dvs muskulär inaktivitet.

    Bakomliggande patogena mekanismer som kopplar långvarigt stillasittande till negativa hälsoeffekter har föreslagits vara låg energiomsättning, vilket leder till ansamling av visceralt fett och låggradig systemisk inflammation; uteblivna endokrina svar från den inaktiva skelettmuskulaturen med påföljande försämrad effekt i flera organ och vävnader samt låg s k skjuvspänning.

    Minskad tid i stillasittande och ökad lågintensiv vardaglig aktivitet är faktorer som kan motverka framtida ohälsa.

  • 48.
    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 and Mats Börjesson's research group.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    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.
    Temporal Trends In Cardiovascular Fitness Among Swedish Adolescents In Ninth Grade Between 1987 And 20072012In: Journal of General Internal Medicine, 2012, Vol. 27, p. 390-390Conference paper (Refereed)
  • 49.
    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.

  • 50.
    Ekblom, Örjan B
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Bak, Elin A M Ekblom
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Ekblom, Björn T
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Cross-sectional trends in cardiovascular fitness in Swedish 16-year-olds between 1987 and 2007.2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 4, p. 565-9Article in journal (Refereed)
    Abstract [en]

    AIM: We sought to investigate the temporal trends in estimated maximal aerobic capacity in adolescents (mean age 16.1).

    METHODS: Analyses were based on data from three population-based samples, collected in 1987 (n=221), 2001 (n=537) and 2007 (n=265). Subjects underwent sub-maximal ergometer testing. Absolute and relative aerobic capacities were estimated using the Åstrand-Ryhming nomogram.

    RESULTS: Compared to 1987, values for estimated relative and absolute maximal aerobic capacities were lower in 2001 and 2007, and values in 2007 were lower compared to 2001, in both boys and girls, except for absolute capacity between 1987 and 2001 in girls. The differences over time did not differ between genders. Absolute values changed from 3.0 and 2.5 L/min in 1987 to 2.5 and 2.2 L/min in 2007, for boys and girls, respectively. Relative values changed from 46.5 and 45.9 mL/min/kg in 1987 to 35.0 and 36.6 mL/min/kg, in 2007, for boys and girls, respectively.

    CONCLUSION: Based on earlier reports on the relationship between aerobic capacity and metabolic risk, the results from the present study provide argument that future public health will be affected negatively.

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