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

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

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

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

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

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

  • 2.
    Nooijen, Carla F J
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska institutet.
    Del Pozo-Cruz, Borja
    Australian Catholic University, Sydney.
    Nyberg, Gisela
    Karolinska institutet.
    Sanders, Taren
    Australian Catholic University, Sydney.
    Galanti, Maria R
    Karolinska institutet.
    Forsell, Yvonne
    Karolinska institutet.
    Are changes in occupational physical activity level compensated by changes in exercise behavior?2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 5, p. 940-943Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 3.
    Ekstedt, Mirjam
    et al.
    KTH.
    Nyberg, Gisela
    Karolinska Institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Ingre, Mikael
    Stockholms Universitet.
    Marcus, Claude
    Karolinska Insitutete.
    Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: a cross-sectional study.2013In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 22, no 10, p. 82-89Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHOD:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 4.
    Nyberg, Gisela
    et al.
    Karolinska institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Stillasittande hos barn och ungdomar2013In: Långvarigt stillasittande: en hälsofara i tiden / [ed] Elin Ekblom Bak, 2013, p. 57-78Chapter in book (Other academic)
  • 5.
    Danielsson, Pernilla
    et al.
    Karolinska Institutet.
    Svensson, Viktoria
    Karolinska Institutet.
    Kowalski, Jan
    Karolinska Institutet.
    Nyberg, Gisela
    Karolinska Institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Marcus, Claude
    Karolinska Institutet.
    Importance of age for 3-year continuous behavioral obesity treatment success and dropout rate.2012In: Obesity Facts, ISSN 1662-4025, E-ISSN 1662-4033, Vol. 5, no 1, p. 34-44Article in journal (Refereed)
    Abstract [en]

    Abstract

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

  • 6.
    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.

  • 7. Nyberg, Gisela
    et al.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Marcus, Claude
    A 4-Year Cluster-Randomised Controlled Intervention Study on Physical Activity Pattern and Sedentary Behaviour in Children2011In: Medicine and Science in Sport and Exercise, 2011, Vol. 43, suppl 15, p. 24-24Conference paper (Refereed)
    Abstract [en]

    PURPOSE: The purpose of the present study was to examine the effects of a cluster-randomised, controlled school-based intervention (the STOPP-study) on objectively measured sedentary time, time spent in light intensity activity and in moderate to vigorous physical activity (MVPA).

    METHODS: A total of 1538 children in grades 1-4 from ten selected schools in Stockholm county area were included. Schools were randomised as intervention (n=5) or control (n=5). Physical activity was aimed to increase by 30 min -1day during school time and sedentary behavior was restricted during after school care time. Physical activity was measured by accelerometry. Percentage of time spent sedentary (below 1.5 METs), in light (between 1.5 and 3 METs), and in MVPA (above 3 METs) were primary outcome variables.

    RESULTS: Adjusted for age, gender and calendar year, children in intervention schools spent less time sedentary, compared to children in control schools (32.3% vs. 33.4% of registered time, P=0.03) and more time in MVPA (28.5% vs. 27.6%, P=0.05). Children in the intervention group spent more time in MVPA (37.2% vs. 34.9%, P=0.002) and less time sedentary (22.0% vs. 24.3%, P<0.001) during after school care time. Normal weight and overweight children in intervention schools spent more time in MVPA and less time sedentary during after school care time compared to children in the control schools. Overweight children in the intervention group spent more time in light intensity activity during evening time. There was a trend for less sedentary activities in overweight intervention children during evening time. The results were attenuated after adjustment for the sampling variation between schools.

    CONCLUSIONS: There were indications of differences between intervention and control groups in time spent sedentary and in MVPA among normal weight and overweight children. Although differences were not statistically significant after adjustment for the cluster effect, the present paper provides argument for school-based interventions in order to decrease sedentary behaviour and increase physical activity.

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