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  • 1.
    Larsson, Kristina
    Sophiahemmet University.
    Supporting healthy movement behaviours in people with metabolic risk, prediabetes, or type 2 diabetes in primary health care2023Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to investigate if a pedometer-based intervention inthe primary health care setting can support people with prediabetes or type 2 diabetestowards healthier movement behaviours. Moreover, health care professionals’experiences of supporting people with metabolic risk factors to increase theirphysical activity were explored.

    This thesis consists of four papers based on data from two research studies. Paper I,II, and III are based on a randomised controlled trial called the Sophia Step Study,which is a two-year, three-armed pedometer-based intervention. The three groupscomprised a multi-component group that received a pedometer and extracounselling, a single-component group that received a pedometer, and a controlgroup that received standard care.

    The aim of the Sophia Step Study was to support individuals with prediabetes or type2 diabetes in becoming regularly physically active by reporting their daily number ofsteps, with or without extra counselling. Paper IV is based on a qualitative interviewstudy that explored nurses’, physicians’, and physiotherapists’ experiences in primaryhealth care when supporting patients with metabolic risk factors to physical activity.In paper I, the effects of self-monitoring steps with or without counselling supportfor HbA1c, other cardiometabolic risk factors and physical activity during the twoyearintervention were evaluated. In paper II, the effects of the intervention wereevaluated on relative time in different movement behaviours. In paper III, predictorsassociated with intermediate and post intervention increases in steps were explored. Finally, in paper IV, barriers and facilitators perceived by health care professionalswho work within Swedish primary care to support people with metabolic risk factorsto increase their physical activity were explored.

    The results show that the Sophia Step Study did not have an effect on the primaryoutcome HbA1c. However, a significant effect was found for the multi-componentgroup on absolute time in moderate-to-vigorous physical activity during the entiretwo-year period, as well as for the single-component group at six months. No effect, however, was found for the absolute time in the other movement behaviours, thenumber of daily steps, any of the biomarkers or the anthropometric variables. Usingrelative time, instead of absolute time, when evaluating the effect showed a morepronounced effect in all movement behaviours within both intervention groups overthe two-year period. At six months, lower number of steps at baseline was asignificant predictor for increasing ≥500 steps per day. At 24 months, men, youngerparticipants, and those with higher self-efficacy at baseline had significantly higherodds for increasing ≥500 steps per day. Barriers and facilitators for supportingpeople with metabolic risk factors in increasing their physical activity, as experiencedby nurses, physiotherapists and physicians, were identified at multiple levels,represented by four generic categories: ‘Patient readiness for change’, ‘Supporting theprocess of change’, ‘The professional role’, and ‘The organisation of primary care’.

    The overall conclusion is that the self-monitoring of steps with a pedometer seems tobe an effective behaviour change technique in maintaining healthy movementbehaviours; however, the counselling component of the intervention did not seem toimprove the effect. In addition, the intervention did not find evidence for improvedmetabolic control or improved cardiometabolic risk factors. Moreover, barriers toand facilitators for supporting patients with metabolic risk factors can be found atseveral levels within primary care, from individual patients and health careprofessionals to the organisational level. In the primary health care setting, thisshould be emphasised when implementing support with the intention to increasephysical activity in people with metabolic risk factors, prediabetes or type 2 diabetes.

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  • 2.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Norman, Åsa
    Experiences of supporting persons with metabolic risk factors to increase physical activity level2022Conference paper (Other academic)
  • 3.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Norman, Åsa
    Health care professionals' experiences of supporting persons with metabolic risk factors to increase their physical activity level: A qualitative study in primary care2023In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 2, p. 116-131Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To be regularly physically active is of major importance for the health of people with metabolic risk factors. Many of these persons are insufficiently active and in need of support. This study aimed to explore barriers and facilitators perceived by health care professionals' within Swedish primary care in their work to support persons with metabolic risk factors to increase their physical activity.

    DESIGN: A qualitative design with focus group discussions was used. The data were analysed using qualitative content analysis with a manifest, inductive approach.

    SETTING: Primary health care in five Swedish healthcare regions.

    SUBJECTS: Nine physiotherapists, ten physicians and five nurses participated in six digital focus group discussions including two to six participants.

    RESULTS: Barriers and facilitators to supporting persons with metabolic risk factors to increase their physical activity were found within four generic categories, where the barriers and facilitators related to each generic category: 'Patient readiness for change', 'Supporting the process of change', 'The professional role', and 'The organisation of primary care'.

    CONCLUSION: The findings suggests that barriers and facilitators for supporting patients with metabolic risk factors can be found at several levels within primary care, from individual patient and the health care professionals to the organisational level. In the primary care setting, this should be highlighted when implementing support to increase physical activity in people with metabolic risk factors.KEY POINTSHealth care professionals within primary care are in a position to support people with metabolic risk factors to increase their physical activity.Barriers and facilitators to support the patients should be addressed at several levels within primary care.The study highlights factors on multiple levels such as professional responsibility, organisational prioritisation and resources, and the challenge to motivate behaviour change.

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  • 4.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    Onell, Clara
    Sophiahemmet University.
    Edlund, Klara
    Sophiahemmet University.
    Källberg, Henrik
    Sophiahemmet University.
    Holm, Lena W
    Sundberg, Tobias
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: A cohort study2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1207Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Changes in Swedish university students' lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex.

    METHODS: Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June-September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations.

    RESULTS: 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex.

    CONCLUSIONS: Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before.

    TRIAL REGISTRATION: ClinicalTrials.gov, NCT04465435 . 10/07/2020.

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  • 5.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    Onell, Clara
    Sophiahemmet University.
    Edlund, Klara
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Lifestyle behaviors in Swedish university students before and during the COVID-19 pandemic2021Conference paper (Other academic)
  • 6.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Self-efficacy and social support are not associated with objectively measured moderate to vigorous intensity physical activity among people with prediabetes and type 2 diabetes2020Conference paper (Other academic)
  • 7.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Norman, Åsa
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Predictors associated with an increase in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, article id 1290Article in journal (Refereed)
    Abstract [en]

    Background: This study aimed to explore predictors associated with intermediate (six months) and post-intervention (24 months) increases in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention.

    Methods: A secondary analysis was conducted based on data from people with prediabetes or type 2 diabetes from two intervention arms of the randomised controlled trial Sophia Step Study. Daily steps were measured with an ActiGraph GT1M accelerometer. Participants were divided into two groups based on their response to the intervention: Group 1) ≥ 500 increase in daily steps or Group 2) a decrease or < 500 increase in daily steps. Data from baseline and from six- and 24-month follow-ups were used for analysis. The response groups were used as outcomes in a multiple logistic regression together with baseline predictors including self-efficacy, social support, health-related variables, intervention group, demographics and steps at baseline. Predictors were included in the regression if they had a p-value < 0.2 from bivariate analyses.

    Results: In total, 83 participants were included. The mean ± SD age was 65.2 ± 6.8 years and 33% were female. At six months, a lower number of steps at baseline was a significant predictor for increasing ≥ 500 steps per day (OR = 0.82, 95% CI 0.69-0.98). At 24 months, women had 79% lower odds of increasing ≥ 500 steps per day (OR = 0.21, 95% CI 0.05-0.88), compared to men. For every year of increase in age, the odds of increasing ≥ 500 steps per day decreased by 13% (OR = 0.87, 95% CI 0.78-0.97). Also, for every step increase in baseline self-efficacy, measured with the Self-Efficacy for Exercise Scale, the odds of increasing ≥ 500 steps per day increased by 14% (OR = 1.14, 95% CI 1.02-1.27).

    Conclusions: In the Sophia Step Study pedometer intervention, participants with a lower number of steps at baseline, male gender, lower age or higher baseline self-efficacy were more likely to respond to the intervention with a step increase above 500 steps per day. More knowledge is needed about factors that influence response to pedometer interventions.

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  • 8.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    von Rosen, Philip
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Changes in physical activity behaviour over a period of two years in people with type 2 diabetes or prediabetes2021Conference paper (Other academic)
  • 9.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    von Rosen, Philip
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Changes in the activity composition over a period of two years in people with type 2 diabetes and prediabetes2021Conference paper (Other academic)
  • 10.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    von Rosen, Philip
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Relative time in physical activity and sedentary behaviour across a 2-year pedometer-based intervention in people with prediabetes or type 2 diabetes: A secondary analysis of a randomised controlled trial2023In: Journal of Activity, Sedentary and Sleep Behaviors, E-ISSN 2731-4391, Vol. 2, no 1, article id 10Article in journal (Refereed)
    Abstract [en]

    Background: People with prediabetes or type 2 diabetes (T2D) need to be physically active, including moderate-to-vigorous intensity physical activity (MVPA) and light-intensity physical activity (LIPA) and reduce time in sedentary behaviour (SB). Few studies have evaluated the effect of randomised controlled trials taking all movement behaviours into account. This study aimed to investigate the effects of a 2-year pedometer-based intervention in people with prediabetes or T2D on relative time in movement behaviours.

    Methods: Secondary analysis of longitudinal data on individuals with prediabetes or T2D from a three-armed randomised controlled trial, the Sophia Step Study, was conducted. The three groups were (1) a multi‑component group (self‑monitoring of steps with a pedometer plus counselling), (2) a single‑component group (self‑monitoring of steps with a pedometer, without counselling), and (3) a standard care group (control). The three behaviours MVPA, LIPA and SB during waking hours were measured with an ActiGraph GT1M accelerometer at baseline, 6, 12, 18 and 24 months. Relative time in MVPA, LIPA and SB for each participant at each time point was calculated and used as outcome measures. Linear mixed models assessed the effect of the intervention over time.

    Results: In total 184 participants with mean (SD) age 64.3 (7.6) years and 41% female was included. In the multi-component group, compared to the control group, a significant group-by-time interaction effect for relative time in all three behaviours was found at 6 and 18 months and for MVPA and SB at 24 months. In the single-component group, compared to the control group, an effect occurred in the MVPA and SB behaviours at 6 months and MVPA and LIPA at 24 months. The estimated marginal means ranged from 0.9 to 1.5% of more MVPA, 1.9–3.9% of less LIPA and from 0.5% of less SB to 1.7 more SB in the intervention groups compared to the control group.

    Conclusions: The findings show a beneficial effect on all behaviours over time in the two intervention groups compared to the control group. A more pronounced effect occurred in the multi-component intervention compared to the single-component intervention, implicating the importance of counselling in pedometer-based interventions.

    Trial registration ClinicalTrials.gov, NCT02374788

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  • 11.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    von Rosen, Philip
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    The effect of a pedometer-based intervention across two years, in people with type 2 diabetes and prediabetes: A compositional data analysis2022Conference paper (Other academic)
  • 12.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Larsson, Kristina
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    von Rosen, Philip
    Physical activity patterns among individuals with prediabetes or type 2 diabetes across two years: A longitudinal latent class analysis2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 6, article id 3667Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aimed to identify distinct profiles of physical activity (PA) patterns among individuals with prediabetes or type 2 diabetes participating in a two-year PA trial and to investigate predictors of the profiles.

    METHODS: Data (n = 168, collected 2013-2020) from the cohort of a randomized trial aimed at increasing PA in individuals with prediabetes and type 2 diabetes were used. PA and sedentary behaviours were assessed by waist-worn ActiGraph GT1M accelerometers at baseline and at 6, 12, 18 and 24 months. Fifteen PA and sedentary variables were entered into a latent class mixed model for multivariate longitudinal outcomes. Multinominal regression analysis modelled profile membership based on baseline activity level, age, gender, BMI, disease status and group randomisation.

    RESULTS: Two profiles of PA patterns were identified: "Increased activity" (n = 37, 22%) included participants increasing time in PA and decreasing sedentary time. "No change in activity" (n = 131, 78%) included participants with no or minor changes. "Increased activity" were younger (p = 0.003) and more active at baseline (p = 0.011), compared to "No change in activity". No other predictor was associated with profile membership.

    CONCLUSIONS: A majority of participants maintained PA and sedentary patterns over two years despite being part of a PA intervention. Individuals improving PA patterns were younger and more active at baseline.

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  • 13.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Larsson, Kristina
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Yngve, Agneta
    Brismar, Kerstin
    Ainsworth, Barbara
    Åberg, Linda
    Johansson, Unn-Britt
    Sophiahemmet University.
    Effects of a three-armed randomised controlled trial using self-monitoring of daily steps with and without counselling in prediabetes and type 2 diabetes: The Sophia Step Study2021In: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 18, no 1, article id 121Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This aimed to evaluate the effects of self-monitoring of daily steps with or without counselling support on HbA1c, other cardiometabolic risk factors and objectively measured physical activity (PA) during a 2-year intervention in a population with prediabetes or type 2 diabetes.

    METHODS: The Sophia Step Study was a three-armed parallel randomised controlled trial. Participants with prediabetes or type 2 diabetes were recruited in a primary care setting. Allocation (1:1:1) was made to a multi-component intervention (self-monitoring of steps with counselling support), a single-component intervention (self-monitoring of steps without counselling support) or standard care. Data were collected for primary outcome HbA1c at baseline and month 6, 12, 18 and 24. Physical activity was assessed as an intermediate outcome by accelerometer (ActiGraph GT1M) for 1 week at baseline and the 6-, 12-, 18- and 24-month follow-up visits. The intervention effects were evaluated by a robust linear mixed model.

    RESULTS: In total, 188 subjects (64, 59, 65 in each group) were included. The mean (SD) age was 64 (7.7) years, BMI was 30.0 (4.4) kg/m2 and HbA1c was 50 (11) mmol/mol, 21% had prediabetes and 40% were female. The dropout rate was 11% at 24 months. Effect size (CI) for the primary outcome (HbA1c) ranged from -1.3 (-4.8 to 2.2) to 1.1 (-2.4 to 4.6) mmol/mol for the multi-component vs control group and from 0.3 (-3.3 to 3.9) to 3.1 (-0.5 to 6.7) mmol/mol for the single-component vs control group. Effect size (CI) for moderate-to-vigorous physical activity ranged from 8.0 (0.4 to 15.7) to 11.1 (3.3 to 19.0) min/day for the multi-component vs control group and from 7.6 (-0.4 to 15.6) to 9.4 (1.4 to 17.4) min/day for the single-component group vs control group.

    CONCLUSION: This 2-year intervention, including self-monitoring of steps with or without counselling, prevented a decrease in PA but did not provide evidence for improved metabolic control and cardiometabolic risk factors in a population with prediabetes or type 2 diabetes.

    TRIAL REGISTRATION: ClinicalTrials.gov, NCT02374788 . Registered 2 March 2015-Retrospectively registered.

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