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  • 1.
    Bergevi, Julia
    et al.
    Sophiahemmet University.
    Andermo, Susanne
    Woldamanuel, Yohannes
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    User perceptions of eHealth and mHealth services promoting physical activity and healthy diets: Systematic review2022In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 9, no 2, article id e34278Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity and a diet that follows general recommendations can help to prevent noncommunicable diseases. However, most adults do not meet current recommended guidelines, and support for behavior change needs to be strengthened. There is growing evidence that shows the benefits of eHealth and mobile health (mHealth) services in promoting healthy habits; however, their long-term effectiveness is uncertain because of nonadherence.

    OBJECTIVE: We aimed to explore users' perceptions of acceptability, engagement, and usability of eHealth and mHealth services that promote physical activity, healthy diets, or both in the primary or secondary prevention of noncommunicable diseases.

    METHODS: We conducted a systematic review with a narrative synthesis. We performed the literature search in PubMed, PsycINFO, and CINAHL electronic databases in February 2021 and July 2021. The search was limited to papers published in English between 2016 and 2021. Papers on qualitative and mixed method studies that encompassed eHealth and mHealth services for adults with a focus on physical activity, healthy diet, or both in the primary or secondary prevention of noncommunicable diseases were included. Three authors screened the studies independently, and 2 of the authors separately performed thematic analysis of qualitative data.

    RESULTS: With an initial finding of 6308 articles and the removal of 427 duplicates, 23 articles were deemed eligible for inclusion in the review. Based on users' preferences, an overarching theme-eHealth and mHealth services provide value but need to be tailored to individual needs-and 5 subthemes-interactive and integrated; varying and multifunctional; easy, pedagogic, and attractive; individualized and customizable; and reliable-emerged.

    CONCLUSIONS: New evidence on the optimization of digital services that promote physical activity and healthy diets has been synthesized. The findings represent users' perceptions of acceptability, engagement, and usability of eHealth and mHealth services and show that services should be personalized, dynamic, easily manageable, and reliable. These findings can help improve adherence to digital health-promoting services.

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  • 2. Bergman, Patrick
    et al.
    Hagströmer, Maria
    Sophiahemmet University.
    No one accelerometer-based physical activity data collection protocol can fit all research questions2020In: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 20, no 1, article id 141Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Measuring physical activity and sedentary behavior accurately remains a challenge. When describing the uncertainty of mean values or when making group comparisons, minimising Standard Error of the Mean (SEM) is important. The sample size and the number of repeated observations within each subject influence the size of the SEM. In this study we have investigated how different combinations of sample sizes and repeated observations influence the magnitude of the SEM.

    METHODS: A convenience sample were asked to wear an accelerometer for 28 consecutive days. Based on the within and between subject variances the SEM for the different combinations of sample sizes and number of monitored days was calculated.

    RESULTS: Fifty subjects (67% women, mean ± SD age 41 ± 19 years) were included. The analyses showed, independent of which intensity level of physical activity or how measurement protocol was designed, that the largest reductions in SEM was seen as the sample size were increased. The same magnitude in reductions to SEM was not seen for increasing the number of repeated measurement days within each subject.

    CONCLUSION: The most effective way of reducing the SEM is to have a large sample size rather than a long observation period within each individual. Even though the importance of reducing the SEM to increase the power of detecting differences between groups is well-known it is seldom considered when developing appropriate protocols for accelerometer based research. Therefore the results presented herein serves to highlight this fact and have the potential to stimulate debate and challenge current best practice recommendations of accelerometer based physical activity research.

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  • 3. Bergqvist-Norén, Linnea
    et al.
    Johansson, Elin
    Xiu, Lijuan
    Hagman, Emilia
    Marcus, Claude
    Hagströmer, Maria
    Sophiahemmet University.
    Patterns and correlates of objectively measured physical activity in 3-year-old children2020In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 20, no 1, article id 209Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To increase the knowledge about physical activity (PA) patterns and correlates among children under the age of 4, there is a need for study's using objective measurements. The aim of this study was therefore to investigate if objectively measured PA among 3-year-old children differed between day of week and time of day and whether it correlated to child weight status and sex as well as parental weight status and education.

    METHODS: Totally 61 children (51% girls) aged 3, participating in Early Stockholm Obesity Prevention Project were included. PA was measured with a tri-axial accelerometer (ActiGraph GT3X+) worn on the non-dominant wrist for one week. The main outcome was average PA expressed as counts per minute from the vector magnitude. PA and demographics/family-related factors were collected at baseline and at age 3. To analyze the results simple linear regression, ANOVA and paired t-tests were performed.

    RESULTS: The mean number of valid days was 6.7 per child. The children were more active on weekdays than weekends (p < 0.01) and the hourly pattern differed over the day with children being most active midmorning and midafternoon (p = 0.0001). Children to parents with low education were more active (p = 0.01) than those with highly educated parents. No differences in PA by child weight status, sex nor parental weight status were found.

    CONCLUSIONS: PA in 3-year-old children was lower during weekends than weekdays and varied over the day. Boys and girls had similar PA patterns, these patterns were independent of child or parental weight status. Children to parents with low education were more active than their counterparts. The fact that PA differed between weekdays and weekends indicates that PA might be affectable in 3-year-old children.

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  • 4. Chastin, Sebastien
    et al.
    McGregor, Duncan
    Palarea-Albaladejo, Javier
    Diaz, Keith M
    Hagströmer, Maria
    Sophiahemmet University.
    Hallal, Pedro Curi
    van Hees, Vincent T
    Hooker, Steven
    Howard, Virginia J
    Lee, I-Min
    von Rosen, Philip
    Sabia, Séverine
    Shiroma, Eric J
    Yerramalla, Manasa S
    Dall, Philippa
    Joint association between accelerometry-measured daily combination of time spent in physical activity, sedentary behaviour and sleep and all-cause mortality: A pooled analysis of six prospective cohorts using compositional analysis2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no 22, p. 1277-1285, article id bjsports-2020-102345Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the joint associations of daily time spent in different intensities of physical activity, sedentary behaviour and sleep with all-cause mortality.

    METHODS: Federated pooled analysis of six prospective cohorts with device-measured time spent in different intensities of physical activity, sedentary behaviour and sleep following a standardised compositional Cox regression analysis.

    PARTICIPANTS: 130 239 people from general population samples of adults (average age 54 years) from the UK, USA and Sweden.

    MAIN OUTCOME: All-cause mortality (follow-up 4.3-14.5 years).

    RESULTS: Studies using wrist and hip accelerometer provided statistically different results (I2=92.2%, Q-test p<0.001). There was no association between duration of sleep and all-cause mortality, HR=0.96 (95% CI 0.67 to 1.12). The proportion of time spent in moderate to vigorous physical activity was significantly associated with lower risk of all-cause mortality (HR=0.63 (95% CI 0.55 to 0.71) wrist; HR=0.93 (95% CI 0.87 to 0.98) hip). A significant association for the ratio of time spent in light physical activity and sedentary time was only found in hip accelerometer-based studies (HR=0.5, 95% CI 0.42 to 0.62). In studies based on hip accelerometer, the association between moderate to vigorous physical activity and mortality was modified by the balance of time spent in light physical activity and sedentary time.

    CONCLUSION: This federated analysis shows a joint dose-response association between the daily balance of time spent in physical activity of different intensities and sedentary behaviour with all-cause mortality, while sleep duration does not appear to be significant. The strongest association is with time spent in moderate to vigorous physical activity, but it is modified by the balance of time spent in light physical activity relative to sedentary behaviour.

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  • 5. Dohrn, Ing-Mari
    et al.
    Welmer, Anna-Karin
    Hagströmer, Maria
    Sophiahemmet University.
    Accelerometry-assessed physical activity and sedentary time and associations with chronic disease and hospital visits: a prospective cohort study with 15 years follow-up2019In: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 16, no 1, article id 125Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking.

    OBJECTIVE: To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days.

    METHODS: In total, 1220 women and men, 18-75 years, from the population-based Sweden Attitude Behaviour and Change study 2000-2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay.

    RESULTS: Over a follow-up of 14.4 years (SD = 1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48-0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33-0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR = 0.56, 95% CI: 0.37-0.85). Higher sedentary time increased the risk of in-hospital days. (IRR = 2.38, 95% CI: 1.20-4.74).

    CONCLUSION: This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message "sit less and move more".

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  • 6. Franzén, Erika
    et al.
    Johansson, Hanna
    Freidle, Malin
    Ekman, Urban
    Wallén, Martin Benka
    Schalling, Ellika
    Lebedev, Alexander
    Lövdén, Martin
    Holmin, Staffan
    Svenningsson, Per
    Hagströmer, Maria
    Sophiahemmet University.
    The EXPANd trial: effects of exercise and exploring neuroplastic changes in people with Parkinson's disease2019In: BMC Neurology, E-ISSN 1471-2377, Vol. 19, no 1, article id 280Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parkinson's disease (PD) affects many physiological systems essential for balance control. Recent studies suggest that intensive and cognitively demanding physical exercise programs are capable of inducing plastic brain changes in PD. We have developed a highly challenging balance training (the HiBalance) program that emphasizes critical aspects of balance control through progressively introducing more challenging exercises which incorporates dual-tasking. Earlier studies have shown it to be effective in improving balance, gait and dual-tasking. The study design has thereafter been adjusted to link intervention-induced behavioral changes to brain morphology and function. Specifically, in this randomized controlled trial, we will determine the effects of the HiBalance program on balance, gait and cognition and relate this to task-evoked functional MRI (fMRI), as well as brain-derived neurotrophic factor (BDNF) in participants with mild-moderate PD.

    METHODS: One hundred participants with idiopathic PD, Hoehn & Yahr stage 2 or 3, ≥ 60 years of age, ≥ 21 on Montreal Cognitive Assessment will be recruited in successive waves and randomized into either the HiBalance program or to an active control group (the HiCommunication program, targeting speech and communication). Both interventions will be performed in small groups, twice a week with 1 h sessions for 10 weeks. In addition, a 1 h, once a week, home exercise program will also be performed. A double-blinded design will be used. At the pre- and post-assessments, participants will be assessed on balance (main outcome), gait, cognitive functions, physical activity, voice/speech function, BDNF in serum and fMRI (3 T Philips) during performance of motor-cognitive tasks.

    DISCUSSION: Since there is currently no cure for PD, findings of neuroplastic brain changes in response to exercise would revolutionize the way we treat PD, and, in turn, provide new hope to patients for a life with better health, greater independence and improved quality of life.

    TRIAL REGISTRATION: ClincalTrials.gov: NCT03213873, first posted July 11, 2017.

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  • 7. Jakobsson, Max
    et al.
    Hagströmer, Maria
    Sophiahemmet University.
    Lotzke, Hanna
    von Rosen, Philip
    Lundberg, Mari
    Sophiahemmet University.
    Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder2023In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 24, article id 874Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Movement behaviours, such as sedentary behaviour (SB) and moderate to vigorous physical activity (MVPA), are linked with multiple aspects of health and can be influenced by various pain-related psychological factors, such as fear of movement, pain catastrophising and self-efficacy for exercise. However, the relationships between these factors and postoperative SB and MVPA remain unclear in patients undergoing surgery for lumbar degenerative conditions. This study aimed to investigate the association between preoperative pain-related psychological factors and postoperative SB and MVPA in patients with low back pain (LBP) and degenerative disc disorder at 6 and 12 months after lumbar fusion surgery.

    METHODS: Secondary data were collected from 118 patients (63 women and 55 men; mean age 46 years) who underwent lumbar fusion surgery in a randomised controlled trial. SB and MVPA were measured using the triaxial accelerometer ActiGraph GT3X+. Fear of movement, pain catastrophising and self-efficacy for exercise served as predictors. The association between these factors and the relative time spent in SB and MVPA 6 and 12 months after surgery was analysed via linear regression models, adjusting for potential confounders.

    RESULTS: Preoperative fear of movement was significantly associated with relative time spent in SB at 6 and 12 months after surgery (β = 0.013, 95% confidence interval = 0.004 to 0.022, p = 0.007). Neither pain catastrophising nor self-efficacy for exercise showed significant associations with relative time spent in SB and MVPA at these time points.

    CONCLUSIONS: Our study demonstrated that preoperative fear of movement was significantly associated with postoperative SB in patients with LBP and degenerative disc disorder. This finding underscores the potential benefits of preoperative screening for pain-related psychological factors, including fear of movement, preoperatively. Such screenings could aid in identifying patients who might benefit from targeted interventions to promote healthier postoperative movement behaviour and improved health outcomes.

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  • 8. Johansson, Hanna
    et al.
    Franzén, Erika
    Roaldsen, Kirsti Skavberg
    Hagströmer, Maria
    Sophiahemmet University.
    Leavy, Breiffni
    Controlling the uncontrollable: Perceptions of balance in people with parkinson disease2019In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, no 11, p. 1501-1510, article id pzz117Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exercise improves balance in Parkinson disease (PD), yet the majority of people with the diagnosis are physically inactive. Insights gained from understanding how people with PD (PwPD) make sense of their symptoms and their ability to control them may inform the communication strategies and motivational approaches adopted by physical therapists. No previous study has qualitatively explored how PwPD perceive the concept of balance and the beliefs they hold concerning their ability to affect balance.

    OBJECTIVE: This study aimed to explore the meaning of balance for PwPD and the beliefs they hold regarding their ability to influence their balance in everyday life.

    DESIGN: The design is a qualitative study with an inductive approach.

    METHODS: In-depth interviews were conducted with 18 participants with PD (age range 46 to 83 years, Hoehn and Yahr range 1 to 4), and transcripts were analyzed using qualitative content analysis.

    RESULTS: Five main themes emerged from the analysis: remaining in control over the body; adapting behavior to deal with uncertainty; directing focus to stay one step ahead; resilience as a defense, and exercise beliefs and reservations. Interpretation of the underlying patterns in the main themes yielded the overarching theme of focus and determination to regain control over shifting balance.

    CONCLUSIONS: The concept of balance was perceived as both bodily equilibrium and mind-body interplay and was described in the context of remaining in control over one's body and everyday life. Cognitive resources were utilized in order to direct focus and attention during balance-challenging situations in a process involving internal dialogue. Even participants who did not express beliefs in their ability to affect balance through exercise used psychological resilience to counter the challenges of impaired balance.

  • 9. Johansson, Hanna
    et al.
    Freidle, Malin
    Ekman, Urban
    Schalling, Ellika
    Leavy, Breiffni
    Svenningsson, Per
    Hagströmer, Maria
    Sophiahemmet University.
    Franzén, Erika
    Feasibility aspects of exploring exercise-induced neuroplasticity in Parkinson's disease: A pilot randomized controlled trial2020In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, Vol. 2020, article id 2410863Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies indicate that exercise can induce neuroplastic changes in people with Parkinson's disease (PwPD). Reports of feasibility outcomes from existing pilot trials however are, of date, insufficient to enable replication by others in larger definitive trials.

    Objective: To evaluate trial design for a definitive trial by exploring process and scientific feasibility.

    Methods: The trial design was a parallel-group RCT pilot with a 1 : 1 allocation ratio to either HiBalance or an active control group (HiCommunication). Both groups received one-hour sessions twice weekly, plus home exercises weekly, for 10 weeks. Participants with mild-to-moderate Parkinson's disease (PD) were recruited via advertisement. Assessment included physical performance, structural and functional MRI, blood sampling, neuropsychological assessment, and speech/voice assessment. Process and scientific feasibility were monitored throughout the study. Process feasibility involved recruitment, participant acceptability of assessments and interventions, assessment procedures (focus on imaging, blood sampling, and dual-task gait analysis), and blinding procedures. Scientific feasibility involved trends in outcome response and safety during group training and home exercises. Data are presented in median, minimum, and maximum values. Changes from pre- to postintervention are reported descriptively.

    Results: Thirteen participants were included (4 women, mean age 69.7 years), with a recruitment rate of 31%. Attendance rates and follow-up questionnaires indicated that both groups were acceptable to participate. Image quality was acceptable; however, diplopia and/or sleepiness were observed in several participants during MRI. With regard to dual-task gait performance, there appeared to be a ceiling effect of the cognitive tasks with seven participants scoring all correct answers at pretest. Blinding of group allocation was successful for one assessor but was broken for half of participants for the other.

    Conclusions: The overall trial design proved feasible to perform, but further strengthening ahead of the definitive RCT is recommended, specifically with respect to MRI setup, cognitive dual-tasks during gait, and blinding procedures. This trial is registered with NCT03213873.

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  • 10. Johansson, Hanna
    et al.
    Hagströmer, Maria
    Sophiahemmet University.
    Grooten, Wilhelmus J A
    Franzén, Erika
    Exercise-induced neuroplasticity in Parkinson's disease: A metasynthesis of the literature2020In: Neural Plasticity, ISSN 2090-5904, E-ISSN 1687-5443, Vol. 2020, article id 8961493Article, review/survey (Refereed)
    Abstract [en]

    Parkinson's disease (PD) is a neurodegenerative disorder for which there is currently only symptomatic treatment. During the last decade, there has been an increased interest in investigating physical exercise as a neuroprotective mechanism in PD. Animal studies have suggested that exercise may in fact induce neuroplastic changes, but evidence in humans is still scarce. A handful of reviews have previously reported on exercise-induced neuroplasticity in humans with PD, but few have been systematic, or have mixed studies on both animals and humans, or focused on one neuroplastic outcome only. Here, we provide a systematic review and metasynthesis of the published studies on humans in this research field where we have also included different methods of evaluating neuroplasticity. Our results indicate that various forms of physical exercise may lead to changes in various markers of neuroplasticity. A narrative synthesis suggests that brain function and structure can be altered in a positive direction after an exercise period, whereas a meta-analysis on neurochemical adaptations after exercise points in disparate directions. Finally, a GRADE analysis showed that the current overall level of evidence for exercise-induced neuroplasticity in people with PD is very low. Our results demonstrate that even though the results in this area point in a positive direction, researchers need to provide studies of higher quality using more rigorous methodology.

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  • 11.
    Kullenberg, Helena
    et al.
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Nyström, Thomas
    Kumlin, Maria
    Sophiahemmet University.
    Svedberg, Marie
    Sophiahemmet University.
    Correlations between insulin-degrading enzyme and metabolic markers in patients diagnosed with type 2 diabetes, Alzheimer's disease, and healthy controls: A comparative studyManuscript (preprint) (Other academic)
  • 12.
    Kullenberg, Helena
    et al.
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Nyström, Thomas
    Kumlin, Maria
    Sophiahemmet University.
    Svedberg, Marie
    Sophiahemmet University.
    Correlations between insulin-degrading enzyme and metabolic markers in patients diagnosed with type 2 diabetes, Alzheimer's disease, and healthy controls: A comparative study2023In: Endocrine, ISSN 1355-008X, E-ISSN 1559-0100Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study aimed to explore correlations between insulin-degrading enzyme (IDE) and markers of metabolic function in a group of patients diagnosed with type 2 diabetes mellitus (T2DM) or Alzheimer's disease (AD) and metabolically healthy volunteers.

    METHOD: We included 120 individuals (47 with T2DM, 9 with AD, and 64 healthy controls). Serum levels of IDE were measured with commercial kits for ELISA. Differences in IDE levels between groups were analyzed with non-parametric ANCOVA, and correlations were analyzed with Spearman's rank correlations. We also investigated the influence of age, sex, and the use of insulin on the correlation using a non-parametric version of partial correlation.

    RESULTS: Patients diagnosed with T2DM had higher IDE levels than patients diagnosed with AD and healthy controls after adjustment for age and sex. IDE was increasingly associated with body mass index (BMI), fasting blood glucose, C-peptide, hemoglobin A1c (HbA1c), insulin resistance, and triglycerides. In stratified analyses, we found a decreasing partial correlation between IDE and HbA1c in patients diagnosed with AD and a decreasing partial correlation between IDE and C-peptide in healthy controls. In patients diagnosed with T2DM, we found no partial correlations.

    CONCLUSION: These results indicate that IDE is essential in metabolic function and might reflect metabolic status, although it is not yet a biomarker that can be utilized in clinical practice. Further research on IDE in human blood may provide crucial insights into the full function of the enzyme.

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  • 13.
    Kullenberg, Helena
    et al.
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Nyström, Thomas
    Kumlin, Maria
    Sophiahemmet University.
    Svedberg, Marie
    Sophiahemmet University.
    Increased levels of insulin-degrading enzyme in patients with type 2 diabetes mellitus2022In: Endocrine, ISSN 1355-008X, E-ISSN 1559-0100, Vol. 77, no 3, p. 561-565Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Decreasing levels of serum insulin-degrading enzyme (IDE) have been associated with an increased risk for Alzheimer´s disease (AD) in patients with type 2 diabetes mellitus (T2DM). Research on serum IDE levels in patients with T2DM is sparse and the aim of this study was to explore serum levels of IDE in patients with T2DM.

    METHOD: Blood serum samples were obtained from a biobank. Samples from subjects with T2DM and without metabolic disease were divided into subgroups; lifestyle treatment (n = 10), oral antidiabetic treatment (n = 17), insulin treatment (n = 20) and metabolically healthy controls (n = 18). Serum levels of IDE were analysed using specific ELISA assays.

    RESULTS: Serum levels of IDE were elevated in subjects with T2DM compared to metabolically healthy individuals (p = 0.033). No significant differences were detected between treatment subgroups.

    CONCLUSION: The present study indicates that patients with T2DM have increased serum IDE levels, compared to metabolically healthy individuals. However, for IDE to be clinically useful as a biomarker, its full function and possible use needs to be further elucidated in larger studies showing reproducible outcomes.

  • 14. Kuster, Roman P
    et al.
    Grooten, Wilhelmus J A
    Baumgartner, Daniel
    Blom, Victoria
    Hagströmer, Maria
    Sophiahemmet University.
    Ekblom, Örjan
    Detecting Prolonged Sitting Bouts with the ActiGraph GT3X2020In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 30, no 3, p. 572-582Article in journal (Refereed)
    Abstract [en]

    The ActiGraph has a high ability to measure physical activity, however, it lacks an accurate posture classification to measure sedentary behaviour. The aim of the present study was to develop an ActiGraph (waist-worn, 30Hz) posture classification to detect prolonged sitting bouts, and to compare the classification to proprietary ActiGraph data. The activPAL, a highly valid posture classification device, served as reference criterion.1 Both sensors were worn by 38 office workers over a median duration of 9 days. An automated feature selection extracted the relevant signal information for a minute based posture classification. The machine-learning algorithm with optimal feature number to predict the time in prolonged sitting bouts (≥5 and ≥10 minutes) was searched and compared to the activPAL using Bland-Altman statistics. The comparison included optimised and frequently used cut-points (100 and 150 counts-per-minute (cpm), with and without low-frequency-extension (LFE) filtering). The new algorithm predicted the time in prolonged sitting bouts most accurate (bias ≤7 minutes/day). Of all proprietary ActiGraph methods, only 150 cpm without LFE predicted the time in prolonged sitting bouts non-significantly different from the activPAL (bias ≤18 minutes/day). However, the frequently used 100 cpm with LFE accurately predicted total sitting time (bias ≤7 minutes/day). To study the health effects of ActiGraph measured prolonged sitting, we recommend using the new algorithm. In case a cut-point is used, we recommend 150 cpm without LFE to measure prolonged sitting, and 100 cpm with LFE to measure total sitting time. However, both cpm cut-points are not recommended for a detailed bout analysis.

  • 15. Larisch, Lisa-Marie
    et al.
    Kallings, Lena V
    Hagströmer, Maria
    Sophiahemmet University.
    Desai, Manisha
    von Rosen, Philip
    Blom, Victoria
    Associations between 24 h movement behavior and mental health in office workers2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 17, article id E6214Article in journal (Refereed)
    Abstract [en]

    The associations between 24 h movement behavior, i.e., the way people distribute their time in different movement-related behaviors, on mental health are not well understood. This study applied a compositional data analysis approach to explore cross-sectional associations between device-measured moderate to vigorous physical activity (MVPA), light intensity physical activity (LIPA), sedentary behavior (SED), self-reported time in bed and mental health outcomes, i.e., depression or anxiety symptoms, burnout, mental wellbeing and stress, in office workers. ActiGraph accelerometers were worn for 24 h for at least 4 days to assess MVPA, LIPA, and SED. Sleep diaries were used in addition to identify time in bed. Analytic sample sizes for the different outcomes ranged from N = 345-370 participants. In this population of office workers with high levels of MVPA, the entire movement behavior composition was not associated to any of the mental health outcomes, but MVPA relative to all other behaviors was positively associated with mental wellbeing. This confirms the importance of MVPA for health relative to other movement-related behaviors.

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  • 16.
    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)
  • 17.
    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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  • 18.
    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)
  • 19.
    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 interventionManuscript (preprint) (Other academic)
  • 20.
    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)
  • 21.
    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)
  • 22.
    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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  • 23.
    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)
  • 24. Leavy, Breiffni
    et al.
    Joseph, Conran
    Löfgren, Niklas
    Johansson, Hanna
    Hagströmer, Maria
    Sophiahemmet University.
    Franzén, Erika
    Outcome evaluation of highly challenging balance training for people with Parkinson disease: A multicenter effectiveness-implementation study2020In: Journal of Neurologic Physical Therapy, ISSN 1557-0576, E-ISSN 1557-0584, Vol. 44, no 1, p. 15-22Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: In order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. There is little evidence for whether efficacious exercise interventions for PwPD remain effective when transferred to standard clinical settings. The aim of this study was to assess the clinical effectiveness of the adapted HiBalance program on balance control and gait among PwPD.

    METHODS: Participants (n = 117) with mild-moderate Parkinson disease were consecutively included into either the 10-week HiBalance group training (n = 61) or the control (n = 56) group. The main outcome was balance performance (Mini-BESTest). Secondary outcomes were comfortable gait speed (10-m Walk Test); functional mobility (Timed Up and Go [TUG] test) and dual-task interference (cognitive TUG test); physical activity level (steps per day); perceived balance confidence (Activities-specific Balance Confidence scale) and perceived walking difficulty (Walk-12G) and self-rated health (EQ-5D visual analog scale).

    RESULTS: In total, 98 people completed the trial. Compared with controls, the training group showed significant improvement in balance performance (P < 0.001), gait speed (P = 0.001), and dual-task interference (P = 0.04) following the intervention. No group differences were observed for physical activity level or any patient-reported measures.

    DISCUSSION AND CONCLUSIONS: Highly challenging balance training is effective at improving balance, gait, and dual-task performance when delivered at a clinically feasible dose, in a range of rehabilitation settings, without direct involvement of the research group.Video Abstract available for more insights from the authors (see the Video, Supplementary Digital Content 1, available at: http://links.lww.com/JNPT/A299).

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  • 25. Porserud, Andrea
    et al.
    Aly, Markus
    Nygren-Bonnier, Malin
    Hagströmer, Maria
    Sophiahemmet University.
    Association between early mobilisation after abdominal cancer surgery and postoperative complications2023In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, no 9, article id 106943Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Postoperative complications and readmission to hospital after major cancer surgery are common. Early mobilisation in hospital is thought to reduce complications, and patients are recommended to mobilise for at least 2 h on the day of surgery, and thereafter at least 6 h per day. Evidence for early mobilisation is limited and therefore also how early mobilisation may influence the development of postoperative complications. The aim of this study was to evaluate the association between early mobilisation after abdominal cancer surgery and readmission to hospital due to postoperative complications.

    MATERIAL AND METHODS: Adult patients who had abdominal cancer surgery due to ovarian, colorectal, or urinary bladder cancer between January 2017 and May 2018 were included in the study. Exposure was set to the mean number of steps taken over the first three postoperative days, measured with an activity monitor. Primary outcome was readmission to hospital within 30 days after discharge, and secondary outcome was severity of complications. Data were obtained from medical records. Logistic regression was used to investigate the association between exposure and outcomes.

    RESULTS: Of 133 patients included in the study, 25 were readmitted to the hospital within 30 days after discharge. The analysis showed no association between early mobilisation and readmission or severity of complications.

    CONCLUSION: Early mobilisation does not seem to increase the odds of readmission, nor the severity of complications. This study contributes to the limited research on the association between early mobilisation and postoperative complications after abdominal cancer surgery.

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  • 26. Porserud, Andrea
    et al.
    Aly, Markus
    Nygren-Bonnier, Malin
    Hagströmer, Maria
    Sophiahemmet University.
    Objectively measured mobilisation is enhanced by a new behaviour support tool in patients undergoing abdominal cancer surgery2019In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, no 10, p. 1847-1853, article id S0748-7983(19)30405-6Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Mobilisation reduces the risk of complications after abdominal surgery. Despite that, patients spend most of their time immobilised during hospital stay. Hence, the aim of this study was to evaluate a tool called the Activity board, which includes behaviour change techniques, regarding effects on mobilisation and postoperative recovery after abdominal cancer surgery.

    MATERIAL AND METHODS: Patients who were planned for abdominal surgery due to colorectal, ovarian or urinary bladder cancer, and at least three postoperative days at Karolinska University Hospital were included in this non-randomised controlled trial, from January 2017 to May 2018. The patients were allocated to Activity board or standard treatment when they were admitted to hospital. Mobilisation was evaluated objectively with activity monitor the first three postoperative days, and postoperative recovery was assessed continuously during hospital stay.

    RESULTS: In total, 133 patients, mean (sd) age 68.1 (12.3) years were included. The patients with the Activity board had postoperatively higher levels of mobilisation, compared to standard treatment, as mean value over the first three days, steps, median (min-max) 1057 (3-10433) and 360 (0-6546), respectively (p = 0.001), and for each day separately. Further, the group with the Activity board had a shorter length of stay, 6 (3-13), compared to standard treatment 7 (3-14) (p = 0.027).

    CONCLUSION: The Activity board is an effective tool to enhance mobilisation after abdominal surgery due to cancer, in hospital settings. Using the Activity board could lead to improved postoperative recovery.

  • 27. Porserud, Andrea
    et al.
    Lundberg, Mari
    Sophiahemmet University.
    Eriksson, Johanna
    Nygren Bonnier, Malin
    Hagströmer, Maria
    Sophiahemmet University.
    Like I said, I would not have likely gotten up otherwise: Patient experiences of using an Activity Board after abdominal cancer surgery.2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Most patients treated in a hospital setting are fully or partially immobilised. The Activity Board (Träningstavlan® Phystec) is a useful tool to enhance mobilisation after major abdominal cancer surgery. Knowledge of patient experiences of the mobilisation tool is crucial in implementing the Activity Board in health care. This study aimed to describe patient experiences of using the Activity Board after surgery for abdominal cancer.

    MATERIALS AND METHODS: Semi-structured face-to-face interviews were conducted in 15 patients who underwent abdominal surgery due to colorectal, ovarian or urinary bladder cancer. All 15 patients (mean age 67.7 years, range 40-86) used the Activity Board postoperatively. The interviews were transcribed verbatim and analysed according to inductive content analysis.

    RESULTS: The overarching theme that emerged from the interviews was that "enabling participation facilitates empowerment over rehabilitation". Three categories supported the theme: prerequisites for using the Activity Board, the value of using supportive behavioural techniques, and the possibility to influence the patients' care.

    CONCLUSIONS: These findings suggest that the Activity Board could be a viable tool that activates the person-centred postoperative rehabilitation process by cooperating with the medical team at the hospital ward.Implications for rehabilitationPatients who are in hospital due to cancer surgery are often immobilised, which increases the risk of complications.The Activity Board can stimulate the patients to participate in the rehabilitation process in a more active way.The Activity Board can be used to improve and clarify the person-centred approach in hospital settings.

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  • 28.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Study center differences in demographics and intervention impact after 6 months of Sophia Step Study2019Conference paper (Other academic)
  • 29.
    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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  • 30.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Hagströmer, Maria
    Sophiahemmet University.
    Yngve, Agneta
    Brismar, Kerstin
    Ainsworth, Barbara
    Johansson, Unn-Britt
    Sophiahemmet University.
    Process evaluation of the Sophia Step Study: A primary care based three-armed randomized controlled trial using self-monitoring of steps with and without counseling in prediabetes and type 2 diabetes2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1191Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Describing implementation features of an intervention is required to compare interventions and to inform policy and best practice. The aim of this study was to conduct a process evaluation of the first 12 months of the Sophia Step Study: a primary care based RCT evaluating a multicomponent (self-monitoring of daily steps plus counseling) and a single component (self-monitoring of steps only) physical activity intervention to standard care on cardiometabolic health.

    METHODS: The evaluation was guided by the Medical Research Council Guidance for complex interventions. To describe the implementation communication with the health professionals implementing the interventions, attendance records and tracking of days with self-monitored pedometer-determined steps were used. Change in physical activity behaviour was measured at baseline, 6 and 12 months as daily steps by accelerometry.

    RESULTS: During April 2013 to January 2018 188 participants were randomized and intervened directly after inclusion. Response rate was 49% and drop out was 10%. A majority, 78%, had type 2 diabetes and 22% were diagnosed with prediabetes. Mean [Standard deviation (SD)] body mass index was 30.4 (4.4) kg/m2 and steps per day was 6566 (3086). The interventions were delivered as intended with minor deviation from the protocol and dose received was satisfying for both the multicomponent and single component group. The mean [95% Confidence Interval (CI)] change in daily steps from baseline to 6 months was 941(227, 1655) steps/day for the multicomponent intervention group, 990 (145, 1836) step/day for the single component group and - 506 (- 1118, 107) for the control group. The mean (95% CI) change in daily steps from baseline to 12 months was 31(- 507, 570) steps/day for the multicomponent intervention group, 144 (- 566, 853) step/day for the single component group and - 890 (- 1485, - 294) for the control group. There was a large individual variation in daily steps at baseline as well as in step change in all three groups.

    CONCLUSIONS: Applying self-monitoring of steps is a feasible method to implement as support for physical activity in the primary care setting both with and without counseling support.

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

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  • 31.
    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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  • 32.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Von Rosen, Philip
    Johansson, Unn-Britt
    Sophiahemmet University.
    Brismar, Kerstin
    Hagströmer, Maria
    Sophiahemmet University.
    Associations of physical activity and sedentary behavior with cardiometabolic biomarkers in prediabetes and type 2 diabetes: A compositional data analysis2020In: Physician and sportsmedicine, ISSN 0091-3847, E-ISSN 2326-3660, Vol. 48, no 2, p. 222-228Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the associations between objectively measured sedentary behavior (SB), light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) and cardiometabolic and endocrine biomarkers, and to estimate the associations of reallocating time from one behavior to another with cardiometabolic and endocrine biomarkers.

    Methods: Baseline data from participants diagnosed with prediabetes or type 2 diabetes, n = 175, 58% men, mean (SD) age = 64.4 (7.7), recruited to a physical activity intervention was used. Time spent in SB, LIPA and MVPA was measured by accelerometer and transformed into isometric log-ratio coordinates. The associations between time spent in SB, LIPA and MVPA and biomarkers were examined by linear regression models. The change in each outcome of reallocating time between the three behaviors was estimated.

    Results: The findings show strong positive associations of time spent in MVPA and negative associations of time spent in SB relative to time spent in the other behaviors with sagittal abdominal diameter (SAD) and homeostasis model assessment for insulin resistance (HOMA-IR) and negative associations of time spent in SB with high-density lipoprotein (HDL) cholesterol. Theoretically, reallocation of 19 minutes MVPA to SB or to LIPA was associated with a 17% and 17% larger SAD, 39% and 36% larger HOMA-IR values and 3.3% and 2.3% lower levels of HDL, respectively.

    Conclusion: In conclusion, our analysis from a time-use perspective supports the current evidence that sedentary time is devastating for the cardiometabolic health. While LIPA probably requires more time, maintaining or increasing time in MVPA are the most important features of the time use behaviors when promoting a favorable cardiometabolic risk profile in adults with prediabetes and type 2 diabetes.

    Trial registration: ClinicalTrials.gov, NCT02374788. Registered 2 March 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02374788.

  • 33. Thurfjell, Åsa
    et al.
    Sandlund, Christina
    Adami, Johanna
    Sophiahemmet University.
    Hasseltröm, Jan
    Hagströmer, Maria
    Sophiahemmet University.
    Lundh, Lena
    General practitioners' experiences of Phosphatidylethanol in treatment of hypertension: A qualitative study2023In: BJGP Open, ISSN 2398-3795, Vol. 7, no 4, article id BJGPO.2023.0037Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hazardous alcohol use increases the risk of hypertension but is underdetected in primary health care patients. Use of the biomarker phosphatidylethanol (PEth), which reflects the last two to three weeks of alcohol consumption, is increasing in Swedish primary health care, but studies from that context are scarce or missing.

    AIM: Explore general practitioners' (GPs') experiences of using PEth to identify hazardous alcohol use in the context of managing hypertension.

    DESIGN & SETTING: A qualitative study of GPs (n=12) experienced in using PEth in hypertension management who were recruited at Swedish primary health care centres in 2021.

    METHOD: The GPs participated in five focus groups interviews. A questioning route was used. The interviews were audio recorded, transcribed verbatim, and analysed with inductive qualitative content analysis.

    RESULTS: The overall theme I don't hesitate anymore reflects the disappearance of GPs' fear that the PEth result might upset the patient, as this rarely occurred and that the positive effects of PEth predominated in the findings. The theme is underpinned by four sub-themes: serving as an eyeopener, improving the dialogue, using with care, and learning by doing.

    CONCLUSION: PEth is a useful tool that changed GPs' routines for addressing alcohol and identifying hazardous alcohol use in patients with hypertension managed in primary health care. The GPs advocated adopting PEth as a routine test in the treatment of hypertension. However, PEth needs to be used with care to maximise benefit and minimise harm.

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  • 34. von Rosen, Philip
    et al.
    Dohrn, Ing-Mari
    Hagströmer, Maria
    Sophiahemmet University.
    Association between physical activity and all-cause mortality: a 15-year follow-up using a compositional data analysis2020In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 30, no 1, p. 100-107Article in journal (Refereed)
    Abstract [en]

    The association between the composition of movement behaviours and mortality risk, acknowledging the composition nature of daily time data, is limited explored. The aim was to investigate how the composition of time spent in sedentary behaviours (SB), light intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) is associated with all-cause mortality, in a cohort with 15 years follow-up time, using compositional data analysis. Eight hundred fifty-one participants (56% women, mean age 53 years) provided objectively assessed physical activity data using an Actigraph accelerometer and were followed for 15 years. Association of daily time composition of movement behaviours with risk of mortality were explored using compositional data analysis and hazard ratios (HR) of mortality were estimated based on a cox regression model. A significant (p<0.001) positive association between time spent in SB relative to time in other behaviours, and a significant (p=0.018) negative association between time spent in LIPA relative to time in other behaviours, with all-cause mortality, was found. Substituting time spent in LIPA or MVPA with time in SB increased the hazard for all-cause mortality, with greater effect found for MVPA (20 min replacement; HR 1.26, 95% CI 1.04-1.52) than for LIPA (20 min replacement; HR 1.06, 95% CI 0.65-1.73). In a public health perspective, it is recommended to substitute SB with either LIPA or MVPA, but for individuals with little time spent in MVPA, the most important message may be to try to maintain that behaviour.

  • 35. von Rosen, Philip
    et al.
    Hagströmer, Maria
    Sophiahemmet University.
    Franzén, Erika
    Leavy, Breiffni
    Physical activity profiles in Parkinson's disease2021In: BMC Neurology, E-ISSN 1471-2377, Vol. 21, no 1, article id 71Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Identifying physical activity (PA) profiles of people with Parkinson's Disease (PD) could provide clinically meaningful knowledge concerning how to tailor PA interventions. Our objectives were therefore to i) identify distinct PA profiles in people with PD based on accelerometer data, ii) explore differences between the profiles regarding personal characteristics and physical function.

    METHODS: Accelerometer data from 301 participants (43% women, mean age: 71 years) was analysed using latent profile analyses of 15 derived PA variables. Physical function measurements included balance performance, comfortable gait speed and single and dual-task functional mobility.

    RESULTS: Three distinct profiles were identified; "Sedentary" (N = 68), "Light Movers" (N = 115), "Steady Movers" (N = 118). "Sedentary" included people with PD with high absolute and relative time spent in Sedentary behaviour (SB), little time light intensity physical activity (LIPA) and negligible moderate-to-vigorous physical activity (MVPA). "Light Movers" were people with PD with values close to the mean for all activity variables. "Steady Movers" spent less time in SB during midday, and more time in LIPA and MVPA throughout the day, compared to the other profiles. "Sedentary" people had poorer balance (P = 0.006), poorer functional mobility (P = 0.027) and were more likely to have fallen previously (P = 0.027), compared to "Light Movers. The Timed Up and Go test, an easily performed clinical test of functional mobility, was the only test that could distinguish between all three profiles.

    CONCLUSION: Distinct PA profiles, with clear differences in how the time awake is spent exist among people with mild-moderate PD.

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  • 36. Wennman, Heini
    et al.
    Härkänen, Tommi
    Hagströmer, Maria
    Sophiahemmet University.
    Jousilahti, Pekka
    Laatikainen, Tiina
    Mäki-Opas, Tomi
    Männistö, Satu
    Tolonen, Hanna
    Valkeinen, Heli
    Borodulin, Katja
    Change and determinants of total and context specific sitting in adults: a 7-year longitudinal study2020In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 23, no 6, p. 596-602, article id S1440-2440(19)30643-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the stability and determinants of total and context specific sitting in a follow-up of adults.

    DESIGN: Longitudinal study.

    METHODS: Participants in the DILGOM cohort (n=3735, men 45%), reported daily sitting in five contexts (work-related, in vehicle, at home by the TV, at home at the computer, and elsewhere) in 2007 and 2014. Sociodemographic background, lifestyle and health were assessed in 2007. Total sitting comprised the sum of context specific sitting. Changes in, and determinants of context specific sitting, stratified by baseline age into young middle-aged (<53 years); late middle-aged (53-68 years) and older-aged (>68 years) were estimated by generalized linear mixed models.

    RESULTS: In 2007, total daily sitting was 7h 26min, 6h 16min, and 6h 3min in young middle-aged, late middle-aged and older-aged groups, respectively. Over 7 years, total sitting decreased on average by 26min. Sitting at the computer increased by 7-17min. The late middle-aged group also increased sitting by the TV, and decreased total, work-related, vehicle and elsewhere sitting. Occupational status determined context specific sitting, but somewhat differently in young and late middle-aged groups. Poor self-rated health determined less work-related and more sitting by the TV in the young, whereas good health determined less work-related sitting in the late middle-aged group.

    CONCLUSIONS: Self-reported sitting is a fairly stable behavior, with the exception for the late middle-aged group, where all context specific and total sitting changed significantly. Occupational status and health determined changes in sitting; however, somewhat differently by age group.

  • 37.
    Woldamanuel, Yohannes
    et al.
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Andermo, Susanne
    Bergman, Patrik
    Åberg, Linda
    Hagströmer, Maria
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Perspectives on promoting physical activity using eHealth in primary care by health care professionals and individuals with prediabetes and type 2 diabetes: Qualitative study2023In: JMIR Diabetes, ISSN 2371-4379, Vol. 8, article id e39474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The trend of an exponential increase in prediabetes and type 2 diabetes (T2D) is projected to continue rising worldwide. Physical activity could help prevent T2D and the progression and complications of the disease. Therefore, we need to create opportunities for individuals to acquire the necessary knowledge and skills to self-manage their chronic condition through physical activity. eHealth is a potential resource that could facilitate self-management and thus improve population health. However, there is limited research on users' perception of eHealth in promoting physical activity in primary care settings.

    OBJECTIVE: This study aims to explore the perspectives of health care professionals and individuals with prediabetes and T2D on eHealth to promote physical activity in primary care.

    METHODS: A qualitative approach was applied using focus group discussions among individuals with prediabetes or T2D (14 participants in four groups) and health care professionals (10 participants in two groups). The discussions were audio-recorded and transcribed verbatim. Qualitative content analysis was used inductively to code the data.

    RESULTS: Three main categories emerged: utility, adoption process, and accountability. The utility of eHealth was described as a motivational, entertaining, and stimulating tool. Registration of daily medical measurements and lifestyle parameters in a cohesive digital platform was recognized as a potential resource for strengthening self-management skills. The adoption process includes eHealth to increase the accessibility of care and personalize the support of physical activity. However, participants stated that digital technology might only suit some and could increase health care providers' administrative burden. Accountability refers to the knowledge and skills to optimize eHealth and ensure data integrity and security.

    CONCLUSIONS: People with prediabetes and T2D and health care professionals positively viewed an integration of eHealth technology in primary care to promote physical activity. A cohesive platform using personal metrics, goal-setting, and social support to promote physical activity was suggested. This study identified eHealth illiteracy, inequality, privacy, confidentiality, and an increased workload on health care professionals as factors of concern when integrating eHealth into primary care. Continuous development of eHealth competence was reported as necessary to optimize the implementation of eHealth technology in primary care.

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  • 38. Xiu, Lijuan
    et al.
    Ekstedt, Mirjam
    Hagströmer, Maria
    Sophiahemmet University.
    Bruni, Oliviero
    Bergqvist-Norén, Linnea
    Marcus, Claude
    Sleep and adiposity in children from 2 to 6 years of age2020In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 145, no 3, article id e20191420Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare sleep in young children at different obesity risks, which were based on parental weight, as well as to explore the longitudinal associations of sleep characteristics with adiposity.

    METHODS: In total, 107 children from an obesity prevention project were included, of which 43 had normal-weight parents (low obesity risk) and 64 had overweight and/or obese parents (high obesity risk). Sleep was measured yearly from ages 2 to 6 years by using actigraphy. Five sleep characteristics, that of late sleep, long sleep latency, short sleep duration, low sleep efficiency, and irregular sleep onset, were defined and scored across ages, with a higher score indicating more frequent exposure. The outcome variables, also measured yearly, were BMI z score and waist circumference.

    RESULTS: There was no difference in sleep patterns among children at different risks. Higher short sleep duration score was associated with a greater increase in BMI z score (0.12; 95% confidence interval [CI] 0.01 to 0.25) across ages. Independently of sleep duration, higher late sleep score was associated with greater increases in BMI z score (0.16; 95% CI 0.05 to 0.27) and waist circumference (0.60 cm; 95% CI 0.23 to 0.98). Moreover, compared with children at low risk and without habitual late sleep, children at high risk and with habitual late sleep had greater increases in BMI z score (0.93; 95% CI 0.40 to 1.45) and waist circumference (3.45 cm; 95% CI 1.78 to 5.12).

    CONCLUSIONS: More frequent exposures to late sleep were associated with greater increases in adiposity measures from ages 2 to 6 years, particularly in children with obese parents.

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