Background: This study compared levels of physical activity (PA) and sedentary behavior (SB) in adults with and without chronicdiseases or multimorbidity, acknowledging sociodemographic factors. Methods: A cross-sectional analysis was conducted with datafrom 27,890 participants (52% women), aged 50–64, from the Swedish CArdioPulmonary bioImage Study cohort. Over 1500chronic diseases were included and categorized into chronic disease and multimorbidity groups. Chronic diseases were retrieved fromnational registries, using International Classification of Disease codes. PA and SB were measured with a triaxial hip-wornaccelerometer, over 7 consecutive days. General linear models were used to calculate estimated means for daily time spent in light-intensity PA (LIPA), moderate- to vigorous-intensity PA and SB. Results: Time spent in LIPA, moderate- to vigorous-intensity PA,and SB did not differ between individuals in a chronic disease group and individuals without chronic diseases. Individuals living withany multimorbidity spent less time in moderate- to vigorous-intensity PA than participants without chronic diseases. Individualsliving with 4 or more chronic diseases spent more time sedentary than individuals without chronic diseases. Women spent more timein LIPA and less time in SB than men, regardless of chronic disease or multimorbidity. Individuals with less education spent moretime in LIPA and less time in SB than individuals with more education, regardless of chronic disease or multimorbidity. Conclusions:When using an extensive set of chronic diseases, marginal differences in PA and SB were seen between individuals living with andwithout chronic diseases. PA and SB seem to significantly differ by sex and education, rather than living with chronic disease.

Objective This study aimed to evaluate the association between physical function before surgery and recovery measured as physical activity in daily life after discharge from the hospital. Material and methods In total, 105 patients undergoing robot-assisted radical cystectomy were included, based on preoperative and baseline measurements taken before the intervention from a randomised controlled trial. Physical function was assessed the day before surgery using Six-minute Walk test for functional capacity and 30-second chair stand test for lower body strength. Recovery was evaluated during the week after discharge by measuring daily physical activity, including daily steps, brisk walking, sedentary time, and sit-to-stand transitions, using an accelerometer (activPAL3 micro activity monitor). Multiple regression analysis was performed to evaluate the association, adjusting for age, sex, and American Society of Anaesthesiologists score. Results Analysis included 73 participants with valid measurements for both physical function and recovery. A significant positive association was observed between functional capacity and daily steps, with a 100-meter increase in walking distance associated with approximately 600 additional steps per day (95% CI: 0.53-11.29). The association between functional capacity and sit-to-stand transitions approached significance (β = 0.05; 95% CI: -0.001-0.09). No significant associations were observed between physical function and brisk walking or sedentary time, nor between lower body strength and any recovery outcomes. Conclusions Higher functional capacity is associated with higher recovery levels, as measured by physical activity after hospital discharge using activity monitors. The findings indicate that interventions aimed at improving physical function before robot-assisted radical cystectomy may enhance recovery. Keywords: Abdominal surgery, activity monitor, cancer rehabilitation, physiotherapy, recovery.

AIMS: To study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC).

METHODS: We used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents.

RESULTS: In total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24-2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06-1.29), physical activity 1.13 (1.06-1.17), unhealthy diet 1.08 (1.04-1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09-1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers.

CONCLUSIONS: These findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.

BACKGROUND: Digital interventions offering behaviour change support are warranted to prevent and treat non-communicable diseases, and have been evaluated rigorously in controlled settings. Effectivenss, factors influencing the uptake of scaled-up interventions-such as reach, received dose, usability and acceptability- and predictors and mediators of efficiency are rarely explored in research. The study described herein aims to evaluate the effectiveness of a personally tailored digital intervention (the app EviBody®), intended to support healthy and sustained lifestyle behaviours among the adult population, on well-being and behaviour change. Further aims are to explore context and uptake factors, predictors and mediators for behaviour change over 24 months.

METHODS: This is a real-world study, employing a quasi-experimental design and a process evaluation. EviBody® will be marketed and managed by its owner. A four-armed design will allow for comparison between three levels of intervention (basic, standard and premium) and a control group. Adults who sign up for the app will be invited to the research study including sharing app data and answering questionnaires at 0, 1, 3, 6, 12, 18, and 24 months. Study start is Autumn 2025. Controls (n = 200 to evaluate the primary endpoint well-being at 6 months) will be recruited through advertisements on social media and asked to answer the same questionnaires at 0 and 6 months provided by email. For predicting and mediating analyses the intention is to recruit 1500 app users. Well-being (measured with the WHO-5 Well-Being Index), goal achievement, physical activity, eating habits, mental health, mediators (motivation, self-efficacy, and perceived barriers), and demographics will be self-reported. Uptake will be collected using analytics and ratings of usability and acceptability, and described by demographics. Mixed models for repeated measures and structural equation modelling will be employed for data analysis.

DISCUSSION: Besides evaluating the effectivenss of a digital intervention, this study also applies a theory-based evaluation to understand which mediators are effective, for whom they are effective, and the specific conditions under which they are most beneficial.

TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT05973383 on 8 July 2023.

BACKGROUND: This cross-sectional study aimed to describe proportions of patients with indications of alcohol consumption using phosphatidylethanol (PEth), the Alcohol Use Disorders Identification Test (AUDIT), and its consumption-focused version (AUDIT-C), in relation to blood pressure (BP) control, overall and by sex.

METHODS: A total of 270 hypertensive primary care patients (ICD-10: I10.9) were stratified into BP control groups: controlled (<140/90 mmHg), uncontrolled (≥140/90 mmHg), and apparent treatment-resistant hypertension (aTRH; ≥140/90 mmHg with ≥3 antihypertensive drugs). A randomized sample from each stratum was invited, baseline data were collected. Alcohol consumption using predefined categories for PEth and AUDIT, and hazardous use (PEth ≥ 0.122 µmol/L; AUDIT ≥ 8; AUDIT-C ≥ 5 for men, ≥4 for women), were analyzed in relation to BP control groups.

RESULTS: Mean age was 67 ± 11 years; 42% were women. PEth indicated high and regular alcohol consumption in 6.4% of controlled, 5.3% of uncontrolled, and 19.2% of aTRH patients (controlled vs. aTRH, P = .027; uncontrolled vs. aTRH, P = .013). AUDIT showed no significant differences in hazardous use between BP groups (P = .865). AUDIT-C identified slightly higher proportions of hazardous use than PEth, across BP groups and sexes. No significant differences were found between BP groups for hazardous use by PEth (P = .339) or AUDIT-C (P = .150).

CONCLUSIONS: PEth revealed significantly higher alcohol use in the aTRH group, undetected by AUDIT. AUDIT-C and PEth identified more hazardous use than AUDIT, suggesting their potential to prompt alcohol-related discussions and support evidence-based hypertension care. PEth correlated more strongly with AUDIT-C than with AUDIT.

CLINICAL TRIAL REGISTRATION: Retrospectively registered in Clinical Trials, SLSO2022-0143, 2022-12-10.

Lifestyle habits significantly impact health, including stroke risk, and structured approaches in primary healthcare are needed to address risk factors and promote healthy lifestyles. Make My Day, a multifactorial activity-focussed and lifestyle-based stroke prevention programme, was developed to address the rising challenges of increasingly unhealthy lifestyle habits and stroke risk factors. This study evaluated the effect of the Make My Day intervention to reduce stroke risk at 12 months in primary healthcare. In this single-blinded randomised controlled trial, 122 individuals at risk for stroke were randomised to intervention group (n = 63) or control group (n = 59). Inferential statistics and a longitudinal mixed-effect logistic regression model were used to analyse the primary outcome. Inferential statistics were applied to analyse secondary outcomes, that is, goal achievement. At 12 months, the odds for high stroke risk (adjusted OR (CI) = 0.390 (0.156; 0.971), P = .043), was found significantly lower in the intervention group, compared to the control group. Both groups showed significant improvements in several stroke risk factors and goal fulfilment at 12 months. The Make My Day intervention trial indicates a reduction in stroke risk, and the potential of individual goals and engaging everyday activities to support lifestyle change. Make My Day can be a valuable means to address stroke prevention within primary healthcare.

The study is registered at ClinicalTrials.gov, Identifier: NCT05279508. Protocol ID: KI2020-00175.

INTRODUCTION/OBJECTIVE: Surgery-induced losses in physical fitness may have detrimental consequences for patients with low reserve capacity at start. Our objective was to evaluate the effect of preoperative exercise on physical fitness in older patients with low physical fitness scheduled for colorectal cancer surgery.

METHODS: In this randomized, controlled trial, patients ≥65 years of age, who were scheduled for colorectal cancer surgery were included if they had a low maximal walking speed. Exercise for 2 to 3 weeks before surgery was home-based, high-intensity, and partly supervised by a primary care physiotherapist. The intervention consisted of inspiratory muscle training, aerobic, and strength exercises. A control group underwent usual preoperative care. Physical fitness was assessed with the 6-min walk test (primary outcome), the 30-s chair stand test and maximal inspiratory pressure which estimates inspiratory muscle strength (secondary outcomes). The effect of preoperative exercise on these outcomes before and after surgery was analyzed with linear mixed-models for the 6-min walk test and maximal inspiratory pressure and with a non-parametric Friedman rank sum test for the 30-s chair stand test. To evaluate adherence, physical activity was measured and compared for both groups.

RESULTS: A total of 52 participants were included. Analyses showed a statistically significant effect of preoperative exercise on postoperative inspiratory muscle strength. We did not find an effect of preoperative exercise on 6-min walk test or 30-s chair stand test performance. Regarding preoperative physical activity, the intervention group engaged more in high-intensity physical activity in relation to their total stepping time compared to the control group.

CONCLUSIONS: Short-term exercise before colorectal cancer surgery can provide benefits in terms of increased postoperative inspiratory muscle strength in older patients with low physical fitness. While we could not demonstrate an effect of preoperative exercise on any other outcomes, these results should be interpreted with caution due to a small sample size.

TRIAL REGISTRATION: Clinicaltrials.gov, identification number: NCT04878185, URL: Study Details | Optimizing Physical Function Before Cancer Surgery in Older People at Risk | ClinicalTrials.gov.

OBJECTIVES: To explore barriers for recruitment, attrition, and mHealth usage in a Swedish randomized controlled trial (RCT) including a mobile health (mHealth) intervention for children 5 to 12 years (n = 79) in obesity treatment.

METHODS: A retrospective process evaluation was conducted using Normalization Process Theory (NPT). To answer the study objectives, data on staff- and parental mHealth experience and usage, staff working time, recruitment, and reasons for attrition were evaluated in relation to the NPT constructs.

RESULTS: Recruitment process was complex and trial enrollment during the summer decreased staff- and participant-engagement. Attrition was influenced by technical issues, lack of motivation, and disliking the mHealth intervention. The major barrier for mHealth usage was technical problems. Staff struggled understanding core intervention components and found the intervention time consuming.

CONCLUSION: Based on our findings we suggest future enablers for sufficient recruitment, retention, and increased mHealth usage of value for conducting pediatric obesity trials.

BACKGROUND: Many studies have identified key factors affecting the rates of engagement in physical activity in older adults with chronic disease. Environmental conditions, such as weather variations, can present challenges for individuals with chronic diseases, such as type 2 diabetes when engaging in physical activity. However, few studies have investigated the influence of weather on daily steps in people with chronic diseases, especially those with prediabetes and type 2 diabetes.

OBJECTIVE: This study investigated the association between weather variations and daily self-monitored step counts over two years among individuals with prediabetes and type 2 diabetes in Sweden.

METHODS: The study is a secondary analysis using data from the Sophia Step Study, aimed at promoting physical activity among people with prediabetes and type 2 diabetes, which recruited participants from two urban primary care centers in Stockholm and one rural primary care center in southern Sweden over eight rounds. This study measured physical activity using step counters (Yamax Digiwalker SW200) and collected self-reported daily steps. Environmental factors such as daily average temperature, precipitation, and hours of sunshine were obtained from the Swedish Meteorological and Hydrological Institute. A robust linear mixed-effects model was applied as the analysis method.

RESULTS: There was no association found between weather variations and the number of steps taken on a daily basis. The analysis indicated that only 10% of the variation in daily steps could be explained by the average temperature, precipitation, and sunshine hours after controlling for age, gender, and BMI. Conversely, individual factors explained approximately 38% of the variation in the observations.

CONCLUSION: This study revealed that there was no association between weather conditions and the number of daily steps reported by individuals with prediabetes and type 2 diabetes taking part in a physical activity intervention over two years. Despite the weather conditions, women and younger people reported more steps than their male and older counterparts.