| 1. |
- Artaxo, Paulo, et al.
(författare)
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Tropical and Boreal Forest – Atmosphere Interactions : A Review
- 2022
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Ingår i: Tellus. Series B, Chemical and physical meteorology. - : Stockholm University Press. - 0280-6509 .- 1600-0889. ; 74:1, s. 24-163
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Forskningsöversikt (refereegranskat)abstract
- This review presents how the boreal and the tropical forests affect the atmosphere, its chemical composition, its function, and further how that affects the climate and, in return, the ecosystems through feedback processes. Observations from key tower sites standing out due to their long-term comprehensive observations: The Amazon Tall Tower Observatory in Central Amazonia, the Zotino Tall Tower Observatory in Siberia, and the Station to Measure Ecosystem-Atmosphere Relations at Hyytiäla in Finland. The review is complemented by short-term observations from networks and large experiments.The review discusses atmospheric chemistry observations, aerosol formation and processing, physiochemical aerosol, and cloud condensation nuclei properties and finds surprising similarities and important differences in the two ecosystems. The aerosol concentrations and chemistry are similar, particularly concerning the main chemical components, both dominated by an organic fraction, while the boreal ecosystem has generally higher concentrations of inorganics, due to higher influence of long-range transported air pollution. The emissions of biogenic volatile organic compounds are dominated by isoprene and monoterpene in the tropical and boreal regions, respectively, being the main precursors of the organic aerosol fraction.Observations and modeling studies show that climate change and deforestation affect the ecosystems such that the carbon and hydrological cycles in Amazonia are changing to carbon neutrality and affect precipitation downwind. In Africa, the tropical forests are so far maintaining their carbon sink.It is urgent to better understand the interaction between these major ecosystems, the atmosphere, and climate, which calls for more observation sites, providing long-term data on water, carbon, and other biogeochemical cycles. This is essential in finding a sustainable balance between forest preservation and reforestation versus a potential increase in food production and biofuels, which are critical in maintaining ecosystem services and global climate stability. Reducing global warming and deforestation is vital for tropical forests.
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| 2. |
- Bargholtz, Marcus, et al.
(författare)
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Test–Retest Reliability, Agreement and Criterion Validity of Three Questionnaires for the Assessment of Physical Activity and Sedentary Time in Patients with Myocardial Infarction
- 2023
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:16
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Tidskriftsartikel (refereegranskat)abstract
- Regular physical activity (PA) and limited sedentary time (SED) are highly recommended in international guidelines for patients after a myocardial infarction (MI). Data on PA and SED are often self-reported in clinical practice and, hence, reliable and valid questionnaires are crucial. This study aimed to assess the test–retest reliability, criterion validity and agreement of two PA and one SED questionnaire commonly used in clinical practice, developed by the Swedish National Board of Health and Welfare (BHW) and the Swedish national quality register SWEDEHEART. Data from 57 patients (mean age 66 ± 9.2 years, 42 males) was included in this multi-centre study. The patients answered three questionnaires on PA and SED at seven-day intervals and wore an accelerometer for seven days. Test–retest reliability, criterion validity and agreement were assessed using Spearman’s rho and linearly weighted kappa. Test–retest reliability was moderate for three of the six-sub questions (k = 0.43–0.54) within the PA questionnaires. For criterion validity, the correlation was fair within three of the six sub-questions (r = 0.41–0.50) within the PA questionnaires. The SED questionnaire had low agreement (k = 0.12) and criterion validity (r = 0.30). The studied questionnaires for PA could be used in clinical practice as a screening tool and/or to evaluate the level of PA in patients with an MI. Future research is recommended to develop and/or evaluate SED questionnaires in patients with an MI.
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| 3. |
- Sandberg, Anna, et al.
(författare)
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The Impact of Nordic Pole Walk Advice Alone or in Combination With Exercise Strategies on Daily Physical Activity in Patients With Intermittent Claudication: A Randomized Clinical Trial.
- 2023
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Ingår i: Physical therapy. - 1538-6724. ; 103:11
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Tidskriftsartikel (refereegranskat)abstract
- The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication.In total, 166 patients with intermittent claudication (mean age=72 [SD=7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA+SEP, or WA+HSEP. All patients received Nordic poles and standardized WA (≥30min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7days at baseline and at 3, 6, and 12months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30minutes and>60minutes.At 1year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD=10.85] min) was significantly different from the mean change for WA (-3.20 [SD=6.24] min). At 6months, the number of sitting bouts (>60min) for SEP was significantly different from WA (mean change=0.24 [SD=0.69] vs -0.23 [SD=0.81]).This study indicates that the addition of 6months of HSEP or SEP does not improve PA at 1year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation.At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group.
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| 4. |
- Åhlund, Kristina, 1978, et al.
(författare)
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Fear-avoidance beliefs and cardiac rehabilitation in patients with first-time myocardial infarction
- 2013
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 45:10, s. 1028-1033
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to examine fear-avoidance beliefs in patients after first-time myocardial infarction and to determine how such beliefs change over time. A futher aim was to analyse fear-avoidance beliefs and physical activity levels in patients attending exercise-based cardiac rehabilitation led by a registered physiotherapist, compared with a control group. Design: Prospective cohort study. Patients: A total of 62 patients after first-time myocardial infarction were consecutively included in the study, mean age 61 years (range 42-73). Thirty-four patients chose exercise-based cardiac rehabilitation and 28 carried out the exercise regime on their own (controls). At follow-up, 57 patients (n=30 and n=27, respectively) responded. Methods: The Fear-Avoidance Beliefs Questionnaire and the Exercise and Physical Activity questionnaires were completed at 1 and 4 months post-infarction. Results: Clinically relevant fear-avoidance beliefs were seen in 48% of all patients at baseline, compared with 21% at follow-up (p=0.01). Corresponding baseline values were 62% for the cardiac rehabilitation group and 29% for controls (p=0.02). At follow-up, 4 months post-infarction, the difference between the groups was no longer seen. The total amount of physical activity increased over time for the cardiac rehabilitation group (p=0.03), and this was also significant compared with the control group (p=0.02). Conclusion: Compared with controls, patients attending exercise-based cardiac rehabilitation led by a registered physiotherapist, demonstrated higher levels of fear-avoidance beliefs at baseline, which decreased over time. Furthermore, attendees increased their level of physical activity and exercise over time. Participation in exercise-based cardiac rehabilitation is therefore strongly recommended for patients with myocardial infarction, especially for those with increased fear of movement.
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| 5. |
- Åhlund, Kristina, 1978-
(författare)
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Physical Fitness in Hospitalized Frail Elderly Patients
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Demographic research shows that the proportion of older people in society is increasing. More people age well, but there are also more people getting old with disability and multimorbidity. The large diversity in functioning illustrates the heterogeneity of aging. Accelerated aging may lead to frailty, which is a geriatric syndrome, often used as a marker of biologic age and associated with decreased physiologic reserves, increased vulnerability and the risk of adverse health out- comes. Frail elderly people are frequent visitors within emergency hospital care and physical decline is common. Unfortunately, elderly patients with substantial multimorbidity are often excluded from clinical trials.Physical fitness comprises a set of measurable health- and skill-related outcomes, such as cardiorespiratory endurance and muscle strength. A decrease in physical fitness may affect the prognosis negatively. However, previous research indicates that it may be possible to reverse frailty and improve physical fitness. It is therefore of the utmost interest to identify frailty and study how care is best provided, in order to prevent, reduce and postpone adverse health consequences.The overall aim of this thesis is to study physical fitness in a group of frail elderly patients, within clinical hospital health care. The patients’ physical fitness will be evaluated and compared in different care settings during and after hospitalization. The aim is also to study the long-term consequences of changes in physical fitness in relation to mortality. To better understand the underlying factors for partici- pation in physical activity and exercise, patients’ perceptions of the phenomena will be explored.This thesis consists of four papers based on two studies comprising frail elderly patients with substantial multimorbidity, in connection with an in-hospital episode. Paper 1 was an observational study with a cross-sectional design (n=408). Different components of physical fitness were measured during an index hospital stay and the results showed that hospitalized frail elderly patients performed below previously described age-related reference values. Furthermore, physical fitness was associated with the degree of frailty, rather than the chronological age. Paper 2 was a prospective controlled trial, with two parallel groups. The patients included in the intervention group (n=206) were cared for at an emergency medical care unit providing care according to Comprehensive Geriatric Assessment and care (CGA). The control group (n=202) was cared for at conventional emergency medical care units. The multi-professional care approach at the CGA unit was shown to be beneficial, in terms of a greater proportion of patients who preserved or improved their function during the first three months after discharge from hospital, compared with conventional care. Paper 3 had a prospective approach when evaluating the association between physical fitness and oneyear mortality in those 390 patients discharged alive from a hospital care episode. The results showed that physical fitness during in-hospital care and the change in physical fitness during the first months after discharge were associated with one-year mortality.In Paper 4, the patients’ perspective in terms of physical activity and exercise was explored. The theme of “Meaningfulness and risk of harm in an aging body” emerged, followed by the three categories of physical activity as part of daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise.These studies highlight the importance of a greater focus on physical fitness in hospitalized elderly patients. A careful assessment and a multi-professional approach may lead to beneficial results and better survival even in a group of frail elderly patients with severe multimorbidity. To increase physical activity and exercise in this group of patients, health care probably needs to improve the means of communicating the benefits and goals of exercise and facilitating them so that the risk of harm is reduced.
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| 6. |
- Borg, Sabina, 1982-
(författare)
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Exercise-Based Cardiac Rehabilitation in Patients with Coronary Artery Disease : Attendance, Adherence and the Added Value of a Behavioural Medicine Intervention
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Coronary artery disease (CAD) is the leading global cause of death. After an index event related to CAD, exercise-based cardiac rehabilitation (exCR) is strongly recommended as part of the secondary prevention. Despite the well-established beneficial effects of exCR in patients with CAD, attendance at and adherence to the programme are low, and remain a matter of major concern. One strategy that may increase adherence and rehabilitation outcomes in patients with CAD is to add a behavioural medicine intervention to routine exCR care. The added value of such interventions needs to be further explored. Although several factors associated with non-attendance at exCR appear to be similar between different countries, patterns of attendance may differ due to differences in contextual aspects. The factors that affect attendance at exCR in a Swedish context remain to be explored.Overall aim: To investigate barriers for exCR attendance and to evaluate the added value of a behavioural medicine intervention in physiotherapy on exercise adherence and rehabilitation outcomes in patients with CAD.Methods: The three papers in this thesis are based on two studies of patients with CAD, one registrybased cohort study of 31,297 patients included from the SWEDEHEART registry (Paper I), and one randomised controlled trial of 170 patients included at a Swedish university hospital (Papers II and III). In the first paper, several individual and structural variables were compared for attenders and nonattenders, using multivariable analysis in a logistic regression model. In Papers II and III, patients were randomised 1:1 either to a behavioural medicine intervention in physiotherapy in addition to routine exCR care or to routine exCR care alone for four months. The behaviour change techniques used in the behavioural medicine intervention – specific goal-setting, re-evaluation of the goals, and selfmonitoring and feedback – were based on control theory. Outcome assessment took place at baseline, four and 12 months, and included physical fitness, psychological outcomes and health-related quality of life. Exercise adherence was evaluated at the end of the four-month intervention. An intention-to-treat and a per-protocol analysis were performed.Results: Individual and structural factors associated with non-attendance at exCR in a Swedish context were identified as having a distance greater than 16 km to the hospital, belonging to a county hospital, having a higher burden of comorbidities, being male, and being retired. Exercise adherence was higher for patients who received the behavioural medicine intervention in physiotherapy together with routine exCR (31%) than it was for those who received routine exCR care alone (19%). Rehabilitation outcomes did not differ significantly between the two groups, either between baseline and four months or between four and 12 months. Both groups improved significantly in all measures of physical fitness, and in several measures of health-related quality of life and anxiety at the four-month follow-up. Sufficient enablement remained for patients in both groups at the 12-months follow-up.Conclusions: Distance to the hospital was the strongest predictor for non-attendance at exCR in a Swedish context. The individual factors associated with non-attendance at exCR identified in this thesis confirm previous results, with the exception that female gender was associated with a higher attendance at exCR. The results of this thesis confirm what others have pointed out: it is challenging to achieve behavioural change in patients with the aim to improve rehabilitation outcomes. Even though adherence was higher when a behavioural medicine intervention was added, it was low in both groups. The current behavioural medicine intervention in physiotherapy did not give any improvements over routine exCR care alone in physical fitness, psychological outcomes or health-related quality of life. As such, there is still room for further development and evaluation of behavioural medicine interventions within the context of exCR. A greater tailoring of these interventions to individual needs in a broader population of patients with CAD is suggested.
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| 7. |
- Brosved, Madeleine, et al.
(författare)
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Effects of Cardiac Rehabilitation on Physical Fitness, Physical Function, and Self-reported Outcomes in Patients ≥80 yr: A RANDOMIZED CONTROLLED TRIAL.
- 2022
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Ingår i: Journal of cardiopulmonary rehabilitation and prevention. - 1932-751X. ; 42:5, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- The beneficial effects of exercise-based cardiac rehabilitation (CR) after an acute coronary syndrome (ACS) are well known, but patients ≥80 yr have been less studied. The aim was to evaluate the effects of CR on patients with ACS ≥80 yr on peak cardiorespiratory fitness (CRF), physical function, and patient-reported outcome measures (PROMs) compared with a control group.A total of 26 patients with ACS, median age 82 (81, 84) yr, were randomized to hospital-based CR combined with a home-based exercise program (CR group) or to a control group (C) for 4 mo. Outcomes were assessed at baseline and 4 mo and included the peak CRF (primary outcome), 6-min walk test (6MWT), muscle endurance, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), one-leg stand test, and PROMs.There were no significant differences between the groups in peak CRF. The CR group improved significantly in terms of the 6MWT ( P = .04), isotonic muscle endurance ( P < .001), one-leg stand test ( P = .001), SPPB total score ( P =.03), Activities-specific Balance Confidence ( P =.01), and anxiety ( P =.03), as compared with C. There were no significant intergroup differences in the TUG, the self-reported health question or depression.Patients with ACS ≥80 yr improved in walking distance, muscle endurance, physical function, and PROMs, but not in peak CRF, by participating in a CR program. These results suggest an increased referral to CR for this growing group of patients to enable preserved mobility and independence in daily living, but this needs to be confirmed in larger studies.
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| 8. |
- Bäck, Maria, 1978, et al.
(författare)
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Effects of high frequency exercise in patients before and after percutaneous coronary intervention
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7, s. 307-313
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to evaluate the effects of high frequency exercise for patients before and after an elective percutaneous coronary intervention (PCI), with special reference to maximal aerobic capacity, muscle function, health related quality of life (HRQoL), waist–hip ratio (WHR) and restenosis. Methods: A randomised, controlled study was performed in Sweden between 2004 and 2006 in thirty-seven patients (five women) with stable coronary artery disease (CAD), age 63.6±6.9 years, randomised to either high frequency exercise or control group. The patients in the training group performed three endurance resistance exercises and trained on a cycle ergometer 30 min, 5 times a week for 8 months at 70% of VO2max. Results: Patients in the training group significantly improved their maximal aerobic capacity (15 (9–46) vs. 8 (0–18)% p≤0.05), shoulder flexion (p≤0.01), shoulder abduction (p≤0.01) and heel-lift (p≤0.05) compared to the control group. There were no significant differences between the groups in HRQoL, WHR and restenosis. Conclusion: High frequency exercise in patients treated with PCI seems to improve maximal aerobic capacity and muscle function, which may reduce the risks of further progression of atherosclerosis. However, further larger studies are needed to fully investigate the effects of exercise in patients with PCI.
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| 9. |
- Bäck, Maria, 1978
(författare)
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Exercise and physical activity in relation to kinesiophobia and cardiac risk markers in coronary artery disease
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Coronary artery disease (CAD) is the leading cause of death worldwide. Patients who have survived a coronary event are the highest priority for secondary prevention. In the secondary prevention of CAD, strong evidence of the beneficial effects of exercise-based cardiac rehabilitation is confirmed. The positive effects of physical activity are well established in primary prevention, but the question of whether these effects also relate to patients with CAD still remains to be explored. It is theoretically possible that kinesiophobia, fear of movement, may prevent successful cardiac rehabilitation. The impact on kinesiophobia by rehabilitation outcomes in patients with CAD has not previously been investigated. The overall aim of this thesis was to study the impact of exercise and physical activity in relation to kinesiophobia and cardiac risk markers in patients with CAD. Study I evaluated the effects of high-frequency exercise before and after an elective percutaneous coronary intervention (PCI). Study II examined the level of physical activity in patients with CAD and investigated the association between physical activity and cardiac risk markers. Study III investigated the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), a brief questionnaire to detect kinesiophobia, in patients with CAD. Study IV described the occurrence of kinesiophobia in patients with CAD and investigated the impact on kinesiophobia by clinical variables with an influence on rehabilitation outcomes. The main findings were that high-frequency exercise improved the maximum aerobic capacity and muscle function in patients treated with PCI, which may have clear advantages when it comes to preventing the progress of CAD. A relatively high level of physical activity was found among patients with CAD, six months after the cardiac event. After adjustment for confounders, statistically significant, yet weak, associations were found between physical activity and several cardiac risk markers. Support was found for the TSK-SV Heart as a reliable, valid questionnaire for measuring kinesiophobia in patients with CAD. A high level of kinesiophobia was found in 20% of patients with CAD, six months after the cardiac event. In addition, an impact on kinesiophobia was identified by clinical variables with an influence on rehabilitation outcomes in patients with CAD, representing medical variables, all components of the International Classification of Functioning, Disability and Health (ICF) and health-related quality of life. In conclusion, high-frequency exercise in patients treated with PCI improved their maximum aerobic capacity and muscle function. Significant, yet weak, associations were identified between physical activity and cardiac risk markers in patients with CAD. Several important clinical findings with an impact on rehabilitation outcomes were found to be associated with a high level of kinesiophobia. Kinesiophobia therefore needs to be considered in cardiac rehabilitation and would benefit from future research.
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| 10. |
- Bäck, Maria, 1978, et al.
(författare)
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Home-based versus hospital-based supervised exercise or walk advice as treatment for intermittent claudication : Hembaserad jämfört med sjukhusbaserad handledd fysisk träning eller träningsråd som behandling vid claudicatio intermittens
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Method and patient group Intermittent claudication, the most common symptomatic presentation of peripheral arterial disease, is present in 7% of Swedish people aged 60 years or older. The progressive atherosclerotic process involves the development of stenoses and/or occlusions in the arteries propagating blood to the lower limbs. This causes effort-induced pain in the affected limb(s). Treatment is usually conservative and includes exercise therapy. Today, current practice in Sweden for patients with IC usually does not include hospital-based supervised exercise programs. A home-based supervised exercise program in a self-chosen environment might bridge the gap between the highly structured and costly hospital-based supervised exercise programs and ’go home and walk advice’. Question at issue Is home-based supervised exercise more effective than either unsupervised ‘go home and walk advice’, or hospital-based supervised exercise, for patients with intermittent claudication, in terms of walking distance, health related quality of life, symptoms, and risks associated with exercise? Studied risks and benefits for patients Ten articles were identified: two systematic reviews, six randomized controlled trials (RCT) and two cohort studies. The systematic reviews were only commented on. The quality of evidence (GRADE ⊕⊕) was low for all conclusions. Concluding remark Home-based supervised exercise for patients with intermittent claudication was compared with hospitalbased supervised exercise, or ‘go home and walk advice’. Six RCTs and two cohort studies were identified. There is low quality of evidence (GRADE ⊕⊕) that home-based supervised exercise, as compared with ‘go home and walk advice’, may slightly improve maximum and pain-free walking distance and result in little or no difference in health-related quality of life, and functional walking ability. There is low quality of evidence (GRADE ⊕⊕) that home-based supervised exercise may lead to less improvement in both maximum and pain-free walking distance than supervised hospital-based exercise, and result in little or no difference in health-related quality of life, and functional walking ability. There are no major ethical issues, and a reliable estimate of the total cost change is not possible, due to a total lack of reliable long-term data.
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