| 1. |
- Balfors, Berit, et al.
(författare)
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Strategisk miljöbedömning för hållbar samhällsplanering : Slutrapport från forskningsprogrammet SPEAK
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Strategisk miljöbedömning är en process som myndigheter och kommuner ska genomföra när de upprättar eller ändrar vissa planer eller program som antas medföra betydande miljöpåverkan. Syftet med en miljöbedömning är att integrera miljöaspekter i planen eller programmet så att en hållbar utveckling främjas.Lagstiftningen om strategisk miljöbedömning har funnits i Sverige i snart 15 år. Men hur fungerar miljöbedömning i planeringen? Det var en av frågorna i forskningsprogrammet SPEAK. Syftet med SPEAK har varit att bidra med kunskap för att stärka miljöbedömningens roll som ett verktyg i samhällsplaneringen för att uppnå miljökvalitetsmålen och främja hållbar utveckling.I Sverige har det saknats en övergripande kartläggning över de planer och miljöbedömningar som genomförts. Därför har SPEAK utvecklat, en för Sverige unik, databas med kommunala planer och tillhörande dokument såsom samrådshandlingar, SEA-dokument och särskilda sammanställningar. Baserat på en analys av miljöbedömningspraktiken har förslag på åtgärder tagits fram för att stärka miljöbedömningen som ett verkningsfullt verktyg i planeringen för hållbar utveckling.
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| 2. |
- Björk, Mathilda, et al.
(författare)
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Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-reported Function : A Systematic Review and Meta-analysis
- 2022
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 74:1, s. 31-43
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: Although physical activity (PA) is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), PA's effect on self-reported function and Quality of Life (QoL) has not been analyzed. This study synthesizes the evidence for the effectiveness of PA on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA).METHODS: The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using RoB 2.0 tool), and data extraction were independently performed by two or more of the authors. The meta-analyses were conducted with a random-effects model.RESULTS: The systematic review included 55 RCTs and the meta-analysis included 37 RCTs. In 55 studies included, 76% investigated RA, 20% investigated SpA, and 4% investigated PsA. In RA effects were found on QoL and function compared to inactive controls, effects not sustained in comparison to active controls. In SpA the effects of PA on QoL were in favor of the control group. Effects on function were found compared to inactive controls and sustained in fatigue and pain when compared to active controls. In PsA no effects on QoL were found but on function compared to inactive controls. The effect size was below 0.30 in the majority of the comparisons.CONCLUSION: PA may improve QoL and self-reported function in RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.
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| 3. |
- Hörnberg, Kristina, et al.
(författare)
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Aerobic capacity over 16 years in patients with rheumatoid arthritis : relationship to disease activity and risk factors for cardiovascular disease
- 2017
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Ingår i: PLOS ONE. - : Public library science. - 1932-6203. ; 12:12
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyse the change in aerobic capacity from disease onset of rheumatoid arthritis (RA) over 16.2 years, and its associations with disease activity and cardiovascular risk factors. Twenty-five patients (20 f/5 m), diagnosed with RA 1995-2002 were tested at disease onset and after mean 16.2 years. Parameters measured were: sub-maximal ergometer test for aerobic capacity, functional ability, self-efficacy, ESR, CRP and DAS28. At follow-up, cardiovascular risk factors were assessed as blood lipids, glucose concentrations, waist circumference, body mass index (BMI), body composition, pulse wave analysis and carotid intima-media thickness. Aerobic capacity [median (IQR)] was 32.3 (27.9-42.1) ml O2/kg x min at disease onset, and 33.2 (28.4-38.9) at follow-up (p>0.05). Baseline aerobic capacity was associated with follow-up values of: BMI (rs = -.401, p = .047), waist circumference (rs = -.498, p = .011), peripheral pulse pressure (rs = -.415, p = .039) self-efficacy (rs = .420, p = .037) and aerobic capacity (rs = .557, p = .004). In multiple regression models adjusted for baseline aerobic capacity, disease activity at baseline and over time predicted aerobic capacity at follow-up (AUC DAS28, 0-24 months; β = -.14, p = .004). At follow-up, aerobic capacity was inversely associated with blood glucose levels (rs = -.508, p = .016), BMI (rs = -.434, p = .030), body fat% (rs = -.419, p = .037), aortic pulse pressure (rs = -.405, p = .044), resting heart rate (rs = -.424, p = .034) and self-efficacy (rs = .464, p = .020) at follow-up. We conclude that the aerobic capacity was maintained over 16 years. High baseline aerobic capacity associated with favourable measures of cardiovascular risk factors at follow-up. Higher disease activity in early stages of RA predicted lower aerobic capacity after 16.2 years.
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| 4. |
- Hörnberg, Kristina, 1964-
(författare)
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Aspects of physical activity in Rheumatoid Arthritis : associations with inflammation and cardiovascular risk factors
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Rheumatoid Arthritis (RA) is associated with an increased risk for cardiovascular disease (CVD), partially attributable to systemic inflammation and traditional risk factors for CVD. Since physical activity (PA) is strongly related to CVD in the general population, the aim of this thesis was to describe aspects of PA in patients with RA, and further to analyse associations with disease activity, traditional risk factors for CVD and subclinical atherosclerosis.Methods: In papers I and II, newly diagnosed RA patients were followed for two (n=66) and mean (SD) 16 (2) (n=25) years respectively. Disease activity and aerobic capacity were measured in both groups. In paper II, the 25 patients were also examined for traditional risk factors for CVD, body composition, with pulse wave analysis and carotid ultrasound. Self-efficacy was assessed using a questionnaire. In paper III, a combined heart rate and movement monitor was used to measure PA in 84 patients with early (<2 years) and 37 patients with long-standing (mean [SD] 16 [2] years) RA. Data were analysed for associations with disease activity, traditional risk factors for CVD and subclinical atherosclerosis, as above. Finally, in paper IV, a pilot study including 13 patients, median (Q1-Q3) age 57 (44-64) years, was conducted to analyse the feasibility as well as the effects of ten weeks of spinning exercise, on aerobic capacity, traditional risk factors for CVD and inflammation.Results: In papers I and II, aerobic capacity was maintained at follow-up. In paper I, median (Q1-Q3) aerobic capacity was 31 (27-39) ml/kg x min at baseline and 33 (25-38) ml/kg x min after two years. In paper II, median (Q1-Q3) aerobic capacity was 32 (28-42) ml/kg x min at baseline and 33 (28-39) ml/kg x min after 16 years. In multiple linear regression analyses, adjusted for baseline aerobic capacity, disease activity during the first two years after diagnosis explained 53 % of the aerobic capacity level after 16 years [b=-0.14, p<0.004]. Higher aerobic capacity was associated with more favourable measures of risk factors for CVD and self-efficacy over time and at follow-up. In paper III, 37 % of the patients with early and 43 % of the patients with long-standing RA, did not reach the national recommendations of PA. Total PA as well as more time spent in moderate to vigorous PA were associated with more favourable risk factors for CVD. Patients with higher disease activity and functional disability were less physically active. In paper IV, intensive spinning exercise proved to be a feasible method, that significantly improved aerobic capacity, systolic blood pressure and the number of tender joints.Conclusions: Aerobic capacity, which could be maintained despite several years of disease, was related to risk factors for CVD and to self-efficacy. Higher disease activity in early disease predicted lower aerobic capacity after 16 years. Higher PA level was associated with a more beneficial cardiovascular profile, however, an insufficient level of PA was found in a substantial proportion of patients. Furthermore, we found, that intensive spinning exercise was a feasible method for the group included, to improve aerobic capacity and blood pressure without detrimental effects on disease activity. Physical activity and aerobic capacity have roles to play in the cardio protective management and are, as other modifiable risk factors, suggested to be estimated regularly. Higher disease activity is known to increase the risk of CVD in RA, and as disease activity also seems to negatively impact future aerobic capacity, interventions and support for health enhancing PA should have high priority in these patients.
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| 5. |
- Hörnberg, Kristina, et al.
(författare)
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Benefits of spinning exercise on cardiovascular risk factors in rheumatoid arthritis : a pilot study
- 2014
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Ingår i: Cardiopulmonary Physical Therapy Journal. - : Wolters Kluwer. - 1541-7891. ; 25:3, s. 68-74
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Exercise is known to reduce this risk in the general population but the cardiovascular effects in patients with RA need further study. The purpose of this pilot study was to examine the effects of spinning exercise on the traditional risk factors for CVD, aerobic capacity and inflammation in patients with RA.Methods: Thirteen subjects (12 females, 1 male; median age 57 years) attended intensive spinning sessions lasting 45 minutes, 3 times per week for 10 weeks. Measurements at baseline and at 10 and 25 weeks were aerobic capacity, pulse wave analysis with aortic and peripheral blood pressure (BP), disease activity (CRP, ESR, tender and swollen joints and global health assessment), blood lipid levels, body mass index (BMI), functional ability, and subjective diary notes. Friedman's test and the paired Wilcoxon rank sum test were used to measure changes over time. Correlation analyses were made by the Spearman rank correlation method.Results: There were significant improvements over time in aerobic capacity, systolic BP, BMI and tender joint count (p<0.05). After 10 weeks the subjects showed significant improvements in terms of aerobic capacity (+7 ml O2/kg x min; p<0.05), systolic BP (-10.8 mm Hg; p<0.01) and tender joint count (p<0.05). After 25 weeks there was still a significant improvement in systolic BP (p<0.05) compared to baseline.Conclusions: Intensive spinning exercise for 10 weeks induced a clinically relevant improvement in aerobic capacity and BP. No detrimental effect on disease activity was recorded.
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| 6. |
- Hörnberg, Kristina, 1964-, et al.
(författare)
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Body function in patients with early rheumatoid arthritis : a 2-year prospective study
- 2007
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Ingår i: Advances in Physiotherapy. - : Taylor & Francis. - 1403-8196 .- 1651-1948. ; 9:4, s. 144-150
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this prospective study was to analyse joint and muscle function and aerobic capacity over 2 years in a group of patients with early rheumatoid arthritis (RA; i.e. symptomatic for <12 months) in relation to age, pain and disease activity. Sixty-six patients with early RA were followed for 24 months. Joint and muscle function was measured using Signals of Functional Impairment (SOFI) index and aerobic capacity with sub-maximal test on ergometer bicycle. Pain was estimated on Visual Analogue Scale (VAS) and disease activity using 28-joint count Disease Activity Score (DAS 28). Joint and muscle function was impaired in almost all patients at inclusion and after 24 months. Male patients were more affected compared with females and the significant correlation with pain and DAS 28 decreased over time. Aerobic capacity was maintained and not influenced by sex, age or pain but related significantly to disease activity. The majority of the patients with early RA had impairments of the joint and muscle function over 24 months, even though disease activity decreased significantly. There is a need for regular evaluations of physical functions besides disease activity to prevent continuous development of functional losses.
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| 7. |
- Hörnberg, Kristina, et al.
(författare)
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Individual regression modelling of spinal mobility measurements in long-term ankylosing spondylitis : In-depth analyses with comparison to norm data
- 2023
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 75:4, s. 793-800
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Normal age-related decline and temporary restrictions in mobility complicate the understanding of spinal mobility deterioration over time in patients with ankylosing spondylitis (AS). In this study, we aimed to determine whether spinal mobility deterioration occurred linearly in patients with AS. We also aimed to compare patterns of change with corresponding age-related normal values and analyze variations in temporary fluctuations in mobility measurements over time.Methods: We included 111 men and 30 women (median age 20.9 years at symptom onset), who were followed for median 34 years since symptom onset. This resulted in 9 697 spinal mobility measurements for analysis. Individual linear regression models for development of lateral spinal flexion (LSF), 10 cm Schober test (ST10), chest expansion (CE), and cervical rotation (CR) were analyzed and compared with normal age-related decline over time.Results: The median values for the constants of all measurements were significantly lower than the norm data. However, LSF, ST10, and CE followed a yearly linear decline comparable to the norm data, whereas CR declined about twice as fast as expected from the norm data (beta median [25th-75th percentile]: -0.62° [-1.16°, -0.22°] and -0.35° [-0.35°, -0.35°]), respectively. Temporary fluctuations in LSF and CE were significantly higher during the early phase of the disease, with decreasing residuals over time.Conclusion: Based on median constants of our data, mobility restrictions related to AS seem to mainly occur during the first years of disease, indicating a narrow window of opportunity for prevention.
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| 8. |
- Hörnberg, Kristina, et al.
(författare)
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Isotemporal Substitution of Time Between Sleep and Physical Activity : Associations With Cardiovascular Risk Factors in Early Rheumatoid Arthritis
- 2021
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Ingår i: ACR Open Rheumatology. - : John Wiley & Sons. - 2578-5745. ; 3:3, s. 138-146
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We aimed to determine relationships between objectively measured nightly sleep, sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) with risk factors for cardiovascular disease (CVD) in patients with early rheumatoid arthritis (RA). Furthermore, we aimed to estimate consequences for these risk factors of theoretical displacements of 30 minutes per day in one behavior with the same duration of time in another.Methods: This cross-sectional study included 78 patients with early RA. Nightly sleep, SB, LPA, and MVPA were assessed by a combined heart rate and accelerometer monitor. Associations with risk factors for CVD were analyzed using linear regression models and consequences of reallocating time between the behaviors by isotemporal substitution modeling.Results: Median (Q1-Q3) nightly sleep duration was 4.6 (3.6-5.8) hours. Adjusted for monitor wear time, age, and sex, 30-minutes-longer sleep duration was associated with favorable changes in the values β (95% confidence interval [CI]) for waist circumference by -2.2 (-3.5, -0.9) cm, body mass index (BMI) by -0.9 (-1.4, -0.4) kg/m2 , body fat by -1.5 (-2.3, -0.8)%, fat-free mass by 1.6 (0.8, 2.3)%, sleeping heart rate by -0.8 (-1.5, -0.1) beats per minute, and systolic blood pressure by -2.5 (-4.0, -1.0) mm Hg. Thirty-minute decreases in SB, LPA, or MVPA replaced with increased sleep was associated with decreased android fat and lower systolic blood pressure levels. Replacement of SB or LPA with MVPA yielded lower BMIs.Conclusion: Shorter sleep during the night is common among patients with early RA and is associated with adverse risk factors for CVD.
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| 9. |
- Hörnberg, Kristina, et al.
(författare)
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Physical activity in early and long-standing RA : relations to disease activity, cardiovascular risk factors and subclinicalatherosclerosis
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The excess risk for cardiovascular disease (CVD) in Rheumatoid Arthritis (RA), is partly attributable to traditional cardiovascular risk factors for CVD and systemic inflammation, factors known to be modified by physical activity.Objectives: The aim of this cross-sectional study was to objectively measure and compare the level of physical activity in patients with early and long-standing RA, and to investigate its associations with disease activity, risk factors for CVD and measures of subclinical atherosclerosis.Methods: This study included 84 patients with early and 37 with long-standing RA (disease duration, mean [SD] 1.4 [0.4] and 16.3 [2.3] years respectively). Physical activity was measured using a combined accelerometer and heart rate monitor and included total physical activity (counts /min), proportion of moderate to vigorous physical activity (MVPA) and sedentary time. Further assessments were; disease activity (Erythrocyte sedimentation rate [ESR], Disease activity score [DAS28]), functional ability (Health Assessment Questionnaire [HAQ]), risk factors for CVD (blood lipids, i.e., triglycerides, high density lipoprotein [HDL], low density protein [LDL], blood glucose, blood pressure, waist circumference, body mass index [BMI]), body fat and subclinical atherosclerosis (pulse wave velocity [PWV], augmentation index [AIx] and carotid intima-media thickness [cIMT]).Results: Physical activity variables did not differ between patients with early and long-standing RA. Thirty- seven % of the patients with early and 43% of the patients with long-standing RA did not reach WHOs recommended levels of MVPA. Univariate linear regression analyses with the two groups combined, showed associations between total physical activity and younger age, lower values for HAQ and ESR, as well as more beneficial values for blood glucose, triglycerides, waist circumference, BMI, body fat, sleeping heart rate (SHR), systolic and diastolic blood pressure, aortic blood pressure and pulse pressure (PP), AIx, PWV, and cIMT. After adjusting each variable for age, sex, disease duration and Actiheart wear time, associations remained for all variables except triglycerides, aortic PP, PWV, AIx and cIMT. In a final regression model, the association with ESR was no longer evident. More time spent in MVPA was associated with younger age and with favourable values of blood glucose, HDL, LDL, waist circumference, SHR and PWV. After the same adjustments, associations remained for HAQ, HDL, blood glucose and SHR.Conclusions: Physical activity behaviour was similar in patients with early and long-standing RA. Total physical activity as well as more time spent in moderate to vigorous physical activity were associated with more favourable risk factors for CVD and measures of subclinical atherosclerosis. Patients with lower functional ability were less physically active. These results stress the importance of promoting physical activity in patients with RA.
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| 10. |
- Hörnberg, Kristina, et al.
(författare)
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Physical activity in rheumatoid arthritis : relationship to cardiovascular risk factors, subclinical atherosclerosis, and disease activity
- 2020
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Ingår i: Scandinavian Journal of Rheumatology. - : Taylor & Francis Group. - 0300-9742 .- 1502-7732. ; 49:2, s. 112-121
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate associations between physical activity and risk factors for cardiovascular disease (CVD), subclinical atherosclerosis, and disease activity in patients with early and long-standing rheumatoid arthritis (RA).Method: This cross-sectional study included 84 patients with early and 37 with long-standing RA (disease duration, mean ± sd: 1.4 ± 0.4 and 16.3 ± 2.3 years, respectively). Physical activity was measured using a combined accelerometer and heart-rate monitor. Further assessments were disease activity (erythrocyte sedimentation rate, Disease Activity Score in 28 joints), functional ability (Health Assessment Questionnaire), risk factors for CVD (blood lipids, i.e. triglycerides, high-density lipoprotein, low-density lipoprotein; blood glucose, blood pressure, sleeping heart rate, waist circumference, body mass index, and body fat), and subclinical atherosclerosis (pulse-wave velocity, augmentation index, and carotid intima–media thickness).Results: Physical activity variables did not differ between patients with early and long-standing RA. However, 37% of the patients with early and 43% of those with long-standing RA did not reach the World Health Organization’s recommended levels of moderate to vigorous physical activity (MVPA). In a final multiple regression model, adjusted for age, gender, disease duration, and activity monitor wear time, higher total physical activity was associated with lower body fat and higher functional ability. With the same adjustments, more time spent in MVPA was associated with lower high-density lipoprotein and lower sleeping heart rate.Conclusions: Physical activity was associated with more favourable risk factors for CVD. However, many patients were physically inactive, stressing the importance of promoting physical activity in RA.
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