| 1. |
- Mazzoni, Anne-Sophie
(författare)
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Promoting physical activity during and after curative cancer treatment : Assessment, experiences and effect of behaviour change support
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims:The overall aim of this thesis was to increase knowledge about the promotion of physical activity (PA) in patients during and after curative cancer treatment. Methods: Study I investigated agreement between a 7-day diary and the SenseWear Armband mini (SWA) when assessing PA and sedentary time in 65 participants with breast cancer. Agreement was examined with Bland-Altman plots. Studies II-IV used data from an RCT, where participants about to start curative treatment for breast, prostate or colorectal cancer, were randomised to six months of high or low-to-moderate intensity exercise (supervised group-based resistance- and home-based endurance training), with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and action planning). In study II, participants randomised to the groups with self-regulatory BCTs answered a questionnaire (n=229) and took part in semi-structured interviews (n=18) after exercise programme completion. The interviews were analysed with thematic analysis. In Study III, all participants (n=577) randomised were included. Exercise adherence during the intervention was assessed with attendance records, training logs and heart rate monitors. Regression analyses were performed to determine the effect of self-regulatory BCTs on exercise adherence. In Study IV, participants (n=301) who provided data about their PA level at 12-month follow-up were included. Regression analyses were performed to determine the effect of self-regulatory BCTs on PA maintenance and potential baseline predictors. Results: There were mean differences and wide limits of agreement between the 7-day diary and the SWA when assessing PA and sedentary time. Participants described different incentives to exercise, which fostered feelings of autonomy, competence and relatedness and helped them find motivation to exercise during cancer treatment. Social support from coaches, feedback, self-registration of exercise and scheduled sessions at a public gym were useful for exercising. There was no effect of the self-regulatory BCTs on exercise adherence during the intervention; however, a positive effect was found on PA maintenance at 12-month follow-up. Baseline predictors of PA maintenance at 12-month follow-up were health-related quality of life, exercise motivation, expectations of exercise and being a former or current smoker/snus user. Conclusions: A 7-day diary and the SWA have limited agreement and cannot be used interchangeably in patients with breast cancer. Individual incentives and a positive and supportive environment are crucial to increase exercise motivation in patients undergoing curative cancer treatment, and can be promoted using specific support (i.e. social support, feedback, self-registration of exercise and scheduled exercise sessions). The addition of self-regulatory BCTs is not likely to improve exercise adherence in patients undergoing curative treatment for breast, prostate or colorectal cancer and participating in structured, well-controlled exercise interventions, but may improve long-term PA maintenance in this population. Patients with low health-related quality of life, low exercise motivation, high expectations of exercise or with a history of tobacco use at the start of their cancer treatment may be those most in need of such support to maintain PA.
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| 2. |
- Ballin, Marcel, 1993-
(författare)
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Physical activity, visceral adipose tissue, and cardiovascular disease in older adults : associations and effects
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Cardiovascular disease (CVD) poses a substantial public health burden and is the leading cause of mortality in older adults. With the population aging rapidly, interventions aimed at improving modifiable risk factors for CVD, such as physical inactivity and visceral obesity, could play an important role in reducing its burden, provided they are proven effective.PURPOSE AND AIMS: The overall purpose of this thesis was to create a deeper understanding of the links between physical activity, visceral adipose tissue (VAT), and CVD in older adults, by studying it from both an observational and an interventional perspective. The specific aims were to investigate the associations of objectively measured physical activity and VAT with the risk of CVD and all-cause mortality, to investigate the effect of structured physical activity (exercise) on VAT, and to review the effects of exercise on CVD and all-cause mortality based on evidence from randomized controlled trials (RCTs).METHODS: This thesis comprised two prospective cohort studies, one RCT, and one narrative review of evidence from RCTs. The cohort studies included about 3,300 men and women aged 70 years with baseline data on physical activity and VAT mass, as obtained using accelerometry and dual-energy X-ray absorptiometry, respectively. Cases of stroke, myocardial infarction, and all-cause mortality during follow-up were collected from Swedish nationwide registers. The RCT included 77 men and women aged 70 years with visceral obesity who were randomly allocated to either 10 weeks of supervised vigorous-intensity exercise or to no exercise, with VAT mass measured before and after the intervention. In the review, evidence from published RCTs and meta-analyses of RCTs reporting on the effects of exercise on CVD (N=19,162) and all-cause mortality (N=37,443) in general older adults and in individuals with chronic conditions (such as obesity, type 2 diabetes, and preexisting CVD) were reviewed.MAIN FINDINGS: In the cohort studies, greater amounts of physical activity of any intensity, but especially that of moderate to vigorous intensity, were associated with lower risk of stroke, myocardial infarction, and all-cause mortality. Conversely, greater VAT mass was associated with higher risk of stroke or myocardial infarction. In the RCT, short-term vigorous-intensity exercise seemed to decrease VAT mass slightly, but the effect was not statistically significant. Finally, the review showed that there is currently no convincing evidence from RCTs that exercise effectively reduces the risk of CVD or all-cause mortality, which stands in sharp contrast to the strong associations typically reported in observational studies. The reasons for the conflicting findings are likely complex and multifactorial. In the RCTs, a lack of statistical power could partly explain why no effects have been detected in the general population of older adults, but it is unlikely to explain the null findings in clinical populations, as some of these trials, including meta-analyses of such trials, have been large. Other potential explanations could be a ceiling effect due to the inclusion of participants who were healthier and more physically active than the general population, or that an effect of exercise was masked by the use of effective medications such as antihypertensives and lipid-lowering agents. On the other hand, observational studies have likely overestimated the benefits of physical activity, because these studies are vulnerable to selection bias, reverse causation, and unmeasured confounding, such as from heritable influences.CONCLUSIONS AND IMPLICATIONS: Despite strong associations, the protective effect of physical activity as a single intervention against CVD and all-cause mortality in older adults is probably not as substantial as is commonly presumed. To uncover the true role of physical activity in preventing CVD, further high-quality trials would be valuable. However, because these trials are very difficult and resource demanding, they should be complemented by innovative observational studies that seek to strengthen causal inference through addressing sources of bias and confounding that are often incompletely accounted for in conventional observational studies. This could include a variety of methodologies, such as utilizing negative control outcomes, instrumental variables, sibling comparisons, and other genetically informed designs. As the aging population continues to grow, it becomes increasingly important to take these scientific steps in order to provide a more definitive answer to the question of the extent to which physical activity alone can reduce the risk of CVD.
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| 3. |
- Sjöberg, Veronica
(författare)
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eVIS – A digital support for physical activity in patients with chronic pain
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic pain is a significant contemporary health challenge, exerting enormous impact on both individuals and societies. Although physical activity is the primary treatment, many patients struggle with incorporating it into their lives. In order to facilitate individualised physical activity within Interdisciplinary Pain Rehabilitation Programs (IPRP), the eVISualisation of physical activity and pain intervention was developed. This intervention consists of device-based measured physical activity, jointly visualised with patient-reported pain intensity, pain interference, and pharmaceutical consumption. Overall aim: To i) develop the eVIS intervention as a digital support for physical activity in IPRP, ii) to evaluate eVIS’s validity, feasibility, and acceptability as a supplementary treatment for patients taking part of IPRP, and iii) to evaluate the feasibility and acceptability of the trial design and conduct of an ongoing Registry-based Randomised Clinical Trial (R-RCT), where the effectiveness of eVIS as an addition to IPRP is evaluated.Methods: The Medical Research Council’s updated framework for development and evaluation of complex interventions guided study designs and methodologies. This thesis contains four papers: I. Evaluation of the criterion validity of a wrist-worn activity tracker, II. Evaluation of pre-clinical content validity of eVIS, III. A study protocol outlining trial design and trial conduct of an ongoing R-RCT, and IV. Evaluation of the aforementioned trial design and trial conduct. Results: The wrist-worn activity tracker provided fair to acceptable measurements of SR. In collaboration with relevant stakeholders, eVIS was continuously developed and found to be relevant, simple, and safe for use by patients, clinicians, and researchers. The first real-world test of the clinical feasibility of the intervention motivated further development in the web application and procedures relating to recruitment and data collection. The evaluation of the acceptability and feasibility of the trial design and conduct provided promising results, with mainly satisfactory feasibility. However, minor revisions are required to safeguard the external validity of the ongoing R-RCT. Conclusions: Through continuous refinement in collaboration with stakeholders and careful consideration of the intervention’s complexity, key uncertainties, and context, indicate that the intervention is relevant, valid, feasible, and well prepared for effectiveness testing.
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| 4. |
- Jonsson, Marcus, 1977-
(författare)
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Physiotherapy and physical activity in patients undergoing cardiac or lung cancer surgery
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cardiovascular diseases are the leading cause of death worldwide. Cardiac surgery is performed to improve prognosis, relieve symptoms and increase functional capacity in patients with cardiac disease. Postoperative pulmonary complications are common after cardiac surgery and a reduced lung function can persist a long time after surgery. A positive association between level of physical activity and lung function has been proposed in both healthy individuals and people with different disabilities. It is not clear if there is an association between level of physical activity and recovery of lung function after cardiac surgery. Lung cancer is one of the most frequently diagnosed forms of cancer worldwide, and a leading cause of cancer deaths. Surgical resection is the primary approach for curative treatment. Despite the fact that physical activity has many positive effects on health, patients undergoing lung cancer surgery often report a low level of physical activity. Measuring physical activity is not easy, self-reported physical activity remains the most clinically applicable type of measurement, and a simple and valid questionnaire for screening patients would be valuable. Patients undergoing lung cancer surgery are often routinely treated by physiotherapists, but this kind of treatment has not been thoroughly investigated. The purpose of this thesis was to investigate the effect of physiotherapy and physical activity in patients undergoing cardiac or lung cancer surgery. This thesis include one cohort study of physical activity and recovery of lung function in patients undergoing cardiac surgery, one validation study of two self-reported physical activity instruments in patients undergoing lung cancer surgery, and two randomized controlled trials investigating the effect of physiotherapy for patients undergoing lung cancer surgery. In study I, patients who remained active or increased their level of physical activity had better recovery of lung function, compared to patients who remained sedentary or reported a lower level of physical activity postoperatively. In study II, two self-reported physical activity instruments were validated against accelerometer data in patients three and twelve months after lung cancer surgery. Both instruments were found able to identify patients not meeting recommendations on physical activity. In study III, patients treated by physiotherapists were significantly more active during the first three days after lung cancer surgery, compared to an untreated control group. In study IV, no between-group differences three months after surgery were found between patients receiving in-hospital physiotherapy compared to an untreated control group. However, the patients in the treatment group reported an increase of physical activity three months after surgery compared to preoperatively, while the patients in the control group did not.
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| 5. |
- Larisch, Lisa-Marie
(författare)
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Movement behavior and mental health in office workers : Associations and intervention effects
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental disorders pose a significant global health challenge. To effectively address this challenge, mental health promotion must be included in various sectors, including workplaces. Various strategies for promoting mental health in the workplace have been suggested, including interventions aimed at improving movement behavior, i.e., sitting less and moving more. Physical activity (PA) and sedentary behavior (SED) are established determinants of mental health. However, there are aspects of the relationship between movement behavior and mental health that are not well understood, for example, the combined effects of all movement behaviors occurring throughout the daily 24-hour cycle, i.e., time in bed, SED, light-intensity physical activity, and moderate to vigorous physical activity (MVPA), on mental health. In addition, only a few well-designed workplace interventions for improving movement and mental health outcomes have been tested. Office workers often spend extensive amounts of time being sedentary and might particularly benefit from such interventions. The aims of this thesis were (1) to investigate cross-sectional associations between 24-hour movement behavior and mental health among office workers and (2) to evaluate the efficacy, acceptability, feasibility, and fidelity of two cluster randomized controlled trial (RCT) interventions for improving movement behavior and mental health using quantitative and qualitative methods.In Paper I, we investigated cross-sectional associations between 24-hour movement behavior and mental health outcomes (symptoms of depression and anxiety, burnout, mental wellbeing, and stress) among office workers (N=345-370). Movement behavior was measured using accelerometers and sleep diaries. Mental health outcomes were assessed using validated questionnaires. Only the proportion of time spent in MVPA, relative to all other behaviors, was positively associated with mental wellbeing. Papers II-IV were based on a three-armed cluster RCT among office workers (N=263). During the 6-month intervention period, the iSED intervention group focused on reducing SED, and the iPA intervention group focused on increasing MVPA compared to a wait-list control group. The multi-level interventions were designed based on ecological models of health behavior, addressing the individual office workers as well as their physical, social, and organizational work environment. Paper II investigated intervention effects on accelerometer-measured 24-hour movement behavior and cardiorespiratory fitness. We considered overall 24-hour movement behavior and movement behavior during work versus non-work time. No intervention effects were found. Paper III was based on a qualitative study that was embedded in the RCT. It investigated the acceptability, feasibility, and fidelity of intervention components that addressed the individual, environmental and organizational level. Interviews and focus group discussions were performed with 38 key stakeholders after the 6-month intervention period. The study included office workers who received the interventions, health coaches who delivered counseling sessions, team leaders who were responsible for implementing group activities, and human resource and higher management staff who provided support at the organizational level. In general, the interventions were well appreciated, and components seemed to work as intended when delivered as intended. Many office workers experienced improvements in movement behavior and wellbeing and ascribed those to the interventions. Acceptability, feasibility, and fidelity of individual-level components were high but reduced for components depending on team leaders, mainly due to challenges associated with recruiting managers as team leaders and forming teams. Manager and team support were considered crucial for promoting more PA and less SED, yet many participants reported a lack of such support. Thus, identified challenges with these components might have reduced overall intervention efficacy. Paper IV investigated intervention effects on mental health outcomes (symptoms of depression or anxiety, mental wellbeing, and stress). In addition, we explored whether changes in mean PA intensity mediated or moderated intervention effects. The interventions improved mental wellbeing for the combined intervention groups and the iSED group but not for the iPA group compared to the control group. The interventions improved mean PA intensity, but mean PA intensity did not mediate intervention effects on any outcome. Mean PA intensity moderated intervention effects on mental wellbeing. Participants who reduced mean PA intensity reduced mental wellbeing compared to participants who did not change mean PA intensity. This highlights the importance of maintaining high levels of PA for mental wellbeing.This thesis contributes to existing knowledge by applying a rigorous investigation of cross-sectional associations between 24-h movement behavior and mental health among office workers and by conducting a comprehensive analysis of intervention effects. It offers valuable insights and considerations that may inform occupational health practitioners, employers, policy makers, and researchers and may contribute to developing future effective interventions.
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| 6. |
- Forsberg, Hanna
(författare)
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Active school transportation : Understanding the parental decision-making process
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Few children and adolescents reach the recommended levels of daily physical activity. This trend is evident in the countries examined in this thesis: Sweden and Spain. In efforts to reverse the current trend, active school transportation (AST) and independent mobility (IM) have been suggested as opportunities to increase levels of physical activity. Unfortunately, AST and IM have decreased during recent decades; consequently, initiatives promoting such behaviors have been called for. Parents are the main decision-makers on a child’s use of AST and IM, and thus, understanding their decisions is important in efforts to promote such behaviors. The overarching aim of this thesis was to increase the understanding of the parental decision-making process concerning their children’s active transport to school.This thesis applied an exploratory sequential design, with both interview (qualitative) and cross-sectional (quantitative) designs used to attain the overall aim. Data was collected through interviews with 20 parents (I) and two surveys: the PILCAST (Parents intentions to let their child use AST) questionnaire (II-III) and the PACO (Pedalea y Anda COlegio [Cycle and walk to school]) family questionnaire (IV). In total, 1024 responses from parents were collected with the PILCAST questionnaire (II). In paper III, a sub-sample of 610 was extracted from the 1024, based on parents responding “yes” or “no” to participation in an AST intervention. In paper IV, a total of 573 parents were included in the study. Data was analyzed with content analysis (I), descriptive statistics (II-IV), confirmatory factor analysis (II), linear regression analysis (II-IV), and logistic regression analysis (IV).The main findings showed that parents’ decisions regarding AST and IM were influenced by social norms, which was reflected in appearing to be a good parent and by what significant others do in their vicinity and neighborhood (I, II, IV). The importance of social norms applied to both Swedish and Spanish parents when it comes to AST. Some, gender differences were found, showing that they might play a more important role for parents of girls when it comes to AST and IM. Further, the findings showed that attitudes influence decisions, which was reflected in how parents master everyday life by sometimes choosing what is most convenient, even though they are aware of the benefits of AST (I-II). Parents identified factors both impeding and facilitating the use of AST, while safety and trusting the child were found to be important (I-II). The findings also indicate that the intervention within the Sustainable Innovation for Children Transporting Actively (SICTA) project might positively influence parents’ beliefs about AST (III). In addition, there seems to be a habitual factor involved in the parental decision-making process (II). Differences were found between parents’ decisions to let their child cycle to school compared to letting their child walk to school (II). Finally, the parental decision-making process seems to be influenced by the child’s age and the distance between home and school (I, II, IV). The PILCAST questionnaire showed acceptable validity and reliability.In conclusion, the findings show that when aiming to promote AST and IM, social acceptance is important. This concerns both other people’s judgments of parenting and what other important referent groups are doing, encompassing the visibility of AST and IM in the parents’ vicinity and neighborhoods. Attention given to gender differences could be beneficial as well. Further, it is also important to understand the prerequisites of modern family life. It is likely that strengthening positive attitudes in parents could promote AST, but the practice also needs to be in line with their everyday life tasks. Efforts should also be made to strengthen the factors that facilitate AST. From a parental perspective, this includes safety and being supported in gaining trust in their children and their children’s capabilities with respect to the age of the children. Habit seems to play an important role, and to encourage parents to form new habits, it might be beneficial to launch AST interventions along with contextual changes, as these might open a window for change, which could occur in the transition between preschool and primary school. It could be beneficial to consider cycling and walking as different behaviors because walking seems to be more dependent on the distance to school than cycling. Further, the PILCAST questionnaire was valid and reliable, providing an increased understanding of these behaviors from a parental perspective. Finally, to make children’s use of active transport to school the more favorable choice, it seems worthwhile not only to give children the opportunity to participate but also to involve parents and address their beliefs when designing interventions.
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| 7. |
- Rossen, Jenny, et al.
(författare)
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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 Study
- 2021
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Ingår i: International Journal of Behavioral Nutrition and Physical Activity. - : BioMed Central. - 1479-5868. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- 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: 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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| 8. |
- Rossen, Jenny, et al.
(författare)
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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 diabetes
- 2021
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDescribing 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.MethodsThe 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.ResultsDuring 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.ConclusionsApplying 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.
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| 9. |
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| 10. |
- Rossen, Jenny
(författare)
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Support for physical activity in individuals with prediabetes and type 2 diabetes in primary care - the Sophia Step Study
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A health promoting-care approach includes supporting the individual to increase control over and to improve his or her health to obtain the best possible wellbeing and quality of life. In prediabetes and type 2 diabetes regular physical activity is of pronounced importance for preventing complications and premature death as well as to enhance quality of life. Supporting the individual in self-management of physical activity and establishing new routines in daily life is a major challenge for the health-care system. There is a need for feasible, low-cost intervention programs to support physical activity in type 2 diabetes care.The overall aim of this thesis was to design and evaluate the implementation of an intervention in primary care intended to support individuals with prediabetes or type 2 diabetes to become physically active on a regular basis. A secondary aim was to explore the theoretical associations of replacing prolonged sedentary time with time being sedentary but taking breaks, engaging in light intensity physical activity or moderate and vigorous physical activity with health parameters.Study I was a study protocol describing the assessment protocol and the theoretical framework underlying the randomized controlled trial Sophia Step Study.Study II was a process evaluation study describing the context of the Sophia Step Study and evaluating the implementation during the first 6 months of intervention. Intervention delivery and dose received were obtained through the process of continuous dialogue with the diabetes specialist nurses, attendance records and data on the number days for step registration and step goal. Changes in physical activity behavior were measured objectively for 159 participants by accelerometers and health outcomes by blood samples, anthropometry and blood pressure. Study III was a qualitative interview study reporting the experiences of 18 adhering participants' after attending 2 years of the Sophia Step Study. Study IV employed a cross-sectional design that included 124 individuals with prediabetes or type 2 diabetes. The study investigated the associations of reallocating sedentary time in bouts (>60 min) to sedentary time in non-bouts (<60 min), light intensity physical activity and to moderate and vigorous physical activity with cardiometabolic risk factors.The participants in the Sophia Step Study were randomized into one of three parallel groups: a multicomponent intervention (A) entailing individual consultations with a diabetes specialist nurse based on motivational interviewing and physical activity on prescription, group meetings and self-monitoring of steps; a single component intervention (B) encompassing self-monitoring of steps; or a control group (C) entailing usual care except for the assessments that were included in the study (study I). Between April 2013 and October 2016 159 persons were recruited. The interventions were feasible to implement in primary care with a low dropout rate (3%) at 6 months and high fidelity to the study protocol, except for the physical activity on prescription component. There was a high grade of delivery and dose among those enrolled in the study. Group A increased mean daily steps with 1097 steps (CI: 232, 1962), group B increased mean daily steps with 1242 steps (CI: 313, 2171) and the control group (C) decreased mean daily steps with 457 step (CI:-1164, 250). Clinical improvements after 6 months were found in the two intervention groups, while the control group showed mixed results (study II). In total 18 participants with high adherence to the interventions and study assessments were interviewed in study III. The health check-ups were described as personalized, giving feedback on health outcomes and positive reinforcement. Overall, the participants felt that they received good care throughout the study. The self-monitoring of steps, the group sessions and the health check-ups were recalled as resources that increased motivation for physical activity, led to the establishment of new daily routines and in empowering them to take control over their own health. Study IV demonstrated that modeling reallocation of 30 min of objectively measured time from sedentary time in 60 min bouts to moderate and vigorous physical activity was beneficially associated with BMI (b = -1.46 95% CI: -2.60, -0.33 kg/m2), waist circumference (b = -4.30 95% CI: -7.23, -1.38 cm), and HDL cholesterol b = 0.11 95% CI: 0.02, 0.21 mmol/l). No associations of reallocating sedentary time from long bouts to shorter bouts or to light intensity physical activity were seen. Accumulating time in moderate and vigorous physical activity was beneficial, independent of the behavior it replaced.In conclusion, this thesis shows that it is possible to implement self-monitoring of steps both with and without counseling support as a strategy to support individuals with prediabetes or type 2 diabetes in the primary care setting. The two interventions were effective in increasing physical activity after 6 months. Self-monitoring of steps, feedback on health outcomes and a personalized approach were highly valued by the individuals and should be considered in primary care. The thesis also confirmed that modeling replacement of sedentary time with time in moderate and vigorous physical activity showed beneficial associations with HDL cholesterol, waist circumference and BMI levels in individuals with prediabetes or type 2 diabetes.
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