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1.
  • Andersson, Alva, et al. (author)
  • Functional muscle power in the lower extremity in adults with congenital heart disease
  • 2023
  • In: International Journal of Cardiology Congenital Heart Disease. - : Elsevier BV. - 2666-6685. ; 11
  • Journal article (peer-reviewed)abstract
    • Background: We aimed to investigate functional muscular power in the lower extremity in adults with congenital heart disease (ACHD) and compare results with those of healthy persons. Secondarily, we set out to assess muscle power in relation to age, sex, and complexity of ACHD.Methods: Between 2013 and 2019, 1126 patients attended the ACHD Unit of Sahlgrenska University Hospital/Ostra and performed a test battery to determine physical fitness. Of these patients, 559 who performed the Timed-Stands Test (TST)-which requires 10 stands from a chair at the maximal possible speed-were included in the study.Results: Patients with ACHD performed the TST slower than reference (14.6 s [12.0-18.0] vs. 11.7 s [9.8-14.3], p < 0.001). Men with ACHD performed the TST more rapidly or according to reference in 8% of patients aged 18-39 years, 21% of patients aged 40-65 years, and 55% of patients aged >65 years. Women with ACHD performed the TST more rapidly or according to reference in 21% of patients aged 18-39 years, 56% of patients aged 40-65 years, and 32% of patients aged >65 years. Men with ACHD performed the TST significantly faster than women with ACHD (p < 0.001).Conclusions: Decreased functional muscle power was observed in patients with ACHD and was most pronounced in patients aged 18-39 years. Decreased muscle power is important to detect and requires further assessment because it may contribute to an increased risk of falling and developing lifestyle related diseases.
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3.
  • Ashman Kröönström, Linda, 1982, et al. (author)
  • Exercise capacity, physical activity, and health-related quality of life in adults with CHD
  • 2020
  • In: Cardiology in the Young. - 1047-9511 .- 1467-1107. ; 30:5, s. 668-673
  • Journal article (peer-reviewed)abstract
    • Objectives: The aim of this study was to assess exercise capacity, physical activity, and health-related quality of life within a broad and unselected group of adults with CHD.Design: From April 2009 to February 2014, 1310 patients were assessed for suitability to participate in this single-centre cross-sectional study. Seven hundred and forty-seven (57%) patients were included, performed a submaximal bicycle test, and answered questionnaires regarding physical activity and health-related quality of life. Exercise capacity, physical activity, and health-related quality of life were compared with reference values and correlations were studied.Results: The exercise capacities of men and women with CHD were 58.7 and 66.3%, respectively, of reference values. Approximately, 20-25% of the patients did not achieve the recommended amount of physical activity. In addition, men scored significantly less points on 7 out of 10 scales of health-related quality of life and women in 6 out of 10 scales, compared with reference values. The strongest correlation was between exercise capacity and the Short Form-36 (physical function).Conclusions: Exercise capacity was impaired in all adults with CHD, including those with less complicated CHD. One-quarter of the patients did not achieve the recommended levels of physical activity. Exercise tests followed by individualised exercise prescriptions may be offered to all patients with CHD aiming to increase exercise capacity, levels of physical activity, improve health-related quality of life, and reduce the risk of acquired life-style diseases.
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5.
  • Ashman Kröönström, Linda, 1982, et al. (author)
  • Muscle function in adults with congenital heart disease
  • 2014
  • In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 170:3, s. 358-363
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The aim was to assess muscle function in a sample of Swedish adult men and women with congenital heart disease (ACHD) and to compare the results with published reference values in healthy adults. METHODS AND RESULTS: From April 2009 to December 2010, 762 adult outpatients were assessed for their suitability and individual need for tests of physical fitness. The patients performed five muscle function tests, two isotonic tests and three isometric tests. Of the 762 patients, 315 (41.3%) patients performed the tests. Patients with ACHD had lower isotonic muscle function compared to healthy reference values. In the heel lift test, men with ACHD performed at 63% and women at 58% of the healthy reference values and in the shoulder flexion test the corresponding performance level was 60% for men with ACHD and 85% for the women. Multiple regression analyses showed that NYHA class II-IV was a significant predictor for a lower isotonic muscle function i.e. heel lift in women (p<0.001) and men (p=0.05) and in shoulder flexion (p<0.001) in women, as well as in isometric knee extension (p=0.04) and isometric shoulder abduction (p<0.001) in women. CONCLUSION: This is the first report of muscle function in a broad and unselected group of patients with ACHD. Our data shows that patients with ACHD have lower isotonic muscle function. The impacts of low muscle function in activities of daily living and the question of whether muscle function could be improved with exercise training need further investigation.
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6.
  • Ashman Kröönström, Linda, 1982, et al. (author)
  • Post-operative musculoskeletal outcomes in patients with coarctation of the aorta following different surgical approaches.
  • 2021
  • In: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 327, s. 80-85
  • Journal article (peer-reviewed)abstract
    • The aim of this study was to examine range of motion and muscle function in the upper extremity and spine in patients with coarctation of the aorta (CoA) comparing different surgical approaches.From October 2017 to February 2019, 150 patients were assessed for inclusion. A total of 99 patients (n=75 CoA, n=24 control), were included and assessed regarding muscle function, arm length and circumference, and spinal and thoracic mobility.There were significant differences between the right and left arm in patients with CoA, operated with the subclavian flap technique compared to controls in regards to shoulder flexion (p<0.001), elbow flexion (p=0.001), shoulder abduction (p=0.02), handgrip strength (p=0.01), length of upper arm (p<0.001), lower arm (p<0.001), and of whole arm (p<0.001), circumference regarding upper arm (p=0.001), lower arm (p<0.001), and wrist (p<0.001). Structural scoliosis was more frequent in patients who had undergone thoracotomy (25.4%) than patients who had not undergone a thoracotomy (5.9%, p=0.04), and were often located in the thoracic part of the spine.Patients with CoA operated on using the subclavian flap technique have impaired muscle function as well as reduced arm length and circumference. An increased rate of structural scoliosis was found in patients who underwent thoracotomy, in comparison with patients who had not undergone a thoracotomy. Further research is needed to determine whether muscle function impaired by surgical procedures can be improved with exercise.
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7.
  • Borland, Maria, 1967, et al. (author)
  • A group-based exercise program did not improve physical activity in patients with chronic heart failure and comorbidity: A randomized controlled trial
  • 2014
  • In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 46:5, s. 461-467
  • Journal article (peer-reviewed)abstract
    • Objective: To investigate how group-based exercise affects the levels of physical activity, physical fitness and health-related quality of life (HRQoL) in patients with chronic heart failure and comorbidities. Patients: A total of 48 patients (10 women, 38 men), mean age 71 years (standard deviation 8 years), ejection fraction 27% (standard deviation 10%), and New York Heart Association functional class I-III. Methods: A bicycle test, 6-min walk test (6MWT) and muscle endurance tests were performed. Physical activity was assessed with a pedometer and the International Physical Activity Questionnaire (IPAQ), BRQoL was evaluated with the Short Form-36 (SF-36). Patients were randomized to control or intervention groups. Intervention consisted of an individually designed group-based exercise programme twice a week, for a period of 3 months. Subjects in the control group were asked to continue with their usual lives. Results: A total of 42 patients completed the study, and 6 dropped-out. Steps/day did not increase significantly after intervention (p=0.351), but IPAQ score did (p=0.008). Exercise tolerance (p=0.001), 6MWT (p=0.014), shoulder abduction (p=0.028), heel lift (p<0.0001) and BRQoL (p=0.018) improved significantly in the intervention group compared with the control group. Conclusion: Group-based exercise did not improve the level of physical activity in patients with chronic heart failure and comorbidity; however, physical fitness and HRQoL were significantly improved.
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8.
  • Borland, Maria, 1967, et al. (author)
  • Effects of 3months of detraining following cardiac rehabilitation in patients with atrial fibrillation.
  • 2022
  • In: European review of aging and physical activity : official journal of the European Group for Research into Elderly and Physical Activity. - : Springer Science and Business Media LLC. - 1813-7253. ; 19
  • Journal article (peer-reviewed)abstract
    • Atrial fibrillation negatively impacts physical fitness and health-related quality of life. We recently showed that 3months of physiotherapist-led exercise-based cardiac rehabilitation improves physical fitness and muscle function in elderly patients with permanent atrial fibrillation and concomitant diseases. Little is, however, known about the consequences for physical fitness, physical activity level, and health-related quality of life after ending the rehabilitation period.Prospective 3months follow-up study of 38 patients out of 40 eligible (10 women) who, as part of a randomized controlled trial, had completed a 3months physiotherapist-led cardiac rehabilitation resulting in improved physical fitness,. In the current study, the participants were instructed to refrain from exercise for 3months after completion of the rehabilitation period. Primary outcome measure was physical fitness measured as highest achieved workload using an exercise tolerance test. Secondary outcome measures were muscle function (muscle endurance tests), physical activity level (questionnaire and accelerometer), and health-related quality of life, (Short Form-36), as in the preceding intervention study. We used the Wilcoxon Signed Rank test to analyse differences between the end of rehabilitation and at follow-up. The effect size was determined using Cohen's d .Exercise capacity and exercise time significantly decresead between end of rehabilitation and at follow-up (p<.0001 for both). A significant reduction in shoulder flexion repetitions (p=.006) was observed as well as reduced health-related quality of life in the Short Form-36 dimensions Physical Function (p=.042), Mental Health (p=.030), and Mental Component Score (p=.035). There were, however, no changes regarding objective and subjective physical activity measurements.In older patients with permanent atrial fibrillation, previously achieved improvements from physiotherapist-led exercise-based cardiac rehabilitation in physical fitness and muscle function were lost, and health-related quality of life was impaired after ending the rehabilitation period. A strategy for conserving improvements after a rehabilitation period is essential.
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9.
  • Borland, Maria, 1967, et al. (author)
  • Exercise-based cardiac rehabilitation improves physical fitness in patients with permanent atrial fibrillation - A randomized controlled study
  • 2020
  • In: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 3:5, s. 415-425
  • Journal article (peer-reviewed)abstract
    • The aim of this multicenter randomized controlled trial was to compare physiotherapist-led exercise-based cardiac rehabilitation (PT-X) with physical activity on prescription (PAP) with regard to physical fitness, physical activity, health-related quality of life (HR-QoL), and metabolic risk markers in patients with permanent atrial fibrillation. Ninety six patients (28 women), age 74 (5) years, and ejection fraction >= 45% were randomized. An exercise tolerance test (primary outcome measure), muscle endurance tests, HR-QoL, physical activity assessments (questionnaire and accelerometer), and blood sampling were performed. The PT-X consisted of 60-minute group sessions and home-based exercise, both twice a week. The PAP consisted of 40 minutes of active walking, 4 times a week. Eighty seven patients completed the study. Exercise tolerance (maximum exercise capacity) improved significantly after PT-X (n = 40) but not after PAP (n = 47) (16 vs -3 W; P < .0001). Muscle endurance also improved after PT-X: shoulder flexion left arm (7 vs -1 repetition; P < .001), heel-lift right leg (4 vs 1 repetition; P < .05), left leg (4 vs -1 repetition; P < .001), and shoulder abduction (17 vs -4 s; P < .010). PAP significantly increased energy expenditure. Health-related quality of life and lab-tests did not differ. PT-X improved physical fitness in patients with permanent atrial fibrillation.
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10.
  • Borland, Maria, 1967, et al. (author)
  • Träning vid kronisk hjärtsvikt för att förbättra livskvaliteten
  • 2015
  • In: Läkartidningen. - 0023-7205. ; 112
  • Journal article (peer-reviewed)abstract
    • Persons with chronic heart failure should be recommended aerobic and resistance exercise to be able to increase maximal oxygen uptake (VO2 max), walking distance, and health related quality of life (moderately strong scientific evidence - quality of evidence +++), and to reduce mortality and hospital admissions and increase muscle strength and endurance (low scientific evidence - quality of evidence ++). Prescription of exercise in chronic heart failure should always be preceded of assessments of aerobic and muscular fitness. The aerobic exercise could be conducted as continuous or interval exercise. In connection with ongoing exercise special attention is needed regarding heart rate, diverging blood pressure reactions, contingent occurrence of arrhythmias and the advent of symptoms such as dizziness and severe dyspnea.
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11.
  • Bäck, Maria, 1978, et al. (author)
  • Effects of high frequency exercise in patients before and after percutaneous coronary intervention
  • 2008
  • In: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7, s. 307-313
  • Journal article (peer-reviewed)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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12.
  • Bäck, Maria, 1978, et al. (author)
  • How does kinesiophobia change over time in patients with acute coronary artery disease?
  • 2015
  • In: Physiotherapy, Oral presentation, World Confederation for Physical Therapy (WCPT), 1-4 May 2015Singapore. - : Elsevier BV. ; 101:Suppl. 1
  • Conference paper (other academic/artistic)abstract
    • The occurrence of kinesiophobia and the impact on kinesiophobia by clinical variables with influence on rehabilitation outcomes in exercise-based cardiac rehabilitation (CR) has by us been identified six months after acute coronary artery disease (CAD). However, the occurrence of kinesiophobia in the acute phase of CAD and how it changes over time has not previously been studied. Moreover, the gender perspective has not been highlighted. The primary purpose was to identify levels of kinesiophobia in the acute phase of CAD and to study changes over time and in relation to gender. Participants: In total, 105 patients with CAD (25 women), mean age 63.1±11.5 were included in the study at the cardiac intensive care, Sahlgrenska University Hospital, Sweden between October 2013 and June 2014. Design and statistics: The patients were asked to fill in a set of questionnaires including the Tampascale for Kinesiophobia Heart (TSK-SV Heart), the Hospital Anxiety and Depression Scale (HADS), Harm Avoidance (HA) and the Positive and Negative Affect Schedule (PANAS). The patients filled in the questionnaires at three different time points: At the cardiac intensive care (T1), after 2 weeks (T2) and after 4 months (T3). A linear mixed model (LMM) procedure was used to compare kinesiophobia across time points. The within-subjects-design factor was data collection time (T1-T3), and the between-subjects-design factor was gender. The dependent variable was kinesiophobia. The questionnaires reflecting personality traits and affective states (HADS, PANAS, HA) were used as covariates in order to discover any effects these might have on differences across groupings. Covariates were included in two steps: first all five, then only those that contributed significantly at p-level < 0.05. Thirty-five patients were excluded due to loss of follow-up or missing data. The mean value on the TSK-SV Heart was 32.1 at T1, 30.3 at T2 and 29.2 at T3. The presence of a high level of kinesiophobia was 24% at T1 and 19% at T2 and T3. Without covariates, there was an effect of gender (p=0.011), with a higher TSK-SV Heart mean score for women, and over time points (p=0.013), with lower TSK-SV Heart mean score at T3. No interaction effect was found. Inclusion of the covariates showed that the HADS variables had no impact on kinesiophobia. Although negative affect (p=0.016), positive affect (p=0.002), and HA (p=0.057) had impact on kinesiophobia, this did not influence the significane of gender (p=0.042) and over time points (p=0.004). Kinesiophobia decreased over time after acute CAD, independent of patients´ personality traits and affective states. Female gender had a significant influence on kinesiohobia. Still 19% of the patients were identified with a high level of kinesiophobia at T3. The further establishment of the impact of kinesiophobia in CR and the design of a treatment intervention should be prioritized in future studies. The results of this study suggest that it is desirable to screen for kinesiophobia in the acute phase of CAD, as recognition may facilitate the appropriate treatment for these patients with the overall target of enhancing attendance at CR.
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13.
  • Bäck, Maria, 1978, et al. (author)
  • Kinesiofobi (rörelserädsla) hos patienter med kranskärlssjukdom
  • 2011
  • In: Abstraktbok Sjukgymnastdagarna 14-16 sept 2011, Stockholm.
  • Conference paper (peer-reviewed)abstract
    • Bakgrund och syfte Att patienter med kranskärlssjukdom är rörelserädda är ett känt kliniskt fenomen, som dock inte finns vetenskapligt studerat. Studiens syfte var tvådelat: 1). Reliabilitets- och validitetstesta Tampaskalan för kinesiofobi – Heart (TSK-SV Heart). 2). Undersöka förekomsten av kinesiofobi bland patienter med kranskärlssjukdom. Metoder Studien bestod av 332 patienter (75 kvinnor) med kranskärlssjukdom som vårdats vid Sahlgrenska Universitetssjukhuset/Sahlgrenska mellan 2007-2009. Patienterna inkluderades 6 månader efter vårdtillfället. Kinesiofobi utvärderades med TSK-SV Heart, ett frågeformulär som subjektivt mäter patientens grad av kinesiofobi. Ett värde >37 poäng indikerar kinesiofobi. För test av reliabilitet av TSK-SV Heart mättes stabilitet över tid, inre konsistens samt homogenitet. Validitetstesterna inkluderade ytvaliditet, innehållsvaliditet samt begreppsvaliditet. Resultat Reliabilitetstesterna visade på en god stabilitet över tid (Intraclass Correlation Coefficient=0.84) och en god inre konsistens (Cronbach’s alpha=0.79). Validitetstesterna resulterade i en god yt- och innehållsvaliditet. Begreppsvaliditeten utvärderades genom en konfirmatorisk faktoranalys som visade på acceptabla modellanpassningmått för en fyra faktor modell. Tjugo procent av patienterna hade en förhöjd grad av kinesiofobi (>37 poäng på TSK-SV Heart). Konklusion Att med ett reliabelt och valitt instrument kunna identifiera de patienter med kranskärlssjukdom som har en hög grad av kinesiofobi kan vara ett första steg mot att utforma en behandling för att öka dessa patienters följsamhet till fysisk aktivitet och träning, som har väl vedertagna positiva effekter.
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14.
  • Bäck, Maria, et al. (author)
  • Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease.
  • 2016
  • In: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 32:8, s. 571-580
  • Journal article (peer-reviewed)abstract
    • PURPOSE: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD).PATIENTS: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.METHODS: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made.RESULTS: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect.CONCLUSIONS: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.
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15.
  • Bäck, Maria, 1978, et al. (author)
  • Physical activity in relation to cardiac risk markers in secondary prevention for patients with coronary artery disease
  • 2012
  • In: European Society of Cardiology (ESC), Münich, Germany.
  • Conference paper (other academic/artistic)abstract
    • Purpose: The strong evidence of the benefits of exercise-based cardiac rehabilitation can not be questioned. However, the relationship between level of habitual physical activity and cardiac risk markers in secondary prevention for patients with coronary artery disease (CAD) has yet to be quantified. The aims of the study were to describe the level of physical activity in patients with CAD, and to investigate the association between physical activity and cardiac risk markers. Methods: In total, 332 patients, mean age 65±9.1 years, diagnosed with CAD at a university hospital were included in the study, six months after the cardiac event. Physical activity was measured with a pedometer (steps/day). Investigation of cardiac risk markers included serum lipids, oral glucose-tolerance test, twenty-four hour blood pressure and heart rate monitoring, smoking, body-mass index, waist-hip ratio, and muscle endurance. Correlations with cardiac risk indicators were assessed using Spearman's rank order correlation, where adjustments were made for characteristics univariately associated (p<0.05) with both pedometer steps/day and the variable in question. Results: The patients performed in median 7027 (inter-quartile range 4553-9356) steps/day. The significant adjusted correlations between pedometer steps/day and cardiac risk markers were in general small. Pedometer steps/day was positively correlated with high-density lipoprotein cholesterol (HDL) (0.19, p<0.001), muscle endurance tests (0.19-0.25, p<0.001) and inversely associated with triglycerides (-0.20, p<0.001), glucose-tolerance (-0.23, p<0.001), twenty-four hour heart rate recording during night (-0.17, p=0.004), and total heart rate over 24h (-0.13, p=0.02). Conclusions: There were small, but significant, associations between habitual physical activity and HDL, muscle endurance, triglycerides, glucose-tolerance, and 24-h heart rate, indicating the possibility of positive effects of physical activity on these parameters. However, before more confirmatory data are available, we recommend that patients with CAD are routinely referred to exercise-based cardiac rehabilitation, due to the principle of evidence-based medicine.
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16.
  • Bäck, Maria, 1978, et al. (author)
  • Physical activity in relation to cardiac risk markers in secondary prevention of coronary artery disease.
  • 2013
  • In: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 168:1, s. 478-483
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The relationship between physical activity and cardiac risk markers in secondary prevention for patients with coronary artery disease (CAD) is uncertain. The aims of the study were therefore to examine the level of physical activity in patients with CAD, and to investigate the association between physical activity and cardiac risk markers. METHODS: In total, 332 patients, mean age, 65±9.1years, diagnosed with CAD at a university hospital were included in the study 6months after their cardiac event. Physical activity was measured with a pedometer (steps/day) and two questionnaires. Investigation of cardiac risk markers included serum lipids, oral glucose-tolerance test, twenty-four hour blood pressure and heart rate monitoring, smoking, body-mass index (BMI), waist-hip ratio, and muscle endurance. The study had a cross-sectional design. RESULTS: The patients performed a median of 7027steps/day. After adjustment for confounders, statistically significant correlations between steps/day and risk markers were found with regard to; high-density lipoprotein cholesterol (HDL-C) (r=0.19, p<0.001), muscle endurance measures (r ranging from 0.19 to 0.25, p=0.001 or less) triglycerides (r=-0.19, p<0.001), glucose-tolerance (r=-0.23, p<0.001), BMI (r=-0.21, p<0.001), 24-h heart rate recording during night (r=-0.17, p=0.004), and average 24-h heart rate (r=-0.13, p=0.02). CONCLUSIONS: A relatively high level of physical activity was found among patients with CAD. There was a weak, but significant, association between pedometer steps/day and HDL-C, muscle endurance, triglycerides, glucose-tolerance, BMI and 24-h heart rate, indicating potential positive effects of physical activity on these parameters. However, before clinical implications can be formed, more confirmatory data are needed.
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17.
  • Bäck, Maria, 1978, et al. (author)
  • Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event
  • 2018
  • In: Journal of Cardiopulmonary Rehabilitation and Prevention. - : Ovid Technologies (Wolters Kluwer Health). - 1932-7501. ; 38:4, s. 224-230
  • Journal article (peer-reviewed)abstract
    • Purpose: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits. Methods: In all, 106 patients with CAD (25 women), mean age 63.1 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates. Results: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant. Conclusions: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.
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18.
  • Bäck, Maria, 1978, et al. (author)
  • The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease
  • 2013
  • In: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 167:2, s. 391-397
  • Journal article (peer-reviewed)abstract
    • Background: The impact on kinesiophobia (fear of movement) for patients with coronary artery disease (CAD) is not known. The aims were to describe the occurrence of kinesiophobia in patients with CAD, and to investigate the influence on kinesiophobia by clinical variables. Material and methods: In total, 332 patients, mean age, 65±9.1 years diagnosed with CAD at a university hospital were included in the study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to assess kinesiophobia. Comparisons between high versus low levels of kinesiophobia were measured for each variable. Binary logistic regression analyses were performed with a high level of kinesiophobia (TSK-SV Heart >37) as dependent variable, and with the observed variables as independent. The study had an exploratory, cross-sectional design. Results: A high level of kinesiophobia was found in 20% of the patients. The following variables decreased the odds ratio (OR) for a high level of kinesiophobia: Attending cardiac rehabilitation (yes vs no; -56.7%), level of physical activity (medium vs high; -80.2%), Short Form-36: general health (-4,3%), physical functioning (-1.8%). Two variables increased the OR for a high level of kinesiophobia: heart failure as complication at hospital (yes vs no; 418.7%), anxiety (19.2%). Previous heart failure (yes vs no) was unexpectedly found to reduce kinesiophobia (-88.3%) due to suppression. Conclusions: Several important clinical findings with impact on rehabilitation and prognosis for patients with CAD were found to be associated with a high level of kinesiophobia. Therefore, kinesiophobia needs to be considered in secondary prevention for patients with CAD.
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19.
  • Bäck, Maria, 1978, et al. (author)
  • Validation of a queationnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease
  • 2011
  • In: World Physical Therapy 16th International WCPT Congress 20-23 June 2011, Amsterdam.
  • Conference paper (peer-reviewed)abstract
    • Purpose The aim of the study was twofold; firstly to examine the reliability and validity of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), and secondly to investigate the occurrence of kinesiophobia among patients with coronary artery disease (CAD). Relevance Kinesiophobia, i.e. debilitating fear of movement, in relation to cardiac disease is a well-known clinical phenomenon. So far, however, there is not known which role kinesiophobia, plays for the level of physical activity in patients with CAD. Participants The study consisted of 331 patients (75 women), age 65±9.1 years, with CAD who attended the medical department at Sahlgrenska University Hospital between year 2007–2009. Exclusion criteria were death during the hospital period, serious diseases interfering participation in the study and inability to understand the Swedish language. Methods The patients were asked to fill in the TSK-SV Heart, which comprises of 17 items that assess the patient’s subjective rating of kinesiophobia. An operational definition of kinesiophobia was defined as TSK-SV Heart >37 points. The reliability test included stability over time, internal consistency and homogeneity. The test of validity comprised face validity, content validity and construct validity. Results In terms of reliability the TSK-SV Heart was found to be stable over time (Intraclass Correlation Coefficient 0.84) and internal consistency measured with Cronbach’s alpha was 0.84. The TSK-SV Heart was considered to have face, content and construct validity. Twenty percentage of the patients had kinesiophobia (TSK-SV Heart >37 points). Conclusion: TSK-SV Heart seems to be a reliable and valid and could be used to detect kinesiophobia in patients with CAD. Impact: One third of a sample of patients with CAD suffered from kinesiophobia, which might negatively impact the patients’ future level of physical activity.
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20.
  • Bäck, Maria, 1978, et al. (author)
  • Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease
  • 2012
  • In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 44:4, s. 363-369
  • Journal article (peer-reviewed)abstract
    • Objective: To investigate the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), which is a brief questionnaire to detect kinesiophobia (fear of movement), in patients with coronary artery disease (CAD). Design: Methodological research (cross-sectional study). Subjects: A total of 332 patients, mean age, 65±9.1 years diagnosed with CAD at a university hospital were included in the study. Methods: The psychometric properties of the TSK-SV Heart were tested. The tests of validity comprised face validity, content validity, and construct validity. The reliability tests included composite reliability, internal consistency and stability over time. Results: In terms of reliability, the TSK-SV Heart was found to be stable over time (Intra Class Correlation coefficient = 0.83), and internally consistent (Cronbach’s alpha = 0.78). A confirmatory factor analysis provided acceptable fit for a hypothesized four-factor model with inclusion of a method factor. Conclusions: These results provide support showing the TSK-SV Heart to be reliable and the questionnaire seems to be valid for use in patients with CAD. However, some items need further investigation due to low influence on some sub-dimensions of the test. The sub-dimensions of kinesiophobia require future studies concerning their implications for the target group.
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21.
  • Bäck, Maria, 1978, et al. (author)
  • What variables predict participation in exercise-based cardiac rehabilitation in patients with coronary artery disease?
  • 2014
  • In: European Heart Journal. European Society of Cardiology, 30 August - 3 September 2014, Barcelona. ; 35:Suppl 1
  • Conference paper (other academic/artistic)abstract
    • Purpose Despite the well-established positive effects of exercise-based cardiac rehabilitation (CR) participation has been shown to be sub-optimal. A significant association between kinesiophobia (fear of movement) and participation in CR has previously been found. Therefore, the aim of this study was to identify predictors of participation in CR in patients with coronary artery disease (CAD), with a special reference to kinesiophobia. Methods In all, 332 patients (75 women; mean age 65±9.1 years) with a diagnosis of CAD were recruited between 2007 and 2009 at Sahlgrenska University Hospital/Sahlgrenska. The patients were tested regarding muscle endurance, level of physical activity, health related quality of life, anxiety, depression and kinesiophobia. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An explorative selection of significant predictors was performed. Results Kinesiophobia (p=.012), waist circumference (p=.023), and a previous history of PCI (p=.037) had direct negative effects on participation in CR, while current incidence of CABG (p<.001), PCI (p=.005) and BMI (p=.008) had positive effects. Compared to patients diagnosed with unstable angina, a diagnosis of myocardial infarction (p=.004) had a positive effect on participation in CR. The following indirect effects on participation in CR were found. Anxiety (p=.001) and previous PCI (p=.025) increased kinesiophobia, while muscle endurance (p=.003), perceptions of general health (p<.001) and physical functioning (p=.009) decreased kinesiophobia. Moreover, men had higher kinesiophobia compared to women (p=.031) and smoking was found to reduce kinesiophobia (p=.004). Conclusions Several important variables with an influence on participation in CR were identified and should be further analysed in relation to clinical practice. A reduction of kinesiophobia can be an efficient way to increase participation in CR and should therefore be given priority in future research.
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22.
  • Cider, Åsa, 1960, et al. (author)
  • Aquatic Exercise Is Effective in Improving Exercise Performance in Patients with Heart Failure and Type 2 Diabetes Mellitus
  • 2012
  • In: Evidence-Based Complementary and Alternative Medicine. - : Hindawi Limited. - 1741-427X .- 1741-4288. ; 2012
  • Journal article (peer-reviewed)abstract
    • Background. Peak oxygen uptake (VO2peak) and muscle function are more decreased in patients with a combination of chronic heart failure (CHF) and type 2 diabetes mellitus (2DM) compared to patients with only one of the conditions. Further, patients with 2DM have peripheral complications that hamper many types of conventional exercises. Aim. To evaluate the efficacy and applicability of eight-week aquatic exercise in patients with the combination of CHF and 2DM. Methods. Twenty patients (four women) with both CHF and 2DM (age 67.4 +/- 7.1, NYHA II-III) were randomly assigned to either aquatic exercise or a control group. The patients exercised for 45 minutes 3 times/week in 33-34 degrees C, swimming pool. Results. The training programme was well tolerated. Work rate (+11.7 +/- 6.6 versus -6.4 +/- 8.1watt, P < 0.001) and VO2peak (+2.1 +/- 0.8 versus -0.9 +/- 1.4 mL.kg(-1) . min(-1), P < 0.001) and walking capacity (P = 0.01) increased significantly in the training group. Muscle function was also significantly improved and Hba1c decreased significantly (P < 0.01) during training, while fasting glucose, insulin, c-peptide, and lipids were unchanged. Training also increased vitality measured by SF-36 significantly (P = 0.05). Conclusion. Aquatic exercise could be used to improve exercise capacity and muscle function in patients with the combination of CHF and 2DM.
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23.
  • Cider, Åsa, 1960, et al. (author)
  • Cardiorespiratory effects of warm water immersion in elderly patients with chronic heart failure
  • 2005
  • In: Clin Physiol Funct Imaging. ; 25:6, s. 313-7
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Hydrotherapy might be included in the rehabilitation of patients with chronic heart failure (CHF), but little is known about the acute cardiorespiratory reaction in warm water. The aim of this study was to assess the acute cardiorespiratory effect of immersion in warm water, in a clinical setting, in elderly patients with CHF compared with healthy age and sex matched persons. METHODS: Twelve patients (three females) with CHF, NYHA II-III, age 64 +/- 6 years, and 12 healthy subjects were studied. Cardiorespiratory changes, on land and in a temperature-controlled swimming pool (33-34 degrees C) were assessed during rest and exercise, in a sitting position, using continuous gas analyses. RESULTS: There were no significant differences, land versus water, in carbon dioxide production, total ventilation, respiratory frequency, respiratory exchange ratio, heart rate or blood pressure in either of the groups. A significant difference was found in oxygen uptake, at rest, land versus water in patients with CHF in comparison with healthy subjects (-0.2 +/- 0.4 versus +0.3 +/- 0.6 ml kg(-1) min(-1), P < 0.01). Oxygen kinetics (tau) increased significantly (P = 0.01) in both groups during exercise in water. CONCLUSION: Hydrotherapy was well tolerated and the vast majority of the cardiorespiratory responses, during warm water immersion in a clinical setting, are similar in patients with CHF compared with healthy subjects. However, further larger studies, are needed to better understand the physiological reactions during hydrotherapy.
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24.
  • Cider, Åsa, 1960 (author)
  • Exercise in patients with chronic heart failure. With emphasis on peripheral muscle training, hydrotherapy and type 2 diabetes mellitus
  • 2005
  • Doctoral thesis (other academic/artistic)abstract
    • Chronic heart failure (CHF) is not uncommon in developed countries with a growing ageing population. CHF is a chronic syndrome, which markedly impact negatively on the patient s life situation. Considerable impaired physical function and reduced health related quality of life is often present. Type 2 diabetes mellitus is a frequent comorbidity in patients with CHF and results in an even greater impairment of physical function. Exercise is physiologically beneficial for patients with these conditions, however little is known about the effect of peripheral muscle training, and hydrotherapy has never earlier been studied in these patients. The aim of this thesis was to evaluate: 1). the chronic effect of peripheral muscle training in patients with CHF, 2). the chronic effect of hydrotherapy in patients with CHF withor without type 2 diabetes mellitus, 3). the acute cardiorespiratory reaction during warm water immersion in patients with CHF and in healthy subjects. Peripheral muscle training during five months was evaluated using ergospirometry, clinical and isokinetic muscle function tests and health related quality of life questionnaires. Twenty-four patients were randomised to either peripheral muscle training or control group. Peripheral muscle training resulted in a significantly improved anaerobic threshold and muscle endurance. The effect of eight weeks hydrotherapy (combined peripheral muscle training and aerobic exercise in warm water) was assessed in two studies, one where 25 randomised older patients with CHF and in another study where 20 patients with the combination of CHF and type 2 diabetes mellitus were evaluated. Exercise capacity, muscle function and health related quality of life was assessed. A test for metabolic function was added in patients with type 2 diabetes mellitus. Hydrotherapy resulted, in both studies, in a significant improved exercise capacity, walking distance and muscle function as well as a decreased HbA1c in type 2 diabetes mellitus. In some items, health related quality of life improved within the training group, both in patients with and without type 2 diabetes mellitus. The cardiorespiratory reaction during warm water immersion was studied in 12 patients with CHF and in 12 healthy subjects using gas analysis and with echocardiography in 13 patients with CHF and 13 healthy subjects. Patients with CHF had a lower oxygen uptake in warm water, at rest compared to healthy subjects. Hemodynamics increased during warm water immersion i.e. ejection fraction increased significantly in patients with CHF and stroke volume and cardiac output increased significantly in healthy subjects. Conclusion: Peripheral muscle training improves muscle function in patients with CHF and hydrotherapy improves exercise capacity and muscle function in patients with CHF, with or without type 2 diabetes mellitus. Moreover, immersion in warm water and hydrotherapy result immediately in an improved heamodynamic function in patients with CHF. These training regimens can therefore be included in the rehabilitation programme for patients with CHF, with or without type 2 diabetes mellitus. A smorgasbord with different exercise regimens might increase the possibility for patients with pronounced disability to remain physically active.
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25.
  • Cider, Åsa, 1960 (author)
  • Fysisk träning vid hjärtsvikt
  • 2005
  • In: Vård vid hjärtsvik. Redaktör Strömberg A. - Lund : Studentlitteratur.
  • Book chapter (other academic/artistic)
  •  
26.
  •  
27.
  • Cider, Åsa, 1960, et al. (author)
  • Hydrotherapy--a new approach to improve function in the older patient with chronic heart failure
  • 2003
  • In: Eur J Heart Fail. ; 5:4, s. 527-35
  • Journal article (peer-reviewed)abstract
    • AIMS: Hydrotherapy, i.e. exercise in warm water, as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure (CHF) due to the increased venous return caused by the hydrostatic pressure. However, hydrotherapy has advantages compared to conventional training. We studied the applicability of an exercise programme in a temperature-controlled swimming pool, with specific reference to exercise capacity, muscle function, quality of life and safety. METHODS AND RESULTS: Twenty-five patients with CHF (NYHA II-III, age 72.1+/-6.1) were randomised into either 8 weeks of hydrotherapy (n=15), or into a control group (n=10). The training program was well tolerated with no adverse events. Patients in the hydrotherapy group improved their maximal exercise capacity (+6.5 vs.-5.9 W, P=0.001), isometric endurance in knee extension (+4 vs.-9 s, P=0.01) together with an improvement in the performance of heel-lift (+4 vs. -3 n.o., P=<0.01), shoulder abduction (+12 vs. -8 s, P=0.01) and shoulder flexion (+6 vs. +4, P=0.01) in comparison to patients in the control group. CONCLUSION: Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF. This new approach broadens the variety of training regimes for older patients with CHF.
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28.
  • Cider, Åsa, 1960, et al. (author)
  • Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure
  • 2006
  • In: Eur J Heart Fail. - : Wiley. - 1388-9842. ; 8:3, s. 308-13
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The effects of immersion and training of patients with chronic heart failure (CHF) in warm water has not been thoroughly investigated. The aim of this study was to assess the acute hemodynamic response of immersion and peripheral muscle training in elderly patients with CHF. METHODS: Thirteen CHF patients and 13 healthy subjects underwent echocardiography on land and in a temperature-controlled swimming pool (33-34 degrees C). RESULTS: Rest. Heart rate decreased (CHF, p=0.01; control, p=0.001) and stroke volume increased (CHF, p=0.01; control, p=0.001) during water immersion in both groups, with no change in systolic or diastolic blood pressure. Ejection fraction (p<0.05) and transmitral Doppler E/A ratio (p=0.01) increased in the CHF group, with no changes in left ventricular volumes. The healthy subjects had similar responses, but also displayed an increase in cardiac output (p<0.01) and left ventricular volumes (p<0.001). Exercise. Cardiac output and systolic blood pressure increased significantly in water, in both groups. CONCLUSION: A general increase in early diastolic filling was accompanied by a decrease in heart rate, leading to an increase in stroke volume and ejection fraction in most patients with CHF during warm water immersion. These beneficial hemodynamic effects might be the reason for the previously observed good tolerability of this exercise regime.
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29.
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30.
  • Cider, Åsa, 1960, et al. (author)
  • Rehabilitering vid hjärtkärlsjukdom
  • 2006
  • In: ”Rehabiliteringsmedicin, Teori och praktik” Studentlitteratur 2006. - Lund : Studentlitteratur. ; , s. 323-328
  • Book chapter (other academic/artistic)
  •  
31.
  • Cider, Åsa, 1960, et al. (author)
  • Reliability of clinical muscular endurance tests in patients with chronic heart failure
  • 2006
  • In: Eur J Cardiovasc Nurs. ; 5:2, s. 122-6
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: In clinical praxis it is important to be able to assess the effect of rehabilitation in patients with chronic heart failure (CHF). There is therefore a need for simple clinical tests that are objective, reliable and valid measures. AIM: The aim of this study was to examine the reliability of three muscle endurance tests for patients with CHF and to compare the results to a healthy control group. METHOD: The study included 20 patients (7 women) with CHF and 20 healthy persons. Dynamic endurance of the shoulder and calf muscle was measured as well as static shoulder endurance. All three tests were performed twice, within 5-10 days. RESULTS: The reliability (rs) of the tests for the patients with CHF was between 0.90-0.99 and for the healthy persons between 0.79-0.98. There was also a significant difference in dynamic endurance in shoulder flexion and in heel-rise left leg test between patients with CHF and healthy persons. CONCLUSION: Tests of dynamic and static endurance of the shoulder muscle and dynamic calf muscle endurance are reliable assessment tools for use in clinical practice. Patients with CHF have reduced isotonic muscular endurance compared with healthy persons.
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32.
  • DuttaRoy, Smita, 1971, et al. (author)
  • High frequency home-based exercise decreases levels of vascular endothelial growth factor in patients with stable angina pectoris.
  • 2015
  • In: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 22:5, s. 575-581
  • Journal article (peer-reviewed)abstract
    • In coronary artery disease (CAD), circulating angiogenic factors have been seen to increase, possibly as a response to ischaemia. Regular physical activity (PA) is recommended for prevention and treatment of CAD, but more research is needed to optimise PA regimes. We investigated the effect of home-based high frequency exercise (HFE) on angiogenic cytokines and cardiac markers in patients with stable CAD.
  •  
33.
  • DuttaRoy, Smita, 1971, et al. (author)
  • The effects of age on circulating vascular markers and cardiac prognostic markers, before and after 2 months home-based high-frequency exercise training in patients with stable coronary artery disease
  • 2014
  • In: European Heart Journal. European Society of Cardiology, 30 August - 3 September 2014, Barcelona. - 0195-668X .- 1522-9645. ; 35:Supplement: 1
  • Conference paper (other academic/artistic)abstract
    • Purpose: Vascular endothelial growth factor (VEGF) and stromal derived factor (SDF-1) play an important role in angiogenesis. Relaxin-2 (Rlx-2) has both angiogenic and vasodilatory properties, while endothelin-1 (ET-1) is a potent vasocontrictor.VEGF, SDF-1 and Rlx-2-levels have shown to be positively modulated by exercise training, while the effect of exercise on (Rlx-2) is not known. Age is a known risk factor for morbidity and mortality in coronary artery disease (CAD). We wanted to investigate how age affects levels of these vascular factors and known prognostic cardiac markers before and after high frequency exercise training (HFE), in patients with CAD. Methods: Patients with stable CAD (age 48-80 years) were randomized to HFE (aerobic exercise 70% of max, 30 minutes, 5 times/week and resistance exercise 3 times/week), performed at home for 8 weeks, or usual lifestyle (ctrl). Serum and plasma was collected from 21 controls and 24 HFE-patients and analyzed at baseline and after 8 weeks. VEGF, SDF-1, Rlx-2 and ET-1were analyzed with enzymelinked immunoadsorbent assay (ELISA). TnT and NT-pro-BNP were analyzed on Cobas e602 (Roche). Correlation was calculated using the statistical software Graph Pad Prism 6. Pearson’s r was calculated to determine correlation between the factors prior to exercise, while Spearman’s r was used for the analysis on the exercise induced effects of the HFE-group. The exercise-induced effect on cardiac biomarkers was determined by comparing % change (from baseline to 8 weeks) between HFE and Ctrl using Mann-Whitney U-test. Results: At baseline, there was a significant positive correlation between age and TnT (r=0.38, p<0.05) and a non-significant positive correlation between age and NT-proBNP (r=0.36, p=0.06), while no correlation was found between age and levels of vascular markers (VEGF r=-0,14, SDF-1 r=-0,13, ET-1 r=0,08, Rlx-2 r=0,06, p=ns for all). As we have previously shown, home-based HFE decreased VEGF (2,6+29% (ctrl) and -3,9 +13% (HFE), p<0,05), but the other studied factors were not significantly affected. We found no correlation between age and changes in cardiac markers after exercise. Conclusions: Elderly patients with stable CAD have higher levels of TnT and NT-proBNP, indicating a higher degree of underlying CAD. This may also reflect their higher mortality in CAD. HFE-training may lower VEGF in patients with stable CAD. Interestingly, there seems to be no difference in the respone response to exercise in cardiac biomarkers, between younger and older CAD patients
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34.
  • Ek, Amanda, 1981-, et al. (author)
  • Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival : results from the SWEDEHEART-registry.
  • 2019
  • In: Clinical Research in Cardiology. - : Springer. - 1861-0684 .- 1861-0692. ; 108:3, s. 324-332
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality.METHODS: A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions.RESULTS: During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission.CONCLUSIONS: The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.
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35.
  • Ekblom, Örjan, 1971-, et al. (author)
  • Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry
  • 2018
  • In: Journal of the American Heart Association. - : American Heart Association. - 2047-9980. ; 7:24
  • Journal article (peer-reviewed)abstract
    • BackgroundWith increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI.Methods and ResultsData from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status.ConclusionsThe present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.
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36.
  • Ekblom, Örjan, 1971-, et al. (author)
  • Participation in exercise-based cardiac rehabilitation is related to reduced total mortality in both men and women : results from the SWEDEHEART registry.
  • 2022
  • In: European Journal of Preventive Cardiology. - : Oxford University Press. - 2047-4873 .- 2047-4881. ; 29:3, s. 485-492
  • Journal article (peer-reviewed)abstract
    • AIMS: Participation in exercise-based cardiac rehabilitation (exCR) increases aerobic capacity and improves outcomes in patients following myocardial infarction (MI) and is therefore universally recommended. While meta-analyses consistently report that participation in exCR reduces cardiovascular mortality, there are conflicting results regarding effects on total mortality. Presently, many eligible patients do not receive exCR in clinical practice. We aimed to investigate the relation between participation in exCR post-MI and total mortality in men and women in a nationwide real-world cohort from the SWEDEHEART registry.DESIGN: Longitudinal, observational cohort study.METHODS AND RESULTS: In total, 20 895 patients from the SWEDEHEART registry were included. Mortality data were obtained from the Swedish National Population Registry. During a mean of 4.55 (±2.33) years of follow-up, 1000 patients died. Using Cox regression for proportional odds and taking a wide range of potential confounders into consideration, participation in exCR was related to significantly lower total mortality [hazard ratio (HR) 0.72, 95% confidence interval 0.62-0.83]. Excluding patients with shorter follow-up than 2 years did not alter the results. Exercise-based CR participation was related to lowered total mortality in most of the investigated subgroups. The risk reduction was more pronounced in women than in men (HR 0.54 vs. 0.81, respectively).CONCLUSION: Participation in exCR was associated with reduced total mortality, and more pronounced in women, compared with men. Our results further support the recommendations to participate in exCR, and hence we argue that exCR should be a mandatory part of comprehensive CR programmes, offered to all patients post-MI.
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37.
  • Ericsson, Anna, et al. (author)
  • Effects of exercise on fatigue and physical capacity in men with chronic widespread pain - a pilot study
  • 2016
  • In: Bmc Sports Science Medicine and Rehabilitation. - : Springer Science and Business Media LLC. - 2052-1847. ; 8
  • Journal article (peer-reviewed)abstract
    • Background: There is very limited knowledge about the effects of exercise on men with Chronic Widespread Pain (CWP), especially regarding fatigue. We wanted to investigate the effects of resistance exercise compared with pool exercise on multidimensional fatigue, psychological distress and physical capacity in men with CWP. Methods: Thirty-four men with CWP, with a mean age of 49 (SD 8, range 26-59) years, were randomised to 12 weeks of standardised pool exercise (PE) or resistance exercise (RE). The primary outcome was the Multidimensional Fatigue Inventory (MFI-20). Depression, anxiety, isometric force, pain and health-related quality of life were also assessed. Results: No significant differences were found for changes in MFI-20 between the exercise groups. The RE group improved the isometric forces of right shoulder abduction (RE: Delta 2.2 SD 1.5 N, PE: Delta 0.6 SD 1.2 N, p = 0.009), right knee flexion (RE: Delta 50, SD 50 N, PE: Delta-17, SD 71 N, p = 0.003) and left knee flexion (RE: Delta 33 SD 39, PE: Delta-9 SD 52 N, p = 0.017) compared with the PE group. The drop-out rate was 29 % in the RE group and 18 % in the PE group. Conclusions: Both a resistance exercise programme and a pool exercise programme improved different dimensions of fatigue in men with CWP. There were no differences in the change in fatigue over time between the exercise groups. Resistance exercise improved isometric strength compared with pool exercise. Because different types of exercise appear to improve different aspects of health, the goals could guide the choice of treatment. Further exercise studies with larger groups are needed to gain more knowledge about the effect of exercise on fatigue in men with CWP.
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38.
  • Grüner Sveälv, Bente, 1956, et al. (author)
  • Benefit of warm water immersion on biventricular function in patients with chronic heart failure
  • 2009
  • In: Cardiovasc Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120 .- 1476-7120. ; 7
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Regular physical activity and exercise are well-known cardiovascular protective factors. Many elderly patients with heart failure find it difficult to exercise on land, and hydrotherapy (training in warm water) could be a more appropriate form of exercise for such patients. However, concerns have been raised about its safety.The aim of this study was to investigate, with echocardiography and Doppler, the acute effect of warm water immersion (WWI) and effect of 8 weeks of hydrotherapy on biventricular function, volumes and systemic vascular resistance. A secondary aim was to observe the effect of hydrotherapy on brain natriuretic peptide (BNP). METHODS: Eighteen patients [age 69 +/- 8 years, left ventricular ejection fraction 31 +/- 9%, peakVO2 14.6 +/- 4.5 mL/kg/min] were examined with echocardiography on land and in warm water (34 degrees C).Twelve of these patients completed 8 weeks of control period followed by 8 weeks of hydrotherapy twice weekly. RESULTS: During acute WWI, cardiac output increased from 3.1 +/- 0.8 to 4.2 +/- 0.9 L/min, LV tissue velocity time integral from 1.2 +/- 0.4 to 1.7 +/- 0.5 cm and right ventricular tissue velocity time integral from 1.6 +/- 0.6 to 2.5 +/- 0.8 cm (land vs WWI, p < 0.0001, respectively). Heart rate decreased from 73 +/- 12 to 66 +/- 11 bpm (p < 0.0001), mean arterial pressure from 92 +/- 14 to 86 +/- 16 mmHg (p < 0.01), and systemic vascular resistance from 31 +/- 7 to 22 +/- 5 resistant units (p < 0.0001).There was no change in the cardiovascular response or BNP after 8 weeks of hydrotherapy. CONCLUSION: Hydrotherapy was well tolerated by all patients. The main observed cardiac effect during acute WWI was a reduction in heart rate, which, together with a decrease in afterload, resulted in increases in systolic and diastolic biventricular function. Although 8 weeks of hydrotherapy did not improve cardiac function, our data support the concept that exercise in warm water is an acceptable regime for patients with heart failure.
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39.
  • Grüner Sveälv, Bente, 1956, et al. (author)
  • Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure?
  • 2012
  • In: Journal of Geriatric Cardiology. - : Tsinghua University Press. - 1671-5411. ; 9:4, s. 408-410
  • Journal article (peer-reviewed)abstract
    • Hydrotherapy (exercise in warm water) is considered to be a safe and beneficial method to use in the rehabilitation of stable heart failure patients, but there is little information on the effect of the increased venous return and enhanced preload in elderly patients with biventricular heart failure. We present a case of an elderly man who was recruited to participate in a hydrotherapy study. We compared echocardiographic data during warm water immersion with land measurements, and observed increases in stroke volume from 32 mL (land) to 42 mL (water), left ventricular ejection fraction from 22% to 24%, left ventricular systolic velocity from 4.8 cm/s to 5.0 cm/s and left atrioventricular plane displacement from 2.1 mm to 2.2 mm. By contrast, right ventricular systolic velocity decreased from 11.2 cm/s to 8.4 cm/s and right atrioventricular plane displacement from 8.1 mm to 4.7 mm. The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during warm water immersion. Thus, although left ventricular systolic function was relatively unaffected during warm water immersion, we observed a decrease in right ventricular function with an augmented right ventricular pressure. We recommend further investigations to observe the cardiac effect of warm water immersion on patients with biventricular systolic heart failure and at risk of elevated right ventricular pressure.
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40.
  • Hambraeus, Kristina, et al. (author)
  • SWEDEHEART annual report 2012
  • 2014
  • In: Scandinavian Cardiovascular Journal. - : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 48:SUPPL. 63, s. 1-333
  • Journal article (peer-reviewed)abstract
    • The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) supports continuous monitoring and improvement of care for coronary artery disease, catheter-based and surgical coronary interventions, secondary prevention as well as catheter based and surgical valve intervention, by providing extensive data on base-line, diagnostic, procedural and outcome variables. Design. This national quality registry collects information from all Swedish hospitals treating patients with acute coronary artery disease and all patients undergoing coronary angiography, catheter-based interventions or heart surgery. Combination with other national mandatory official registries enables complete follow-up of all individuals regarding myocardial infarction, new interventional procedures, death and all-cause hospitalizations. The registry is governed by an independent steering committee and funded by the Swedish National Health care provider. The software is developed by Uppsala Clinical Research Center. Results. The SWEDEHEART Quality Index reflects overall quality of care for coronary artery disease including secondary prevention. In comparison with 2011, an improvement of the index occurred in 2012 overall. There was however, still a wide range in performance between individual centers, emphasizing the need for continuous monitoring of quality of care at a national as well as on a center level. © 2014 Informa Healthcare.
  •  
41.
  • Lange, Elvira, et al. (author)
  • Physiological Adaptation in Women Presenting Fibromyalgia: Comparison with Healthy Controls
  • 2017
  • In: Clinical and Experimental Psychology. - : OMICS Publishing Group. - 2471-2701. ; 1:3
  • Journal article (peer-reviewed)abstract
    • Objective: To compare the heart rate variability (HRV) before and after a sub-maximal exercise test in women with fibromyalgia (FM) and to compare the result to matched controls. Additionally, to compare heart rate (HR) before, during and after the sub-maximal exercise test. Methods: Twenty-four women with FM and 26 controls performed a sub-maximal exercise test. HRV was registered for 5 minutes at rest before and after the exercise test. HR was registered at baseline, during the exercise test and at recovery. Results: The HRV of the healthy group was statistically different from the exercise test but the women with FM showed no such difference. HR was significantly higher among the women with FM than in the healthy group at baseline and up to 75W but lower at peak (138/152 bpm, p<0.008). In women with FM HR during exercise (HR2) was predicted by heart rate recovery (HRR20) and physical exertion (RPE2). HRR20 and RPE2 accounted for 0.465 of the variance (p=0.006) in HR2. In healthy women HR2 correlated with HRR20 and negatively with physical activity (PhA). In the reference group HRR20 and PhA accounted for 0.448 (p=0.002) of the variance HR. Conclusion:The HRV in women with FM show less adjustment of the ANS while not being significantly affected by submaximal exercise as healthy women. In healthy women heart rate during the test was negatively related to PhA. In women with FM exertion seems to replace an effect from exercise on physiological adaptation. FM may entail imperceptible extraction of power from PhA while under load. Links to FM pain will be discussed. Women with FM seem to rate exertion “Very hard” on lower workload and HR than healthy women. The physiotherapeutic methodology for measuring HRV with basic HR monitors should be improved before it can be recommended for clinical use.
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42.
  • Lans, Charlotta, et al. (author)
  • Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long-term effects on walking distance and quality of life; a pilot study
  • 2018
  • In: Esc Heart Failure. - : Wiley. - 2055-5822. ; 5:2, s. 241-248
  • Journal article (peer-reviewed)abstract
    • Aims This study aimed to describe a method of peripheral muscle training with resistance bands in patients with chronic heart failure (CHF) and to evaluate its effects on the 6 min walk test and quality of life up to 12 months using a home-based programme. Methods and results Twenty-two patients with stable CHF (19 men and 3 women), mean age 63.2 years (SD 8.1), New York Heart Association class II-III were randomized to individual home-based training (HT group), or home-based training with a group-based start-up in a hospital setting (GT group). A 6 min walk test, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and Short Form with 36 items (SF-36) were administered at baseline and after 3, 6, 9, and 12 months. Exercise training resulted in statistically significant increased walking distance in both groups. The HT group increased on average 107 (80) m from baseline to 12 months, and the GT group by 100 (96) m. Health-related quality of life, measured with MLHFQ and SF-36, reached statistically significant improvements in both groups but at different time points. There were no statistically significant differences between groups on any parameters or follow-ups. Conclusions Long-term home-based peripheral muscle training in patients with CHF, with or without an introductory period in a hospital setting, can be used for initial improvement and retention of walking distance and health-related quality of life.
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43.
  • Lans, Charlotta, et al. (author)
  • Test–retest reliability of six-minute walk tests over a one-year period in patients with chronic heart failure
  • 2020
  • In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 40:4, s. 284-289
  • Journal article (peer-reviewed)abstract
    • Purpose: The aims of this study were to determine the test–retest reliability of the duplicated six-minute walk test (6MWT) in patients with chronic heart failure (HF), and to evaluate its variation over time. Methods: Forty-six patients (9 women) with HF performed duplicated 6MWT every third month for 1year (5 follow-ups), for a total of 198 paired tests. The patients completed two 6MWT on the same day with a 45-min seated rest between tests. Results: The mean distance in metres, for the first (6MWT1) versus the second (6MWT2), for each follow-up, was 408±100 versus 411±96, 449±94 versus 465±94, 464±96 versus 473±100, 462±103 versus 468±104 and 472±105 versus 482±107. On average, a marginally, clinically insignificant longer walked distance, 9m (2.0%), was seen in the second 6MWT. The standard error of a single determination (Smethod) ranged from 2.4% to 3.9% over the study period, and the intraclass correlation coefficient (ICC) ranged from 0.96 to 0.99 (CI 95% 0.94–0.99). The variation over time of ICC or Smethod was not statistically significant. Conclusion: The 6MWT is highly reliable over time in patients with HF, and one test is, therefore, sufficient in clinical follow-ups. © 2020 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine
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44.
  • Lans, Charlotta, et al. (author)
  • The relationship between six-minute walked distance and health-related quality of life in patients with chronic heart failure
  • 2022
  • In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 56:1, s. 310-315
  • Journal article (peer-reviewed)abstract
    • Objectives. To assess the relationship between the six-minute walk test (6MWT) and health-related quality of life (HRQL) in patients with chronic heart failure. Methods. Forty-six patients (37 men and 9 women) with chronic heart failure, mean age 68 (SD 9), NYHA II-III and EF 29 (9) % were included. They performed 6MWT and assessed HRQL using two tools, a Swedish version of the 36-item Short Form (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). This was performed repeatedly during a study period of one year. Results. Patients with a walking distance lower than median experienced a lower HRQL than the higher performing half of the cohort, in four dimensions of the SF-36 and the summary of physical and mental components, but not in the dimensions of MLHFQ. Conclusion. Patients with heart failure with a short walking distance assessed their quality of life as inferior in half of the dimensions in the SF-36 but not in the dimensions measured with the MLHFQ. Thus, different aspects of the symptomatology are uncovered using the 6MWT and the different HRQL tools.
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45.
  • Lundqvist, Stefan, et al. (author)
  • Long-term physical activity on prescription intervention for patients with insufficient physical activity level-a randomized controlled trial
  • 2020
  • In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 21:1
  • Journal article (peer-reviewed)abstract
    • BackgroundPhysical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting.MethodsWe included 190 patients, 27-77years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups.ResultsAt the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved >= 150min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p=0.004 vs. baseline), increased mental health status (MCS) (p=0.036), and reduced body mass index (BMI) (p=0.001), with no difference between groups.ConclusionDuring long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies.Trial registrationClinicalTrials.gov NCT03012516. Registered on 30 December 2016-retrospectively registered.
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46.
  • Lundqvist, Stefan, et al. (author)
  • Physical Activity on Prescription (PAP), in patients with metabolic risk factors. A 6-month follow-up study in primary health care
  • 2017
  • In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
  • Journal article (peer-reviewed)abstract
    • There is strong evidence that inadequate physical activity (PA) leads to an increased risk of lifestyle-related diseases and premature mortality. Physical activity on prescription (PAP) is a method to increase the level of PA of patients in primary care, but needs further evaluation. The aim of this observational study was to explore the association between PAP-treatment and the PA level of patients with metabolic risk factors and the relationship between changes in the PA level and health outcomes at the 6 month follow-up. This study included 444 patients in primary care, aged 27-85 years (56% females), who were physically inactive with at least one component of metabolic syndrome. The PAP-treatment model included: individualized dialogue concerning PA, prescribed PA, and a structured follow-up. A total of 368 patients (83%) completed the 6 months of follow-up. Of these patients, 73% increased their PA level and 42% moved from an inadequate PA level to sufficient, according to public health recommendations. There were significant improvements (p <= 0.05) in the following metabolic risk factors: body mass index, waist circumference, systolic blood pressure, fasting plasma glucose, cholesterol, and low density lipoprotein. There were also significant improvements regarding health-related quality of life, assessed by the Short Form 36, in: general health, vitality, social function, mental health, role limitation-physical/emotional, mental component summary, and physical component summary. Regression analysis showed a significant association between changes in the PA level and health outcomes. During the first 6-month period, the caregiver provided PAP support 1-2 times. This study indicates that an individual-based model of PAP-treatment has the potential to change people's PA behavior with improved metabolic risk factors and self-reported quality of life at the 6 month follow-up. Thus, PAP seems to be feasible in a clinical primary care practice, with minimum effort from healthcare professionals.
  •  
47.
  • Lundqvist, Stefan, et al. (author)
  • The effects of a 5-year physical activity on prescription (PAP) intervention in patients with metabolic risk factors.
  • 2022
  • In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 17:10
  • Journal article (peer-reviewed)abstract
    • Increased physical activity (PA) has positive effects on health and longevity. In Swedish healthcare, the physical activity on prescription (PAP) method reportedly increases patients' PA levels for up to 12 months, but long-term follow ups are lacking. As it remains difficult to maintain lifestyle changes, our aim was to evaluate adherence and clinical effects at a 5-year follow-up of PAP treatment in primary healthcare.This longitudinal, prospective cohort study included 444 patients, (56% female), aged 27-85 years, with at least one metabolic risk factor. Participants were offered PAP by nurses or physiotherapists. The PAP intervention included an individualised dialogue, a PA recommendation by written prescription, and individually adjusted follow-up over 5 years, according to the Swedish PAP model. Patient PA level, metabolic risk factors, and health related quality of life (HRQoL) were measured at baseline and at the 6-month, 1.5-year, 2.5-year, 3.5-year, and 5-year follow-ups. Estimated latent growth curves were used to examine levels and rates of change in the outcomes.The study dropout rate was 52%, with 215 of 444 patients completing the 5-year follow-up. At follow-up, the mean PA level had increased by 730 MET-minutes per week or 3 hours of moderate-intensity PA/week when compared to baseline. During the 5-year intervention, we observed significant positive changes (p ≤ 0.05) in 9 of 11 metabolic risk factors and HRQoL parameters: body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, triglycerides, cholesterol, high-density lipoprotein, and mental component summary.This first evaluation of a 5-year PAP intervention in primary care demonstrated positive long-term (5 years) effects regarding PA level, metabolic health, and HRQoL. The recorded long-term adherence was ~50%, which is in line with medical treatment. Despite limitations, PAP can have long-term effects in an ordinary primary care setting.
  •  
48.
  • Lundqvist, Stefan, et al. (author)
  • Which patients benefit from physical activity on prescription (PAP)? A prospective observational analysis of factors that predict increased physical activity.
  • 2019
  • In: BMC public health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19:1
  • Journal article (peer-reviewed)abstract
    • There is robust evidence that regular physical activity (PA) has positive health effects. However, the best PA methods and the most important correlates for promoting PA remain unclear. Physical activity on prescription (PAP) aims to increase the patient's motivation for and level of PA. This study investigated possible predictive baseline correlates associated with changes in the PA level over a 6-month period of PAP treatment in order to identify the primary care patients most likely to benefit from a PAP intervention.The study included 444 patients with metabolic risk factors who were aged 27 to 85years and physically inactive. The patients received PAP treatment that included individual counseling plus an individually-tailored PA recommendation with a written prescription and individualised structured follow-up for 6months. Eight baseline correlates of PA were analysed against the PA level at the 6-month follow-up in a predictor analysis.Five baseline correlates predicted the PA level at the 6-month follow-up: self-efficacy expectations for changing PA; the patient's preparedness and confidence regarding readiness to change PA; a BMI<30; and a positive valued physical health. The proportion of patients increasing the PA level and achieving a PA level that was in accordance with public health recommendations was higher with a positive valued baseline correlate. The odds of achieving the recommended PA level increased substantially when 2 to 4 predictive correlates were present. PA levels increased to a greater extent among patients with low PA at baseline than patients with high PA at baseline, especially in combination with 2 to 4 positively-valued correlates (87-95% vs. 62-75%).This study identified potential predictive correlates of an increased PA level after a 6-month PAP intervention. This contributes to our understanding of PAP and could help individualise PAP support. The proportion of patients with the lowest PA level at baseline increased their PA level in a higher extent (84%) and thus may benefit the most from PAP. These results have clinical implications for behavioural change in those patients having the greatest health gains by increasing their PA level.ClinicalTrials.gov ; NCT03586011 . Retrospectively registered on July 17, 2018.
  •  
49.
  • Mannerkorpi, Kaisa, 1955, et al. (author)
  • Acute effects of physical exercise on the serum insulin-like growth factor system in women with fibromyalgia
  • 2017
  • In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1
  • Journal article (peer-reviewed)abstract
    • © 2017 The Author(s).Background: Increased Serum insulin-like growth factor-1 (S-IGF-1) has been noted after physical activity in healthy subjects, while the acute release of S-IGF-1 in relation to exercise has not previously been studied in women with fibromyalgia (FM). S-IGF-1 and its binding protein (S-IGFBP-3) are mediated by growth hormone and have anabolic effects on the skeletal muscle. Aim of the study was to investigate acute release of IGF-1 after aerobic exercise in women with FM. Methods: The acute effect of physical exercise on S-IGF-1 and S-IGFBP-3 were studied in 22 women with FM and in 27 healthy controls during moderate and high-intensity cycling (i.e. ratings 12-13 and 15-17, on Borg's perceived exertion scale (RPE), respectively). Self-reported pain and fatigue were recorded. Differences within and between the two groups were analyzed. Results: After 15 min of bicycling, S-IGF-1 and S-IGFBP-3 increased both within the group with FM and in the healthy controls (p < 0.01). The increases in S-IGF-1 did not significantly differ between the women with FM and the healthy control group (mean increase 11 ± 10 vs. 11 ± 15 ng/ml and 13 ± 10 vs. 19 ± 22 ng/ml) when bicycling at moderate or high intensity, respectively. Self-reported pain and fatigue during exercise, irrespective of intensity, were higher in women with FM compared with healthy controls (p < 0.001). Conclusions: Fifteen minutes bicycling at moderate intensity was sufficient to acutely mobilise S-IGF-1 in women with FM similarly to healthy controls in spite of higher score of fatigue and pain in women with FM. Hence, patients with FM were able to activate their skeletal muscle metabolism during a short, moderate bout of exercise and were not resistant to training effects. The result is important for encouraging clinical rehabilitation of patients with FM who commonly exercise at a moderate, rather than at a high-intensity level. Trial registration: ClinicalTrials.govNCT01592916, May 4, 2012.
  •  
50.
  • Mannerkorpi, Kaisa, 1955, et al. (author)
  • Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial
  • 2010
  • In: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 12:5
  • Journal article (peer-reviewed)abstract
    • INTRODUCTION: The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking (NW) on functional capacity and pain in fibromyalgia (FM). METHODS: A total of 67 women with FM were recruited to the study and randomized either to moderate-to-high intensity Nordic Walking (n = 34, age 48 ± 7.8 years) or to a control group engaging in supervised low-intensity walking (LIW, n = 33, age 50 ± 7.6 years). Primary outcomes were the six-minute walk test (6MWT) and the Fibromyalgia Impact Questionnaire Pain scale (FIQ Pain). Secondary outcomes were: exercise heart rate in a submaximal ergometer bicycle test, the FIQ Physical (activity limitations) and the FIQ total score. RESULTS: A total of 58 patients completed the post-test. Significantly greater improvement in the 6MWT was found in the NW group (P = 0.009), as compared with the LIW group. No between-group difference was found for the FIQ Pain (P = 0.626). A significantly larger decrease in exercise heart rate (P = 0.020) and significantly improved scores on the FIQ Physical (P = 0.027) were found in the NW group as compared with the LIW group. No between-group difference was found for the change in the FIQ total. The effect sizes were moderate for the above mentioned outcomes. CONCLUSIONS: Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise, resulting in improved functional capacity and a decreased level of activity limitations. Pain severity did not change over time during the exercise period. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT00643006.
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