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1.	Ademuyiwa, Adesoji O., et al. (author) Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries 2016 In: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4 Journal article (peer-reviewed)abstract Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
2.	Frykholm, Erik, 1985- (author) The relevance and assessment of limb muscle function in individuals with chronic obstructive pulmonary disease 2021 Doctoral thesis (other academic/artistic)abstract Chronic obstructive pulmonary disease (COPD) is a disease that is characterised by persistent respiratory symptoms and airflow limitation. Consequences beyond the airways and lungs are common, and include limb muscle dysfunction. Limb muscle dysfunction is treated with exercise training, and should be preceded by assessments to individualise prescriptions. Guidelines recommend assessment of quadriceps strength, but limb muscle dysfunction affects more than strength. Other less investigated assessments may be of interest. During training, direct physiological (cardiorespiratory, metabolic, and biomechanical) and symptomatic responses are important, since they can affect training effectivity, and they may differ depending on whether arms or legs are used. The main aims of this thesis were to investigate the relevance of assessments of quadriceps function, feasibility and reliability of methods to assess quadriceps endurance, and to compare the direct physiological and symptomatic responses during arm and leg activities in people with COPD.Method: This thesis is based on four papers. These include one systematic review with a meta-analysis of studies comparing direct physiological and symptomatic responses to activities performed with the arms versus the legs, and three papers based on an international cross-sectional multicentre study investigating reliability, feasibility, and relevance of three leg extension assessments of quadriceps endurance. Relative and absolute reliability were determined via interclass correlation coefficient (ICC), coefficient of variation (CV %), and limits of agreement (LoA %) for measures of isokinetic total work, isokinetic fatigue index, isometric time to exhaustion, and isotonic repetitions to exhaustion. The relevance of the measures of quadriceps endurance and other quadriceps functions were determined by the association to functional capacity and physical activity with Pearson correlation analyses (r) and multiple linear regression models (R2, adjusted R2, Δ R2, and Δ adjusted R2).Results: Results from the meta-analyses show that leg-cycle ergometer resulted in greater tidal volume (137 mL), minute ventilation (4.8 L/min), and oxygen consumption (164 mL/min) compared to arm cycle ergometer, while symptomatic responses were similar. Physiological responses (e.g., minute ventilation and oxygen consumption) during arm compared to leg resistance training exercises were similar. Results from studies on functional activities depend on the type and intensity of the activity performed. Isokinetic total work was the measurement with the highest relative reliability (ICC = 0.98) and the smallest absolute reliability (e.g., CV% = 6.5). Isokinetic fatigue index, isometric, and isotonic measures demonstrated low-to-high relative reliability (ICC = 0.64, 0.88, 0.91), and absolute reliability was larger (e.g., CV% = 20.3, 14.9, and 15.8%). Participants performed better on the retest for isokinetic total work and isometric measurements (4.8 and 10%, p < 0.001). The feasibility was similar across protocols, with an average time consumption of< 7.5 minutes, limited perceived dyspnoea compared to leg fatigue, and no major adverse advents. The measures of quadriceps function had mostly similar (r = +/- 0.07–0.45) levels of correlations to the functional capacity and physical activity. In multiple regression analyses improved quadriceps power the models to predict functional capacity the most (Δ adjusted R2= 0.10, 0.15, adjusted R2 = 0.60, 0.39). Isotonic endurance was the only muscle function that improved all physical activity models (ΔR2 = 0.04–0.07, p < 0.05, R2 = 0.38–0.49).Conclusions: The results indicate that if the goal of an activity is to maximise physiological responses such as minute ventilation and oxygen consumption, activities involving the legs should be preferred. Symptomatic responses seems task and intensity dependent, which suggest that strategies used to reduce symptoms should be based on relative intensity. In the assessment of quadriceps endurance, isokinetic, isometric and isotonic protocols present low to very high relative reliability. Differences in reliability and the better performance at retest might reflect differences in ability to detect true change. Quadriceps power seems to be more relevant to functional capacity, and isotonic quadriceps endurance seems to be more relevant to physical activity.
3.	Hibar, Derrek P., et al. (author) Novel genetic loci associated with hippocampal volume 2017 In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 8 Journal article (peer-reviewed)abstract The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (r(g) = -0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness.
4.	Pattaro, Cristian, et al. (author) Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function 2016 In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 7 Journal article (peer-reviewed)abstract Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways.
5.	Satizabal, Claudia L., et al. (author) Genetic architecture of subcortical brain structures in 38,851 individuals 2019 In: Nature Genetics. - : Nature Publishing Group. - 1061-4036 .- 1546-1718. ; 51:11, s. 1624- Journal article (peer-reviewed)abstract Subcortical brain structures are integral to motion, consciousness, emotions and learning. We identified common genetic variation related to the volumes of the nucleus accumbens, amygdala, brainstem, caudate nucleus, globus pallidus, putamen and thalamus, using genome-wide association analyses in almost 40,000 individuals from CHARGE, ENIGMA and UK Biobank. We show that variability in subcortical volumes is heritable, and identify 48 significantly associated loci (40 novel at the time of analysis). Annotation of these loci by utilizing gene expression, methylation and neuropathological data identified 199 genes putatively implicated in neurodevelopment, synaptic signaling, axonal transport, apoptosis, inflammation/infection and susceptibility to neurological disorders. This set of genes is significantly enriched for Drosophila orthologs associated with neurodevelopmental phenotypes, suggesting evolutionarily conserved mechanisms. Our findings uncover novel biology and potential drug targets underlying brain development and disease.
6.	Artigas Soler, María, et al. (author) Genome-wide association and large-scale follow up identifies 16 new loci influencing lung function. 2011 In: Nature genetics. - : Springer Science and Business Media LLC. - 1546-1718 .- 1061-4036. ; 43:11, s. 1082-90 Journal article (peer-reviewed)abstract Pulmonary function measures reflect respiratory health and are used in the diagnosis of chronic obstructive pulmonary disease. We tested genome-wide association with forced expiratory volume in 1 second and the ratio of forced expiratory volume in 1 second to forced vital capacity in 48,201 individuals of European ancestry with follow up of the top associations in up to an additional 46,411 individuals. We identified new regions showing association (combined P < 5 × 10(-8)) with pulmonary function in or near MFAP2, TGFB2, HDAC4, RARB, MECOM (also known as EVI1), SPATA9, ARMC2, NCR3, ZKSCAN3, CDC123, C10orf11, LRP1, CCDC38, MMP15, CFDP1 and KCNE2. Identification of these 16 new loci may provide insight into the molecular mechanisms regulating pulmonary function and into molecular targets for future therapy to alleviate reduced lung function.
7.	Bergqvist, Matilda, et al. (author) Dynamic and static quadriceps muscle endurance in people with COPD and healthy age and gender-matched controls 2019 In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 54:suppl 63 Journal article (peer-reviewed)abstract Introduction: It is commonly known that quadriceps muscle endurance is decreased among people with COPD, however, whether static and dynamic quadriceps muscle endurance is affected to the same extent, remains to be determined. The latter of importance for the design of exercise modalities targeting quadriceps endurance in COPD.Methods: Static (isometric) and dynamic (isokinetic, isotonic) measurements of quadriceps muscle endurance was performed using a computerized dynamometer on 30 of individuals with COPD (FEV1 63% predicted) and 30 healthy age and gender-matched controls. Test order was randomized, separated by 30 min of rest. Comparisons between groups included both relative (seconds/repetitions) and absolute (total work [Nm]) measures of quadriceps endurance. Between-group results are presented as percentage difference (%) and effect sizes (ES).Results: When compared to healthy age and gender matched controls, people with COPD had significantly lower absolute measures of quadriceps endurance (isometric -32%, ES 0.66 [moderate]; isokinetic -29%, ES 0.94 [large], isotonic -38%, ES 0.89 [large], all p <0.05) as well as lower relative measures of dynamic quadriceps endurance (isotonic [repetitions] -20%, ES 0.50 [moderate], p = 0.02) while static quadriceps endurance did not differ between groups (isometric [seconds] -3%, ES 0.06 [trivial], p = 0.617).Conclusion: As evident by larger ES, dynamic quadriceps endurance seems to be reduced to a larger extent than static quadriceps endurance in people with COPD. Thus, exercise modalities that aim to improve quadriceps endurance should preferably be designed to increase dynamic quadriceps muscle enduranceFootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, OA3814.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
8.	Björklund, Martin, 1961-, et al. (author) Office-cycling while working : An innovative concept to prevent and reduce musculoskeletal pain in office workers - a controlled feasibility study 2015 Conference paper (peer-reviewed)abstract Background: According to the World Health Organization, WHO, a sedentary lifestyle is the single largest health risk for a number of diseases including musculoskeletal disorders and metabolic diseases. The negative health effects of excessive sitting are not compensated for by shorter bouts of increased physical activity. However, evidence shows that increased physical activity reduces musculoskeletal pain, which is very prevalent in those who are inactive. About 50-70 % of those who work at a computer report musculoskeletal pain and spend on average about 5 hours/day with very low energy metabolism. Work places are therefore an important arena for prevention and intervention by means of reducing sedentary time and increasing physical activity both for general health benefits and effects on the musculoskeletal pain.Purpose: To test the feasibility of office-cycling in an office work place and explore its potential effects on musculoskeletal pain in office workers.Methods: Twenty office workers (ages 27-61, 5 males) with musculoskeletal pain participated in this three-week controlled pilot field study. The intervention group (n=10), had access to an innovative customized cycle ergometer (OfficeBiking®) at their regular office workstation whilst performing their usual work tasks. Offie-cycling was an alternative to sitting/standing by their height adjustable office desk; they were instructed to bike as often as comfortable. The control group (n=10) was instructed to continue to work as usual. The experiences of office-cycling and how it influenced work performance was studied with a questionnaire. Musculoskeletal pain was evaluated using pain drawings and pain ratings and participants' total pain was calculated by adding each individuals' self-reported pain from their three most painful areas (NRS 0-10).Results: Importantly, office-cycling did not reduce self-reported work performance; the majority (9/10) would like daily access; and made suggestions to improve the user-friendliness of the bike. Office-cycling was used regularly (median, 11/15 workdays; median active time 59 min/day IQR 39;91). There was no observed difference regarding either number of self-reported areas of pain (NSAP) or general musculoskeletal pain (GMP) between the intervention group and the control group at baseline. Self-reported GMP decreased in 8 persons in the intervention group which was one more than in the control group (n=7). NSAP decreased in the intervention group (n=7; md -1,0 IQR -2,3;0,0); and the control group (n=5; md -0,5 IQR -1,3;0,3). The difference in total pain (intervention end-baseline) revealed a clinically important change in the intervention group (NRS -2,5, IQR -8,8;4,0) but not in the control group (NRS 0,0 IQR -6,2;2,5).Conclusions: The results suggest that office-cycling is a feasible method for use in work place interventions with some promising results. Future research suggestions are: underlying mechanisms regarding effects of physical activity on pain in parallel with controlled studies in laboratory environments to investigate dose-effects for metabolic expenditure and optimal pain reduction whilst office-cycling.Implications: The results in this feasibility study indicate a promising potential of the innovative office-cycling concept to prevent and reduce musculoskeletal pain in sedentary office workers.
9.	Brinck, Tore, 1965-, et al. (author) Electrostatics and polarization determine the strength of the halogen bond : a red card for charge transfer 2019 In: Journal of Molecular Modeling. - : Springer Nature. - 1610-2940 .- 0948-5023. ; 25:5 Journal article (peer-reviewed)abstract A series of 20 halogen bonded complexes of the types R-Br center dot center dot center dot Br- (R is a substituted methyl group) and R '-CC-Br center dot center dot center dot Br- are investigated at the M06-2X/6-311+G(d,p) level of theory. Computations using a point-charge (PC) model, in which Br- is represented by a point charge in the electronic Hamiltonian, show that the halogen bond energy within this set of complexes is completely described by the interaction energy (E-PC) of the point charge. This is demonstrated by an excellent linear correlation between the quantum chemical interaction energy and E-PC with a slope of 0.88, a zero intercept, and a correlation coefficient of R-2=0.9995. Rigorous separation of E-PC into electrostatics and polarization shows the high importance of polarization for the strength of the halogen bond. Within the data set, the electrostatic interaction energy varies between 4 and-18kcal mol(-1), whereas the polarization energy varies between -4 and-10kcal mol(-1). The electrostatic interaction energy is correlated to the sum of the electron-withdrawing capacities of the substituents. The polarization energy generally decreases with increasing polarizability of the substituents, and polarization is mediated by the covalent bonds. The lower (more favorable) E-PC of CBr4---Br- compared to CF3Br center dot center dot center dot Br- is found to be determined by polarization as the electrostatic contribution is more favorable for CF3Br center dot center dot center dot Br-. The results of this study demonstrate that the halogen bond can be described accurately by electrostatics and polarization without any need to consider charge transfer.
10.	Brinck, Tore, Professor, 1965-, et al. (author) The Importance of Electrostatics and Polarization for Noncovalent Interactions : Ionic Hydrogen Bonds vs Ionic Halogen Bonds 2022 In: Journal of Molecular Modeling. - : Springer Nature. - 1610-2940 .- 0948-5023. ; 28:9 Journal article (peer-reviewed)abstract A series of 26 hydrogen-bonded complexes between Br- and halogen, oxygen and sulfur hydrogen-bond (HB) donors is investigated at the M06-2X/6-311 +G(2df,2p) level of theory. Analysis using a model in which Br- is replaced by a point charge shows that the interaction energy (Delta E-Int) of the complexes is accurately reproduced by the scaled interaction energy with the point charge (Delta E-Int(PC)). This is demonstrated by Delta E-Int = 0.86 Delta E-Int(PC) with a correlation coefficient, R-2=0.999. The only outlier is (Br-H-Br)(-), which generally is classified as a strong charge-transfer complex with covalent character rather than a HB complex. Delta E-Int(PC) can be divided rigorously into an electrostatic contribution (Delta E-ES(PC)) and a polarization contribution (Delta E-pol(PC)).Within the set of HB complexes investigated, the former varies between -7.2 and -32.7 kcal mol(-1), whereas the latter varies between -1.6 and -11.5 kcal mol(-1). Compared to our previous study of halogen-bonded (XB) complexes between Br and C-Br XB donors, the electrostatic contribution is generally stronger and the polarization contribution is generally weaker in the HB complexes. However, for both types of bonding, the variation in interaction strength can be reproduced accurately without invoking a charge-transfer term. For the Br-center dot center dot center dot HF complex, the importance of charge penetration on the variation of the interaction energy with intermolecular distance is investigated. It is shown that the repulsive character of Delta E-Int at short distances in this complex to a large extent can be attributed to charge penetration.
11.	Bui, Kim-Ly, et al. (author) Functional tests in chronic obstructive pulmonary disease part 1 : clinical relevance and links to the International classification of functioning, disability and health 2017 In: Annals of the American Thoracic Society. - : American Thoracic Society. - 2329-6933 .- 2325-6621. ; 14:5, s. 778-784 Journal article (peer-reviewed)abstract Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability. A thorough patient-centered outcome assessment, including not only measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity and performance in activities of daily life, is imperative for a comprehensive management of chronic obstructive pulmonary disease. This American Thoracic Society Seminar Series is devoted to help clinicians substantiate their choice of functional outcome measures in this population. In Part 1 of this two-part Seminar Series, we aim to describe the various domains of functional status, to elucidate terms and key concepts intertwined with functioning, and to demonstrate the clinical relevance of assessing functional capacity in the context of activities of daily living, in agreement with the International Classification of Functioning, Disability and Health. We hope that a better understanding of the various defining components of functional status will be instrumental to healthcare providers to optimize chronic obstructive pulmonary disease evaluation and management, ultimately leading to improved quality of life of patients afflicted by this condition. This first paper also serves as an introduction to Part 2 of this Seminar Series, where the main functional tests available to assess upper and lower body functional capacity of these patients will be discussed.
12.	Bui, Kim-Ly, et al. (author) Functional tests in chronic obstructive pulmonary disease part 2 : measurement properties 2017 In: Annals of the American Thoracic Society. - : American Thoracic Society. - 2329-6933 .- 2325-6621. ; 14:5, s. 785-794 Journal article (peer-reviewed)abstract Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability and handicap. For a thorough patient-centered outcome assessment and comprehensive management of the disease, measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity in activities of daily life are necessary. In Part 2 of this Seminar Series, we will discuss the main functional tests to assess upper and lower body functional capacity in patients with COPD, to help clinicians substantiate their choice of functional outcome measures in COPD. In agreement with the International Classification of Functioning, Disability and Health to assess functional capacity representative of daily life activities, this review focuses on functional tests that include components such as changing and maintaining body positions, walking, moving and climbing, as well as carrying, moving and handling objects. We will review the validity, reliability and responsiveness of these tests. With 11 links to the International Classification of Functioning, Disability and Health framework addressing several upper and lower body components of functional activities, the Glittre Activities of Daily Life test seems to be the most promising and comprehensive test to evaluate functional capacity in activities of daily life. The links between functional capacity tests and real participation in daily life, as well as with important clinical outcomes such as morbidity and mortality, need further investigation. More studies are also recommended to document minimal detectable changes, minimal clinically important differences and normative values for these functional tests.
13.	Bui, Kim-Ly, et al. (author) The Relevance of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease : A Review For Clinicians 2019 In: Clinics in Chest Medicine. - : Elsevier. - 0272-5231 .- 1557-8216. ; 40:2, s. 367-383 Journal article (peer-reviewed)abstract "Chronic obstructive pulmonary disease (COPD) is often accompanied by extrapulmonary manifestations such as limb muscle dysfunction. This term encompasses several features, including atrophy, weakness, and reduced oxidative capacity. Clinicians should become accustomed with this manifestation of COPD because of its relevance for important outcomes such as exercise tolerance and survival. Measuring muscle strength and mass can be performed with simple and valid tools that could be implemented in clinical practice. One identified, limb muscle dysfunction is amenable to therapy such as exercise training that has been repeatedly shown to improve muscle mass, strength, and oxidative capacity in COPD."
14.	Carvalho Bittencourt, André (author) On Modeling and Diagnosis of Friction and Wear in Industrial Robots 2012 Licentiate thesis (other academic/artistic)abstract Industrial robots are designed to endure several years of uninterrupted operation and therefore are very reliable. However, no amount of design effort can prevent deterioration over time, and equipments will eventually fail. Its impacts can, nevertheless, be considerably reduced if good maintenance/service practices are performed. The current practice for service of industrial robots is based on preventive and corrective policies, with little consideration about the actual condition of the system. In the current scenario, the serviceability of industrial robots can be greatly improved with the use of condition monitoring/diagnosis methods, allowing for condition-based maintenance (cbm).This thesis addresses the design of condition monitoring methods for industrial robots. The main focus is on the monitoring and diagnosis of excessive degradations caused by wear of the mechanical parts. The wear processes may take several years to be of significance, but can evolve rapidly once they start to appear. An early detection of excessive wear levels can therefore allow for cbm, increasing maintainability and availability. Since wear is related to friction, the basic idea pursued is to analyze the friction behavior to infer about wear.To allow this, an extensive study of friction in robot joints is considered in this work. The effects of joint temperature, load and wear changes to static friction in robot a joint are modeled based on empirical observations. It is found that the effects of load and temperature to friction are comparable to those caused by wear. Joint temperature and load are typically not measured, but will always be present in applications. Therefore, diagnosis solutions must be able to cope with them.Different methods are proposed which allow for robust wear monitoring. First, a wear estimator is suggested. Wear estimates are made possible with the use of a test-cycle and a friction model. Second, a method is defined which considers the repetitive behavior found in many applications of industrial robots. The result of the execution of the same task in different instances of time are compared to provide an estimate of how the system changed over the period. Methods are suggested that consider changes in the distribution of data logged from the robot. It is shown through simulations and experiments that robust wear monitoring is made possible with the proposed methods.
15.	De Brandt, Jana, 1991-, et al. (author) The Borg Cycle Strength Test (BCST) for prescribing supramaximal high-intensity interval training (HIIT) in COPD 2023 In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 62:Supplement 67 Journal article (other academic/artistic)abstract Background: Prescription of supramaximal HIIT is ideally based on an all-out test. This is, however, not suitable for people with COPD, leading to the use of workloads obtained during a maximal incremental test (CPET), which are less specific for the prescription of supramaximal HIIT. Hence, we evaluated the feasibility of a submaximal anaerobic test, the BCST, that has been used in older adults to prescribe supramaximal HIIT, and the anaerobic cycle capacity of people with COPD vs. matched healthy controls (HC).Methods: Sixteen persons with COPD and HC performed a CPET and a BCST. The BCST is an incremental stepwise test (30s cycling, 30s rest) with two end-of-test criteria: 1) Rating of perceived exertion (RPE) ≥17 or 2) cadence <75 RPM for >5s. End-of-test RPE, symptoms, peak workload (Wpeak) and cardiorespiratory demand were obtained to assess feasibility.Results: A higher Wpeak and lower RPE, symptoms and cardiorespiratory demand were observed in the BCST vs. CPET in both groups (Table1). Absolute BCST Wpeak was significantly lower, while relative BCST Wpeak (%Wpeak CPET) was similar in people with COPD (146±24%) vs. HC (157±17%)(P=0.114).Conclusion: In people with COPD, the BCST is a feasible short-duration submaximal anaerobic test specific for prescribing supramaximal HIIT. Compared to the CPET, it allows for higher workloads with lower cardiorespiratory demand and symptom burden.
16.	De Brandt, Jana, 1991-, et al. (author) Update on the etiology, assessment, and management of copd cachexia : considerations for the clinician 2022 In: The International Journal of Chronic Obstructive Pulmonary Disease. - : Taylor & Francis. - 1176-9106 .- 1178-2005. ; 17, s. 2957-2976 Journal article (peer-reviewed)abstract Cachexia is a commonly observed but frequently neglected extra-pulmonary manifestation in patients with chronic obstructive pulmonary disease (COPD). Cachexia is a multifactorial syndrome characterized by severe loss of body weight, muscle, and fat, as well as increased protein catabolism. COPD cachexia places a high burden on patients (eg, increased mortality risk and disease burden, reduced exercise capacity and quality of life) and the healthcare system (eg, increased number, length, and cost of hospitalizations). The etiology of COPD cachexia involves a complex interplay of non-modifiable and modifiable factors (eg, smoking, hypoxemia, hypercapnia, physical inactivity, energy imbalance, and exacerbations). Addressing these modifiable factors is needed to prevent and treat COPD cachexia. Oral nutritional supplementation combined with exercise training should be the primary multimodal treatment approach. Adding a pharmacological agent might be considered in some, but not all, patients with COPD cachexia. Clinicians and researchers should use longitudinal measures (eg, weight loss, muscle mass loss) instead of cross-sectional measures (eg, low body mass index or fat-free mass index) where possible to evaluate patients with COPD cachexia. Lastly, in future research, more detailed phenotyping of cachectic patients to enable a better comparison of included patients between studies, prospective longitudinal studies, and more focus on the impact of exacerbations and the role of biomarkers in COPD cachexia, are highly recommended.
17.	Ekblom Bak, Elin, 1981-, et al. (author) Accelerometer derived physical activity patterns in 27.890 middle‐aged adults : The SCAPIS cohort study 2022 In: Scandinavian Journal of Medicine and Science in Sports. - : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 32:5, s. 866-880 Journal article (peer-reviewed)abstract The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfillment of PA recommendations in a large sample of middle-aged men and women, and to study differences between subgroups of socio-demographic, socio-economic, and lifestyle-related variables. A total of 27 890 (92.5% of total participants, 52% women, aged 50–64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden, and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an “at-risk” behavior, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.
18.	Ekström, Magnus, et al. (author) Exertional breathlessness related to medical conditions in middle-aged people: the population-based SCAPIS study of more than 25,000 men and women. 2024 In: Respiratory research. - : BioMed Central (BMC). - 1465-993X .- 1465-9921. ; 25:1 Journal article (peer-reviewed)abstract Breathlessness is common in the population and can be related to a range of medical conditions. We aimed to evaluate the burden of breathlessness related to different medical conditions in a middle-aged population.Cross-sectional analysis of the population-based Swedish CArdioPulmonary bioImage Study of adults aged 50-64years. Breathlessness (modified Medical Research Council [mMRC]≥2) was evaluated in relation to self-reported symptoms, stress, depression; physician-diagnosed conditions; measured body mass index (BMI), spirometry, venous haemoglobin concentration, coronary artery calcification and stenosis [computer tomography (CT) angiography], and pulmonary emphysema (high-resolution CT). For each condition, the prevalence and breathlessness population attributable fraction (PAF) were calculated, overall and by sex, smoking history, and presence/absence of self-reported cardiorespiratory disease.We included 25,948 people aged 57.5±[SD] 4.4; 51% women; 37% former and 12% current smokers; 43% overweight (BMI 25.0-29.9), 21% obese (BMI≥30); 25% with respiratory disease, 14% depression, 9% cardiac disease, and 3% anemia. Breathlessness was present in 3.7%. Medical conditions most strongly related to the breathlessness prevalence were (PAF 95%CI): overweight and obesity (59.6-66.0%), stress (31.6-76.8%), respiratory disease (20.1-37.1%), depression (17.1-26.6%), cardiac disease (6.3-12.7%), anemia (0.8-3.3%), and peripheral arterial disease (0.3-0.8%). Stress was the main factor in women and current smokers.Breathlessness mainly relates to overweight/obesity and stress and to a lesser extent to comorbidities like respiratory, depressive, and cardiac disorders among middle-aged people in a high-income setting-supporting the importance of lifestyle interventions to reduce the burden of breathlessness in the population.
19.	Frykholm, Erik, 1985-, et al. (author) Effect and feasibility of non-linear periodized resistance training in people with COPD : study protocol for a randomized controlled trial 2019 In: Trials. - : BioMed Central (BMC). - 1745-6215. ; 20:1 Journal article (peer-reviewed)abstract BACKGROUND: In people with chronic obstructive pulmonary disease (COPD), limb-muscle dysfunction is one of the most troublesome systemic manifestations of the disease, which at the functional level is evidenced by reduced strength and endurance of limb muscles. Improving limb-muscle function is an important therapeutic goal of COPD management, for which resistance training is recommended. However, current guidelines for resistance training in COPD mainly focus on improving muscle strength which only reflects one aspect of limb-muscle function and does not address the issue of reduced muscle endurance. The latter is of importance considering that the reduction in limb-muscle endurance often is greater than that of muscle weakness, and also, limb-muscle endurance seems to be closer related to walking capacity as well as arm function than to limb-muscle strength within this group of people. Thus, strategies targeting multiple aspects of the decreased muscle function are warranted to increase the possibility for an optimal effect for the individual patient. Periodized resistance training, which represents a planned variation of resistance training variables (i.e., volume, intensity, frequency, etc.), is one strategy that could be used to target limb-muscle strength as well as limb-muscle endurance within the same exercise regimen.METHODS: This is an international, multicenter, randomized controlled trial comparing the effect and feasibility of non-linear periodized resistance training to traditional non-periodized resistance training in people with COPD. Primary outcomes are dynamic limb-muscle strength and endurance. Secondary outcomes include static limb-muscle strength and endurance, functional performance, quality of life, dyspnea, intramuscular adaptations as well as the proportion of responders. Feasibility of the training programs will be assessed and compared on attendance rate, duration, satisfaction, drop-outs as well as occurrence and severity of any adverse events.DISCUSSION: The proposed trial will provide new knowledge to this research area by investigating and comparing the feasibility and effects of non-linear periodized resistance training compared to traditional non-periodized resistance training. If the former strategy produces larger physiological adaptations than non-periodized resistance training, this project may influence the prescription of resistance training in people with COPD.TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03518723 . Registered on 13 April 2018.
20.	Frykholm, Erik, 1985-, et al. (author) Inter-day test–retest reliability and feasibility of isokinetic, isometric, and isotonic measurements to assess quadriceps endurance in people with chronic obstructive pulmonary disease : A multicenter study 2018 In: Chronic Respiratory Disease. - : Sage Publications. - 1479-9723 .- 1479-9731. ; 16, s. 1-9 Journal article (peer-reviewed)abstract The aims were to determine reliability and feasibility of measurements to assess quadriceps endurance in people with chronic obstructive pulmonary disease. Sixty participants (forced expiratory volume in one second (mean ± standard deviation) 55 ± 18% of predicted, age 67 ± 8 years) were tested in an inter-day, test–retest design. Isokinetic, isometric, and isotonic protocols were performed using a computerized dynamometer. Test–retest relative and absolute reliability was determined via intraclass correlation coefficient (ICC), coefficient of variation (CV%), and limits of agreement (LoA%). Isokinetic total work demonstrated very high relative reliability (ICC: [95% confidence interval] = 0.98 [0.94–0.99]) and the best absolute reliability (CV% (LoA%) = 6.5% (18.0%)). Isokinetic fatigue index, isometric, and isotonic measures demonstrated low-to-high relative reliability (ICC = 0.64 [0.46–0.77], 0.88 [0.76–0.94], 0.91 [0.85–0.94]), and measures of absolute reliability (CV% (LoA%)) were 20.3% (56.4%), 14.9% (40.8%), and 15.8% (43.1%). For isokinetic total work and isometric measurements, participants performed better on retest (4.8% and 10.0%, respectively). The feasibility was similar across protocols with an average time consumption of less than 7.5 minutes. In conclusion, isokinetic, isometric, and isotonic measurements of quadriceps endurance were feasible to a similar extent and presented low-to-very high relative reliability. Absolute reliability seems to favor isokinetic total work measurements.
21.	Frykholm, Erik, 1985-, et al. (author) Isotonic quadriceps endurance is better associated with daily physical activity than quadriceps strength and power in COPD : an international multicentre cross-sectional trial 2021 In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 11:1 Journal article (peer-reviewed)abstract Knowledge about modifiable determinants of daily physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is crucial to design effective PA interventions. The present study aimed to determine the contribution of quadriceps strength, power and endurance to daily PA in COPD. Additionally, for quadriceps endurance, we also aimed to determine to what extent the association varies according to the mode of movement (isotonic, isometric, or isokinetic). Using a multicentre cross-sectional trial design we determined the contribution of quadriceps function to daily PA (steps, sedentary time and time spent doing moderate-to-very-vigorous physical activity [MVPA]) using bivariate and partial Pearson correlation analysis (r) and multiple linear regression models (ΔR2). Pre-determined controlling factors were sex, age, body mass index (BMI), COPD-assessment test, forced expiratory volume in one second in percent of the predicted value (FEV1pred), and distance walked on the 6-minute walk test. Eighty-one patients with COPD (mean ± SD: age 67 ± 8 years, FEV1pred 57 ± 19%, daily steps 4968 ± 3319, daily sedentary time 1016 ± 305 min, and MVPA time 83 ± 45 min) were included. Small to moderate bivariate correlations (r =.225 to.452, p <.05) were found between quadriceps function and measures of PA. The best multiple linear regression models explained 38–49% of the variance in the data. Isotonic endurance was the only muscle contributor that improved all PA models; daily steps (ΔR2 =.04 [relative improvement 13%] p =.026), daily sedentary time (ΔR2 =.07 [23%], p =.005) and MVPA-minutes (ΔR2 =.08 [20%], p =.001). Isotonic endurance was also independently associated with most PA variables, even when controlling for strength, power or isometric-isokinetic endurance properties of the muscle (r =.246 to.384, p <.05). In contrast, neither strength, power, isometric-or isokinetic endurance properties of the muscle was independently associated with PA measures when controlling for isotonic endurance (r =.037 to.219, p >.05). To conclude, strength, power, and endurance properties of the quadriceps were low to moderately associated with PA in patients with COPD. Isotonic quadriceps endurance was the only quadriceps property that was independently associated with the different measures of PA after controlling for a basic set of known determinants of PA, quadriceps strength or power, or isometric or isokinetic quadriceps endurance. Future longitudinal studies should investigate its potential as a modifiable determinant of PA.
22.	Frykholm, Erik, 1985-, et al. (author) Physiological and Symptomatic Responses to Arm versus Leg Activities in People with Chronic Obstructive Pulmonary Disease : A Systematic Review and Meta-Analysis 2019 In: COPD. - : Taylor & Francis. - 1541-2555 .- 1541-2563. ; 16:5-6, s. 390-405 Journal article (peer-reviewed)abstract While the mechanisms underlying exercise limitations and symptoms during leg activities have been investigated in detail, knowledge of potential differences between leg and arm activities are not well understood and results from individual studies are contradictory. Thus, the aim of the present study was to synthesize physiological and symptomatic responses during activities involving the arms relative to activities involving the legs in people with Chronic Obstructive Pulmonary Disease (COPD). Any study with a cross-sectional comparison of acute physiological (cardiorespiratory, metabolic) and symptomatic responses to activities performed with the arms versus the legs were included. Studies were sub-grouped based on the type of activity performed (cycle ergometer, resistance exercises, or functional test/activities). Eighteen studies with 423 individuals with COPD were included. Leg cycle ergometer resulted in greater tidal volume (137?mL), minute ventilation (4.8?L/min), and oxygen consumption (164?mL/min) than arm cycle ergometer, while symptomatic responses were similar. Resistance exercises resulted in similar physiological and symptomatic responses irrespective of whether the legs or the arms were involved while studies on functional activities report different results depending on the type and intensity of the activity performed. With the exception of cycle ergometer activities, physiological and symptomatic responses do not seem to depend on whether the arms or the legs are used, but rather seem to be task and intensity dependent. These novel findings suggest, for example, that strategies used to increase exercise tolerance should not be dependent on whether the arms or the legs are used, but rather the intensity of specific activity performed.
23.	Frykholm, Erik, 1985-, et al. (author) Physiological and symptomatic responses to arm versus leg activity in people with COPD : a systematic review and meta-analysis 2019 In: European Respiratory Journal. - Sheffield : European Respiratory Society Journals. - 0903-1936 .- 1399-3003. ; 54 Journal article (other academic/artistic)
24.	Frykholm, Erik, 1985-, et al. (author) Physiological responses to arm versus leg activity in patients with chronic obstructive pulmonary disease : a systematic review protocol 2018 In: BMJ Open. - : BMJ. - 2044-6055. ; 8:2, s. 1-5 Journal article (peer-reviewed)abstract Compared with healthy older adults, people with chronic obstructive pulmonary disease (COPD) have reduced capacity and increased symptoms during leg and arm activities. While the mechanisms underlying limitations and symptoms during leg activities have been investigated in detail, limitations and symptoms during arm activities are not well understood, and the potential differences between physiological responses of leg and arm activities have not been systematically synthesised. Determining physiological responses and symptoms of arm activities compared with physiological responses and symptoms of leg activities will help us understand the mechanisms behind the difficulties that people with COPD experience when performing physical activities, and determine how exercise training should be prescribed. Thus, the aim of this systematic review is to compare the physiological responses and symptoms during activities involving the arms relative to activities involving the legs in people diagnosed with COPD.
25.	Frykholm, Erik, 1985-, et al. (author) Test-retest reliability of three strategies to measure quadriceps muscle endurance in people with COPD 2018 In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52 Journal article (other academic/artistic)abstract Despite its clinical relevance, there is no consensus on how to measure quadriceps muscle endurance in people with COPD. Moreover, the reliability of available measurement strategies are only partly known.Aim: To determine test-retest reliability and feasibility of isokinetic, isometric and isotonic protocols to assess quadriceps muscle endurance in people with COPD.Method: Fifty nine participants (FEV1 of predicted 55±18%, age 67±8 years) were included and tested in an interday multicentre test-retest design with test occasions separated by 5-9 days. Quadriceps muscle endurance was assessed using isokinetic, isometric and isotonic knee extension protocols controlled by a computerized dynamometer. Relative reliability was determined by intra-class correlation coefficient (ICC)( two-way mixed effects, absolute agreement, single measurement) and absolute reliability by standard error of measurement (SEM).Result: Isokinetic measurements demonstrated very high relative reliability (ICC: [95% confidence interval] 0.97 [0.94-0.99]), and isometric and isotonic demonstrated high relative reliability (0.89 [0.79-0.94], and 0.89 [0.82-0.94], respectively). Mean values across test-retest occasions were 2122 joules, 49 seconds, and 29 repetitions, for isokinetic, isometric and isotonic measurements, respectively. Corresponding SEM values were 150 joules, 7 seconds, and 5 repetitions. All three measurement strategies were feasible with an average time consumption of less than 10 minutes and no major adverse events.Conclusion: The results indicate that isokinetic, isotonic and isometric measurements of quadriceps muscle endurance are reliable and feasible in people with COPD.
26.	Gendron, Louis McCusky, et al. (author) Active mind‐body movement therapies as an adjunct to or in comparison to pulmonary rehabilitation for people with chronic obstructive pulmonary disease 2016 In: Cochrane Database of Systematic Reviews. - 1469-493X. ; :7 Journal article (peer-reviewed)abstract This is the protocol for a review and there is no abstract. The objectives are as follows:To assess the effect of active mind-body movement therapies (AMBMT) compared with pulmonary rehabilitation (PR), or in addition to PR, in the management of chronic obstructive pulmonary disease (COPD).
27.	Gendron, Louis McCusky, et al. (author) Active mind‐body movement therapies as an adjunct to or in comparison with pulmonary rehabilitation for people with chronic obstructive pulmonary disease 2018 In: Cochrane Database of Systematic Reviews. - : John Wiley & Sons. - 1469-493X. ; :10 Research review (peer-reviewed)abstract Background: Active mind‐body movement therapies (AMBMTs), including but not limited to yoga, tai chi, and qigong, have been applied as exercise modalities for people with chronic obstructive pulmonary disease (COPD). AMBMT strategies have been found to be more effective than usual care; however, whether AMBMT is inferior, equivalent, or superior to pulmonary rehabilitation (PR) in people with COPD remains to be determined.Objectives: To assess the effects of AMBMTs compared with, or in addition to, PR in the management of COPD.Search methods: We searched the Cochrane Airways Group Specialised Register of trials and major Chinese databases, as well as trial registries from inception to July 2017. In addition, we searched references of primary studies and review articles. We updated this search in July 2018 but have not yet incorporated these results.Selection criteria: We included (1) randomised controlled trials (RCTs) comparing AMBMT (i.e. controlled breathing and/or focused meditation/attention interventions for which patients must actively move their joints and muscles for at least four weeks with no minimum intervention frequency) versus PR (any inpatient or outpatient, community‐based or home‐based rehabilitation programme lasting at least four weeks, with no minimum intervention frequency, that included conventional exercise training with or without education or psychological support) and (2) RCTs comparing AMBMT + PR versus PR alone in people with COPD. Two independent review authors screened and selected studies for inclusion.Data collection and analysis: Two review authors independently selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors if necessary to ask them to provide missing data. We calculated mean differences (MDs) using a random‐effects model.Main results: We included in the meta‐analysis 10 studies with 762 participants across one or more comparisons. The sample size of included studies ranged from 11 to 206 participants. Nine out of 10 studies involving all levels of COPD severity were conducted in China with adults from 55 to 88 years of age, a higher proportion of whom were male (78%). Nine out of 10 studies provided tai chi and/or qigong programmes as AMBMT, and one study provided yoga. Overall, the term 'PR' has been uncritically applied in the vast majority of studies, which limits comparison of AMBMT and PR. For example, eight out of 10 studies considered walking training as equal to PR and used this as conventional exercise training within PR. Overall study quality for main comparisons was moderate to very low mainly owing to imprecision, indirectness (exercise component inconsistent with recommendations), and risk of bias issues. The primary outcomes for our review were quality of life, dyspnoea, and serious adverse events.When researchers compared AMBMT versus PR alone (mainly unstructured walking training), statistically significant improvements in disease‐specific quality of life (QoL) (St. George's Respiratory Questionnaire (SGRQ) total score) favoured AMBMT: mean difference (MD) ‐5.83, 95% confidence interval (CI) ‐8.75 to ‐2.92; three trials; 249 participants; low‐quality evidence. The common effect size, but not the 95% CI around the pooled treatment effect, exceeded the minimal clinically important difference (MCID) of minus four. The COPD Assessment Test (CAT) also revealed statistically significant improvements favouring AMBMT over PR, with scores exceeding the MCID of three, with an MD of 6.58 units (95% CI ‐9.16 to – 4.00 units; one trial; 74 participants; low‐quality evidence). Results show no between‐group differences with regard to dyspnoea measured by the modified Medical Research Council Scale (MD 0.00 units, 95% CI ‐0.37 to 0.37; two trials; 127 participants; low‐quality evidence), the Borg Scale (MD 0.44 units, 95% CI ‐0.88 to 0.00; one trial; 139 participants; low‐quality evidence), or the Chronic Respiratory Questionnaire (CRQ) Dyspnoea Scale (MD ‐0.21, 95% CI ‐2.81 to 2.38; one trial; 11 participants; low‐quality evidence). Comparisons of AMBMT versus PR alone did not include assessments of generic quality of life, adverse events, limb muscle function, exacerbations, or adherence.Comparisons of AMBMT added to PR versus PR alone (mainly unstructured walking training) revealed significant improvements in generic QoL as measured by Short Form (SF)‐36 for both the SF‐36 general health summary score (MD 5.42, 95% CI 3.82 to 7.02; one trial; 80 participants; very low‐quality evidence) and the SF‐36 mental health summary score (MD 3.29, 95% CI 1.45 to 4.95; one trial; 80 participants; very low‐quality evidence). With regard to disease‐specific QoL, investigators noted no significant improvement with addition of AMBMT to PR versus PR alone (SGRQ total score: MD ‐2.57, 95% CI ‐7.76 to 2.62 units; one trial; 192 participants; moderate‐quality evidence; CRQ Dyspnoea Scale score: MD 0.04, 95% CI ‐2.18 to 2.26 units; one trial; 80 participants; very low‐quality evidence). Comparisons of AMBMT + PR versus PR alone did not include assessments of dyspnoea, adverse events, limb muscle function, exacerbations, or adherence.Authors' conclusions: Given the quality of available evidence, the effects of AMBMT versus PR or of AMBMT added to PR versus PR alone in people with stable COPD remain inconclusive. Evidence of low quality suggests better disease‐specific QoL with AMBMT versus PR in people with stable COPD, and evidence of very low quality suggests no differences in dyspnoea between AMBMT and PR. Evidence of moderate quality shows that AMBMT added to PR does not result in improved disease‐specific QoL, and evidence of very low quality suggests that AMBMT added to PR may lead to better generic QoL versus PR alone. Future studies with adequate descriptions of conventional exercise training (i.e. information on duration, intensity, and progression) delivered by trained professionals with a comprehensive understanding of respiratory physiology, exercise science, and the pathology of COPD are needed before definitive conclusions can be drawn regarding treatment outcomes with AMBMT versus PR or AMBMT added to PR versus PR alone for patients with COPD.
28.	Gephine, Sarah, et al. (author) Relationship between functional capacity, dynamic and static muscle function assessments in people with Chronic Obstructive Pulmonary Disease (COPD) 2018 In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52 Journal article (other academic/artistic)abstract Introduction: In addition to impaired lung function, patients with COPD often exhibit limb muscle dysfunction and impaired functional status, negatively impacting quality of life. However, whether and how these two components related to each other remains to be established. The objective of this study was to examine relationships between quadriceps muscle function and functional capacity in patients with COPD.Methods: Forty participants (age :69±7 years, FEV1 :57±18 % predicted) were evaluated. Quadriceps strength was measured during isometric and isokinetic knee extension while quadriceps endurance was evaluated using isometric, isokinetic and isotonic knee extension protocols. Functional capacity was assessed with a battery of test including the 6 minute walking test (6MWT), the ADL Glittre test, the 1 minute Sit to Stand (1STS) and the Short Physical Performance Battery test (SPPB). Univariate correlation analyses between indices of muscle strength and endurance and functional tests were performed.Results: Pearson correlations coefficients between functional capacity and quadriceps function are provided in the table.Conclusion: Several indices of muscle function moderately correlate with functional capacity in patients with COPD, with stronger correlations noted for the dynamic contraction protocols (isokinetic, isotonic).
29.	Gephine, Sarah, et al. (author) Specific contribution of quadriceps muscle strength, endurance, and power to functional exercise capacity in people with chronic obstructive pulmonary disease : a multicenter study 2021 In: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 101:6, s. 1-8 Journal article (peer-reviewed)abstract OBJECTIVE: Various functional muscle properties affect different aspects of functional exercise capacity in people with COPD. The purpose of this study was to investigate the contribution of quadriceps muscle strength, endurance, and power to the 6-minute walking distance (6MWD) and the 1-minute sit-to-stand test (1STS) performance in people with COPD.METHODS: The study was a prospective, multicenter cross-sectional study. Anthropometrics, Medical Research Council (MRC) dyspnea scale, lung function, 6MWD and the 1STS number of repetitions were assessed. Isometric quadriceps strength (Strength-ISOM) and endurance (Endurance-ISOM), isotonic quadriceps endurance (Endurance-ISOT), isokinetic quadriceps strength (Strength-ISOKIN), and power (Power-ISOKIN) were assessed on a computerized dynamometer while functional quadriceps power was determined during 5 sit-to-stand repetitions (Power-5STS). Univariate and multivariate analyses were performed to determine the contribution of functional muscle properties on the 6MWD and the 1STS number of repetitions.RESULTS: The study included 70 people with COPD (mean % predicted FEV1 = 58.9 [SD = 18.2]). The 6MWD correlated with each functional muscle property, except the Endurance-ISOM. The number of repetitions during the 1STS correlated with each functional muscle property except isometric measurements. Multivariate models explained respectively 60% and 39% of the variance in the 6MWD and 1STS number of repetitions, with Power-5STS being the muscle functional property with the strongest contribution to the models.CONCLUSION: Except for isometric endurance, quadriceps strength, endurance, and power were associated with functional exercise capacity in people with moderate COPD. Among these functional muscle properties, muscle power contributed the most to the 6MWD and 1STS number of repetitions, suggesting that muscle power is more relevant to functional exercise capacity than muscle strength or endurance in people with COPD.IMPACT: Understanding the individual contribution of muscle properties to functional status is important to designing interventions. This study provides the guidance that muscle power may be more important to functional exercise capacity than muscle strength or endurance in people with COPD.
30.	Gloeckl, Rainer, et al. (author) Optimising upper-limb exercise in patients with COPD : another step towards personalised pulmonary rehabilitation? 2024 In: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 10:1 Journal article (other academic/artistic)
31.	Jakobsson, Johan, et al. (author) Acute physiological effects of supramaximal high-intensity interval training in people with or without COPD 2023 In: Medicine & Science in Sports & Exercise. - : Wolters Kluwer. - 0195-9131 .- 1530-0315. ; 55, s. 549-549 Journal article (peer-reviewed)abstract High-intensity exercise is essential for optimal development of cardiorespiratory fitness and health. This is, however, challenging for most people with chronic obstructive pulmonary disease (COPD) due to ventilatory limitations, leading to exercise at lower intensities accompanied by suboptimal stress on the cardiovascular and muscular system.PURPOSE: To compare the acute effects of a novel concept of short-duration supramaximal high-intensity interval training (HIIT) vs. moderate-intensity continuous training (MICT) in people with COPD and matched healthy controls (HC).METHODS: Sixteen people with mild to severe COPD (75 ± 6 yr; 8 males; 73 ± 13 FEV1%pred; 119 ± 37 W max aerobic power [MAP]) and 14 HC (74 ± 5 yr; 8 males; 106 ± 14 FEV1%pred; 169 ± 38 W MAP) performed HIIT and MICT on a cycle ergometer in a randomized order. HIIT consisted of 10x6s sprints interspersed with 1-min recovery and was performed at two intensities: 60% of max mean power output for 6-sec (MPO6) and 80%MPO6, estimated from the Borg cycle strength test. MICT consisted of 20-min at 60% of MAP, derived from a cardiopulmonary exercise test. Cardiorespiratory parameters, blood lactate concentration, ratings of exertion/symptoms, and exercise modality preference were obtained.RESULTS: Exercise characteristics and physiological data collected at the end of exercise are shown in Table 1. All HIIT sessions were completed, while 1 in 3 people with COPD did not complete MICT. The HIIT modality was preferred by 13/16 (COPD) and 12/14 (HC).CONCLUSION: Short-duration supramaximal HIIT was feasible and enabled a 3.5-fold increase in exercise intensity vs. MICT in people with COPD and HC. Notably, despite the higher exercise intensities, the cardiorespiratory demand during HIIT was similar to MICT and clinically relevant reductions in symptoms were seen in favor of HIIT, in people with COPD. Also, >80% of participants preferred HIIT over MICT.
32.	Jakobsson, Johan, et al. (author) Effects and mechanisms of supramaximal High-Intensity Interval Training on extrapulmonary manifestations in people with and without Chronic Obstructive Pulmonary Disease (COPD-HIIT) : study protocol for a multi-centre, randomized controlled trial Other publication (other academic/artistic)abstract Background: Beyond being a pulmonary disease, chronic obstructive pulmonary disease (COPD) presents with extrapulmonary manifestations including reduced cognitive, cardiovascular, and muscle function. While exercise training is the cornerstone in the non-pharmacological treatment of COPD, there is a need for new exercise training methods due to suboptimal adaptations when following traditional exercise guidelines, often applying moderate-intensity continuous training (MICT). In people with COPD, short-duration high-intensity interval training (HIIT) holds the potential to induce a more optimal stimulus for training adaptations while circumventing the ventilatory burden often associated with MICT in people with COPD. We aim to determine the effects of supramaximal HIIT and MICT on extrapulmonary manifestations in people with COPD compared to matched healthy controls.Methods: COPD-HIIT is a prospective, multi-centre, randomised, controlled trial with blinded assessors and data analysts, employing a parallel-group trial. In Phase 1, we will investigate the effects and mechanisms of a 12-week intervention of supramaximal HIIT compared to MICT in people with COPD (n = 92) and matched healthy controls (n = 70). Participants will perform watt-based cycling 2–3 times weekly. In Phase 2, we will determine how exercise training and inflammation impact the trajectories of neurodegeneration, in people with COPD, over 24 months. In addition to the 92 participants with COPD performing HIIT or MICT, a usual care group (n = 46) is included in phase 2. In both phases, the primary outcomes are change from baseline in cognitive function, cardiorespiratory fitness, and muscle power. Key secondary outcomes include change from baseline exercise tolerance, brain structure and function measured by MRI, neuroinflammation measured by PET/CT, systemic inflammation, and intramuscular adaptations. Feasibility of the interventions will be comprehensively investigated.Discussion: The COPD-HIIT trial will determine the effects of supramaximal HIIT compared to MICT in people with COPD and healthy controls. We will provide evidence for a novel exercise modality that might overcome the barriers associated with MICT in people with COPD. We will also shed light on the impact of exercise at different intensities to reduce neurodegeneration. The goal of the COPD-HIIT trial is to improve the treatment of extrapulmonary manifestations of the disease.Trial registration: Clinicaltrials.gov: NCT06068322. Prospectively registered on 2023-09-28.
33.	Jakobsson, Johan, et al. (author) Innovative exercise for optimizing exercise intensity in COPD 2022 In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 60:Suppl. 66 Journal article (peer-reviewed)abstract Background: High-intensity exercise is essential for optimal physiological exercise adaptations but challenging to perform for most people with COPD due to ventilatory limitations, leading to use of lower exercise intensities accompanied by suboptimal stress on the cardiovascular and muscular system. This study compared the acute effects of a novel concept of short-duration supramaximal high-intensity interval training (HIIT) vs. traditional moderate-intensity continuous training (MICT) in people with COPD.Methods: Thirteen people with COPD (75±6 yr; 8 males; 72±13 FEV1%pred; 124±37 Wpeak) performed short-duration supramaximal HIIT and MICT on a cycle ergometer in a randomized order. HIIT consisted of 10x6s sprints interspersed with 1-min recovery and was performed at two intensities (HIIT60% & HIIT80%). MICT consisted of 20-min at 60% of CPET Wpeak. Cardiorespiratory parameters, blood lactate concentration, ratings of exertion/symptoms, and exercise modality preference were obtained.Results: Exercise characteristics and physiological data are seen in Table 1. All patients completed HIIT, while 4 out of 13 stopped MICT prematurely. Notably, 85% preferred HIIT over MICT.Conclusion: The novel concept of short-duration supramaximal HIIT enabled a 3 to 4-fold increase in exercise intensity vs. MICT. Notably, the cardiorespiratory demand during HIIT was similar to MICT, and clinically relevant reductions in symptoms were even seen in favor of HIIT.
34.	Jakobsson, Johan, et al. (author) Physiological responses and adaptations to exercise training in people with or without chronic obstructive pulmonary disease : protocol for a systematic review and meta-analysis 2022 In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:9 Journal article (peer-reviewed)abstract Introduction: Exercise training is a cornerstone in managing chronic obstructive pulmonary disease (COPD), leading to several physiological adaptations including, but not limited to, structural and muscular alterations, increased exercise capacity and improved cognitive function. Still, it is not uncommon that the acute physiological response to an exercise session and the extent of chronic adaptations to exercise training are altered compared with people without COPD. To date, potential differences in acute physiological responses and chronic adaptations in people with or without COPD are not fully understood, and results from individual studies are contradictory. Therefore, the current study aims to synthesise and compare the acute physiological responses and chronic adaptations to exercise training in people with COPD compared with people without COPD.Methods and analyses: A systematic review of randomised controlled trials (RCTs), non-randomised studies of interventions (NRSIs) and cross-sectional studies (CSSs) will be conducted. A comprehensive search strategy will identify relevant studies from MEDLINE, Scopus, CINAHL, SPORTDiscus, CENTRAL and Cochrane Airways Trials Register databases. Studies including adults with and without COPD will be considered. Outcomes will include cardiorespiratory, muscular and cognitive function, intramuscular adaptations, lung volumes and cardiometabolic responses. The protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Methodological Expectations of Cochrane Intervention Reviews. Risk of bias assessment will be conducted using Cochrane Risk-of-Bias 2 Tool (for RCTs), Risk-of-Bias in Non-Randomised Studies Tool (for NRSIs) and Downs and Black checklist (for CSS). Meta-analyses will be conducted when appropriate, supplemented with a systematic synthesis without meta-analysis.Ethics and dissemination: As this study is a systematic review, ethical approval is not required. The final review results will be submitted for publication in a peer-reviewed journal and presented at international conferences.PROSPERO registration number: CRD42022307577
35.	Jakobsson, Johan, et al. (author) Quality of aerobic training description and its relation to intervention efficacy in chronic obstructive pulmonary disease trials : study protocol for a systematic review, meta-analysis and meta-regression 2024 In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:5 Journal article (peer-reviewed)abstract Introduction Chronic obstructive pulmonary disease (COPD) is a major global health concern, characterised by ventilatory constraints, decreased cardiovascular fitness and reduced limb muscle function, profoundly affecting patients’ quality of life. Aerobic training plays a crucial role in the treatment of COPD, but the variability in methodologies and incomplete reporting of key components in aerobic training trials limits the assessment of their effectiveness. This systematic review aims to critically evaluate the application of training principles and reporting of key components in aerobic training trials in randomised controlled trials (RCTs) in the COPD literature.Methods and analysisThe protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol guidelines. The review will include RCTs utilising aerobic training in individuals with COPD. A comprehensive search, following a predefined search strategy will identify studies published from 2007 to 2024 in English from MEDLINE, Embase, CINAHL, CENTRAL and PEDro. Studies including people with COPD and any aerobic training intervention will be included. Two reviewers will independently screen abstracts and titles for inclusion. Two reviewers will independently conduct the screening of full-text documents and data extraction. Study quality will be assessed using the Tool for the assESsment of sTudy quality and bias in Exercise, specifically developed for exercise training studies. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. A systematic synthesis will be provided, with meta-analyses and meta-regression when appropriate.Ethics and disseminationAs this review will involve the analysis of published data, ethical approval is not required. The findings of this review will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration number CRD42021247343.
36.	Jönsson, André, et al. (author) Modeling, implementation and evaluation of IEEE 802.11ac in NS-3 for enterprise networks 2016 In: IFIP Wireless Days. - 9781509024940 ; 2016-April Conference paper (peer-reviewed)abstract In this work we implement features for IEEE 802.11ac in the NS-3 simulator, in particular wider channels and bit-error calculations for higher modulation coding schemes. We also implement four wireless LAN deployment scenarios from the 802.11ax working group scenario document, and evaluate their performance under different operating conditions. Our simulation results demonstrate that many nodes in an enterprise network will yield lower average throughput to each AP and several APs on the same channel will create unreliable networks with some stations getting high throughput and some not able to send at all. Significant improvement in throughput was also observed with the use of frame aggregation.
37.	Kahn, Nicolas, et al. (author) Early Career Members at the ERS International Congress 2017 : highlights from the Assemblies. 2017 In: Breathe. - : European Respiratory Society (ERS). - 1810-6838 .- 2073-4735. ; 13:4, s. e121-e129 Journal article (peer-reviewed)abstract The 2017 ERS International Congress was, as always, well organised, providing participants with a good mixture of translational and clinical science. Early career members were very well represented in thematic poster, poster discussion and oral presentation sessions and were also actively involved in chairing sessions. The efforts of the Early Career Members Committee (ECMC) to increase the number of early career members included in the competence list (the list of early career members with an interest in being more actively involved in the society) paid off immensely, because the number of early career members registered improved hugely across all assemblies after the Congress. Several newly registered early career members have collated some highlights of the Congress for their assemblies, which should be of interest to all members. As assemblies 12 and 13 are new, there is no report from assembly 12 as there is not yet, at the time of writing, an early career member representative for this newly created assembly.
38.	Lundell, Sara, 1982-, et al. (author) Conditions for COPD management in municipal healthcare : healthcare professionals' perspective. A qualitative study 2020 In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 56 Journal article (other academic/artistic)
39.	Lundell, Sara, 1982-, et al. (author) Groping around in the dark for adequate COPD management : a qualitative study on experiences in long-term care 2020 In: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 20:1 Journal article (peer-reviewed)abstract Background: Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases worldwide. Since COPD is a chronic and progressive disease, treatment is necessary throughout life. For people with COPD who cannot live independently, long-term care facilities are often required. However, knowledge is very limited about aspects of importance for effective COPD management in these settings in accordance with current treatment guidelines.The aim of this study was to explore aspects of importance in long-term care facilities for providing interventions according to treatment guidelines for people with COPD, from the perspective of healthcare professionals, in an effort to prove novel knowledge that could be used to facilitate implementation of treatment guidelines in these settings.Methods: A qualitative study was performed in northern Sweden. In Sweden, municipalities are responsible for providing long-term care. Interviews with 36 healthcare professionals (nurses, physiotherapists, occupational therapists and dieticians) in municipal healthcare were conducted and analysed using qualitative content analysis with triangulation by the authors.Results: The overarching theme that emerged from the analysis was Groping around in the dark for adequate COPD management. This represents healthcare professionals’ experiences of working with a complex diagnosis somewhat overlooked in the municipal healthcare, an underdog in the healthcare system. The groping around in the dark theme further represents the healthcare professionals’ lack of COPD-related competence, lack of interprofessional collaboration, and insufficient communication with the county council. The fragile group of people with COPD and their relatives were considered in need of support adapted to their context, but routines and resources for COPD management were limited. This lack of routines and resources also resulted in professionals being pragmatic and adopting short-term solutions without focusing on specific needs related to the diagnosis.Conclusions: The COPD management in long-term care settings showed several insufficiencies, indicating a large gap between clinical practice and treatment guidelines for COPD. It is crucial to improve COPD management in long-term care settings. Consequently, several actions are needed, such as increasing professional competence, establishing new routines, acknowledging and making COPD a higher priority, as well as adapting treatment guidelines to the context.
40.	Lundell, Sara, 1982-, et al. (author) Telehealthcare in COPD : a systematic review and meta-analysis on physical outcomes and dyspnea 2015 In: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 109:1, s. 11-26 Research review (peer-reviewed)abstract Background: Only a minority of patients with chronic obstructive pulmonary disease (COPD) have access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used in efforts to make PR more available. The aim of this systematic review was to investigate the effects of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and to describe the interventions used. Methods: Randomized controlled trials were identified through database searches, reference lists and included authors. Articles were reviewed based on eligibility criteria by three authors. Risk of bias was assessed by two authors. Standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated. Forest plots were used to present data visually.Results: Nine studies (982 patients) were included. For physical activity level, there was a significant effect favoring telehealthcare (MD, 64.7 min; 95% CI, 54.4-74.9). No difference between groups was found for physical capacity (MD, -1.3 m; 95% CI, -8.1-5.5) and dyspnea (SMD, 0.088; 95% CI, -0.056-0.233). Telehealthcare was promoted through phone calls, websites or mobile phones, often combined with education and/or exercise training. Comparators were ordinary care, exercise training and/or education. Conclusions: The use of telehealthcare may lead to improvements in physical activity level, although the results should be interpreted with caution given the heterogeneity in studies. This is an important area of research and further studies of the effect of telehealthcare for patients with COPD would be beneficial.
41.	Marklund, Sarah, MSc, 1986- (author) COPD management : exploring conditions for, and experiences of, evidence-based care and eHealth 2023 Doctoral thesis (other academic/artistic)abstract Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and premature death worldwide. It is a systemic disease that affects the whole person, although dyspnea is the mostprominent symptom. COPD is expected to increase in prevalence during the coming 40 years due to an increase in relevant risk behaviors, and today over 230 million people suffer from COPD worldwide. A common extra pulmonary manifestation of the disease is quadriceps dysfunction, where muscle strength, power, and/or endurance properties are reducedand affect everyday function. However, reference values and valid reference equations are needed to evaluate and offer appropriate treatment for quadriceps dysfunction. Moreover, a crucial part of COPD management is pulmonary rehabilitation, e.g., where disease management and strategies are conveyed and put into practice. However, due to knowledge gaps within health care, we need to develop new ways of informing and supporting people with COPD. One way is through eHealth, although these sources must be evaluated so that they constructively contribute to health care.Aim: The overall aim of this thesis is to explore the conditions for, and perspectives on, evidence-based care and eHealth in COPD management. This aim is twofold. The first is to explore the experiences, interactions, and context of using eHealth tools in managing COPD in primary carefrom the perspective of people with COPD and health care professionals (HCPs). The second is to develop reference values and equations for quadriceps function.Method: This dissertation contains three papers (Papers I, II, and III) based on individual interviews analyzed with qualitative research methods in which an eHealth tool, the COPD Web, is evaluated. Lastly, it contains one paper(Paper IV) based on an international multicenter data collection analyzed with quantitative research methods.Results: Paper I: The findings indicate that the level of motivation, comfortability with IT tools, and health literacy seem to affect the usage of an eHealth tool over time. Some level of use and the passage of time appears to be needed to perceive gained benefits from the eHealth tool. In short, this suggests that eHealth tools such as the COPD Web can be suitable for supporting COPD-specific self-management skills. Paper II: The findings indicated that using the COPD Web provided knowledge support for HCPs and improved the quality of care for people with COPD. However, it seems some barriers need to be addressed to successfully implement the eHealth tool in daily practice. Paper III: Findings lead to the theme “Perceiving enough control to enable action”, which suggests that having or perceiving a certain amount of control is essential to maintain or increase the level of physical activity when one has COPD and uses an eHealth tool. Paper IV: The findings indicate that for people without COPD, age, sex, height, and BMI explained 50 – 70 % of the variance of quadriceps strength, endurance, and power. Our findings also suggested moderate construct validity of the reference equations in people with COPD.Conclusion: To conclude, the web-based eHealth tool, the COPD Web, seems to support and help when self-managing COPD and treating people with COPD. There are still barriers for people with COPD to use a web-based eHealth tool, and we probably ought to screen people with COPD for health literacy before discussing and deciding on PR strategies with them. There are still barriers to implementing new tools in the health care setting, which should need time, support, and education to circumvent. Findings regarding the developed reference values and equations for quadriceps strength, power, and endurance will make further tailoring of the treatment regime for the individual possible. As such, this, too, should assist in improving disease management, although the construct validity of the equations was moderate.
42.	Marklund, Sarah, et al. (author) Experiences and factors affecting usage of an ehealth tool for self-management among people with chronic obstructive pulmonary disease : qualitative study 2021 In: Journal of Medical Internet Research. - Toronto : JMIR Publications. - 1438-8871. ; 23:4 Journal article (peer-reviewed)abstract BACKGROUND: Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.OBJECTIVE: This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.METHODS: The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months' access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.RESULTS: Three main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants' experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.CONCLUSIONS: Findings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.
43.	Marklund, Sarah, et al. (author) Measuring and monitoring skeletal muscle function in COPD : current perspectives 2019 In: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press. - 1176-9106 .- 1178-2005. ; 14, s. 1825-1838 Journal article (peer-reviewed)abstract Skeletal muscle dysfunction is an important systemic consequence of chronic obstructive pulmonary disease (COPD) that worsens the natural cause of the disease. Up to a third of all people with COPD express some form of impairment which encompasses reductions in strength and endurance, as well as an increased fatigability. Considering this complexity, no single test could be used to measure and monitor all aspects of the impaired skeletal muscle function within the COPD population, resulting in a wide range of available tests and measurement techniques. The aim of the current review is to highlight current and new perspectives relevant to skeletal muscle function measurements within the COPD population in order to provide guidance for researchers as well as for clinicians. First of all, standardized and clinically feasible measurement protocols, as well as normative values and predictive equations across the spectrum of impaired function in COPD, are needed before assessment of skeletal muscle function can become a reality in clinical praxis. This should minimally target the quadriceps muscle; however, depending on the objective of measurements, eg, to determine upper limb muscle function or walking capacity, other muscles could also be tested. Furthermore, even though muscle strength measurements are important, current evidence suggests that other aspects, such as the endurance and power capacity of the muscle, should also be considered. Moreover, although static (isometric) measurements have been favored, dynamic measurements of skeletal muscle function should not be neglected as they, in a larger extent than static measurements, are related to tasks of daily living. Lastly, the often modest relationships between functional tests and skeletal muscle function measurements indicate that they evaluate different constructs and thus cannot replace one another. Therefore, for accurate measurements of skeletal muscle function in people with COPD, specific and formal measurements should still be prioritized.
44.	Marklund, Sarah, et al. (author) To act or not to act - a sense of control is important for people with chronic obstructive pulmonary disease to increase physical activity : grounded theory study 2023 In: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 7 Journal article (peer-reviewed)abstract Background: Among people with chronic obstructive pulmonary disease (COPD), low level of daily physical activity (PA) is the main risk factor for developing cardiovascular, metabolic, and musculoskeletal comorbidities. Increasing PA in people with COPD is complex as PA behavior itself is complex and multifaceted, including personal, physiological, and psychologicalelements as well as social and environmental factors. Although eHealth solutions such as web-based support or websites haveshown positive effects on PA in people with COPD, the results are inconclusive, and it is still unclear how eHealth solutionsmight be used to support positive changes in PA behavior in people with COPD.Objective: This study aimed to explore the perceptions of increasing objective PA when using a web-based eHealth tool amongpeople with COPD.Methods: This study was part of a pragmatic randomized controlled trial with in-depth interviews between the 3- and 12-month follow-ups. The methodology used was constructivist grounded theory. All sampling included participants from the randomized controlled trial intervention group, that is, participants who had access to the eHealth tool in question and agreed to be contacted for an in-depth interview. Inclusion of participants continued until data saturation was reached, resulting in an inclusion of 14 (n=8, 57% women) participants aged between 49 and 84 years and living in 8 municipalities in Middle and Northern Sweden. Two interviews were conducted face-to-face, and the remaining interviews were conducted via telephone. All interviews were recorded using a Dictaphone.Results: The analysis resulted in 3 main categories: welcoming or not welcoming action, having or lacking resources, and lowering the threshold. The first 2 categories contain barriers and facilitators, whereas the third category contains only facilitators. The categories lead to the more latent theme Perceiving enough control to enable action, meaning that it seems that perceiving the right amount of control is essential to maintain or increase the level of PA when using an eHealth tool, among patients with COPD. However, the right amount of control seemed to depend on the individual (and context) in question.Conclusions: The core category indicates that a need for a certain sense of control was interpreted as necessary for increasing the PA level as well as for using an eHealth tool to help increase the PA level. The eHealth tool seemed to strengthen or weaken the perception of control by either providing support or by being too demanding on the user. Perceptions varied depending onother environmental factors. The Fogg Behavior Model illustrated how motivational levels, ability levels, and functional triggers interact within our findings. Thus, this study provides further evidence for the importance of empowering the patients to boost their level of agency and their ability to improve PA levels.
45.	Marklund, Sarah, et al. (author) To use or not to use : a qualitative analysis of factors associated with using or not using an electronic health (eHealth) tool among people with COPD 2020 In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 56 Journal article (other academic/artistic)
46.	Nordin, Fredrik, et al. (author) Concurrent validity of a fixated hand-held dynamometer for measuring isometric knee extension strength in adults with congenital heart disease 2019 In: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 22:4, s. 206-211 Journal article (peer-reviewed)abstract Purpose: The purpose of this study was to examine the concurrent validity of a fixated hand-held dynamometer (HHD) in comparison to a load cell in measurement of maximal isometric knee extension force in adults with congenital heart disease (CHD) and healthy adults.Methods: Fourteen adults with CHD and fourteen healthy adults were included. Each participant was tested three times with each method and the mean of the top two results for each participant and method was used in analysis.Results: The agreement between the two methods was excellent in both groups (intraclass correlation coefficient [ICC], 95% confidence interval [CI]) 0.98 (0.92–1.00) in the CHD group and ICC 0.99 (0.96–1.00) in the healthy group). There was a small difference of 19.5 Newton or 4.8% (p<.05) between the two methods in the CHD group. No significant difference was seen between the two methods in the healthy group (p>.05).Conclusions: The fixated HHD demonstrated excellent concurrent validity when compared to a load cell among adults with CHD as well as in healthy adults. Thus, in a healthy population the methods can be used interchangeably, however, a small difference between the methods is seen in the CHD group.
47.	Nyberg, Andre, et al. (author) A Cohort Study to Evaluate the Feasibility of Low Load/High Repetition Elastic Band Resistance Training for People with Chronic Obstructive Pulmonary Disease 2014 In: Journal of Novel Physiotherapies. - : OMICS Publishing Group. - 2165-7025. ; 4 Journal article (peer-reviewed)abstract Background: Resistance training is an important component of pulmonary rehabilitation in people with Chronic Obstructive Pulmonary Disease (COPD). A vast majority or resistance training studies in COPD have focused on increasing muscular strength with use of weight machines and has been found to be a feasible approach in COPD. However, regarding feasibility of resistance training equipment other than weight machines, such as elastic resistance equipment, information is scarce. In addition, little is known regarding other trainable muscle characteristics, such as peripheral muscular endurance in COPD. We therefore aim to evaluate the feasibility of a low load/high repetition elastic band Resistance Training (RT) regimen in people with moderate to severe COPD. We also aim to evaluate if the RT regimen is feasible for the physiotherapists, conducting the intervention.Methods: Twenty-two participants with moderate to severe COPD (mean forced expiratory volume in one second, FEV1 58.7% predicted) and five physiotherapists participated in the study. Measurements of attendance, assessment and progression of exercise intensity, adverse events, participant and compliance (participant and physiotherapist) were collected for assessment of feasibility.Results: The mean (95% confidence interval) attendance rate was 94% (91-97) and mean exercise intensity was 79% (74-83) of the predicted maximum intensity. Furthermore, the median (interquartile range) compliance was 96% (94-96) and 100% (94-100) for the people with COPD and the physiotherapists respectively. Exercise intensity increased on all exercises and any recorded adverse events were considered minor and temporary.Conclusions: Low load/high repetition elastic band resistance training appears to be feasible for both people with COPD and the physiotherapists performing the intervention. These results indicate that elastic bands could be a feasible alternative to weight machines in resistance training for people with COPD.
48.	Nyberg, Andre, et al. (author) Acute Effects of Low-Load/High-Repetition Single-Limb Resistance Training in COPD 2016 In: Medicine & Science in Sports & Exercise. - : Wolters Kluwer. - 0195-9131 .- 1530-0315. ; 48:12, s. 2353-2361 Journal article (peer-reviewed)abstract Exercising small muscle groups at a time allows higher muscle specific workloads compared to whole body aerobic exercises in people with chronic obstructive pulmonary disease (COPD). Whether similar effects also occur with partitioning exercise during low load/high-repetition resistance exercises is uncertain.PURPOSE: To investigate the acute effects of partitioning exercise on exercise workload, exertional symptoms and quadriceps muscle fatigue during low load/high-repetition resistance exercises in people with COPD and healthy controls.METHODS: We compared the acute physiological effects of single-limb (SL) versus two-limb (TL) execution of isokinetic knee-extension and of six low load/high-repetition elastic resistance exercises in 20 people with COPD (FEV1 = 38% predicted) and 15 healthy controls.RESULTS: Among people with COPD, SL exercises resulted in higher exercise workloads during isokinetic knee-extension (17 ± 31%, p<0.05) and elastic exercises (rowing 17 ± 23%; leg curl 23 ± 21%; elbow flexion 19 ± 26%; chest press 14 ± 15%; shoulder flexion 33 ± 24% and knee-extension 24 ± 18%, all p<0.05). Muscle fatigue ratings were similar during SL compared to TL exercises, while dyspnea ratings were similar between conditions during isokinetic exercises and lower during SL compared to TL elastic exercises (p<0.05). In COPD, SL knee-extension resulted in greater quadriceps fatigue than TL knee-extension as evidenced by a greater fall in quadriceps potentiated twitch force after the former exercise (-24 ± 10 vs. -16 ± 8%, p=0.025). In healthy controls, partitioning exercise with SL exercise did not modify workload, quadriceps fatigue nor dyspnea achieved during the various exercises.CONCLUSION: Partitioning exercise by exercising using a SL allowed higher muscle localized exercise workloads, larger amount of quadriceps muscle fatigue with lower or similar level of exertional symptoms during low load/high-repetition resistance exercises in people with advanced COPD.
49.	Nyberg, Andre, et al. (author) Adaptations in limb muscle function following pulmonary rehabilitation in patients with COPD – a review 2016 In: Revista Portuguesa de Pneumologia. - : Elsevier. - 0873-2159 .- 2172-6825 .- 2173-5115. ; 22:6, s. 342-350 Research review (peer-reviewed)abstract Even though chronic obstructive pulmonary disease (COPD) is primarily a disease of the respiratory system, limb muscle dysfunction characterized by muscle weakness, reduced muscle endurance and higher muscle fatigability, is a common secondary consequence and a major systemic manifestation of the disease. Muscle dysfunction is especially relevant in COPD because it is related to important clinical outcomes such as mortality, quality of life and exercise intolerance, independently of lung function impairment. Thus, improving muscle function is considered an important therapeutic goal in COPD management. Pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based and comprehensive approach used to promote better self-management of the disease, minimize symptom burden, optimize functional status, and increase participation in activities of daily life. Exercise training, including cardiovascular and muscle exercises, is the cornerstone of PR and is considered the best available strategy to improve exercise tolerance and muscle function among patients with COPD. This paper addresses the various components of exercise training within PR used to improve limb muscle function in COPD, providing clinicians and health-care professionals with an overview and description of these various exercise modalities and of their effects on limb muscle function. Guidance and recommendations to help design optimal limb muscle training regimens for these patients are also presented.
50.	Nyberg, Andre, et al. (author) Assessing the effect of high-repetitive single limb exercises (HRSLE) on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) : study protocol for randomized controlled trial 2012 In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 13, s. 114- Journal article (peer-reviewed)abstract Background: Single-limb knee extension exercises have been found to be effective at improving lower extremity exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Since the positive local physiological effects of exercise training only occur in the engaged muscle(s), should upper extremity muscles also be included to determine the effect of single limb exercises in COPD patients. Methods/design: Trial design: a prospective, assessor-blind, block randomized controlled, parallel-group multicenter trial. Participants: stage II-IV COPD patients, > 40 years of age, ex-smokers, with stable medical treatment will be included starting May 2011. Recruitment at three locations in Sweden. Interventions: 1) high-repetitive single limb exercise (HRSLE) training with elastic bands, 60 minutes, three times/week for 8 weeks combined with four sessions of 60 minutes patient education, or 2) the same patient education alone. Outcomes: Primary: determine the effects of HRSLE on local muscle endurance capacity (measured as meters walked during 6-minute walk test and rings moved on 6-minute ring and pegboard test) and quality of life (measured as change on the Swedish version of the Chronic Respiratory Disease Questionnaire). Secondary: effects on maximal strength, muscular endurance, dyspnea, self-efficacy, anxiety and depression. The relationship between changes in health-related variables and changes in exercise capacity, sex-related differences in training effects, feasibility of the program, strategies to determine adequate starting resistance and provide accurate resistance for each involved movement and the relationship between muscle fatigue and dyspnea in the different exercise tests will also be analyzed. Randomization: performed by a person independent of the recruitment process and using a computer random number generator. Stratification by center and gender with a 1: 1 allocation to the intervention or control using random block sizes. Blinding: all outcome assessors will be blinded to group assignment. Discussion: The results of this project will contribute to increase the body of knowledge regarding COPD and HRSLE.

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Type of publication: journal article (73); doctoral thesis (4); research review (4); conference paper (3); other publication (2); licentiate thesis (1); show more...; show less...

Type of content: peer-reviewed (66); other academic/artistic (19); pop. science, debate, etc. (2)

Author/Editor: Nyberg, André (40); Nyberg, Andre, Docen ... (33); Wadell, Karin (23); Maltais, François (22); Saey, Didier (21); Frykholm, Erik, 1985 ... (14); show more...; Lundell, Sara, 1982- (12); De Brandt, Jana, 199 ... (10); Tistad, Malin (8); Klijn, Peter (7); Jakobsson, Johan (6); Lindström, Britta (6); Hedlund, Mattias (6); Bui, Kim-Ly (6); Géphine, Sarah (6); Hofman, Albert (5); Uitterlinden, André ... (5); Gudnason, Vilmundur (5); Rotter, Jerome I. (4); Harris, Tamara B (4); Homuth, Georg (4); Launer, Lenore J (4); Psaty, Bruce M (4); Smith, Albert V (4); van Hees, Hieronymus ... (4); Lemson, Arthur (4); Stål, Per (3); van Duijn, Cornelia ... (3); Nyberg, Fredrik, 196 ... (3); Martin, Nicholas G. (3); Schmidt, Reinhold (3); Schmidt, Helena (3); Deary, Ian J (3); Sörlin, Ann, PhD, 19 ... (3); Montgomery, Grant W. (3); Holmner, Åsa (3); Rivadeneira, Fernand ... (3); Fornage, Myriam (3); Eiriksdottir, Gudny (3); Liu, Yongmei (3); Francks, Clyde (3); Johnson, Andrew D. (3); Rullander, Anna-Clar ... (3); Teumer, Alexander (3); Bis, Joshua C. (3); Ford, Ian (3); Trompet, Stella (3); Nauck, Matthias (3); Janaudis-Ferreira, T ... (3); Pesola, Ulla-Maija (3); show less...

University: Umeå University (77); Karolinska Institutet (13); Högskolan Dalarna (6); University of Gothenburg (5); Uppsala University (5); Lund University (5); show more...; Linköping University (3); Royal Institute of Technology (2); Luleå University of Technology (2); University of Gävle (2); Örebro University (1); The Swedish School of Sport and Health Sciences (1); show less...

Language: English (83); Swedish (4)

Research subject (UKÄ/SCB): Medical and Health Sciences (81); Natural sciences (5); Social Sciences (2); Engineering and Technology (1)

Year

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