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Background: Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality., Methods: A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions., Results: During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission., Conclusions: The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.

Objective: The effect of a healthy lifestyle on diabetes-related dementia remains unknown. We examined whether an active lifestyle and rich social network may counteract the increased risk of dementia in people with diabetes., Research Design and Methods: Dementia-free older adults from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) ( n = 2,650) were followed up for 10 years. Diabetes was ascertained on the basis of medical history, medication use, medical records, or glycated hemoglobin (HbA 1c ) ≥6.5% and prediabetes as HbA 1c between 5.7 and 6.5%. Dementia was diagnosed by specialists following standard criteria. An active lifestyle was defined as a moderate to high (vs. low) level of engagement in leisure activities or a rich social network (having moderate to rich [vs. poor] social connections and support). Hazard ratios (HRs) of dementia risk were derived from Cox regression models., Results: There were 246 incident dementia cases during follow-up. Those with diabetes ( n = 243), but not those with prediabetes ( n = 921), had greater risk of dementia (adjusted HR 2.0 [95% CI 1.4-2.9]) than diabetes-free participants. Participants with diabetes but low level of engagement in leisure activities (HR 4.2 [95% CI 2.2-8.2]) or a poor social network (HR 3.4 [95% CI 1.9-6.1]) had greater dementia risk than diabetes-free participants with moderate to high levels of leisure activity engagement or a moderate to rich social network. In participants with diabetes, an active lifestyle (high level of engagement in leisure activities or a rich social network) was associated with less of a raised risk (HR 1.9 [95% CI 1.1-3.4])., Conclusions: An active and socially integrated lifestyle may significantly counteract the detrimental effect of diabetes on dementia risk., (© 2018 by the American Diabetes Association.)

Background: Poor nutrition and age per see add to the development of sarcopenia, i.e. loss of muscle mass and strength, which contributes to increased risk of impaired activities of daily living (ADL) and reduced independence. Protein deficiency plays an important role in the development of sarcopenia. In order to increase the muscle mass protein intake should be combined with physical exercise. A daily physical activity, the sit-to-stand exercise, has been proven to decrease older persons' dependence in ADL. Our study aims to evaluate the effects of the sit-to-stand exercise in combination with a protein-rich nutritional supplement, on physical function and independence in frail nursing home residents. The resident's perceptions and experiences of the intervention and the staff's experiences of supporting the resident to complete the intervention will also be explored., Methods: The study is a two-arm cluster-randomized controlled trial which will be performed in nursing homes at two municipalities in Sweden. We will recruit 120 residents, age 75 or older and able to stand up from a seated position. Residents (n = 60) randomized to the intervention group will perform the sit-to-stand exercise at four occasions daily and will be offered a protein-rich oral supplement, twice a day. The intervention period will last for 12 weeks and measures of physical function, nutritional status, quality of life and health economy will be performed at baseline and at 12-weeks follow-up. The primary outcome will be the number of chair rises performed in 30 s. The control group will receive standard care. Data will be analysed by intention-to-treat analysis and with mixed effect models. During the last part of the intervention period individual interviews with the residents, on the topic of feasibility with the OPEN concept will be held. Likewise, focus-group-interviews with staff will be performed., Discussion: The residents' physical and mental health could be expected to improve. Even the work situation for staff could be positively affected. One innovative feature of the OPEN study is the simple intervention consisting of a basic daily activity that can be performed by several nursing home residents with the support of existing staff and available resources., Trial Registration: ClinicalTrials.gov Identifier: NCT02702037.

Background: Most adult patients with congenital heart disease (CHD) have reduced aerobic exercise capacity. Their habitual physical activity (PA) level is, however, less well studied. In this study, habitual PA level in a cohort of adults with CHD compared with healthy age- and sex-matched controls was investigated., Methods: Eighty adults with CHD, classed as either "complex" (n = 40) or "simple" (n = 40), and 42 healthy controls were studied with a combined uniaxial accelerometer and heart rate monitor worn during 4 consecutive days. We analyzed: (1) the time spent during moderate or vigorous PA; (2) accelerometer counts per day; and (3) to what extent the World Health Organization recommendations on PA were reached., Results: Patients with simple lesions had higher total accelerometer counts per day compared with patients with complex lesions and controls (simple lesions: median [interquartile range] 107.7 [76.3-139.1] vs complex lesions: 72.8 [49.2-101.0] and controls: 78.3 [58.7-106.9]; P ≤ 0.001 and P = 0.002). Furthermore, no differences in time spent during moderate or vigorous PA was found between patients and controls. In addition 46% of the patients with simple lesions, 55% of the patients with complex lesions, and 44% of the controls did not reach the World Health Organization-recommended level of daily PA, but no significant differences between groups were found. There were no differences in achieving recommended PA level between patients in New York Heart Association (NYHA) class I vs NYHA class II and III., Conclusions: Patients with CHD follow the same PA level pattern as the general population. Broad strategies to promote an active lifestyle are needed across the population and especially for patients with complex CHD and impaired NYHA class., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Because of the possible implications for intervention and thus successful aging, researchers have striven to determine whether the age changes in physical and cognitive functioning are coincident or does functioning in one domain change before, and possibly contribute to, functioning in the other., Methods: Bivariate dual change score models were applied to four cognitive factors and three motor functioning factors available from 813 adults who participated in the Swedish Adoption/Twin Study of Aging. Participants were aged 50-88 at the first of six waves of testing covering a 19-year follow-up period; 68% participated in at least three waves., Results: Model comparisons indicated dynamic coupling relationships between Balance and Fine Motor factors and the Speed cognitive factor. Decline in motor function precedes decline in performance on processing speed tasks, even though the motor function tasks were not timed. Results indicated possible bidirectional coupling between Fine Motor and Speed., Conclusions: Combined with other dual change score model analyses of cognition and physical function, a picture is beginning to emerge of the cascade of events that may lead to cognitive aging., (© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Physical activity and structural differences in the hippocampus have been linked to educational outcome. We investigated whether a curriculum-based physical activity intervention correlates positively with children's academic achievement, psychological well-being, health-related quality of life (HRQoL), fitness, and structural development of the brain., Methods: The study had a quasi-experimental design and a control group. National test results were gathered from 545 students, 122 in the intervention school, and 423 in 3 control schools. HRQoL and socioemotional data were collected with child and proxy versions of KIDSCREEN and the Strength and Difficulties Questionnaire. Overall, 79 students in grades 5 and 6 were recruited for an in-depth study, consisting of a submaximal oxygen consumption test and magnetic resonance imaging of the brain. HRQoL and socioemotional data were collected from 349 students (65%), 182 (52%) in the intervention school, and 167 (48%) in one of the control schools., Results: Girls attending the intervention school were more likely to pass national tests in Swedish (odds ratio 5.7) and Mathematics (odds ratio 3.2). The fourth to sixth graders in the intervention school reported lower levels of conduct problems (p < .05), and the girls were also less likely to report hyperactivity (p < .05). Girls reported higher levels of emotional problems (p < .05) than boys. Boys in the intervention group had significantly higher levels of estimated maximal oxygen uptake (p < .05) than controls. No difference in hippocampal structure was seen., Conclusions: Curriculum-based physical activity in school may improve the academic achievement and psychological health of children, particularly for girls., (© 2015, American School Health Association.)

Purpose: Physical activity and body mass index (BMI) are involved in prostate cancer etiology; possible biologic mechanisms include their effects on hormonal levels. Our aim was to investigate the relationship between physical activity, obesity, and prostate cancer., Methods: We followed a cohort of 13,109 Swedish men for 13 years and investigated the association of self-reported physical activity and BMI at baseline with prostate cancer incidence. We further analyzed whether BMI could modulate effects of physical activity. Occupational, recreational, and total physical activity were analyzed in relation to overall, localized, and advanced prostate cancer., Results: During the study follow-up, we observed a total of 904 cases of prostate cancer (429 localized, 407 advanced, and 68 unclassified). High levels of occupational physical activity were associated with a nonsignificantly decreased risk of overall (HR 0.81, 95 % CI 0.61-1.07), localized (HR 0.75, 95 % CI 0.51-1.12), and advanced (HR 0.85, 95 % CI 0.55-1.31) prostate cancer. We found no association between high BMI and risk of prostate cancer incidence: We observed, however, a significant interaction between BMI and leisure physical activity., Conclusion: No association was confirmed between total physical activity and localized or advanced prostate cancer. The highest, relative to the lowest, level of occupational physical activity tended to be linked to a lower risk of prostate cancer, with a suggested dose-response relationship. We found no association between high BMI and risk of prostate cancer incidence; however, our analyses suggested an interaction between BMI and physical activity during recreational time that merits further investigation in future studies.

Objective: Previous studies have found that regular participation in intense physical activity increases the risk of developing atrial fibrillation (AF) in men, but it remains unclear how physical activity influences the risk of AF in women. We aimed to examine whether physical activity of different types and at different ages influences the development of AF in women., Methods: In the population-based Swedish Mammography Cohort, information about physical activity was obtained from 36 513 AF-free women (49-83 years old, median age 60 years) who had completed a questionnaire at study entry (1997). Participants reported their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at study entry, and at 30 and 50 years of age). We used the Swedish National Inpatient Register (IPR) to determine whether the participants were diagnosed with AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CI, adjusted for potential confounders., Results: During a median follow-up of 12 years (10th percentile 7.5 years, 90th percentile 12.0 years), 2915 cases of AF were diagnosed. The risk of AF decreased with increasing levels of leisure-time exercise at study entry (RR 0.85, 95% CI 0.75 to 0.95 for ≥4 h/week vs <1 h/week) and walking/bicycling (RR 0.81, 95% CI 0.72 to 0.92, for ≥40 min/day vs almost never)., Conclusions: Physical activity is associated with a reduced risk of AF in women. Moderate amount of physical activity was sufficient to significantly reduce AF risk., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: This study investigated if total physical activity, as well as different types of physical activity, were associated with heart failure risk., Background: Physical activity has shown to be associated with reduced risks of coronary heart disease and stroke. Studies have also suggested that physical activity is associated with heart failure development., Methods: A study population of 33,012 men was followed from beginning of 1998 until the end of 2012. First event of heart failure was ascertained through linkage to the Swedish National Patient Register and Cause of Death Register. The data were analyzed by using Cox proportional hazards regression and Laplace regression., Results: During a mean follow-up of 13 years, we ascertained a total of 3,609 first events of heart failure. The average age at study baseline was 60 ± 9 years of age. When examining the entire study population, a U-shaped association between total physical activity and heart failure risk was detected, with both extremely high (57 metabolic equivalent [MET] h/day) and extremely low (38 MET h/day) levels of total physical activity associated with an increased risk of heart failure. When investigating different types of physical activity, we found that walking/bicycling at least 20 min/day was associated with 21% lower risk of heart failure (95% confidence interval: 0.72 to 0.87); corresponding to a median age at heart failure 8 months later for those who had actively walked or biked daily. When looking at long-term behavior of walking/bicycling, the results suggested a trend toward more recent active behavior being more related to heart failure protection than past physical activity levels., Conclusions: This study suggests that both low levels and high levels of total physical activity, in comparison with moderate levels, could increase heart failure risk in men and that certain types of physical activity are associated with a protective effect on heart failure in men. When examining different types of physical activity, walking/bicycling at least 20 min per day was associated with the largest risk reduction of heart failure., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: In subjects with chronic obstructive pulmonary disease (COPD), symptoms of fatigue, concomitant heart disease and low physical activity levels are more frequently described than in subjects without COPD. However, there are no population-based studies addressing the relationship between physical activity, fatigue and heart disease in COPD. The aim was to compare physical activity levels among subjects with and without COPD in a population based study, and to evaluate if concomitant heart disease and fatigue was associated to physical activity., Methods: In this, 470 subjects with COPD and 659 subjects without COPD (non-COPD) participated in examinations including structured interview and spirometry. A ratio of the forced expiratory volume in one second (FEV1)/best of forced vital capacity (FVC) and vital capacity (VC) < 0.7 was used to define COPD. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ), and fatigue with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F)., Results: The prevalence of low physical activity was higher among subjects with FEV1 < 80% predicted compared to non-COPD subjects (22.4% vs. 14.6%, p = 0.041). The factors most strongly associated with low physical activity in subjects with COPD were older age, OR 1.52, (95% CI 1.12-2.06), a history of heart disease, OR 2.11 (1.10-4.08), and clinically significant fatigue, OR 2.33 (1.31-4.13); while obesity was the only significant factor among non-COPD subjects, OR 2.26 (1.17-4.35)., Conclusion: Physical activity levels are reduced when lung function is decreased below 80% of predicted, and the factors associated with low physical activity are different among subject with and without COPD. We propose that the presence of fatigue and heart disease are useful to evaluate when identifying subjects for pulmonary rehabilitation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aim: we identified clusters of older people with similar health-related behaviours and assessed the association between those clusters and the risk of injurious fall., Methods: we linked self-reported and register-based data on the over-65s from the Stockholm public health cohort (N = 20,212). Groups of people with similar health-related behaviours were identified by cluster analysis using four measures of physical activity, two of smoking and alcohol habits and two individual attributes (age and type of housing). The association between clusters and falls leading to hospitalisation (422 cases) was studied using a nested case-control design. Odds ratios (ORs), crude and adjusted for health status, were compiled by cluster using the one with the most 'protective' health behaviour profile as the reference., Results: five clusters were identified revealing a variety of combinations of health-related behaviours, all linked to specific age groups and types of housing and with a tendency towards higher levels of physical activity among the younger ones. The risk of injurious falls differed across clusters, and for three out of four, it was significantly higher than in the comparison cluster. Adjusting for health status only partially reduced the ORs for those clusters and this was observed both in men and women., Conclusion: health-related behaviours aggregate in different manners among older people. Some health-related profiles are associated with an excess risk of falls leading to hospitalisation. Although this is partly a reflection of age differences across clusters, health status alone cannot fully explain the association., (© The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Purposes: To assess predictors of presenteeism (reduced productivity at work) and activity impairment outside work in patients with spondyloarthritis (SpA)., Methods: Multivariate logistic regression analysis was used to study predictors of presenteeism and activity impairment in 1,253 patients with SpA based on a 2.5 year follow-up questionnaire. The Work Productivity and Activity Impairment (WPAI) questionnaire was used as main outcome. Age, gender, lifestyle factors, subgroups, disease duration, and different patient reported outcome measures (PROMs) were studied as possible predictors. The association between presenteeism and WPAI activity impairment outside work was assessed., Results: Out of 1,253 patients, 757 reported being in work and of these 720 responded to the WPAI questionnaire. The mean (confidence interval, CI) reported presenteeism was 25% (23-27%) and mean activity impairment 33% (31-35%) (0-100%, 0 = no reduction). Significant predictors of presenteeism and activity impairment at follow-up (controlled for gender, age, spondyloarthritis subgroups and presenteeism at baseline) were presenteeism at baseline, poor quality of life, worse disease activity, decreased physical function, lower self-efficacy pain and symptom, higher scores of anxiety, depression, smoking and low education level, and for activity impairment also female sex. There was a strong association between presenteeism and activity impairment outside work (OR 16.7; 95% CI 11.6-24.3; p < 0.001)., Conclusions: Presenteeism and activity impairment were not only predicted by presenteeism at baseline, but also by several PROMs commonly used in clinical rheumatology practice. Impaired activity outside work could indicate problems also at work suggesting why both areas need to be addressed in the clinical situation.

Introduction: Only one study has analysed the association between exercise and development of rheumatoid arthritis (RA), showing no association. Aim of this paper was to evaluate the association of physical activity in all its aspect with RA., Methods: To examine this association, middle age and elderly women from the Swedish Mammography Cohort, a population-based prospective study, were analysed. Data on physical activity were collected in 1997 by self-administrated food-frequency questionnaire. Risk of RA associated with physical activity was estimated using Cox proportional hazard regression models., Results: Among 30,112 women born between 1914 and 1948 followed-up from January 1, 2003 to December 31, 2010, 201 RA cases were identified (226,477 person-years). There was a statistically significant 35% lower risk of RA (relative risk (RR), 0.65; 95% confidence interval (CI), 0.43-0.96) among women in the highest category of leisure-time activity (combining more than 20 minute per day of walking/bicycling (median 40-60 minute per day) and more than 1 hour per week of exercise (median 2-3 hours per week)) as compared to women in the lowest category (less than 20 minute per day of walking/bicycling and less than 1 hour per week of exercise). A non-statistically significant decreased risk was observed for household work (-32%) and work/occupation (-15%), while an increased risk was observed for leisure-time physical inactivity (+27%). Daily energy expenditure was not associated with risk of RA., Conclusions: This prospective population-based cohort study of women supports the hypothesis that physical activity can be a protective factor in the etiology of rheumatoid arthritis. Our results add to accumulated evidence on benefits of modifiable leisure-time physical activity for prevention of many other chronic diseases.

Objectives: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier., Method: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years., Results: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2., Conclusions: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

Objectives: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA)., Method: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed., Results: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91] and having a below average income (OR 1.35, 95% CI 1.12-1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40-2.84) and poor health (OR 1.59, 95% CI 1.10-2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35-0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52-0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke's R(2))., Conclusions: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.

Background: Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls., Methods: Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls., Results: During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk., Conclusions: In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.

Background: The nature of the association between levels of physical activity and risk of heart failure is little known. We investigated nonlinear associations of total and leisure time physical activity with risk of heart failure., Methods and Results: In 1997, 39 805 persons without heart failure completed a questionnaire of lifestyle factors and medical history. We used Cox regression models to investigate total (adjusting for education and previous myocardial infarction) and direct (multivariable-adjusted) effects of self-reported total and leisure time physical activity on risk of heart failure of any cause and heart failure of nonischemic origin. Heart failure diagnoses were obtained until December 31, 2010. Higher leisure time physical activity was associated with lower risk of heart failure of any cause; hazard ratio of the total effect of leisure time physical activity was for fifth versus first quintile 0.54; 95% confidence interval was 0.44 to 0.66. The direct effect was similar. High total daily physical activity level was associated with lower risk of heart failure, although the effect was less pronounced than for leisure time physical activity (total effect hazard ratio, 0.81; 95% confidence interval, 0.69-0.95; fifth versus first quintile). A similar direct effect observed., Conclusions: Leisure time physical activity was inversely related to risk of developing heart failure in a dose-response fashion. This was reflected in a similar but less pronounced association of total physical activity with risk of heart failure. Only part of the effects appeared to be mediated by traditional risk factors., (© 2014 American Heart Association, Inc.)

Nursing education should prepare students for a lifelong professional career including managing clinical physical demands. Musculoskeletal symptoms, such as bodily pain, have been reported among nurses and nursing students but less is known about the impact of symptoms in daily activities. The aim was to explore the prevalence of self-reported musculoskeletal symptoms and their impact on general physical activity among nursing students. This cross-sectional study was based on a questionnaire to all undergraduate nursing students at one university. The prevalence of symptoms and physical impact during past 3 and 12 months was calculated for each study year. Odds ratio was analysed with logistic regression. Of 348 students 224 responded, 84% women, mean age 24.6 years (range 20-46). Of those 143 (64%) reporting symptoms during the past 12 months, 91 (64%) reported impact on physical activities. Most commonly reported were everyday activities such as transportations and prolonged sitting. The odds ratio for reporting symptoms was 1.8 for year 2 (95% CI: 0.9-3.5), and 4.7 for year 3 (95% CI: 2.1-10.7). The prevalence of musculoskeletal symptoms was high among nursing students and higher the final study year and not only resulted in discomfort but had an impact on the students' general physical activities., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: There is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences., Methods: The sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey - Revised, Exercise Self-Efficacy Scale, Falls-Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%., Results: Men were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men., Conclusions: Men were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e.g. men may need more support to be physically active.

Purpose: The aim of this study was to describe physical activity, quality of and satisfaction with life, pain, joint mobility and muscle function in adults with mild-to-moderate osteogenesis imperfecta (OI) to form the basis of improved clinical care and physical therapy treatment., Method: A total of 40 men and women aged between 21 and 71 years were identified and a prospective, cross-sectional study was performed on 29 (18 women) included participants. The participants had to be able to walk and to have a diagnosis of mild-to-moderate OI. Self-administered questionnaires and clinical examinations were used., Results: Difficulties were found in all domains of the International Classification of Functioning, Activity and Health. Pain was reported in 25 of 29 participants and scoliosis was found in 23 participants. Difficulty to run was estimated in 18 participants. A total of 19 of 27 participants reported reaching the recommendations of 30 min of moderate-intensity activity preferably every day. Life satisfaction was high even though health-related quality of life, assessed with the Short Form 36, was significantly lower than the Swedish norm., Conclusion: Impairments and activity limitations involved pain, scoliosis, contractures as well as trouble with running, heavy lifting, heavy work and sports. This study show that individuals with mild-to-moderate OI perceive themselves as having decreased health-related quality of life and this seems to depend on decreased physical functioning. Despite that, as a group, they estimated high life satisfaction and 19 participants reported adhering to the general recommendation of 30 min of moderate-intensity activity preferably every day., (Copyright © 2012 John Wiley & Sons, Ltd.)

Background: Having asthma has in previous reports been related to a lower physical activity level. At the same time the prevalence of asthma among elite athletes is high. The aim of this study was to investigate the association between physical activity level and asthma., Methods: A postal questionnaire was completed by 25,610 individuals in Sweden. Current asthma was defined as having had an asthma attack during the last 12 months or current use of asthma medication. The participants were asked how often and for how many hours a week they were physically active., Results: In the population 1830 subjects (7.1%) had current asthma. There was no significant difference in the proportion of subjects that reported being inactive or slightly physically active between asthmatic and non-asthmatics (57 vs. 58%) while the proportion of subjects that were vigorously physically active (≥2 times a week and ≥7 h per week) was higher among the subjects with asthma (6.7 vs. 4.8%, p < 0.0001). Being vigorously physically active was independently related to current asthma (OR (95% CI)) 1.40 (1.11-1.77)), wheeze (1.39 (1.17-1.65)), wheeze and breathlessness (1.68 (1.38-2.04)), and wheezing without having a cold (1.39 (1.13-1.71)). The association between being vigorously physically active and wheeze was significantly stronger in women compared to men., Conclusions: There was no difference in the proportion of subjects with a reported low level of physical activity between asthmatics and non-asthmatics. Health care professionals should, however, be aware of the increased prevalence of asthma and asthma-related symptoms in vigorously physically active subjects., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Summary: Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus., Introduction: Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture., Methods: The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years., Results: Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk., Conclusion: This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

The aim of the study was to survey the self-reported health and physical activity in a sample of community mental healthcare users in a city of Sweden. The study was conducted through a cross-sectional design with participants requested to fill out a self-report questionnaire. Participants (n = 103) were persons with psychiatric disabilities living in residential psychiatric settings and/or participating in daily activities provided by community mental healthcare services. The results showed that the group is affected with serious risk factors, such as high body mass index, low rated extent and frequency of physical activity and low self-estimated general state of health. Even though some difficulties associated with the answering process of this questionnaire emerged, these self-reported results clearly confirm the fact that persons with psychiatric disabilities constitute a vulnerable group in need for health-promoting caring activities and interventions., (© 2012 Blackwell Publishing.)

Background: Active travel has a potential to increase children's physical activity (PA). Pedometers offer a valid option to measure PA, but do not capture cycling activity. Children's self-reported cycling distances can be analyzed by the Geografic Information System (GIS)., Aim: To combine pedometry and GIS mapping to identify the relative amount of cycling in children's PA., Study Group: Of all children in 4th grade (n=187) in Staffanstorp Sweden, 144 had valid pedometer data. Fifty-six children were non-cyclists while 88 children (32 boys, 47 girls, 9 gender unknown) reported at least one cycle journey., Methods: Cycle trips were entered into GIS and calculated to total cycling distance. Average length of the single distances cycled per day was 676 m (SD=534 m). A previously reported cycling speed (13.5 km/h) was used to calculate time spent cycling. Consequently distance=676 m, speed=13.5 km/h=13,500 m/3600 s=3.75 m/s and time=676m/3.75m/s=180.26 s=3 min. Expenditure of 4 and 5 metabolic equivalents (METs) has in children been reported equivalent to 122 and 127 steps/min, respectively. We estimated 4.7 METs (13.5 km/h) as 126 steps for every min of cycling (127-122=5×0.7=125.5)., Results: The daily mean cycle distance was 676 m, on average 379 additional steps/day for cycling children (min. 21, max. 1385, SD=299) with no gender difference. Additional "steps" obtained by cycling corresponded to on average 3% of their PA., Conclusion: The relative contribution of cycling in 10-year-old children's PA level is quite small and stable between children across different levels of activity levels, regardless of gender.

Background: Patients with lower extremity osteoarthritis (OA) have increased all cause and disease specific mortality compared to the general population and epidemiological data suggests that OA management should include increased physical activity., Aim: To measure physical activity assessed as daily energy expenditure and accumulated steps day-1 in patients with severe OA of the hip or knee and compare with healthy controls. Furthermore, to investigate if gender, age, BMI and affected joint influence measures of physical activity., Design: Cross sectional study., Setting: Community., Population: Fifty-one patients (49% women, age: 68±5 years, BMI: 28.4±4.6) with severe knee (N.=25) or hip (N.=26) OA scheduled for total joint replacement and 15 healthy population-based controls (53 % women, age: 68±5 years, BMI: 26.9±4.3)., Methods: Subjects wore an accelerometer (SenseWear™ Pro2 Armband) on 5 consecutive days. Time on body, total energy expenditure, average intensity (METS), time being sedentary, time above 3 METS and numbers of steps day(-1) were calculated., Results: Patients had similar daily energy expenditure to controls (2632 vs. 2633 calories per day) but walked on average 29.3% fewer steps day(-1) (6632 vs. 8576 P=0.033). Gender and affected joint (hip or knee) did not influence the results. Age and BMI explained 15.4%-32.7% of the variation in total energy expenditure, average METS, time being sedentary, and steps day(-1)., Conclusion: The present data indicate a need for interventions improving walking ability in patients with severe hip and knee OA. This need is independent regarding gender and affected joint but higher for older and heavier patients. Simultaneously assessed measures of physical activity gave different results, raising concern about validity of physical activity measures in patients with lower extremity OA and indicating caution when comparing results from studies applying different measures., Clinical Rehabilitation Impact: It is of potential interest for patients and practitioners that a relative high physical activity is possible for end-stage OA patients since this may reduce the increased all cause and disease specific mortality.

Background: To be able to draw any conclusions regarding the health effects of occupational physical activity (OPA), more information is needed regarding valid measures to assess OPA. Aims were to compare OPA as assessed with the International Physical Activity Questionnaire long version (IPAQ-L) with OPA assessed with an accelerometer and to assess the contribution of OPA to total PA., Methods: Working adults (n = 441; mean age = 49.4 yrs; 44% males) wore an accelerometer for 7 days in free-living situations and completed the IPAQL. Comparisons were made between IPAQ-L-work and accelerometer data limited to working time (Moderate and Vigorous PA (accelerometer-MVPA-work) and average intensity). Subgroup analyses were performed., Results: Spearman correlation was r = .46 (P < .01) between IPAQ-L-work and accelerometer-MVPA-work. Correlations ranged from r = .27 to r = .55 in respectively obese and overweight subjects. The contribution of IPAQ-L-work to IPAQ-total was 24.7%., Conclusions: The IPAQ-L work domain is a moderately good measure of time spent on MVPA at work and can be used to assess the contribution of OPA to total PA. This study provides valuable information regarding the use of the IPAQ-L in assessing work domain specific PA, and underscores the importance of assessing OPA, as it can contribute for a substantial part to total PA.

Aims: The aim of this study was to explore the association between pedometer-determined physical activity versus measures of obesity, inflammatory markers and arterial stiffness in people with Type 2 diabetes., Methods: We analysed data from 224 men and 103 women with Type 2 diabetes, aged 54-66 years. Physical activity was measured with waist-mounted pedometers during three consecutive days and the number of steps/day were calculated and classified in four groups: < 5000 steps/day, 5000-7499 steps/day, 7500-9999 steps/day and ≥ 10000 steps/day. Blood samples were analysed for lipids, HbA(1c), inflammatory markers including C-reactive protein and interleukin-6. Nurses measured blood pressure and anthropometrics. Aortic pulse wave velocity was measured with applanation tonometry over the carotid and femoral arteries., Results: Mean steps/day was 7683 ± 3883 (median 7222, interquartile range 4869-10,343). There were no differences in age, diabetes duration, blood pressure, lipids or glycaemic control between the four groups of pedometer-determined physical activity. Subjects with higher steps/day had lower BMI (28.8 vs. 31.5 kg/m(2), P < 0.001), waist circumference (101.7 vs. 108.0 cm, P < 0.001), lower levels of C-reactive protein (1.6 vs. 2.6 mg/l, P = 0.007), lower levels of interleukin-6 (1.9 vs. 3.8 pg ml, P < 0.001) and lower pulse wave velocity (10.2 vs. 11.0 m/s, P = 0.009) compared with less physically active people., Conclusions: We conclude that physical activity measured with pedometer was associated not only with less abdominal obesity, but also with decreased systemic low-grade inflammation as well as with low arterial stiffness, in people with Type 2 diabetes., (© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.)

Purpose: The study's purpose was to investigate concordance between objective and perceived neighborhood walkability, their associations with self-reported walking and objective physical activity, and sociodemographic characteristics of individuals in neighborhoods with objectively assessed high walkability who misperceive it as low., Methods: In 1925 individuals age 20-66 yr of both high and low neighborhood walkability recruited from administrative areas in the city of Stockholm, Sweden, objective neighborhood walkability was assessed within a 1000-m radius of each individual's residential address using geographic information systems. Perceived walkability was based on the Neighborhood Environment Walkability Scale. Walking was assessed using the International Physical Activity Questionnaire, and total physical activity and moderate-to-vigorous physical activity (MVPA) were assessed by an accelerometer (ActiGraph). Sociodemographic characteristics were self-reported., Results: Objective and perceived neighborhood walkability agreed in 67.0% of the individuals, with κ = 0.34 (95% confidence interval (CI) = 0.30-0.38). One-third of the individuals in neighborhoods with objectively assessed high walkability misperceived it as low. This nonconcordance was more common among older and married/cohabiting individuals. After adjustment for sociodemographic characteristics, high objective neighborhood walkability was associated with 35.0 (95% CI = 14.6-64.6) and 10.5 (95% CI = -5.2 to 28.5) more minutes per week of walking for transportation and leisure, respectively, and 2.8 (95% CI = 0.9-5.0) more minutes per day of MVPA. High perceived neighborhood walkability was associated with 41.5 (95% CI = 15.8-62.9) and 21.8 (95% CI = 2.8-40.0) more minutes per week of walking for transportation and leisure, respectively, and 1.7 (95% CI = -0.3 to 3.7) more minutes per day of MVPA., Conclusions: Objective and perceived neighborhood walkability both contribute to the amount of walking and objective physical activity. Both measures of neighborhood walkability may be important factors to target in interventions aiming at increasing physical activity.

Background/objectives: Energy costs of pregnancy approximate 320  MJ in well-nourished women, but whether or not these costs may be partly covered by modifications in activity behavior is incompletely known. In healthy Swedish women: (1) to evaluate the potential of the Intelligent Device for Energy Expenditure and Physical Activity (IDEEA) to assess energy expenditure during free-living conditions, (2) to assess activity pattern, walking pace and energy metabolism in pregnant women and non-pregnant controls, and (3) to assess the effect on energy expenditure caused by changes in physical activity induced by pregnancy., Subjects/methods: Activity pattern was assessed using the IDEEA in 18 women in gestational week 32 and in 21 non-pregnant women. Activity energy expenditure (AEE) was assessed using IDEEA, as well as using the doubly labelled water method and indirect calorimetry., Results: AEE using the IDEEA was correlated with reference estimates in both groups (r=0.4-0.5; P<0.05). Reference AEE was 0.9 MJ/24 h lower in pregnant than in non-pregnant women. Pregnant women spent 92 min/24 h more on sitting, lying, reclining and sleeping (P=0.020), 73 min/24 h less on standing (P=0.037) and 21 min/24 h less on walking and using stairs (P=0.049), and walked at a slower pace (1.1 ± 0.1 m/s versus 1.2±0.1 m/s; P=0.014) than did non-pregnant controls. The selection of less demanding activities and slower walking pace decreased energy costs by 720 kJ/24 h and 80 kJ/24 h, respectively., Conclusion: Healthy moderately active Swedish women compensated for the increased energy costs of pregnancy by 0.9 MJ/24 h. The compensation was mainly achieved by selecting less demanding activities.

Aim: This study's aim was to increase knowledge about maternal and paternal self-rated health and body mass index in relation to lifestyle during early pregnancy., Methods: Study subjects were expectant parents visiting antenatal care (2006-07) as part of the Salut Programme in northern Sweden. During early pregnancy, 468 females and 413 male partners completed questionnaires. The questions addressed sociodemography, self-rated general health, weight and height, satisfaction with weight, and lifestyle, such as dietary habits, physical activity, sleeping pattern, and alcohol, tobacco, and drug use., Results: Most rated their general health as good, very good, or excellent, although women less often than men (88% and 93%). The sex difference was more prominent when restricting the comparison to self-rated health being very good or excellent--49% of the women compared to 61% of the men. Being overweight or obese was common (53% of the men and 30% of the women). Few participants fulfilled the national recommendations with respect to a health-enhancing lifestyle; this was somewhat more common for women than men. Expectant parents with normal body mass index and vigorous physical activity were more likely to have very good or excellent self-rated health., Conclusions: Most expectant parents perceived their general health as good, although this perception was less for women than men. Being overweight and having a non-health-enhancing lifestyle were more common for men than women. Thus, there is need for more powerful health-promoting interventions for expectant parents.

Objective: To evaluate the health-related quality of life effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care in acute or subacute low back pain patients., Study Design: A randomized, controlled trial during 10 weeks with four treatment groups., Setting: Nine primary health care and one outpatient orthopaedic hospital department., Subjects: One hundred and sixty patients with acute or subacute low back pain., Interventions: Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or 'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching, manual therapy and steroid injections (group 4)., Main Measures: The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score., Results: In a multivariate analysis adjusted for possible outcome affecting variables other than the treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in groups 1-4, respectively (P for trend <0.05). There were significant trends for the well-being components patience (P < 0.005), energy (P < 0.05), mood (P < 0.05) and family situation (P < 0.05). The remaining two components and Complaint score showed a non-significant trend towards improvement., Conclusion: The effects on health-related quality of life were greater the larger the number of treatment modalities available. The 'stay active' treatment group, with the most restricted number of modalities, had the most modest health-related quality of life improvement, while group 4 with the most generous choice of treatment modalities, had the greatest improvement.

Aim: The aim of this population-based study was to describe function in cerebral palsy (CP) in relation to neuroimaging., Method: Motor function, accompanying impairments, and neuroimaging (86 by magnetic resonance imaging, 74 by computed tomography) were studied in 186 children born in western Sweden between 1999 and 2002 (96 males, 90 females; age range at data collection 4-8 y). results: Forty per cent of the children had unilateral spastic CP, 39% bilateral, 16% dyskinetic CP, and 5% ataxia. Fifty-one per cent were in level I of the Gross Motor Function Classification System (GMFCS), 14% in level II, 3% in level III, 11% in level IV, and 22% level V. Forty per cent of the children were in level I of the Manual Ability Classification System 19% were in II, 9% at III, 8% in IV, and 24% in level V. Seventy-six per cent of the children with white-matter lesions were in GMFCS levels I and II, whereas 67% with basal ganglia lesions were in levels IV and V. Learning disability* (45%), epilepsy (44%), and visual impairment (17%) were most common in children with brain maldevelopment, and cortical/subcortical or basal ganglia lesions. Speech was impaired in 49% of the children, absent in 30%, and 6% had a neuropsychiatric diagnosis. Compared with children born between 1991 and 1998, the numbers of those in GMFCS level I increased (p=0.007), as did those with epilepsy (p=0.015)., Interpretation: Neuroimaging improves the understanding of the neuroanatomical basis for function in CP. Type and severity of motor impairment and accompanying impairments are related to the timing of lesions., (© The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.)

Aim: This study evaluates whether accelerometer-measured physical activity is related to higher composite risk factor scores for cardiovascular disease (CVD) in children., Methods: Cross-sectional study that included 223 children aged 7.9-11.1 years (boys n = 123, girls n = 100). Daily physical activity was assessed by accelerometers for 4 days. Body fat was quantified by dual X-ray absorptiometry. Maximal oxygen uptake was measured during a maximal exercise test. Resting heart rate and blood pressure were measured. Z-scores [(value for the individual - mean value for group)/SD] were calculated for each variable, and the sum of different risk factor z-scores used as an index of composite risk factors score for CVD., Results: Partial correlations, from General Linear Model, between moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA) and general physical activity versus index of composite risk factor score were in boys 0.29, 0.33 and 0.30 (all p < 0.05), respectively. The corresponding correlations in girls were -0.28, -0.32 (both p < 0.05) and -0.18 (NS), respectively., Conclusion: Low amounts of MVPA and VPA were related to higher composite risk factor scores for CVD in children aged 8-11 years., (© 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.)

Purpose: upper respiratory tract infection (URTI) is the most common reason for seeking primary care in many countries. Still, little is known about potential strategies to reduce susceptibility. We investigated the relationships between physical activity level, perceived stress, and incidence of self-reported URTI., Methods: we conducted a population-based prospective cohort study of 1509 Swedish men and women aged 20-60 yr with a follow-up period of 4 months. We used a Web-based questionnaire to assess disease status and lifestyle factors at the start of the study. We assessed physical activity and inactivity as total MET-hours (MET task) per day and perceived stress by the 14-item Perceived Stress Scale. Participants were contacted every 3 wk via e-mail to assess incidence of URTI. They reported a total of 1181 occurrences of URTI. We used Poisson regression models to control for age, sex, and other potential confounding factors., Results: we found that high levels of physical activity (≥ 55 MET·h·d) were associated with an 18% reduced risk (incidence rate ratio (IRR) = 0.82, 95% confidence interval (CI) = 0.69-0.98) of self-reporting URTI compared with low levels of physical activity (<45 MET·h·d). This association was stronger among those reporting high levels of stress (IRR = 0.58, 95% CI = 0.43-0.78), especially among men (IRR = 0.37, 95% CI = 0.24-0.59), but absent in the group with low levels of stress., Conclusions: we found that high physical activity was associated with a lower risk of contracting URTI for both men and women. In addition, we found that highly stressed people, particularly men, appear to benefit more from physical activity than those with lower stress levels.

Background: Route environments can positively influence people's active commuting and thereby contribute to public health. The Active Commuting Route Environment Scale (ACRES) was developed to study active commuters' perceptions of their route environments. However, bicycle commuters represent a small portion of the population in many cities and thus are difficult to study using population-based material. Therefore, the aim of this study is to expand the state of knowledge concerning the criterion-related validity of the ACRES and the representativity using an advertisement-recruited sample. Furthermore, by comparing commuting route environment profiles of inner urban and suburban areas, we provide a novel basis for understanding the relationship between environment and bikeability., Methods: Bicycle commuters from Greater Stockholm, Sweden, advertisement- (n = 1379) and street-recruited (n = 93), responded to the ACRES. Traffic planning and environmental experts from the Municipality of Stockholm (n = 24) responded to a modified version of the ACRES. The criterion-related validity assessments were based on whether or not differences between the inner urban and the suburban route environments, as indicated by the experts and by four existing objective measurements, were reflected by differences in perceptions of these environments. Comparisons of ratings between advertisement- and street-recruited participants were used for the assessments of representativity. Finally, ratings of inner urban and suburban route environments were used to evaluate commuting route environment profiles., Results: Differences in ratings of the inner urban and suburban route environments by the advertisement-recruited participants were in accord with the existing objective measurements and corresponded reasonably well with those of the experts. Overall, there was a reasonably good correspondence between the advertisement- and street-recruited participants' ratings. Distinct differences in commuting route environment profiles were noted between the inner urban and suburban areas. Suburban route environments were rated as safer and more stimulating for bicycle-commuting than the inner urban ones. In general, the findings applied to both men and women., Conclusions: The overall results show: considerable criterion-related validity of the ACRES; ratings of advertisement-recruited participants mirroring those of street-recruited participants; and a higher degree of bikeability in the suburban commuting route environments than in the inner urban ones.

Aims: The purpose was to describe the patterns of commuting to school in young people and to examine its associations with physical activity (PA) and cardiorespiratory fitness., Methods: The sample comprised 2271 Estonian and Swedish children and adolescents (1218 females) aged 9-10 years and 15-16 years. Data were collected in 1998/99. Mode of commuting to and from school was assessed by questionnaire. Time spent (min/day) in PA and average PA (counts/min) was measured by accelerometry. Cardiorespiratory fitness was assessed by means of a maximal cycle ergometer test., Results: Sixty-one percent of the participants reported active commuting to school (ACS). Estonian youth showed lower levels of ACS than Swedish (odds ratio, 0.64; 95% confidence interval, 0.53-0.76) and girls reported lower levels than boys (0.74; 0.62-0.88). ACS boys showed higher PA levels than non-ACS boys for moderate, vigorous, MVPA, and average PA levels (all p ≤ 0.01). Participants who cycled to school had higher cardiorespiratory fitness than walkers or passive travellers (p < 0.001)., Conclusions: Nearly two-thirds of the participants actively commuted to school. ACS may provide an opportunity to increase levels of daily PA, especially in boys, and cardiorespiratory fitness, especially if cycling. Public health strategies should develop and test ACS patterns to get more evidence and promote bike-friendly environments.

Background: To study the trends in cardiovascular risk factors in middle-aged city-dwelling Swedish women from 1980 to 2003., Methods: Using cross-sectional population-based surveys, five random population samples of a total of 1915 women aged between 45 and 54 years, participating in the BEDA study in 1980, WHO MONICA studies in 1985, 1990 and 1995, and a study of 50-year-old women in 2003 were measured for the following parameters: anthropometry, serum cholesterol and triglyceride levels, smoking habits, blood pressure, physical activity and stress., Results: Over almost 25 years, middle-aged women gained on average 4.4 kg in weight, with a net increase in body mass index (BMI) from 24.7 to 25.6 kg m⁻². The proportion of participants classified as obese (≥30 kg m⁻²) increased by 50% from 10.4% to 15.1%. Women who were smokers in 2003 did not have lower BMI values than nonsmokers. Mean serum cholesterol concentrations decreased markedly, whereas smoking habits did not significantly change. The prevalence of hypertension decreased by 8%, whereas that of diabetes remained stable at around 2%. Optimal risk factor status - no smoking, normotension and serum cholesterol <5 mmol l⁻¹ - was present in less than one in six women in 2003, and similar across BMI categories., Conclusion: The favourable decline in cholesterol levels and hypertension and the increase in leisure time physical activity were offset by an increase in obesity, triglyceride levels and experience of stress, with only a minority of participants (less than one in six) having an optimal level of risk factors with respect to smoking, serum cholesterol and hypertension in 2003. This applied also to overweight and obese women. In earlier cohorts, subjects with low BMI values were more often smokers, whereas the opposite is observed in recent cohorts. Thus, women who smoke no longer have the advantage of lower weight., (© 2010 The Association for the Publication of the Journal of Internal Medicine.)

Background: Refugee women have a high risk of coronary heart disease with low physical activity as one possible mediator. Furthermore, cultural and environmental barriers to increasing physical activity have been demonstrated. The aim of the study was to evaluate the combined effect of an approximate 6-month primary health care- and community-based exercise intervention versus an individual written prescription for exercise on objectively assessed cardiorespiratory fitness in low-active refugee women., Methods: A controlled clinical trial, named "Support for Increased Physical Activity", was executed among 243 refugee women recruited between November 2006 and April 2008 from two deprived geographic areas in southern Stockholm, Sweden. One geographic area provided the intervention group and the other area the control group. The control group was on a higher activity level at both baseline and follow-up, which was taken into consideration in the analysis by applying statistical models that accounted for this. Relative aerobic capacity and fitness level were assessed as the two main outcome measures., Results: The intervention group increased their relative aerobic capacity and the percentage with an acceptable fitness level (relative aerobic capacity > 23 O2 mlxkgxmin-1) to a greater extent than the control group between baseline and the 6-month follow-up, after adjusting for possible confounders (P = 0.020)., Conclusions: A combined primary health-care and community-based exercise programme (involving non-profit organizations) can be an effective strategy to increase cardiorespiratory fitness among low-active refugee women., Trial Registration: ClinicalTrials.gov ID: NCT00747942.

Background: Physical activity (PA) is part of a healthy lifestyle and prevents many chronic health problems, in addition to promoting mental health. PA performed outdoors has been found particularly good for promoting one's well-being. The aim of this study was to investigate the extent to which outdoor recreational PA was carried out during 1 year, and the factors influencing such activities from a gender perspective among persons >or= 60 years of age., Methods: This study included 999 individuals 60-96 years of age living in the south eastern part of Sweden. Data collection was carried out during the years of 2001-2003. We measured the amount of regular light and/or intense outdoor recreational PA performed during the last year and determined the probability of performing PA as a function of 10 variables covering individual and socioeconomic factors., Results: Our results suggest that being independent physically and healthy enough to manage one's personal hygiene and having access to areas for country walks were the most important factors associated with the probability of engaging in outdoor recreational PA for both men and women. Despite the level of performance being almost equal for the sexes as two-thirds of both had performed outdoor recreational PA during the preceding year more factors, i.e., living alone, being unable to cover an unexpected cost, fear of being violated, and fear of falling, were associated with the possibilities of engaging in outdoor recreational PA among women. Also increasing age seems to affect activities among women negatively to a higher extent than men., Conclusion: Men and women seem to have different opportunities and needs with respect to performing PA. These considerations do not seem to be sufficiently taken into account today and improvements could be made concerning e.g., health-promoting activities suggested to the elderly by healthcare personnel and spatial planning within society. Promoting outdoor recreational PA that has restorative effects on well-being needs to focus on activities which are attractive and affordable for the majority of both men and women.

Context: Blood levels of 25-hydroxyvitamin D [25(OH)D] is the generally accepted indicator of vitamin D status, but no universal reference level has been reached., Objective: The objective of the study was to determine the threshold at which low plasma 25(OH)D levels are associated with fractures in elderly men and clarify the importance of low levels on total fracture burden., Design and Participants: In the Uppsala Longitudinal Study of Adult Men, a population-based cohort (mean age, 71 yr, n = 1194), we examined the relationship between 25(OH)D and risk for fracture. Plasma 25(OH)D levels were measured with high-pressure liquid chromatography-mass spectrometry., Setting: The study was conducted in the municipality of Uppsala in Sweden, a country with a high fracture incidence., Main Outcome Measure: Time to fracture was measured., Results: During follow-up (median 11 yr), 309 of the participants (26%) sustained a fracture. 25(OH)D levels below 40 nmol/liter, which corresponded to the fifth percentile of 25(OH)D, were associated with a modestly increased risk for fracture, multivariable-adjusted hazard ratio 1.65 (95% confidence interval 1.09-2.49). No risk difference was detected above this level. Approximately 3% of the fractures were attributable to low 25(OH)D levels in this population., Conclusions: Vitamin D insufficiency is not a major cause of fractures in community-dwelling elderly men in Sweden. Despite the fact that cutaneous synthesis of previtamin D during the winter season is undetectable at this northern latitude of 60 degrees, only one in 20 had 25(OH)D levels below 40 nmol/liter, the threshold at which the risk for fracture started to increase. Genetic adaptations to limited UV light may be an explanation for our findings.

Summary: In a highly representative sample of young adult Swedish men (n = 2,384), we demonstrate that physical activity during childhood and adolescence was the strongest predictor of calcaneal bone mineral density (BMD), and that peak bone mass was reached at this site at the age of 18 years., Introduction: The purpose of the present study was to determine if physical activity during growth is associated with peak calcaneal BMD in a large, highly representative cohort of young Swedish men., Methods: In this study, 2,384 men, 18.3 +/- 0.3 (mean +/- SD) years old, were included from a population attending the mandatory tests for selection to compulsory military service in Sweden. BMD (g/cm(2)) of the calcaneus was measured using dual-energy X-ray absorptiometry. Training habits were investigated using a standardized questionnaire., Results: Regression analysis (with age, height, weight, smoking, and calcium intake as covariates) demonstrated that history of regular physical activity was the strongest predictor and could explain 10.1% of the variation in BMD (standardized beta = 0.31, p < 0.001). A regression model with quadratic age effect revealed maximum BMD at 18.4 years., Conclusions: We found that history of physical activity during growth was the strongest predictor of peak calcaneal BMD in young men.

The first Kavli Prize in Neuroscience recognizes a confluence of career achievements that together provide a fundamental understanding of how brain and spinal cord circuits are assembled during development and function in the adult. The members of the Kavli Neuroscience Prize Committee have decided to reward three scientists (Sten Grillner, Thomas Jessell, and Pasko Rakic) jointly "for discoveries on the developmental and functional logic of neuronal circuits". Pasko Rakic performed groundbreaking studies of the developing cerebral cortex, including the discovery of how radial glia guide the neuronal migration that establishes cortical layers and for the radial unit hypothesis and its implications for cortical connectivity and evolution. Thomas Jessell discovered molecular principles governing the specification and patterning of different neuron types and the development of their synaptic interconnection into sensorimotor circuits. Sten Grillner elucidated principles of network organization in the vertebrate locomotor central pattern generator, along with its command systems and sensory and higher order control. The discoveries of Rakic, Jessell and Grillner provide a framework for how neurons obtain their identities and ultimate locations, establish appropriate connections with each other, and how the resultant neuronal networks operate. Their work has significantly advanced our understanding of brain development and function and created new opportunities for the treatment of neurological disorders. Each has pioneered an important area of neuroscience research and left a legacy of exceptional scientific achievement, insight, communication, mentoring and leadership.

Background: Dizziness is a very common complaint. The frequency of dizziness increases with age. It affects quality of life negatively for older persons in several ways., Objectives: This study intended to investigate which variables (physical activity, loneliness, health complaints, need of help for daily living and falls) differed between those with and without dizziness and also to investigate which factors affected quality of life among older persons with dizziness., Method: An age-stratified, randomised sample of senior citizens - aged 75 or older - living in the south of Sweden (n = 4,360) answered a questionnaire concerning demographic data, social network, health complaints and diseases, feelings of loneliness, quality of life (Short Form 12), frequency of falls and activities., Results: Dizziness was associated with an increased risk of falling. Falls in the last 3 months were reported in 31% of the subjects with dizziness compared to 15% among those without (p < 0.001). Dizziness also correlated with depression, with 42.5% feeling depressed among the elderly reporting dizziness as compared with 13.2%. Exercise, both light (i.e. go for a walk) or heavy (i.e. work in the garden), correlated with reduced risk of low quality of life among older, dizzy persons, both mental (light exercise OR 0.58; heavy OR 0.48) and physical (light OR 0.62; heavy OR 0.21). The proportion of dizzy persons doing light exercise was 75.6% versus 87.4% among the not dizzy (p < 0.001). Exercise reduces the risk of falling and the risk of being depressed, and increases quality of life., Conclusion: Even light exercise seems beneficial both for improving quality of life and to decrease the risk of falling, which in turn will lower the mortality rate. Older persons reporting dizziness should be encouraged and perhaps helped to exercise. If one could increase physical activity among the elderly, it would reduce the number of falls, diminish medical costs, suffering for the individual, and be of paramount medicosocial importance for society.

Objective: To compare the effects of goal directed functional therapy (GDT) to activity focused therapy (AT) for preschool children with cerebral palsy (CP) on everyday activities and gross motor function. Another aim was to evaluate goal attainment in the GDT group., Methods: A prospective intervention study comparing two types of intervention carried out in ecological settings. Forty-four children with CP, (25 boys, 19 girls; mean age 4 year 1 month [SD 1 year 5 month]), Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels I-IV participated. Twenty-two children were recruited to the GDT group and 22 to the AT group. Outcome measures were the Pediatric Evaluation of Disability Inventory (PEDI), and the Gross Motor Function Measure-66. Furthermore, goal attainment scaling (GAS) was used in the GDT group. The assessments were performed before and after an intervention period of 12 weeks., Results: The children in the GDT group improved more in most aspects of everyday activities measured by the PEDI than the children in the AT group (p < 0.001). Only functional skills in social function did not differ between the groups. Furthermore, gross motor function improved more in the GDT group than in the AT group (p < 0.001). Goal attainment to the expected level or higher was achieved in 93/110 goals in the GDT group. The variance of improvements in the different PEDI scales in the GDT group could not be explained by either age, sex, distribution of CP, GMFCS or MACS levels., Conclusion: GDT demonstrated clear gains for children with cerebral palsy in everyday activities and gross motor function in comparison to AT.

Background: The aims of this study were (i) to investigate the potential influence of pre-pregnancy regular leisure-time physical activity (PA) on the risk of persistent LBPP half a year after pregnancy, and (ii) to explore the starting time and prevalence of PA among women experiencing LBPP during pregnancy, in relation to remission or persistent LBPP half a year after pregnancy., Methods: This study is a follow-up study of 639 women who reported LBPP during pregnancy. These women were sent a questionnaire at approximately six months after delivery. The respondents were divided into three groups: 'no pain', 'recurrent pain', and 'continuous pain'. Data were analysed using an independent samples t-test, Pearson's chi-squared test, and univariate and multivariate logistic regression analyses., Results: 44.5% of subjects reported current PA at six months post partum. The mean starting time of PA was 2.6 months post partum and the mean number of current, weekly events of PA was 3.4; there were no differences between the groups. 82.2% reported previous PA at some period in life. Women with BMI >/= 30 reported current PA to a lesser extent. The number of years of pre-pregnancy PA did not influence the risk of persistent LBPP., Conclusion: Almost half of women who had experienced LBPP during pregnancy reported PA at six months post partum. The number of years of pre-pregnancy PA did not influence the risk of persistent LBPP. Obesity was a risk factor for not practising PA.

Inverse association between physical activity and colon cancer is well established, at least in men. We investigated the association of occupational physical activity with subsite-specific colorectal cancer risk. On the basis of occupational titles from the Swedish nationwide censuses in 1960 and 1970, we defined a cohort of women and men with the same work-related physical demands in 1960 and 1970. Incidence of colon and rectum cancer during 1971-1989 was ascertained through linkages to the Cancer Register. Relative risks (RRs) were estimated through Poisson regression. The risk for colon cancer increased with decreasing occupational physical activity. RR among sedentary women and men was 1.2 and 1.3 (P for trend=0.08 and <0.001). For men, the risks for proximal and distal colon cancer increased by 20 and 40% (P for trend=0.005 and <0.001). Inactivity seemed to be particularly associated with descending colon cancer (RR =2.4, P for trend<0.001). In women, the inverse association with activity was concentrated to proximal parts of colon; RR for cancer in the proximal and transverse colon among sedentary women was 1.4 and 2.0 (P for trend <0.07 and <0.01). Cancer of the rectum was not associated with activity in either sex. We confirmed the well-known inverse relationship between activity and risk of colon cancer but not rectal cancer in both sexes. Data suggest that the physical activity-related variation in risk among women is greatest in the proximal and middle parts of the colon, whereas the corresponding peak in men seems to be more distal. Sex-specific anatomic and motility differences of the colon might contribute to this subsite difference.

Introduction: Strong evidence suggests a link between physical inactivity and chronic disease prevalence in the adult population. To target the right groups for interventions in a population, accurate assessment of physical activity is important. The objective of this study was to assess the levels and pattern of physical activity and inactivity in an adult population sample using an objective method., Methods: In total, 1114 adults (56% women, 45+/-15 yr), randomly recruited from the Swedish population across a year, used an accelerometer (Actigraph MTI) for seven consecutive days. Inactivity was defined as <100 counts per minute, and cutoff values for moderate and vigorous activity were 1952-5724 and >5724 counts per minute, respectively. Average intensity was measured as counts per minute., Results: The adults were active in at least moderate-intensity activity for a median (intraquartile range) of 31 (18-47) min.d(-1). Fifty-two percent accumulated 30 min.d(-1) of at least moderate-intensity physical activity. Only 1% achieved those 30 min from three or more bouts of at least 10 min. Average intensity, moderate and vigorous physical activity was lower with higher age or body mass index (BMI). Men spent more time than women in moderate and vigorous physical activity, but there was no gender difference in average intensity. The variation in inactivity could not be explained by gender, age, or BMI., Conclusion: Objectively obtained estimates of physical activity yielded lower values and a different activity pattern compared with those obtained by commonly used self-reports. This highlights the need to better understand the nature and measurement issues of health-enhancing physical activity of adults.

Background: High body mass index (BMI) and lack of physical activity have been recognized as important risk factors for coronary heart disease. The aim of the present study was to evaluate whether leisure-time physical activity compensates for the increased risk of acute myocardial infarction associated with overweight and obesity., Methods: Data from the SHEEP (Stockholm Heart Epidemiology Program) study were used. The SHEEP study is a large Swedish population-based case-control study, comprising 1204 male and 550 female cases, and 1538 male and 777 female controls, conducted in Stockholm County, Sweden, during the period 1992-1994. Odds ratios (OR), together with 95 % confidence intervals (95% CI), were calculated using unconditional logistic regression, as estimates of the relative risks., Results: Regular leisure-time physical activity was associated with a decreased risk of myocardial infarction among lean, normal-weight and overweight subjects, but not among obese subjects. Obese (BMI > or = 30) and physically active persons had an almost twofold risk of myocardial infarction, compared with normal-weight and sedentary persons (OR 1.85, 95% CI 1.07-3.18). The results were similar for men and women., Conclusion: While regular leisure-time physical activity seems to provide protection against myocardial infarction among lean, normal-weight and overweight subjects, this does not appear to be the case in obese subjects.

Improved methods for quantitative self-reports of total physical activity in epidemiological studies are needed. We evaluated randomly selected individuals' ability to integrate their perception of physical activity over time to produce an estimate of the "usual" level, using a novel instrument for self-quantification of energy expenditure. A population-based sample of 418 Swedish men and women, age 20-59, completed a questionnaire containing the new instrument. For validation, three 24 hour recalls by phone served as gold standard. Reproducibility was assessed through administering the instrument another three times. The validation involved 133 subjects and another 160 completed the reproducibility evaluation. Pearson correlation between usual daily energy expenditure measured by the instrument and the mean of the 24 hour recalls was 0.73. After subdividing the self-reported daily energy expenditure and the mean of the 24 hour recalls into quintiles, 83.5% of the participants remained in the same quintile, or one quintile apart. There was a tendency towards overestimation of usual daily physical activity. This was significantly associated with low education. Reproducibility showed an intraclass correlation of 0.55. Although integrated reports of usual daily energy expenditure over longer periods seem to be afflicted with a tendency of overestimation, total energy expenditure can be estimated with reasonable validity and reproducibility using our instrument.

Objective: To assess physical activity and energy expenditure and to identify their correlates during adolescence and early adulthood., Design: In a cohort study, total energy expenditure (TEE) and physical activity level (PAL) were assessed at 15 and 21 y from a 7-day activity diary and predicted BMR. The influences on TEE and PAL of body size, gender, sexual maturity, physical activity habits, sitting time, region, social conditions, employment, food habits, smoking and alcohol intake were examined in multivariate analyses., Subjects: 71 male and 89 female subjects, living in two socioeconomically different regions of Sweden, a university region and an industrial region., Setting: The university city of Uppsala and the industrial town of Trollhättan., Results: At both 15 and 21 y, PAL and TEE were high, with gender, sitting time and physical activity habits as main correlates. At age 21 y, employment and the mother's educational level also appeared as significant correlates. The relations between the main variables and their correlates were more complex than at age 15 y, and the sitting time was reduced and the activity habits were changed., Conclusions: A reduction of daily sitting appears to be a major reason why high levels of physical activity and energy expenditure were maintained from 15 to 21 y of age in spite of changed and less frequent activity habits during this interval.