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INTRODUCTION: There is an ongoing debate about the impact of endurance exercise on cardiovascular health. Not at least data on cardiac biomarker changes (e.g. troponin T (cTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and cardiac specific myosin heavy chain-alpha (MHC-α) have raised questions about exercise related cardiac injury. METHODS: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after a full Ironman distance triathlon (Swim 3.9 km, Bike 180 km, Run 42.2 km) . In 19 of these athletes (9 female, 10 male) echocardiography with 30 different standard measurements was performed before and directly after the race. RESULTS: Only MHC-α [µg/L] showed a two-peaked increase directly after (2.57 ± 0.78) and on day 4 (2.74 ± 0.55). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). No significant echocardiographic changes were recorded. E.g. left ventricular end diastolic diameter (49.0 ± 4.7 mm before, 47.7 ± 5.0 mm after the race, right ventricular end diastolic diameter (34.3 ± 4.3 mm before, 33.3 ± 5.7 mm after the race), right atrial area (17.5 ± 2.9 cm2 before, 17.7 ± 3.6 cm2 after the race) and left atrial area (18.8 ± 3.7 cm2 before, 17.8 ± 2.2 cm2 after the race) did not show any significant acute changes. CONCLUSION: While an Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT after the race was in the range of myocardial infarction in 100% of women and 97% of men, these alterations were not correlated to any acute echocardiographi

INTRODUCTION: Ironman competitions and other extreme endurance events has spread worldwide attracting thousands of endurance-trained athletes, athletes who differ in anthropometric and training characteristics. The relationship between peak oxygen uptake and finishing- and segment time during a full distance IRONMAN competition (Swim 3.9km, Bike 180km and Run 42.2km) has not been examined thoroughly in non-elite athletes. PURPOSE: The aim of the present study was to investigate the relationship between peak oxygen uptake (VO2peak), finishing time and segment time in non-elite athletes. METHODS: 39 non-elite athletes (10 female; age 41.1 ± 9.7, range 24-70 years) performed a 20 m shuttle run test to assess VO2peak. Association between VO2 and finishing- and segment time was estimated using bivariate correlation tests. Gender specific analysis was also performed. RESULTS: VO2peak peak was on average 49.9 ± 6.4 O2 ml/kg/minute, range 36.5-63.9 (pooled genders). Finishing time was on average 11h and 52 min. The average times for the different segments were; Swim 1h 21m, Bike 5h 46min and Run 4h 33min. The relationship between VO2peak and finishing time was significant to p<0.001 and 0.51. The relationship between segment times were Swim 0.19, Bike 0.37 and Run 0.46 all at p<0.001. Gender specific analyses revealed that the association between VO2peak and finishing time was 0.80 for females and 0.49 for males. CONCLUSION: Our results suggest that VO2peak is a good predictor of finishing time (approx. 50%) as well as for segment time with 19%, 37% and 46% for Swim, Bike and Run respectively (pooled genders). For females VO2peak explains as much as 80% of the variation in finishing time., IRON(WO)MAN

INTRODUCTION: IntroductionPhysical exercise has been proven beneficial for health in all ages. In elderly, physical exercise, may contribute to prolonged life with maintained high quality and less costs associated with health care for society. In this study we explore if exercise out of doors may provide extra benefits as compared to exercise indoors and we measure power output, lactate levels and perceived effort in 49 senior citizens performing 20 minutes of moderate physical activity.METHODS:MethodThe HERO project is a randomized cross-over experiment with three different treatments . The study sample consisted of 49 healthy senior citizens. They performed 20 minutes moderate intensity physical activity on an ergometer bike in all three conditions. Before immediately after and at minutes 10, 20, 30, 60 and 120 we sampled blood lactate. Power output was computed at 7 occasions during the 20 minutes of cycling, as was the rating of perceived exertion . Data was analyzed using mixed linear models. RESULTS:ResultsOur findings show that there were no differences between the two indoor treatments in any of the measured variables. In the outdoor treatment, however, there were significant effects on blood lactate levels and power output but not in perceived exertion, suggesting that exercise out of doors makes the test person more efficient although the experience of effort stay unaffected.CONCLUSION:Discussion/conclusionsOur results support the notion that the outdoors may provide extraordinary conditions for exercise, not only because it appear to results in more exercise/effort, the outdoors is also an “arena” with high availability and most often totally for free. Previous results from the HERO project also suggests that white blood cell counts are affected by the outdoor treatment, something that may be related to the observed increased power output herein

Brain-derived neurotrophic factor (BDNF) has a central role in brain plasticity by mediating changes in cortical thickness and synaptic density in response to physical activity and environmental enrichment. Previous studies suggest that physical exercise can augment BDNF levels, both in serum and the brain, but no other study has examined how different types of activities compare with physical exercise in their ability to affect BDNF levels. By using a balanced cross over experimental design, we exposed nineteen healthy older adults to 35-minute sessions of physical exercise, cognitive training, and mindfulness practice, and compared the resulting changes in mature BDNF levels between the three activities. We show that a single bout of physical exercise has significantly larger impact on serum BDNF levels than either cognitive training or mindfulness practice in the same persons. This is the first study on immediate BDNF effects of physical activity in older healthy humans and also the first study to demonstrate an association between serum BDNF responsivity to acute physical exercise and working memory function. We conclude that the BDNF increase we found after physical exercise more probably has a peripheral than a central origin, but that the association between post-intervention BDNF levels and cognitive function could have implications for BDNF responsivity in serum as a potential marker of cognitive health., SAGE

Background: There is an ongoing debate about the significance of cardiac troponin T (cTnT) elevation after strenuous exercise: heart muscle cell death versus physiologic mechanism of release through an intact cell membrane. While cTnT is a small molecule (37 kDa), cardiac specific myosin heavy chain-alpha (MHC-α) is much larger (224 kDa) and an increase after exercise could hardly be explained by passage through an intact cardiac cell membrane. PURPOSE: To measure MHC-α, and other biomarkers (C-reactive protein (CRP); cTnT, creatine kinase (CK), myoglobin (MG), creatinine (C), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) before and after a full distance Ironman in order to answer the question of heart muscle cell death versus physiologic changes. Methods: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after the race. MHC-α was measured with a commercially available ELISA with no cross reactivity with other myosins. Results: The course of MHC-α concentration [µg/L] was 1.33 ± 0.53 (before), 2.57 ± 0.78 (directly after), 1.51 ± 0.53 (day 1), 2.74 ± 0.55 (day 4) and 1.83 ± 0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). There was a significant correlation between MHC-α and NT-proBNP (R=0.48; p<0.001) but neither between MHC-α and cTnT (R=0.13; p=0.36) nor MHC-α and myoglobin (R=0.18; p=0.2). Conclusion: An Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT was in the range of myocardial infarction in 100% of women

To investigate (1) the amount of self-reported time spent sedentary among a large cohort of persons with rheumatoid arthritis (RA), and (2) the contribution of sedentary time to explain perceived health and activity limitation in RA beyond that of previously known correlates. This cross-sectional study used data from a postal questionnaire and the Swedish Rheumatology Quality registers (SRQ). The International Physical Activity Questionnaire was used to assess sedentary time (sitting) and moderate, vigorous and walking activity (MVPA). Sociodemographics, pain, fatigue, fear-avoidance beliefs, anxiety/depression, disease duration, MVPA and sedentary time were included in multiple regression models with perceived health (Visual Analogue Scale 0-100) and activity limitation (Stanford Health Assessment Questionnaire) as dependent variables. RESULTS: In all 3152 (59%) of 5391 persons identified as eligible from the SRQ, responded to the questionnaire. 2819 individuals with complete data on all study variables were analysed. Mean time (SD) spent sedentary was 257 (213) minutes per day. Sedentary time did not contribute significantly to explain perceived health and only minimally to explain activity limitation. Instead, variation was mainly explained by pain; for perceived health (Beta = 0.780, p < 0.001) and for activity limitation (Beta = 0.445, p < 0.001).The results indicate a non-significant role of sedentary time and a need for increased focus on pain in the management of RA. Future studies should use prospective designs and objective assessment methods to further investigate the associations between sedentary time and health outcomes in persons with R

Introduction Natural environments are known to promote health and may also provide extraordinary conditions for post exercise recovery (Kuo 2015). In the project Health Effects of Recreation Outdoors (HERO) we explore the hypothesis that post exercise recovery in natural environments may be reflected in white blood cell counts (WBC). In our study 50 seniors (age >65 years) performed moderate physical activity (20 min) followed by passive recovery (2h) in three different environments (indoors, simulated outdoors and “true” outdoors). Method The experimental setup was a randomized cross-over design, thus all test persons did all treatments in a randomized order. We sampled white blood cells (WBC-diff), which were used to detect and quantify inflammatory response. Results Our early findings provide some support for the hypothesis that environment may impose differences in recovery effectiveness. White blood cell count (WBC-diff) appears to differ between the treatments and there is a significant interaction between sampling time and recovery environment in the monocytes, suggesting that the monocyte numbers differ, not only between sampling times but also between environments. In addition, WBC also show that some of the test persons develop leukocytosis during exercise and that white blood cell levels decrease rapidly immediately post exercise to levels significantly lower than base line values. Discussion Our results suggest that moderate physical activity in senior citizens may result in acute leukocytosis (see e.g. Sand et. al. 2013) and that recovery effectiveness (e.g in monocyte response) may be dependent upon environmental factors. The clinical importance of our results are not fully understood but there has been suggested an “open window” immediately post exercise in which infection risk may be elevated (Pedersen & Toft 2000) and it is possible that recovery out of doors may reduce this risk. References Sand, K., L, Flatebo, K., Andersen, M., B., Maghaza, Project funded by:The Kamprad Family Foundation for Entrepreneurship, Research and Charityref no 20132082, HERO

Strenuous and prolonged exercise like marathon, ultra running and triathlon can lead to changes in biomarkers of cardiac, muscle and kidney functional damage. We present the data of 29 (15 male, 14 female) non-elite participants of the Kalmar Ironman 2015 3.8 km swimming, 180 km cycling, 42 km running). Pre-race electrocardiograms and echocardiograms showed a high frequency of abnormalities. Post race elevations of troponin T, creatine kinase, myoglobin, N-terminal pro b-type natriuretic peptide, aspartataminotransferas, creatinine and leucocytes returned to normal in almost all cases within 5-8 days. In 100% of male and 93% of female participants’ troponin T increase was compatible with the diagnosis of minor myocardial infarction. Some results are shown in the table (* denotes level of significance between male and female results). Before race Directly after race 5-8 days after race CK [µkat/L] male 3.7 ± 2.1** 48,1 ± 44.1 4.5 ± 4.0 female 1.5 ± 0.7 30.5 ± 41.5 3.1 ± 3.6 Myoglobin [µg/L] male 58.3 ± 35.9 2449 ± 1923 51.3 ± 38.5 female 30.6 ± 11.0 1134 ± 756* 50.4 ± 67.7 Creatinine [µmol/L] male 87.4 ± 11.4 119.9 ± 23.4 85.1 ± 12.1 female 73.0 ± 13.4 84.1 ± 14.1*** 69.6 ± 6.3 p-NT-proBNP [ng/L] male 60.1 ± 25.2 658.7 ± 354.9 61.9 ± 22.7 female 95.5 ± 69.5 907.9 ± 433.1 76.9 ± 26.9 Troponin T [ng/L] male 8.5 ± 4.3 68.1 ± 41.1 7.4 ± 4.4 female

Biochemical changes after strenuous exercise - data from the Kalmar Ironman Strenuous and prolonged exercise like marathon, ultra running and triathlon can lead to changes in biomarkers of cardiac, muscle and kidney functional damage. We present the data of 30 (15 men, 15 women) participants of the Kalmar Ironman 2015. Pre-race electrocardiograms and echocardiograms showed a high frequency of abnormalities. Post race elevations of troponin T, creatine kinase, myoglobin, N-terminal prohormone of brain natriuretic peptide, and creatinine returned to normal in almost all cases within 5-8 days. In all but one participant the troponin T pattern was compatible with the diagnosis of myocardial infarction. It is an up-to-date unanswered question whether the increase of troponin represents myocardial damage or just is a benign consequence of an intermittent change of the permeability of myocardial cell membranes., Intensiv uthållighetsidrott som maratonlöpning och triatlon påverkar alla organsystem, och akuta förändringar har visats inte minst för hjärt- och njurfunktion. Vi rapporterar data från 30 deltagare i Kalmar Ironman (15 män, 15 kvinnor) som undersökts med EKG, ekokardiografi och blodprov. Akuta stegringar av hjärt-, muskel- och njurvärden var mycket vanliga. Samtliga deltagare förutom en uppvisade direkt efter tävlingen troponin T-värden som skulle vara förenliga med diagnosen hjärtinfarkt. Det är oklart om troponinläckaget står för en hjärtmuskelskada eller om det är en godartad konsekvens av en tillfällig ändring av permeabiliteten av hjärtmuskelcellerna.

This article analyses older adults’ trajectories leading to membership in a gym, and the ways in which they negotiate their self-understanding, aging, and health in this context. Emanating from an ethnographic study, the arguments are based on a constructionist approach. The results show that older adults’ decision to start going to a gym should be understood in relation to an individualized health care system in Swedish society and as a means of negotiating deteriorating health, retirement, lost body capacity, and the meaning of becoming old. The physical activities carried out and the social relationships developed in these contexts are used to construct an empowered self-understanding prepared to challenge the “stiffness” of the dying body.

Considering that adults spend a considerable proportion of their day at work, employment is a key determinant for daily PA. However, specifics of how and under what circumstances occupational PA (OPA) influences total PA, including other PA domains (e.g. leisure time PA, transport), are unclear. Little is also known about OPA patterns in different occupational groups and how OPA patterns can be changed, among for example those who have mostly sedentary occupations. One important issue concerns if working in a standing position and the use of dynamic chairs has any effect on OPA levels, for instance among office workers. This despite the fact that ergonomists advocate sedentary workers to work in a standing position or use an “active sitting” approach using “dynamic” chairs. To be able to give recommendations regarding PA to employees with different OPA, more insight is needed on how to optimally measure OPA. To move the field forward, knowledge should be combined from different disciplines involved in measuring OPA. Therefore, we want to initiate an interdisciplinary discussion on appropriate measurements of OPA. The aim of the symposium is to present a holistic approach to measuring OPA by combining our expertise in the field of PA and health, measurement of PA using objective measures and self-reported measures, ergonomics, occupational health and public health science.

OBJECTIVE: To describe and identify the explanatory factors of variation in current and maintained health-enhancing physical activity (HEPA) in persons with rheumatoid arthritis (RA). METHODS: In this cross-sectional study, current HEPA was assessed with the International Physical Activity Questionnaire and maintained HEPA with the Exercise Stage Assessment Instrument, the latter explicitly focusing on both aerobic physical activity and muscle strength training. Sociodemographic, disease-related, and psychosocial data were retrieved from the Swedish Rheumatology Quality (SRQ) registers and a postal questionnaire. The explained variations in the respective HEPA behaviors were analyzed with logistic regression. RESULTS: In all, 3,152 (58.5%) of 5,391 persons identified as eligible from the SRQ registers responded to the questionnaire. Current HEPA was reported by 69%, and maintained HEPA by 11% of the respondents. The most salient and consistent factors explaining variation in both current and maintained HEPA were self-efficacy, social support, and outcome expectations related to physical activity. CONCLUSION: To our knowledge, this is the first study exploring maintained physical activity in a large well-defined sample of persons with RA. Our results indicate that a minority perform maintained HEPA, including both aerobic physical activity and muscle strength training, and that psychosocial factors are the most salient and consistent in the explanation of HEPA variation.

Background: Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA. Methods: A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5 +/- 12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U. S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country. Results: A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e. g., U. S. disprop

BACKGROUND: The relevance of physical activity (PA) for combating cardiovascular disease (CVD) risk in children has been highlighted, but to date there has been no large-scale study analyzing that association in children aged ≤9 years of age. This study sought to evaluate the associations between objectively-measured PA and clustered CVD risk factors in a large sample of European children, and to provide evidence for gender-specific recommendations of PA. METHODS: Cross-sectional data from a longitudinal study in 16,224 children aged 2 to 9 were collected. Of these, 3,120 (1,016 between 2 to 6 years, 2,104 between 6 to 9 years) had sufficient data for inclusion in the current analyses. Two different age-specific and gender-specific clustered CVD risk scores associated with PA were determined. First, a CVD risk factor (CRF) continuous score was computed using the following variables: systolic blood pressure (SBP), total triglycerides (TG), total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-c) ratio, homeostasis model assessment of insulin resistance (HOMA-IR), and sum of two skinfolds (score CRFs). Secondly, another CVD risk score was obtained for older children containing the score CRFs + the cardiorespiratory fitness variable (termed score CRFs + fit). Data used in the current analysis were derived from the IDEFICS ('Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS') study. RESULTS: In boys <6 years, the odds ratios (OR) for CVD risk were elevated in the least active quintile of PA (OR: 2.58) compared with the most active quintile as well as the second quintile for vigorous PA (OR: 2.91). Compared with the most active quintile, older children in the first, second and third quintiles had OR for CVD risk score CRFs + fit ranging from OR 2.69 to 5.40 in boys, and from OR 2.85 to 7.05 in girls. CONCLUSIONS: PA is important to protect against clustering of CVD risk factors in young children, being mo

BACKGROUND: Different types of devices are available and the choice about which to use depends on various factors: cost, physical characteristics, performance, and the validity and intra- and interinstrument reliability. Given the large number of studies that have used uniaxial or triaxial devices, it is of interest to know whether the different devices give similar information about PA levels and patterns. The aim of this study was to compare physical activity (PA) levels and patterns obtained simultaneously by triaxial accelerometry and uniaxial accelerometry in adolescents in free-living conditions. METHODS: Sixty-two participants, aged 13-16 years, were recruited in this ancillary study, which is a part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA). All participants wore a uniaxial accelerometer (ActiGraph GT1M®, Pensacola, FL) and a triaxial accelerometer (RT3®, Stayhealthy, Monrovia, CA) simultaneously for 7 days. The patterns were calculated by converting accelerometer data output as a percentage of time spent at sedentary, light, moderate, and vigorous PA per day. Analysis of output data from the two accelerometers were assessed by two different tests: Equivalence Test and Bland & Altman method. RESULTS: The concordance correlation coefficient between the data from the triaxial accelerometer and uniaxial accelerometer at each intensity level was superior to 0.95. The ANOVA test showed a significant difference for the first three lower intensities while no significant difference was found for vigorous intensity. The difference between data obtained with the triaxial accelerometer and the uniaxial monitor never exceeded 2.1% and decreased as PA level increased. The Bland & Altman method showed good agreement between data obtained between the both accelerometers (p < 0.05). CONCLUSIONS: Uniaxial and triaxial accelerometers do not differ in their measurement of PA in population studies, and either could be used in such studie

BACKGROUND: Since stress is hypothesized to play a role in the etiology of obesity during adolescence, research on associations between adolescent stress and obesity-related parameters and behaviours is essential. Due to lack of a well-established recent stress checklist for use in European adolescents, the study investigated the reliability and validity of the Adolescent Stress Questionnaire (ASQ) for assessing perceived stress in European adolescents. METHODS: The ASQ was translated into the languages of the participating cities (Ghent, Stockholm, Vienna, Zaragoza, Pecs and Athens) and was implemented within the HELENA cross-sectional study. A total of 1140 European adolescents provided a valid ASQ, comprising 10 component scales, used for internal reliability (Cronbach alpha) and construct validity (confirmatory factor analysis or CFA). Contributions of socio-demographic (gender, age, pubertal stage, socio-economic status) characteristics to the ASQ score variances were investigated. Two-hundred adolescents also provided valid saliva samples for cortisol analysis to compare with the ASQ scores (criterion validity). Test-retest reliability was investigated using two ASQ assessments from 37 adolescents. RESULTS: Cronbach alpha-values of the ASQ scales (0.57 to 0.88) demonstrated a moderate internal reliability of the ASQ, and intraclass correlation coefficients (0.45 to 0.84) established an insufficient test-retest reliability of the ASQ. The adolescents' gender (girls had higher stress scores than boys) and pubertal stage (those in a post-pubertal development had higher stress scores than others) significantly contributed to the variance in ASQ scores, while their age and socio-economic status did not. CFA results showed that the original scale construct fitted moderately with the data in our European adolescent population. Only in boys, four out of 10 ASQ scale scores were a significant positive predictor for baseline wake-up salivary cortisol, suggesting a rathe

The aim of this study was to examine the interrater reliability (trained vs. untrained raters) and criterion-related validity (manual vs. automatic timing) of the 4 x 10-m shuttle run and 30-m running speed tests (times measured). The study comprised 85 adolescents (38 girls) aged 13.0-16.9 years from the Healthy Lifestyle in Europe by Nutrition in Adolescence study. The time required to complete the 4 x 10-m shuttle run and 30-m running tests was simultaneously measured (a) manually with a stopwatch by both trained and untrained raters (for interrater reliability analysis), and (b) by using photoelectric cells (for validity analysis). Systematic error, random error, and heteroscedasticity were studied with repeated-measured analysis of variance and Bland-Altman plots. The systematic error for untrained vs. trained raters and the untrained raters vs. photoelectric cells were in all cases approximately 0.1 seconds (p < 0.01), that is, untrained raters recorded higher times. No systematic error was found between trained raters and photoelectric cells (p > 0.05). No heteroscedasticity was shown in any case (p > 0.05). The findings indicate that manual measurements by a trained rater, using a stopwatch, seem to be a valid method to assess speed and agility fitness testing in adolescents. Researchers must be trained to minimize the measurement error.

BACKGROUND: Large-scale policy and environmental changes, such as congestion road taxes, may be a way to promote active transportation. PURPOSE: This study aimed to examine the potential effect of a congestion road tax on physical activity. METHODS: Baseline data were collected during October-November 2003, follow-up data in May 2006, and analysis was performed in September 2008. The short self-administered version of the International Physical Activity Questionnaire was used to assess physical activity. Data from those with access to motorized vehicles in the Stockholm region (n=165), where the tax was in place, were compared with those from the Goteborg/Malmo regions (n=138). Within each region before and during the road tax implementation, the data were analyzed for differences in time spent at different intensity levels of physical activity, in addition to sitting, as well as for changes in reported time in overall (weighted) physical activity. RESULTS: There were no significant differences in the magnitude of the changes of the intensity levels of physical activity, weighted overall physical activity, or sitting, between Stockholm and Goteborg/Malmo. Among those exposed to the congestion road tax and with access to motorized vehicles, an increase in moderate physical activity (p=0.036); overall physical activity (p=0.015); and a reduction in time spent sitting (p=0.009) was observed. No differences were observed among those unexposed. CONCLUSIONS: The results from this study on the influence of a congestion road tax on levels of physical activity, though inconclusive, suggest that policy changes such as a congestion road tax might promote improvements in physical activity levels in individuals with motorized vehicles.

BACKGROUND: A physically active lifestyle is beneficial for good health. Despite this, it seems that many people are not sufficiently active. Attempts to promote the population levels of physical activity have not been successful. This has led researchers to find new ways to tackle the problem. Ecological models place more emphasis on the physical environment s potential influence on physical activity behaviour than other behavioural models do, but a greater understanding of the effect of the environment on physical activity is needed. AIMS: This thesis examined; 1) adherence to the current physical activity guidelines in Sweden and how different sociodemographic factors influence the adherence, 2) the test-retest reliability of an instrument aimed at assessing the perception of the neighbourhood environment, 3) the association between neighbourhood environmental factors and Health Enhancing Physical Activity (HEPA), and 4) the effect of a major environmental change on population levels of physical activity. METHODS: During 2003, a nationally representative sample of Swedish adults completed the International Physical Activity Questionnaire (IPAQ) to which questions related to sociodemographic factors and the neighbourhood environment had been added. This was repeated in 2006 while a trial of a congestion road tax was ongoing in Stockholm. RESULTS: Overall, 63 % of the Swedish adults adhered to the physical activity recommendations. Large differences between sociodemographic groups were observed. The environmental module showed good test-retest reliability, with intra-class correlations ranging from 0.36 regarding questions of a subjective nature to 0.98 for questions of an objective nature, with minor differences in reliability seen between the genders. Walking was positively associated with the degree of urbanisation while HEPA was negatively associated with it. Those living in Stockholm during the congestion road tax increased their physical activity at moderate

Background Understanding environmental correlates of physical activity can inform policy changes. Surveys were conducted in 11 countries using the same self-report environmental variables and the International Physical Activity Questionnaire, allowing analyses with pooled data. Methods The participating countries were Belgium, Brazil, Canada, Colombia, China (Hong Kong), Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S., with a combined sample of 11,541 adults living in cities. Samples were reasonably representative, and seasons of data collection were comparable. Participants indicated whether seven environmental attributes were present in their neighborhood. Outcomes were measures of whether health-related guidelines for physical activity were met. Data were collected in 2002–2003 and analyzed in 2007. Logistic regression analyses evaluated associations of physical activity with environmental attributes, adjusted for age, gender, and clustering within country. Results Five of seven environmental variables were significantly related to meeting physical activity guidelines, ranging from access to low-cost recreation facilities (OR=1.16) to sidewalks on most streets (OR=1.47). A graded association was observed, with the most activity–supportive neighborhoods having 100% higher rates of sufficient physical activity compared to those with no supportive attributes. Conclusions Results suggest neighborhoods built to support physical activity have a strong potential to contribute to increased physical activity. Designing neighborhoods to support physical activity can now be defined as an international public health issue.

Background This study examines the relationship of neighbourhood environment factors with walking and total health enhancing physical activity. Methods A population-based cross-sectional study. The short self-administered version of the validated International Physical Activity Questionnaire (IPAQ) was used to assess health enhancing physical activity including walking. The neighbourhood environment was assessed using a 17-item environmental module. A principal component analysis among the environmental variables was conducted. The factor scores were divided into tertiles and independent associations between factor tertiles and physical activity categories and walking were studied by multinomial logistic regression with adjustment for confounders. Results In adjusted models, a lower odds ratio (OR) for reaching the middle, OR: 0.66 (95% Confidence Interval (CI): 0.47–0.98), and upper, OR: 0.65 (0.45–0.95), tertile of walking was observed among those in the lowest tertile of the degree of urbanisation. A higher OR for reaching the middle, OR: 1.84 (1.28–1.64), and upper tertile, OR: 1.64 (1.14–2.36), of walking was observed among those in the lowest tertile of fear of crime. A higher OR for reaching the high category of total health enhancing physical activity was observed among those in the lowest, OR: 2.01 (1.32–3.05), and middle tertile, OR: 1.52 (1.02–2.25), of the factor degree of urbanisation. Conclusion The findings suggest that the environment is differentially related to walking and total health enhancing physical activity. This should be explored in future research to disentangle the complex relationship between different levels and aspects of physical activity and their relationship with the environment.