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Sagelv, E. H., Hopstock, L. A., Morseth, B., Hansen, B. H., Steene-Johannessen, J., Johansson, J., . . . Tarp, J. (2023). Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies. British Journal of Sports Medicine, 57(22), 1457-1463
Open this publication in new window or tab >>Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies
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2023 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 57, no 22, p. 1457-1463Article, review/survey (Refereed) Published
Abstract [en]

Objectives: To examine whether moderate-to-vigorous physical activity (MVPA) modifies the association between sedentary time and mortality and vice versa, and estimate the joint associations of MVPA and sedentary time on mortality risk.

Methods: This study involved individual participant data analysis of four prospective cohort studies (Norway, Sweden, USA, baseline: 2003-2016, 11 989 participants ≥50 years, 50.5% women) with hip-accelerometry-measured physical activity and sedentary time. Associations were examined using restricted cubic splines and fractional polynomials in Cox regressions adjusted for sex, education, body mass index, smoking, alcohol, study cohort, cardiovascular disease, cancer, and/or diabetes, accelerometry wear time and age.

Results: 6.7% (n=805) died during follow-up (median 5.2 years, IQR 4.2 years). More than 12 daily sedentary hours (reference 8 hours) was associated with mortality risk only among those accumulating <22 min of MVPA per day (HR 1.38, 95% CI 1.10 to 1.74). Higher MVPA levels were associated with lower mortality risk irrespective of sedentary time, for example, HR for 10 versus 0 daily min of MVPA was 0.85 (95% CI 0.74 to 0.96) in those accumulating <10.5 daily sedentary hours and 0.65 (95% CI 0.53 to 0.79) in those accumulating ≥10.5 daily sedentary hours. Joint association analyses confirmed that higher MVPA was superior to lower sedentary time in lowering mortality risk, for example, 10 versus 0 daily min of MVPA was associated with 28-55% lower mortality risk across the sedentary time spectrum (lowest risk, 10 daily sedentary hours: HR 0.45, 95% CI 0.31 to 0.65).

Conclusions: Sedentary time was associated with higher mortality risk but only in individuals accumulating less than 22 min of MVPA per day. Higher MVPA levels were associated with lower mortality risk irrespective of the amount of sedentary time.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
Epidemiology, Physical activity, Public health, Sedentary Behavior
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-217027 (URN)10.1136/bjsports-2022-106568 (DOI)001091230600001 ()37875329 (PubMedID)2-s2.0-85174460361 (Scopus ID)
Available from: 2023-11-23 Created: 2023-11-23 Last updated: 2023-11-27Bibliographically approved
Esquivel, K. M., Gillespie, J., Kelly, D., Condell, J., Davies, R., McHugh, C., . . . Nordström, A. (2023). Factors influencing continued wearable device use in older adult populations: quantitative study. JMIR Aging, 6, Article ID e36807.
Open this publication in new window or tab >>Factors influencing continued wearable device use in older adult populations: quantitative study
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2023 (English)In: JMIR Aging, E-ISSN 2561-7605, Vol. 6, article id e36807Article in journal (Refereed) Published
Abstract [en]

Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services.

Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device.

Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants’ intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device.

Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants’ age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (τ=0.34) and whether the device was fit for purpose (τ=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%.

Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies.

Place, publisher, year, edition, pages
JMIR Publications Inc., 2023
Keywords
mobile phone, older adults, remote sensing, sensor systems, usability, wearable device
National Category
Human Computer Interaction Gerontology, specialising in Medical and Health Sciences Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-205924 (URN)10.2196/36807 (DOI)000999614000009 ()36656636 (PubMedID)2-s2.0-85149909230 (Scopus ID)
Available from: 2023-03-27 Created: 2023-03-27 Last updated: 2023-09-05Bibliographically approved
Gentile, A., Ficarra, S., Thomas, E., Bianco, A. & Nordström, A. (2023). Nature through virtual reality as a stress-reduction tool: a systematic review. International Journal of Stress Management, 30(4), 341-353
Open this publication in new window or tab >>Nature through virtual reality as a stress-reduction tool: a systematic review
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2023 (English)In: International Journal of Stress Management, ISSN 1072-5245, E-ISSN 1573-3424, Vol. 30, no 4, p. 341-353Article, review/survey (Refereed) Published
Abstract [en]

The current systematic review aims to assess the acute stress-reduction effects of virtual reality (VR) natural environments. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, while the inclusion criteria were established through population, intervention, comparison, outcome, and study design (PICOS). The studies were included if (a) based on a nonclinical population; (b) compared the exposure to virtual nature through 360° images, biophilic elements, VR prerecorded videos, or immersive environments, excluding augmented reality; (c) objective (physiological parameters) or subjective (e.g., self-report questionnaires) measures were reported; (d) the reported measures contained quantitative outcomes; and (e) the records were published between 2010 and 2023. Four hundred nine studies were initially retrieved, 19 of which were finally included for synthesis. The eligible studies comprised a total of 1,168 participants. The quality assessment of the studies revealed a score of 10.1/15, indicating that studies were of overall "moderate quality." Heterogeneity among the type of natural environment, type of stress induction, and type of comparator (nonnatural environment) was retrieved. Differences were also present regarding either the physiological or psychological variables analyzed. The exposure to natural environments through VR seemingly reduces objective and subjective stress levels. The presence of (a) natural sounds, (b) natural lighting, and (c) water elements seem to be key elements that help VR users reducing stress.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2023
Keywords
head-mounted display, natural landscape, relaxation, stress recovery
National Category
Applied Psychology Other Health Sciences
Identifiers
urn:nbn:se:umu:diva-214509 (URN)10.1037/str0000300 (DOI)001023501400001 ()2-s2.0-85170207117 (Scopus ID)
Available from: 2023-09-26 Created: 2023-09-26 Last updated: 2024-01-11Bibliographically approved
Paluch, A. E., Bajpai, S., Ballin, M., Bassett, D. R., Buford, T. W., Carnethon, M. R., . . . Fulton, J. E. (2023). Prospective association of daily steps with cardiovascular disease: a harmonized meta-analysis. Circulation, 147(2), 122-131
Open this publication in new window or tab >>Prospective association of daily steps with cardiovascular disease: a harmonized meta-analysis
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2023 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 147, no 2, p. 122-131Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Taking fewer than the widely promoted "10 000 steps per day" has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose-response relationship between steps per day and CVD can help inform clinical and public health guidelines.

METHODS: Eight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance-weighted random effects models.

RESULTS: The mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, <60 years of age). For older adults, the HR for quartile 2 was 0.80 (95% CI, 0.69 to 0.93), 0.62 for quartile 3 (95% CI, 0.52 to 0.74), and 0.51 for quartile 4 (95% CI, 0.41 to 0.63) compared with the lowest quartile. For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46 to 1.35), 0.90 for quartile 3 (95% CI, 0.64 to 1.25), and 0.95 for quartile 4 (95% CI, 0.61 to 1.48) compared with the lowest quartile. Restricted cubic splines demonstrated a nonlinear association whereby more steps were associated with decreased risk of CVD among older adults.

CONCLUSIONS: For older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician-patient communication and population health to reduce the risk of CVD.

Keywords
cardiovascular disease, exercise, public health, risk reduction behavior
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-203550 (URN)10.1161/CIRCULATIONAHA.122.061288 (DOI)000918503500006 ()36537288 (PubMedID)2-s2.0-85145966261 (Scopus ID)
Funder
NIH (National Institutes of Health)Novo NordiskSwedish Research Council, 2016-02589
Available from: 2023-01-19 Created: 2023-01-19 Last updated: 2023-09-05Bibliographically approved
Nordström, P., Ballin, M. & Nordström, A. (2023). Safety and effectiveness of monovalent COVID-19 mRNA vaccination and risk factors for hospitalisation caused by the omicron variant in 0.8 million adolescents: a nationwide cohort study in Sweden. PLoS Medicine, 20(2), Article ID e1004127.
Open this publication in new window or tab >>Safety and effectiveness of monovalent COVID-19 mRNA vaccination and risk factors for hospitalisation caused by the omicron variant in 0.8 million adolescents: a nationwide cohort study in Sweden
2023 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 20, no 2, article id e1004127Article in journal (Refereed) Published
Abstract [en]

Background: Real-world evidence on the safety and effectiveness of Coronavirus Disease 2019 (COVID-19) vaccination against severe disease caused by the omicron variant among adolescents is sparse. In addition, evidence on risk factors for severe COVID-19 disease, and whether vaccination is similarly effective in such risk groups, is unclear. The aim of the present study was therefore to examine the safety and effectiveness of monovalent COVID-19 mRNA vaccination against COVID-19 hospitalisation, and risk factors for COVID-19 hospitalisation in adolescents.

Methods and findings: A cohort study was conducted using Swedish nationwide registers. The safety analysis included all individuals in Sweden born between 2003 and 2009 (aged 11.3 to 19.2 years) given at least 1 dose of monovalent mRNA vaccine (N = 645,355), and never vaccinated controls (N = 186,918). The outcomes included all-cause hospitalisation and 30 selected diagnoses until 5 June 2022. The vaccine effectiveness (VE) against COVID-19 hospitalisation, and risk factors for hospitalisation, were evaluated in adolescents given 2 doses of monovalent mRNA vaccine (N = 501,945), as compared to never vaccinated controls (N = 157,979), for up to 5 months follow-up during an omicron predominant period (1 January 2022 to 5 June 2022). Analyses were adjusted for age, sex, baseline date, and whether the individual was born in Sweden. The safety analysis showed that vaccination was associated with 16% lower (95% confidence interval (CI) [12, 19], p < 0.001) risk of all-cause hospitalisation, and with marginal differences between the groups regarding the 30 selected diagnoses. In the VE analysis, there were 21 cases (0.004%) of COVID-19 hospitalisation among 2-dose recipients and 26 cases (0.016%) among controls, resulting in a VE of 76% (95% CI [57, 87], p < 0.001). Predominant risk factors for COVID-19 hospitalisation included previous infections (bacterial infection, tonsillitis, and pneumonia) (odds ratio [OR]: 14.3, 95% CI [7.7, 26.6], p < 0.001), and cerebral palsy/development disorders (OR: 12.7, 95% CI [6.8, 23.8], p < 0.001), with similar estimates of VE in these subgroups as in the total cohort. The number needed to vaccinate with 2 doses to prevent 1 case of COVID-19 hospitalisation was 8,147 in the total cohort and 1,007 in those with previous infections or developmental disorders. None of the individuals hospitalised due to COVID-19 died within 30 days. Limitations of this study include the observational design and the possibility of unmeasured confounding.

Conclusions: In this nationwide study of Swedish adolescents, monovalent COVID-19 mRNA vaccination was not associated with an increased risk of any serious adverse events resulting in hospitalisation. Vaccination with 2 doses was associated with a lower risk of COVID-19 hospitalisation during an omicron predominant period, also among those with certain predisposing conditions who should be prioritised for vaccination. However, COVID-19 hospitalisation in the general population of adolescents was extremely rare, and additional doses in this population may not be warranted at this stage.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology General Practice
Identifiers
urn:nbn:se:umu:diva-205727 (URN)10.1371/journal.pmed.1004127 (DOI)000989141600001 ()36802397 (PubMedID)2-s2.0-85149482318 (Scopus ID)
Available from: 2023-03-17 Created: 2023-03-17 Last updated: 2023-09-05Bibliographically approved
Mikkilä, S., Johansson, J., Nordström, A., Nordström, P., Emaus, N., Handegård, B. H., . . . Welde, B. (2022). A 15-year follow-up study of hip bone mineral density and associations with leisure time physical activity: the Tromsø Study 2001-2016. PLOS ONE, 17, Article ID e0262228.
Open this publication in new window or tab >>A 15-year follow-up study of hip bone mineral density and associations with leisure time physical activity: the Tromsø Study 2001-2016
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2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, article id e0262228Article in journal (Refereed) Published
Abstract [en]

Aims: The aim was to investigate the long-term association between leisure time physical activity and hip areal bone mineral density (aBMD), in addition to change in hip aBMD over time, in 32-86 years old women and men.

Methods: Data were retrieved from the 2001, 2007-2008, and 2015-2016 surveys of the Tromsø Study, a longitudinal population study in Norway. Leisure time physical activity was assessed by the four-level Saltin-Grimby Physical Activity Level Scale which refers to physical exertion in the past twelve months. Hip aBMD was assessed by Dual-Energy X-ray Absorptiometry. Linear Mixed Model analysis was used to examine long-term associations between physical activity and hip aBMD (n = 6324). In addition, the annual change in hip aBMD was analyzed in a subsample of 3199 participants.

Results: Physical activity was significantly and positively associated with total hip aBMD in the overall cohort (p<0.005). Participants who reported vigorous activity had 28.20 mg/cm2 higher aBMD than those who were inactive (95% CI 14.71; 41.69, controlled for confounders), and even light physical activity was associated with higher aBMD than inactivity (8.32 mg/cm2, 95% CI 4.89; 11.76). Associations between physical activity and femoral neck aBMD yielded similar results. Hip aBMD decreased with age in both sexes, although more prominently in women. From 2001 to 2007-2008, aBMD changed by -5.76 mg/cm2 per year (95% CI - 6.08; -5.44) in women, and -2.31 mg/cm2 (95% CI -2.69; -1.93), in men. From 2007-2008 to 2015-2016, the change was -4.45 mg/cm2 per year (95% CI -4.84; -4.06) in women, and -1.45 mg/cm2 (95% CI -1.92; -0.98) in men.

Conclusions: In this cohort of adult men and women, physical activity levels were positively associated with hip aBMD in a dose-response relationship. Hip aBMD decreased with age, although more pronounced in women than men. Copyright:

Place, publisher, year, edition, pages
Public Library of Science, 2022
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-192159 (URN)10.1371/journal.pone.0262228 (DOI)000829607600025 ()2-s2.0-85123552826 (Scopus ID)
Available from: 2022-02-04 Created: 2022-02-04 Last updated: 2023-09-05Bibliographically approved
Paluch, A. E., Bajpai, S., Bassett, D. R., Carnethon, M. R., Ekelund, U., Evenson, K. R., . . . Fulton, J. E. (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. The Lancet Public Health, 7(3), e219-e228
Open this publication in new window or tab >>Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts
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2022 (English)In: The Lancet Public Health, ISSN 2468-2667, Vol. 7, no 3, p. e219-e228Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.

METHODS: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.

FINDINGS: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]).

INTERPRETATION: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.

FUNDING: US Centers for Disease Control and Prevention.

Place, publisher, year, edition, pages
Elsevier, 2022
National Category
Health Sciences
Identifiers
urn:nbn:se:umu:diva-195542 (URN)10.1016/S2468-2667(21)00302-9 (DOI)000765912700011 ()35247352 (PubMedID)2-s2.0-85125451203 (Scopus ID)
Funder
NIH (National Institute of Health)
Available from: 2022-05-30 Created: 2022-05-30 Last updated: 2023-09-05Bibliographically approved
Nordström, P., Ballin, M. & Nordström, A. (2022). Effectiveness of a fourth dose of mRNA COVID-19 vaccine against all-cause mortality in long-term care facility residents and in the oldest old: a nationwide, retrospective cohort study in Sweden. The Lancet Regional Health: Europe, 21, Article ID 100466.
Open this publication in new window or tab >>Effectiveness of a fourth dose of mRNA COVID-19 vaccine against all-cause mortality in long-term care facility residents and in the oldest old: a nationwide, retrospective cohort study in Sweden
2022 (English)In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 21, article id 100466Article in journal (Refereed) Published
Abstract [en]

Background: The effect of a fourth dose of COVID-19 vaccine on the risk of death in the oldest and frailest individuals is unknown.

Methods: Two matched cohorts were formed using Swedish nationwide registers. In the first, residents of long-term care facilities (LTCFs) given a fourth dose of an mRNA vaccine from 1 January 2022 onwards were matched 1:1 on birth year and county of residence to residents given at least a third dose (N = 24,524). In the second, all individuals aged ≥80 years given a fourth dose were matched 1:1 to individuals given at least a third dose (N = 394,104). Cox regression models were used to estimate hazard ratios for all-cause mortality in fourth-dose recipients as compared with in third-dose recipients, with relative vaccine effectiveness (VE) estimated as 1 minus the hazard ratio.

Findings: From 7 days after baseline and onwards, there were 1119 deaths in the LTCF cohort during a median follow-up of 77 days and a maximum follow-up of 126 days. During days 7 to 60, the VE of the fourth dose was 39% (95% CI, 29-48), which declined to 27% (95% CI, -2-48) during days 61 to 126. In the cohort of all individuals aged ≥80 years, there were 5753 deaths during a median follow-up of 73 days and a maximum follow-up of 143 days. During days 7 to 60, the VE of the fourth dose was 71% (95% CI, 69-72), which declined to 54% (95% CI, 48-60) during days 61 to 143. The VE of the fourth dose seemed stronger when it was compared to third-dose recipients where at least four months had passed since vaccination (P < 0·001 for interaction).

Interpretation: As compared with a third dose, a fourth dose of an mRNA COVID-19 vaccine, administered during the Omicron era, was associated with reduced risk of death from all causes in residents of LTCFs and in the oldest old during the first two months, after which the protection became slightly lower. These findings suggest that a fourth dose may prevent premature mortality in the oldest and frailest even after the emergence of the Omicron variant, although the timing of vaccination seems to be important with respect to the slight waning observed after two months.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
COVID-19, Nursing home residents, Vaccination
National Category
Immunology in the medical area Public Health, Global Health, Social Medicine and Epidemiology Geriatrics
Identifiers
urn:nbn:se:umu:diva-199556 (URN)10.1016/j.lanepe.2022.100466 (DOI)000880780100001 ()35855494 (PubMedID)2-s2.0-85138253770 (Scopus ID)
Available from: 2022-09-20 Created: 2022-09-20 Last updated: 2022-12-29Bibliographically approved
Vikberg, S., Björk, S., Nordström, A., Nordström, P. & Hult, A. (2022). Feasibility of an Online Delivered, Home-Based Resistance Training Program for Older Adults: A Mixed Methods Approach. Frontiers in Psychology, 13, Article ID 869573.
Open this publication in new window or tab >>Feasibility of an Online Delivered, Home-Based Resistance Training Program for Older Adults: A Mixed Methods Approach
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2022 (English)In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 13, article id 869573Article in journal (Refereed) Published
Abstract [en]

Background: Physical inactivity and low muscle mass are risk factors for falls, fractures and overall poor health. However, physical activity is reduced with increased age and only a fraction of older adults engages in resistance training (RT). Thus, strategies that facilitate RT among older adults are needed. The aim of the present study was to evaluate the effectiveness and user experience, and explore barriers and motivators toward an online delivered, home-based RT program in older adults with low muscle mass.

Methods: Thirty men and women, 70–71 years of age with low muscle mass were assigned home-based RT with online exercise videos (3 times/week, 45 min/session for 10 weeks) accompanied with an initial supervised try-out session. Quantitative outcome measures included changes in lean body mass and physical function. Semi structured one-to-one interviews with a subset of the participants (n = 8) were also conducted to generate a greater understanding of the participants experience of the digitally supported RT. The material was transcribed and analyzed with qualitative content analysis.

Results: Twenty-seven participants (90%) completed the trial. Lean body mass increased by 0.39 kg (95% CI: 0.06–0.72, p < 0.05) and chair stand time improved by 1.6 s (95% CI: 0.8–2.3, p < 0.001). No significant improvements were seen for balance or gait speed. The theme “Engaging in Digital Resistance Training with Personal Adaptation Leads to a Sense of Strength and Vitality” captured the participants experience of the intervention, where a sense of how the body was changing toward a more active lifestyle was described. Instructions, feedback, and intrinsic motivation were identified as key elements for compliance. 

Conclusion: The online delivered RT program for older adults with low muscle mass was feasible based on high compliance, user satisfaction, increased lean mass and improved chair-stand time. The participant experiences may explain the high compliance to the intervention and effects on outcomes. Based on these results, online delivered RT could be an accessible exercise routine for older adults with low muscle mass. More research is needed to verify the present findings and assess changes in a long-term perspective.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
ageing, e-health, elderly, functional strength, home-based exercise, motivation, online training, sarcopenia
National Category
Sport and Fitness Sciences Geriatrics
Identifiers
urn:nbn:se:umu:diva-198041 (URN)10.3389/fpsyg.2022.869573 (DOI)000816009700001 ()35726270 (PubMedID)2-s2.0-85133348400 (Scopus ID)
Funder
Umeå University, IH 5.3–4-2019
Available from: 2022-07-15 Created: 2022-07-15 Last updated: 2022-07-15Bibliographically approved
Ficarra, S., Thomas, E., Bianco, A., Gentile, A., Thaller, P., Grassadonio, F., . . . Hofmann, H. (2022). Impact of exercise interventions on physical fitness in breast cancer patients and survivors: a systematic review. Breast Cancer, 29, 402-418
Open this publication in new window or tab >>Impact of exercise interventions on physical fitness in breast cancer patients and survivors: a systematic review
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2022 (English)In: Breast Cancer, ISSN 1340-6868, E-ISSN 1880-4233, Vol. 29, p. 402-418Article, review/survey (Refereed) Published
Abstract [en]

Background: This systematic review aims to identify the effects of exercise interventions in patients with breast cancer (BCP) and survivors (BCS) on selected variables of physical fitness.

Methods: A comprehensive literature search was conducted using Medline and Scopus. Randomized controlled trials with isolated exercise interventions in BCP and BCS women (< 5 years from therapy completion) were included. The risk of bias (RoB) assessment was conducted using the Cochrane RoB-2-tool. Variables regarding cardiorespiratory fitness (CRF), strength (ST), fatigue (F) and health-related quality of life (HRQoL) were discussed.

Results: Of the 336 studies initially identified, 22 met all the inclusion criteria and were deemed eligible. RoB assessment indicated that the studies had predominantly “some concerns” or had “low RoB”, with only 3 studies presenting a “high RoB”. The mean duration and frequency of exercise interventions were 19 weeks and 3 sessions/week, performed at moderate intensity (65% VO2max and 66% 1RM, for aerobic and resistance-training interventions, respectively).

Conclusions: Exercise interventions seem to be a valuable strategy in BCP to avoid the decline of CRF, ST, F and HRQoL. Conversely, improved physical function among BCS is observed for the same variables. Resistance training and combined interventions seem to provide the most encouraging variations of the selected outcomes.

PROSPERO registration ID: CRD42021237917.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Breast neoplasm, Fatigue, Physical activity, Quality of life, Strength
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-193230 (URN)10.1007/s12282-022-01347-z (DOI)000767905500002 ()35278203 (PubMedID)2-s2.0-85126143203 (Scopus ID)
Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2022-07-12Bibliographically approved
Projects
BONE STRUCTURE, MUSCLE STRENGTH, GENETIC FACTORS AND THE RISK OF FRACTURES IN WOMEN AND IN MEN [2011-03094_VR]; Umeå UniversityBone structure, muscle strength, genetic factors and the risk of fractures in women and in men [2012-02522_VR]; Umeå UniversityBone structure, muscle strength, genetic factors and the risk of fractures in women and in men [2012-07113_VR]; Umeå UniversityEffects of zoledronic acid after a fragility fracture [2020-00448_VR]; Uppsala University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3534-456X

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