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Nagel, G., Stafoggia, M., Pedersen, M., Andersen, Z. J., Galassi, C., Munkenast, J., . . . Weinmayr, G. (2018). Air pollution and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts for Air Pollution Effects (ESCAPE). International Journal of Cancer, 143(7), 1632-1643
Open this publication in new window or tab >>Air pollution and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts for Air Pollution Effects (ESCAPE)
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2018 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, no 7, p. 1632-1643Article in journal (Refereed) Published
Abstract [en]

Air pollution has been classified as carcinogenic to humans. However, to date little is known about the relevance for cancersof the stomach and upper aerodigestive tract (UADT). We investigated the association of long-term exposure to ambient airpollution with incidence of gastric and UADT cancer in 11 European cohorts. Air pollution exposure was assigned by land-useregression models for particulate matter (PM) below 10mm (PM10), below 2.5mm (PM2.5), between 2.5 and 10mm (PMcoarse),PM2.5absorbance and nitrogen oxides (NO2and NOX) as well as approximated by traffic indicators. Cox regression modelswith adjustment for potential confounders were used for cohort-specific analyses. Combined estimates were determined withrandom effects meta-analyses. During average follow-up of 14.1 years of 305,551 individuals, 744 incident cases of gastriccancer and 933 of UADT cancer occurred. The hazard ratio for an increase of 5mg/m3of PM2.5was 1.38 (95% CI 0.99; 1.92)for gastric and 1.05 (95% CI 0.62; 1.77) for UADT cancers. No associations were found for any of the other exposures consid-ered. Adjustment for additional confounders and restriction to study participants with stable addresses did not influencemarkedly the effect estimate for PM2.5and gastric cancer. Higher estimated risks of gastric cancer associated with PM2.5wasfound in men (HR 1.98 [1.30; 3.01]) as compared to women (HR 0.85 [0.5; 1.45]). This large multicentre cohort study showsan association between long-term exposure to PM2.5and gastric cancer, but not UADT cancers, suggesting that air pollutionmay contribute to gastric cancer risk.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
ESCAPE, air pollution, epidemiology, gastric cancer, upper aerodigestive tract cancer
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-147272 (URN)10.1002/ijc.31564 (DOI)000443392100009 ()29696642 (PubMedID)
Available from: 2018-05-02 Created: 2018-05-02 Last updated: 2018-11-05Bibliographically approved
Raza, W., Forsberg, B., Johansson, C. & Nilsson Sommar, J. (2018). Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling. Global Health Action, 11(1), Article ID 1429081.
Open this publication in new window or tab >>Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling
2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1429081Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Promotion of active commuting provides substantial health and environmental benefits by influencing air pollution, physical activity, accidents, and noise. However, studies evaluating intervention and policies on a mode shift from motorized transport to cycling have estimated health impacts with varying validity and precision.

OBJECTIVE: To review and discuss the estimation of air pollution exposure and its impacts in health impact assessment studies of a shift in transport from cars to bicycles in order to guide future assessments.

METHODS: A systematic database search of PubMed was done primarily for articles published from January 2000 to May 2016 according to PRISMA guidelines.

RESULTS: We identified 18 studies of health impact assessment of change in transport mode. Most studies investigated future hypothetical scenarios of increased cycling. The impact on the general population was estimated using a comparative risk assessment approach in the majority of these studies, whereas some used previously published cost estimates. Air pollution exposure during cycling was estimated based on the ventilation rate, the pollutant concentration, and the trip duration. Most studies employed exposure-response functions from studies comparing background levels of fine particles between cities to estimate the health impacts of local traffic emissions. The effect of air pollution associated with increased cycling contributed small health benefits for the general population, and also only slightly increased risks associated with fine particle exposure among those who shifted to cycling. However, studies calculating health impacts based on exposure-response functions for ozone, black carbon or nitrogen oxides found larger effects attributed to changes in air pollution exposure.

CONCLUSION: A large discrepancy between studies was observed due to different health impact assessment approaches, different assumptions for calculation of inhaled dose and different selection of dose-response functions. This kind of assessments would improve from more holistic approaches using more specific exposure-response functions.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Active commuting, mode shift, emission factors, population exposure, commuters’ exposure, exposure response function, comparative risk assessment
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-144660 (URN)10.1080/16549716.2018.1429081 (DOI)000424246900001 ()29400262 (PubMedID)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2018-06-09Bibliographically approved
Shirdel, M., Sommar, J. N., Andersson, B. M., Bergdahl, I. A., Wingfors, H. & Liljelind, I. E. (2018). Choosing the number of images and image position when analysing the UNC Passive Aerosol Sampler for occupational exposure assessment. Journal of Occupational and Environmental Hygiene, 15(11), 767-772
Open this publication in new window or tab >>Choosing the number of images and image position when analysing the UNC Passive Aerosol Sampler for occupational exposure assessment
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2018 (English)In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 15, no 11, p. 767-772Article in journal (Refereed) Published
Abstract [en]

The University of North Carolina passive aerosol sampler (UNC sampler) could be an alternative when measuring occupational dust exposure, but the time required for microscopic imaging of the sampler needs to be reduced to make it more attractive. The aims of this study were to 1) characterise the effect on precision when reducing imaging, in order to shorten analysis time and 2) assess if the position of the images makes a difference. Eighty-eight samplers were deployed in different locations of an open pit mine. Sixty images were captured for each UNC sampler, covering 51% of its collection surface, using scanning electron microscopy. Bootstrapped samples were generated with different image combinations, to assess the within-sampler coefficient of variation (CVws) for different numbers of images. In addition, the particle concentration relative to the distance from the centre of the sampler was studied. Reducing the number of images collected from the UNC sampler led to up to 8.3% CVws for ten images when calculating respirable fraction. As the overall CV has previously been assessed to 36%, the additional contribution becomes minimal, increasing the overall CV to 37%. The mean concentrations of the images were modestly related to distance from the centre of the sampler. The CVws changed from 8.26% to 8.13% for ten images when applying rules for the image collection based on distance. Thus, the benefit of these rules on the precision is small and the images can therefore be chosen at random. In conclusion, reducing the number of images analysed from 60 to 10, corresponding to a reduction of the imaged sampling area from 51% to 8.5%, results in a negligible loss in precision for respirable fraction dust measurements in occupational environments.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Dust particles, PM10, PM2.5, occupational hygienist, passive sampling, respirable fraction
National Category
Public Health, Global Health, Social Medicine and Epidemiology Environmental Sciences
Identifiers
urn:nbn:se:umu:diva-152114 (URN)10.1080/15459624.2018.1508875 (DOI)000451621900002 ()30111275 (PubMedID)
Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2018-12-19Bibliographically approved
Schantz, P., Wahlgren, L., Salier Eriksson, J., Nilsson Sommar, J. & Rosdahl, H. (2018). Estimating duration-distance relations in cycle commuting in the general population. PLoS ONE, 13(11), Article ID e0207573.
Open this publication in new window or tab >>Estimating duration-distance relations in cycle commuting in the general population
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207573Article in journal (Refereed) Published
Abstract [en]

It is important to estimate the duration-distance relation in cycle commuting in the general population since this enables analyses of the potential for various public health outcomes. Therefore, the aim is to estimate this relation in the Swedish adult population of 2015. For that purpose, the first step was to establishit for adult male and female cycle commuters in Greater Stockholm, Sweden. Whether or not the slopes of these relations needed to be altered in order to make them representative of the general population was evaluated by comparing the levels of maximal oxygen uptake in samples of commuter cyclists and the population. The measure used was the maximal oxygen uptake divided by both the body weight and a cycle weight of 18.5 kg. The body weights in the population samples were adjusted to mirror relevant levels in 2015. Age adjustments for the duration-distance relations were calculated on the basis of the maximal oxygen uptake in the population samples aged 20-65 years. The duration-distance relations of the cycle commuters were downscaled by about 24-28% to mirror levels in the general population. The empirical formula for the distance (D, km) was based on duration (T, minutes) · speed (km/min) · a correction factor from cycle commuter to the general population · age adjustment (A, years). For the males in the general population the formula was: D = T · 20.76 km/h · 0.719 · (1.676-0.0147 · A). For females, the formula was: D = T · 16.14 km/h · 0.763 · (1.604-0.0129 · A). These formulas, combined with distributions of route distances between home and work in the population, enable realistic evaluations of the potential for different public health outcomes through cycle commuting.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-153803 (URN)10.1371/journal.pone.0207573 (DOI)000450420900042 ()30444927 (PubMedID)2-s2.0-85056699840 (Scopus ID)
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2018-12-07Bibliographically approved
Andersson Kallin, S., Lindberg, E., Nilsson Sommar, J., Bossios, A., Ekerljung, L., Malinovschi, A., . . . Janson, C. (2018). Excessive daytime sleepiness in asthma: what are the risk factors?. Journal of Asthma, 55(18), 844-850
Open this publication in new window or tab >>Excessive daytime sleepiness in asthma: what are the risk factors?
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2018 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 18, p. 844-850Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics.

METHODS: Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16-75 years in four Swedish cities.

RESULTS: Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs 28.5%, p<0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10-4.84), chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53-2.62), current smoking (OR, 1.60; 95% CI, 1.15-2.22) and obesity (OR, 1.53; 95% CI, 1.09-2.13).

CONCLUSIONS: EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.

Place, publisher, year, edition, pages
Abingdon: Taylor & Francis, 2018
Keywords
asthma severity, chronic rhinosinusitis, insomnia, physical activity, rhinitis, smoking
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-132454 (URN)10.1080/02770903.2016.1263316 (DOI)000446112800004 ()27880055 (PubMedID)
Funder
Swedish Asthma and Allergy Association, 2008021Swedish Heart Lung Foundation, HLF20070500
Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-10-30Bibliographically approved
Svedmark, Å., Björklund, M., Häger, C. K., Nilsson Sommar, J. & Wahlström, J. (2018). Impact of workplace exposure and stress on neck pain and disabilities in women: a longitudinal follow-up after a rehabilitation intervention. Annals of Work exposure and Health, 62(5), 591-603
Open this publication in new window or tab >>Impact of workplace exposure and stress on neck pain and disabilities in women: a longitudinal follow-up after a rehabilitation intervention
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2018 (English)In: Annals of Work exposure and Health, ISSN 2398-7308, Vol. 62, no 5, p. 591-603Article in journal (Refereed) Published
Abstract [en]

Introduction: The aim was to evaluate if pain, disability, and work productivity are influenced by physical and psychosocial work exposures as well as by stress, up to 1 year after a randomized controlled trial treatment intervention, and to determine whether any such association differed between treatment and control groups.

Methods: Ninety-seven working women suffering non-specific neck pain (n = 67 treatment group, n = 30 control group) were followed from end of treatment intervention and at 9- and 15-month follow-ups, respectively. Physical and psychosocial exposures, as well as perceived stress, were assessed after the treatment intervention. Pain, neck disability, and work productivity were assessed at baseline, after intervention 3 months later and at 9- and 15-month follow-ups. Longitudinal assessment was conducted using the exposure level at 3 months as predictor of pain, disability, and work productivity at 3, 9, and 15 months, respectively. Mixed models were used to estimate longitudinal associations, accounting for within-individual correlation of repeated outcome measures by incorporation of a random intercept. Age and duration of neck pain were adjusted for in all models. To evaluate group differences, interactions between exposures and treatment groups were estimated.

Results: High perceived stress was associated with more neck pain, more neck disability, and decreased work productivity in both cross-sectional and longitudinal analyses. High ‘control of decision’ was associated with less neck pain, less neck disability, and higher work productivity in cross-sectional analyses but only to less disability and higher productivity in longitudinal analyses. Shoulder/arm load was the only physical exposure variable that was significantly associated with work productivity in the univariate analyses. Only small differences were observed between treatment and control groups.

Conclusion: High perceived stress and low ‘control of decision’ were associated with more neck pain, increased neck disability, and decreased work productivity. Treatment interventions for individuals with neck pain should take into account psychosocial workplace exposures and stress to improve intermediate and long-term results.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
non-specific neck pain, physiotherapy, shoulder pain, work productivity
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-139392 (URN)10.1093/annweh/wxy018 (DOI)000449420200007 ()29562318 (PubMedID)2-s2.0-85050676120 (Scopus ID)
Funder
AFA Insurance, 090288Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1403
Available from: 2017-09-11 Created: 2017-09-11 Last updated: 2018-11-26Bibliographically approved
Shirdel, M., Andersson, B. M., Bergdahl, I., Sommar, J. N., Wingfors, H. & Liljelind, I. E. (2018). Improving the UNC passive aerosol sampler model based on comparison with commonly used aerosol sampling methods. Annals of Work Exposures and Health, 62(3), 328-338
Open this publication in new window or tab >>Improving the UNC passive aerosol sampler model based on comparison with commonly used aerosol sampling methods
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2018 (English)In: Annals of Work Exposures and Health, ISSN 2398-7308, Vol. 62, no 3, p. 328-338Article in journal (Refereed) Published
Abstract [en]

Objectives: In an occupational environment, passive sampling could be an alternative to active sampling with pumps for sampling of dust. One passive sampler is the University of North Carolina passive aerosol sampler (UNC sampler). It is often analysed by microscopic imaging. Promising results have been shown for particles above 2.5 µm, but indicate large underestimations for PM2.5. The aim of this study was to evaluate, and possibly improve, the UNC sampler for stationary sampling in a working environment.

Methods: Sampling was carried out at 8-h intervals during 24 h in four locations in an open pit mine with UNC samplers, respirable cyclones, PM10 and PM2.5 impactors, and an aerodynamic particle sizer (APS). The wind was minimal. For quantification, two modifications of the UNC sampler analysis model, UNC sampler with hybrid model and UNC sampler with area factor, were compared with the original one, UNC sampler with mesh factor derived from wind tunnel experiments. The effect of increased resolution for the microscopic imaging was examined.

Results: Use of the area factor and a higher resolution eliminated the underestimation for PM10 and PM2.5. The model with area factor had the overall lowest deviation versus the impactor and the cyclone. The intraclass correlation (ICC) showed that the UNC sampler had a higher precision and better ability to distinguish between different exposure levels compared to the cyclone (ICC: 0.51 versus 0.24), but lower precision compared to the impactor (PM10: 0.79 versus 0.99; PM2.5: 0.30 versus 0.45). The particle size distributions as calculated from the different UNC sampler analysis models were visually compared with the distributions determined by APS. The distributions were obviously different when the UNC sampler with mesh factor was used but came to a reasonable agreement when the area factor was used.

Conclusions: High resolution combined with a factor based on area only, results in no underestimation of small particles compared to impactors and cyclones and a better agreement with the APS’s particle size distributions. The UNC sampler had lower precision than the impactors, but higher than the respirable cyclone. The UNC sampler with area factor could be used for PM2.5, PM10 and respirable fraction measurements in this working environment without wind.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
inorganic dust, mesh factor, PM10, PM2.5, respirable fraction, UNC passive aerosol sampler, working environment
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-145698 (URN)10.1093/annweh/wxx110 (DOI)000432804600008 ()29300818 (PubMedID)
Available from: 2018-03-14 Created: 2018-03-14 Last updated: 2018-06-26Bibliographically approved
Pedersen, M., Stafoggia, M., Weinmayr, G., Andersen, Z. J., Galassi, C., Sommar, J., . . . Raaschou-Nielsen, O. (2018). Is there an association between ambient air pollution and bladder cancer incidence?: Analysis of 15 European cohorts. European Urology Focus, 4(1), 113-120
Open this publication in new window or tab >>Is there an association between ambient air pollution and bladder cancer incidence?: Analysis of 15 European cohorts
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2018 (English)In: European Urology Focus, ISSN 1540-0085, E-ISSN 1788-618X, Vol. 4, no 1, p. 113-120Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of urinary bladder cancer (BC). Little is known about whether exposure to air pollution influences BC in the general population.

OBJECTIVE: To evaluate the association between long-term exposure to ambient air pollution and BC incidence.

DESIGN, SETTING, AND PARTICIPANTS: We obtained data from 15 population-based cohorts enrolled between 1985 and 2005 in eight European countries (N=303431; mean follow-up 14.1 yr). We estimated exposure to nitrogen oxides (NO2 and NOx), particulate matter (PM) with diameter <10μm (PM10), <2.5μm (PM2.5), between 2.5 and 10μm (PM2.5-10), PM2.5absorbance (soot), elemental constituents of PM, organic carbon, and traffic density at baseline home addresses using standardized land-use regression models from the European Study of Cohorts for Air Pollution Effects project.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and meta-analyses to estimate summary hazard ratios (HRs) for BC incidence.

RESULTS AND LIMITATIONS: During follow-up, 943 incident BC cases were diagnosed. In the meta-analysis, none of the exposures were associated with BC risk. The summary HRs associated with a 10-μg/m(3) increase in NO2 and 5-μg/m(3) increase in PM2.5 were 0.98 (95% confidence interval [CI] 0.89-1.08) and 0.86 (95% CI 0.63-1.18), respectively. Limitations include the lack of information about lifetime exposure.

CONCLUSIONS: There was no evidence of an association between exposure to outdoor air pollution levels at place of residence and risk of BC.

PATIENT SUMMARY: We assessed the link between outdoor air pollution at place of residence and bladder cancer using the largest study population to date and extensive assessment of exposure and comprehensive data on personal risk factors such as smoking. We found no association between the levels of outdoor air pollution at place of residence and bladder cancer risk.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Air pollution, Bladder cancer, Environment, Prevention
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-137924 (URN)10.1016/j.euf.2016.11.008 (DOI)28753823 (PubMedID)2-s2.0-85007499735 (Scopus ID)
Available from: 2017-07-31 Created: 2017-07-31 Last updated: 2018-11-16Bibliographically approved
Andersen, Z. J., Pedersen, M., Weinmayr, G., Stafoggia, M., Galassi, C., Jørgensen, J. T., . . . Raaschou-Nielsen, O. (2018). Long-term Exposure to Ambient Air Pollution and Incidence of Brain Tumor: the European Study of Cohorts for Air Pollution Effects (ESCAPE). Paper presented at Neuro Oncol. 2018 Feb 19;20(3):420-432. doi: 10.1093/neuonc/nox163.. Neuro-Oncology, 20(3), 420-432
Open this publication in new window or tab >>Long-term Exposure to Ambient Air Pollution and Incidence of Brain Tumor: the European Study of Cohorts for Air Pollution Effects (ESCAPE)
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2018 (English)In: Neuro-Oncology, ISSN 1522-8517, E-ISSN 1523-5866, Vol. 20, no 3, p. 420-432Article in journal (Refereed) Published
Abstract [en]

Background: Epidemiological evidence on the association between ambient air pollution and brain tumor risk is sparse and inconsistent.

Methods: In 12 cohorts from 6 European countries, individual estimates of annual mean air pollution levels at the baseline residence were estimated by standardized land-use regression models developed within the ESCAPE and TRANSPHORM projects: particulate matter (PM) ≤2.5, ≤10, and 2.5–10 μm in diameter (PM2.5, PM10, and PMcoarse), PM2.5 absorbance, nitrogen oxides (NO2 and NOx) and elemental composition of PM. We estimated cohort-specific associations of air pollutant concentrations and traffic intensity with total, malignant, and nonmalignant brain tumor, in separate Cox regression models, adjusting for risk factors, and pooled cohort-specific estimates using random-effects meta-analyses.

Results: Of 282194 subjects from 12 cohorts, 466 developed malignant brain tumors during 12 years of follow-up. Six of the cohorts also had data on nonmalignant brain tumor, where among 106786 subjects, 366 developed brain tumor: 176 nonmalignant and 190 malignant. We found a positive, statistically nonsignificant association between malignant brain tumor and PM2.5 absorbance (hazard ratio and 95% CI: 1.67; 0.89–3.14 per 10–5/m3), and weak positive or null associations with the other pollutants. Hazard ratio for PM2.5 absorbance (1.01; 0.38–2.71 per 10–5/m3) and all other pollutants were lower for nonmalignant than for malignant brain tumors.

Conclusion: We found suggestive evidence of an association between long-term exposure to PM2.5 absorbance indicating traffic-related air pollution and malignant brain tumors, and no association with overall or nonmalignant brain tumors.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
air pollution, brain cancer, brain tumor, traffic
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-140538 (URN)10.1093/neuonc/nox163 (DOI)000425492600015 ()29016987 (PubMedID)2-s2.0-85042325926 (Scopus ID)
Conference
Neuro Oncol. 2018 Feb 19;20(3):420-432. doi: 10.1093/neuonc/nox163.
Available from: 2017-10-13 Created: 2017-10-13 Last updated: 2018-06-15Bibliographically approved
Sondell, A., Rosendahl, E., Nilsson Sommar, J., Littbrand, H., Lundin-Olsson, L. & Lindelöf, N. (2018). Motivation to participate in high-intensity functional exercise compared with a social activity in older people with dementia in nursing homes. PLoS ONE, 13(11), Article ID e0206899.
Open this publication in new window or tab >>Motivation to participate in high-intensity functional exercise compared with a social activity in older people with dementia in nursing homes
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0206899Article in journal (Refereed) Published
Abstract [en]

Background: Motivation to participate in exercise among people with dementia has not been well studied. The symptoms of dementia, including apathy, may lead to low motivation to participate in exercise. The aim of this study was to evaluate the motivation of older people with dementia to participate in a high-intensity exercise program compared with motivation of those participating in a social group activity.

Methods: The Umeå Dementia and Exercise Study (UMDEX) was a cluster-randomized controlled intervention trial including 186 people (mean age; 85, 75% female) with dementia in nursing homes. Participants were randomized to participate in the High-Intensity Functional Exercise (HIFE) Program (n = 93) or a seated social group activity (n = 93). The activities were conducted in groups of 3–8 participants for 45 minutes, five times per two-week period, for 4 months (40 sessions in total). Participants’ motivation to go to and during activity sessions were assessed by the activity leaders and nursing homes staff using a five-point Likert scale. Data were analyzed using cumulative link mixed models.

Results: Motivation was high or very high during 61.0% of attended sessions in the exercise group and 62.6% in the social activity group. No overall significant difference between groups was observed, but motivation increased over time in the exercise group and decreased in the social activity group (p < 0.05). Motivation during the sessions was significantly higher than motivation to go to the sessions, especially in the exercise group [OR 2.39 (95% CI 2.38–2.40) and 1.50 (95% CI 1.32–1.70), respectively].

Conclusions: Among older people with dementia in nursing homes, motivation to participate in a high-intensity functional exercise program seems to be high, comparable to motivation to participate in a social activity, and increase over time. Since motivation during activity sessions was higher than motivation to go to sessions the promotion of strategies to encourage people with dementia to join exercise groups is of great importance.

National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-153346 (URN)10.1371/journal.pone.0206899 (DOI)000450138500071 ()30427894 (PubMedID)
Funder
Swedish Research Council, K2009-69P-21298-01-4Swedish Research Council, K2009-69X-21299-01-1Swedish Research Council, K2009-69P-21298-04-4Swedish Research Council, K2014-99X-22610-01-6Forte, Swedish Research Council for Health, Working Life and WelfareVårdal FoundationThe Dementia Association - The National Association for the Rights of the DementedVästerbotten County Council
Available from: 2018-11-16 Created: 2018-11-16 Last updated: 2018-12-19Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8854-498x

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