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Sandberg, Camilla
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Publications (10 of 26) Show all publications
Larsson, L., Johansson, B., Wadell, K., Thilen, U. & Sandberg, C. (2019). Adults with congenital heart disease overestimate their physical activity level. IJC Heart & Vasculature, 22, 13-17
Open this publication in new window or tab >>Adults with congenital heart disease overestimate their physical activity level
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2019 (English)In: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, p. 13-17Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity reduces the risk of acquired cardiovascular disease, which is of great importance in patients with congenital heart disease (CHD). There are diverging data whether physical activity level (PAL) differs between patients with CHD and controls. Furthermore, it is unknown if PAL can be reliably assessed in patients with CHD using self-reported instruments.

Methods: Seventy-five patients with CHD (mean age 37.5 ± 15.5 years, women n = 29 [38.7%]) and 42 age and sex matched controls completed the International Physical Activity Questionnaire (IPAQ) and carried the activity monitor Actiheart over 4 days. Time spent at ≥3 METS ≥21.4 min/day, i.e. reaching the WHO recommendation for PAL to promote health, was used as the outcome measure. Data on PAL obtained from IPAQ were compared with Actiheart.

Results: The proportion of individuals reaching target PAL according to IPAQ was similar in patients with CHD and controls (70.7%vs.76.2%, p = 0.52) as well as between patients with simple and complex lesions. There was an overall difference between IPAQ and Actiheart in detecting recommended PAL (72.6%vs.51.3%, p b 0.001). In a subgroup analysis, this difference was also detected in patients but was borderline for controls. The negative predictive value for IPAQ in detecting insufficient PAL was higher in patients than in controls (73%vs.40%).

Conclusions: The proportion of persons reaching sufficient PAL to promote health was similar in patients and controls. The self-reported instrument overestimated PAL in relation to objective measurements. However, with a high negative predictive value, IPAQ is a potentially useful tool for detecting patients with insufficient PAL.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Adult congenital heart disease, Physical activity level, IPAQ, Actiheart
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-158111 (URN)10.1016/j.ijcha.2018.11.005 (DOI)000462184100003 ()30480085 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, 20150579Västerbotten County Council
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Larsson, L., Rinnström, D., Sandberg, C., Högström, G., Thilen, U., Nordström, P. & Johansson, B. (2019). Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects. International Journal of Cardiology, 280, 57-60
Open this publication in new window or tab >>Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 280, p. 57-60Article in journal (Refereed) Published
Abstract [en]

Background: Atrial septal defect (ASD) is a congenital heart lesion that often remains undiagnosed until adulthood. The reasons for this may be multifactorial. It is, however, known that closure of a hemodynamically significant ASD improves exercise capacity. This study aimed to explore whether the aerobic capacity in late adolescence is associated with time to diagnosis and intervention in adult men with late diagnosis of an atrial shunt.

Methods: The Swedish Military Conscription Service Register contains data on exercise tests performed in late adolescence. By linking these data with the National Patient Register, 254 men with a later intervention for an ASD were identified.

Results: Interventions were performed at a mean of 26.5 +/- 7.9 years after the initial exercise tests. The mean absolute workload among those with a later diagnosed ASD was similar to those without a later diagnosed ASD (274 +/- 51W vs. 276 +/- 52 W, p = 0.49). Men with a higher exercise capacity (>= 1 SD) had their intervention earlier (21.9 +/- 8.6 years vs. 27.5 +/- 7.4 years, p < 0.001).

Conclusions: The aerobic exercise capacity was similar in adolescent men with later interventions for ASD compared to the reference population. Furthermore, those with high exercise capacity appeared to be diagnosed earlier. Thus, low exercise capacity may not be a feature of ASD during adolescence, but rather develop later in life as a natural progression of the disease.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Congenital heart disease, Atrial septal defect
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-156856 (URN)10.1016/j.ijcard.2018.12.073 (DOI)000458491600013 ()30651192 (PubMedID)
Available from: 2019-03-13 Created: 2019-03-13 Last updated: 2019-03-13Bibliographically approved
Nordin, F., Nyberg, A. & Sandberg, C. (2019). Concurrent validity of a fixated hand-held dynamometer for measuring isometric knee extension strength in adults with congenital heart disease. European Journal of Physiotherapy, 1-6
Open this publication in new window or tab >>Concurrent validity of a fixated hand-held dynamometer for measuring isometric knee extension strength in adults with congenital heart disease
2019 (English)In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, p. 1-6Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: The purpose of this study was to examine the concurrent validity of a fixated hand-held dynamometer (HHD) in comparison to a load cell in measurement of maximal isometric knee extension force in adults with congenital heart disease (CHD) and healthy adults.

Methods: Fourteen adults with CHD and fourteen healthy adults were included. Each participant was tested three times with each method and the mean of the top two results for each participant and method was used in analysis.

Results: The agreement between the two methods was excellent in both groups (intraclass correlation coefficient [ICC], 95% confidence interval [CI]) 0.98 (0.92–1.00) in the CHD group and ICC 0.99 (0.96–1.00) in the healthy group). There was a small difference of 19.5 Newton or 4.8% (p<.05) between the two methods in the CHD group. No significant difference was seen between the two methods in the healthy group (p>.05).

Conclusions: The fixated HHD demonstrated excellent concurrent validity when compared to a load cell among adults with CHD as well as in healthy adults. Thus, in a healthy population the methods can be used interchangeably, however, a small difference between the methods is seen in the CHD group.

National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-159245 (URN)10.1080/21679169.2019.1573920 (DOI)
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-05-27
Gonzalez, M., Sjölin, I., Bäck, M., Ögmundsdottir Michelsen, H., Tanha, T., Sandberg, C., . . . Leosdottir, M. (2019). Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients: study protocol for a multi-center randomized controlled trial. Trials, 20, Article ID 76.
Open this publication in new window or tab >>Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients: study protocol for a multi-center randomized controlled trial
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2019 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 20, article id 76Article in journal (Refereed) Published
Abstract [en]

Background: Cardiac rehabilitation (CR) programs addressing risk factor management, educational interventions, and exercise contribute to reduce mortality after myocardial infarction (MI). However, the fulfillment of guideline-recommended CR targets is currently unsatisfactory. eHealth, i.e., the use of electronic communication for healthcare, including the use of mobile smartphone applications combined with different sensors and interactive computerized programs, offers a new array of possibilities to provide clinical care. The present study aims to assess the efficacy of a web-based application (app) designed to support persons in adhering to lifestyle advice and medication as a complement to traditional CR programs for improvement of risk factors and clinical outcomes in patients with MI compared with usual care.

Methods/design: An open-label multi-center randomized controlled trial is being conducted at different CR centers from three Swedish University Hospitals. The aim is to include 150 patients with MI < 75 years of age who are confident smartphone and/or Internet users. In addition to participation in CR programs according to the usual routine at each center, patients randomized to the intervention arm will receive access to the web-based app. A CR nurse reviews the patients’ self-reported data twice weekly through a medical interface at the clinic. The primary outcome of the study will be change in submaximal exercise capacity (in watts) between 2 and 4 weeks after discharge and when the patient has completed his/her exercise program at the CR center, usually around 3–6 months post-discharge. Secondary outcomes include changes in self-reported physical activity, objectively assessed physical activity by accelerometry, self-rated health, dietary, and smoking habits, body mass index, blood pressure, blood lipids, and glucose/HbA1c levels between inclusion and follow-up visits during the first year post-MI. Additionally, we will assess uptake and adherence to the application, the number of CR staff contacts, and the incidence of cardiovascular events at 1 and 3 years after the MI. Patient recruitment started in 2016, and the first study results are expected in the beginning of 2019.

Discussion: The present study will add evidence to whether electronic communication can be used to improve traditional CR programs for patients after MI.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
eHealth, Myocardial infarction, Cardiac rehabilitation, Web-based application, Smartphone application, Cardiovascular, Risk factors, Prognosis, Quality of life
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-156601 (URN)10.1186/s13063-018-3118-1 (DOI)000457237000001 ()30678709 (PubMedID)
Available from: 2019-02-20 Created: 2019-02-20 Last updated: 2019-02-20Bibliographically approved
Bay, A., Lämås, K., Berghammer, M., Sandberg, C. & Johansson, B. (2019). Enablers and barriers for physical activity in adults with congenital heart disease. In: : . Paper presented at Berzelius symposium 99, The Cardiac Patient from Birth to Adulthood, Stockholm, Sweden, 21-22 February 2019..
Open this publication in new window or tab >>Enablers and barriers for physical activity in adults with congenital heart disease
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2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Cardiac and Cardiovascular Systems Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-156923 (URN)
Conference
Berzelius symposium 99, The Cardiac Patient from Birth to Adulthood, Stockholm, Sweden, 21-22 February 2019.
Available from: 2019-03-01 Created: 2019-03-01 Last updated: 2019-03-07Bibliographically approved
Sandström, A., Sandberg, C., Rinnström, D., Engström, K. G., Dellborg, M., Thilen, U., . . . Johansson, B. (2019). Factors associated with health-related quality of life among adults with tetralogy of Fallot. Open heart, 6(1), Article ID e000932.
Open this publication in new window or tab >>Factors associated with health-related quality of life among adults with tetralogy of Fallot
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2019 (English)In: Open heart, E-ISSN 2053-3624, Vol. 6, no 1, article id e000932Article in journal (Refereed) Published
Abstract [en]

Background: Due to improved care, the numbers of patients with tetralogy of Fallot (ToF) are increasing. However, long-term morbidity and need for reinterventions are concerns and also address issues of quality of life (QoL).

Methods: Patients with ToF and valid EuroQol-5 dimensions questionnaire (EQ-5D) were identified in the national Swedish register on congenital heart disease. EQ-5Dindex was calculated and dichotomised into best possible health-related QoL (EQ-5Dindex=1) or differed from 1.

Results: 288 patients met the criteria and were analysed. Univariate logistic regression showed a positive association between New York Heart Association (NYHA) class I (OR 8.32, 95% CI 3.80 to 18.21), physical activity >3 h/week (OR 3.34, 95% CI 1.67 to 6.66) and a better right ventricular function (OR 2.56, 95% CI 1.09 to 6.02). A negative association between symptoms (OR 0.23, 95% CI 0.13 to 0.42), cardiovascular medication (OR 0.31, 95% CI 0.18 to 0.53), age (OR 0.97, 95% CI 0.96 to 0.99) and EQ-5Dindex was observed. In multivariate logistic regression, NYHA I (OR 7.28, 95% CI 3.29 to 16.12) and physical activity >3 h/week (OR 2.27, 95% CI 1.07 to 4.84) remained associated with best possible health-related QoL. Replacing NYHA with symptoms in the model yielded similar results.

Conclusion: In this registry study, self-reported physical activity, staff-reported NYHA class and absence of symptoms were strongly associated with best possible health-related QoL measured by EQ-5D. Physical activity level is a potential target for intervention to improve QoL in this population but randomised trials are needed to test such a hypothesis.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-161553 (URN)10.1136/openhrt-2018-000932 (DOI)000471922200023 ()30997127 (PubMedID)
Funder
Västerbotten County CouncilSwedish Heart Lung Foundation
Available from: 2019-07-10 Created: 2019-07-10 Last updated: 2019-07-10Bibliographically approved
Larsson, L., Johansson, B., Sandberg, C., Apers, S., Kovacs, A. H., Luyckx, K., . . . Moons, P. (2019). Geographical variation and predictors of physical activity level in adults with congenital heart disease. IJC Heart & Vasculature, 22, 20-25
Open this publication in new window or tab >>Geographical variation and predictors of physical activity level in adults with congenital heart disease
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2019 (English)In: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, p. 20-25Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity is important to maintain and promote health. This is of particular interest in patients with congenital heart disease (CHD) where acquired heart disease should be prevented. The World Health Organization (WHO) recommends a minimum of 2.5 h/week of physical activity exceeding 3 metabolic equivalents(METS) to achieve positive health effects. It is unknown whether physical activity levels (PAL) in adult CHD patients differ by country of origin.

Methods: 3896 adults with CHD recruited from 15 countries over 5 continents completed self-reported instruments, including the Health Behaviour Scale (HBS-CHD), within the APPROACH-IS project. For each patient, we calculated whether WHO recommendations were achieved or not. Associated factors were investigated using Generalized Linear Mixed Models.

Results: On average, 31% reached the WHO recommendations but with a great variation between geographical areas (India: 10%–Norway: 53%). Predictors for physical activity level in line with the WHO recommendations, with country of residence as random effect, were male sex (OR 1.78, 95%CI 1.52–2.08), NYHA-class I (OR 3.10, 95%CI 1.71–5.62) and less complex disease (OR 1.46, 95%CI 1.16–1.83). In contrast, older age (OR 0.97, 95%CI 0.96–0.98), lower educational level (OR 0.41, 95%CI 0.26–0.64) and being unemployed (OR 0.57, 95%CI 0.42–0.77) were negatively associated with reaching WHO recommendations.

Conclusions: A significant proportion of patients with CHD did not reach the WHO physical activity recommendations. There was a large variation in physical activity level by country of origin. Based on identified predictors, vulnerable patients may be identified and offered specific behavioral interventions.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Adult congenital heart disease, Physical activity level, Patient-reported outcome, Health-behaviour scale, Physical activity recommendation, Metabolic equivalent
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-158110 (URN)10.1016/j.ijcha.2018.11.004 (DOI)000462184100005 ()30511012 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20130607
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Sandberg, C., Johansson, K., Christersson, C., Hlebowicz, J., Thilen, U. & Johansson, B. (2019). Sarcopenia is common in adults with complex congenital heart disease. International Journal of Cardiology, 296, 57-62
Open this publication in new window or tab >>Sarcopenia is common in adults with complex congenital heart disease
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 296, p. 57-62Article in journal, Editorial material (Other academic) Published
Abstract [en]

Background: Adults with complex congenital heart disease (CHD) have reduced aerobic capacity and impaired muscle function. We therefore hypothesized that patients have a lower skeletal muscle mass and higher fat mass than controls.

Methods: Body composition was examined with full body Dual-Energy x-ray Absorptiometry (DXA) in 73 patients with complex CHD (mean age 35.8 ± 14.3, women n = 22) and 73 age and sex matched controls. Patients fulfilling criteria for low skeletal muscle mass in relation to their height and fat mass were defined as sarcopenic.

Results: Male patients (n = 51) were shorter (177.4 ± 6.6 cm vs. 180.9 ± 6.7 cm, p = 0.009) and weighed less (76.0 ± 10.8 kg vs. 82.0 ± 12.4 kg, p = 0.01) than controls. Also, patients had a lower appendicular lean mass-index (ALM-index) (7.57 ± 0.97 kg/m2 vs. 8.46 ± 0.90 kg/m2, p < 0.001). Patients’ relative tissue fat mass (27.9 ± 7.0% vs. 25.4 ± 8.6%, p = 0.1) did not differ. Forty-seven percent of the men (n = 24) were classified as sarcopenic.

Female patients (n = 22) were also shorter (163.5 ± 8.7 cm vs. 166.7 ± 5.9 cm, p = 0.05) but had a higher BMI (25.7 ± 4.2 vs. 23.0 ± 2.5, p=0.02) than controls. Patients also had a lower ALM-index (6.30 ± 0.75 vs. 6.67 ± 0.55, p = 0.05), but their relative body fat mass (40.8 ± 7.6% vs. 32.0 ± 7.0%, p < 0.001) were higher. Fifty-nine percent of the women (n = 13) were classified as sarcopenic.

Conclusions: The body composition was altered toward lower skeletal muscle mass in patients with complex CHD. Approximately half of the patients were classified as sarcopenic. Contrary to men, the women had increased body fat and a higher BMI. Further research is required to assess the cause, possible adverse long-term effects and whether sarcopenia is preventable or treatable.

Keywords
Adult congenital heart disease, Complex congenital heart disease, DXA, Dual-energy x-ray sorptiometry, Sarcopenia
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-165664 (URN)10.1016/j.ijcard.2019.06.011 (DOI)000488960200014 ()31230936 (PubMedID)
Funder
Västerbotten County Council, VLL-574081
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2019-12-05Bibliographically approved
Bay, A., Sandberg, C., Thilén, U., Wadell, K. & Johansson, B. (2018). Exercise self-efficacy in adults with congenital heart disease. International Journal of Cardiology: Heart and vasculature, 18, 7-11
Open this publication in new window or tab >>Exercise self-efficacy in adults with congenital heart disease
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2018 (English)In: International Journal of Cardiology: Heart and vasculature, E-ISSN 2352-9067, Vol. 18, p. 7-11Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity improves health, exercise tolerance and quality of life in adults with congenital heart disease (CHD), and exercise training is in most patients a high-benefit low risk intervention. However, factors that influence the confidence to perform exercise training, i.e. exercise self-efficacy (ESE), in CHD patients are virtually unknown. We aimed to identify factors related to low ESE in adults with CHD, and potential strategies for being physically active.

Methods: Seventy-nine adults with CHD; 38 with simple lesions (16 women) and 41 with complex lesions (17 women) with mean age 36.7 ± 14.6 years and 42 matched controls were recruited. All participants completed questionnaires on ESE and quality of life, carried an activity monitor (Actiheart) during four consecutive days and performed muscle endurance tests.

Results: ESE in patients was categorised into low, based on the lowest quartile within controls, (≤ 29 points, n = 34) and high (> 29 points, n = 45). Patients with low ESE were older (42.9 ± 15.1 vs. 32.0 ± 12.4 years, p = 0.001), had more complex lesions (65% vs. 42%, p = 0.05) more often had New York Heart Association functional class III (24% vs. 4%, p = 0.01) and performed fewer shoulder flexions (32.5 ± 15.5 vs. 47.7 ± 25.0, p = 0.001) compared with those with high ESE. In a logistic multivariate model age (OR; 1.06, 95% CI 1.02-1.10), and number of shoulder flexions (OR; 0.96, 95% CI 0.93-0.99) were associated with ESE.

Conclusion: In this study we show that many adults with CHD have low ESE. Age is an important predictor of low ESE and should, therefore, be considered in counselling patients with CHD. In addition, muscle endurance training may improve ESE, and thus enhance the potential for being physically active in this population.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
adult congenital heart disease, exercise self-efficacy, muscle function, physical activity, quality of life
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-144626 (URN)10.1016/j.ijcha.2017.12.002 (DOI)000432566900002 ()29349286 (PubMedID)
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2019-05-21Bibliographically approved
Bay, A., Berghammer, M., Lämås, K., Sandberg, C. & Johansson, B. (2018). Facilitators and barriers for physical activity in adults with congenital heart disease. In: European Heart Journal: ESC Congress 2018 25 - 29 August Munich, Germany. Paper presented at European Society of Cardiology (ESC), Munich, Germany, 25-29 August 2018.. Oxford University Press, 39, Article ID P5433.
Open this publication in new window or tab >>Facilitators and barriers for physical activity in adults with congenital heart disease
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2018 (English)In: European Heart Journal: ESC Congress 2018 25 - 29 August Munich, Germany, Oxford University Press, 2018, Vol. 39, article id P5433Conference paper, Poster (with or without abstract) (Refereed)
Place, publisher, year, edition, pages
Oxford University Press, 2018
Series
European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645
National Category
Cardiac and Cardiovascular Systems Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-156922 (URN)10.1093/eurheartj/ehy566.P5433 (DOI)
Conference
European Society of Cardiology (ESC), Munich, Germany, 25-29 August 2018.
Note

Issue supplement 1, August 2018

Available from: 2019-03-01 Created: 2019-03-01 Last updated: 2019-03-07Bibliographically approved
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