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  • 1. Carsin, Anne-Elie
    et al.
    Fuertes, Elaine
    Schaffner, Emmanuel
    Jarvis, Debbie
    Antó, Josep M.
    Heinrich, Joachim
    Bellisario, Valeria
    Svanes, Cecilie
    Keidel, Dirk
    Imboden, Medea
    Weyler, Joost
    Nowak, Dennis
    Martinez-Moratalla, Jesus
    Gullón, José-Antonio
    Sanchez Ramos, José Luis
    Caviezel, Seraina
    Beckmeyer-Borowko, Anna
    Raherison, Chantal
    Pin, Isabelle
    Demoly, Pascal
    Cerveri, Isa
    Accordini, Simone
    Gislason, Thorarinn
    Toren, Kjell
    Department of Public Health and Community Medicine, Institute of Medicine, Goteburg, Sweden..
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden..
    Jogi, Rain
    Emtner, Margareta
    Gómez Real, Francisco
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Leynaert, Bénédicte
    Pascual, Silvia
    Guerra, Stefano
    Dharmage, Shyamali C.
    Probst-Hensch, Nicole
    Garcia-Aymerich, Judith
    Restrictive spirometry pattern is associated with low physical activity levels: A population based international study2019In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 146, p. 116-123Article in journal (Refereed)
    Abstract [en]

    Introduction: Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry.

    Methods: Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC ≥ Lower Limit of Normal and a FVC<80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (<1st study-specific tertile) was evaluated using adjusted logistic regression models.

    Results: Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07–1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding.

    Conclusion: Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.

  • 2. Fuertes, Elaine
    et al.
    Carsin, Anne-Elie
    Antó, Josep M.
    Bono, Roberto
    Corsico, Angelo Guido
    Demoly, Pascal
    Gislason, Thorarinn
    Gullón, José-Antonio
    Janson, Christer
    Jarvis, Deborah
    Heinrich, Joachim
    Holm, Mathias
    Leynaert, Bénédicte
    Marcon, Alessandro
    Martinez-Moratalla, Jesús
    Nowak, Dennis
    Erquicia, Silvia Pascual
    Probst-Hensch, Nicole M.
    Raherison, Chantal
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Real, Francisco Gómez
    Russell, Melissa
    Sánchez-Ramos, José Luis
    Weyler, Joost
    Aymerich, Judith Garcia
    Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study2018In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 73, no 4, p. 376-384Article in journal (Refereed)
    Abstract [en]

    Objective: We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort. Methods: FEV1 and FVC were measured in 3912 participants at 27-57 years and 39-67 years (mean time between examinations= 11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity >= 2 times and >= 1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC. Results: Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline. Conclusion: Leisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.

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  • 3.
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Impacts of Active Transport on Health: with a focus on physical activity, air pollution, and cardiovascular disease2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: There are increasing number of health impact assessment studies investigating the health effects by transferring trips made by motorised transport to active commuting; however, air pollution exposure during active commuting and its impact on health has been less thoroughly assessed. It is furthermore uncertain whether there is any interaction effect between air pollution and physical activity for the risk of cardiovascular diseases. The overall aim of the thesis was to improve the knowledge base for assessments of the total impact on health of a mode shift resulting in both increased physical activity and increased air pollution exposure, especially regarding combined effects on cardiovascular risks.

    Methods: The thesis is based on four studies. In Study I, methodological issues related to the assessment of air pollution in previous studies on the health impact of changes in transport mode were critically reviewed. In Study II, the effect of leisure time and active commuting physical activity, on chronic diseases was quantified by conducting a random-effect meta-analysis. In two prospective cohort studies, participants of the Västerbotten Intervention Programme living in the Umeå region were studied to assess the impact as well as interaction effect of physical activity and air pollution on the incidence (Study III) and recurrence (Study IV) of cardiovascular diseases.

    Results: In previous studies on the health impact of changes in transport mode, there was a large methodological discrepancy between studies due to different assumptions for air pollution exposure assessments in general populations and commuters as well as methods for estimation of impacts. Randomeffect meta-analyses showed a beneficial effect of leisure time physical activity and active commuting on morbidity among individuals performing these activities at the minimum level of physical activity recommended by WHO, equivalent to 11.25 MET-hours per week. Beneficial effects of exercise on firstincident ischemic heart disease (IHD) were observed among individuals with high residential PM10/PM2.5 concentrations, but not among individuals with low concentrations. Adverse effects associated with high residential PM10 and PM2.5 concentrations were only observed among the individuals whom less frequently exercised. A statistically significant interaction effect was found between air pollution and exercise in training clothes for first-incident IHD but not for recurrence of IHD/stroke.

    Conclusions: The results in this thesis strengthen the public health message that physical activity is beneficial for cardiovascular health, even in areas with air pollution. Therefore, public health and transport policies should be designed to improve population health through promotion of active transport and mitigation of air pollution.

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  • 4.
    Raza, Wasif
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Christer
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1429081Article, review/survey (Refereed)
    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.

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  • 5.
    Raza, Wasif
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Krachler, Benno
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Air pollution, physical activity and ischaemic heart disease: a prospective cohort study of interaction effects2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 4, article id e040912Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess a possible interaction effect between physical activity and air pollution on first incidence of ischaemic heart disease (IHD).

    DESIGN: Prospective cohort study.

    SETTING: Umeå, Northern Sweden.

    PARTICIPANTS: We studied 34 748 adult participants of Västerbotten Intervention Programme cohort from 1990 to January 2014. Annual particulate matter concentrations (PM2.5 and PM10) at the participants' residential addresses were modelled and a questionnaire on frequency of exercise and active commuting was completed at baseline. Cox proportional hazards modelling was used to estimate (1) association with physical activity at different levels of air pollution and (2) the association with particulate matter at different levels of physical activity.

    OUTCOME: First incidence of IHD.

    RESULTS: Over a mean follow-up of 12.4 years, there were 1148 IHD cases. Overall, we observed an increased risk of IHD among individuals with higher concentrations of particles at their home address. Exercise at least twice a week was associated with a lower risk of IHD among participants with high residential PM2.5 (hazard ratio (HR) 0.60; 95% CI: 0.44 to 0.82) and PM10 (HR 0.55; 95% CI: 0.4 to 0.76). The same beneficial effect was not observed with low residential PM2.5 (HR 0.94; 95% CI: 0.72 to 1.22) and PM10 (HR 0.99; 95% CI: 0.76 to 1.29). An increased risk associated with higher long-term exposure to particles was only observed among participants that exercised in training clothes at most one a week and among those not performing any active commuting. However, only the interaction effect on HRs for exercise was statistically significant.

    CONCLUSION: Exercise was associated with a lower risk of first incidence of IHD among individuals with higher residential particle concentrations. An air pollution-associated risk was only observed among those who exercised less. The findings support the promotion of physical activity and a mitigation of air pollution.

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  • 6.
    Raza, Wasif
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Krachler, Benno
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Health benefits of leisure time and commuting physical activity: a meta-analysis of effects on morbidity2020In: Journal of Transport and Health, ISSN 2214-1405, E-ISSN 2214-1405, Vol. 18, article id 100873Article in journal (Refereed)
    Abstract [en]

    Introduction: A protective role of leisure time physical activity with regard to non-communicable chronic diseases (NCDs) is well established. However, shapes of dose-response relationships and the extent of BMI mediation between physical activity and disease risk are not well known. Furthermore, the knowledge about risk reductions from active commuting is limited. Methods: Meta-analyses of prospective cohort studies published from January 1990 to June 2019 were conducted, 1) to assess the effect of leisure time and commuting physical activity on cardiovascular disease (CVD), type 2 diabetes, breast cancer and colon cancer, and 2) to quantify the extent to which adjustment for BMI affect these relations. Results: Random effect meta-analyses of 59 prospective cohort studies estimated that individuals who engaged in 11.25 MET-hours/week of active commuting had a decreased risk of myocardial infarction (MI) by 18% (95% CI: 1-33%) and type 2 diabetes by 22% (95% CI: 4-37%) compared with non-commuters. Corresponding risk reductions for leisure-time physical activity (LTPA) were 22% for MI, 26% for CVD, 27% for heart failure, 23% for stroke, 22% for type 2 diabetes, 15% for colon cancer and 7% for breast cancer. Except for breast cancer, adjustment for BMI reduced the benefit of physical activity. Conclusion: Both active commuting and LTPA are associated with lower risk for NCD. Currently, available data is insufficient to establish detail and reliable dose-response curves.

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  • 7. Russell, M.
    et al.
    Janson, C.
    Real, F.
    Johannessen, A.
    Waatevik, M.
    Benediktsdottir, B.
    Holm, M.
    Lindberg, E.
    Schlunssen, V
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Svanes, C.
    Dharmage, S.
    Physical activity and the association with asthma and wheeze in the respiratory health in northern Europe (rhine) study2015In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 20, p. 53-53Article in journal (Other academic)
  • 8. Russell, Melissa A.
    et al.
    Janson, Christer
    Gomez Real, Francisco
    Johannessen, Ane
    Waatevik, Marie
    Benediktsdottir, Bryndis
    Holm, Mathias
    Lindberg, Eva
    Schlünssen, Vivi
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dharmage, Shyamali C.
    Svanes, Cecilie
    Physical activity and asthma: a longitudinal and multi-country study2017In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 54, no 9, p. 938-945Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis.

    Methods: The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999–2001) and all centres at RHINE III (2010–2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (&lt;20, 20–24.99, 25–29.99, 30+ kg/m2) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity.

    Results: In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories.

    Conclusion: These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.

  • 9. Russell, Melissa Anne
    et al.
    Dharmage, Shyamali
    Fuertes, Elaine
    Marcon, Alessandro
    Carsin, Anne-Elie
    Pascual Erquicia, Silvia
    Heinrich, Joachim
    Johannessen, Ane
    Abramson, Michael J.
    Amaral, Andre F. S.
    Cerveri, Isa
    Demoly, Pascal
    Garcia-Larsen, Vanessa
    Jarvis, Deborah
    Martinez-Moratalla, Jesus
    Nowak, Dennis
    Palacios-Gomez, Leopoldo
    Squillacioti, Giulia
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Emtner, Margareta
    Garcia-Aymerich, Judith
    The effect of physical activity on asthma incidence over 10 years: population-based study2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 1, article id 00970-2020Article in journal (Refereed)
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  • 10.
    Strömgren, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography.
    Schantz, Peter
    Research Unit for Movement, Health and Environment, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Markstedt, Anders
    WSP Civils, Stockholm, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Modeling commuter modal shift from car trips to cycling: Scenario construction and outcomes for Stockholm, Sweden2020In: Journal of Transport Geography, ISSN 0966-6923, E-ISSN 1873-1236, no 86, article id 102740Article in journal (Refereed)
    Abstract [en]

    This article presents the construction and outcomes of scenarios modeling commuter modal shift from car trips to cycling in the metropolitan region of Stockholm, the capital of Sweden. Building and improving upon previous studies in terms of both methodological approach and degree of spatial resolution of the modeling output, we examine scenarios where car commuters able to reach their workplace within 30 and 50 minutes of cycling shift commuting mode. Overall, car–bicycle modal shift figures were 31.6% and 48.7%, respectively. However, there were considerable geographical differences. While a substantial number of new bicycle commuters appeared in all five macro-level subdivisions of the study area, relative modal shift was by far the highest among car commuters living in the Inner City and its immediate surroundings.

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