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Studies of physical activity in the Swedish population
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.ORCID iD: 0000-0003-3591-5123
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cheap and effective tools for measuring patients’ physical activity (PA) level are needed. The first aim in this thesis was therefore to assess the validity of two PA -questions, and their three associated answer modes, that are used within the Swedish health care system. Sitting, light intensity PA (LIPA), and moderate and vigorous intensity PA (MVPA), are associated with health and longevity, but detailed population data assessed with objective methods is needed. The second aim was thus to assess the above with motion sensor technology, in a middle-aged Swedish sample. Low self-perceived health is a strong predictor of morbidity and mortality, but this association may vary over time with changes in the society and our lifestyle. The third aim was to assess secular trends in the interrelations between self-perceived health, physical fitness, and selected covariates. The effects of PA on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear, thus the fourth aim was to explore this.

Methods: All data was collected in the Swedish population. Data from the PA -questions and accelerometers, aerobic fitness, counter movement jump, and balance tests, blood samples, and self-rated general health were collected in 365 participants, 21–66 yrs. The PA pattern was assessed in 948 individuals, 50‒64 yrs, from the SCAPIS pilot study. Self-perceived physical health, and measured aerobic fitness, counter movement jump height, and balance, and demographic and lifestyle data, was assessed in three independent samples from 1990, 2000 and 2013, including 3564 adults, 20‒65 yrs. The effects of Swedish PAP on HRQoL was assessed in a randomized controlled trial including 101 men and women, 67‒68 yrs, that were inactive, overweight (BMI>25 kg/m2), and had a waist circumference ≥102 cm (men) or ≥88 cm (women), who were randomized to an intervention group or a control group. The 36-item Short Form Health Survey (SF-36) was used to assess HRQoL.

Results: The multiple choice answer mode of the two PA -questions was found to have the strongest validity, compared with the two other (an open mode, and one where PA minutes is specified per weekday). The validity is in line with many other established PA-questionnaires, but the open mode has limitations. The assessment of PA pattern showed that 61% of motion sensor wear time represented sitting, 35% LIPA, and 4% MVPA. Only 7% of the sample met the PA recommendations. The odds for describing perceived health as good was found to increase by 5% per each increment of 1 ml/kg/min in VO2max. This was stable across genders and all three LIV-samples (i.e. over time). Waist circumference, chronic disease, sleep problems, and level of satisfaction with one’s life, were also important correlates. The Swedish PAP group improved significantly more, and more participants displayed clinically relevant improvements (OR 2.43), in mental aspects of HRQoL, compared to the controls. Physical aspects of HRQoL improved in the PAP group, but not in the control group.

Conclusions: The multiple choice answer mode has the strongest validity and Open mode the weakest. The PA -questions may be used in populations, or in individuals to determine appropriateness for treatment. The questions’ advantages and limitations must be considered and further reliability and validity studies are needed. The results regarding sitting, LIPA, MVPA and fulfillment of PA recommendations, are of high clinical relevance. A great challenge remains to further implement methods to increase the level of PA in the Swedish population. Physical fitness is related to self-perceived health independently of changes in society and lifestyle over time, and simple questions may be useful for the clinical assessment of physical fitness. Swedish PAP has a positive effect on mental aspects of HRQoL, measured by the SF-36. This finding supports the clinical use of the Swedish PAP model.

Place, publisher, year, edition, pages
Stockholm: Gymnastik- och idrottshögskolan, GIH , 2016. , 71 p.
Series
Avhandlingsserie för Gymnastik- och idrottshögskolan, 05
Keyword [en]
physical activity, physical fitness, sedentary, questionnaire, validity, self-rated health, sensitivity, specificity, physical activity on prescription, accelerometry, the Ekblom-Bak test, answer modes, movement pattern, health-related quality of life, physical health
National Category
Health Sciences
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-4309ISBN: 978-91-980862-5-6 (print)OAI: oai:DiVA.org:gih-4309DiVA: diva2:898545
Public defence
2016-02-19, Aulan, Lidingövägen 1, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Projects
LIV 2013
Available from: 2016-01-28 Created: 2016-01-27 Last updated: 2016-02-17Bibliographically approved
List of papers
1. Categorical answer modes provides superior validity to open answers when asking for level of physical activity: A cross-sectional study
Open this publication in new window or tab >>Categorical answer modes provides superior validity to open answers when asking for level of physical activity: A cross-sectional study
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2016 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 1, 70-76 p., 1403494815602830Article in journal (Refereed) Published
Abstract [en]

AIMS:

Physical activity (PA) used as prevention and treatment of disease has created a need for effective tools for measuring patients' PA level. Our aim was therefore to assess the validity of two PA questions and their three associated answer modes.

METHODS:

Data on PA according to the PA questions and Actigraph GT3X+ accelerometers, aerobic fitness (VO2max), cardiovascular biomarkers, and self-rated general health were collected in 365 Swedish adults (21-66 years). The PA questions ask about weekly PA via categories (Categorical), an open-ended answer (Open), or specified day by day (Table).

RESULTS:

The Categorical mode, compared with the Open mode, correlated (Spearman's rho) significantly more strongly (p<0.05) with accelerometer PA (0.31 vs. 0.18) and VO2max (0.27 vs. 0.06), and the level of BMI (-0.20 vs. -0.02), waist circumference (-0.22 vs. -0.03), diastolic blood pressure (-0.16 vs. 0.08), glucose (-0.18 vs. 0.04), triglycerides (-0.31 vs. -0.07), and general health (0.35 vs. 0.19). The validity of the Categorical and Table modes were similar regarding VO2max and accelerometry, but the Categorical mode exhibited more significant and stronger correlations with cardiovascular biomarkers. The capacity of the PA questions to identify insufficiently physically active individuals ranged from 0.57 to 0.76 for sensitivity and from 0.47 to 0.79 for specificity.

CONCLUSIONS:

The Categorical mode exhibits the strongest validity and Open mode the weakest. The PA questions may be used on a population level, or as a tool for determining patents' appropriateness for treatment.

National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-3958 (URN)10.1177/1403494815602830 (DOI)000369969000011 ()26392418 (PubMedID)
Available from: 2015-08-04 Created: 2015-08-04 Last updated: 2017-12-04Bibliographically approved
2. The Daily Movement Pattern and Fulfilment of Physical Activity Recommendations in Swedish Middle-Aged Adults: The SCAPIS Pilot Study.
Open this publication in new window or tab >>The Daily Movement Pattern and Fulfilment of Physical Activity Recommendations in Swedish Middle-Aged Adults: The SCAPIS Pilot Study.
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, e0126336Article in journal (Refereed) Published
Abstract [en]

Different aspects of the daily movement pattern-sitting, light intensity physical activity, and moderate- and vigorous intensity physical activity-have each independently been associated with health and longevity. Previous knowledge of the amount and distribution of these aspects in the general Swedish population, as well as the fulfilment rate of physical activity recommendations, mainly relies on self-reported data. More detailed data assessed with objective methods is needed. The aim of the study was to present descriptive data on the daily movement pattern in a middle-aged Swedish population assessed by hip-worn accelerometers. The cohort consisted of 948 participants (51% women), aged 50 to 64 years, from the Swedish CArdioPulmonary bioImage pilot Study. In the total sample, 60.5% of accelerometer wear time was spent sitting, 35.2% in light physical activity and 3.9% in moderate- and vigorous physical activity. Men and participants with high educational level spent a larger proportion of time sitting, compared to women and participants with low educational level. Men and participants with a high educational level spent more time, and the oldest age-group spent less time, in moderate- and vigorous physical activity. Only 7.1% of the study population met the current national physical activity recommendations, with no gender, age or education level differences. Assessment of all three components of the daily movement pattern is of high clinical relevance and should be included in future research. As the fulfilment of national physical activity recommendations is very low and sitting time is very high in our middle-aged population, the great challenge remains to enhance the implementation of methods to increase the level of physical activity in this population.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-3822 (URN)10.1371/journal.pone.0126336 (DOI)25970580 (PubMedID)
Available from: 2015-05-21 Created: 2015-05-21 Last updated: 2017-12-04
3. Is the relationship between self-perceived physical health and measured physical fitness robust over time and between genders?
Open this publication in new window or tab >>Is the relationship between self-perceived physical health and measured physical fitness robust over time and between genders?
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(English)Manuscript (preprint) (Other academic)
Keyword
Physical fitness, aerobic fitness, the LIV -studie, LIV 2013, LIV 90, LIV 2000, self-perceived health, the Ekblom-Bak test, aerobic fitness, counter-movement jump, balance, secular trends
National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4311 (URN)
Projects
LIV 2013
Note

At the time of Gustav Olsson's dissertation this paper was a manuscript.

Available from: 2016-01-27 Created: 2016-01-27 Last updated: 2016-01-28Bibliographically approved
4. Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial
Open this publication in new window or tab >>Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial
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2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 687Article in journal (Refereed) Published
Abstract [en]

Background

The effects of physical activity on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear. We therefore aimed to explore the effects of the Swedish PAP model on HRQoL in overweight older adults.

Methods

Participants were recruited from a cohort of men and women born between 1937 and 1938, and living in Stockholm County. Inclusion criteria were; insufficiently physically active, i.e. <30 min of at least moderate intensity physical activity (PA) per day; body mass index >25 kg/m 2 ; and waist circumference ≥102 cm (men) or ≥88 cm (women). Altogether, 101 individuals, aged 67 years, were randomly assigned to two parallel groups: intervention group (n = 47) receiving individualised PAP or control group (n = 54). The 36-item Short Form Health Survey (SF-36) was administered before and after the six months intervention. Main outcomes were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Intention to treat analysis was utilised. Regression analysis was performed to assess whether changes in PA and body weight affected changes in HRQoL.

Results

At the six months follow-up, regarding the MCS score, the intervention group had improved significantly more (median: 4.4 [interquartile range (IQR): −2.4 to 23.3]) vs (median: 0.0 [IQR: −4.0 to 4.9]); p < 0.05) and a higher proportion of participants had attained relevant improvements (OR 2.43 (95 % CI 1.00–5.88) p < 0.05) compared to the controls. A within group improvement in the PCS score (median: 3.8 [IQR: −1.9 to 19.5] p < 0.05) was found in the intervention group. Changes in PA and body weight had a small, but significant, mediating effect on the changes in HRQoL.

Conclusions

PAP had a positive effect on HRQoL, measured by the SF-36 MCS, but no significant between group effect was seen on the PCS in overweight older adults. These effects were, to some extent, mediated by changes in PA and body weight. Our findings support clinical use of the Swedish PAP model.

Trial registration

ClinicalTrials.gov NCT02320760.

Keyword
Clinical research; Health promotion; Intervention study; Older adults; Prescribed physical activity; Health related quality of life; Overweight
National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-3957 (URN)10.1186/s12889-015-2036-3 (DOI)26193882 (PubMedID)
Available from: 2015-08-04 Created: 2015-08-04 Last updated: 2017-12-04Bibliographically approved

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  • nn-NB
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  • Other locale
More languages
Output format
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  • asciidoc
  • rtf