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Olsson, T. T., Svensson, M., Hållmarker, U., James, S. & Deierborg, T. (2020). Delayed Clinical Manifestation of Parkinson's Disease Among Physically Active: Do Participants in a Long-Distance Ski Race Have a Motor Reserve?. Journal of Parkinson's Disease, 10(1), 267-274
Åpne denne publikasjonen i ny fane eller vindu >>Delayed Clinical Manifestation of Parkinson's Disease Among Physically Active: Do Participants in a Long-Distance Ski Race Have a Motor Reserve?
Vise andre…
2020 (engelsk)Inngår i: Journal of Parkinson's Disease, ISSN 1877-7171, E-ISSN 1877-718X, Vol. 10, nr 1, s. 267-274Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Physical activity is associated with reduced risk of Parkinson's disease (PD). The explanations for this association are not completely elucidated. We use long-term PD-incidence data from long-distance skiers to study the relationship between exercise and PD.

OBJECTIVE: We aimed to investigate if physical activity is associated with long-term lower risk of PD and if this association could be explained by physically active people being able to sustain more PD neuropathology before clinical symptoms, a motor reserve.

METHODS: Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet (n = 197,685), exhibited reduced incidence of PD compared to matched individuals from the general population (n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5-15 years).

RESULTS: Vasaloppet skiers (median age 36.0 years [IQR 29.0-46.0], 38% women) had lower incidence of PD (HR: 0.71; 95 % CI 0.56-0.90) compared to non-skiers. When reducing risk for reverse causation by excluding PD cases within the first five years from race participation, there was still a trend for lower risk of PD (HR: 0.80; 95 % CI 0.62-1.03). Further, the PD prevalence converged between skiers and non-skiers after 15 years of follow-up, which is more consistent with a motor reserve in the physically active rather than neuroprotection.

CONCLUSIONS: A physical active lifestyle is associated with reduced risk for PD. This association weakens with time and might be explained by a motor reserve among the physically active.

sted, utgiver, år, opplag, sider
IOS Press, 2020
Emneord
Parkinson’s disease, Physical activity, exercise, motor reserve
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-401561 (URN)10.3233/JPD-191762 (DOI)000508614100026 ()31609700 (PubMedID)
Forskningsfinansiär
The Swedish Brain FoundationThe Crafoord FoundationThe Dementia Association - The National Association for the Rights of the DementedStiftelsen Olle Engkvist ByggmästareSwedish Research Council
Tilgjengelig fra: 2020-01-08 Laget: 2020-01-08 Sist oppdatert: 2020-03-09bibliografisk kontrollert
Svensson, M., Brundin, L., Erhardt, S., Madaj, Z., Hållmarker, U., James, S. & Deierborg, T. (2019). Long distance ski racing is associated with lower long-term incidence of depression in a population based, large-scale study. Psychiatry Research, 281, Article ID 112546.
Åpne denne publikasjonen i ny fane eller vindu >>Long distance ski racing is associated with lower long-term incidence of depression in a population based, large-scale study
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2019 (engelsk)Inngår i: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 281, artikkel-id 112546Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Physical activity has been proposed to be beneficial for prevention of depression, although the importance of exercise intensity, sex-specific mechanisms, and duration of the effects need to be clarified. Using an observational study design, following 395,369 individuals up to 21 years we studied whether participation in an ultralong-distance cross-country ski race was associated with lower risk of developing depression. Skiers (participants in the race) and matched non-skiers from the general population (non-participants in the race) were studied after participation (same year for non-participation) in the race using the Swedish population and patient registries. The risk of depression in skiers (n = 197,685, median age 36 years, 38% women) was significantly lower, to nearly half of that in non-skiers (adjusted hazard ratio, HR 0.53) over the follow-up period. Further, a higher fitness level (measured as the finishing time to complete the race, a proxy for higher exercise dose) was associated with lower incidence of depression in men (adjusted HR 0.65), but not in women. Our results support the recommendations of engaging in physical activity as a preventive strategy decreasing the risk for depression in both men and women. Furthermore, the exercise could reduce risk for depression in a dose-dependent matter, in particular in males.

sted, utgiver, år, opplag, sider
ELSEVIER IRELAND LTD, 2019
Emneord
Exercise, Psychiatric disorder, Mental health, Women, Men, Long-term effect
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-400098 (URN)10.1016/j.psychres.2019.112546 (DOI)000497252200017 ()31622872 (PubMedID)
Forskningsfinansiär
Swedish Research CouncilThe Swedish Brain FoundationMultidisciplinary research focused on Parkinson’s disease - MultiParkStiftelsen Olle Engkvist ByggmästareThe Dementia Association - The National Association for the Rights of the DementedSwedish Research Council, 2017-00875
Tilgjengelig fra: 2020-01-07 Laget: 2020-01-07 Sist oppdatert: 2020-01-08bibliografisk kontrollert
Svedberg, N., Sundström, J., James, S., Hållmarker, U., Hambraeus, K. & Andersen, K. (2019). Long-Term Incidence of Atrial Fibrillation and Stroke Among Cross-Country Skiers Cohort Study of Endurance-Trained Male and Female Athletes. Circulation, 140(11), 910-920
Åpne denne publikasjonen i ny fane eller vindu >>Long-Term Incidence of Atrial Fibrillation and Stroke Among Cross-Country Skiers Cohort Study of Endurance-Trained Male and Female Athletes
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2019 (engelsk)Inngår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 140, nr 11, s. 910-920Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Studies have revealed a higher incidence of atrial fibrillation among well-trained athletes. We aim to investigate associations of endurance training with incidence of atrial fibrillation and stroke and to establish potential sex differences of such associations in a cohort of endurance trained athletes. Methods: All Swedish skiers (208 654) completing 1 or more races in the 30 to 90 km cross-country skiing event Vasaloppet (1989-2011) and a matched sample (n=527 448) of nonskiers were followed until first event of atrial fibrillation or stroke. Cox regression was used to investigate associations of number of completed races and finishing time with incidence of atrial fibrillation and stroke. Results: Female skiers in Vasaloppet had a lower incidence of atrial fibrillation than did female nonskiers (hazard ratio [HR], 0.55; 95% CI, 0.48-0.64), independent of finishing time and number of races. Male skiers had a similar incidence to that of nonskiers (HR, 0.98; 95% CI, 0.93-1.03). Skiers with the highest number of races or fastest finishing times had the highest incidence. Skiers of either sex had a lower incidence of stroke than did nonskiers (HR, 0.64; 95% CI, 0.60-0.67), independent of the number of races and finishing time. Skiers with atrial fibrillation had higher incidence of stroke than did skiers and nonskiers without atrial fibrillation (men: HR, 2.28; 95% CI, 1.93-2.70; women: HR, 3.51; 95% CI, 2.17-5.68; skiers with atrial fibrillation vs. skiers without atrial fibrillation). After diagnosis of atrial fibrillation, skiers with atrial fibrillation had a lower incidence of stroke (HR, 0.73; 95% CI, 0.50-0.91) and lower mortality compared with nonskiers with atrial fibrillation (HR, 0.57; 95% CI, 0.49-0.65). Conclusions: Female skiers in Vasaloppet had lower incidence of atrial fibrillation and stroke. Male skiers had similar incidence of atrial fibrillation and lower risk of stroke. Men with higher number of races and faster finishing times had the highest incidence of atrial fibrillation. After diagnosis of atrial fibrillation, skiers had lower incidence of stroke and death than did nonskiers with atrial fibrillation. This indicates that although on an individual level atrial fibrillation in well-trained individuals is associated with higher incidence of stroke, on population level, risk of stroke is low and that exercise should not be avoided.

Emneord
athletes, atrial fibrillation, death, stroke
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-394959 (URN)10.1161/CIRCULATIONAHA.118.039461 (DOI)000484975900013 ()31446766 (PubMedID)
Tilgjengelig fra: 2019-10-18 Laget: 2019-10-18 Sist oppdatert: 2019-10-18bibliografisk kontrollert
Hansson, O., Svensson, M., Gustaysson, A.-M., Andersson, E., Yang, Y., Nagga, K., . . . Deierborg, T. (2019). Midlife physical activity is associated with lower incidence of vascular dementia but not Alzheimer's disease. Alzheimer's Research & Therapy, 11, Article ID 87.
Åpne denne publikasjonen i ny fane eller vindu >>Midlife physical activity is associated with lower incidence of vascular dementia but not Alzheimer's disease
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2019 (engelsk)Inngår i: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Vol. 11, artikkel-id 87Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Physical activity might reduce the risk of developing dementia. However, it is still unclear whether the protective effect differs depending on the subtype of dementia. We aimed to investigate if midlife physical activity affects the development of vascular dementia (VaD) and Alzheimer's disease (AD) differently in two large study populations with different designs.

Methods: Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet (n = 197,685) exhibited reduced incidence of VaD or AD compared to matched individuals from the general population (n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5-15 years). Next, we studied the association between self-reported physical activity, stated twice 5 years apart, and incident VaD and AD in 20,639 participants in the Swedish population-based Malmo Diet and Cancer Study during 18 years of follow-up (median 15, IQR 14-17 years). Finally, we used a mouse model of AD and studied brain levels of amyloid-beta, synaptic proteins, and cognitive function following 6 months of voluntary wheel running.

Results Vasaloppet skiers (median age 36.0 years [IQR 29.0-46.0], 38% women) had lower incidence of all-cause dementia (adjusted hazard ratio (HR) 0.63, 95% CI 0.52-0.75) and VaD (adjusted HR 0.49, 95% CI 0.33-0.73), but not AD, compared to non-skiers. Further, faster skiers exhibited a reduced incidence of VaD (adjusted HR 0.38, 95% CI 0.16-0.95), but not AD or all-cause dementia compared to slower skiers. In the Malmo Diet and Cancer Study (median age 57.5 years [IQR 51.0-63.8], 60% women), higher physical activity was associated with reduced incidence of VaD (adjusted HR 0.65, 95% CI 0.49-0.87), but not AD nor all-cause dementia. These findings were also independent of APOE-epsilon 4 genotype. In AD mice, voluntary running did not improve memory, amyloid-beta, or synaptic proteins.

Conclusions: Our results indicate that physical activity in midlife is associated with lower incidence of VaD. Using three different study designs, we found no significant association between physical activity and subsequent development of AD.

sted, utgiver, år, opplag, sider
BMC, 2019
Emneord
Physical activity, Alzheimer's disease, Vascular dementia, Exercise, Amyloid-beta
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-396705 (URN)10.1186/s13195-019-0538-4 (DOI)000491349200001 ()31630687 (PubMedID)
Forskningsfinansiär
EU, European Research CouncilSwedish Research CouncilKnut and Alice Wallenberg FoundationMarianne and Marcus Wallenberg FoundationThe Swedish Brain FoundationThe Crafoord FoundationThe Dementia Association - The National Association for the Rights of the DementedStiftelsen Olle Engkvist Byggmästare
Tilgjengelig fra: 2019-11-08 Laget: 2019-11-08 Sist oppdatert: 2019-11-08bibliografisk kontrollert
Ahl, M., Avdic, U., Strandberg, M. C., Chugh, D., Andersson, E., Hållmarker, U., . . . Ekdahl, C. T. (2019). Physical Activity Reduces Epilepsy Incidence: a Retrospective Cohort Study in Swedish Cross-Country Skiers and an Experimental Study in Seizure-Prone Synapsin II Knockout Mice. Sports medicine - open, 5(1), Article ID 52.
Åpne denne publikasjonen i ny fane eller vindu >>Physical Activity Reduces Epilepsy Incidence: a Retrospective Cohort Study in Swedish Cross-Country Skiers and an Experimental Study in Seizure-Prone Synapsin II Knockout Mice
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2019 (engelsk)Inngår i: Sports medicine - open, ISSN 2199-1170, Vol. 5, nr 1, artikkel-id 52Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Epilepsy patients commonly exercise less than the general population. Animal studies indicate beneficial effects of physical activity in established epilepsy, while its effect on the development is currently less known.

METHODS: Here, we investigated the incidence of epilepsy during 20 years in a cohort of participants from the long-distance Swedish cross-country ski race Vasaloppet (n = 197,685) and compared it to the incidence of non-participating-matched controls included in the Swedish population register (n = 197,684). Individuals diagnosed with diseases such as stroke and epilepsy before entering the race were excluded from both groups. Experimentally, we also determined how physical activity could affect the development of epilepsy in epilepsy-prone synapsin II knockout mice (SynIIKO), with and without free access to a running wheel.

RESULTS: We identified up to 40-50% lower incidence of epilepsy in the Vasaloppet participants of all ages before retirement. A lower incidence of epilepsy in Vasaloppet participants was seen regardless of gender, education and occupation level compared to controls. The participants included both elite and recreational skiers, and in a previous survey, they have reported a higher exercise rate than the general Swedish population. Sub-analyses revealed a significantly lower incidence of epilepsy in participants with a faster compared to slower finishing time. Dividing participants according to specified epilepsy diagnoses revealed 40-50% decrease in focal and unspecified epilepsy, respectively, but no differences in generalized epilepsy. Voluntary exercise in seizure-prone SynIIKO mice for 1 month before predicted epilepsy development decreased seizure manifestation from > 70 to 40%. Brain tissue analyses following 1 month of exercise showed increased hippocampal neurogenesis (DCX-positive cells), while microglial (Iba1) and astrocytic activation (GFAP), neuronal Map2, brain-derived neurotrophic factor and its receptor tyrosine receptor kinase B intensity were unaltered. Continued exercise for additionally 2 months after predicted seizure onset in SynIIKO mice resulted in a 5-fold reduction in seizure manifestation (from 90 to 20%), while 2 months of exercise initiated at the time of predicted seizure development gave no seizure relief, suggesting exercise-induced anti-epileptogenic rather than anti-convulsive effect.

CONCLUSION: The clinical study and the experimental findings in mice indicate that physical activity may prevent or delay the development of epilepsy.

sted, utgiver, år, opplag, sider
Springer, 2019
Emneord
Epilepsy, Epilepsy incidence, Epileptogenesis, Exercise, Physical activity, Seizures
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-401550 (URN)10.1186/s40798-019-0226-8 (DOI)000513574600001 ()31844999 (PubMedID)
Forskningsfinansiär
EU, FP7, Seventh Framework Programme, 2007-2013Swedish Research CouncilThe Crafoord FoundationMultidisciplinary research focused on Parkinson’s disease - MultiParkThe Swedish Brain FoundationStiftelsen Olle Engkvist ByggmästareÅke Wiberg FoundationThe Dementia Association - The National Association for the Rights of the DementedGun och Bertil Stohnes Stiftelse
Tilgjengelig fra: 2020-01-08 Laget: 2020-01-08 Sist oppdatert: 2020-03-24bibliografisk kontrollert
Stattin, K., Hållmarker, U., Ärnlöv, J., James, S., Michaëlsson, K. & Byberg, L. (2018). Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals. Journal of Bone and Mineral Research, 33(10), 1842-1850
Åpne denne publikasjonen i ny fane eller vindu >>Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals
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2018 (engelsk)Inngår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, nr 10, s. 1842-1850Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

It is not known how physical exercise affects the risk of different types of fractures, especially in highly active individuals. To investigate this association, we studied a cohort of 118,204 men and 71,757 women who from 1991 to 2009 participated in Vasaloppet, a long-distance cross-country skiing race in Sweden, and 505,194 nonparticipants frequency-matched on sex, age, and county of residence from the Swedish population. Participants ranged from recreational exercisers to world-class skiers. Race participation, distance of race run, number of races participated in, and finishing time were used as proxies for physical exercise. Incident fractures from 1991 to 2010 were obtained from national Swedish registers. Over a median follow-up of 8.9 years, 53,175 fractures of any type, 2929 hip, 3107 proximal humerus, 11,875 lower leg, 11,733 forearm, and 2391 vertebral fractures occurred. In a Cox proportional hazard regression analysis using time-updated exposure and covariate information, participation in the race was associated with an increased risk of any type of fracture (hazard ratio [HR], 1.02; 95% CI, 1.00 to 1.05); forearm fractures had an HR, 1.11 with a 95% CI, 1.06 to 1.15. There was a lower risk of hip (HR, 0.75; 95% CI, 0.67 to 0.83), proximal humerus (HR, 0.90; 95% CI, 0.82 to 0.98), and lower leg fractures (HR, 0.93; 95% CI, 0.89 to 0.97), whereas the HR of vertebral fracture was 0.97 with a 95% CI, 0.88 to 1.07. Among participants, the risk of fracture was similar irrespective of race distance and number of races run. Participants close to the median finishing time had a lower risk of fracture compared with faster and slower participants. In summary, high levels of physical exercise were associated with a slightly higher risk of fractures of any type, including forearm fractures, but a lower risk of hip, proximal humerus, and lower leg fractures. © 2018 American Society for Bone and Mineral Research.

Emneord
EPIDEMIOLOGY, EXERCISE, FRACTURE PREVENTION, ORTHOPEDICS, OSTEOPOROSIS
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-367531 (URN)10.1002/jbmr.3476 (DOI)000448078300011 ()29933501 (PubMedID)
Tilgjengelig fra: 2018-11-30 Laget: 2018-11-30 Sist oppdatert: 2020-01-19bibliografisk kontrollert
Hållmarker, U., Lindbäck, J., Michaëlsson, K., Ärnlöv, J., Åsberg, S., Wester, P., . . . James, S. K. (2018). Survival and incidence of cardiovascular diseases in participants in a long-distance ski race (Vasaloppet, Sweden) compared to the background population. European Heart Journal - Quality of Care and Clinical Outcomes, 4(2), 91-97
Åpne denne publikasjonen i ny fane eller vindu >>Survival and incidence of cardiovascular diseases in participants in a long-distance ski race (Vasaloppet, Sweden) compared to the background population
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2018 (engelsk)Inngår i: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 4, nr 2, s. 91-97Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

We studied the relationship between taking part in a long-distance ski race and incidence of cardiovascular diseases (CVDs) to address the hypothesis that lifestyle lowers the incidence. A cohort of 399 630 subjects in Sweden, half were skiers in the world's largest ski race, and half were non-skiers. Non-skiers were frequency matched for sex, age, and year of race. Individuals with severe diseases were excluded. The endpoints were death, myocardial infarction, or stroke. The subjects were followed up for a maximum of 21.8 years and median of 9.8 years. We identified 9399 death, myocardial infarction, or stroke events among non-skiers and 4784 among the Vasaloppet skiers. The adjusted hazard ratios (HRs) comparing skiers and non-skiers were 0.52 [95% confidence interval (CI) 0.49-0.54] for all-cause mortality, 0.56 (95% CI 0.52-0.60) for myocardial infarction and 0.63 (95% CI 0.58-0.67) for stroke and for all three outcomes 0.56 (95% CI 0.54-0.58). The results were consistent across subgroups: age, sex, family status, education, and race year. For skiers, a doubling of race time was associated with a higher age-adjusted risk of 19%, and male skiers had a doubled risk than female skiers, with a HR 2.06 (95% CI 1.89-2.41). The outcome analyses revealed no differences in risk of atrial fibrillation between skiers and non-skiers. This large cohort study provides additional support for the hypothesis that individuals with high level of physical activity representing a healthy lifestyle, as evident by their participation in a long-distance ski race, have a lower risk of CVD or death.

sted, utgiver, år, opplag, sider
Oxford University Press, 2018
Emneord
Incidence of cardiovascular disease, Physical activity, Lifestyle, Prevention, Cross-country skiing, Epidemiology, Vasaloppet
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-344291 (URN)10.1093/ehjqcco/qcy005 (DOI)000429458200006 ()29390055 (PubMedID)
Tilgjengelig fra: 2018-03-06 Laget: 2018-03-06 Sist oppdatert: 2019-03-11bibliografisk kontrollert
Hållmarker, U., Michaëlsson, K., Ärnlöv, J., Hellberg, D., Lagerqvist, B., Lindbäck, J. & James, S. K. (2016). Risk of recurrent ischaemic events after myocardial infarction in long-distance ski race participants. European Journal of Preventive Cardiology, 23(3), 282-290
Åpne denne publikasjonen i ny fane eller vindu >>Risk of recurrent ischaemic events after myocardial infarction in long-distance ski race participants
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2016 (engelsk)Inngår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, nr 3, s. 282-290Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

AIMS: To study whether a high level of physical activity prior to myocardial infarction (MI) also protects against recurrent MI (re-MI) or death.

METHODS AND RESULTS: A longitudinal study of a primary cohort consisting of 204,038 skiers with a proved substantially high level of physical activity in the world's largest long-distance ski race, Vasaloppet, and 499,543 non-skiers selected from the Swedish population. Individuals with severe diseases at baseline were excluded. In the nationwide clinical register, Swedeheart, we identified 7092 individuals with a first MI incident between 1989 and 2010. Of these, 1039 (0.5%) were skiers and 6053 (1.2%) were non-skiers. One hundred and sixty-three (15.7%) skiers and 1352 (22.3%) non-skiers suffered a re-MI or died during follow-up (median 4.44 years), corresponding to an incidence rate of 38.9 (95% confidence interval (CI) 33.2-45.4)/1000 person-years and 55.6 (95% CI 52.7-58.7)/1000 person-years, respectively. Severity of MI in both groups was the same. For skiers compared to non-skiers the unadjusted hazard ratio (HR) for re-MI was 0.66 (95% CI 0.52-0.82). For death or re-MI, HR was 0.70 (95% CI 0.59-0.82) with consistent results in subgroups based on race year, age, gender, education level, marital status. After adjustment for also smoking, diabetes, hypertension and cardiovascular medication, HR was 0.80 (95% CI 0.67-0.97).

CONCLUSIONS: This large cohort study supports the hypothesis that patients with MI and with prior physical activity and healthy lifestyle, as evidenced by their participation in a long-distance ski race, have a lower risk of subsequent re-MI or death.

Emneord
Myocardial infarction Cross-country skiing Vasaloppet Physical activity Sports Medicine
HSV kategori
Forskningsprogram
Epidemiologi
Identifikatorer
urn:nbn:se:uu:diva-260137 (URN)10.1177/2047487315578664 (DOI)000369526800007 ()25827685 (PubMedID)
Tilgjengelig fra: 2015-08-17 Laget: 2015-08-17 Sist oppdatert: 2017-12-04bibliografisk kontrollert
Hållmarker, U. (2015). Epidemiological Studies on Long Distance Cross-Country Skiers: Participants in the Vasaloppet 1955-2010. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Åpne denne publikasjonen i ny fane eller vindu >>Epidemiological Studies on Long Distance Cross-Country Skiers: Participants in the Vasaloppet 1955-2010
2015 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The overall aim of this thesis was to study the influence of physical activity on health. Risks and benefits of physical activity is of particular interest since there is a global trend of less physical activity among youths and adults.

In order to investigate this aim we used a database from a large cross country ski race, Vasaloppet, with participants with a wide age range, and with both elite athletes and ordinary people who exercise and promote their health. The most serious risk of strenuous exercise is sudden death and it is challenging to identify preventive effects of major endemic diseases.

Using epidemiological methodology we studied 200 000 Vasaloppet skiers and compared them with the general population. Based on personal identification numbers we added data from Swedish national personal and health registers, clinical registers as the cancer register, Swedeheart, or Swedish stroke register, and socioeconomic information from Statistics Sweden. In the Vasaloppet database we collected data on age, gender, finish time and number of races during the period 1989 to 2010.

We evaluated risk of death during the race in two papers (I,II). During 90 years of annual races, cardiac arrest occurred in 20 skiers, of which five survived. The death rate is in average two per 100 000 skiers.

We also studied the association with cancer incidence (paper III). The overall reduction of cancer was modest among skiers compared with the general population, but for cancers related to lifestyle the risks were markedly lower.

We investigated the risk for recurrent myocardial infarction and found a 30% reduction among skiers (paper IV). In paper V we showed that skiers with a first stroke have a lower incidence of all-cause death. The skiers had a higher frequency of atrial fibrillation but had less severe stroke and no increased risk of recurrent stroke. Thus our data suggest that a lifestyle with a high level of physical activity may work as a protection after a cardiovascular event.

Summary: The short excess mortality in endurance physical activity is by far outweighed by the long term protective effect of exercise in cardiovascular diseases and cancer.

 

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2015. s. 108
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1132
Emneord
Epidemiology, Cohort study, Physical activity, Lifestyle, Prevention, Sports medicine, Cancer, Cardiovascular disease, Mortality, Cardiac arrest, Atrial fibrillation, Myocardial infarction, Stroke, Cross-Country skiing, Vasaloppet, Sweden
HSV kategori
Forskningsprogram
Epidemiologi
Identifikatorer
urn:nbn:se:uu:diva-260994 (URN)978-91-554-9324-0 (ISBN)
Disputas
2015-10-22, Enghoffsalen, ingång 50, Akademiska sjukhuset, Uppsala, 13:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2015-09-30 Laget: 2015-08-27 Sist oppdatert: 2015-10-01
Hållmarker, U., Åsberg, S., Michaëlsson, K., Ärnlöv, J., Hellberg, D., Lindbäck, J., . . . James, S. K. (2015). Risk of Recurrent Stroke and Death After First Stroke in Long‐Distance Ski Race Participants. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 4(10), Article ID e002469.
Åpne denne publikasjonen i ny fane eller vindu >>Risk of Recurrent Stroke and Death After First Stroke in Long‐Distance Ski Race Participants
Vise andre…
2015 (engelsk)Inngår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 4, nr 10, artikkel-id e002469Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background Physical activity is of benefit for primary prevention of cardiovascular diseases, but it appears to increase the risk for atrial fibrillation. We aimed to study a cohort of patients following a first stroke in individuals with previous high physical activity, compare them to the general population with respect to recurrent stroke and death, and relate these to atrial fibrillation.

Methods and Results From the participants of the Vasaloppet, the world's largest ski‐race, and matched individuals from the general population (n=708 604), we identified 5964 patients hospitalized with a first‐time stroke between 1994 and 2010. Individuals with severe diseases were excluded. One half percent of skiers and 1% of nonskiers were hospitalized due to stroke. The incidence rate was 8.3 per 100 person‐years among skiers and 11.1 among nonskiers. The hazard ratio (HR) for recurrent stroke or death between the 2 groups was 0.76 (95% CI 0.67 to 0.86). The result was consistent in subgroups. The HR for death was 0.66 (95% CI 0.56 to 0.78) and for recurrent stroke 0.82 (95% CI 0.70 to 0.96). After adjustment for smoking and socioeconomic factors, the HR for death was consistent at 0.70 (95% CI 0.56 to 0.87) while the HR for recurrent stroke was not statistically significant. Outcomes for skiers with atrial fibrillation tended to show a lower risk than for nonskiers.

Conclusions This large cohort study supports the hypothesis that patients with a stroke and with prior regular physical activity have a lower risk of death, while their risk for recurrent stroke is similar to that of nonskiers. The skiers had a higher incidence of atrial fibrillation, but still no increased risk of recurring stroke.

Emneord
atrial fibrillation; cerebrovascular disease; cross-country skiing; epidemiology; lifestyle; physical activity; prevention; recurrent stroke; sports medicine; Sweden; Vasaloppet
HSV kategori
Forskningsprogram
Epidemiologi
Identifikatorer
urn:nbn:se:uu:diva-260198 (URN)10.1161/JAHA.115.002469 (DOI)000364153000039 ()
Tilgjengelig fra: 2015-08-17 Laget: 2015-08-17 Sist oppdatert: 2019-03-11bibliografisk kontrollert
Organisasjoner
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-2146-7382