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Lindmark, Birgitta
Publications (10 of 27) Show all publications
Vahlberg, B., Lindmark, B., Zetterberg, L., Hellström, K. & Cederholm, T. (2017). Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial. Disability and Rehabilitation, 39(12), 1207-1214
Open this publication in new window or tab >>Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial
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2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 12, p. 1207-1214Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke.

METHODS: In this randomized controlled trial, 43 community-dwelling subjects (65-85 years, mean age 73 ± 5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n = 20) or a control group (n = 23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita®). Physical function was measured using the six-minute walk test.

RESULTS: Complete case analyses revealed reduced fat mass in the IG compared with the control (-1.5 vs. (0).13% of body weight, respectively; effect size =0.62; p = 0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. -10 m, respectively, effect size =0.69, p = 0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r = 0.48, p = 0.038) in the IG.

CONCLUSIONS: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke.

Implications for rehabilitation - This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following:

• Improved walking capacity was associated with a reduction in fat mass.

• IGF-1 is reduced, possibly indicating improved insulin sensitivity.

Keywords
Exercise, fat mass, muscles, postural balance, stroke, walking capacity
National Category
Geriatrics Physiotherapy
Research subject
Geriatrics; Nutrition; Physiotherapy
Identifiers
urn:nbn:se:uu:diva-236914 (URN)10.1080/09638288.2016.1191551 (DOI)000398436100007 ()27341068 (PubMedID)
Note

Title in Thesis list of papers: Body composition and physical function after progressive resistance and balance training among older adults after stroke

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2018-09-03Bibliographically approved
Vahlberg, B., Cederholm, T., Lindmark, B., Zetterberg, L. & Hellström, K. (2017). Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial. Disability and Rehabilitation, 39(16), 1615-1622
Open this publication in new window or tab >>Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial
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2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 16, p. 1615-1622Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals.

MATERIALS AND METHODS: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65-85 years) with a stroke 1-3 years previously were allocated to an intervention group (IG, n = 34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n = 33). The primary outcomes were balance (Berg Balance Scale, 0-56 points) and mobility (Short Physical Performance Battery, 0-12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy.

RESULTS: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p < 0.01) and comfortable walking speed (MD 0.04 versus -0.05 m/s; ES, 0.68; p = 0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes.

CONCLUSIONS: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months. Implications for Rehabilitation A progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke. People with poor balance and motor function discontinued the study more often and may require additional support. There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.

Keywords
Depression; health-related quality of life, high-intensity functional exercise, self-related self-efficacy, walking
National Category
Physiotherapy Neurology Geriatrics
Research subject
Neurology; Geriatrics; Physiotherapy
Identifiers
urn:nbn:se:uu:diva-236912 (URN)10.1080/09638288.2016.1206631 (DOI)000401704500007 ()27415645 (PubMedID)
Note

Title in Thesis list of papers: Effects of Progressive Resistance and Balance training in Chronic Stroke: A Randomized Controlled Trial

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2018-09-10Bibliographically approved
Vahlberg, B., Zetterberg, L., Lindmark, B., Hellström, K. & Cederholm, T. (2016). Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding. BMC Geriatrics, 16, Article ID 48.
Open this publication in new window or tab >>Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 48Article in journal (Refereed) Published
Abstract [en]

Background:Muscle wasting and obesity may complicate the post-stroke trajectory. We investigated the relationshipsbetween nutritional status, body composition, and mobility one to 3 years after stroke.

Methods:Among 279 eligible home-dwelling individuals who had suffered a stroke (except for subarachnoidbleeding) 1–3 years earlier, 134 (74 ± 5 years, 69 % men) were examined according to the Mini NutritionalAssessment-Short Form (MNA-SF, 0–14 points), including body mass index (BMI, kg/m2), body composition bybio-impedance analyses (Tanita BC-545), the Short Physical Performance Battery (SPPB, 0–12 points) combiningwalking speed, balance, and chair stand capacity, and the self-reported Physical Activity Scale for the Elderly (PASE).

Results:BMI≥30 kg/m2was observed in 22 % of cases, and 14 % were at risk for malnutrition according to theMNA-SF. SPPB scores≤8 in 28 % of cases indicated high risk for disability. Mobility based on the SPPB was notassociated with the fat-free mass index (FFMI) or fat mass index (FMI). Multivariate logistic regression indicatedthat low mobility, i.e., SPPB≤8 points, was independently related to risk for malnutrition (OR 4.3, CI 1.7–10.5,P= 0.02), low physical activity (PASE) (OR 6.5, CI 2.0–21.2,P= 0.02), and high age (OR 0.36, CI 0.15–0.85,P= 0.02).Sarcopenia, defined as a reduced FFMI combined with SPPB scores≤8 or reduced gait speed (<1 m/s), was observedin 7 % of cases. None of the individuals displayed sarcopenic obesity (SO), defined as sarcopenia with BMI > 30 kg/m2.

Conclusions:Nutritional disorders, i.e., obesity, sarcopenia, or risk for malnutrition, were observed in about one-thirdof individuals 1 year after stroke. Risk for malnutrition, self-reported physical activity, and age were related to mobility(SPPB), whereas fat-free mass (FFM) and fat mass (FM) were not. Nutrition and exercise treatment could be furtherevaluated as rehabilitation opportunities after stroke

Keywords
mobility limitations, stroke, sarcopenia, muscle atrophy, sarcopen obesitas, physical activity, obesity, malnutrition, aging
National Category
Medical and Health Sciences
Research subject
Geriatrics; Nutrition
Identifiers
urn:nbn:se:uu:diva-236911 (URN)10.1186/s12877-016-0226-1 (DOI)000370483600001 ()26895855 (PubMedID)
Note

Title in Thesis list of papers: Body Composition, Nutritional Status, and Physical Function in Community-Living Individuals 1-2 Years after Suffering a Stroke

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2018-02-22Bibliographically approved
Langhammer, B. & Lindmark, B. (2016). Norwegian General Motor Function assessment as an outcome measure for a frail elderly population: A validity study. Geriatrics & Gerontology International, 16(4), 432-439
Open this publication in new window or tab >>Norwegian General Motor Function assessment as an outcome measure for a frail elderly population: A validity study
2016 (English)In: Geriatrics & Gerontology International, ISSN 1444-1586, E-ISSN 1447-0594, Vol. 16, no 4, p. 432-439Article in journal (Refereed) Published
Abstract [en]

Aim: To establish the validity of the Norwegian General Motor Function (NGMF) assessment scale.

Method: To establish construct and criteria validity, Spearman's rank correlation coefficients were calculated for the NGMF, and age, sex, medical conditions, history of falls and to four functional tests. Content validity was evaluated by asking participating physiotherapists about the usefulness of the items in the scale. Absolute reliability was evaluated by establishing the standard error of measurement and the minimal detectable change at the 95% level of confidence for total scores of the NGMF subscales for dependence, pain and insecurity.

Results: Construct validity was established to medical status and medication with subscales dependence and insecurity but not to subscale pain. Criterion validity was established between the NGMF subscales dependence, pain and insecurity, and the Barthel Index, the Falls Efficacy Scale to subscales dependence and insecurity, but not with pain, and the Timed Up-and-Go test, to subscale insecurity. Neither the Chair Stand Test nor registered falls were significantly associated with any of the subscales of the NGMF. Content validity of the NGMF was perceived relevant to work in a geriatric setting and as a communication tool for a multidisciplinary team. Minimal detectable change was calculated for dependence (2.76), pain (4.9) and insecurity (6.1), respectively.

Conclusion: The construct, criteria and content validity of the NGMF was established. 

Keywords
assessments, Norwegian General Motor Function Assessment Scale, older adults, validity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-295547 (URN)10.1111/ggi.12491 (DOI)000373611800004 ()25952530 (PubMedID)
Available from: 2016-06-08 Created: 2016-06-08 Last updated: 2017-11-30Bibliographically approved
Langhammer, B., Stanghelle, J. K. & Lindmark, B. (2015). Walking ability, independence and health-related quality of life. International Journal of Stroke, 10(S2), 176-176
Open this publication in new window or tab >>Walking ability, independence and health-related quality of life
2015 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, no S2, p. 176-176Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-262148 (URN)000359304001091 ()
Available from: 2015-09-09 Created: 2015-09-09 Last updated: 2017-12-04Bibliographically approved
Langhammer, B., Lindmark, B. & Stanghelle, J. (2014). Are effects of a 1-year long-term intervention period in persons with stroke sustained 3 years after?: The longitudinal follow-up of a randomized controlled trial. Brain Injury, 28(5-6), 556-556
Open this publication in new window or tab >>Are effects of a 1-year long-term intervention period in persons with stroke sustained 3 years after?: The longitudinal follow-up of a randomized controlled trial
2014 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 28, no 5-6, p. 556-556Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-228230 (URN)000335017000102 ()
Available from: 2014-07-10 Created: 2014-07-08 Last updated: 2017-12-05Bibliographically approved
Langhammer, B. & Lindmark, B. (2014). Can balance, sitting, standing static or dynamic balance in persons with acute stroke be a predictor for hand/arm function 1 and 3 years poststroke?. Paper presented at 9th World Stroke Congress, 22-25 October 2014, Istanbul, Turkey. International Journal of Stroke, 9(SI), 231-231
Open this publication in new window or tab >>Can balance, sitting, standing static or dynamic balance in persons with acute stroke be a predictor for hand/arm function 1 and 3 years poststroke?
2014 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 9, no SI, p. 231-231Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-240920 (URN)000345767700655 ()
Conference
9th World Stroke Congress, 22-25 October 2014, Istanbul, Turkey
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2017-12-05Bibliographically approved
Langhammer, B. & Lindmark, B. (2014). General motor function assessment scale: reliability of a Norwegian version. Disability and Rehabilitation, 36(20), 1704-1712
Open this publication in new window or tab >>General motor function assessment scale: reliability of a Norwegian version
2014 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 20, p. 1704-1712Article in journal (Refereed) Published
Abstract [en]

Purpose: The General Motor Function assessment scale (GMF) measures activity-related dependence, pain and insecurity among older people in frail health. The aim of the present study was to translate the GMF into a Norwegian version (N-GMF) and establish its reliability and clinical feasibility. Methods: The procedure used in translating the GMF was a forward and backward process, testing a convenience sample of 30 frail elderly people with it. The intra-rater reliability tests were performed by three physiotherapists, and the inter-reliability test was done by the same three plus nine independent colleagues. The statistical analyses were performed with a pairwise analysis for intra- and inter-rater reliability, using Cronbach's alpha, Percentage Agreement (PA), Svensson's rank transformable method and Cohen's kappa. Results: The Cronbach's alpha coefficients for the different subscales of N-GMF were 0.68 for Dependency, 0.73 for Pain and 0.75 for Insecurity. Intra-rater reliability: The variation in the PA for the total score was 40-70% in Dependence, 30-40% in Pain and 30-60% in Insecurity. The Relative Rank Variant (RV) indicated a modest individual bias and an augmented rank-order agreement coefficient r(a) of 0.96, 0.96 and 0.99, respectively. The variation in the kappa statistics was 0.27-0.62 for Dependence, 0.17-0.35 for Pain and 0.13-0.47 for Insecurity. Inter-rater reliability: The PA between different testers in Dependence, Pain and Insecurity was 74%, 89% and 74%, respectively. The augmented rank-order agreement coefficients were: for Dependence r(a) = 0.97; for Pain, r(a) = 0.99; and for Insecurity, r(a) = 0.99. Conclusion: The N-GMF is a fairly reliable instrument for use with frail elderly people, with intra-rater and inter-rater reliability moderate in Dependence and slight to fair in Pain and Insecurity. The clinical usefulness was stressed in regard to its main focus, the frail elderly, and for communication within a multidisciplinary team.

Keywords
Assessments, general motor function assessment scale, Norway, older adults, reliability
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-237598 (URN)10.3109/09638288.2013.868045 (DOI)000343004700006 ()24344834 (PubMedID)
Available from: 2014-12-04 Created: 2014-12-03 Last updated: 2017-12-05Bibliographically approved
Langhammer, B., Lindmark, B. & Stanghelle, J. K. (2014). Physiotherapy and physical functioning post-stroke: Exercise habits and functioning 4 years later? Long-term follow-up after a 1-year long-term intervention period: A randomized controlled trial. Brain Injury, 28(11), 1396-1405
Open this publication in new window or tab >>Physiotherapy and physical functioning post-stroke: Exercise habits and functioning 4 years later? Long-term follow-up after a 1-year long-term intervention period: A randomized controlled trial
2014 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 28, no 11, p. 1396-1405Article in journal (Refereed) Published
Abstract [en]

Introduction: Physical activity is mandatory if patients are to remain healthy and independent after stroke. Objective: Maintenance of motor function, tone, grip strength, balance, mobility, gait, independence in personal and instrumental activities of daily living, health-related quality-of-life and an active lifestyle 4 years post-stroke. Methods: A prospective randomized controlled trial. Results: Four years post-stroke, 37 of the 75 participating persons were eligible for follow-up; 19 (54.3%) from the intensive exercise group and 18 (45%) from the regular exercise group. Both groups were performing equally well with no significant differences in total scores on the BI (p=0.3), MAS (p=0.4), BBS (p=0.1), TUG (p=0.08), 6MWT (p=0.1), bilateral grip strength (affected hand, p=0.8; non-affected hand, p=0.9) nor in the items of NHP (p>0.005). Independence in performing the IADL was 40%, while 60% had help from relatives or community-based services. Conclusion: This longitudinal study shows that persons with stroke in two groups with different exercise regimes during the first year after stroke did not differ in long-term outcomes. Both groups maintained function and had a relatively active life style 4 years after the acute incident. The results underline the importance of follow-up testing and encouragement to exercise, to motivate and sustain physical activity patterns, to maintain physical function, not only in the acute but also in the chronic phase of stroke.

Keywords
Function, intervention, longitudinal follow-up, rehabilitation, stroke
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-235209 (URN)10.3109/02699052.2014.919534 (DOI)000341969200006 ()24945241 (PubMedID)
Available from: 2014-10-29 Created: 2014-10-29 Last updated: 2017-12-05Bibliographically approved
Langhammer, B. & Lindmark, B. (2014). Predictors for walking capacity after stroke: Sitting, standing static or dynamic balance?. Brain Injury, 28(5-6), 561-561
Open this publication in new window or tab >>Predictors for walking capacity after stroke: Sitting, standing static or dynamic balance?
2014 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 28, no 5-6, p. 561-561Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-228231 (URN)000335017000114 ()
Available from: 2014-07-10 Created: 2014-07-08 Last updated: 2017-12-05Bibliographically approved
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