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Physical Activity and Eating Behaviour Changes in Patients with Obstructive Sleep Apnea Syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. (Behavioural medicine and physiotherapy)
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aimed at developing and evaluating a tailored behavioural sleep medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome (OSAS) and overweight.

Participants with moderate or severe OSAS (apnea-hypopnea index ≥15) and obesity (Studies I-II) or overweight (Studies III-IV), treated with continuous positive airway pressure (CPAP) (Studies I-II) or admitted to CPAP treatment (Studies III-IV), were recruited from the sleep clinic at Uppsala University Hospital, Sweden. Semi-structured individual interviews were analysed using qualitative content analysis (Study I). Data on moderate-to-vigorous physical activity (MVPA) and sedentary time were collected with three measurement methods and analysed regarding the level of measurement agreement (Study II). Potential disease-related and psychological correlates for the amount of MVPA, daily steps and sedentary time were explored using multiple linear regression (Study III). Physical activity and eating behaviour changes were examined after a six month behaviour change trial (Study IV). A tailored behavioural sleep medicine intervention targeting physical activity and healthy eating in combination with first- time CPAP treatment was compared with CPAP treatment and advice on the association between weight and OSAS.

According to participants’ conceptions, a strong incentive is needed for a change in physical activity and bodily symptoms, external circumstances and thoughts and feelings influence physical activity engagement (Study I). Compared with accelerometry, the participants overestimated the level of MVPA and underestimated sedentary time when using self-reports (Study II). The participants spent 11 hours 45 minutes (71.6% of waking hours) while sedentary. Fear of movement contributed to the variation in steps and sedentary time. Body mass index was positively correlated to MVPA (Study III). The experimental group increased intake of fruit and fish and reduced more weight and waist circumference compared with controls. There were no changes in physical activity (Study IV).

The novel tailored behavioural sleep medicine intervention combined with first-time CPAP facilitated eating behaviour change, with subsequent effects on anthropometrics, but it had no effects on physical activity and sedentary time. Fear of movement may be a salient determinant of sedentary time, which has to be further explored in this population. The results confirm sedentary being a construct necessary to separate from the lower end of a physical activity continuum and highlight the need of developing interventions targeting sedentary behaviours specifically.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 885
Keyword [en]
Obstructive sleep apnea, physical activity, eating behaviour, sedentary time, health behaviour change
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-197595ISBN: 978-91-554-8638-9 (print)OAI: oai:DiVA.org:uu-197595DiVA: diva2:613955
Public defence
2013-05-17, Universitetshuset, sal IX, Övre Slottsgatan 2, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-24 Created: 2013-03-29 Last updated: 2013-08-30Bibliographically approved
List of papers
1. Physical activity in sleep apnea and obesity: personal incentives, challenges, and facilitators for success
Open this publication in new window or tab >>Physical activity in sleep apnea and obesity: personal incentives, challenges, and facilitators for success
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2012 (English)In: Behavioural Sleep Medicine, ISSN 1540-2002, E-ISSN 1540-2010, Vol. 10, no 2, 122-137 p.Article in journal (Refereed) Published
Abstract [en]

Background:

Physical activity combined with changes in eating habits is recommended for weight reduction in obstructive sleep apnea (OSA). Studies of how to enhance such health behaviours in persons with OSA and obesity are scarce.

Aim:

To explore aspects associated with engagement in physical activity in individuals with OSA and obesity.

Method:

7 women and 8 men with moderate or severe OSA (apnea-hypopnea index >15) and obesity (mean BMI 38.2) were selected from the Sleep clinic at Uppsala University Hospital, Sweden. Using semi-structured interviews, following content areas were covered: 1) health perceptions and susceptibility, 2) outcome expectations, and 3) facilitating and hindering factors for physical activity. Transcribed data were analysed according to content analysis using researcher triangulation.

Results:

Two comprehensive themes evolved exploring influences on engagement: 1) Incentives strong enough, and 2) Facilitators for success and challenges to overcome. Five categories reflected the meaning of theme 1: Consequences of OSA and obesity, Reasons to devote oneself to physical activity, Perceived benefits, Perceived disadvantages, and Ambivalence. Three categories reflected theme 2: Cognitions, Context, and Disease and physical symptoms.

Conclusion:

What constitutes strong incentives to change seems crucial for the understanding of how physical activity is initiated and maintained. Identified challenges and facilitators concerned a broad spectrum of cognitions and contextual aspects and were not only related to disease and physical symptoms. Future interventions aiming at enhanced physical activity may benefit from integrating these aspects.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-153826 (URN)10.1080/15402002.2011.574763 (DOI)000304277100004 ()22468930 (PubMedID)
Available from: 2011-05-19 Created: 2011-05-19 Last updated: 2017-12-11Bibliographically approved
2. Level of agreement between methods for measuring moderate-to-vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity
Open this publication in new window or tab >>Level of agreement between methods for measuring moderate-to-vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity
2013 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 93, no 1, 50-59 p.Article in journal (Refereed) Published
Abstract [en]

Background

There is ambiguity about what measures to use to best identify physical activity and sedentary behavior, and agreement between methods for measuring physical activity and sedentary behavior in people with obstructive sleep apnea syndrome (OSAS) and obesity has not been evaluated.

Objective

The objective of this study was to examine the level of agreement between an accelerometer and a self-report questionnaire (International Physical Activity Questionnaire [IPAQ]) or a logbook for measuring time spent on moderate to vigorous physical activity and time spent sedentary in people with OSAS and obesity.

Design

This prospective study was a psychometric evaluation of agreement between measurement methods.

Methods

Thirty-nine people who were obese (mean body mass index 36.1 kg/m2, SD=4.35) and had moderate to severe OSAS (apnea-hypopnea index of ≥15) were consecutively recruited from a sleep clinic in Sweden. All were treated with continuous positive airway pressure and were waiting for a follow-up sleep evaluation.

Results

Agreement between the measurement methods was limited. For physical activity, the mean difference between the accelerometer and the IPAQ was 47 minutes, and the mean difference between the accelerometer and the logbook was 32 minutes. Agreement was limited for sedentary time as well; the mean difference between the accelerometer and the IPAQ was 114 minutes, and the mean difference between the accelerometer and the logbook was 86 minutes.

Limitations

The small sample size may affect the interpretation and generalizability of the results.

Conclusions

The results imply that the methods cannot be used interchangeably. A combination of an accelerometer and a daily logbook seems to provide a detailed description of physical activity and sedentary behavior.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181011 (URN)10.2522/ptj.20120123 (DOI)000313320400006 ()
Available from: 2012-09-14 Created: 2012-09-14 Last updated: 2017-12-07Bibliographically approved
3. Physical activity and sedentary time in persons with obstructive sleep apnea and overweight enrolled in a randomized controlled trial for enhanced physical activity and healthy eating
Open this publication in new window or tab >>Physical activity and sedentary time in persons with obstructive sleep apnea and overweight enrolled in a randomized controlled trial for enhanced physical activity and healthy eating
2013 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, no 4, 1257-1266 p.Article in journal (Refereed) Published
Abstract [en]

Background

The aim of the study was to describe the amount of physical activity and sedentary time in patients with obstructive sleep apnea syndrome (OSAS) and overweight, and to explore potential disease-related and psychological correlates.

Methods

A descriptive and correlational study was performed. Prospective data of physical activity and sedentary time were collected through accelerometry, and a one-point measurement of body mass index (BMI), daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms. Seventy-three participants with overweight (mean BMI 35kg/m2 SD 5) and moderate/severe OSAS (Apnea-Hypopnea Index >15) were consecutively recruited. Multivariate associations were determined through multiple linear regression analysis.

Results

The participants took a daily average of 7734 (SD 3528) steps, spent an average of 77 (SD 54) minutes in moderate-to-vigorous physical activity (MVPA), and spent 11h 45 min (SD 2h 8 min) sedentary. BMI, daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms did not explain variance in MVPA or steps, but explained 22.9% of variance in sedentary time. In backward selection analysis, BMI contributed to the explanatory degree of MVPA with 9% whereas, fear of movement explained 6.3% of the variance in steps and 14.3% of the variance in sedentary time.

Conclusions

An important implication for future physical activity interventions is that both physical activity and sedentary behaviors should be targeted, and fear of movement may be an important determinant for change in patients with OSAS and overweight.

National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-197191 (URN)10.1007/s11325-013-0831-6 (DOI)000326928000020 ()
Available from: 2013-03-18 Created: 2013-03-18 Last updated: 2017-12-06Bibliographically approved
4. Tailored behavioral medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome and overweight
Open this publication in new window or tab >>Tailored behavioral medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome and overweight
2014 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, no 3, 655-668 p.Article in journal (Refereed) Published
Abstract [en]

This study aims to evaluate the effects on physical activity (PA) and eating behavior (EB) of a tailored behavioral medicine intervention and first-time continuous positive airway pressure (CPAP) treatment compared with first-time CPAP treatment and advice in patients with obstructive sleep apnea syndrome (OSAS) and overweight. Seventy-three patients (mean +/- SD, 55 +/- 12 years) with overweight (body mass index (BMI), 34.5 +/- 4.8) and moderate or severe OSAS (Apnea-Hypopnea Index, 41.7 +/- 20.9) scheduled for CPAP prescription were randomized to a control group (CPAP and advice on the association between weight and OSAS) or an experimental group (CPAP and a 6-month behavioral medicine intervention targeting PA and EB). At baseline and after 6 months, eating behavior (food frequency screening and Dutch Eating Behavior Questionnaire), weight, BMI, and waist circumference were assessed at one point, while PA and sedentary time were measured with accelerometry during 4 days. The experimental group reduced 2.1 kg (+/- 4.6) in weight and 3 cm (+/- 4.9) in waist circumference, significantly more than the control group. At 6 months, the experimental group ate more fruit and fish/shellfish than the control group. Low and moderate to vigorous PA did not change over time either within or between groups. Regarding BMI, steps, and sedentary time, there were within-group differences but no differences between groups. The behavioral medicine intervention did not change physical activity but facilitated changes in EB in patients with OSAS and overweight. The amount of weight loss and reduction in waist circumference favored the participants receiving this treatment. Since the strategies for achieving behavioral changes were tailored according to the individual's goals and personal functional behavioral analyses and progressed slowly in a graded manner, it might require higher PA quotas or a period longer than 6 months to reveal a behavioral change of larger proportions.

National Category
Respiratory Medicine and Allergy Neurology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-197593 (URN)10.1007/s11325-013-0929-x (DOI)000341820300026 ()
Note

Correction in: Sleep and Breathing, May 2015, Volume 19, Issue 2, p 753

DOI: 10.1007/s11325-015-1147-5

Available from: 2013-03-29 Created: 2013-03-29 Last updated: 2017-12-06Bibliographically approved

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