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  • 1.
    Ahlström, Isabell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Anens, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Reliability of the Swedish version of the Exercise Self-Efficacy Scale (S-ESES): a test-retest study in adults with neurological disease2015In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, no 3, p. 194-199Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the test-retest reliability of the Swedish translated version of the Exercise Self-Efficacy Scale (S-ESES) in people with neurological disease and to examine internal consistency.

    Design: Test-retest study.

    Subjects: A total of 30 adults with neurological diseases including: Parkinson's disease; Multiple Sclerosis; Cervical Dystonia; and Charcot Marie Tooth disease.

    Method: The S-ESES was sent twice by surface mail. Completion interval mean was 16 days apart. Weighted kappa, intraclass correlation coefficient 2,1 [ICC (2,1)], standard error of measurement (SEM), also expressed as a percentage value (SEM%), and Cronbach's alpha were calculated.

    Results: The relative reliability of the test-retest results showed substantial agreement measured using weighted kappa (MD = 0.62) and a very high-reliability ICC (2,1) (0.92). Absolute reliability measured using SEM was 5.3 and SEM% was 20.7. Excellent internal consistency was shown, with an alpha coefficient of 0.91 (test 1) and 0.93 (test 2).

    Conclusion: The S-ESES is recommended for use in research and in clinical work for people with neurological diseases. The low-absolute reliability, however, indicates a limited ability to measure changes on an individual level.

  • 2.
    Ahmadi, Zainab
    et al.
    Univ Lund Hosp, Div Resp Med & Allergol, Dept Clin Sci, SE-22100 Lund, Sweden..
    Lundstrom, Staffan
    Stockholms Sjukhem Fdn, Palliat Care Serv, Stockholm, Sweden.;Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala Univ, Dept Med Sci Resp Med & Allergol, Uppsala, Sweden..
    Strang, Peter
    Stockholms Sjukhem Fdn, Palliat Care Serv, Stockholm, Sweden.;Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Currow, David C.
    Flinders Univ S Australia, Discipline Serv, Adelaide, SA 5001, Australia.;Flinders Univ S Australia, Palliat Serv, Adelaide, SA 5001, Australia.;Flinders Univ S Australia, Support Serv, Adelaide, SA 5001, Australia..
    Ekström, Magnus
    Univ Lund Hosp, Div Resp Med & Allergol, Dept Clin Sci, SE-22100 Lund, Sweden.;Flinders Univ S Australia, Discipline Serv, Adelaide, SA 5001, Australia.;Flinders Univ S Australia, Palliat Serv, Adelaide, SA 5001, Australia.;Flinders Univ S Australia, Support Serv, Adelaide, SA 5001, Australia..
    End-of-life care in oxygen-dependent COPD and cancer: a national population-based study2015In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 46, no 4, p. 1190-1193Article in journal (Refereed)
  • 3.
    Andersson, Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Accuracy of three activity monitors in patients with chronic obstructive pulmonary disease: A comparison with video recordings2014In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 11, no 5, p. 560-567Article in journal (Refereed)
    Abstract [en]

    Low physical activity and sedentary behaviour characterise the lives of patients with chronic obstructive pulmonary disease (COPD). Using activity monitors, assessment of both aspects are possible, but many outcomes are not well validated. The aim of this study was to assess the accuracy and equivalency of three activity monitors regarding steps, body position and their ability to differentiate between periods of physical activity and inactivity.

    Fifteen patients with COPD (8 females; median (interquartile range, IQR) age, 64 (59-69) years; forced expiratory volume in one second, 37 (28-48) % predicted; six-minute walk distance, 444 (410-519) m) were enrolled. The DynaPort ADL-monitor, the DynaPort MiniMod monitor and the SenseWear Armband Pro 3 monitor were assessed. Subjects performed a structured protocol alternating physical activity and inactivity while simultaneously wearing all three monitors and being video recorded.

    The mean difference (limits of agreement) in step count from monitors compared to manual step count was -69 (-443 to 305) for the ADL-monitor, -19 (-141 to 103) for the MiniMod and -479 (-855 to -103) for the SenseWear Armband. Compared to the video, the sitting time was 97 (94-100) % when measured by the ADL-monitor and 121 (110-139) % by the MiniMod. Standing time was 114 (107-122) % when measured by the ADL-monitor and 68 (47-106) % by the MiniMod.

    Activity monitors are not equivalent in their abilities to detect steps or body positions. The choice of monitor should be based on the particular outcome of interest. 

  • 4.
    Andersson, Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Moberg, Linda
    Svantesson, Ulla
    Sundbom, Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Johansson, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Measuring walking speed in COPD: test-retest reliability of the 30-metre walk test and comparison with the 6-minute walk test2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 434-440Article in journal (Refereed)
    Abstract [en]

    AIMS:

    To examine test-retest reliability of the 30-metre walk test (30mWT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the 30mWT with the 6-minute walk test (6MWT).

    METHODS:

    Forty-nine subjects with stable COPD were included. The 30mWT consists of walking at different walking intensities over a distance of 30 metres - self-selected speed (ss-30mWT) and maximal speed (ms-30mWT). The test was conducted twice and the time to walk 30 metres was recorded. The 6MWT was performed in duplicate on the same day.

    RESULTS:

    Test-retest reliability was high: intraclass correlation coefficient (ICC2.1) = 0.93 (95% CI 0.87 to 0.97) for maximal walking speed and 0.87 (95% CI 0.78 to 0.93) for self-selected walking speed. Both maximal and self-selected speed had a standard error of measurement (SEM) of 0.07 m/s and SEM% was 4.4 for maximal speed and 5.9 for self-selected speed. The correlation, criterion validity, between ms-30mWT and the 6MWT was r=0.78 (p<0.001). Heart rate, dyspnoea, exertion and oxygen saturation were more affected after the 6MWT than after the 30mWT (p<0.001).

    CONCLUSIONS:

    The 30mWT is a reliable submaximal test that is easy to perform and can be used to measure physical function (walking ability) in patients with COPD. It may be well suited for primary care settings.

  • 5.
    Andersson, Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Slinde, Frode
    Groenberg, Anne Marie
    Svantesson, Ulla
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Physical activity level and its clinical correlates in chronic obstructive pulmonary disease: a cross-sectional study2013In: Respiratory research (Online), ISSN 1465-9921, E-ISSN 1465-993X, Vol. 14, p. 128-Article in journal (Refereed)
    Abstract [en]

    Background: Decreased physical activity is associated with higher mortality in subjects with COPD. The aim of this study was to assess clinical characteristics and physical activity levels (PALs) in subjects with COPD. Methods: Seventy-three subjects with COPD (67 +/- 7 yrs, 44 female) with one-second forced expiratory volume percentage (FEV1%) predicted values of 43 +/- 16 were included. The ratio of total energy expenditure (TEE) and resting metabolic rate (RMR) was used to define the physical activity level (PAL) (PAL = TEE/RMR). TEE was assessed with an activity monitor (ActiReg), and RMR was measured by indirect calorimetry. Walking speed (measured over 30-meters), maximal quadriceps muscle strength, fat-free mass and systemic inflammation were measured as clinical characteristics. Hierarchical linear regression was applied to investigate the explanatory values of the clinical correlates to PAL. Results: The mean PAL was 1.47 +/- 0.19, and 92% of subjects were classified as physically very inactive or sedentary. The walking speed was 1.02 +/- 0.23 m/s, the quadriceps strength was 31.3 +/- 11.2 kg, and the fat-free mass index (FFMI) was 15.7 +/- 2.3 kg/m(2), identifying 42% of subjects as slow walkers, 21% as muscle-weak and 49% as FFM-depleted. The regression model explained 45.5% (p < 0.001) of the variance in PAL. The FEV1% predicted explained the largest proportion (22.5%), with further improvements in the model from walking speed (10.1%), muscle strength (7.0%) and FFMI (3.0%). Neither age, gender nor systemic inflammation contributed to the model. Conclusions: Apart from lung function, walking speed and muscle strength are important correlates of physical activity. Further explorations of the longitudinal effects of the factors characterizing the most inactive subjects are warranted.

  • 6.
    Andersson, Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Stridsman, Caroline
    Ronmark, Eva
    Lindberg, Anne
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Physical activity and fatigue in chronic obstructive pulmonary disease - A population based study2015In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, no 8, p. 1048-1057Article in journal (Refereed)
    Abstract [en]

    Background: In subjects with chronic obstructive pulmonary disease (COPD), symptoms of fatigue, concomitant heart disease and low physical activity levels are more frequently described than in subjects without COPD. However, there are no population-based studies addressing the relationship between physical activity, fatigue and heart disease in COPD. The aim was to compare physical activity levels among subjects with and without COPD in a population based study, and to evaluate if concomitant heart disease and fatigue was associated to physical activity. Methods: In this, 470 subjects with COPD and 659 subjects without COPD (non-COPD) participated in examinations including structured interview and spirometry. A ratio of the forced expiratory volume in one second (FEV1)/best of forced vital capacity (FVC) and vital capacity (VC) <0.7 was used to define COPD. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ), and fatigue with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F). Results: The prevalence of low physical activity was higher among subjects with FEV1 <80% predicted compared to non-COPD subjects (22.4% vs. 14.6%, p = 0.041). The factors most strongly associated with low physical activity in subjects with COPD were older age, OR 1.52, (95% CI 1.12-2.06), a history of heart disease, OR 2.11 (1.10-4.08), and clinically significant fatigue, OR 2.33 (1.31-4.13); while obesity was the only significant factor among non-COPD subjects, OR 2.26 (1.17-4.35). Conclusion: Physical activity levels are reduced when lung function is decreased below 80% of predicted, and the factors associated with low physical activity are different among subject with and without COPD. We propose that the presence of fatigue and heart disease are useful to evaluate when identifying subjects for pulmonary rehabilitation.

  • 7.
    Andersson, Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Stridsman, Caroline
    Luleå University of Technology.
    Rönmark, Eva
    Umeå University.
    Lindberg, Anne
    Umeå University.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Physical activity and fatigue in chronic obstructive pulmonary disease: A population based studyManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction

    Dyspnea with exertion and fatigue are the cardinal symptoms of chronic obstructive pulmonary disease (COPD); impaired muscle function and reduced exercise capacity are also frequently associated with COPD. We aimed to assess the physical activity levels, in a population based sample study, of subjects with and without COPD. We also aimed to investigate the factors associated with low physical activity in these groups.

    Methods

    In this study, 470 subjects with COPD (FEV1/FVC< 0.70) and 569 subjects without COPD (Non-COPD) were analyzed. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ). Fatigue was investigated with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F). An interview questionnaire was used to record the sample characteristics and history of heart disease. Binary logistic regression was used to investigate the factors associated with low physical activity.

    Results

    Low physical activity was significantly more prevalent in GOLD grade ≥II COPD subjects, and this prevalence was higher than that for Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low physical activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10 - 4.08), and clinically significant fatigue, OR 2.33 (1.31 - 4.13); obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17 – 4.35).

    Conclusion

    Physical activity levels are reduced for COPD grade II and higher, and the factors associated with lower levels of physical activity are different for the COPD group compared to the Non-COPD group. We propose that measurements of fatigue and a history of heart disease are useful tools to include when screening subjects for pulmonary rehabilitation.

  • 8.
    Anens, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Exploratory Study of Physical Activity in Persons With Charcot-Marie-Tooth Disease2015In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 96, no 2, p. 260-268Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore and describe the perceived facilitators and barriers to physical activity, and to examine the physical activity correlates in people with Charcot-Marie-Tooth (CMT) disease. Design: Cross-sectional survey study. Setting: Community-living subjects. Participants: Swedish people with CMT disease (N=44; men, 54.5%; median age, 59.5y [interquartile range, 45.3-64.8y]). Interventions: Not applicable. Main Outcome Measures: The survey included open-ended questions and standardized self-reported scales measuring physical activity, fatigue, activity limitation, self-efficacy for physical activity, fall-related self-efficacy, social support, and enjoyment of physical activity. Physical activity was measured by the Physical Activity Disability Survey-Revised. Results: Qualitative content analysis revealed that personal factors such as fatigue, poor balance, muscle weakness, and pain were important barriers for physical activity behavior. Facilitators of physical activity were self-efficacy for physical activity, activity-related factors, and assistive devices. Multiple regression analysis showed that self-efficacy for physical activity (beta=.41) and fatigue (beta=-.30) explained 31.8% of the variation in physical activity (F-2,F-40=10.78, P=.000). Conclusions: Despite the well-known benefits of physical activity, physical activity in people with CMT disease is very sparsely studied. These new results contribute to the understanding of factors important for physical activity behavior in people with CMT disease and can guide health professionals to facilitate physical activity behavior in this group of patients. (C) 2015 by the American Congress of Rehabilitation Medicine

  • 9.
    Anens, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Physical activity in subjects with multiple sclerosis with focus on gender differences: a survey2014In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 14, p. 47-Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences. Methods: The sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey - Revised, Exercise Self-Efficacy Scale, Falls-Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%. Results: Men were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men. Conclusions: Men were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e. g. men may need more support to be physically active.

  • 10.
    Anens, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Urell, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study2017In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 17, article id 204Article in journal (Refereed)
    Abstract [en]

    Background: The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls self-efficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity.

    Methods: This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey – Revised.

    Results: Multiple regression analyzes showed that 59% (F(6,3)=64.9, p=0.000) of the variation in physical activity was explained by having less severe disease (β=-0.30), being employed (β=0.26), having high falls self-efficacy (β=0.20), having high self-efficacy for physical activity (β=0.17), and enjoying physical activity (β=0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity.

    Conclusions: Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences.

  • 11.
    Arnardóttir, Ragnheiður Harpa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Larsson, Kjell
    Boman, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Peak exercise capacity estimated from incremental shuttle walking test in patients with COPD: A methodological study2006In: Respiratory research (Online), ISSN 1465-9921, E-ISSN 1465-993X, Vol. 7, p. 127-Article in journal (Refereed)
    Abstract [en]

    Background: In patients with COPD, both laboratory exercise tests and field walking tests are used to assess physical performance. In laboratory tests, peak exercise capacity in watts ( W peak) and/or peak oxygen uptake (VO2 peak) are assessed, whereas the performance on walking tests usually is expressed as distance walked. The aim of the study was to investigate the relationship between an incremental shuttle walking test (ISWT) and two laboratory cycle tests in order to assess whether W peak could be estimated from an ISWT.

    Methods: Ninety-three patients with moderate or severe COPD performed an ISWT, an incremental cycle test (ICT) to measure W peak and a semi-steady-state cycle test with breath-by-breath gas exchange analysis (CPET) to measure VO2 peak. Routine equations for conversion between cycle tests were used to estimate W peak from measured VO2 peak (CPET). Conversion equation for estimation of W peak from ISWT was found by univariate regression.

    Results: There was a significant correlation between W peak and distance walked on ISWT x body weight (r=0.88, p<0.0001). The agreement between W peak measured by ICT and estimated from ISWT was similar to the agreement between measured W peak (ICT) and W peak estimated from measured VO2 peak by CPET.

    Conclusion: Peak exercise capacity measured by an incremental cycle test could be estimated from an ISWT with similar accuracy as when estimated from peak oxygen uptake in patients with COPD.

  • 12.
    Arne, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Staffan
    Wilde-Larsson, Bodil
    COPD patients' perspectives at the time of diagnosis: a qualitative study2007In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 16, no 4, p. 215-221Article in journal (Refereed)
    Abstract [en]

    Aims: To gain understanding of chronic obstructive pulmonary disease (COPD) patients´ perspectives and perceptions of their disease at the time of diagnosis. Methods: Qualitative study; grounded theory. Ten patients in primary care in Sweden, newly diagnosed with COPD or diagnosed with suspected COPD were interviewed. Results: The analysis created a process model with a core category “Consequences of smoking” and main categories “Shame”, “Appearance of symptoms”, “Adaptation”, “Reflection”, and “Action”. “Restrictions in physical capacity” was a key indicator of evolving disease and “Getting a diagnosis” was crucial for the patient. Conclusions: The COPD patient needs a clear diagnosis at an early stage. It is important to seize the moment when the presumptive COPD patient is receptive towards support and further action. To detect and support the patient, health professionals must be aware of minor symptoms and underlying mechanisms of possible shame.

  • 13.
    Arne, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Primary Care Res Unit, Karlstad, Sweden.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lisspers, Karin H.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wadell, Karin
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden2016In: European clinical respiratory journal, E-ISSN 2001-8525, Vol. 3, article id 31601Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden.

    METHODS: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support.

    RESULTS: A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients - neither in primary care nor at hospitals.

    CONCLUSION: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

  • 14.
    Arne, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Boman, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    How often is diagnosis of COPD confirmed with spirometry?2010In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, no 4, p. 550-556Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Diagnosis is customarily confirmed with spirometry, but there are few studies on documented spirometry use in everyday clinical practice. Methods: In a cross-sectional survey and study of the medical records of primary and secondary care COPD patients aged 18-75 in a Swedish region, patients with COPD were randomly selected from the registers of 56 primary care centres and 14 hospital outpatient clinics. Spirometry data at diagnosis ±6 months were analyzed. Results: From 1,114 patients with COPD, 533 with a new diagnosis of COPD during the four-year study period were identified. In 59% (n=316), spirometry data in connection with diagnosis were found in the medical records. Spirometry data with post-bronchodilator forced expiratory volume in one second (FEV1)/ vital capacity (VC) ratios were available in 45% (n=241). FEV1/VC ratio <0.70 were found in 160 patients, which corresponds to 30% of the patients with a new diagnosis. Lower age, female gender, current smoking, higher body mass index (BMI) and shorter forced exhalation time were related to COPD diagnosis despite an FEV1/VC ratio of ≥0.70. The most common problem in the quality assessment was an insufficient exhalation time. Conclusions: Only a third of Swedish patients with COPD had their diagnosis confirmed with spirometry. Our data indicate that female gender, current smoking, higher BMI and short exhalation time increase the risk of being diagnosed with COPD without fulfilling the spirometric criteria for the disease.

  • 15.
    Arne, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lundin, Fredrik
    Boman, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Staffan
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Factors associated with good self-rated health and quality of life in subjects with self-reported COPD2011In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 6, p. 511-519Article in journal (Refereed)
    Abstract [en]

    Background: Recent guidelines for chronic obstructive pulmonary disease (COPD) state that COPD is both preventable and treatable. To gain a more positive outlook on the disease it is interesting to investigate factors associated with good, self-rated health and quality of life in subjects with self-reported COPD in the population.

    Methods: In a cross-sectional study design, postal survey questionnaires were sent to a stratified, random population in Sweden in 2004 and 2008. The prevalence of subjects (40–84 years) who reported having COPD was 2.1% in 2004 and 2.7% in 2008. Data were analyzed for 1475 subjects. Regression models were used to analyze the associations between health measures (general health status, the General Health Questionnaire, the EuroQol five-dimension questionnaire) and influencing factors.

    Results: The most important factor associated with good, self-rated health and quality of life was level of physical activity. Odds ratios for general health varied from 2.4 to 7.7 depending on degree of physical activity, where subjects with the highest physical activity level reported the best health and also highest quality of life. Social support and absence of economic problems almost doubled the odds ratios for better health and quality of life.

    Conclusions: In this population-based public health survey, better self-rated health status and quality of life in subjects with self-reported COPD was associated with higher levels of physical activity, social support, and absence of economic problems. The findings indicated that of possible factors that could be influenced, promoting physical activity and strengthening social support are important in maintaining or improving the health and quality of life in subjects with COPD. Severity of the disease as a possible confounding effect should be investigated in future population studies.

  • 16.
    Carsin, Anne-Elie
    et al.
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain;IMIM Hosp Mar Med Res Inst, Barcelona, Spain.
    Fuertes, Elaine
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain.
    Schaffner, Emmanuel
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Jarvis, Debbie
    Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England;Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England.
    Anto, Josep M.
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain;IMIM Hosp Mar Med Res Inst, Barcelona, Spain.
    Heinrich, Joachim
    German Res Ctr Environm Hlth, Helmholtz Zentrum Munchen, Inst Epidemiol 1, Neuherberg, Germany;Ludwig Maximilians Univ Munchen, Comprehens Pneumol Ctr Munich, Inst & Clin Occupat Social & Environm Med, Univ Hosp,German Ctr Lung Res DZL, Munich, Germany.
    Bellisario, Valeria
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy.
    Svanes, Cecilie
    Univ Bergen, Ctr Int Hlth, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Keidel, Dirk
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Imboden, Medea
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Weyler, Joost
    Univ Antwerp, Dept Epidemiol & Social Med ESOC, Stat UA Stat Ctr, Fac Med & Hlth Sci, Antwerp, Belgium.
    Nowak, Dennis
    Ludwig Maximilians Univ Munchen, Comprehens Pneumol Ctr Munich, Inst & Clin Occupat Social & Environm Med, Univ Hosp,German Ctr Lung Res DZL, Munich, Germany.
    Martinez-Moratalla, Jesus
    Univ Castilla La Mancha, Fac Med, Complejo Hosp Univ Albacete, Serv Neumol, Albacete, Spain.
    Gullon, Jose-Antonio
    Hosp San Agustin, Dept Pneumol, Aviles, Asturias, Spain.
    Sanchez Ramos, Jose Luis
    Univ Huelva, Dept Nursing, Huelva, Spain.
    Caviezel, Seraina
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Beckmeyer-Borowko, Anna
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Raherison, Chantal
    Univ Bordeaux, Bordeaux Populat Hlth Res Ctr, INSERM, Team EPICENE,UMR 1219, Bordeaux, France.
    Pin, Isabelle
    CHU Grenoble Alpes, Dept Pediatrie, INSERM,IAB,U1209, Team Environm Epidemiol Appl Reprod & Resp Hlth, Grenoble, France.
    Demoly, Pascal
    Sorbonne Univ, Univ Hosp Montpellier, Montpellier, France.
    Cerveri, Isa
    Univ Pavia, San Matteo Hosp Fdn, IRCCS, Pavia, Italy.
    Accordini, Simone
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland.
    Toren, Kjell
    Inst Med, Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogia, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Gomez Real, Francisco
    Haukeland Hosp, Dept Obstet & Gynecol, Bergen, Norway.
    Raza, Wasif
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Leynaert, Benedicte
    INSERM, UMR 1152, Pathophysiol & Epidemiol Resp Dis, Paris, France;Univ Paris Diderot Paris, UMR 1152, Paris, France.
    Pascual, Silvia
    Galdakao Hosp, Resp Dept, OSI Barrualde Galdakao, Biscay, Spain.
    Guerra, Stefano
    ISGlobal, Barcelona, Spain;Univ Arizona, Asthma & Airway Dis Res Ctr, Tucson, AZ USA.
    Dharmage, Shyamali C.
    Univ Melbourne, Sch Populat & Global Hlth, Allergy & Lung Hlth Unit, Ctr Epidemiol & Biostat, Melbourne, Vic, Australia.
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Garcia-Aymerich, Judith
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain.
    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.

  • 17.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Fysisk aktivitet och träning vid Kroniskt Obstruktiv Lungsjukdom, KOL2012In: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur, 2012, p. 207-217Chapter in book (Other academic)
  • 18.
    Emtner, Margareta
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Department of Neuroscience.
    Arne, Mats
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Sjukgymnastik vid astma.2006In: Astma hos vuxna, AstraZeneca, Södertälje , 2006, p. 437-459Chapter in book (Other (popular scientific, debate etc.))
  • 19.
    Emtner, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Finne, Merja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Stålenheim, Gunnemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    A 3-year follow-up of asthmatic patients participating in a 10-week rehabilitation program with emphasis on physical training1998In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 79, no 5, p. 539-544Article in journal (Refereed)
    Abstract [en]

    Objective: To determine if asthmatic patients who had participated in a 10-week rehabilitation program with emphasis on physical training (1) continued with physical training, (2) maintained their improved cardiovascular condition and lung function, and (3) retained their good asthma control through the following 3 years.

    Design: A descriptive 3-year follow-up study.

    Patients and Setting: A convenience sample of 58 patients who had previously undergone a 10-week outpatient rehabilitation program were followed up 6 months and 1, 1.5, 2, and 3 years after the start of the program at a lung clinic in a university hospital.

    Main Outcome Measures: A training log was kept by each patient to record frequency, intensity, and mode of training. Physical condition was evaluated with a submaximal 6-minute ergometry test and a 12-minute walking test, respiratory function with static and dynamic spirometry, and bronchial hyperreactivity with a metacholine provocation test. Asthma symptoms and asthma control were measured with a study-specific questionnaire.

    Results: Thirty-nine subjects (68%) exercised regularly during all 3 years. The cardiovascular condition and lung function values remained almost unchanged in all 58 patients. There was a significant decrease in number of emergency room visits the year after the 10-week rehabilitation program compared to the year before. It remained stable throughout the following 2 years. There was also a decrease in asthma symptoms in all patients, but the decrease was significant only in a subgroup of 26 patients, who exercised one or two times a week.

    Conclusions: It is possible for asthmatic subjects to exercise at a moderate intensity level on a long-term basis without deleterious effects. Moreover, the high compliance rate might indicate that inactive asthmatic patients who are taught how to exercise choose to continue to be physically active.

  • 20.
    Emtner, Margareta
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Department of Neuroscience.
    Gilliam, H
    Larsson, K
    Behandling av KOL2006Chapter in book (Other (popular scientific, debate etc.))
  • 21.
    Emtner, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hallin, Runa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Arnardóttir, Erna Sif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Effect of physical training on fat-free mass in patients with chronic obstructive pulmonary disease (COPD)2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 1, p. 52-58Article in journal (Refereed)
    Abstract [en]

    Background. Weight loss and depletion of fat-free mass are common problems in patients with chronic obstructive pulmonary disease (COPD) and are related to muscular weakness and exercise intolerance. Physical training of COPD patients has good effect on exercise tolerance and quality of life. The aim of this study was to examine factors that affect change in fat-free mass after physical training, in patients with COPD.

    Patients. Patients were examined before and after a 4-month exercise period. Weight and height were measured, and bioelectrical impedance was performed. Fat-free mass (FFM) was calculated, by a three-compartment model, and fat-free mass index (FFMI) was calculated as FFM kg/m(2) and body mass index (BMI) as kg/m(2). A symptom-limited ramp ergometer test and 12-minute walk test (12MWT) were performed. Dyspnoea score of daily activities was determined by Chronic Respiratory Disease Questionnaire (CRDQ). Blood was taken for analyses of C-reactive protein (CRP) and fibrinogen. Patients with a BMI <21 kg/m(2) were given nutritional support during the training period.

    Results. A total of 27 patients completed the training (64 years, FEV1 31% of predicted). Patients with low FFMI gained 1.2 kg, whereas those with normal FFMI lost 0.7 kg (p = 0.04). In multivariate analyses high age (p = 0.03), low FEV1 (p = 0.02), and a high level of dyspnoea (p = 0.01) at baseline were found to be negative predictors for increase in FFM. Conclusions. Difficulties in increasing the fat-free mass in COPD patients by physical training seem to be associated with dyspnoea in daily life and impaired lung function (FEV1).

  • 22.
    Emtner, Margareta
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Neuroscience.
    Hedin, Anna
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Neuroscience.
    Adherence to and effects of physical activity on health in adults with asthma.2005In: Advances in Physiotherapy, Vol. 7, p. 123-134Article in journal (Refereed)
  • 23.
    Emtner, Margareta
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Neuroscience. Department of Medical Sciences. Enheten för sjukgymnastik.
    Larsson, Kjell
    Fysisk träning bör erbjudas alla KOL-patienter-oavsett sjukdomsgrad.2005In: Läkartidningen: I Motion som Medicin., Vol. 102, no (10), p. 766-771Article in journal (Other (popular scientific, debate etc.))
  • 24.
    Emtner, Margareta
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Lungmedicin och allergologi.
    Olséni, L
    Sjukgymnastik vid KOL2006In: KOL : kroniskt obstruktiv lungsjukdom, Studentlitteratur AB , 2006, p. 301-318Chapter in book (Other (popular scientific, debate etc.))
  • 25.
    Emtner, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Wadell, K.
    Umea Univ, Dept Community Med & Rehabil Physiotherapy, Umea, Sweden..
    Effects of exercise training in patients with chronic obstructive pulmonary disease: a narrative review for FYSS (Swedish Physical Activity Exercise Prescription Book)2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 6, p. 368-391Article, review/survey (Refereed)
    Abstract [en]

    The aims of this review were to determine the level of evidence for exercise training in the management of patients with chronic obstructive pulmonary disease (COPD) and provide evidence-based recommendations on exercise training. This review was performed in PubMed and Cochrane Library. Included studies investigated patients with COPD who had been randomised to exercise training or no training. Six systematic reviews were included. The methodological quality was scored using a grading system (GRADE). The analysis showed that aerobic and resistance training in patients in a stable state of COPD results in improved health-related quality of life and decreased dyspnoea, anxiety and depression (moderately strong scientific evidence, grade +++), and increased physical capacity and decreased dyspnoea in daily activities (limited scientific evidence, grade ++). In patients with an acute exacerbation, aerobic and resistance training, performed directly after the exacerbation, results in improved health-related quality of life (moderately strong scientific evidence, grade +++), improved exercise capacity and decreased mortality and hospitalisation (limited scientific evidence, grade ++). Thus, patients with COPD should be recommended to take part in exercise training.

  • 26.
    Emtner, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Wadell, Karin
    Personer med KOL behöver träna: Ökad fysisk aktivitet kan förbättra livskvalitet, dyspné, kondition och styrka och minska risken för förtida död2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id D6PCArticle in journal (Refereed)
    Abstract [en]

    Persons with COPD should be recommended training Persons with chronic obstructive pulmonary disease (COPD) should be recommended aerobic and resistance training to be able to improve quality of life and physical capacity, and to decrease dyspnoea, anxiety and depression (moderately strong scientific evidence - quality of evidence grade 3). Subjects with an exacerbation should be recommended training at a low intensity in direct connection with the exacerbation to improve quality of life and physical capacity (moderately strong scientific evidence - quality of evidence grade 3), and to lower the risk of mortality and hospitalization (limited scientific evidence - quality of evidence grade 2). Prescription of exercise should be based on assessment of physical capacity. Aerobic exercise can be performed as interval or continuous training. Special attention is needed regarding oxygen saturation, heart rate, blood pressure and subjective rating of dyspnea and leg fatigue.

  • 27.
    Emtner, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Wadell, Karin
    Sjukgymnastik vid KOL2013In: I KOL-Kroniskt Obstruktiv Lungsjukdom / [ed] Kjell Larsson, Lund: Studentlitteratur, 2013, 2, p. 301-318Chapter in book (Other academic)
  • 28.
    Farkhooy, Amir
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Arnardottir, Rangheidur Harpa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Impaired Carbon Monoxide Diffusing Capacity is the Strongest Predictor of Exercise Intolerance in COPD2013In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 10, no 2, p. 180-185Article in journal (Refereed)
    Abstract [en]

    Background: Exercise intolerance is a hallmark of chronic obstructive pulmonary disease (COPD) and forced expiratory volume in one second (FEV1) is the traditional metric used to define the severity of COPD. However, there is dissociation between FEV1 and exercise capacity in a large proportion of subjects with COPD. The aim of this study was to investigate whether other lung function parameters have an additive, predictive value for exercise capacity and whether this differs according to the COPD stage. Methods: Spirometry, body plethysmography and diffusing capacity for carbon monoxide (DLCO) were performed on 88 patients with COPD GOLD stages II-IV. Exercise capacity (EC) was determined in all subjects by symptom-limited, incremental cycle ergometer testing. Results: Significant relationships were found between EC and the majority of lung function parameters. DLCO, FEV1 and inspiratory capacity (IC) were found to be the best predictors of EC in a stepwise regression analysis explaining 72% of EC. These lung function parameters explained 76% of EC in GOLD II, 72% in GOLD III and 40% in GOLD IV. DLCO alone was the best predictor of exercise capacity in all GOLD stages. Conclusions: Diffusing capacity was the strongest predictor of exercise capacity in all subjects. In addition to FEV1, DLCO and IC provided a significantly higher predictive value regarding exercise capacity in COPD patients. This suggests that it is beneficial to add measurements of diffusing capacity and inspiratory capacity when clinically monitoring COPD patients.

  • 29.
    Farkhooy, Amir
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Arnardóttir, Ragnheidur Harpa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Impaired Carbon Monoxide Diffusing Capacity is the strongest lung function predictor of decline in 12 minute-walking distance in COPD: a 5-year follow-up study2015In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 12, no 3, p. 240-248Article in journal (Refereed)
    Abstract [en]

    Background:

    The purpose of this study was to evaluate the longitudinal relationship between functional exercise capacity, assessed through standardized 12-minute walk test (12 MWT), and various lung function parameters obtained using spirometry, body plethysmography and diffusing capacity (DLco) measurements in patients with COPD.

    Methods:

    Spirometry, body plethysmography and DLco-measurements were performed at baseline in 84 subjects with moderate to very severe COPD and at follow-up visit (n = 34) after 5 years. Functional exercise capacity was determined using standardized 12MWT.

    Results:

    Patients were characterized at baseline by FEV1 of 1.2 ± 0.4 L (41 ± 13% predicted), RV of 3.4 ± 1.0 L (187 ± 58% predicted) and DLco of 3.8 ± 1.2 mmol/min/kPa (51 ± 16% predicted). A decrease of 12MWD was found between baseline and follow-up (928 ± 193 m vs. 789 ± 273 m, p < 0.001). DLco and 12MWD at baseline were the only independent predictors of 12MWD at follow-up in a multiple logistic regression model that also included all other lung function parameters, gender, age and BMI. Decline in 12MWD was mainly explained by deterioration in DLco. Furthermore, DLco value at baseline had the highest explanatory value for the loss in 12MWD after 5 years (R2 = 0.18, p = 0.009).

    Conclusions:

    In a 5-year longitudinal study, DLco-measurements at baseline were the most important predictors of declining exercise capacity in COPD patients. These results suggest that integration of DLco in the clinical workup provides a more comprehensive assessment in patients with COPD.

  • 30.
    Fuertes, Elaine
    et al.
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain;Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England.
    Markevych, Iana
    Ludwig Maximilians Univ Munchen, Univ Hosp, Inst & Clin Occupat Social & Environm Med, Munich, Germany;German Res Ctr Environm Hlth, Helmholtz Zentrum Munchen, Inst Epidemiol 1, Neuherberg, Germany.
    Jarvis, Deborah
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England.
    Vienneau, Danielle
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    de Hoogh, Kees
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Maria Anto, Josep
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain.
    Bowatte, Gayan
    Univ Melbourne, Sch Populat & Global Hlth, Ctr Epidemiol & Biostat, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia.
    Bono, Roberto
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy.
    Corsico, Angelo G.
    IRCCS Policlin San Matteo Fdn, Div Resp Dis, Pavia, Italy;Univ Pavia, Dept Internal Med & Therapeut, Pavia, Italy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Gislason, Thorarinn
    Landspitali Univ Hosp Reykjavik, Dept Resp Med & Sleep, Reykjavik, Iceland.
    Antonio Gullon, Jose
    Hosp San Agustin, Dept Pneumol, Aviles, Asturias, Spain.
    Heinrich, Joachim
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England;Ludwig Maximilians Univ Munchen, Univ Hosp, Inst & Clin Occupat Social & Environm Med, Munich, Germany.
    Henderson, John
    Univ Bristol, Britsol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Holm, Mathias
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Johannessen, Ane
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Leynaert, Benedicte
    INSERM, UMR 1152, Pathophysiol & Epidemiol Resp Dis, Paris, France;Univ Paris Diderot Paris, UMR 1152, Paris, France.
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Marchetti, Pierpaolo
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Martinez Moratalla, Jesus
    Complejo Hosp Univ Albacete CHUA, Serv Neumol, Albacete, Spain;Serv Salud Castilla La Mancha SESCAM, Castilla La Mancha, Spain;Univ Castilla La Mancha, Fac Med Albacete, Albacete, Spain.
    Pascual, Silvia
    OSI Barrualde Galdakao, Galdakao Hosp, Resp Dept, Biscay, Spain.
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Dept Publ Hlth, Basel, Switzerland.
    Luis Sanchez-Ramos, Jose
    Univ Huelva, Dept Nursing, Huelva, Spain.
    Siroux, Valerie
    UGA, Inst Adv Biosci, Team Environm Epidemiol Appl Reprod & Resp Hlth, Inserm,U1209,CNRS,UMR 5309, Grenoble, France.
    Sommar, Johan
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden.
    Weyler, Joost
    Univ Antwerp, Epidemiol & Social Med, Antwerp, Belgium.
    Kuenzli, Nino
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Jacquemin, Benedicte
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain;Inst Med Sante & Rech Med, U1168, VIMA Aging & Chron Dis Epidemiol & Publ Hlth Appr, Villejuif, France;Univ Versailles St Quentin En Yvelines, UMR S1168, Versailles, France.
    Garcia-Aymerich, Judith
    ISGlobal, Barcelona, Spain;Univ Pompeu Fabra UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain.
    Residential air pollution does not modify the positive association between physical activity and lung function in current smokers in the ECRHS study2018In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 120, p. 364-372Article in journal (Refereed)
    Abstract [en]

    Background: Very few studies have examined whether a long-term beneficial effect of physical activity on lung function can be influenced by living in polluted urban areas.

    Objective: We assessed whether annual average residential concentrations of nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters < 2.5 mu m (PM2.5) and < 10 mu m (PM10) modify the effect of physical activity on lung function among never- (N = 2801) and current (N = 1719) smokers in the multi-center European Community Respiratory Health Survey. Methods: Associations between repeated assessments (at 27-57 and 39-67 years) of being physically active (physical activity: >= 2 times and >= 1 h per week) and forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated using adjusted mixed linear regression models. Models were conducted separately for never-and current smokers and stratified by residential long-term NO2, PM2.5 mass and PM10 mass concentrations (<= 75th percentile (low/medium) versus > 75th percentile (high)).

    Results: Among current smokers, physical activity and lung function were positively associated regardless of air pollution levels. Among never-smokers, physical activity was associated with lung function in areas with low/medium NO2, PM2.5 mass and PM10 mass concentrations (e.g. mean difference in FVC between active and non-active subjects was 43.0 mL (13.6, 72.5), 49.5 mL (20.1, 78.8) and 49.7 mL (18.6, 80.7), respectively), but these associations were attenuated in high air pollution areas. Only the interaction term of physical activity and PM10 mass for FEV1 among never-smokers was significant (p-value = 0.03).

    Conclusions: Physical activity has beneficial effects on adult lung function in current smokers, irrespective of residential air pollution levels in Western Europe. Trends among never-smokers living in high air pollution areas are less clear.

  • 31.
    Hagman, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Breathing retraining: A five-year follow-up of patients with dysfunctional breathing2011In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 105, no 8, p. 1153-1159Article in journal (Refereed)
    Abstract [en]

    Introduction: The term dysfunctional breathing (DB) has been introduced to describe patients who display divergent breathing patterns and have breathing problems that cannot be attributed to a specific medical diagnosis. Patients with DB are often misdiagnosed as having asthma. Objectives: To describe patients with DB, five years after a breathing retraining intervention. Methods: Out of initially 25 patients with DB and 25 age and sex-matched patients with asthma, 22 patients with DB and 23 patients with asthma (ages 25-78 years) were followed up after five years. Data were collected from posted self-report questionnaires. Only patients with DB had received breathing retraining, consisting of information; advice and diaphragmatic breathing. Patients were evaluated regarding quality of life (SF-36), anxiety, depression, sense of coherence, hyperventilation, influence on daily life, emergency room (ER) visits, and symptoms associated with DB. Results: Quality of life (SF-36), physical component summary scale (PCS), had improved in patients with DB from 43 to 47 (p = 0.03). The number of ER visits had decreased from 18 to 2 in patients with DB (p = 0.02). Symptoms associated with DB had decreased extensively, from a mean score of 6.9 to 2.7, on a DB criterion list (p < 0.001). Patients with DB were less impaired by their breathing problems both in daily life and when exercising (p < 0.001). The only difference found over time in the asthma group concerned quality of health, bodily pain, which had deteriorated, from 77 to 68 (p = 0.049). Conclusion: This five-year follow-up study indicates that patients with dysfunctional breathing benefit from breathing retraining.

  • 32.
    Hallin, Runa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Arnardottir, Harpa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Olsson, Roger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Branth, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemical endocrinology.
    Boman, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Slinde, Frode
    Relation between physical capacity, nutritional status and systemic inflammation in COPD2011In: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 5, no 3, p. 136-142Article in journal (Refereed)
    Abstract [en]

    Background: Decreased physical capacity, weight loss, fat-free mass depletion and systemic inflammation are frequently observed in patients with chronic obstructive pulmonary disease (COPD).

    Objective: Our aim was to examine relations between physical capacity, nutritional status, systemic inflammation and disease severity in COPD.

    Method: Forty nine patients with moderate to severe COPD were included in the study. Spirometry was preformed. Physical capacity was determined by a progressive symptom limited cycle ergo meter test, incremental shuttle walking test, 12-minute walk distance and hand grip strength test. Nutritional status was investigated by anthropometric measurements, (weight, height, arm and leg circumferences and skinfold thickness) and bioelectrical impedance assessment was performed. Blood samples were analyzed for C-reactive protein (CRP) and fibrinogen.

    Result: Working capacity was positively related to forced expiratory volume in 1 s (FEV(1)) (p < 0.001), body mass index and fat free mass index (p = 0.01) and negatively related to CRP (p = 0.02) and fibrinogen (p = 0.03). Incremental shuttle walk test was positively related to FEV(1) (p < 0.001) and negatively to CRP (p = 0.048). Hand grip strength was positively related to fat free mass index, and arm and leg circumferences. Fifty to 76% of the variation in physical capacity was accounted for when age, gender, FEV(1), fat free mass index and CRP were combined in a multiple regression model.

    Conclusion: Physical capacity in chronic obstructive pulmonary disease is related to lung function, body composition and systemic inflammation. A depiction of all three aspects of the disease might be important when targeting interventions in chronic obstructive pulmonary disease.

  • 33.
    Hellström, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Vahlberg, Birgit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Urell, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Fear of falling, fall-related self-efficacy, anxiety and depression in individuals with chronic obstructive pulmonary disease2009In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 12, p. 1136-1144Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the risk and frequency of falls, prevalence of fear of falling and activity avoidance, the magnitude of fall-related self-efficacy, and anxiety and depression in patients with chronic obstructive pulmonary disease. DESIGN AND SETTINGS: A cross-sectional study in patients with a diagnosis of chronic obstructive pulmonary disease who visited a lung clinic at a university hospital in Sweden. SUBJECTS: Successive inclusion from autumn 2005 to spring 2006 of 80 patients with a mean age of 65 years. INTERVENTION: Nil. MAIN MEASURES: A questionnaire about fall history and consequences of fall, The Falls Efficacy Scale, Swedish version, and the Hospital Anxiety and Depression Scale were used. RESULTS: Twenty patients (25%) reported at least one fall in the last year and 29% displayed fear of falling. Odds ratio for falling was 4-5 times higher in patients with severe chronic obstructive pulmonary disease. Older patients, women and patients with previous falls had a higher rate of fear of falling, and those with fear of falling had lower fall-related self-efficacy, increased level of anxiety and depression, more activity avoidance and use of assistive device. CONCLUSION: The increased risk of falls in patients with chronic obstructive pulmonary disease warrants attention in order to reduce serious and adverse health consequences of falls.

  • 34.
    Högman, Marieann
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Cell Biology. integrativ fysiologi.
    Holmkvist, Thomas
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Cell Biology. integrativ fysologi.
    Wegener, Thomas
    Emtner, Margareta
    Department of Medical Sciences. Department of Neuroscience.
    Andersson, Magnus
    Hedenström, Hans
    Department of Medical Sciences.
    Meriläinen, Pekka
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Cell Biology. integrativ fysiologi.
    Extended NO analysis applied to patients with COPD, allergic asthma and allergic rhinitis2002In: Respir Med, Vol. 96, no 24-30Article in journal (Refereed)
  • 35.
    Igelström, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Level of agreement between methods for measuring moderate-to-vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity2013In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 93, no 1, p. 50-59Article in journal (Refereed)
    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.

  • 36.
    Igelström, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    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 eating2013In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, no 4, p. 1257-1266Article in journal (Refereed)
    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.

  • 37.
    Igelström, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Tailored behavioral medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome and overweight2014In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, no 3, p. 655-668Article in journal (Refereed)
    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.

  • 38.
    Igelström, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Martin, Cathrin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Educational Sciences, Department of Education.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Physical activity in sleep apnea and obesity: personal incentives, challenges, and facilitators for success2012In: Behavioural Sleep Medicine, ISSN 1540-2002, E-ISSN 1540-2010, Vol. 10, no 2, p. 122-137Article in journal (Refereed)
    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.

  • 39.
    Igelström, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Improvement in obstructive sleep apnea after a tailored behavioural sleep medicine intervention targeting healthy eating and physical activity: a randomised controlled trial2018In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 22, no 3, p. 653-661Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of the present single-centre randomised controlled trial was to assess the effect of a behavioural sleep medicine (BSM) intervention on obstructive sleep apnea (OSA) severity in patients who have been referred for new treatment with continuous positive airway pressure (CPAP).

    METHODS: After baseline assessment including ventilatory and anthropometric parameters, and physical activity monitoring, 86 patients who were overweight (BMI ≥ 25) and had moderate-severe OSA with apnea-hypopnea index (AHI) ≥ 15 were randomised into a control group (CG; CPAP and advice about weight loss) or an experimental group (ExpG; CPAP and BSM intervention targeting physical activity and eating behaviour). The BSM intervention comprised 10 individual sessions with a dietician and a physiotherapist and included behaviour change techniques such as goal setting and self-monitoring. After 6 months, a new recording of ventilatory parameters was performed without CPAP.

    RESULTS: In ExpG, 40% (n = 14) had improved from severe to moderate or mild OSA or from moderate to mild OSA compared to 16.7% in CG (n = 6, p = 0.02). Further, a lower AHI and amount body fat at baseline were correlated with improvement in severity class. Being in ExpG implied a mean improvement in AHI by 9.7 and an odds ratio of 4.5 for improving in severity classification.

    CONCLUSIONS: The results highlight the clinical importance of lifestyle modifications in conjunction with CPAP treatment in patients with OSA.

  • 40.
    Jerning, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Martinander, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Bjerg, Anders
    Ekerljung, Linda
    Franklin, Karl A.
    Jarvholm, Bengt
    Larsson, Kjell
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, Roelinde
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Asthma and physical activity - A population based study results from the Swedish GA(2)LEN survey2013In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, no 11, p. 1651-1658Article in journal (Refereed)
    Abstract [en]

    Background: Having asthma has in previous reports been related to a lower physical activity level. At the same time the prevalence of asthma among elite athletes is high. The aim of this study was to investigate the association between physical activity level and asthma. Methods: A postal questionnaire was completed by 25,610 individuals in Sweden. Current asthma was defined as having had an asthma attack during the last 12 months or current use of asthma medication. The participants were asked how often and for how many hours a week they were physically active. Results: In the population 1830 subjects (7.1%) had current asthma. There was no significant difference in the proportion of subjects that reported being inactive or slightly physically active between asthmatic and non-asthmatics (57 vs. 58%) while the proportion of subjects that were vigorously physically active (>= 2 times a week and >= 7 h per week) was higher among the subjects with asthma (6.7 vs. 4.8%, p < 0.0001). Being vigorously physically active was independently related to current asthma (OR (95% CI)) 1.40 (1.11-1.77)), wheeze (1.39 (1.17-1.65)), wheeze and breathlessness (1.68 (1.38-2.04)), and wheezing without having a cold (1.39 (1.13-1.71)). The association between being vigorously physically active and wheeze was significantly stronger in women compared to men. Conclusions: There was no difference in the proportion of subjects with a reported low level of physical activity between asthmatics and non-asthmatics. Health care professionals should, however, be aware of the increased prevalence of asthma and asthma-related symptoms in vigorously physically active subjects.

  • 41.
    Johansson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Norlander, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Exercise induced dyspnea among adolescents - prevalence and incidence, a five-year follow-up2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 42.
    Johansson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Norlander, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Exercise test using dry air in random adolescents: temporal profile and predictors of bronchoconstriction2016In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 21, no 2, p. 289-296Article in journal (Refereed)
    Abstract [en]

    Background and objective

    Guidelines recommend exercise tests using dry air to diagnose exercise-induced bronchoconstriction (EIB). Lung function changes subsequent to these tests have not been investigated in a general adolescent population, and it remains unknown whether signs of airway inflammation, measured using exhaled nitric oxide (FeNO), can predict a positive response. The aim of this study was to investigate the temporal aspect of decline in forced expiratory volume in 1 s (FEV1) after an exercise test using dry air, and to investigate predictors of EIB.

    Methods

    From a cross-sectional study on adolescents aged 13–15 years (n = 3838), a random subsample of 146 adolescents (99 with and 47 without self-reported exercise-induced dyspnoea) underwent standardized treadmill exercise tests for EIB while breathing dry air.

    Results

    Of the adolescents, 34% had a positive EIB test (decline of ≥10% in FEV1 from baseline) within 30 min. Of the subjects with EIB, 53% showed the greatest decline in FEV1 at 5 to 10 min (mean decline 18.5%), and the remaining 47% of the subjects showed the greatest decline at 15 to 30 min (mean decline 18.9%) after exercise. Increased FeNO (>20 ppb), female gender and self-reported exercise-induced dyspnoea were independently associated with a positive EIB test.

    Conclusion

    When assessing general adolescents for EIB with exercise test using dry air, there is a temporal variation in the greatest FEV1 decline after exercise. Therefore, lung function should be measured for at least 30 min after the exercise. Increased FeNO, female gender and self-reported exercise-induced dyspnoea can be predictors of a positive EIB test.

  • 43.
    Johansson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Norlander, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population2015In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 70, no 1, p. 57-63Article in journal (Refereed)
    Abstract [en]

    Background Exercise-induced respiratory symptoms are common among adolescents. Exercise is a known stimulus for transient narrowing of the airways, such as exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO). Our aim was to investigate the prevalence of EIB and EILO in a general population of adolescents. Methods In this cross-sectional study, a questionnaire on exercise-induced dyspnoea was sent to all adolescents born in 1997 and 1998 in Uppsala, Sweden (n=3838). A random subsample of 146 adolescents (99 with self-reported exercise-induced dyspnoea and 47 without this condition) underwent standardised treadmill exercise tests for EIB and EILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease of >= 10% in FEV1 from baseline. EILO was investigated using continuous laryngoscopy during exercise. Results The estimated prevalence of EIB and EILO in the total population was 19.2% and 5.7%, respectively. No gender differences were found. In adolescents with exercise-induced dyspnoea, 39.8% had EIB, 6% had EILO and 4.8% had both conditions. In this group, significantly more boys than girls had neither EIB nor EILO (64.7% vs 38.8%; p=0.026). There were no significant differences in body mass index, lung function, diagnosed asthma or medication between the participants with exercise-induced dyspnoea who had or did not have a positive EIB or EILO test result. Conclusions Both EIB and EILO are common causes of exercise-induced dyspnoea in adolescents. EILO is equally common among girls and boys and can coexist with EIB.

  • 44.
    Johansson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Norlander, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Exercise-induced dyspnea is a problem among the general adolescent population2014In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 108, no 6, p. 852-858Article in journal (Refereed)
    Abstract [en]

    Rationale: Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. Objective: To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. Methods: A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). Results: Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often. than the group without EID. No difference was found in the level of physical activity between participants with and without EID. Conclusion: Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms. 

  • 45.
    Johansson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Norlander, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    The relationship between exercise induced bronchial obstruction and health related quality of life in female and male adolescents from a general population2016In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 16, article id 63Article in journal (Other academic)
    Abstract [en]

    Background: Previous studies have observed that exercise-induced bronchoconstriction (EIB) is more common and more strongly related to exercise related breathing problems in female adolescents than male adolescents. However, few studies have investigated the association between EIB and health related quality of life (HRQoL) from a gender perspective. The aim of this study was to examine the association between EIB and HRQoL and physical activity level in female and male adolescents with and without EIB. Methods: From a population based study on exercise-induced breathing problems among adolescents (13-15 years, n = 3838) a cross sectional study with prospective data collection was carried out in a random subsample of 140 adolescents. The subjects in the sample were tested for EIB with a standardised exercise test, of which 49 adolescents were tested positive. HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQL) and the adolescents' physical activity levels were measured objectively with accelerometer. Results: The female subjects with EIB reported a lower HRQoL, both in total score (p = 0.03) and physical functioning score (p = 0.009) and had a lower baseline FEV1 compared to females without EIB (88 vs. 94 % predicted, p = 0.001). No differences were found in HRQoL or baseline lung function between males with or without EIB. There were no differences in minutes of moderate to vigorous physical activity per day between females or males with and without EIB. Conclusion: In a general population, the female adolescents with EIB had lower HRQoL and poorer baseline lung function compared to counterparts without EIB. These differences were not observed in males. EIB does not appear to affect the level of daily physical activity neither in females nor males.

  • 46.
    Jonsson, Marcus
    et al.
    Örebro University.
    Urell, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Westerdahl, Elisabeth
    Örebro University.
    Self-reported physical activity and lung function two months after cardiac surgery: a prospective cohort study2014In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, no 9, p. 59-Article in journal (Refereed)
    Abstract [en]

    Background

    Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported.

    Methods

    Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health’s national survey. Formal lung function testing was performed preoperatively and two months postoperatively.

    Results

    The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p<0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94±11% of preoperative value vs. 91±9%; p=0.03), inspiratory capacity (94±14% vs. 88±19%; p=0.008), and total lung capacity (96±11% vs. 90±11%; p=0.01).

    Conclusions

    An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results.

  • 47. Lindahl, B
    et al.
    Emtner, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Department of Neuroscience. Lungmedicin och allergologi.
    Modell skapar förståelse för beteendeförändring.2007In: Svensk Idrottsmedicin, ISSN 1103-7652, no 4, p. 16-19Article, review/survey (Other (popular scientific, debate etc.))
  • 48.
    Lövström, Ludvig
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    High levels of physical activity are associated with poorer asthma control in young females but not in males2016In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 21, no 1, p. 79-87Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Earlier studies on the levels of physical activity in asthma patients compared with controls have yielded varying results. We have previously reported that high versus moderate levels of physical activity were associated with higher prevalence of wheezing, especially in females. Here we studied the levels of physical activity in young patients with asthma and healthy subjects and their effect on asthma control.

    METHODS: Four hundred eight physician-diagnosed patients with asthma and 118 controls (10-34 years) answered questions concerning frequency and/or duration of physical activity and undertook the Asthma Control Test (ACT), spirometry, methacholine challenges and exhaled nitric oxide measurements.

    RESULTS: Asthma patients were more frequently physically active (P = 0.01) and for longer durations (P = 0.002) than controls. Highly versus moderately physically active patients with asthma had a higher prevalence of not well-controlled asthma (ACT < 20) when physical activity was assessed by frequency (40.6% vs 24.1%, P = 0.001) or duration (39.0% vs 21.7%, P < 0.001). This was only seen in females who had reduced ACT items (P < 0.05). Frequently versus moderately active females had an odds ratio of 4.81 (2.43, 9.51) to have ACT < 20, while no such effect was found in males (OR 1.18 (0.61, 2.30)) and this interaction was statistically significantly associated with gender (P = 0.003). No differences in fraction of exhaled nitric oxide or methacholine reactivity were found between moderately and highly physically active females with asthma.

    CONCLUSION: Young asthma patients were more active than controls. High levels of physical activity were associated with poor asthma control as judged by the ACT in females, but not in males, and this appears unrelated to airway inflammation or responsiveness.

  • 49. Måhlin, Carolina
    et al.
    von Sydow, Henrik
    Osmancevic, Amra
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Grönberg, Anne M
    Larsson, Sven
    Slinde, Frode
    Vitamin D status and dietary intake in a Swedish COPD population2014In: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 8, no 1, p. 24-32Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Emerging evidence indicates that patients with chronic obstructive pulmonary disease (COPD) have a poorer vitamin D status than the general population, possibly affecting several comorbidities. In northern latitudes, these problems could be even more accentuated wintertime because of the low ultraviolet B radiation.

    OBJECTIVES:

    To examine the dietary intake of vitamin D and the levels of 25-hydroxyvitamin D (25-OH-D) in a COPD population compared with a reference group in Swedish settings.

    METHODS:

    Ninety-eight COPD patients (forced expiratory volume in 1 s/vital capacity ratio < 0.65) recruited from the outpatient clinics at the university hospitals in Gothenburg and Uppsala, Sweden were included in this cross-sectional study. The reference group (149 individuals) was randomly selected from the Swedish National Registry. The serum concentrations of 25-OH-D, intact parathyroid hormone, creatinine and calcium were measured. A trained dietitian conducted a dietary history interview to evaluate food intake of vitamin D, prescribed drugs and supplements containing vitamin D.

    RESULTS AND CONCLUSIONS:

    The mean serum concentration of 25-OH-D was significantly higher in the reference group (57.6 ± 23 nmol/L) compared with the COPD group (51.5 ± 22 nmol/L) (P = 0.039). The dietary intake was predominantly below the recommendations in both groups. Mean total daily intake of vitamin D and mean daily supplementation of vitamin D was significantly higher in the COPD group (P = 0.012 and P = 0.030, respectively). Low intake of vitamin D and low serum levels of 25-OH-D are common in both COPD patients and an elderly Swedish population. Monitoring vitamin D status and possibly routinely treating COPD patients with vitamin D and calcium should be considered to minimise the risk of severe vitamin D deficiency among COPD patients.

  • 50.
    Porszasz, Janos
    et al.
    Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center.
    Emtner, Margareta
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Lungmedicin och allergologi.
    Goto, Shinichi
    Tokyo Women’s Medical University School of Medicine.
    Somfay, Attila
    Department of Pulmonology.
    Whipp, Brian J.
    Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center.
    Casaburi, Richard
    Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center.
    Exercise training decreases ventilatory requirements and exercise-induced hyperinflation at submaximal intensities in patients with COPD2005In: Chest, Vol. 128, p. 2025-2034Article in journal (Refereed)
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