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  • 1. Axelsson, John
    et al.
    Ingre, Michael
    Åkerstedt, Torbjörn
    Holmbäck, Ulf
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Institutionen för medicinska vetenskaper.
    Effects of acutely displaced sleep on testosterone.2005Ingår i: J Clin Endocrinol Metab, ISSN 0021-972X, Vol. 90, nr 8, s. 4530-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    CONTEXT: It is not yet clear whether the diurnal variation in testosterone is regulated by circadian or homeostatic (sleep) influences. OBJECTIVE: The present study tested whether testosterone is driven by a circadian-independent sleep effect by shifting sleep acutely to daytime in a 24-h sampling regiment. DESIGN, SETTING, AND PARTICIPANTS: In the sleep laboratory, seven healthy young men (age, 22-32 yr) participated in three conditions: habituation (sleep between 2300-0700 h), night sleep (2300-0700 h), and day sleep (0700-1500 h), the latter two in a balanced order. INTERVENTION AND MAIN OUTCOME MEASURE: Serum testosterone was, in all conditions, sampled by hourly blood drawing for 24 h during constant bed rest. RESULTS: Mean testosterone levels increased as a log-linear function of time (hours) across both sleep periods (b = 4.88; P < 0.001), from 15.3 +/- 2.1 to 25.3 +/- 2.2 nmol/liter during night sleep and from 17.3 +/- 2.1 to 26.4 +/- 2.9 nmol/liter during day sleep. Similarly, mean testosterone levels decreased with time (log-linear) awake (b = -1.80; P < 0.001). There was also evidence of a weak circadian component (acrophase ranging between 0651-0924 h) and an increase with time in the laboratory. Moreover, all these effects, except for the increase during sleep, differed significantly between individuals. CONCLUSION: In conclusion, testosterone increased during sleep and fell during waking, whereas circadian effects seemed marginal. Individual differences were pronounced.

  • 2.
    Bauer, Juergen M.
    et al.
    Carl von Ossietzky Univ Oldenburg, Dept Geriatr Med, D-26133 Oldenburg, Germany..
    Verlaan, Sjors
    Nutricia Adv Med Nutr, Nutricia Res, Utrecht, Netherlands.;Vrije Univ Amsterdam, Med Ctr, Dept Internal Med, Sect Gerontol & Geriatr, Amsterdam, Netherlands..
    Bautmans, Ivan
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Brandt, Kirsten
    Newcastle Univ, Inst Ageing, Sch Agr Food & Rural Dev, Human Nutr Res Ctr, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England..
    Donini, Lorenzo M.
    Univ Roma La Sapienza, Sect Med Pathophysiol Endocrinol & Human Nutr, Dept Expt Med, I-00185 Rome, Italy..
    Maggio, Marcello
    Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Movement Disorders & Prevent Disabil, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Food Sci Unit, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Endocrinol Aging Unit, I-43100 Parma, Italy..
    McMurdo, Marion E. T.
    Univ Dundee, Ninewells Hosp & Med Sch, Ninewells Hosp, Ageing & Hlth, Dundee DD1 9SY, Scotland..
    Mets, Tony
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Seal, Chris
    Newcastle Univ, Inst Ageing, Sch Agr Food & Rural Dev, Human Nutr Res Ctr, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England..
    Wijers, Sander L.
    Nutricia Adv Med Nutr, Nutricia Res, Utrecht, Netherlands..
    Ceda, Gian Paolo
    Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Movement Disorders & Prevent Disabil, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Food Sci Unit, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Endocrinol Aging Unit, I-43100 Parma, Italy..
    De Vito, Giuseppe
    Univ Coll Dublin, Inst Sport & Hlth, Dublin 2, Ireland..
    Donders, Gilbert
    Femicare, Clin Res Women, Tienen, Belgium..
    Drey, Michael
    Klinikum Univ Munchen LMU, Schwerpunkt Akutgeriatrie, Med Klin & Poliklin 4, Munich, Germany..
    Greig, Carolyn
    Univ Birmingham, Sch Sport Exercise & Rehabil Sci, Birmingham, W Midlands, England.;Univ Birmingham, Ctr Musculoskeletal Ageing Res, Birmingham, W Midlands, England..
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Narici, Marco
    Univ Nottingham, Royal Derby Hosp, MRC ARUK Ctr Musculoskeletal Ageing Res, Fac Med, Derby, England..
    McPhee, Jamie
    Manchester Metropolitan Univ, Sch Healthcare Sci, All Saints, Manchester M15 6BH, Lancs, England..
    Poggiogalle, Eleonora
    Univ Roma La Sapienza, Sect Med Pathophysiol Endocrinol & Human Nutr, Dept Expt Med, I-00185 Rome, Italy..
    Power, Dermot
    Mater Misericordiae Univ Hosp, Dept Med Older Persons, Dublin, Ireland.;Univ Coll Dublin, Dublin 2, Ireland..
    Scafoglieri, Aldo
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Schultz, Ralf
    St Marien Hosp, Clin Geriatr, Cologne, Germany..
    Sieber, Cornel C.
    Univ Erlangen Nurnberg, Inst Biomed Ageing, Nurnberg, Germany..
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial2015Ingår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, nr 9, s. 740-747Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could positively influence aspects of sarcopenia and thereby prevent mobility disability. Objective: To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia. Design: A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention. Results: Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): -1.01 seconds (-1.77 to -0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004-0.338), P = .045. Conclusions: This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.

  • 3.
    Branth, Stefan
    et al.
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Institutionen för medicinska vetenskaper. Klinisk kemi.
    Sjödin, Anders
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. klinisk nutrition och metabolism.
    Forslund, Anders
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Institutionen för kvinnors och barns hälsa. Klinisk nutrition och metabolism.
    Hambraeus, Leif
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Klinisk nutrition och metabolism.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Klinisk Nutrition och Metabolism.
    Minor changes in blood lipids after 6 weeks of high-volume low- intensity physical activity with strict energy balance control.2006Ingår i: Eur J Appl Physiol, ISSN 1439-6319, Vol. 96, nr 3, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Physical activity has been shown to favorably affect metabolic risk markers, including blood lipids. The impact of high-energy turnover, without influencing the traditionally used markers of exercise training effects, on blood lipids is still unclear. The aim was to study the effect of high-volume low-intensity physical activity on the blood lipid pattern, with a tight control of diet and energy balance. Eight untrained men [42.5 (12.1) years, body mass index 24.2 (2.8) kg m(-2)] were tested in two different 6-week protocols. In the sedentary protocol, the subjects were instructed to limit their everyday physical activity. In the activity protocol, a 2-h physical activity bout was performed 5 days week(-1) (~40% of VO(2max); equivalent of an additional 21 MJ week(-1) in energy expenditure). The diet for both protocols comprised ~40 energy percent (E%) fat, ~50 E% carbohydrates (CHO). The polyunsaturated fatty acids to saturated fatty acids ratio of the diet was ~0.12. There were no changes during each 6-week period or differences between the two protocols in body weight, body composition or aerobic capacity. Low-intensity physical activity did not affect lipid parameters substantially, except for a slightly lower Apo-B/Apo-A1 ratio with the activity protocol (P<0.05). Total and low-density lipoprotein cholesterol, as well as Apo-B and Apo-A1, were increased during the beginning of each 6-week period (P<0.05), but returned to basal levels by the sixth week. In conclusion, 6 weeks of high-volume low-intensity physical activity did not affect blood lipids substantially.

  • 4.
    Grönberg, Malin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Onkologisk endokrinologi.
    Tsolakis, Apostolos V
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Onkologisk endokrinologi.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Stridsberg, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Grimelius, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Molekylär och morfologisk patologi.
    Janson, Eva T
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Onkologisk endokrinologi.
    Ghrelin and Obestatin in Human Neuroendocrine Tumors: Expression and Effect on Obestatin Levels after Food Intake2013Ingår i: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 97, nr 4, s. 291-299Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Ghrelin and obestatin are derived from the same peptide hormone precursor and are mainly produced by the gastric mucosa. Ghrelin is involved in many biological processes, whereas the physiological function of obestatin needs further investigation. The aims of the present study were to establish the incidence of ghrelin- and obestatin-immunoreactive cells in a comprehensive panel of human neuroendocrine tumors (NETs) and to investigate if blood obestatin concentrations are influenced during a standardized meal stimulation test in healthy individuals and patients with NETs.

    Materials and Methods:

    The expression of ghrelin and obestatin was investigated in NETs (n = 149) and other endocrine-related disorders (n = 3) using immunohistochemistry with specific polyclonal antibodies. Coexpression of the peptides was evaluated by double immunofluorescence. Concentrations of obestatin in blood were measured during a meal test in 6 healthy individuals and 5 patients with pancreatic NETs.

    Results:

    Ghrelin and obestatin were expressed in 14/152 and 19/152 tumor tissues, respectively, mainly representing NETs of foregut origin and in pancreatic tissue from a nesidioblastosis patient. Double immunofluorescence staining showed colocalization of the peptides. During the meal test, obestatin levels in blood were unchanged in all patients but decreased significantly in the healthy individuals.

    Conclusion:

    Only a minority of NETs express ghrelin and obestatin. However, analysis of patients with tumors originating from tissues that express the peptides in normal conditions could be of importance. The results from the meal test indicate that the hormone levels are affected by food intake in healthy individuals, whereas obestatin levels remained unchanged in pancreatic NET patients.

  • 5.
    Holmback, U
    et al.
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Forslund, A
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lowden, A
    Forslund, J
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Åkerstedt, T
    Lennernas, M
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Hambraeus, L
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Stridsberg, M
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Endocrine responses to nocturnal eating - possible implications for nightwork.2003Ingår i: Eur J Nutr, Vol. 42, s. 75-Artikel i tidskrift (Refereegranskat)
  • 6. Holmbäck, Ulf
    et al.
    Berglund, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Sundbom, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Body composition, energy metabolism and endocrine variables in weight stable gastric-bypass patients2013Ingår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 27, nr S1, s. lb309-Artikel i tidskrift (Övrigt vetenskapligt)
  • 7.
    Holmbäck, Ulf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Berglund, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Forslund, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    No Association between Body Composition and Activity Level in Obese Children and Adolescents Due to Low Overall Activity Level2015Ingår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 29, nr 1 SupplementArtikel i tidskrift (Övrigt vetenskapligt)
  • 8.
    Holmbäck, Ulf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Berglund, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Johansson, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Subjective and Objective Assessment of Physical Activity-Influence of Newly Diagnosed Exercise Induced Bronchoconstriction and Gender2017Ingår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 31Artikel i tidskrift (Övrigt vetenskapligt)
  • 9.
    Holmbäck, Ulf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Forslund, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Forslund, Jeanette
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Hambraeus, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lennernäs, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lowden, Arne
    Stridsberg, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Åkerstedt, Torbjörn
    Metabolic responses to nocturnal eating in men are affected by sources of dietary energy2002Ingår i: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 132, nr 7, s. 1892-1899Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Because night work is becoming more prevalent, we studied whether feeding at different times of a 24-h period would elicit different metabolic responses and whether dietary macronutrient composition would affect these responses. Seven men (26-43 y, 19.9-26.6 kg/m(2)) consumed two isocaloric diets, in a crossover design. The diets were a high carbohydrate (HC) diet [65 energy % (E%) carbohydrates, 20E% fat] and a high fat (HF) diet (40E% carbohydrates, 45E% fat). After a 6-d diet-adjustment period, the men were kept awake for 24 h and the food (continuation of respective diet) was provided as six isocaloric meals (i.e., every 4 h). Energy and substrate turnover, heart rate, mean arterial pressure (MAP), blood glucose, triacylglycerol (TAG), nonesterified fatty acid (NEFA) and glycerol were measured throughout the 24-h period. Significantly higher energy expenditure and NEFA concentration, and lower blood glucose and TAG concentrations were observed when the men consumed the HF diet than when they consumed the HC diet. Significant circadian patterns were seen in body and skin temperature (nadir, 0400-0500 h). When the men consumed the HF diet, significant circadian patterns were seen in fat oxidation (nadir, 0800-1200 h; plateau, 1200-0800 h), heat release (nadir, 0800-1200 h; plateau, 1600-0800 h), heart rate (nadir, 0000 h), blood glucose (nadir, 0800-1200 h; peak, 0000-0400 h), NEFA (nadir, 0800-1200 h; peak, 1200-2000 h) and TAG (nadir, 0800-1200 h; peak, 0400-0800 h) concentrations. Energy expenditure, carbohydrate oxidation, MAP and glycerol concentration did not display circadian patterns. Unequal variances eradicated most circadian effects in the HC-diet data. The increased TAG concentration in response to feeding at 0400 h might be involved in the higher TAG concentrations seen in shift workers. Distinct macronutrient/circadian-dependent postprandial responses were seen in most studied variables.

  • 10.
    Holmbäck, Ulf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Fridman, Jennifer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Gustafsson, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Proos, Lemm
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sundelin, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Forslund, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Overweight more prevalent among children than among adolescents2007Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, nr 4, s. 577-581Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims

    To study if there is a change in paediatric overweight/obesity prevalence from 1982 to 2002 in a population with a high proportion of post-graduate education.

    Design

    Two samples of children in Uppsala County, Sweden, were compared: children who were 4, 10 and 16 year old in 1982; or 4, 10 and 16 year old in 2002. Mean BMI (in the lowest 10%, middle 50% and highest 10%) and ISO-BMI ('age adjusted BMI') cut-off values were calculated in each age and gender group.

    Results

    Using the mean BMI or ISO-BMI cut-off values, the BMI-distribution shifted from 1982 to 2002. More 4- and 10-year-old girls and boys were overweight/obese, although this shift was larger in girls. No shift was seen in the 16-year-olds, only the middle 50% group in the 16-year-old girls had a slight increase of their mean BMI. In the 2002 4-year-old, and both 10-year-old samples, a higher proportion of the girls were overweight/obese compared to the boys, but no difference was seen in the 16-year-old sample.

    Conclusion

    Young children, especially girls, have become much more overweight/obese during the past 20 years, despite a high proportion of post-graduate education in the population. The lack of major change in 16-year-olds may suggest a rather recent change in the children's environment/lifestyle.

  • 11.
    Johansson, Henrik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Berglund, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Subjective and objective assessment of physical activity - Influence of newly diagnosed exercise induced bronchoconstriction and gender.2017Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 131, s. 205-209, artikel-id S0954-6111(17)30308-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To investigate if occurrence of newly diagnosed exercise induced bronchoconstriction (EIB) would affect adolescents' ability to assess their physical activity.

    METHODS: 99 selected adolescents with and 47 adolescents without self-reported exercise induced dyspnea were included. All of the 146 adolescents then performed a standardized exercise challenge test on a treadmill with dry-air inhalation to detect EIB. Free living physical activity was assessed during seven days with both accelerometer (objective assessment) and a validated activity diary (subjective assessment). Height, weight and subjective sleep were recorded.

    RESULTS: Out of the 146 adolescents 49 were diagnosed with EIB. Forty-six of the adolescents with EIB (35 girls and 11 boys) and 84 of the control adolescents (45 girls and 39 boys) had complete 7 day activity diary and accelerometer data. There were no differences in age, BMI and sleep between EIB and control adolescents. Boys with EIB overestimated subjective assessment compared to objective assessment more than girls with EIB. No difference was seen between control boys and girls. Furthermore, boys with EIB reported a much higher frequency of high intensity exercise than girls with EIB, but no difference was observed between control boys and girls.

    CONCLUSION: Adolescent boys with newly diagnosed EIB overestimated their physical activity compared to EIB girls. Caution may thus be used when choosing methods measuring level of physical activity in this group and especially when investigating gender differences.

  • 12. Klingenberg, L
    et al.
    Sjödin, A
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Astrup, A
    Chaput, J-P
    Short sleep duration and its association with energy metabolism2012Ingår i: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 13, nr 7, s. 565-577Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A growing body of observational evidence suggests that short sleep duration is a risk factor for the development of obesity. Although increased energy intake is the most prevailing causal explanation for this association, we should also consider possible effects on energy metabolism to understand fully the potential impact of short sleep duration on the regulation of energy balance. We performed a search of the literature from 1970 to 2011, including original papers, investigating the relation between short sleep and energy metabolism in animals and humans. Although the limited number of experimental studies in humans precludes any definitive conclusions about causality, short sleep duration does not seem to substantially affect total daily energy expenditure, nor is there sufficient evidence in support of any meaningful effect of restricted sleep on the specific components of energy metabolism (i.e. resting metabolic rate, intentional as well as unintentional physical activity, diet-induced thermogenesis, and substrate utilization). As studies on rats suggest that other factors that can potentially influence energy metabolism could be affected (i.e. hormonal systems and thermoregulation), we included these factors in our literature search and found some indications in support of an up-regulation of thyroid hormones and glucocorticoids as well as increased heat dissipation following total or severe sleep deficit. Although we found some evidence also in humans that suggests a possible effect on energy metabolism, the limitations of the studies make it difficult to draw conclusions on the effect of short sleep on energy metabolism under relevant free living conditions. To explore this area further, more studies using suitable methodology under relevant conditions to mimic real-life situations are needed.

  • 13. Klingenberg, Lars
    et al.
    Chaput, Jean-Philippe
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Jennum, Poul
    Astrup, Arne
    Sjodin, Anders
    Sleep restriction is not associated with a positive energy balance in adolescent boys2012Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, nr 2, s. 240-248Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A short sleep (SS) duration has been linked to obesity in observational studies. However, experimental evidence of the potential mechanisms of sleep restriction on energy balance is conflicting and, to our knowledge, nonexistent in adolescents.

    Objective: We investigated the effects of 3 consecutive nights of partial sleep deprivation on components of energy balance.

    Design: In a randomized, crossover design, 21 healthy, normal-weight male adolescents (mean +/- SD age: 16.8 +/- 1.3 y) completed the following 2 experimental conditions, each for 3 consecutive nights: an SS (4 h/night) and a long sleep (LS; 9 h/night) duration. Endpoints were 24-h energy expenditure (EE), spontaneous physical activity (SPA), postintervention diet-induced thermogenesis (DIT), appetite sensations, ad libitum energy intake (EI), and profiles of plasma ghrelin and leptin.

    Results: The 24-h EE on day 3 was 370 +/- 496 kJ higher in the SS condition than in the LS condition (P = 0.003). This difference in EE was explained by prolonged wakefulness in the SS condition and a 19% higher SPA (P = 0.003). In a postintervention breakfast-meal challenge, there was a 0.19-kJ/min smaller incremental AUC in DIT over 4 h in the SS condition than in the LS condition (P = 0.012) with no time X condition effect (P = 0.29). Subjects consumed 13% less energy in the ad libitum meal in the SS condition (P = 0.031), with a concomitant decreased motivation to eat. Concentrations of ghrelin and leptin remained unchanged with sleep restriction.

    Conclusion: Short-term sleep restriction in male adolescents is associated with a small negative energy balance driven by increased EE from prolonged wakefulness and a concomitant decreased El and motivation to eat. This trial was registered at clinicaltrials.gov as NCT01198431.

  • 14. Klingenberg, Lars
    et al.
    Chaput, Jean-Philippe
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Visby, Trine
    Jennum, Poul
    Nikolic, Miki
    Astrup, Arne
    Sjodin, Anders
    Acute Sleep Restriction Reduces Insulin Sensitivity in Adolescent Boys2013Ingår i: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 36, nr 7, s. 1085-1090Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Short sleep duration has been linked to impaired glucose metabolism in many experimental studies. Moreover, studies have reported indications of an increased metabolic stress following sleep restriction. Objective: We aimed to investigate the effects of partial sleep deprivation on markers of glucose metabolism. Additionally, we aimed to investigate if short sleep duration induces a state of endocrine stress. Design: A randomized crossover design, with 2 experimental conditions: 3 consecutive nights of short sleep (SS, 4 h/night) and long sleep (LS, 9 h/night) duration. Subjects and Measurements: In 21 healthy, normal-weight male adolescents (mean +/- SD age: 16.8 +/- 1.3 y) we measured pre- and post-prandial glucose, insulin, C-peptide, and glucagon concentrations. Furthermore, we measured fasting cortisol, 24-h catecholamines, and sympathovagal balance. Results: Fasting insulin was 59% higher (P = 0.001) in the SS than the LS condition as was both fasting (24%, P < 0.001) and post-prandial (11%, P = 0.018) C-peptide. Pre- and post-prandial glucose and glucagon were unchanged between conditions. The homeostasis model assessment of insulin resistance (HOMA-IR) index was 65% higher (P = 0.002) and the Matsuda index was 28% lower (P = 0.007) in the SS condition compared to the LS condition. The awakening cortisol response and 24-h norepinephrine were not affected by sleep duration, whereas 24-h epinephrine was 24% lower (P = 0.013) in the SS condition. Neither daytime nor 24-h sympathovagal balance differed between sleep conditions. Short wave sleep was preserved in the SS condition. Conclusion: Short-term sleep restriction is associated with decreased insulin sensitivity in healthy normal-weight adolescent boys. There were no indications of endocrine stress beyond this.

  • 15. Leproult, Rachel
    et al.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Van Canter, Eve
    Circadian Misalignment Augments Markers of Insulin Resistance and Inflammation, Independently of Sleep Loss2014Ingår i: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 63, nr 6, s. 1860-1869Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Shift workers, who are exposed to irregular sleep schedules resulting in sleep deprivation and misalignment of circadian rhythms, have an increased risk of diabetes relative to day workers. In healthy adults, sleep restriction without circadian misalignment promotes insulin resistance. To determine whether the misalignment of circadian rhythms that typically occurs in shift work involves intrinsic adverse metabolic effects independently of sleep loss, a parallel group design was used to study 26 healthy adults. Both interventions involved 3 inpatient days with 10-h bedtimes, followed by 8 inpatient days of sleep restriction to 5 h with fixed nocturnal bedtimes (circadian alignment) or with bedtimes delayed by 8.5 h on 4 of the 8 days (circadian misalignment). Daily total sleep time (SD) during the intervention was nearly identical in the aligned and misaligned conditions (4 h 48 min [5 min] vs. 4 h 45 min [6 min]). In both groups, insulin sensitivity (SI) significantly decreased after sleep restriction, without a compensatory increase in insulin secretion, and inflammation increased. In male participants exposed to circadian misalignment, the reduction in SI and the increase in inflammation both doubled compared with those who maintained regular nocturnal bedtimes. Circadian misalignment that occurs in shift work may increase diabetes risk and inflammation, independently of sleep loss.

  • 16. Lowden, Arne
    et al.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Akerstedt, Torbjörn
    Forslund, Jeanette
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lennernäs, Maria
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Forslund, Anders
    Institutionen för kvinnors och barns hälsa. Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Performance and sleepiness during a 24 h wake in constant conditions are affected by diet.2004Ingår i: Biol Psychol, ISSN 0301-0511, Vol. 65, nr 3, s. 251-63Artikel i tidskrift (Övrigt vetenskapligt)
  • 17. Lowden, Arne
    et al.
    Moreno, Claudia
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Lennernäs, Maria
    Tucker, Philip
    Eating and shift work: effects on habits, metabolism and performance2010Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 36, nr 2, s. 150-162Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Compared to individuals who work during the day, shift workers are at higher risk of a range of metabolic disorders and diseases (eg, obesity, cardiovascular disease, peptic ulcers, gastrointestinal problems, failure to control blood sugar levels, and metabolic syndrome). At least some of these complaints may be linked to the quality of the diet and irregular timing of eating, however other factors that affect metabolism are likely to play a part, including psychosocial stress, disrupted circadian rhythms, sleep debt, physical inactivity, and insufficient time for rest and revitalization. In this overview, we examine studies on food and nutrition among shift workers [ie, dietary assessment (designs, methods, variables) and the factors that might influence eating habits and metabolic parameters]. The discussion focuses on the quality of existing dietary assessment data, nutritional status parameters (particularly in obesity), the effect of circadian disruptions, and the possible implications for performance at work. We conclude with some dietary guidelines as a basis for managing the nutrition of shift workers.

  • 18. Morio, Beatrice
    et al.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Gore, Dennis
    Wolfe, Robert R
    Increased VLDL-TAG turnover during and after acute moderate-intensity exercise.2004Ingår i: Med Sci Sports Exerc, ISSN 0195-9131, Vol. 36, nr 5, s. 801-6Artikel i tidskrift (Övrigt vetenskapligt)
  • 19. Rehman, Javaid-ur
    et al.
    Brismar, Kerstin
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Åkerstedt, Torbjorn
    Axelsson, John
    Sleeping during the day: effects on the 24-h patterns of IGF-binding protein 1, insulin, glucose, cortisol, and growth hormone2010Ingår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 163, nr 3, s. 383-390Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Disturbed sleep is a major risk factor for metabolic disturbances, including type 2 diabetes, but the involved mechanisms are still poorly understood. We investigated how an acute shift of sleep to the daytime affected IGF-binding protein 1 (IGFBP1), which is a risk factor for diabetes. Methods: Seven healthy men (age, 22-32 years) participated in a night sleep condition (sleep 2300-0700 h) and a day sleep condition (0700-1500 h) with hourly blood samples taken for 25 h (starting at 1900 h) and isocaloric meals every 4th hour awake. The blood samples were analyzed for IGFBP1, insulin, GH, glucose, and cortisol. Result: The acute shift of sleep and meal timing (to 8 h) shifted the 24-h patterns of IGFBP1, glucose, insulin, and GH to a similar degree. However, the day sleep condition also resulted in elevated levels of IGFBP1 (area under curve (AUC)+22%, P < 0.05), and reduced glucose levels (AUC-7%, P < 0.05) compared with nocturnal sleep. Sleeping during the day resulted in elevated cortisol levels during early sleep and reduced levels in late sleep, but also in increased levels the subsequent evening (P's < 0.05). Conclusion: Sleep-fasting seems to be the primary cause for the elevation of IGFBP1, irrespective of sleep timing. However, sleeping during the day resulted in higher levels of IGFBP1 than nocturnal sleep, suggesting altered metabolism among healthy individuals, which may have implications for other groups with altered sleep/eating habits such as shift workers. Moreover, sleep and meal times should be accounted for while interpreting IGFBP1 samples.

  • 20.
    Sima, Eduardo
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Sundbom, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Energy Expenditure And Carbohydrate Oxidation In Responders And Non-Responders After Gastric Bypass2016Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, s. S82-S83Artikel i tidskrift (Refereegranskat)
  • 21.
    Skogar, Martin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Hedberg, Jakob
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Risérus, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Sundbom, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Preserved Fat-Free Mass after Gastric Bypass and Duodenal Switch2017Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, nr 7, s. 1735-1740Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Concerns for the possibility of an excessive loss of fat-free mass (FFM) and resting metabolic rate (RMR) after bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) and duodenal switch (BPD/DS), have been raised.

    OBJECTIVES: This study aims to examine body composition and RMR in patients after RYGB and BPD/DS and in non-operated controls.

    METHODS: Body composition and RMR were studied with Bod Pod and indirect calorimetry in weight-stable RYGB (n = 15) and BPD/DS patients (n = 12) and compared with non-operated controls (n = 17). All patients were 30-55 years old and weight stable with BMI 28-35 kg/m(2).

    RESULTS: FFM% was 58% (RYGB), 61% (BPD/DS), and 58% (controls). Body composition did not differ after RYGB and BPD/DS compared to controls, despite 27 and 40% total body weight loss, respectively. No difference in RMR or RMR/FFM was observed (1539, 1617, and 1490 kcal/24 h; and 28.9, 28.4, and 28.8 kcal/24 h/kg).

    CONCLUSION: Weight-stable patients with BMI 28-35 kg/m(2) after RYGB and BPD/DS have a body composition and RMR similar to that of non-operated individuals within the same BMI interval.

  • 22.
    Tollerz, Linda. U. Bratteby
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Forslund, Anders H.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Olsson, Roger. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Lidström, Helene
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik. Linkoping Univ, Dept Social & Welf Studies, Norrkoping, Sweden..
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Children with cerebral palsy do not achieve healthy physical activity levels2015Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, nr 11, s. 1125-1129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimThis study compared daily activity energy expenditure (AEE) in children with cerebral palsy with a control group and investigated whether the children achieved healthy levels of physical activity. MethodsWe enrolled eight children with bilateral cerebral palsy, from eight to 10years of age, and a group of controls matched for age and gender. For three days, physical activity was simultaneously measured by accelerometers and self-reports using a diary. The daily AEE results were compared between groups and methods. The number of children that achieved healthy physical activity levels in each group was explored. ResultsChildren with cerebral palsy had significantly lower daily AEE, as measured by accelerometers, than the controls, and they did not achieve the healthy moderate to heavy physical activity level defined in the Nordic Nutrition Recommendations. Self-reports using the diaries resulted in an overestimation of physical activity compared with the ankle accelerometer measurements in both groups. ConclusionOur investigation of physical activity in children with cerebral palsy and controls using accelerometers and a diary found low levels of daily AEE and physical activity, and these results were most prominent in the group with cerebral palsy. The diaries overestimated physical activity in both groups.

  • 23.
    Vahlberg, Birgit
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Holmbäck, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Eriksson, Staffan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Protocol and pilot study of a short message service-guided training after acute stroke/transient ischemic attack to increase walking capacity and physical activity2018Ingår i: Preventive medicine reports, ISSN 2211-3355, Vol. 11, s. 109-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Physical activity in community-living individuals after a stroke is usually scarce. This protocol describes a study that will evaluate a method to increase physical activity by performing a 3-month outdoor walking and muscle strengthening program and will examine the 3-month and 1-year effects of this program on individuals with acute stroke (AS) or transient ischemic attack (TIA). In a prospective randomized controlled trial in Uppsala, Sweden, 80 individuals with AS or TIA who maintained cognitive and motor function will be randomized into groups for continuous training for three months or for regular standard care. The training will be supervised by daily cellphone-delivered messages (short message services; SMS), and the intensity, duration and workload will be gradually increased. The primary outcome is a change in walking capacity according to the 6-Minute Walk Test and chair-rising at three months. Secondary outcomes include mobility, gait speed, handgrip strength, body composition (fat mass and muscle mass), biochemical risk-markers, health-related quality of life, and cardiovascular events. Adherence to the training program will be documented with a self-reported diary and step counts over two weeks. The major study started in November 2016, and results are expected in 2019. In a pilot study of 15 subjects post-stroke (mean-age 65 years), we observed improved walking capacity (increasing from 23 to 255 m) and chair-rising (decreasing 2.42 s) from baseline to three months. SMS-guided outdoor training will be tested as a potential therapeutic strategy to increase physical activity and thereby improve walking capacity and physical function following a stroke.

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