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  • 1.
    Tsampasian, Vasiliki
    et al.
    Univ East Anglia, England.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Bernardi, Marco
    Sapienza Univ Rome, Italy.
    Cavarretta, Elena
    Sapienza Univ Rome, Italy; Mediterranea Cardioctr, Italy.
    Debski, Maciej
    Univ East Anglia, England.
    Gati, Sabiha
    UK & Imperial Coll London, England.
    Hansen, Dominique
    Jessa Hosp, Belgium; Hasselt Univ, Belgium.
    Kraenkel, Nicolle
    DZHK German Ctr Cardiovasc Res, Germany; Charite Univ Med Berlin, Germany; Charite Univ Med Berlin, Germany.
    Koskinas, Konstantinos C.
    Univ Bern, Switzerland.
    Niebauer, Josef
    Paracelsus Med Univ, Austria.
    Spadafora, Luigi
    Sapienza Univ Rome, Italy.
    Frias Vargas, Manuel
    Univ Complutense Madrid, Spain; San Andres Primary Care Hlth Ctr, Spain.
    Biondi-Zoccai, Giuseppe
    Sapienza Univ Rome, Italy; Mediterranea Cardioctr, Italy.
    Vassiliou, Vassilios S.
    Univ East Anglia, England; Norfolk & Norwich Univ Hosp, England.
    Cardiovascular disease as part of Long COVID: a systematic review2024In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881Article, review/survey (Refereed)
    Abstract [en]

    Aims Long COVID syndrome has had a major impact on million patients' lives worldwide. The cardiovascular system is an important aspect of this multifaceted disease that may manifest in many ways. We have hereby performed a narrative review in order to identify the extent of the cardiovascular manifestations of the Long COVID syndrome.Methods and results An in-depth systematic search of the literature has been conducted for this narrative review. The systematic search of PubMed and Cochrane databases yielded 3993 articles, of which 629 underwent full-text screening. A total of 78 studies were included in the final qualitative synthesis and data evaluation. The pathophysiology of the cardiovascular sequelae of Long COVID syndrome and the cardiac manifestations and complications of Long COVID syndrome are critically evaluated. In addition, potential cardiovascular risk factors are assessed, and preventive methods and treatment options are examined in this review.Conclusion This systematic review poignantly summarizes the evidence from the available literature regarding the cardiovascular manifestations of Long COVID syndrome and reviews potential mechanistic pathways, diagnostic approaches, preventive measures, and treatment options. Graphical Abstract

  • 2.
    Nordanstig, Joakim
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Behrendt, Christian-Alexander
    Asklepios Med Sch, Germany.
    Baumgartner, Iris
    Univ Bern, Switzerland.
    Belch, Jill
    Ninewells Hosp & Med Sch, Scotland.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Fitridge, Robert
    Univ Adelaide, Australia; Royal Adelaide Hosp, Australia.
    Hinchliffe, Robert
    Univ Bristol, England.
    Lejay, Anne
    Univ Hosp, France; Ctr Res Biomed Strasbourg, France.
    Mills, Joseph L.
    Baylor Coll Med, TX USA.
    Rother, Ulrich
    Friedrich Alexander Univ Erlangen Nurnberg FAU, Germany.
    Sigvant, Birgitta
    Orebro Univ, Sweden; Uppsala Univ, Sweden.
    Spanos, Konstantinos
    Univ Thessaly, Greece.
    Szeberin, Zoltan
    Semmelweis Univ, Hungary.
    van de Water, Willemien
    Maastricht Univ Med Ctr, Netherlands.
    Editor's Choice - European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication2024In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 67, no 1Article in journal (Other academic)
  • 3.
    Wittboldt, Susanna
    et al.
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden.
    Ravn Fischer, Annica
    Univ Gothenburg, Sweden.
    Ekman, Björn
    Lund Univ, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Exercise-based cardiac rehabilitation after acute myocardial infarction in Sweden - standards, costs, and adherence to European guidelines (The Perfect-CR study)2024In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 40, no 2, p. 366-376Article in journal (Refereed)
    Abstract [en]

    Aims Information on standards including structure- and process-based metrics and how exercise-based cardiac rehabilitation (EBCR) is delivered in relation to guidelines is lacking. The aims of the study were to evaluate standards and adherence to guidelines at Swedish CR centers and to conduct a cost analysis of the physiotherapy-related activities of EBCR. Methods and Results EBCR standards at all 78 CR centers in Sweden in 2016 were surveyed. The questions were based on guideline-recommended core components of EBCR for patients after a myocardial infarction (MI). The cost analysis included the identification, quantification, and valuation of EBCR-related cost items. Patients were offered a pre-discharge consultation with a physiotherapist at n = 61, 78% of the centers. A pre-exercise screening visit was routinely offered at n = 64, 82% of the centers, at which a test of aerobic capacity was offered in n = 58, 91% of cases, most often as a cycle ergometer exercise test n = 55, 86%. A post-exercise assessment was offered at n = 44, 56% of the centers, with a functional test performed at n = 30, 68%. Almost all the centers n = 76, 97% offered supervised EBCR programs. The total cost of delivering physiotherapy-related activities of EBCR according to guidelines was approximately 437 euro (4,371 SEK) per patient. Delivering EBCR to one MI patient required 11.25 hours of physiotherapy time. Conclusion While the overall quality of EBCR programs in Sweden is high, there are several areas of potential improvement to reach the recommended European standards across all centers. To improve the quality of EBCR, further compliance with guidelines is warranted.

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  • 4.
    Jess, Laura
    et al.
    Univ Gothenburg, Sweden; Narhalsan Bollebygd Rehabil Clin, Sweden.
    Jarfelt, Marianne
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Reliability and validity of self-report questions for assessing levels of physical activity and sedentary time in adult childhood cancer survivors2024In: BMC SPORTS SCIENCE MEDICINE AND REHABILITATION, ISSN 2052-1847, Vol. 16, no 1, article id 66Article in journal (Refereed)
    Abstract [en]

    BackgroundRegular physical activity and limited sedentary time are recommended for adult childhood cancer survivors. The Swedish National Board of Health and Welfare designed a questionnaire to assess levels of physical activity (BHW-Q), including two questions: one on vigorous physical activity (BHW-Q VPA) and one on moderate physical activity (BHW-Q MPA). Furthermore, a single-item question was developed to measure sedentary time (SED-GIH-Q). These questions are recommended for clinical practice and have been found valid for the general population but have so far not been tested in adult childhood cancer survivors. The aim of the study was to assess test-retest reliability, agreement and criterion-related validity of the BHW-Q and the SED-GIH-Q in adult childhood cancer survivors.MethodA non-experimental methodological study. In total 60 participants (50% women), median age 28 (min-max 18-54) years were included at the Long-Term Follow-Up Clinic at Sahlgrenska University Hospital. Participants were instructed to wear an accelerometer for seven days, and to answer the BHW-Q and the SED-GIH-Q before and after the seven days. Test-retest reliability and criterion-related validity comparing the BHW-Q and SED GIH-Q with accelerometer data were calculated with weighted Kappa (k) (agreement) and by using Spearman ' s rho (r) (correlation).ResultsTest-retest reliability regarding the SED-GIH-Q showed a high agreement (k = 0.88) and very strong correlation (r = 0.93), while the BHW-Q showed a moderate agreement and moderately strong correlation, BHW-Q VPA (k = 0.50, r = 0.64), BHW-Q MPA (k = 0.47, r = 0.58). Both the agreement and the correlation of the criterion-related validity were interpreted as fair for the BHW-Q VPA (k = 0.29, r = 0.45), while the agreement for BHW-Q MPA was interpreted as low (k = 0.07), but the correlation as fair (r = 0.37). The agreement of the SED-GIH-Q (k = 0.13) was interpreted as low and the correlation as poor (r = 0.26).ConclusionThese simple questions assessing physical activity and sedentary time can be used as screening tools in clinical practice to identify adult childhood cancer survivors in need of support to increase physical activity level. Further development is needed on the design of a sufficiently valid question measuring sedentary time.Trial registrationThis research project was registered in the Swedish National Database of Research and Development; identifier 275251, November 25, 2020. https://www.researchweb.org/is/vgr/project/275251.

  • 5.
    Michelsen, Halldora Ogmundsdottir
    et al.
    Lund Univ, Sweden; Helsingborg Gen Hosp, Sweden.
    Lidin, Matthias
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Duncan, Therese Scott
    Uppsala Univ, Sweden.
    Ekman, Bjorn
    Lund Univ, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden.
    Hagglund, Maria
    Uppsala Univ, Sweden.
    Lindahl, Bertil
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden.
    Schlyter, Mona
    Skane Univ Hosp, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    The effect of audit and feedback and implementation support on guideline adherence and patient outcomes in cardiac rehabilitation: a study protocol for an open-label cluster-randomized effectiveness-implementation hybrid trial2024In: Implementation Science, E-ISSN 1748-5908, Vol. 19, no 1, article id 35Article in journal (Refereed)
    Abstract [en]

    Background Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs.Methods The study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation.Discussion Optimizing cardiac rehabilitation centres' delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI.Trial registration ClinicalTrials.gov. Identifier: NCT05889416. Registered 2023-03-23.

  • 6.
    Blomqvist, Andreas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Usability and feasibility analysis of an mHealth-tool for supporting physical activity in people with heart failure2024In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 24, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    BackgroundPhysical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial.MethodsA mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively.ResultsTen people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. Feasibility: Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves.ConclusionsIt was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial.Trial registrationClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.

  • 7.
    Jess, Laura
    et al.
    Univ Gothenburg, Sweden; Narhalsan Bollebygd Rehabil Ctr, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Jarfelt, Marianne
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Adult childhood cancer survivors perceptions of factors that influence their ability to be physically active2023In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 31, no 7, article id 409Article in journal (Refereed)
    Abstract [en]

    Purpose Studies indicate that adult childhood cancer survivors do not achieve recommended physical activity levels. A deeper understanding of factors that influence their ability to be physically active is essential to identify individuals in need of support. The aim was to explore factors that influence adult childhood cancer survivors ability to be physically active. Method Semi-structured interviews were conducted from June to October 2020 with 20 adult childhood cancer survivors with a median age of 31 (min-max 20-47) years. Interviews were transcribed verbatim and analyzed with qualitative content analysis. Results Four main categories: "The impact of environmental factors," "Personal factors of importance," "Consequences of the treatment or disease," and "The impact of support from healthcare" and 10 sub-categories, were identified. Participants described how family habits and encouragement from others influenced their present ability to be physically active. Experienced benefits of physical activity were described as a facilitator for current physical activity while suffering from late complications was identified as a barrier. Participants highlighted the importance of specific and individualized physical activity recommendations. Conclusion This study includes adult childhood cancer survivors several years after completion of treatment, hence highlighting the importance for support both during treatment and follow-up to sustain their physical activity. Healthcare providers need to identify individuals suffering from late complications, even several years after treatment; provide individualized physical activity recommendations; and educate families and schools about the importance of physical activity in childhood cancer survivorship.

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  • 8.
    Soloveva, Anzhela
    et al.
    Almazov Natl Med Res Ctr, Russia.
    Gale, Chris P.
    Univ Leeds, England.
    Han, Naung Tun
    Univ Vermont, VT USA.
    Hurdus, Ben
    Univ Leeds, England.
    Aktaa, Suleman
    Leeds Gen Infirm, England.
    Palin, Victoria
    Leeds Gen Infirm, England.
    Mebrahtu, Teumzghi F.
    Bradford Teaching Hosp NHS Fdn Trust, England.
    Van Spall, Harriette
    Populat Hlth Res Inst, Canada; McMaster Univ, Canada.
    Batra, Gorav
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Dondo, Tatendashe Bernadette
    Univ Leeds, England.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Munyombwe, Theresa
    Univ Leeds, England.
    Associations of health-related quality of life with major adverse cardiovascular and cerebrovascular events for individuals with ischaemic heart disease: systematic review, meta-analysis and evidence mapping2023In: Open heart, E-ISSN 2053-3624, Vol. 10, no 2, article id e002452Article, review/survey (Refereed)
    Abstract [en]

    ObjectiveTo investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD).MethodsMedline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the studies. Descriptive synthesis, evidence mapping and random-effects meta-analysis were performed stratified by HRQoL measures and effect estimates. Between-study heterogeneity was assessed using the Higgins I2 statistic.ResultsFifty-one articles were included with a total of 134 740 participants from 53 countries. Meta-analysis of 23 studies found that the risk of MACCE increased with lower baseline HeartQoL score (HR 1.49, 95% CI 1.16 to 1.93) and Short Form Survey (SF-12) physical component score (PCS) (HR 1.39, 95% CI 1.28 to 1.51). Risk of all-cause mortality increased with a lower HeartQoL (HR 1.64, 95% CI 1.34 to 2.01), EuroQol 5-dimension (HR 1.17, 95% CI 1.12 to 1.22), SF-36 PCS (HR 1.29, 95% CI 1.19 to 1.41), SF-36 mental component score (HR 1.18, 95% CI 1.08 to 1.30).ConclusionsThis study found an inverse association between baseline values or change in HRQoL and MACCE or components of MACCE in individuals with IHD, albeit with between-study heterogeneity. Standardisation and routine assessment of HRQoL in clinical practice may help risk stratify individuals with IHD for tailored interventions.PROSPERO registration numberCRD42021234638.

  • 9.
    Leosdottir, Margret
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Dahlbom, Lars
    Bollnas Hosp, Sweden; Uppsala Clin Res Ctr, Sweden.
    Ekstrom, Mattias
    Karolinska Inst, Sweden.
    Lindahl, Bertil
    Uppsala Clin Res Ctr, Sweden; Uppsala Univ, Sweden.
    Hagstrom, Emil
    Uppsala Clin Res Ctr, Sweden; Uppsala Univ, Sweden.
    Cohort profile: Data standards for cardiac rehabilitation structure and processes for the SWEDEHEART cardiac rehabilitation (SWEDEHEART-CR) registry2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 11, article id e0293840Article in journal (Refereed)
    Abstract [en]

    Data standards for quality registries should be evidence-based and follow guideline recommendations. To optimally monitor quality of care, not only patient-level variables, but also centre-level variables need to be included. Here we describe the development of variables to audit the structure and processes in cardiac rehabilitation for patients after myocardial infarction, and the resulting data standards to be implemented in the Swedish quality registry for cardiac disease, SWEDEHEART. The methodology used for the development of international clinical data standards for the European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) was followed. Based on national guidelines for secondary prevention, candidate variables were prepared, after which a multiprofessional expert group on cardiac rehabilitation selected key variables and assured face validity. An external reference group had the role of peer reviewing, ascertaining content validity and test-retest reliability. The process has resulted in 30 data standards to be introduced into the SWEDEHEART cardiac rehabilitation registry and administered on centre-level biannually. The data standards include measures of human resources, centre requirements and process-based metrics. Including registry variables which audit centre-level structure and processes is essential to improve benchmarking and standardize monitoring of quality of care, covering both services provided and patient outcomes.

  • 10.
    Borg, Sabina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Alfredsson, Joakim
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine.
    Soderlund, Anne
    Malardalen Univ, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Effectiveness of a behavioral medicine intervention in physical therapy on secondary psychological outcomes and health-related quality of life in exercise-based cardiac rehabilitation: a randomized, controlled trial2023In: BMC SPORTS SCIENCE MEDICINE AND REHABILITATION, ISSN 2052-1847, Vol. 15, no 1, article id 42Article in journal (Refereed)
    Abstract [en]

    BackgroundInterventions promoting adherence to exercise-based cardiac rehabilitation (exCR) are important to achieve positive physical and psychological outcomes, but knowledge of the added value of behavioral medicine interventions for these measures is limited. The aim of the study was to investigate the added value of a behavioral medicine intervention in physical therapy (BMIP) in routine exCR on psychological outcomes and health-related quality of life (HRQoL) versus routine exCR alone (RC).MethodsA total of 170 patients with coronary artery disease (136 men), mean age 62.3 +/- 7.9 years, were randomized at a Swedish university hospital to a BMIP plus routine exCR or to RC for four months. The outcome assessments included HRQoL (SF-36, EQ-5D), anxiety and depression (HADS), patient enablement and self-efficacy and was performed at baseline, four and 12 months. Between-group differences were tested with an independent samples t-test and, for comparisons within groups, a paired t-test was used. An intention-to-treat and a per-protocol analysis were performed.ResultsNo significant differences in outcomes between the groups were shown between baseline and four months or between four and 12 months. Both groups improved in most SF-36 domains, EQ-VAS and HADS anxiety at the four-month follow-up and sufficient enablement remained at the 12-months follow-up.ConclusionA BMIP added to routine exCR care had no significant effect on psychological outcomes and HRQoL compared with RC, but significant improvements in several measures were shown in both groups at the four-month follow-up. Since recruited participants showed a better psychological profile than the general coronary artery disease population, further studies on BMIP in exCR, tailored to meet individual needs in broader patient groups, are needed.Trial registration number NCT02895451, 09/09/2016, retrospectively registered.

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  • 11.
    Pedretti, Roberto F. E.
    et al.
    IRCCS MultiMed, Italy.
    Hansen, Dominique
    Hasselt Univ, Belgium; Jessa Hosp, Belgium.
    Ambrosetti, Marco
    Santa Marta Hosp, Italy.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Berger, Thomas
    St John God Hosp Linz, Austria.
    Ferreira, Mariana Cordeiro
    Ctr Univ Hosp Lisboa Norte, Portugal.
    Cornelissen, Veronique
    Katholieke Univ Leuven, Belgium.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Doehner, Wolfram
    Charite Univ Med Berlin, Germany; Charite Univ Med Berlin & German, Germany; Ctr Cardiovasc Res DZHK, Germany; Charite Univ Med Berlin, Germany.
    Zarzosa, Carmen de Pablo Y.
    Univ Hosp Ramon Y Cajal, Spain.
    Frederix, Ines
    Hasselt Univ, Belgium; Univ Antwerp, Belgium; Antwerp Univ Hosp, Belgium.
    Greco, Andrea
    Univ Bergamo, Italy.
    Kurpas, Donata
    Wroclaw Med Univ, Poland.
    Michal, Matthias
    Univ Med Ctr Mainz, Germany; German Ctr Cardiovasc Res DZHK, Germany.
    Osto, Elena
    Univ & Univ Hosp Zurich, Switzerland; Univ & Univ Hosp Zurich, Switzerland.
    Pedersen, Susanne
    Univ Southern Denmark, Denmark; Odense Univ Hosp, Denmark.
    Salvador, Rita Esmeralda
    Vienna , Austria.
    Simonenko, Maria
    Almazov Natl Med Res Ctr, Russia.
    Steca, Patrizia
    Univ Milano Bicocca, Italy.
    Thompson, David R.
    Queens Univ Belfast, North Ireland.
    Wilhelm, Matthias
    Univ Bern, Switzerland.
    Abreu, Ana
    Univ Lisbon, Portugal; Univ Lisbon, Portugal; Univ Lisbon, Portugal.
    How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology2023In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 30, no 2, p. 149-166Article in journal (Refereed)
    Abstract [en]

    A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.

  • 12.
    Nilsson, Ulrika
    et al.
    Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden.
    Öberg, Birgitta
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Bäck, Maria
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; Insitute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Patients' Perceptions of Exercise-Based Cardiac Telerehabilitation after a Myocardial Infarction-A Qualitative Study2023In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, no 7, article id 5420Article in journal (Refereed)
    Abstract [en]

    To be able to design telerehabilitation programs targeting the needs and preferences of end-users, patients' in-depth perspectives are needed. To date, such studies are lacking and, therefore, the aim of the present study was to describe patients' perceptions of performing exercise-based cardiac telerehabilitation after a myocardial infarction (MI). Individual semi-structured interviews were performed with 15 patients (3 women, median age 69 years) after an MI who had participated in exercise-based cardiac telerehabilitation for three months. The interviews were transcribed verbatim and analyzed with inductive content analysis. An overall theme was defined as "Cardiac telerehabilitation-a new alternative for exercising that is easily accessible and up to date". Four categories, including "The important role of a physical therapist with expert knowledge", "Prerequisites playing an important role in the willingness to participate", "Making exercise accessible and adjustable" and "Inspiring future exercise", and 15 subcategories were identified. Understanding the patient's perspective is an important key to further improving and successfully implementing exercise-based cardiac telerehabilitation, as an alternative or adjunct to traditional, centre-based programs. The findings can serve to improve patient-physiotherapist interactions and to inform important aspects related to exercise, technology and a sense of security from an exercise-based cardiac telerehabilitation program.

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  • 13.
    Leosdottir, Margret
    et al.
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden.
    Hadziosmanovic, Nermin
    Uppsala Clin Res Ctr, Sweden.
    Norhammar, Anna
    Karolinska Inst, Sweden; Capio Sankt Gorans Sjukhus, Sweden.
    Lindahl, Bertil
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden.
    Hambraeus, Kristina
    Falun Cent Hosp, Sweden.
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Temporal trends in cardiovascular risk factors, lifestyle and secondary preventive medication for patients with myocardial infarction attending cardiac rehabilitation in Sweden 2006-2019: a registry-based cohort study2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 5, article id e069770Article in journal (Refereed)
    Abstract [en]

    ObjectivesRegistries have been highlighted as means to improve quality of care. Here, we describe temporal trends in risk factors, lifestyle and preventive medication for patients after myocardial infarction (MI) registered in the quality registry Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). DesignA registry-based cohort study. SettingAll coronary care units and cardiac rehabilitation (CR) centres in Sweden. ParticipantsPatients attending a CR visit at 1-year post-MI 2006-2019 were included (n=81 363, 18-74 years, 74.7% men). Outcome measuresOutcome measures at 1-year follow-up included blood pressure (BP) <140/90 mm Hg, low-density lipoprotein-cholesterol (LDL-C)<1.8 mmol/L, persistent smoking, overweight/obesity, central obesity, diabetes prevalence, inadequate physical activity, and prescription of secondary preventive medication. Descriptive statistics and testing for trends were applied. ResultsThe proportion of patients attaining the targets for BP<140/90 mmHg increased from 65.2% (2006) to 86.0% (2019), and LDL-C<1.8 mmol/L from 29.8% (2006) to 66.9% (2019, p<0.0001 both). While smoking at the time of MI decreased (32.0% to 26.5%, p<0.0001), persistent smoking at 1 year was unchanged (42.8% to 43.2%, p=0.672) as was the prevalence of overweight/obesity (71.9% to 72.9%, p=0.559). Central obesity (50.5% to 57.0%), diabetes (18.2% to 27.2%) and patients reporting inadequate levels of physical activity (57.0% to 61.5%) increased (p<0.0001 for all). From 2007, >90.0% of patients were prescribed statins and approximately 98% antiplatelet and/or anticoagulant therapy. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription increased from 68.7% (2006) to 80.2% (2019, p<0.0001). ConclusionsWhile little change was observed for persistent smoking and overweight/obesity, large improvements were observed for LDL-C and BP target achievements and prescription of preventive medication for Swedish patients after MI 2006-2019. Compared with published results from patients with coronary artery disease in Europe during the same period, these improvements were considerably larger. Continuous auditing and open comparisons of CR outcomes might possibly explain some of the observed improvements and differences.

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  • 14.
    Bargholtz, Marcus
    et al.
    Department of Medicine, Lindesberg Hospital, 711 82 Lindesberg, Sweden.
    Brosved, Madeleine
    Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
    Heimburg, Katarina
    Department of Clinical Sciences Lund, Neurology, Skane University Hospital, Lund University, 222 42 Lund, Sweden.
    Hellmark, Marie
    Department of Physiotherapy, Orebro University Hospital, 701 85 Orebro, Sweden.
    Leosdottir, Margret
    Department of Cardiology, Skane University Hospital, 214 28 Malmo, Sweden; Department of Clinical Sciences Malmo, Lund University, 214 28 Malmo, Sweden.
    Hagströmer, Maria
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 171 77 Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, 113 65 Stockholm, Sweden.
    Bäck, Maria
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Test-Retest Reliability, Agreement and Criterion Validity of Three Questionnaires for the Assessment of Physical Activity and Sedentary Time in Patients with Myocardial Infarction2023In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, no 16, article id 6579Article in journal (Refereed)
    Abstract [en]

    Regular physical activity (PA) and limited sedentary time (SED) are highly recommended in international guidelines for patients after a myocardial infarction (MI). Data on PA and SED are often self-reported in clinical practice and, hence, reliable and valid questionnaires are crucial. This study aimed to assess the test-retest reliability, criterion validity and agreement of two PA and one SED questionnaire commonly used in clinical practice, developed by the Swedish National Board of Health and Welfare (BHW) and the Swedish national quality register SWEDEHEART. Data from 57 patients (mean age 66 ± 9.2 years, 42 males) was included in this multi-centre study. The patients answered three questionnaires on PA and SED at seven-day intervals and wore an accelerometer for seven days. Test-retest reliability, criterion validity and agreement were assessed using Spearman's rho and linearly weighted kappa. Test-retest reliability was moderate for three of the six-sub questions (k = 0.43-0.54) within the PA questionnaires. For criterion validity, the correlation was fair within three of the six sub-questions (r = 0.41-0.50) within the PA questionnaires. The SED questionnaire had low agreement (k = 0.12) and criterion validity (r = 0.30). The studied questionnaires for PA could be used in clinical practice as a screening tool and/or to evaluate the level of PA in patients with an MI. Future research is recommended to develop and/or evaluate SED questionnaires in patients with an MI.

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  • 15.
    Bäck, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Leosdottir, Margret
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Ekstrom, Mattias
    Danderyd Hosp, Sweden.
    Hambraeus, Kristina
    Falun Cent Hosp, Sweden.
    Ravn-Fischer, Annica
    Univ Gothenburg, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ostlund, Ollie
    Uppsala Univ, Sweden.
    James, Stefan
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    The remote exercise SWEDEHEART study-Rationale and design of a multicenter registry-based cluster randomized crossover clinical trial (RRCT)2023In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 262, p. 110-118Article in journal (Refereed)
    Abstract [en]

    Background Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) participate in and complete these programs.Study design and objectives The Remote Exercise SWEDEHEART study is a large multicenter registry-based cluster randomized crossover clinical trial with a planned enrollment of 1500 patients with a recent MI. Patients at intervention centers will be offered supervised EBCR, either delivered remotely, center-based or as a combination of both modes, as self -preferred choice. At control centers, patients will be offered supervised center-based EBCR, only. The duration of each time period (intervention/control) for each center will be 15 months and then cross-over occurs. The primary aim is to evaluate if remotely delivered EBCR, offered as an alternative to center-based EBCR, can increase participation in EBCR sessions. The proportion completers in each group will be presented in a supportive responder analysis. The key secondary aim is to investigate if remote EBCR is as least as effective as center-based EBCR, in terms of physical fitness and patient-reported outcome measures. Follow-up of major adverse cardiovascular events (cardiovascular-and all-cause mortality, recurrent hospitalization for acute coronary syndrome, heart failure hospitalization, stroke, and coronary revascularization) will be performed at 1 and 3 years. Safety monitoring of serious adverse events will be registered, and a cost-effectiveness analysis will be conducted to estimate the cost per quality-adjusted life-year (QALY) associated with the intervention compared with control.Conclusions The cluster randomized crossover clinical trial Remote Exercise SWEDEHEART study is evaluating if par-ticipation in EBCR sessions can be increased, which may contribute to health benefits both on a group level and for individual patients including a more equal access to health care.Trial registration The study is registered at ClinicalTrials.gov (Identifier: NCT04260958) (Am Heart J 2023;262:110-118.)

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  • 16.
    Visseren, Frank L. J.
    et al.
    Univ Med Ctr Utrecht, Netherlands.
    Mach, Francois
    Geneva Univ Hosp, Switzerland.
    Smulders, Yvo M.
    Amsterdam Univ Med Ctr, Netherlands.
    Carballo, David
    Geneva Univ Hosp, Switzerland.
    Koskinas, Konstantinos C.
    Bern Univ Hosp INSELSPITAL, Switzerland.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Benetos, Athanase
    CHRU Nancy, France; Univ Lorraine, France.
    Biffi, Alessandro
    FIMS, Italy; EFSMA, Italy.
    Boavida, Jose-Manuel
    IDF E Int Diabet Federat Europe, Portugal.
    Capodanno, Davide
    Univ Catania, Italy.
    Cosyns, Bernard
    Univ Ziekenhuis Brussel, Belgium.
    Crawford, Carolyn
    ESC Patient Forum, France.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Desormais, Ileana
    Univ Limoges, France.
    Di Angelantonio, Emanuele
    Univ Cambridge, England.
    Franco, Oscar H.
    Univ Bern, Switzerland.
    Halvorsen, Sigrun
    Oslo Univ Hosp Ullevaal, Norway.
    Hobbs, F. D. Richard
    Univ Oxford, England.
    Hollander, Monika
    Univ Utrecht, Netherlands.
    Jankowska, Ewa A.
    Wroclaw Med Univ, Poland.
    Michal, Matthias
    Univ Med Ctr Mainz, Germany.
    Sacco, Simona
    Univ Aquila, Italy.
    Sattar, Naveed
    Univ Glasgow, Scotland.
    Tokgozoglu, Lale
    Hacettepe Univ, Turkey.
    Tonstad, Serena
    Oslo Univ Hosp, Norway.
    Tsioufis, Konstantinos P.
    Natl & Kapodistrian Univ, Greece.
    van Dis, Ineke
    European Heart Network, Belgium.
    van Gelder, Isabelle C.
    Univ Groningen, Netherlands.
    Wanner, Christoph
    Univ Wurzburg, Germany.
    Williams, Bryan
    UCL, England.
    2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC)2022In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 29, no 1, p. 5-115Article in journal (Refereed)
    Abstract [en]

    n/a

  • 17.
    Michelsen, Halldora Ögmundsdottir
    et al.
    Lund Univ, Sweden; Helsingborg Hosp, Sweden.
    Sjölin, Ingela
    Skane Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Garcia, Manuel Gonzalez
    Umea Univ, Sweden; Univ Queensland, Australia.
    Olsson, Anneli
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Sandberg, Camilla
    Umea Univ, Sweden; Umea Univ, Sweden.
    Schiopu, Alexandru
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial2022In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 3, article id e25224Article in journal (Refereed)
    Abstract [en]

    Background: Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. Objective: This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care). Methods: All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables. Results: There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic -27.7 vs -16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic -25.3 vs -16.4 mm Hg; P=.02, and diastolic -13.4 vs -9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25. Conclusions: Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation.

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  • 18.
    Aktaa, Suleman
    et al.
    Univ Leeds, England; Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    Gencer, Baris
    Geneva Univ Hosp, Switzerland; Univ Bern, Switzerland.
    Arbelo, Elena
    Univ Barcelona, Spain; Inst Invest August Pi i Sunyer IDIBAPS, Spain; Ctr Invest Biomed Enfermedades Cardiovasc CIBERCV, Spain.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Desormais, Ileana
    Dupuytren Univ Hosp, France.
    Hollander, Monika
    Univ Utrecht, Netherlands.
    Abreu, Ana
    Ctr Hosp Univ Lisboa Norte CHULN Lisboa, Portugal.
    Ambrosetti, Marco
    Rivolta Dadda Hosp, Italy.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Carballo, David
    Univ Hosp Geneva, Switzerland.
    Crawford, Carolyn
    ESC Patient Forum, France.
    Deaton, Christi
    Univ Cambridge, England.
    Dendale, Paul
    Hasselt Univ, Belgium; Hasselt Univ, Belgium.
    Eijsvogels, Thijs M. H.
    Radboud Univ Nijmegen, Netherlands.
    Galbraith, Mary
    ESC Patient Forum, France.
    Piepoli, Massimo Francesco
    Guglielmo da Saliceto Hosp, Italy; Univ Pof Parma, Italy.
    Salzwedel, Annett
    Univ Potsdam, Germany.
    Smulders, Yvo
    Amsterdam UMC, Netherlands.
    Wilhelm, Matthias
    Univ Bern, Switzerland.
    Biondi-Zoccai, Giuseppe
    Sapienza Univ Rome, Italy; Mediterranea Cardioctr, Italy.
    Mach, Francois
    Geneva Univ Hosp, Switzerland.
    Visseren, Frank L. J.
    Univ Utrecht, Netherlands.
    Gale, Chris P.
    Univ Leeds, England; Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology2022In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 7, p. 1060-1071Article in journal (Refereed)
    Abstract [en]

    Aims To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention. Methods and results The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with Task Force members of the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice and the European Association of Preventive Cardiology (EAPC). We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care for ASCVD prevention by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. In total, 17 main and 14 secondary QIs were selected across six domains of care for ASCVD prevention: (i) structural framework, (ii) risk assessment, (iii) care for people at risk for ASCVD, (iv) care for patients with established ASCVD, (v) patient education and experience, and (vi) outcomes. Conclusion We present the 2021 ESC QIs for Cardiovascular Disease Prevention, which have been co-constructed with EAPC using the ESC methodology for QI development. These indicators are supported by evidence from the literature, underpinned by expert consensus and aligned with the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice to offer a mechanism for the evaluation of ASCVD prevention care and outcomes.

  • 19.
    Marques-Sule, Elena
    et al.
    Univ Valencia, Spain.
    Soderlund, Anne
    Malardalen Univ, Sweden.
    Almenar, Luis
    Hosp Univ & Politecn La Fe, Spain; Univ Valencia, Spain; CIBERCV, Spain.
    Victoria Espi-Lopez, Gemma
    Univ Valencia, Spain.
    Lopez-Vilella, Raquel
    Hosp Univ & Politecn La Fe, Spain.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Influence on kinesiophobia by disability, physical, and behavioural variables after a heart transplantation( )2022In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 21, no 6, p. 537-543Article, review/survey (Refereed)
    Abstract [en]

    Background From clinical experience, kinesiophobia represents a barrier to being physically active after a heart transplantation (HTx), but studies in this field are lacking. Identifying the factors associated with kinesiophobia is essential to determine preventive interventions to avoid negative consequences for health. Aims To study the influence of disability, physical, and behavioural variables on kinesiophobia in patients with an HTx. Methods A total of 117 patients with an HTx [51 women; mean age 56 (SD 12.1) years] were recruited at an outpatient clinic. These patients were asked to fill in questionnaires measuring kinesiophobia, self-reported physical activity (PA), exercise self-efficacy, motivation for PA, and disability. A multiple regression analysis was conducted to examine the statistical prediction of kinesiophobia as a dependent variable, with the questionnaires, gender and education as independent variables. Results The independent variables explained 70% of the variance in kinesiophobia. The prediction model was significant (F = 32.1, P < 0.001). The time from transplantation (standardised coefficient, beta; -0.17), the total exercise self-efficacy (-0.16), extrinsic motivation (-0.23), and the disability total score (0.63) were significant predictors of kinesiophobia, while the independent variables of gender, education, intrinsic motivation, and the PA total score were not significant. Conclusions This study highlights that a short time from transplantation, low self-efficacy, low extrinsic motivation, and a high level of disability explained high levels of kinesiophobia in patients after an HTx. These results suggest that an increased awareness of the biopsychosocial health perspective is essential in order to maximising patient outcomes after an HTx.

  • 20.
    Pelliccia, Antonio
    et al.
    Inst Sport Med & Sci, Italy.
    Sharma, Sanjay
    St Georges Univ London, England.
    Gati, Sabiha
    Imperial Coll, England; Royal Brompton & Harefield Hosp NHS Fdn Trust, England.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Borjesson, Mats
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden; Gothenburg Univ, Sweden.
    Caselli, Stefano
    Hirslanden Klin Pk, Switzerland.
    Collet, Jean-Philippe
    Sorbonne Univ, France.
    Corrado, Domenico
    Univ Padua, Italy.
    Drezner, Jonathan A.
    Univ Washington, WA 98195 USA.
    Halle, Martin
    Tech Univ Munich, Germany.
    Hansen, Dominique
    Hasselt Univ, Belgium.
    Heidbuchel, Hein
    Univ Hosp Antwerp, Belgium; Antwerp Univ, Belgium.
    Myers, Jonathan
    VA Palo Alto Hlth Care Syst, CA USA; Stanford Univ, CA 94304 USA.
    Niebauer, Josef
    Paracelsus Med Univ, Austria; Ludwig Boltzmann Inst Digital Hlth & Prevent, Austria.
    Papadakis, Michael
    St Georges Univ London, England.
    Piepoli, Massimo Francesco
    Guglielmo da Saliceto Hosp, Italy; Univ Parma, Italy.
    Prescott, Eva
    Bispebjerg Hosp, Denmark.
    Roos-Hesselink, Jolien W.
    Erasmus MC, Netherlands.
    Stuart, A. Graham
    Bristol Heart Inst, England.
    Taylor, Rod S.
    Univ Glasgow, Scotland.
    Thompson, Paul D.
    Hartford Hosp, CT 06115 USA.
    Tiberi, Monica
    Azienda Unica Reg Marche, Italy.
    Vanhees, Luc
    Kuleuven, Belgium.
    Wilhelm, Matthias
    Univ Bern, Switzerland.
    2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 1, p. 17-96Article, review/survey (Refereed)
    Abstract [en]

    n/a

  • 21.
    Visseren, Frank L. J.
    et al.
    Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
    Mach, Francois
    Cardiology Department, Geneva University Hospital, Geneva, Switzerland.
    Smulders, Yvo M.
    Univ Amsterdam, Netherlands.
    Carballo, David
    Geneva Univ Hosp, Switzerland.
    Koskinas, Konstantinos C.
    Bern Univ Hosp INSELSPITAL, Switzerland.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Benetos, Athanase
    CHRU Nancy, France; Univ Lorraine, France.
    Biffi, Alessandro
    FIMS, Italy; EFSMA, Italy.
    Boavida, Jose-Manuel
    IDF E Int Diabet Federat Europe, Portugal.
    Capodanno, Davide
    Univ Catania, Italy.
    Cosyns, Bernard
    Univ Ziekenhuis Brussel, Belgium.
    Crawford, Carolyn
    ESC Patient Forum, France.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Desormais, Ileana
    Univ Limoges, France.
    Di Angelantonio, Emanuele
    Univ Cambridge, England.
    Franco, Oscar H.
    Univ Bern, Switzerland.
    Halvorsen, Sigrun
    Oslo Univ Hosp Ullevaal, Norway.
    Hobbs, F. D. Richard
    Univ Oxford, England.
    Hollander, Monika
    Univ Utrecht, Netherlands.
    Jankowska, Ewa A.
    Wroclaw Med Univ, Poland.
    Michal, Matthias
    Univ Med Ctr Mainz, Germany.
    Sacco, Simona
    Univ Aquila, Italy.
    Sattar, Naveed
    Univ Glasgow, Scotland.
    Tokgozoglu, Lale
    Hacettepe Univ, Turkey.
    Tonstad, Serena
    Oslo Univ Hosp, Norway.
    Tsioufis, Konstantinos P.
    Natl & Kapodistrian Univ, Greece.
    van Dis, Ineke
    European Heart Network, Belgium.
    van Gelder, Isabelle C.
    Univ Groningen, Netherlands.
    Wanner, Christoph
    Univ Wurzburg, Germany.
    Williams, Bryan
    UCL, England.
    2021 ESC Guidelines on cardiovascular disease prevention in clinical practice Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC)2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 34, p. 3227-3337Article in journal (Refereed)
    Abstract [en]

    n/a

  • 22.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ben Gal, Tuvia
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Ben Avraham, Binyamin
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Boyne, Josiane
    Maastricht Univ, Netherlands.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Chiala, Oronzo
    Univ Roma Tor Vergata, Italy.
    Dickstein, Kenneth
    Univ Bergen, Norway.
    Evangelista, Lorraine
    Univ Texas Med Branch, TX 77555 USA.
    Hagenow, Andreas
    Ctr Clin Res Sudbrandenburg, Germany.
    Hoes, Arno W.
    Univ Med Ctr Utrecht, Netherlands; Univ Utrecht, Netherlands.
    Hagglund, Eva
    Karolinska Univ Hosp, Sweden.
    Piepoli, Massimo F.
    AUSL Piacenza, Italy; Univ Parma, Italy.
    Vellone, Ercole
    Univ Roma Tor Vergata, Italy.
    Zuithoff, Nicolaas P. A.
    Univ Med Ctr Utrecht, Netherlands; Univ Utrecht, Netherlands.
    Martensson, Jan
    Jonkoping Univ, Sweden.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicentre randomized controlled trial2021In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 23, no 1, p. 114-124Article in journal (Refereed)
    Abstract [en]

    Aims Exergaming is a new tool to increase physical activity. This study aimed to determine the effects of access to a home-based exergame (Nintendo Wii) in patients with heart failure (HF) on exercise capacity, self-reported physical activity and patient-reported outcome measures. Methods and results We enrolled 605 HF patients in New York Heart Association functional class I-IV, independent of ejection fraction, in an international multicentre randomized controlled trial. Patients were randomized to exergame (intervention) or motivational support (control). The primary endpoint was change in submaximal aerobic exercise capacity as measured by the distance walked in 6 min (6MWT) between baseline and 3 months. Secondary endpoints included long-term submaximal aerobic exercise capacity, muscle function, self-reported physical activity, exercise motivation, exercise self-efficacy at 3, 6 and 12months. At baseline, patients on average walked 403142m on the 6MWT. Patients in the exergame group walked further compared to controls at 3 months (454123 vs. 420 +/- 127m, P = 0.005), at 6 months (452 +/- 123 vs. 426 +/- 133m, P = 0.015) and 12months (456 +/- 122 vs. 420 +/- 135m, P = 0.004). However, correcting for baseline 6MWT values by means of a linear mixed-effects model revealed no main effect for the intervention on 6MWT. Small significant effects on muscle function were found. Statistically significant treatment effects were found for muscle function but after correction for baseline and confounders, only the treatment effect for the heel-rise left at 6 months was significant (P<0.05). No treatment effect was found for exercise motivation, exercise self-efficacy, or self-reported physical activity. ConclusionExergaming was safe and feasible in patients with HF with different profiles in different health care systems, cultures and climates. However, it was not effective in improving outcomes on submaximal aerobic exercise capacity. Subgroup analysis did not identify specific subgroups benefiting from the intervention. Clinical Trial Registration: Identifier: NCT01785121.

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  • 23. Pelliccia, Antonio
    et al.
    Sharma, Sanjay
    Gati, Sabiha
    Imperial Coll, England; Royal Brompton & Harefield Hosp NHS Fdn Trust, England.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Borjesson, Mats
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden; Gothenburg Univ, Sweden.
    Caselli, Stefano
    Hirstanden Klin Pk, Switzerland.
    Collet, Jean-Philippe
    Sorbonne Univ, France.
    Corrado, Domenico
    Univ Padua, Italy.
    Drezner, Jonathan A.
    Univ Washington, WA USA.
    Halle, Martin
    Tech Univ Munich, Germany.
    Hansen, Dominique
    Hasselt Univ, Belgium.
    Heidbuchel, Hein
    Univ Hosp Antwerp, Belgium; Antwerp Univ, Belgium.
    Myers, Jonathan
    VA Palo Alto Hlth Care Syst, CA USA; Stanford Univ, CA 94304 USA.
    Niebauer, Josef
    Paracelsus Med Univ, Austria; Ludwig Boltzmann Inst Digital Hlth & Prevent, Austria.
    Papadakis, Michael
    St Georges Univ London, England.
    Piepoli, Massimo Francesco
    Guglielmo da Saliceto Hosp, Italy; Univ Parma, Italy.
    Prescott, Eva
    Bispebjerg Hosp, Denmark.
    Roos-Hesselink, Jolien W.
    Erasmus MC, Netherlands.
    Stuart, A. Graham
    Bristol Heart Inst, England.
    Taylor, Rod S.
    Univ Glasgow, Scotland.
    Thompson, Paul D.
    Hartford Hosp, CT 06115 USA.
    Tiberi, Monica
    Azienda Unica Reg Marche, Italy.
    Vanhees, Luc
    Kuleuven, Belgium.
    Wilhelm, Matthias
    Univ Bern, Switzerland.
    ESC 2020 Guideline on sport and exercise cardiology in patients with cardiovascular disease ESC task force on sport cardiology and exercise cardiology in patients with cardiovascular disease2021In: Revista Española de Cardiología, ISSN 0300-8932, E-ISSN 1579-2242, Vol. 74, no 6Article in journal (Refereed)
    Abstract [en]

    n/a

  • 24.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Perkiö Kato, Naoko
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ben Gal, Tuvia
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Chiala, Oronzo
    Univ Roma Tor Vergata, Italy.
    Evangelista, Lorraine
    Univ Texas Med Branch, TX 77555 USA.
    Mårtensson, Jan
    Jönköping Univ, Sweden.
    Piepoli, Massimo F.
    AUSL, Italy; Fdn Toscana G Monasterio, Italy.
    Vellone, Ercole
    Univ Roma Tor Vergata, Italy.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Factors associated with lack of improvement in submaximal exercise capacity of patients with heart failure2021In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 8, no 6, p. 4539-4548Article in journal (Refereed)
    Abstract [en]

    Aims Improvement in exercise capacity is the primary goal of physical activity programmes for patients with heart failure (HF). Although activity programmes are effective for some patients, others do not benefit. Identifying factors related to a lack of improvement in submaximal exercise capacity may help us interpret findings and design new interventions. The aim of this study is to identify factors contributing to a lack of improvement in submaximal exercise capacity 3 months after physical activity advice or an exergame intervention in patients with HF. Additionally, we aimed to assess differences in lack of improvement in submaximal exercise capacity of patients whose baseline exercise capacity predicted a worse compared with better prognosis of HF. Methods and results This secondary analysis of the HF-Wii study analysed baseline and 3 month data of the 6 min walk test (6MWT) from 480 patients (mean age 67 years, 72% male). Data were analysed separately in patients with a pre-defined 6 min walking distance at baseline of <300 m (n = 79) and >= 300 m (n = 401). Among patients with a baseline 6MWT of >= 300 m, 18% had deteriorated submaximal exercise capacity. In the multiple logistic regression analysis, lower baseline levels of self-reported physical activity [odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60-0.97], lower baseline levels of cognitive function (OR = 0.87, 95%CI = 0.79-0.96) were significantly associated with lack of improvement in exercise capacity at 3 months. Not randomized to exergaming (OR = 0.63, 95%CI = 0.37-1.09) was likely (P = 0.097) to be associated with lack of improvement in exercise capacity at 3 months. Among the 79 patients with baseline 6MWT of <300 m, 41% (n = 32) did not improve 6MWT distance at 3 months. Independent predictors for the lack of improvement for 6MWT were New York Heart Association class III/IV (OR = 4.68, 95%CI = 1.08-20.35), higher levels of serum creatinine (OR = 1.02, 95%CI = 1.003-1.03), lower cognitive function (OR = 0.86, 95%CI = 0.75-0.99), and fewer anxiety symptoms (OR = 0.84, 95%CI = 0.72-0.98). Conclusions Lower self-reported physical activity and cognitive impairment predict lack of improvement in submaximal exercise capacity in HF patients. Patients who have a worse prognosis (score <300 m at the 6MWT) are often frail and gain less in exercise capacity. These patients may need a more comprehensive approach to have an effect on exercise capacity, including an individually tailored exercise programme with aerobic exercise (if tolerated) and strength exercises.

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  • 25.
    Bäck, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Norhammar, Anna
    Karolinska Univ Hosp, Sweden; Capio Srt Gorans Hosp, Sweden.
    Hag, Emma
    Cty Hosp Ryhov, Sweden.
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Wallentin, Lars
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Lindahl, Bertil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Hambraeus, Kristina
    Falun Cent Hosp, Sweden.
    The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry)2021In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 7, no 5, p. 431-437Article in journal (Refereed)
    Abstract [en]

    Aims The quality registry SWEDEHEART covers data across the patient pathway after an acute myocardial infarction (MI), from hospital care to secondary prevention. Although cardiac rehabilitation (CR) is strongly recommended after an MI, there is still heterogeneity regarding standards, uptake, and adherence rates. The aim of the SWEDEHEART-CR registry is to provide continuous information on secondary prevention and CR performance to support the audit and development of evidence-based practice. To facilitate quality improvement and research initiatives, a description of the characteristics and development of the SWEDEHEART-CR registry is needed. Methods and results The SWEDEHEART-CR registry starts with data obtained during hospital care and then collects data at out-patient visits 2 months and 1-year after discharge, and at start and end of an exercise-based CR programme. The registry data covers comorbidities, biochemistry, blood pressure, anthropometric variables, medication, psychosocial- and lifestyle variables, readmissions, patient-reported outcome measures, attendance in CR-related programmes, and physical fitness variables. Over 100 000 patients with MI have been included in the SWEDEHEART-CR registry since its start in 2005. From initially covering 35 centres (47%) and 2200 patients annually (27%), SWEDEHEART-CR has developed to a nation-wide registry with 75 centres (100%) and 8800 patients annually (80%) in 2020. Conclusion The SWEDEHEART-CR registry includes a high proportion of the national MI population entering a CR programme and is a powerful tool for quality audit, improvement, and research. The registry provides insights into the characteristics, treatment, and outcomes of evidence-based secondary preventive practice, ultimately leading to better cardiovascular health.

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  • 26.
    Åhlund, Kristina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. NU Hosp Grp, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ekerstad, Niklas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. NU Hosp Grp, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    A balance between meaningfulness and risk of harm - frail elderly patients perceptions of physical activity and exercise - an interview study2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, no 1, article id 490Article in journal (Refereed)
    Abstract [en]

    BackgroundThere is growing evidence of the benefits of physical activity and exercise for frail elderly patients with comorbidity. In order to improve participation in physical activity and exercise interventions, there is a need to increase our understanding of the patients perspective.AimThe aim of this study is to explore the perceptions of physical activity and exercise among frail elderly patients with a severe comorbidity burden.MethodFace-to-face, in-depth interviews were conducted with eighteen frail elderly patients with a severe comorbidity burden, median age 85.5years (min-max 75-94). The interviews were transcribed verbatim and analyzed according to content analysis inspired by Krippendorf.ResultsAn overall theme, defined as "Meaningfulness and risk of harm in an aging body" was identified, followed by three main categories, labeled physical activity in daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise, and eight sub-categories.ConclusionThis study suggests that, in frail elderly patients with severe multimorbidity, physical activity and exercise is a balance between what is perceived as meaningful and the risk of harm. Patients perceived aging as an inevitable process that they needed to accept and gradually adapt their physical activities in daily life to match. As patients said they were unclear about the benefits and risks of exercise and referred to their previous life and experiences when describing physical activity and exercise, it is likely that the communication relating to this within the healthcare system needs to be further developed To promote physical activity and exercise to maintain or improve physical fitness in this frail population, healthcare providers need to use extended, personalized information to tailor the type of physical activities, goals and prerequisites for each patient.

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  • 27.
    Sjölin, Ingela
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Schiopu, Alexandru
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Association between attending exercise-based cardiac rehabilitation and cardiovascular risk factors at one-year post myocardial infarction2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 5, article id e0232772Article in journal (Refereed)
    Abstract [en]

    Background Randomized trials confirm the benefits of exercise-based cardiac rehabilitation on cardiovascular risk factors. Whether exercise-based cardiac rehabilitation provides the same favourable effects in real-life cardiac rehabilitation settings, in the modern era of myocardial infarction treatment, is less well known. We examined the association between attending exercise-based cardiac rehabilitation and improvements in cardiovascular risk factors at one-year post myocardial infarction in patients included in the Swedish heart disease registry, SWEDEHEART. Methods In this retrospective registry-based cohort study, we included 19 136 patients post myocardial infarction (75% men, 62.8 +/- 8.7 years) who were registered in SWEDEHEART between 2011 and 2013. The association between attending exercise-based cardiac rehabilitation (43% participation rate) and changes in cardiovascular risk profile between baseline and one-year follow-up was assessed using multivariable regression analysis adjusting for age, comorbidities and medication. Results Attenders more often reported to have stopped smoking (men 64% vs 50%; women 64% vs 53%, p< 0.001 for both, only smokers at baseline considered), be more physically active (men 3.9 +/- 2.5 vs 3.4 +/- 2.7 days/week; women 3.8 +/- 2.6 vs 3.0 +/- 2.8 days/week, p< 0.001 for both) and achieved a slightly larger reduction in triglycerides (men -0.2 +/- 0.8 vs -0.1 +/- 0.9 mmol/L, p = 0.001; women -0.1 +/- 0.6 vs 0.0 +/- 0.8 mmol/L, p = 0.01) at one-year compared to non-attenders. Male attenders gained less weight (+0.0 +/- 5.7 vs +0.3 +/- 5.7 kg, p = 0.01) while female attenders achieved better lipid control (total cholesterol -1.2 +/- 1.4 vs -0.9 +/- 1.4 mmol/L, p< 0.001; low-density lipoprotein -1.2 +/- 1.2 vs -0.9 +/- 1.2 mmol/L, p< 0.001) compared to nonattenders. Conclusions In an unselected registry cohort of patients post myocardial infarction, compared to nonattenders those attending exercise-based cardiac rehabilitation achieved significantly larger improvements in cardiovascular risk factors at one-year after the acute event.

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  • 28.
    Michelsen, Halldora Ogmundsdottir
    et al.
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Sjolin, Ingela
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Schlyter, Mona
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden.
    Kiessling, Anna
    Karolinska Inst, Sweden.
    Henriksson, Peter
    Karolinska Inst, Sweden.
    Held, Claes
    Uppsala Univ, Sweden.
    Hag, Emma
    Cty Hosp Ryhov, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Schiopu, Alexandru
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Zaman, M. Justin
    James Paget Univ Hosp, England.
    Leosdottir, Margret
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Cardiac rehabilitation after acute myocardial infarction in Sweden - evaluation of programme characteristics: and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study2020In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 27, no 1, p. 18-27Article in journal (Refereed)
    Abstract [en]

    Background While patient performance after participating in cardiac rehabilitation programmes after acute myocardial infarction is regularly reported through registry and survey data, information on cardiac rehabilitation programme characteristics is less well described. Aim The aim of this study was to evaluate Swedish cardiac rehabilitation programme characteristics and adherence to European Guidelines on Cardiovascular Disease Prevention. Method Cardiac rehabilitation programme characteristics at all 78 cardiac rehabilitation centres in Sweden in 2016 were surveyed using a web-based questionnaire (100% response rate). The questions were based on core components of cardiac rehabilitation as recommended by European Guidelines. Results There was a wide variation in programme duration (2-14 months). All programmes reported offering an individual post-discharge visit with a nurse, and 90% (n = 70) did so within three weeks from discharge. Most programmes offered centre-based exercise training (n = 76, 97%) and group educational sessions (n = 61, 78%). All programmes reported to the national audit, SWEDEHEART, and 60% (n = 47) reported that performance was regularly assessed using audit data, to improve quality of care. Ninety-six per cent (n = 75) had a core team consisting of a cardiologist, a physiotherapist and a nurse and 76% (n = 59) reported having a medical director. Having other allied healthcare professionals included in the cardiac rehabilitation team varied. Forty per cent (n = 31) reported having regular team meetings where nurses, physiotherapists and cardiologist could discuss patient cases. Conclusion The overall quality of cardiac rehabilitation programmes provided in Sweden is high. Still, there are several areas of potential improvement. Monitoring programme characteristics as well as patient outcomes might improve programme quality and patient outcomes both at a local and a national level.

  • 29.
    Vellone, Ercole
    et al.
    Univ Roma Tor Vergata, Italy.
    Chiala, Oronzo
    Univ Roma Tor Vergata, Italy.
    Boyne, Josiane
    Maastricht Univ, Netherlands.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Evangelista, Lorraine S.
    Univ Calif Irvine, CA USA.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ben Gal, Tuvia
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Martensson, Jan
    Jonkoping Univ, Sweden.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Cognitive impairment in patients with heart failure: an international study2020In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 41, no 1, p. 47-54Article in journal (Refereed)
    Abstract [en]

    Aims Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients. Methods and results A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients older age, lower education, and lower 6MWT scores (R-2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores. Conclusions CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.

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  • 30.
    Freene, Nicole
    et al.
    Univ Canberra, Australia.
    Borg, Sabina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    McManus, Margaret
    Canberra Hlth Serv, Australia.
    Mair, Tarryn
    Canberra Hlth Serv, Australia.
    Tan, Ren
    Canberra Hlth Serv, Australia.
    Davey, Rachel
    Univ Canberra, Australia.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Comparison of device-based physical activity and sedentary behaviour following percutaneous coronary intervention in a cohort from Sweden and Australia: a harmonised, exploratory study2020In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 12, no 1, article id 17Article in journal (Refereed)
    Abstract [en]

    Background Few studies have measured device-based physical activity and sedentary behaviour following a percutaneous coronary intervention (PCI), with no studies comparing these behaviours between countries using the same methods. The aim of the study was to compare device-based physical activity and sedentary behaviour, using a harmonised approach, following a PCI on-entry into centre-based cardiac rehabilitation in two countries. Methods A cross-sectional study was conducted at two outpatient cardiac rehabilitation centres in Australia and Sweden. Participants were adults following a PCI and commencing cardiac rehabilitation (Australia n = 50, Sweden n = 133). Prior to discharge from hospital, Australian participants received brief physical activity advice (< 5 mins), while Swedish participants received physical activity counselling for 30 min. A triaxial accelerometer (Actigraph GT3X/ActiSleep) was used to objectively assess physical activity (light (LPA), moderate-to-vigorous (MVPA)) and sedentary behaviour. Outcomes included daily minutes of physical activity and sedentary behaviour, and the proportion and distribution of time spent in each behaviour. Results There was no difference in age, gender or relationship status between countries. Swedish (S) participants commenced cardiac rehabilitation later than Australian (A) participants (days post-PCI A 16 vs S 22, p < 0.001). Proportionally, Swedish participants were significantly more physically active and less sedentary than Australian participants (LPA A 27% vs S 30%, p < 0.05; MVPA A 5% vs S 7%, p < 0.01; sedentary behaviour A 68% vs S 63%, p < 0.001). When adjusting for wear-time, Australian participants were doing less MVPA minutes (A 42 vs S 64, p < 0.001) and more sedentary behaviour minutes (A 573 vs S 571, p < 0.001) per day. Both Swedish and Australian participants spent a large part of the day sedentary, accumulating 9.5 h per day in sedentary behaviour. Conclusion Swedish PCI participants when commencing cardiac rehabilitation are more physically active than Australian participants. Potential explanatory factors are differences in post-PCI in-hospital physical activity education between countries and pre-existing physical activity levels. Despite this, sedentary behaviour is high in both countries. Internationally, interventions to address sedentary behaviour are indicated post-PCI, in both the acute setting and cardiac rehabilitation, in addition to traditional physical activity and cardiac rehabilitation recommendations.

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  • 31.
    Bäck, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Caldenius, Victoria
    Occupat Healthcare Serv, Sweden.
    Svensson, Leif
    Karolinska Inst, Sweden.
    Lundberg, Mari
    Univ Gothenburg, Sweden; Karolinska Inst, Sweden.
    Perceptions of Kinesiophobia in Relation to Physical Activity and Exercise After Myocardial Infarction: A Qualitative Study2020In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 100, no 12, p. 2110-2119Article in journal (Refereed)
    Abstract [en]

    Objective. Physical activity and exercise are central components in rehabilitation after a myocardial infarction. Kinesiophobia (fear of movement) is a well-known barrier for a good rehabilitation outcome in these patients; however, there is a lack of studies focusing on the patient perspective. The aim of this study was to explore patients perceptions of kinesiophobia in relation to physical activity and exercise 2 to 3 months after an acute myocardial infarction. Methods. This qualitative study design used individual semi-structured interviews. Face-to-face interviews were conducted with 21 patients post-myocardial infarction who were screened for kinesiophobia (>= 32 on the Tampa Scale for Kinesiophobia Heart). The interviews were transcribed and analyzed according to an inductive content analysis. Results. An overarching theme was defined as "coping with fear of movement after a myocardial infarction-a dynamic process over time" comprising 2 subthemes and explaining how coping with kinesiophobia runs in parallel processes integrating the patients internal process and a contextual external process. The 2 processes are described in a total of 8 categories. The internal process was an iterative process governed by a combination of factors: ambivalence, hypervigilance, insecurity about progression, and avoidance behavior. The external process contains the categories of relatives anxiety, prerequisites for feeling safe, information, and the exercise-based cardiac rehabilitation program. Conclusion. Coping with fear of movement after a myocardial infarction is a dynamic process that requires internal and external support. To further improve cardiac rehabilitation programs, person-centered strategies that support the process of each person-as well as new treatment strategies to reduce kinesiophobia-need to be elaborated. Impact. Patients with a myocardial infarction were found to be ambivalent about how they expressed their fear of movement; therefore, it is crucial for physical therapists to acknowledge signs of fear by listening carefully to the patients full story in addition to using adequate self-reports and tests of physical fitness. These results will inform the design, development, and evaluation of new treatment strategies, with the overall aim of reducing kinesiophobia and increasing physical activity and participation in exercise-based cardiac rehabilitation.

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  • 32.
    Borg, Sabina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Söderlund, Anne
    Malardalen Univ, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    The Added Value of a Behavioral Medicine Intervention in Physiotherapy on Adherence and Physical Fitness in Exercise-Based Cardiac Rehabilitation (ECRA): A Randomised, Controlled Trial2020In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 14, p. 2517-2529Article in journal (Refereed)
    Abstract [en]

    Purpose: Despite beneficial effects, adherence to exercise-based cardiac rehabilitation (exCR) is low in patients with coronary artery disease (CAD). The aim of this study was to investigate adherence to and the effects of a behavioral medicine intervention in physiotherapy (BMW) added to routine exCR care on the primary outcome of physical fitness compared with routine exCR care. Patients and Methods: In a randomized, controlled trial, 170 patients with CAD (136 men), mean age 62.3 (7.9) years, were included at a Swedish university hospital. Patients were randomized 1:1 to routine exCR care (RC) or to a BMIP added to routine exCR care for four months, with a long-term follow-up at 12 months. The outcome assessment included submaximal aerobic exercise capacity, muscle endurance and self-reported physical activity and physical capacity. Results: The four-month follow-up showed improvements in all outcomes for both groups, but changes did not differ significantly between the groups. Patients in the BMIP group were more adherent to exCR recommendations compared with the RC group (31% vs 19%) and a non-significant tendency towards the maintenance of submaximal aerobic exercise capacity over time was seen in the BMIP group, whereas patients in the RC group appeared to deteriorate. Conclusion: Both groups improved significantly at the four-month follow-up, while the 12-month follow-up showed a non-significant tendency towards better long-term effects on submaximal aerobic exercise capacity and exercise adherence for a BMIP compared with RC. In spite of this, a better understanding of the role of a BMIP in enhancing adherence is needed.

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  • 33.
    Blomqvist, Andreas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Utility of single-item questions to assess physical inactivity in patients with chronic heart failure2020In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 7, no 4, p. 1467-1476Article in journal (Refereed)
    Abstract [en]

    Aim The purpose of this study was to explore the utility of two single-item self-report (SR) questions to assess physical inactivity in patients with heart failure (HF). Methods and results This is a cross-sectional study using data from 106 patients with HF equipped with accelerometers for 1 week each. Two SR items relating to physical activity were also collected. Correlations between accelerometer activity counts and the SR items were analysed. Patients were classified as physically active or inactive on the basis of accelerometer counts, and the SR items were used to try to predict that classification. Finally, patients were classified as having high self-reported physical activity or low self-reported physical activity, on the basis of the SR items, and the resulting groups were analysed for differences in actual physical activity. There were significant but weak correlations between the SR items and accelerometer counts: rho = 0.24, P = 0.016 for SR1 and rho = 0.21, P = 0.033 for SR2. Using SR items to predict whether a patient was physically active or inactive produced an area under the curve of 0.62 for SR1, with a specificity of 92% and a sensitivity of 30%. When dividing patients into groups on the basis of SR1, there was a significant difference of 1583 steps per day, or 49% more steps in the high self-reported physical activity group (P < 0.001). Conclusions There might be utility in the single SR question for high-specificity screening of large populations to identify physically inactive patients in order to assign therapeutic interventions efficiently where resources are limited.

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  • 34.
    Borg, Sabina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Lindholm, Daniel
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Correction:Factors associated with non-attendance at exercise-based cardiac rehabilitation (vol 11, 13, 2019)2019In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 11, no 1, article id 24Article in journal (Other academic)
    Abstract [en]

    n/a

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  • 35.
    Gonzalez, Manuel
    et al.
    Umea Univ, Sweden; Umea Univ, Sweden; Commonwealth Sci Res and Ind Org CSIRO, Australia.
    Sjolin, Ingela
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Michelsen, Halldora Ogmundsdottir
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Tanha, Tina
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Sandberg, Camilla
    Umea Univ, Sweden; Umea Univ, Sweden; Umea Univ, Sweden.
    Schiopu, Alexandru
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients: study protocol for a multi-center randomized controlled trial2019In: Trials, E-ISSN 1745-6215, Vol. 20, article id 76Article in journal (Refereed)
    Abstract [en]

    BackgroundCardiac rehabilitation (CR) programs addressing risk factor management, educational interventions, and exercise contribute to reduce mortality after myocardial infarction (MI). However, the fulfillment of guideline-recommended CR targets is currently unsatisfactory. eHealth, i.e., the use of electronic communication for healthcare, including the use of mobile smartphone applications combined with different sensors and interactive computerized programs, offers a new array of possibilities to provide clinical care. The present study aims to assess the efficacy of a web-based application (app) designed to support persons in adhering to lifestyle advice and medication as a complement to traditional CR programs for improvement of risk factors and clinical outcomes in patients with MI compared with usual care.Methods/designAn open-label multi-center randomized controlled trial is being conducted at different CR centers from three Swedish University Hospitals. The aim is to include 150 patients with MI amp;lt;75years of age who are confident smartphone and/or Internet users. In addition to participation in CR programs according to the usual routine at each center, patients randomized to the intervention arm will receive access to the web-based app. A CR nurse reviews the patients self-reported data twice weekly through a medical interface at the clinic. The primary outcome of the study will be change in submaximal exercise capacity (in watts) between 2 and 4weeks after discharge and when the patient has completed his/her exercise program at the CR center, usually around 3-6months post-discharge. Secondary outcomes include changes in self-reported physical activity, objectively assessed physical activity by accelerometry, self-rated health, dietary, and smoking habits, body mass index, blood pressure, blood lipids, and glucose/HbA1c levels between inclusion and follow-up visits during the first year post-MI. Additionally, we will assess uptake and adherence to the application, the number of CR staff contacts, and the incidence of cardiovascular events at 1 and 3 years after the MI. Patient recruitment started in 2016, and the first study results are expected in the beginning of 2019.DiscussionThe present study will add evidence to whether electronic communication can be used to improve traditional CR programs for patients after MI.Trial registrationClinicalTrials.gov, NCT03260582. Retrospectively registered on 24 August 2017.

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  • 36.
    Borg, Sabina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Lindolm, Daniel
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Factors associated with non-attendance at exercise-based cardiac rehabilitation2019In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 11, article id 13Article in journal (Refereed)
    Abstract [en]

    BackgroundDespite its well-established positive effects, exercise-based cardiac rehabilitation (exCR) is underused in patients following an acute myocardial infarction (AMI). The aim of the study was to identify factors associated with non-attendance at exCR in patients post-AMI in a large Swedish cohort.MethodsA total of 31,297 patients who have suffered an AMI, mean age 62.44years, were included from the SWEDEHEART registry during the years 2010-2016. Comparisons between attenders and non-attenders at exCR were done at baseline for the following variables: age, sex, body mass index, occupational status, smoking, previous diseases, type of index cardiac event and intervention, and left ventricular function. Distance of residence from the hospital and type of hospital were added as structural variables in logistic regression analyses, with non-attendance at exCR at one-year follow-up as dependent, and with individual and structural variables as independent variables.ResultsIn total, 16,214 (52%) of the patients did not attend exCR. The strongest predictor for non-attendance was distance to the exCR centre (OR 1.75 [95% CI: 1.64-1.86]). Other predictors for non-attendance included smoking, history of stroke, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), AMI or diabetes, male sex, being retired vs. being employed, and being followed-up at a county hospital. Patients with ST-elevation myocardial infarction (STEMI) and those intervened with PCI or CABG were more likely to attend exCR.Conclusions A distance greater than 16km was associated with increased probability of non-attendance at exCR, as were smoking, a higher burden of comorbidities, and male sex. A better understanding of individual and structural factors can support the development of future rehabilitation services.

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  • 37.
    Strauch, Stefanie
    et al.
    Sahlgrens Univ Hosp, Sweden.
    Hagstromer, Maria
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Objectively Assessed Physical Activity in the Oldest Old Persons With Coronary Artery Disease2019In: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 42, no 4, p. E69-E76Article in journal (Refereed)
    Abstract [en]

    Background and Purpose: Accelerometer threshold values to detect physical activity intensity in the oldest old persons with coronary artery disease (CAD) are lacking as well as knowledge about their free-living physical activity behavior. The purpose of this study was 2-fold. (1) To assess the sensitivity and specificity of 3 existing intensity threshold values for Acti-Graph accelerometers for the oldest old persons with CAD. (2) To assess free-living physical activity, applying the threshold values with the highest sensitivity and specificity for assessing at least moderate intensity, among these persons. Methods: In a cross-sectional design, a total of 24 persons with CAD, mean age 87.5 (3.7) years, participated in the study at a university hospital in Sweden. To assess the sensitivity and specificity of the existing threshold values, the participants walked at different speeds wearing the accelerometer at a pace corresponding to individualized perceived exertion at light, moderate, and high intensity according to the Borg Rating of Perceived Exertion Scale. For the free-living physical activity assessment, the persons wore the accelerometer for 7 consecutive days. The percentage agreement for light-, moderate-, and high-intensity threshold values, as well as receiver operating characteristic curves, was used to identify the sensitivity and specificity of the existing threshold values for moderate intensity. Results and Discussion: The threshold values for at least moderate intensity at 1041 counts per minute according to Copeland had the highest sensitivity (0.739) and specificity (0.609) to identify at least moderate intensity for the ActiGraph GT3X+ accelerometer. In a free-living setting, the oldest old persons with CAD spent 11 of 13.5 (81%) waking hours in a sedentary position and, of the 2.5 hours of being active, 19 minutes (2%) were at least at moderate intensity. Nine of 24 persons (38%) reached 20 minutes of moderate- to vigorous-intensity physical activity 3 days a week, according to guidelines for exercise-based cardiac rehabilitation. Conclusions: The existing threshold values according to Copeland had the highest sensitivity and specificity to identify at least moderate intensity and are valid for use in the oldest old persons with CAD. Using accelerometry as an objective measurement for physical activity can help further improve our understanding of free-living physical activity behavior and to assess relationships between free-living physical activity and health outcomes among the oldest old persons with CAD.

  • 38.
    Åhlund, Kristina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Physiotherapy, NU Hospital Group, Trollhättan, Sweden.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlson, Bjorn W.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden2019In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, p. 577-586Article in journal (Refereed)
    Abstract [en]

    Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis.

    Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty.

    Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p<0.001) and HRHS2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032).

    Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.

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  • 39.
    Mahmood, Zeid
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Enocsson, Helena
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Chung, Rosanna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lundberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Salivary and plasma levels of matrix metalloproteinase-9 and myeloperoxidase at rest and after acute physical exercise in patients with coronary artery disease2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 2, article id e0207166Article in journal (Refereed)
    Abstract [en]

    Background Low-grade systemic inflammation is a predictor of recurrent cardiac events in patients with coronary artery disease (CAD). Plasma proteins such as matrix metalloproteinase (MMP)-9 and myeloperoxidase (MPO) have been shown to reflect basal as well as stress-induced inflammation in CAD. Measurements of MMP-9 and MPO in saliva might pose several advantages. Therefore, we investigated whether salivary levels of MMP-9 and MPO corresponded to plasma levels in patients with coronary artery disease (CAD), both at rest and after acute physical exercise. Methods A bicycle ergometer test was used as a model for stress-induced inflammation. Twenty-three CAD patients performed the test on two occasions 3-6 months apart. Whole unstimulated saliva was collected before, directly after and 30 min after exercise while plasma was collected before and after 30 min. MMP-9 and MPO in saliva and plasma were determined by Luminex. Results MMP-9 and MPO levels were 2- to 4-fold higher in saliva than in plasma. Amongst the saliva samples, and also to a great extent amongst the plasma samples, the levels of both types of protein showed strong intercorrelations between the levels at rest and after exercise during the two visits. However, there were no (or weak) correlations between salivary and plasma MMP-9 and none between salivary and plasma MPO. Conclusion We conclude that salivary diagnostics cannot be used to assess systemic levels of MMP-9 and MPO in CAD patients, neither at rest nor after acute physical exercise.

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  • 40.
    Åhlund, Kristina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. NU Hosp Grp, Sweden.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU Hosp Grp, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Physical Performance Impairments and Limitations Among Hospitalized Frail Older Adults2018In: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 41, no 4, p. 230-235Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Early rehabilitation is important for frail older adults due to reduced reserve capacity and physical fitness. To facilitate individualized rehabilitation programs, we need tools to make it possible to assess physical fitness in relation to frailty, instead of chronological age. The purpose of this study was, in a Swedish context, to describe measures of physical fitness in hospitalized frail older adults in relation to their degree of frailty. Methods: This was a cross-sectional study. A total of 408 frail older adults, mean age 86.6 years (75-99 years), in need of emergency medical inpatient care, were included in the NAL-Uddevalla (NU) hospital group in Sweden. During the hospital stay, physical fitness was assessed using 4 different tests: hand-grip strength, the Timed Up and Go Test, 5-time sit-to-stand test, and 6-minute walk test. In the analyses, the physical fitness outcomes were related to the degree of frailty using the FRail Elderly Support ResearcH group screening instrument and previously used cutoffs or age-related reference values for older adults. Results and Discussion: This study showed that most hospitalized frail older adults perform far lower than previously described age-related reference values relating to physical fitness. An increased degree of frailty contributes to reduced physical fitness in tests assessing strength and endurance. Conclusions: A frail-related screening instrument may be useful in the evaluation of physical fitness in hospitalized frail older adults and may facilitate the development of realistic, individualized rehabilitation programs beneficial to an early start on the emergency medical ward.

  • 41.
    Bäck, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Lundberg, Mari
    Karolinska Inst, Sweden.
    Cider, Asa
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Herlitz, Johan
    Univ Boras, Sweden.
    Jansson, Bengt
    Univ Gothenburg, Sweden.
    Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event2018In: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, ISSN 1932-7501, Vol. 38, no 4, p. 224-230Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits. Methods: In all, 106 patients with CAD (25 women), mean age 63.1 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates. Results: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant. Conclusions: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.

  • 42.
    Hellmark, Marie
    et al.
    Orebro Univ Hosp, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Test-retest reliability and responsiveness to change of clinical tests of physical fitness in patients with acute coronary syndrome included in the SWEDEHEART register2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 486-495Article in journal (Refereed)
    Abstract [en]

    Background: To maximise the benefits obtainable from exercise-based cardiac rehabilitation, an evaluation of physical fitness using reliable, clinically relevant tests is strongly recommended. Recently, objective tests of physical fitness have been implemented in the SWEDEHEART register. The reliability of these tests has, however, not been examined for patients with acute coronary syndrome. Aims: The aim of this study was to assess the test-retest reliability and responsiveness to change of the symptom-limited bicycle ergometer test, the dynamic unilateral heel-lift test and the unilateral shoulder-flexion test in patients with acute coronary syndrome. Methods: In a longitudinal study design, a total of 40 patients (mean age 63.8 9.5 years, five women), with ACS, aged amp;lt; 75 years, were included at a university hospital in Sweden. The intra-class correlation coefficient (ICC) with a 95% confidence interval, standard error of measurement (SEM) and responsiveness in terms of the minimal detectable change were calculated. Results: Excellent reliability was found, showing ICC values of 0.98 (0.96-0.99), SEM 4.71 for the bicycle ergometer test, ICC 0.87 (0.75-0.93), SEM 4.62 for the shoulder-flexion test and ICC 0.84 (0.71-0.91), SEM 2.24 for the heel-lift test. The minimal detectable change was 13 W, 13 and 6 repetitions for the bicycle ergometer test, shoulder-flexion and heel-lift tests respectively. Conclusions: The test-retest reliability of clinical tests evaluating physical fitness in patients with acute coronary syndrome included in the SWEDEHEART register was excellent. This makes the future comparison and evaluation of treatment effects in large unselected clinical populations of acute coronary syndrome possible.

  • 43.
    Åhlund, Kristina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. NU Hospital Grp, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens University Hospital, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU Hospital Grp, Sweden.
    Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients2017In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, p. 1929-1939Article in journal (Refereed)
    Abstract [en]

    Introduction: Frail elderly people often use emergency care. During hospitalization, physical decline is common, implying an increased risk of adverse health outcomes. Comprehensive Geriatric Assessment (CGA) has been shown to be beneficial for these patients in hospital care. However, there is very limited evidence about the effects on physical fitness. The aim was to compare effects on physical fitness in the acute care of frail elderly patients at a CGA unit versus conventional care, 3 months after discharge. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted. Patients aged $ 75 years, assessed as frail and in need of inpatient care, were assigned to a CGA unit or conventional care. Measurements of physical fitness, including handgrip strength (HS), timed up-and-go (TUG), and the 6-minute walk test (6-MWT) were made twice, at the hospital index care period and at the 3-month follow-up. Data were analyzed as the mean change from index to the 3-month follow-up, and dichotomized as decline versus stability/improvement in physical fitness. Results: In all, 408 participants, aged 85.7 +/- 5.4 years, were included. The intervention group improved significantly in all components of physical fitness. The controls improved in TUG and declined in HS and 6-MWT. When the changes were dichotomized the intervention group declined to a lesser extent; HS pamp;lt;0.001, 6-MWT pamp;lt;0.001, TUG pamp;lt;0.003. The regression analysis showed the following odds ratios (ORs) for how these outcomes were influenced by the intervention; HS OR 4.4 (confidence interval [CI] 95% 2.2-9.1), 6-MWT OR 13.9 (CI 95% 4.2-46.2), and TUG OR 2.5 (CI 95% 1.1-5.4). Conclusion: This study indicates that the acute care of frail elderly patients at a CGA unit is superior to conventional care in terms of preserving physical fitness at 3 months follow-up. CGA management may positively influence outcomes of great importance for these patients, such as mobility, strength, and endurance.

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  • 44.
    Bäck, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Important aspects in relation to patients attendance at exercise-based cardiac rehabilitation - facilitators, barriers and physiotherapists role: a qualitative study2017In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 17, article id 77Article in journal (Refereed)
    Abstract [en]

    Background: In order to improve attendance at exercise-based cardiac rehabilitation (CR), a greater insight into patients perspectives is necessary. The aim of the study was to explore aspects that influence patients attendance at exercise-based CR after acute coronary artery disease (CAD) and the role of the physiotherapist in patients attendance at exercise-based CR. Methods: A total of 16 informants, (5 women; median age 64.5, range 47-79 years), diagnosed with CAD, were included in the study at the Cardiology Department, Linkping University Hospital, Sweden. Qualitative interviews were conducted and analysed according to inductive content analysis. Results: Four main categories were identified: (i) previous experience of exercise, (ii) needs in the acute phase, (iii) important prerequisites for attending exercise-based CR and (iv) future ambitions. The categories demonstrate that there are connections between the past, the present and the future, in terms of attitudes to facilitators, barriers and the use of strategies for managing exercise. An overall theme, defined as existential thoughts, had a major impact on the patients attitudes to attending exercise-based CR. The interaction and meetings with the physiotherapists in the acute phase were described as important factors for attending exercise-based CR. Moreover, informants could feel that the physiotherapists supported them in learning the right level of effort during exercise and reducing the fear of exercise. Conclusions: This study adds to previous knowledge of barriers and facilitators for exercise-based CR that patients with CAD get existential thoughts both related to exercise during the rehabilitation process and for future attitudes to exercise. This knowledge might necessitate greater attention to the physiotherapist-patient interaction. To be able to tailor exercise-based CR for patients, physiotherapists need to be aware of patients past experiences of exercise and previous phases of the rehabilitation process as these are important for how patients perceive their need and ability of exercise.

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  • 45.
    Borg, Sabina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Söderlund, Anne
    Mälardalen University, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) - the study protocol of a randomised, controlled trial2017In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 17, article id 134Article in journal (Refereed)
    Abstract [en]

    Background: To help patients with coronary artery disease (CAD) benefit from the positive health effects attained by exercise-based cardiac rehabilitation (CR), adherence to these programmes according to international guidelines is important. Strategies to increase adherence to exercise-based CR are mainly an unexplored area. The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy, containing goal-setting, self-monitoring and feedback, with the aim of improving rehabilitation outcomes for exercise-based CR, compared with usual care. Methods: This is a randomised, controlled trial. A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden. Patients are randomised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy, in addition to usual care for 4 months. Outcome assessment at baseline, 4 and 12 months includes submaximal aerobic capacity (primary outcome), exercise adherence, muscle endurance, level of physical activity, biomarkers, anxiety and depression, health-related quality of life, patient enablement and self-efficacy (secondary outcomes). Discussion: This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes. The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.

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  • 46.
    Bäck, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens University Hospital, Sweden; University of Gothenburg, Sweden.
    Cider, Åsa
    Sahlgrens University Hospital, Sweden; University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Lundberg, Mari
    University of Gothenburg, Sweden.
    Jansson, Bengt
    University of Gothenburg, Sweden.
    Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease2016In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 32, no 8, p. 571-580Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD). Patients: In total, 332 patients (75 women; mean age 65 +/- 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden. Methods: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made. Results: A current incidence of coronary bypass grafting (p amp;lt; 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect. Conclusions: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.

  • 47.
    Wittboldt, Susanna
    et al.
    Sahlgrenska University Hospital.
    Cider, Åsa
    Sahlgrenska University Hospital, University of Gothenburg.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Reliability of two questionnaires on physical function in patients with stable coronary artery disease.2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 142-149Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exercise-based cardiac rehabilitation is highly recommended for patients with coronary artery disease, as it improves physical fitness and reduces mortality and morbidity. Physical fitness per se does not always correlate with the patient's physical function. For this reason, additional measurements of physical function could be included in cardiac rehabilitation programmes to further tailor interventions to suit the individual patient. As a result, reliable measurements to assess physical function are required for patients with coronary artery disease.

    AIM: The aim of this study was to evaluate the reliability of the Patient-Specific Functional Scale (PSFS) and the Disability Rating Index (DRI) in patients with stable coronary artery disease.

    MATERIAL: Fifty-one patients (11 women), age 63.9 (SD 7.6) years, with stable coronary artery disease and coronary-angiographic changes indicating an elective percutaneous coronary intervention, were recruited at the Cardiology Department at Sahlgrenska University Hospital, Gothenburg.

    METHODS: The reliability tests included stability over time, evaluated with a test-retest procedure using the intraclass correlation coefficient (ICC), and internal consistency, measured with Cronbach's alpha and item-total correlation coefficients.

    RESULTS: Both questionnaires were stable over time (DRI, ICC=0.74, and PSFS, ICC=0.72). The internal consistency for the DRI was good, with a Cronbach's alpha value of > 0.85 for all items. The item-total correlation coefficients presented acceptable values of > 0.40, apart from two items.

    CONCLUSION: We have provided introductory support for the reliability of the DRI and PSFS questionnaires in patients with stable CAD. These questionnaires can be used to assess physical function and to evaluate the effect of interventions in addition to measuring physical fitness.

  • 48.
    Bäck, Maria
    et al.
    Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg.
    Jivegård, Lennart
    Department of Vascular Surgery, Sahlgrenska University Hospital/Sahlgrenska.
    Johansson, Anna
    Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg.
    Nordanstig, Joakim
    Department of Vascular Surgery, Sahlgrenska University Hospital/Sahlgrenska.
    Svanberg, Therese
    HTA-Centrum, Region Västra.
    Adania, Ulla Wikberg
    Medical Library, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden.
    Sjögren, Petteri
    HTA-Centrum, Region Västra.
    Home-based supervised exercise versus hospital-based supervised exercise or unsupervised walk advice as treatment for intermittent claudication: a systematic review.2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 9, p. 801-808Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of home-based supervised exercise vs hospital-based supervised exercise, and the effects of home-based supervised exercise vs unsupervised "go home and walk advice" on daily life and corridor-walking capacity, health-related quality of life and patient-reported functional walking capacity in patients with intermittent claudication.

    DATA SOURCES: Systematic literature searches were conducted in PubMed, EMBASE, ProQuest, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), the Cochrane Library, and a number of Health Technology Assessment (HTA)-databases in October 2014.

    STUDY SELECTION: Randomized controlled trials and non-randomized controlled trials (> 100 patients) were considered for inclusion.

    DATA EXTRACTION: Data extraction and risk of bias assessment was performed independently and discussed in meetings.

    DATA SYNTHESIS: Seven randomized controlled trials and 2 non-randomized controlled studies fulfilled the inclusion criteria. The included studies had some, or major, limitations.

    CONCLUSION: Based on a low quality of evidence, home-based supervised exercise may lead to less improvement in maximum and pain-free walking distance, and in more improvement in daily life walking capacity, compared with hospital-based supervised exercise. Home-based supervised exercise may improve maximum and pain-free walking distance compared with "go home and walk advice" and result in little or no difference in health-related quality of life and functional walking capacity compared with hospital-based supervised exercise or "go home and walk advice". Further research is needed to establish the optimal exercise modality for these patients.

  • 49.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Ben Gal, Tuvia
    Rabin Medical Centre, Israel; Tel Aviv University, Israel.
    Boyne, Josiane
    Maastricht University, Netherlands.
    Vellone, Ercole
    University of Roma Tor Vergata, Italy.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Dickstein, Kenneth
    University of Bergen, Norway.
    Fridlund, Bengt
    Jonköping University, Sweden.
    Hoes, Arno
    University of Medical Centre Utrecht, Netherlands.
    Piepoli, Massimo F.
    AUSL Piacenza, Italy; Fdn Toscana G Monasterio, Italy.
    Chiala, Oronzo
    University of Roma Tor Vergata, Italy.
    Martensson, Jan
    Jonköping University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF-Wii study; a multicentre randomized controlled trial2015In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, no 7, p. 743-748Article in journal (Refereed)
    Abstract [en]

    Aims

    Exercise is known to be beneficial for patients with heart failure (HF), and these patients should therefore be routinely advised to exercise and to be or to become physically active. Despite the beneficial effects of exercise such as improved functional capacity and favourable clinical outcomes, the level of daily physical activity in most patients with HF is low. Exergaming may be a promising new approach to increase the physical activity of patients with HF at home. The aim of this study is to determine the effectiveness of the structured introduction and access to a Wii game computer in patients with HF to improve exercise capacity and level of daily physical activity, to decrease healthcare resource use, and to improve self-care and health-related quality of life.

    Methods and results

    A multicentre randomized controlled study with two treatment groups will include 600 patients with HF. In each centre, patients will be randomized to either motivational support only (control) or structured access to a Wii game computer (Wii). Patients in the control group will receive advice on physical activity and will be contacted by four telephone calls. Patients in the Wii group also will receive advice on physical activity along with a Wii game computer, with instructions and training. The primary endpoint will be exercise capacity at 3months as measured by the 6min walk test. Secondary endpoints include exercise capacity at 6 and 12 months, level of daily physical activity, muscle function, health-related quality of life, and hospitalization or death during the 12 months follow-up.

    Conclusion

    The HF-Wii study is a randomized study that will evaluate the effect of exergaming in patients with HF. The findings can be useful to healthcare professionals and improve our understanding of the potential role of exergaming in the treatment and management of patients with HF.

    Trial registration

    NCT01785121

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  • 50.
    Eriksson, Anna
    et al.
    Rehab City Östermalm, Stockholms läns landsting.
    Johansson, Fredrik R
    Department of environmental Medicine,Musculoskeletal and Sportsinjury epidemiologycenter, Karolinska institutet, Stockholm.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Reliability and criterion-related validity of the 20-yard shuttle test in competitive junior tennis players2015In: Open Access Journal of Sports Medicine, E-ISSN 1179-1543, Vol. 6, p. 269-276Article in journal (Refereed)