Publications by authors named "Sveinung Berntsen"

86 Publications

Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study - A cluster randomized controlled trial.

Prev Med Rep 2021 Dec 24;24:101648. Epub 2021 Nov 24.

Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway.

Little information exists on the mechanism of how physical activity interventions effects academic performance. We examined whether the effects of a school-based physical activity intervention on academic performance were mediated by aerobic fitness. The School in Motion study was a nine-month cluster randomized controlled trial between September 2017 and June 2018. Students from 30 Norwegian lower secondary schools ( = 2,084, mean age [] = 14 [0.3] years) were randomly assigned into three groups: the Physically Active Learning (PAL) intervention ( = 10), the Don't Worry-Be Happy (DWBH) intervention ( = 10), or control ( = 10). Aerobic fitness was assessed by the Andersen test and academic performance by national tests in reading and numeracy. Mediation was assessed according to the causal steps approach using linear mixed models. In the PAL intervention, aerobic fitness partially mediated the intervention effect on numeracy by 28% from a total effect of 1.73 points (95% CI: 1.13 to 2.33) to a natural direct effect of 1.24 points (95% CI: 0.58 to 1.91), and fully mediated the intervention effect on reading, with the total effect of 0.89 points (95% CI: 0.15 to 1.62) reduced to the natural direct effect of 0.40 points (95% CI: -0.48 to 1.28). Aerobic fitness did not mediate the effects on academic performance in the DWBH intervention. As aerobic fitness mediated the intervention effect on academic performance in one intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents.
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http://dx.doi.org/10.1016/j.pmedr.2021.101648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8684017PMC
December 2021

Effect of self-regulatory behaviour change techniques and predictors of physical activity maintenance in cancer survivors: a 12-month follow-up of the Phys-Can RCT.

BMC Cancer 2021 Nov 25;21(1):1272. Epub 2021 Nov 25.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Background: Current knowledge about the promotion of long-term physical activity (PA) maintenance in cancer survivors is limited. The aims of this study were to 1) determine the effect of self-regulatory BCTs on long-term PA maintenance, and 2) identify predictors of long-term PA maintenance in cancer survivors 12 months after participating in a six-month exercise intervention during cancer treatment.

Methods: In a multicentre study with a 2 × 2 factorial design, the Phys-Can RCT, 577 participants with curable breast, colorectal or prostate cancer and starting their cancer treatment, were randomized to high intensity exercise with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and self-monitoring) or low-to-moderate intensity exercise with or without self-regulatory BCTs. Participants' level of PA was assessed at the end of the exercise intervention and 12 months later (i.e. 12-month follow-up), using a PA monitor and a PA diary. Participants were categorized as either maintainers (change in minutes/week of aerobic PA ≥ 0 and/or change in number of sessions/week of resistance training ≥0) or non-maintainers. Data on potential predictors were collected at baseline and at the end of the exercise intervention. Multiple logistic regression analyses were performed to answer both research questions.

Results: A total of 301 participants (52%) completed the data assessments. A main effect of BCTs on PA maintenance was found (OR = 1.80, 95%CI [1.05-3.08]) at 12-month follow-up. Participants reporting higher health-related quality-of-life (HRQoL) (OR = 1.03, 95%CI [1.00-1.06] and higher exercise motivation (OR = 1.02, 95%CI [1.00-1.04]) at baseline were more likely to maintain PA levels at 12-month follow-up. Participants with higher exercise expectations (OR = 0.88, 95%CI [0.78-0.99]) and a history of tobacco use at baseline (OR = 0.43, 95%CI [0.21-0.86]) were less likely to maintain PA levels at 12-month follow-up. Finally, participants with greater BMI increases over the course of the exercise intervention (OR = 0.63, 95%CI [0.44-0.90]) were less likely to maintain their PA levels at 12-month follow-up.

Conclusions: Self-regulatory BCTs improved PA maintenance at 12-month follow-up and can be recommended to cancer survivors for long-term PA maintenance. Such support should be considered especially for patients with low HRQoL, low exercise motivation, high exercise expectations or with a history of tobacco use at the start of their cancer treatment, as well as for those gaining weight during their treatment. However, more experimental studies are needed to investigate the efficacy of individual or combinations of BCTs in broader clinical populations.

Trial Registration: NCT02473003 (10/10/2014).
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http://dx.doi.org/10.1186/s12885-021-08996-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613944PMC
November 2021

Who makes it all the way? Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT.

Support Care Cancer 2022 Feb 28;30(2):1739-1748. Epub 2021 Sep 28.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Purpose: To compare sociodemographic, health- and exercise-related characteristics of participants vs. decliners, and completers vs. drop-outs, in an exercise intervention trial during cancer treatment.

Methods: Patients with newly diagnosed breast, prostate, or colorectal cancer were invited to participate in a 6-month exercise intervention. Background data for all respondents (n = 2051) were collected at baseline by questionnaire and medical records. Additional data were collected using an extended questionnaire, physical activity monitors, and fitness testing for trial participants (n = 577). Moreover, a sub-group of decliners (n = 436) consented to additional data collection by an extended questionnaire . Data were analyzed for between-group differences using independent t-tests and chi-tests.

Results: Trial participants were younger (59 ± 12yrs vs. 64 ± 11yrs, p < .001), more likely to be women (80% vs. 75%, p = .012), and scheduled for chemotherapy treatment (54% vs. 34%, p < .001), compared to decliners (n = 1391). A greater proportion had university education (60% vs 40%, p < .001), reported higher anxiety and fatigue, higher exercise self-efficacy and outcome expectations, and less kinesiophobia at baseline compared to decliners. A greater proportion of trial participants were classified as 'not physically active' at baseline; however, within the group who participated, being "physically active" at baseline was associated with trial completion. Completers (n = 410) also reported less kinesiophobia than drop-outs (n = 167).

Conclusion: The recruitment procedures used in comprehensive oncology exercise trials should specifically address barriers for participation among men, patients without university education and older patients. Individualized efforts should be made to enroll patients with low exercise self-efficacy and low outcome expectations of exercise. To retain participants in an ongoing exercise intervention, extra support may be needed for patients with kinesiophobia and those lacking health-enhancing exercise habits at baseline.
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http://dx.doi.org/10.1007/s00520-021-06576-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727419PMC
February 2022

Should we individualize training based on force-velocity profiling to improve physical performance in athletes?

Scand J Med Sci Sports 2021 Dec 12;31(12):2198-2210. Epub 2021 Sep 12.

Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.

The present study aimed to examine the effectiveness of an individualized training program based on force-velocity (FV) profiling on jumping, sprinting, strength, and power in athletes. Forty national level team sport athletes (20 ± 4years, 83 ± 13 kg) from ice-hockey, handball, and soccer completed a 10-week training intervention. A theoretical optimal squat jump (SJ)-FV-profile was calculated from SJ with five different loads (0, 20, 40, 60, and 80 kg). Based on their initial FV-profile, athletes were randomized to train toward, away, or irrespective (balanced training) of their initial theoretical optimal FV-profile. The training content was matched between groups in terms of set x repetitions but varied in relative loading to target the different aspects of the FV-profile. The athletes performed 10 and 30 m sprints, SJ and countermovement jump (CMJ), 1 repetition maximum (1RM) squat, and a leg-press power test before and after the intervention. There were no significant group differences for any of the performance measures. Trivial to small changes in 1RM squat (2.9%, 4.6%, and 6.5%), 10 m sprint time (1.0%, -0.9%, and -1.7%), 30 m sprint time (0.9%, -0.6%, and -0.4%), CMJ height (4.3%, 3.1%, and 5.7%), SJ height (4.8%, 3.7%, and 5.7%), and leg-press power (6.7%, 4.2%, and 2.9%) were observed in the groups training toward, away, or irrespective of their initial theoretical optimal FV-profile, respectively. Changes toward the optimal SJ-FV-profile were negatively correlated with changes in SJ height (r = -0.49, p < 0.001). Changes in SJ-power were positively related to changes in SJ-height (r = 0.88, p < 0.001) and CMJ-height (r = 0.32, p = 0.044), but unrelated to changes in 10 m (r = -0.02, p = 0.921) and 30 m sprint time (r = -0.01, p = 0.974). The results from this study do not support the efficacy of individualized training based on SJ-FV profiling.
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http://dx.doi.org/10.1111/sms.14044DOI Listing
December 2021

Deep Learning for Classifying Physical Activities from Accelerometer Data.

Sensors (Basel) 2021 Aug 18;21(16). Epub 2021 Aug 18.

CAIR, Department of ICT, University of Agder, Jon Lilletunsvei 9, 4879 Grimstad, Norway.

Physical inactivity increases the risk of many adverse health conditions, including the world's major non-communicable diseases, such as coronary heart disease, type 2 diabetes, and breast and colon cancers, shortening life expectancy. There are minimal medical care and personal trainers' methods to monitor a patient's actual physical activity types. To improve activity monitoring, we propose an artificial-intelligence-based approach to classify physical movement activity patterns. In more detail, we employ two deep learning (DL) methods, namely a deep feed-forward neural network (DNN) and a deep recurrent neural network (RNN) for this purpose. We evaluate the two models on two physical movement datasets collected from several volunteers who carried tri-axial accelerometer sensors. The first dataset is from the UCI machine learning repository, which contains 14 different activities-of-daily-life (ADL) and is collected from 16 volunteers who carried a single wrist-worn tri-axial accelerometer. The second dataset includes ten other ADLs and is gathered from eight volunteers who placed the sensors on their hips. Our experiment results show that the RNN model provides accurate performance compared to the state-of-the-art methods in classifying the fundamental movement patterns with an overall accuracy of 84.89% and an overall F1-score of 82.56%. The results indicate that our method provides the medical doctors and trainers a promising way to track and understand a patient's physical activities precisely for better treatment.
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http://dx.doi.org/10.3390/s21165564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8402311PMC
August 2021

Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology (LETSGO study): a study protocol for a multicentre longitudinal interventional study using mobile health technology and biobanking.

BMJ Open 2021 07 12;11(7):e050930. Epub 2021 Jul 12.

Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Vest-Agder, Norway.

Introduction: The number of gynaecological cancer survivors is increasing and there is a need for a more sustainable model of follow-up care. Today's follow-up model is time-consuming and patients have reported unmet needs regarding information about their cancer and strategies for managing the consequences of treatment. The main aim of this study is to assess health-related empowerment-in terms of patient education, psychosocial support, and promotion of physical activity-in a new follow-up model by comparing it to standard follow-up in a quasi-randomised study involving intervention hospitals and control hospitals.

Methods And Analysis: At the intervention hospitals, patients will be stratified by risk of recurrence and late effects to either 1 or 3 years' follow-up. Nurses will replace doctors in half of the follow-up visits and focus in particular on patient education, self-management and physical activity. They will provide patients with information and guide them in goal setting and action planning. These measures will be reinforced by a smartphone application for monitoring symptoms and promoting physical activity. At the control hospitals, patients will be included in the standard follow-up programme. All patients will be asked to complete questionnaires at baseline and after 3, 6, 12, 24 and 36 months. Blood samples will be collected for biobanking at 3, 12 and 36 months. The primary outcome is health-related empowerment. Secondary outcomes include health-related quality of life, adherence to physical activity recommendations, time to recurrence, healthcare costs and changes in biomarkers. Changes in these outcomes will be analysed using generalised linear mixed models for repeated measures. Type of hospital (intervention or control), time (measurement point), and possible confounders will be included as fixed factors.

Ethics And Dissemination: The study is approved by the Regional Committee for Medical Research Ethics (2019/11093). Dissemination of findings will occur at the local, national and international levels.

Trial Registration Number: NCT04122235.
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http://dx.doi.org/10.1136/bmjopen-2021-050930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276283PMC
July 2021

Does organized sports participation in childhood and adolescence positively influence health? A review of reviews.

Prev Med Rep 2021 Sep 30;23:101425. Epub 2021 May 30.

Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.

Sports participations have the potential for both positive and negative health outcomes. We hence aimed (i) to assess systematically reviewed associations between organized sports participation in children and adolescents and their health, and (ii) to assess qualitative syntheses of experiences among children and adolescents concerning organized sports participation and health. A search was undertaken in April 2020 across the databases MEDLINE, EMBASE, APA PsycInfo (Ovid), Scopus, SPORTDiscus (EBSCO), and specialized databases for reviews. The recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction, and data synthesis was used. Systematic reviews were included that covered children and/or adolescents aged ≤ 18 years, and adult participants with retrospective exposure to-or experiences of-organized sports participation before the age of 19 and examining health outcomes and experiences (Prospero protocol CRD 42020206677). Five reviews based mainly on cross-sectional data, two mainly on longitudinal data, and one on experimental studies were included. A causal relationship of moderate-to-high level of evidence between organized sports participation and moderate crude weight reduction accentuated by diet control and team sports was identified. Evidence of causal relationships between sports participation and reduced anxiety, and depression and increased physical activity was at a moderate level. Evidence of causal relationships between sports participation and health was of low-to-moderate level concerning obesity status (inconclusive), bone health (positive), and psychological and social health (positive and negative). Causal relationships between organized child and adolescent sports participation and health remain uncertain. Experimental and well-conducted longitudinal primary studies are highly warranted.
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http://dx.doi.org/10.1016/j.pmedr.2021.101425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190469PMC
September 2021

Effects of a school-based physical activity intervention on academic performance in 14-year old adolescents: a cluster randomized controlled trial - the School in Motion study.

BMC Public Health 2021 05 6;21(1):871. Epub 2021 May 6.

Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806, Oslo, Norway.

Background: School-based physical activity interventions evaluating the effect on academic performance usually includes children. We aimed to investigate the effect of a nine-month, school-based physical activity intervention titled School in Motion (ScIM) on academic performance in adolescents.

Methods: Thirty secondary schools in Norway were cluster-randomized into three groups: the Physically active learning (PAL) group (n = 10), the Don't worry - Be Happy (DWBH) group (n = 10) or control (n = 10). Target dose in both intervention groups was 120 min/week of additional PA during school hours. Parental consent was obtained from 2084 adolescent students (76%). Standardized national tests in reading and numeracy was conducted at baseline and at the end of the intervention. We used linear mixed model to test intervention effects. We found significant intervention effects in numeracy and reading among students in both interventions when compared with controls.

Results: The mean difference in change in numeracy was 1.7 (95% CI: 0.9 to 2.5; Cohen's d = 0.12) and 2.0 (95% CI: 1.4 to 2.7; Cohen's d = 0.23) points in favour of students in the PAL and DWBH intervention, respectively. Similar results were found for reading, where the mean difference in change was 0.9 (95% CI 0.2 to 1.6; Cohen's d = 0.06) and 1.1 (95% CI 0.3 to 1.9; Cohen's d = 0.18) points in favour of students in the PAL and DWBH intervention, respectively. When conducting intention to treat analysis with imputed data the estimates were attenuated and some no longer significant.

Conclusion: The ScIM study demonstrates that two different school-based PA interventions providing approximately 120 min of additional PA weekly over nine months, significantly improved numeracy and reading performance in 14-year old students compared with controls. However, the results should be interpreted with caution as the effect sizes reported were very small or small and the estimates were attenuated when conducting intention to treat analysis. Despite this, our results are still positive and suggest that PA interventions are viable models to increase academic performance among adolescents.

Trial Registration: Retrospectively registered (25/01/2019): NCT03817047 .
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http://dx.doi.org/10.1186/s12889-021-10901-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101111PMC
May 2021

High-frequency blood flow-restricted resistance exercise results in acute and prolonged cellular stress more pronounced in type I than in type II fibers.

J Appl Physiol (1985) 2021 08 6;131(2):643-660. Epub 2021 May 6.

Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway.

Myocellular stress with high-frequency blood flow-restricted resistance exercise (BFRRE) was investigated by measures of heat shock protein (HSP) responses, glycogen content, and inflammatory markers. Thirteen participants [age: 24 ± 2 yr (means ± SD), 9 males] completed two 5-day blocks of seven BFRRE sessions, separated by 10 days. Four sets of unilateral knee extensions to failure at 20% of one-repetition maximum (1RM) were performed. Muscle samples obtained before, 1 h after the first session in the first and second block ( and ), after three sessions (), during the "rest week," and at 3 () and 10 days postintervention () were analyzed for HSP70, αB-crystallin, glycogen [periodic acid-Schiff (PAS) staining], mRNAs, miRNAs, and CD68 (macrophages) and CD66b (neutrophils) cell numbers. αB-crystallin translocated from the cytosolic to the cytoskeletal fraction after and ( < 0.05) and immunostaining revealed larger responses in type I than in type II fibers (, 225 ± 184% vs. 92 ± 81%, respectively, = 0.001). HSP70 was increased in the cytoskeletal fraction at and , and immunostaining intensities were more elevated in type I than in type II fibers at (206 ± 84% vs. 72 ± 112%, respectively, <0.001), during the rest week (98 ± 66% vs. 42 ± 79%, < 0.001), and at (115 ± 82% vs. 28 ± 78%, = 0.003). Glycogen content was reduced in both fiber types, but most pronounced in type I, which did not recover until the rest week (-15% to 29%, ≤ 0.001). Intramuscular macrophage numbers were increased by ∼65% postintervention, but no changes were observed in muscle neutrophils. We conclude that high-frequency BFRRE with sets performed till failure stresses both fiber types, with type I fibers being most affected. BFRRE has been reported to preferentially stress type I muscle fibers, as evidenced by HSP responses. We extend these findings by showing that the HSP responses occur in both fiber types but more so in type I fibers and that they can still be induced after a short-term training period. Furthermore, the reductions in glycogen content of type I fibers after strenuous frequent BFRRE in unaccustomed subjects can be prolonged (≥5 days), probably due to microdamage.
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http://dx.doi.org/10.1152/japplphysiol.00115.2020DOI Listing
August 2021

Frequent blood flow restricted training not to failure and to failure induces similar gains in myonuclei and muscle mass.

Scand J Med Sci Sports 2021 Jul 7;31(7):1420-1439. Epub 2021 May 7.

Center for Health and Performance, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Göteborg, Sweden.

The purpose of the present study was to compare the effects of short-term high-frequency failure vs non-failure blood flow-restricted resistance exercise (BFRRE) on changes in satellite cells (SCs), myonuclei, muscle size, and strength. Seventeen untrained men performed four sets of BFRRE to failure (Failure) with one leg and not to failure (Non-failure; 30-15-15-15 repetitions) with the other leg using knee-extensions at 20% of one repetition maximum (1RM). Fourteen sessions were distributed over two 5-day blocks, separated by a 10-day rest period. Muscle samples obtained before, at mid-training, and 10-day post-intervention (Post10) were analyzed for muscle fiber area (MFA), myonuclei, and SC. Muscle size and echo intensity of m.rectus femoris (RF) and m.vastus lateralis (VL) were measured by ultrasonography, and knee extension strength with 1RM and maximal isometric contraction (MVC) up until Post24. Both protocols increased myonuclear numbers in type-1 (12%-17%) and type-2 fibers (20%-23%), and SC in type-1 (92%-134%) and type-2 fibers (23%-48%) at Post10 (p < 0.05). RF and VL size increased by 5%-10% in both legs at Post10 to Post24, whereas the MFA of type-1 fibers in Failure was decreased at Post10 (-10 ± 16%; p = 0.02). Echo intensity increased by ~20% in both legs during Block1 (p < 0.001) and was ~8 to 11% below baseline at Post24 (p = 0.001-0.002). MVC and 1RM decreased by 5%-10% after Block1, but increased in both legs by 6%-11% at Post24 (p < 0.05). In conclusion, both short-term high-frequency failure and non-failure BFRRE induced increases in SCs, in myonuclei content, muscle size, and strength, concomitant with decreased echo intensity. Intriguingly, the responses were delayed and peaked 10-24 days after the training intervention. Our findings may shed light on the mechanisms involved in resistance exercise-induced overreaching and supercompensation.
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http://dx.doi.org/10.1111/sms.13952DOI Listing
July 2021

Effects of heavy-load resistance training during (neo-)adjuvant chemotherapy on muscle cellular outcomes in women with breast cancer.

Medicine (Baltimore) 2021 Mar;100(10):e24960

Department of Physical Performance, Norwegian School of Sport Science, Oslo, Norway.

Introduction: (Neo-)adjuvant chemotherapy for breast cancer has a deleterious impact on muscle tissue resulting in reduced cardiorespiratory fitness, skeletal muscle mass and function. Physical exercise during treatment may counteract some of these negative effects. However, the effects of resistance training (RT) alone have never been explored. The present study aims to investigate if heavy-load RT during (neo-)adjuvant chemotherapy counteracts deleterious effects on skeletal muscle in women diagnosed with breast cancer. We hypothesize that (neo-)adjuvant treatment with chemotherapy will reduce muscle fiber size, impair mitochondrial function, and increase indicators of cellular stress and that RT during treatment will counteract these negative effects. We also hypothesize that RT during (neo-)adjuvant chemotherapy will increase muscle and blood levels of potential antitumor myokines and reduce treatment-related side effects on muscle strength and cardiorespiratory fitness.

Methods: Fifty women recently diagnosed with breast cancer scheduled to start (neo-)adjuvant chemotherapy will be randomized to either randomized to either intervention group or to control group.The intervention group will perform supervised heavy-load RT twice a week over the course of chemotherapy (approximately 16-weeks) whereas the control group will be encouraged to continue with their usual activities. Muscle biopsies from m. vastus lateralis will be collected before the first cycle of chemotherapy (T0), after chemotherapy (T1), and 6 months later (T2) for assessment of muscle cellular outcomes. The primary outcome for this study is muscle fiber size. Secondary outcomes are: regulators of muscle fiber size and function, indicators of cellular stress and mitochondrial function, myokines with potential antitumor effects, muscle strength, and cardiorespiratory fitness.

Ethics And Dissemination: Ethical approval has been obtained from the Regional Ethical Review Board in Uppsala, Sweden (Dnr:2016/230/2). Results will be disseminated through presentations at scientific meetings, publications in peer-reviewed journals, social media, and patient organizations.

Trial Registration Number: NCT04586517.
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http://dx.doi.org/10.1097/MD.0000000000024960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969308PMC
March 2021

Exercise intensity and markers of inflammation during and after (neo-) adjuvant cancer treatment.

Endocr Relat Cancer 2021 03;28(3):191-201

Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Exercise training has been hypothesized to lower the inflammatory burden for patients with cancer, but the role of exercise intensity is unknown. To this end, we compared the effects of high-intensity (HI) and low-to-moderate intensity (LMI) exercise on markers of inflammation in patients with curable breast, prostate and colorectal cancer undergoing primary adjuvant cancer treatment in a secondary analysis of the Phys-Can randomized trial (NCT02473003). Sub-group analyses focused on patients with breast cancer undergoing chemotherapy. Patients performed 6 months of combined aerobic and resistance exercise on either HI or LMI during and after primary adjuvant cancer treatment. Plasma taken at baseline, immediately post-treatment and post-intervention was analyzed for levels of interleukin 1 beta (IL1B), IL6, IL8, IL10, tumor-necrosis factor alpha (TNFA) and C-reactive protein (CRP). Intention-to-treat analyses of 394 participants revealed no significant between-group differences. Regardless of exercise intensity, significant increases of IL6, IL8, IL10 and TNFA post-treatment followed by significant declines, except for IL8, until post-intervention were observed with no difference for CRP or IL1B. Subgroup analyses of 154 patients with breast cancer undergoing chemotherapy revealed that CRP (estimated mean difference (95% CI): 0.59 (0.33; 1.06); P = 0.101) and TNFA (EMD (95% CI): 0.88 (0.77; 1); P = 0.053) increased less with HI exercise post-treatment compared to LMI. Exploratory cytokine co-regulation analysis revealed no difference between the groups. In patients with breast cancer undergoing chemotherapy, HI exercise resulted in a lesser increase of CRP and TNFA immediately post-treatment compared to LMI, potentially protecting against chemotherapy-related inflammation.
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http://dx.doi.org/10.1530/ERC-20-0507DOI Listing
March 2021

Physical activity and sedentary time in children and adolescents with asthma: A systematic review and meta-analysis.

Scand J Med Sci Sports 2021 Jun 28;31(6):1183-1195. Epub 2021 Feb 28.

Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway.

The influence of asthma on physical activity (PA) in youth remains equivocal. This review synthesizes the evidence regarding the influence of asthma on PA and sedentary time and evaluates the role of key moderators for this relationship. In accordance with PRISMA guidelines, six electronic databases and gray literature were searched. Primary studies in English were included if they reported device-assessed PA in youth with and without asthma. Random effects meta-analyses examined the effect of asthma on PA and, separately, sedentary time. Mixed-effect meta-regression analyses were conducted using age and sex as moderators, with sub-group comparisons for study quality and asthma diagnosis criteria. Overall, of 3944 citations retrieved, 2850 were screened after the removal of supplication and 2743 citations excluded. Of the 107 full-text publications reviewed, 16 were included in data extraction and analysis, with 15 and five studies included in the PA and sedentary time meta-analyses, respectively. The robust effect size estimate for the influence of asthma on PA and sedentary time was -0.04 [95% CI = -0.11, 0.03] and -0.09 [95% CI = -0.12, -0.06], indicating a non-significant and significant trivial effect, respectively. The effect of asthma on PA levels or sedentary time was not associated with age or sex. Youth with controlled asthma are equally physically (in)active as their healthy peers, with asthma associated with less sedentary time. However, methodological limitations and a paucity of clear methodological reporting temper these conclusions. More rigorous device-based assessments, with a particular focus on sedentary time, and more robust diagnoses of asthma, especially with regard to severity, are needed.
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http://dx.doi.org/10.1111/sms.13937DOI Listing
June 2021

Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.

Scand J Med Sci Sports 2021 May 2;31(5):1144-1159. Epub 2021 Mar 2.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n = 144), low-to-moderate intensity (n = 144), high intensity with BCS (n = 144) or low-to-moderate intensity with BCS (n = 145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference -1.05 [95% CI: -1.85, -0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.
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http://dx.doi.org/10.1111/sms.13930DOI Listing
May 2021

Cardiorespiratory Fitness Is Associated With Drop Out From Sport in Norwegian Adolescents. A Longitudinal Study.

Front Public Health 2020 4;8:502307. Epub 2020 Dec 4.

Faculty of Education and Arts, Nord University, Levanger, Norway.

Several studies indicate that participation in organized sport may result in higher physical activity levels among youth which are associated with high levels of cardiorespiratory fitness. However, no study has examined whether cardiorespiratory fitness (VO) is associated with drop out from sport. The study was a 5-year longitudinal study which followed a sample of adolescents, with measures of cardiorespiratory fitness, weight and height between the age of 14 and 19 yrs. Self-reported data about participation in sport, active commuting and physical activity level were also included. Through logistic regression analyses we found a positive association between cardiorespiratory fitness at the age of 14 years and participation in organized sport at the age of 19. However, no significant associations were found between physical activity (PA) level, overweight, gender and active commuting to school at the age of 14, and participation in organized sport at the age of 19. We argue that a high level of cardiorespiratory fitness may increase the probability for experiencing high levels of enjoyment, competence and performance in sport, because sport participation requires a certain level of cardiorespiratory fitness. The findings indicates the importance of removing barriers, and to increase access and design of sport programs of interest to youth in the contexts in which they live, attract adolescents with different levels of ambition and abilities in sport. Further studies should include longitudinal studies among young children, and their drop out patterns from sport during adolescence.
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http://dx.doi.org/10.3389/fpubh.2020.502307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746544PMC
May 2021

Is it safe to exercise during oncological treatment? A study of adverse events during endurance and resistance training - data from the Phys-Can study.

Acta Oncol 2021 Jan 18;60(1):96-105. Epub 2020 Dec 18.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Introduction: Few studies have systematically evaluated the risk of adverse events (AEs) among persons exercising during oncological treatment. We aimed to describe incidence and types of AEs during exercise for persons undergoing oncological treatment, and associations to exercise intensity, exercise adherence, chemotherapy treatment, initial aerobic fitness. A second aim was to compare incidence of lymphedema, periphery inserted central catheter (PICC) complications, and other new medical conditions (any illness or injury occurred during the exercise trial) between high-intensity vs low-to-moderate exercise and usual care (UC).

Methods: This descriptive, comparative study was based on data from an observational study including patients in an UC setting ( = 90) and a randomized exercise trial ( = 577) in which participants exercised at high-intensity (HI) or low-moderate intensity (LMI). Persons with breast, prostate, or colorectal cancer undergoing neo/adjuvant treatment were included. AEs were reported by exercise coaches, participants, and identified in medical records, as were lymphedema, PICC-complications, and new medical conditions.

Results: Coaches reported AEs for 20% of the participants, while 28% of participants self-reported AEs. The most common coach- and participant reported AEs were musculoskeletal and the majority (97%) were considered minor. HI had higher likelihood of AEs than LMI, according to both coaches (OR: 1.9 [95%CI 1.16-3.21], =.011) and participants (OR: 3.36 [95%CI 2.00-5.62], .001). Lymphedema rates were low (4-9%) and PICC complications ranged from 15% in LMI to 23% in UC and there were no statistically significant differences between HI, LMI, and UC. There were no statistically significant differences between HI and LMI regarding new medical conditions.

Conclusions: Exercise during treatment is safe for these patient groups in this setting, even HI exercise can be recommended if no medical contraindications are present. Similar to healthy populations, a higher risk of having minor AEs when exercising at HI in comparison to LMI may exist.
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http://dx.doi.org/10.1080/0284186X.2020.1851046DOI Listing
January 2021

The effect of a school-based intervention on physical activity, cardiorespiratory fitness and muscle strength: the School in Motion cluster randomized trial.

Int J Behav Nutr Phys Act 2020 11 26;17(1):154. Epub 2020 Nov 26.

Department of Physical Performance, Norwegian School of Sport Sciences, Ullevål Stadion, PB 4014, 0806, Oslo, Norway.

Background: Physical activity (PA) declines throughout adolescence, therefore PA promotion during this period is important. We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents.

Methods: For the nine-month School in Motion intervention study (ScIM), we cluster-randomized 30 Norwegian secondary schools (N = 2084, mean age [SD] = 14 [0.3] years) to one of three study arms. The physically active learning (PAL) intervention included 30 min physically active learning, 30 min PA and a 60 min physical education (PE) lesson per week. The Don't worry-Be happy (DWBH) intervention included a 60 min PA lesson and a 60 min PE lesson per week, both tailored to promote friendships and wellbeing. Both intervention arms were designed to engage the adolescents in 120 min of PA per week in addition to recess and mandatory PE lessons. The control group continued as per usual, including the standard amount of mandatory PE. PA (main outcome) was assessed by accelerometers, CRF and muscle strength (secondary outcomes) were assessed by an intermittent running test and selected tests from the Eurofit test battery.

Results: Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (- 11.6 m, 95% CI: - 22.0, - 1.1).

Conclusion: The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF.

Trial Registration: ClinicalTrials.gov ID nr: NCT03817047 . Registered 01/25/2019 'retrospectively registered'.
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http://dx.doi.org/10.1186/s12966-020-01060-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690135PMC
November 2020

A Mapping Review of Physical Activity Recordings Derived From Smartphone Accelerometers.

J Phys Act Health 2020 10 7;17(11):1184-1192. Epub 2020 Oct 7.

Background: Smartphones with embedded sensors, such as accelerometers, are promising tools for assessing physical activity (PA), provided they can produce valid and reliable indices. The authors aimed to summarize studies on the PA measurement properties of smartphone accelerometers compared with research-grade PA monitors or other objective methods across the intensity spectrum, and to report the effects of different smartphone placements on the accuracy of measurements.

Methods: A systematic search was conducted on July 1, 2019 in PubMed, Embase, SPORTDiscus, and Scopus, followed by screening.

Results: Nine studies were included, showing moderate-to-good agreements between PA indices derived from smartphone accelerometers and research-grade PA monitors and/or indirect calorimetry. Three studies investigated measurement properties across smartphone placements, with small differences. Large heterogeneity across studies hampered further comparisons.

Conclusions: Despite moderate-to-good agreements between PA indices derived from smartphone accelerometers and research-grade PA monitors and/or indirect calorimetry, the validity of smartphone monitoring is currently challenged by poor intermonitor reliability between smartphone brands/versions, heterogeneity in protocols used for validation, the sparsity of studies, and the need to address the effects of smartphone placement.
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http://dx.doi.org/10.1123/jpah.2020-0041DOI Listing
October 2020

Cumbersome but desirable-Breaking the code of everyday cycling.

PLoS One 2020 14;15(9):e0239127. Epub 2020 Sep 14.

Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.

Introduction: Cycling for transport could integrate physical activity (PA) into daily routines and potentially increase total PA levels. However, for parents with young children, most factors affecting transport mode choice tend to facilitate car use. Greater insight is necessary into reasons for (not) using sustainable transport modes in parents with young children. Therefore, the objective of this study was to explore the experiences, including motives, perceptions, attitudes, and norms, of parents of young children by using an e-bike, a longtail bike, and a traditional bike for everyday travel to the workplace, kindergarten, and the grocery store during the autumn, winter, and spring, in nine months.

Methods: Semistructured focus group interviews were conducted with 18 parents of young children residing in southern Norway. Parents were recruited through Facebook announcements and direct contact with kindergartens, selected organisations, and companies in the Kristiansand municipality. Data were analysed by systematic text condensation by using NVivo V.11.

Results: Participants' experiences were summarised by three main themes: 'cycling is cumbersome', 'cycling reflects the desirable me', and 'breaking the cycling code'. Time use, planning, logistics, wet and cold weather, long distances, and no cycling habit were frequently mentioned barriers, and the most notable facilitator was the children's attitude towards cycling. In general, children loved to cycle and preferred cycling to driving. Additionally, the freedom and independence of cycling were emphasised and valued.

Conclusion: In challenging weather conditions, parents of young children may experience cycling as cumbersome but desirable, and bike access could increase the feasibility of daily cycling.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239127PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489513PMC
November 2020

Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial.

Integr Cancer Ther 2020 Jan-Dec;19:1534735420946834

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Introduction: Adherence to exercise interventions in patients with cancer is often poorly described. Further, it is unclear if self-regulatory behavior change techniques (BCTs) can improve exercise adherence in cancer populations. We aimed to (1) describe exercise adherence in terms of frequency, intensity, time, type (FITT-principles) and dropouts, and (2) determine the effect of specific self-regulatory BCTs on exercise adherence in patients participating in an exercise intervention during curative cancer treatment.

Methods: This study was a secondary analysis using data from a Swedish multicentre RCT. In a 2×2 factorial design, 577 participants recently diagnosed with curable breast, colorectal or prostate cancer were randomized to 6 months of high (HI) or low-to-moderate intensity (LMI) exercise, or self-regulatory BCTs (e.g., goal-setting and self-monitoring). The exercise program included supervised group-based resistance training and home-based endurance training. Exercise adherence (performed training/prescribed training) was assessed using attendance records, training logs and heart rate monitors, and is presented descriptively. Linear regression and logistic regression were used to assess the effect of self-regulatory BCTs on each FITT-principle and dropout rates, according to intention-to-treat.

Results: For resistance training (groups vs self-regulatory BCTs), participants attended on average 52% vs 53% of prescribed sessions, performed 79% vs 76% of prescribed intensity, and 80% vs 77% of prescribed time. They adhered to exercise type in 71% vs 68% of attended sessions. For endurance training (groups vs self-regulatory BCTs), participants performed on average 47% vs 51% of prescribed sessions, 57% vs 62% of prescribed intensity, and 71% vs 72% of prescribed time. They adhered to exercise type in 79% vs 78% of performed sessions. Dropout rates (groups vs self-regulatory BCTs) were 29% vs 28%. The regression analysis revealed no effect of the self-regulatory BCTs on exercise adherence.

Conclusion: An exercise adherence rate ≥50% for each FITT-principle and dropout rates at ~30% can be expected among patients taking part in long-term exercise interventions, combining resistance and endurance training during curative cancer treatment. Our results indicate that self-regulatory BCTs do not improve exercise adherence in interventions that provide evidence-based support to all participants (e.g., supervised group sessions).

Trial Registration: NCT02473003.
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http://dx.doi.org/10.1177/1534735420946834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493247PMC
August 2021

: adjuvant chemotherapy is associated with a reduction whereas physical activity level before start of treatment is associated with maintenance of maximal oxygen uptake in patients with cancer.

BMC Sports Sci Med Rehabil 2020 3;12:53. Epub 2020 Sep 3.

Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.

Background: Adjuvant therapy may cause multiple sideeffects on long term health, including reduced cardiorespiratory fitness (CRF) in patients with breast cancer (1, 2). However, there is currently limited knowledge regarding the effect of different types of adjuvant cancer treatment on CRF in other cancer populations. The primary objective of the present study was to assess whether previously known correlates (age, diagnosis, initial CRF, physical activity level), type of adjuvant treatment and cancer-related fatigue were associated with changes in in patients with breast, prostate or colorectal cancer.

Methods: Prospective study with two time points of assessment, 85 patients scheduled for adjuvant cancer treatment were included. Cardiorespiratory fitness was assessed by during a maximal incremental exercise test on a treadmill before start of adjuvant therapy and again six months later. Physical activity level was recorded with a physical activity monitor (Sense Wear™ Mini) at baseline as average minutes of moderate-to-vigorous intensity physical activity (MVPA) per day. Physical fatigue at baseline was reported using the Multidimensional Fatigue Inventory-20 questionaire.

Results: In multivariate linear regression analysis, 30 min higher daily MVPA at baseline was associated with a 5% higher at six months follow up when adjusted for adjuvant treatment ( = 0.010). Patients receiving adjuvant chemotherapy had a mean decline in of 10% (- 19, - 1; 95% confidence interval) compared to patients receiving adjuvant endocrine treatment ( = 0.028). Adjuvant radiotherapy, fatigue, age and diagnosis were not significantly associated with changes in .

Conclusion: The results of the present study indicate that adjuvant chemotherapy is associated with a subsequent reduction in in patients with cancer whereas MVPA before start of adjuvant treatment is positively associated with a higher after end of adjuvant treatment.
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http://dx.doi.org/10.1186/s13102-020-00205-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470619PMC
September 2020

Criteria for the determination of maximal oxygen uptake in patients newly diagnosed with cancer: Baseline data from the randomized controlled trial of physical training and cancer (Phys-Can).

PLoS One 2020 11;15(6):e0234507. Epub 2020 Jun 11.

Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.

Introduction: Maximal oxygen uptake ([Formula: see text]) is a measure of cardiorespiratory fitness often used to monitor changes in fitness during and after treatment in cancer patients. There is, however, limited knowledge in how criteria verifying [Formula: see text] work for patients newly diagnosed with cancer. Therefore, the aim of this study was to describe the prevalence of fulfillment of typical criteria verifying [Formula: see text] and to investigate the associations between the criteria and the test leader's evaluation whether a test was performed "to exhaustion". An additional aim was to establish new cut-points within the associated criteria.

Methods: From the Phys-Can randomized controlled trial, 535 patients (59 ±12 years) newly diagnosed with breast (79%), prostate (17%) or colorectal cancer (4%) performed an incremental [Formula: see text] test on a treadmill. The test was performed before starting (neo-)adjuvant treatment and an exercise intervention. Fulfillment of different cut-points within typical criteria verifying [Formula: see text] was described. The dependent key variables included in the initial bivariate analysis were achievement of a [Formula: see text] plateau, peak values for maximal heart rate, respiratory exchange ratio (RER), the patients' rating of perceived exertion on Borg's scale6-20 and peak breathing frequency (fR). A receiver operating characteristic analysis was performed to establish cut-points for variables associated with the test leader's evaluation. Last, a cross-validation of the cut-points found in the receiver operating characteristic analysis was performed on a comparable sample of cancer patients (n = 80).

Results: The criteria RERpeak (<0.001), Borg's RPE (<0.001) and fR peak (p = 0.018) were associated with the test leader's evaluation of whether a test was defined as "to exhaustion". The cut-points that best predicted the test leader's evaluation were RER ≥ 1.14, RPE ≥ 18 and fR ≥ 40. Maximal heart rate and [Formula: see text] plateau was not associated with the test leader's evaluation.

Conclusion: We recommend a focus on RER (in the range between ≥1.1 and ≥1.15) and RPE (≥17 or ≥18) in addition to the test leader's evaluation. Additionally, a fR peak of ≥40 breaths/min may be a cut-point to help the test leader evaluate the degree of exhaustion. However, more research is needed to verify our findings, and to investigate how these criteria will work within a population that are undergoing or finished with cancer treatment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234507PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289625PMC
August 2020

Motivation for physical activity in adolescents with asthma.

J Asthma 2021 09 26;58(9):1247-1255. Epub 2020 Jun 26.

Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.

Objective: We explored motivation for physical activity (PA) and exercise in adolescents with asthma who entered and continued a 10-week play-based exercise intervention.

Methods: Eighteen adolescents with asthma, aged 13-17 years, participated in a 10-week play- and interval-based indoor exercise intervention during winter and autumn months. Semi-structured focus group interviews were conducted in weeks 2 and 8, focusing on motivation for PA and exercise, as well as field observations of exercise sessions in weeks 2, 6, and 8. The first interview was analyzed separately from the second one and descriptive observational data were obtained using thematic analysis and self-determination theory as a framework.

Results: In the first round of focus group interviews, participants ( = 18) described amotivation and motivation for PA within the following five themes: "teachers' lack of asthma knowledge", "embarrassment over asthma symptoms", "not being able to keep pace with peers", "seasonal challenges", and "mastering fun physical activities". Based on the second interview ( = 14) and descriptive observational data ( = 18), participants reported and revealed amotivation and motivation for PA within the following four themes: "understanding and relatedness", "social support", "competition", and "mastering fun activities".

Conclusion: We conclude that play-based exercises designed for groups of adolescents with asthma can support motivation for PA and exercise and reduce social and asthma-specific barriers.
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http://dx.doi.org/10.1080/02770903.2020.1778025DOI Listing
September 2021

Moderate-to-vigorous intensity physical activity is associated with modified fatigue during and after cancer treatment.

Support Care Cancer 2020 Jul 23;28(7):3343-3350. Epub 2019 Nov 23.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Purpose: The primary objective was to investigate the association between the amount of time spent in moderate-to-vigorous intensity physical activity (MVPA) and cancer-related fatigue (CRF) before, during, and 2 years after start of treatment.

Methods: The results of the present study are based on data from the study "Early rehabilitation of cancer patients." Two hundred and forty patients (109 females) with one of the following cancer types were included: breast, colorectal, prostate and testicular cancer, and lymphoma. Chalder's fatigue questionnaire (FQ) was used to map CRF at baseline, 4, 8, 12, and 24 months post-inclusion. Baseline was at the time of diagnosis, before treatment start. Physical activity was recorded using SenseWear armband (SWA) at baseline, 4 and 24 months post-inclusion.

Results: One hour increased MVPA daily at baseline was associated with lower fatigue with - 0.8 at 4 months' follow-up (p < 0.001), - 0.7 at 8 months' follow-up (p = 0.001), - 0.6 at 12 months' follow-up (p = 0.008), and - 0.5 at 24 months' follow-up (p < 0.043). The participants maintained and improved PA level at the two follow-up points.

Conclusion: The results imply that the amount of time spent in moderate to vigorous intensity physical activity at baseline can modify cancer related fatigue during and after cancer treatment. The participants managed to maintain and improve their activity level at the two follow-up points. Future research should map fatigue and measure activity, with objective measurement units, at several measurement points to map activity level over time and to substantiate these results.
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http://dx.doi.org/10.1007/s00520-019-05176-3DOI Listing
July 2020

Cancer-related fatigue: Patients' experiences of an intervention at a green care rehabilitation farm.

Complement Ther Clin Pract 2019 11 27;37:133-139. Epub 2019 Sep 27.

University of Agder, Faculty of Health and Sport Sciences, Norway.

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http://dx.doi.org/10.1016/j.ctcp.2019.101062DOI Listing
November 2019

"Finding my own motivation" - A Mixed Methods Study of Exercise and Behaviour Change Support During Oncological Treatment.

Int J Behav Med 2019 Oct;26(5):499-511

Department of Public Health and Caring Sciences, Section of Lifestyle and Rehabilitation in Long-term Illness, Uppsala University, Uppsala, Sweden.

Background: Exercising during oncological treatment is beneficial but challenging for persons with cancer and may require strategies to increase motivation. Behaviour change support, including specific behaviour change techniques (BCTs), have been used to facilitate exercise in persons undergoing oncological treatment, but more detailed knowledge from an individual perspective is needed to inform clinical practice. The aims were to explore the motivational experiences of exercise combined with behaviour change support, and to describe how specific BCTs were valued among persons exercising during oncological treatment.

Methods: A mixed-methods study was conducted using semi-structured interviews (n = 18) and a questionnaire (n = 229). Participants with breast, colorectal or prostate cancer who completed or dropped out of a six-month exercise programme during oncological treatment were included. The interviews were analysed with thematic analysis and the questionnaire with descriptive statistics (median and interquartile range).

Results: The participants underwent a motivational process through the exercise programme. By experiencing 'Health gains and mastery', 'Learning', 'Affinity', 'Commitment', and 'Managing challenges', they found incentives that fostered feelings of autonomy, competence and relatedness, leading to an increased motivation to exercise. Social support from coaches, structuring the physical environment with scheduled sessions, self-monitoring with resistance training log, and feedback based on heart rate monitor and fitness tests were the most valued BCTs.

Conclusions: The results indicate the importance of finding incentives and creating an environment that fosters autonomy, competence and relatedness to motivate persons to exercise during oncological treatment. Some BCTs appear particularly useful and may be used by health professionals to increase patients' motivation to exercise.
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http://dx.doi.org/10.1007/s12529-019-09809-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785591PMC
October 2019

From cars to bikes - The effect of an intervention providing access to different bike types: A randomized controlled trial.

PLoS One 2019 10;14(7):e0219304. Epub 2019 Jul 10.

Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.

Introduction: We aimed to investigate whether providing parents with children in kindergarten with access to different bicycle types could influence (i) travel behavior and cycling amount, and (ii) intrinsic motivation for cycling and psychological constructs related to car use.

Methods: A randomized, controlled trial was conducted in Southern Norway from September 2017 to June 2018. In total 36 parents were recruited and randomly drawn into an intervention (n = 18) or control group (n = 18). The intervention group was in random order equipped with an e-bike with trailer (n = 6), a cargo (longtail) bike (n = 6) and a traditional bike with trailer (n = 6).

Results: At follow-up, more participants from the intervention group (vs. the control group) were classified as cyclists to the workplace (n = 7 (38.9%) vs. n = 1 (5.9%), p = 0.04), but not to the kindergarten (n = 6 (33.3%) vs. n = 2 (11.8%), p = 0.23) or to the grocery store (n = 2 (11.1%) vs. n = 0 (0%), p = 0.49). A significant (p = ≤0.05) increase in cycling frequency (0.1 to 2.0 days/week) from baseline to follow-up was found in the intervention group for all destinations and seasons, except to the grocery store during winter (p = 0.16). A decrease in frequency of car driving (-0.2 to -1.7 days/week) was found to be apparent in terms of travelling to the workplace and the kindergarten for all seasons, yet not to the grocery store for any season (p = 0.15-0.49). The intervention group (vs. the control group) reported significantly higher "intrinsic regulation" for cycling (p = 0.01) at follow-up.

Conclusion: Access to different bike types for parents with children attending kindergarten resulted in overall increased cycling, decreased car use and higher intrinsic motivation for cycling. E-bikes obtained the greatest cycling amount in total, with the smallest sample variability. Hence, providing parents with children in kindergarten with access to e-bikes might result in increased and sustained cycling, also during the winter season.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219304PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619759PMC
February 2020

Which exercise prescriptions optimize V̇O max during cancer treatment?-A systematic review and meta-analysis.

Scand J Med Sci Sports 2019 Sep 28;29(9):1274-1287. Epub 2019 May 28.

Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway.

The aims of the present systematic review and meta-analysis were to investigate the effect of exercise on maximal oxygen uptake ( ) and to investigate whether exercise frequency, intensity, duration, and volume are associated with changes in among adult patients with cancer undergoing treatment. Medline and Embase through OvidSP were searched to identify randomized controlled trials. Two reviewers extracted data and assessed the risk of bias. The overall effect size and differences in effects for different intensities and frequencies were calculated on change scores and post-intervention data, and the meta-regression of exercise duration and volumes was analyzed using the Comprehensive Meta-Analysis software. Fourteen randomized controlled trials were included in the systematic review, comprising 1332 patients with various cancer types receiving (neo-)adjuvant chemo-, radio-, and/or hormone therapy. Exercise induced beneficial changes in compared to usual care (effect size = 0.46, 95% Confidence Interval = 0.23-0.69). Longer session duration (P = 0.020), and weekly duration (P = 0.010), larger weekly volume (P < 0.001), and shorter intervention duration (P = 0.005) were significantly associated with more beneficial changes in . No differences in effects between subgroups with respect to frequency and intensity were found. In conclusion, exercise has beneficial effects on in patients with cancer undergoing (neo-)adjuvant treatment. As interventions with larger exercise volumes and longer session durations resulted in larger beneficial changes in , exercise frequency, intensity, and duration should be considered carefully for sufficient exercise volume to induce changes in for this patient group.
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http://dx.doi.org/10.1111/sms.13442DOI Listing
September 2019

Do Obese Children Achieve Maximal Heart Rate during Treadmill Running?

Sports (Basel) 2019 Jan 19;7(1). Epub 2019 Jan 19.

Department of Sports Medicine, Norwegian School of Sport Sciences, 0806 Oslo, Norway.

Objective: Maximal heart rate (HR) is commonly defined as the highest HR obtained during a progressive exercise test to exhaustion. Maximal HR is considered one of the criteria to assess maximum exertion in exercise tests, and is broadly used when prescribing exercise intensity. The aim of the present study was to compare peak HR measurements during maximal treadmill running and active play in obese children and adolescents.

Design: Comparison of peak heart rate during active play vs. maximal treadmill running in 39 (7⁻17 years old, 18 males) obese children and adolescents.

Methods: Heart rate was recorded during intensive active play sessions, as well as during a progressive running test on a treadmill until exhaustion. HR, respiratory exchange ratio (RER), and oxygen uptake were continuously measured during the test. The criteria for having reached maximal effort was a subjective assessment by the technician that the participants had reached his or her maximal effort, and a RER above 1.00 or reporting perceived exertion (RPE) above 17 using the Borg-RPE-Scale.

Results: Thirty-four children had a RER ≥1.00, and 37 reported a RPE ≥ 17. Thirty-two children fulfilled both criteria. During active play, peak HR was significantly ( < 0.0001) increased (4%) (mean and 95% confidence intervals; 204 (201, 207) beats/min), compared to during maximal treadmill running (196 (194, 199) beats/min), respectively.

Conclusion: The results of the present study indicate that peak heart rate measurements during progressive running to exhaustion in obese children and adolescents cannot necessarily be determined as maximal heart rate.
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http://dx.doi.org/10.3390/sports7010026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359420PMC
January 2019

Delayed myonuclear addition, myofiber hypertrophy, and increases in strength with high-frequency low-load blood flow restricted training to volitional failure.

J Appl Physiol (1985) 2019 03 13;126(3):578-592. Epub 2018 Dec 13.

Department of Physical Performance, Norwegian School of Sport Sciences , Oslo , Norway.

The purpose of the present study was to investigate muscle hypertrophy, strength, and myonuclear and satellite cell (SC) responses to high-frequency blood flow-restricted resistance exercise (BFRRE). Thirteen individuals [24 ± 2 yr (mean ± SD), 9 men] completed two 5-day blocks of 7 BFRRE sessions, separated by a 10-day rest period. Four sets of unilateral knee extensions to voluntary failure at 20% of one repetition maximum (1RM) were conducted with partial blood flow restriction (90-100 mmHg). Muscle samples obtained before, during, 3 days, and 10 days after training were analyzed for muscle fiber area (MFA), myonuclei, SC, and mRNA and miRNA expression. Muscle size was measured by ultrasonography and magnetic resonance imaging and strength with 1RM knee extension. With the first block of BFRRE, SC number increased in both fiber types (70%-80%, P < 0.05), whereas type I and II MFA decreased by 6 ± 7% and 15 ± 11% ( P < 0.05), respectively. With the second block of training, muscle size increased by 6%-8%, whereas the number of SCs (type I: 80 ± 63%, type II: 147 ± 95%), myonuclei (type I: 30 ± 24%, type II: 31 ± 28%), and MFA (type I: 19 ± 19%, type II: 11 ± 19%) peaked 10 days after the second block of BFRRE, whereas strength peaked after 20 days of detraining (6 ± 6%, P < 0.05). Pax7- and p21 mRNA expression were elevated during the intervention, whereas myostatin, IGF1R, MyoD, myogenin, cyclinD1 and -D2 mRNA did not change until 3-10 days postintervention. High-frequency low-load BFRRE induced robust increases in SC, myonuclei, and muscle size but modest strength gains. Intriguingly, the responses were delayed and peaked 10-20 days after the training intervention, indicating overreaching. NEW & NOTEWORTHY In line with previous studies, we demonstrate that high-frequency low-load blood flow-restricted resistance exercise (HF-BFRRE) can elicit robust increases in satellite cell and myonuclei numbers, along with gains in muscle size and strength. However, our results also suggest that these processes can be delayed and that with very strenuous HF-BFRRE, there may even be transient muscle fiber atrophy, presumably because of accumulated stress responses. Our findings have implications for the prescription of BFR exercise.
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http://dx.doi.org/10.1152/japplphysiol.00397.2018DOI Listing
March 2019
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