Publications by authors named "Ulf Ekelund"

472 Publications

Total energy expenditure is repeatable in adults but not associated with short-term changes in body composition.

Nat Commun 2022 01 10;13(1):99. Epub 2022 Jan 10.

Maastricht University, Maastricht, The Netherlands.

Low total energy expenditure (TEE, MJ/d) has been a hypothesized risk factor for weight gain, but repeatability of TEE, a critical variable in longitudinal studies of energy balance, is understudied. We examine repeated doubly labeled water (DLW) measurements of TEE in 348 adults and 47 children from the IAEA DLW Database (mean ± SD time interval: 1.9 ± 2.9 y) to assess repeatability of TEE, and to examine if TEE adjusted for age, sex, fat-free mass, and fat mass is associated with changes in weight or body composition. Here, we report that repeatability of TEE is high for adults, but not children. Bivariate Bayesian mixed models show no among or within-individual correlation between body composition (fat mass or percentage) and unadjusted TEE in adults. For adults aged 20-60 y (N = 267; time interval: 7.4 ± 12.2 weeks), increases in adjusted TEE are associated with weight gain but not with changes in body composition; results are similar for subjects with intervals >4 weeks (N = 53; 29.1 ± 12.8 weeks). This suggests low TEE is not a risk factor for, and high TEE is not protective against, weight or body fat gain over the time intervals tested.
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http://dx.doi.org/10.1038/s41467-021-27246-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8748652PMC
January 2022

Adding historical high-sensitivity troponin T results to rule out acute myocardial infarction.

Eur Heart J Acute Cardiovasc Care 2022 Jan 3. Epub 2022 Jan 3.

Department of Medicine Solna, Framstegsgatan 21, Building D1:04, Karolinska Institutet, SE-171 64 Solna, Stockholm, Sweden.

Aims : The clinical usefulness of historical concentrations of high-sensitivity cardiac troponin T (hs-cTnT) is unknown. This study investigated the ability to rule out myocardial infarction (MI) with the use of historical hs-cTnT concentrations among patients with chest pain in the emergency department (ED).

Methods And Results : The derivation cohort consisted of patients presenting with chest pain to nine different EDs (n = 60 071), where we included those with ≥1 hs-cTnT analysed at the index visit and ≥1 hs-cTnT results prior to the visit. We developed an algorithm to rule out MI within 30 days with a pre-specified target negative predictive value (NPV) of ≥99.5%. The performance was then validated in a separate cohort of ED chest pain patients (n = 10 994). A historical hs-cTnT < 12 ng/L and a < 3 ng/L absolute change between the historical and the index visit hs-cTnT had the best performance and ruled out 24 862 (41%) patients in the derivation cohort. In the validation cohort, these criteria identified 4764 (43%) low-risk patients in whom 18 (0.4%) MIs within 30 days occurred, and had an NPV for MI of 99.6% (99.4-99.8), a sensitivity of 96.9% (95.2-.2), and an LR- of 0.11 (0.07-0.14).

Conclusion : Combining a historical hs-cTnT with a single new hs-cTnT may safely rule out MI and thereby reduce the need for serial hs-cTnT measurements in ED patients with chest pain.
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http://dx.doi.org/10.1093/ehjacc/zuab123DOI Listing
January 2022

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

PR interval prolongation and 1-year mortality among emergency department patients: a multicentre transnational cohort study.

BMJ Open 2021 Dec 14;11(12):e054238. Epub 2021 Dec 14.

Department of Emergency Medicine, Odense University Hospital, Odense, Syddanmark, Denmark.

Objectives: Emerging evidence supports that PR interval prolongation is associated with increased mortality. However, most previous studies have limited confounder control, and clinical impact in a population of acute ill patients is unknown. The aim of this study was to investigate whether 1-year all-cause mortality was increased in patients presenting with PR interval prolongation in the emergency department (ED).

Design And Setting: We conducted a register-based cohort study in two Swedish and two Danish EDs. We included all adult patients with an ECG performed at arrival to the Danish EDs during March 2013 to May 2014 and Swedish EDs during January 2010 to January 2011. Using propensity score matching, we analysed HR for 1-year all-cause mortality comparing patients with PR interval prolongation (>200 ms) and normal PR interval (120-200 ms).

Participants And Results: We included 106 124 patients. PR interval prolongation occurred in 8.9% (95% CI 8.7% to 9.0%); these patients were older and had more comorbidity than those with a normal PR interval. The absolute 1-year risk of death was 13% (95% CI 12.3% to 13.7%) for patients with PR interval prolongation and 7.9% (95% CI 7.7% to 8.0%) for those without. After confounder adjustments by propensity score matching, PR interval prolongation showed no association with 1-year mortality with a HR of 1.00 (95% CI 0.93% to 1.08%).

Conclusion: PR interval prolongation does not constitute an independent risk factor for 1-year mortality in ED patients.
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http://dx.doi.org/10.1136/bmjopen-2021-054238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672022PMC
December 2021

Device-measured physical activity, adiposity and mortality: a harmonised meta-analysis of eight prospective cohort studies.

Br J Sports Med 2021 Dec 7. Epub 2021 Dec 7.

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

Background: The joint associations of total and intensity-specific physical activity with obesity in relation to all-cause mortality risk are unclear.

Methods: We included 34 492 adults (72% women, median age 62.1 years, 2034 deaths during follow-up) in a harmonised meta-analysis of eight population-based prospective cohort studies with mean follow-up ranging from 6.0 to 14.5 years. Standard body mass index categories were cross-classified with sample tertiles of device-measured total, light-to-vigorous and moderate-to-vigorous physical activity and sedentary time. In five cohorts with waist circumference available, high and low waist circumference was combined with tertiles of moderate-to-vigorous physical activity.

Results: There was an inverse dose-response relationship between higher levels of total and intensity-specific physical activity and mortality risk in those who were normal weight and overweight. In individuals with obesity, the inverse dose-response relationship was only observed for total physical activity. Similarly, lower levels of sedentary time were associated with lower mortality risk in normal weight and overweight individuals but there was no association between sedentary time and risk of mortality in those who were obese. Compared with the obese-low total physical activity reference, the HRs were 0.59 (95% CI 0.44 to 0.79) for normal weight-high total activity and 0.67 (95% CI 0.48 to 0.94) for obese-high total activity. In contrast, normal weight-low total physical activity was associated with a higher risk of mortality compared with the obese-low total physical activity reference (1.28; 95% CI 0.99 to 1.67).

Conclusions: Higher levels of physical activity were associated with lower risk of mortality irrespective of weight status. Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low.
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http://dx.doi.org/10.1136/bjsports-2021-104827DOI Listing
December 2021

Cross-sectional and prospective associations of sleep duration and bedtimes with adiposity and obesity risk in 15 810 youth from 11 international cohorts.

Pediatr Obes 2021 Dec 1:e12873. Epub 2021 Dec 1.

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

Objectives: To investigate associations of bedtimes and sleep durations with adiposity levels in children and adolescents.

Methods: Individual data were pooled for 12 247 children (5819 with follow-up adiposity at 2.3 ± 1.4 years post-baseline) and 3563 adolescents from 11 international studies. Associations between questionnaire-based sleep durations, bedtimes and four groups of combined bedtimes and sleep lengths (later-shorter [reference]/earlier-shorter/later-longer/earlier-longer) with measured adiposity (body mass index [BMI] and waist circumference z-scores) and weight status, were investigated.

Results: In children, longer sleep durations were consistently associated with lower adiposity markers, and earlier bedtimes were related to lower BMI z-score. Compared to sleeping <10 h, longer baseline sleep duration favourably predicted Δwaist z-score in girls (≥10 and <11 h (β-coefficient (95% confidence interval [CI])): -0.06 (-0.12 to -0.01)) and boys (≥11 h: -0.10 [-0.18 to -0.01]). Combined groups that were defined by longer sleep (later-longer and earlier-longer sleep patterns) were associated with lower adiposity, and later-longer sleep favourably predicted Δwaist z-score in girls (-0.09 [-0.15 to -0.02]). In adolescents, longer sleep durations and earlier bedtimes were associated with lower BMI z-score in the whole sample, and also with lower waist z-score in boys. Combined groups that were characterized by earlier bedtimes were associated with the same outcomes. For example, earlier-shorter (-0.22 (-0.43 to -0.01) and earlier-longer (-0.16 (-0.25 to -0.06) sleep were both associated with lower BMI z-score.

Conclusions: If the associations are causal, longer sleep duration and earlier bedtimes should be targeted for obesity prevention, emphasizing longer sleep for children and earlier bedtimes for adolescents.
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http://dx.doi.org/10.1111/ijpo.12873DOI Listing
December 2021

Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction : An International Collaborative Meta-analysis.

Ann Intern Med 2022 Jan 23;175(1):101-113. Epub 2021 Nov 23.

Harvard School of Public Health, Boston, Massachusetts (W.H.).

Background: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI).

Purpose: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.

Data Sources: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).

Study Selection: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI.

Data Extraction: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality.

Data Synthesis: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays.

Limitation: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies.

Conclusion: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.

Primary Funding Source: National Taiwan University Hospital.
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http://dx.doi.org/10.7326/M21-1499DOI Listing
January 2022

Improving Machine Learning 30-Day Mortality Prediction by Discounting Surprising Deaths.

J Emerg Med 2021 Dec 27;61(6):763-773. Epub 2021 Oct 27.

Halland Hospital, Region Halland, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: Machine learning (ML) is an emerging tool for predicting need of end-of-life discussion and palliative care, by using mortality as a proxy. But deaths, unforeseen by emergency physicians at time of the emergency department (ED) visit, might have a weaker association with the ED visit.

Objectives: To develop an ML algorithm that predicts unsurprising deaths within 30 days after ED discharge.

Methods: In this retrospective registry study, we included all ED attendances within the Swedish region of Halland in 2015 and 2016. All registered deaths within 30 days after ED discharge were classified as either "surprising" or "unsurprising" by an adjudicating committee with three senior specialists in emergency medicine. ML algorithms were developed for the death subclasses by using Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM).

Results: Of all 30-day deaths (n = 148), 76% (n = 113) were not surprising to the adjudicating committee. The most common diseases were advanced stage cancer, multidisease/frailty, and dementia. By using LR, RF, and SVM, mean area under the receiver operating characteristic curve (ROC-AUC) of unsurprising deaths in the test set were 0.950 (SD 0.008), 0.944 (SD 0.007), and 0.949 (SD 0.007), respectively. For all mortality, the ROC-AUCs for LR, RF, and SVM were 0.924 (SD 0.012), 0.922 (SD 0.009), and 0.931 (SD 0.008). The difference in prediction performance between all and unsurprising death was statistically significant (P < .001) for all three models.

Conclusion: In patients discharged to home from the ED, three-quarters of all 30-day deaths did not surprise an adjudicating committee with emergency medicine specialists. When only unsurprising deaths were included, ML mortality prediction improved significantly.
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http://dx.doi.org/10.1016/j.jemermed.2021.09.004DOI Listing
December 2021

Longitudinal and cross-sectional associations of adherence to 24-hour movement guidelines with cardiometabolic risk.

Scand J Med Sci Sports 2022 Jan 23;32(1):255-266. Epub 2021 Oct 23.

Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland.

This study aimed to examine (1) adherence to 24 h movement guidelines over a 2 years follow-up in children aged 6-8 years and (2) association of this adherence with cardiometabolic risk factors. Physical activity and sleep were assessed by a monitor combining heart rate and accelerometry measurements. Screen time was reported by the parents. Body fat percentage, waist circumference, blood glucose, serum insulin, plasma lipids, and blood pressure were assessed, and a cardiometabolic risk score was calculated using z-scores. Children were classified as meeting the guidelines if they had on average ≥60 min/day of moderate-to-vigorous physical activity during the valid days; ≤120 min/day of screen time; and 9-11 h/day of sleep. In total, 485 children had valid data at baseline or at 2 years follow-up. Analyses were conducted using adjusted logistic and linear regression models. Most children adhered to the 24 h movement guidelines at baseline, but the adherence decreased over the 2 years follow-up. Meeting physical activity guidelines individually, or in combination with screen time and/or sleep, was longitudinally associated with a lower cardiometabolic risk score, insulin and waist circumference, and cross-sectionally additionally with lower diastolic blood pressure and higher high-density lipoprotein cholesterol. However, these associations became statistically non-significant after adjustment for body fat. In conclusion, meeting 24 h movement guidelines at baseline increases the odds of meeting them at 2 years follow-up in school-aged children. Furthermore, meeting 24 h movement guidelines is associated with lower levels of cardiometabolic risk factors, but these associations are partly explained by lower body fat. Thus, promoting movement behaviors, especially physical activity, and healthy weight in early childhood is important in supporting cardiometabolic health in children.
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http://dx.doi.org/10.1111/sms.14081DOI Listing
January 2022

Glucose and high-sensitivity troponin T predict a low risk of major adverse cardiac events in emergency department chest pain patients.

Scand Cardiovasc J 2021 Dec 7;55(6):354-361. Epub 2021 Oct 7.

Department of Internal and Emergency Medicine, Skåne University Hospital, Lund University, Lund, Sweden.

Glucose is emerging as a biomarker for early and safe rule-out of acute myocardial infarction in emergency department (ED) chest pain patients. We evaluated the diagnostic accuracy of dual testing with high sensitivity TnT (hs-cTnT) and glucose for prediction of major adverse cardiac events (MACE) within 30 days. This was a secondary analysis of a single-center prospective observational study of 1167 ED chest-pain patients with hs-cTnT and glucose testing at presentation (0 h), and hs-cTnT 1 h later. We tested the addition of glucose <5.6 mmol/L to three MACE rule-out strategies: hs-cTnT <5 ng/L, ≤14 ng/L or a 0 h/1h algorithm, i.e. initial hs-cTnT <12 ng/L with a 1 h change of <3 ng/L. We also tested the addition of glucose ≥11mmol/L to three rule-in strategies: hs-cTnT ≥52 ng/L, a 1 h change ≥5 ng/L or hs-cTnT >14 ng/L. The outcomes were 30-day MACE and 30-day MACE without UA. Two dual-testing approaches reached our target NPV for rule-out: A 0 h hs-cTnT ≤14 ng/L and glucose <5.6 mmol/L identified 252 patients (24.4%) with a 98.8% NPV for 30-day MACE and 99.6% for MACE without UA. The 0 h/1h hs-cTnT algorithm combined with glucose identified 240 patients (23.2%) with a 99.2% NPV for 30-day MACE and 100.0% for MACE without UA. No dual rule-in strategy performed better than using hs-cTnT alone. A combination of hs-cTnT and blood glucose at presentation can be used to identify almost ¼ of ED chest pain patients with a very low risk of 30-day MACE where further testing is not needed. Adding glucose did not improve the rule-in of 30-day MACE.
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http://dx.doi.org/10.1080/14017431.2021.1987512DOI Listing
December 2021

Association between Personal Activity Intelligence (PAI) and body weight in a population free from cardiovascular disease - The HUNT study.

Lancet Reg Health Eur 2021 Jun 21;5:100091. Epub 2021 Mar 21.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway.

Background: Personal Activity Intelligence (PAI) is a new metric for physical activity tracking, and is associated with reduced risk of all-cause and cardiovascular mortality. We prospectively investigated whether PAI is associated with lower body weight gain in a healthy population.

Methods: We included 85,243 participants (40,037 men and 45,206 women) who participated in at least one of three waves of the Trøndelag Health Study (HUNT1: 1984-86, HUNT2: 1995-97, and HUNT3: 2006-08). We used questionnaires to estimate PAI, and linear mixed models to examine body weight according to PAI levels at three study waves. We also conducted regression analyses to assess separate relationships between change in PAI and the combined changes in PAI and physical activity recommendations, according to body weight from HUNT1 to HUNT3.

Findings: Compared with HUNT1, body weight was 8.6 and 6.7 kg higher at HUNT3 for men and women, respectively, but was lower among those with ≥200 PAI at HUNT3. For both sexes, a change from inactive (0 PAI) at HUNT1 to ≥100 weekly PAI-score at HUNT2 and HUNT3, and a ≥100 PAI-score at all three occasions were associated with lower body weight gain, compared with the reference group (0 PAI at all three waves). Importantly, among both sexes, obtaining ≥100 weekly PAI at HUNT1 and HUNT3 was associated with lower body weight gain regardless of adhering to physical activity guidelines.

Interpretation: Adhering to a high PAI over time may be a useful tool to attenuate excessive body weight gain in a population free from cardiovascular disease.

Funding: Norwegian Research Council and the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and technology.
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http://dx.doi.org/10.1016/j.lanepe.2021.100091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8454800PMC
June 2021

A Global Survey of Emergency Department Responses to the COVID-19 Pandemic.

West J Emerg Med 2021 Aug 21;22(5):1037-1044. Epub 2021 Aug 21.

Skane University at Lund, Department of Emergency Medicine, Lund, Sweden.

Introduction: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (COVID-19) pandemic with varying degrees of success. We leveraged the 17-country, Emergency Medicine Education & Research by Global Experts (EMERGE) network and non-EMERGE ED contacts to understand ED emergency preparedness and practices globally when combating the COVID-19 pandemic.

Methods: We electronically surveyed EMERGE and non-EMERGE EDs from April 3-June 1, 2020 on ED capacity, pandemic preparedness plans, triage methods, staffing, supplies, and communication practices. The survey was available in English, Mandarin Chinese, and Spanish to optimize participation. We analyzed survey responses using descriptive statistics.

Results: 74/129 (57%) EDs from 28 countries in all six World Health Organization global regions responded. Most EDs were in Asia (49%), followed by North America (28%), and Europe (14%). Nearly all EDs (97%) developed and implemented protocols for screening, testing, and treating patients with suspected COVID-19 infections. Sixty percent responded that provider staffing/back-up plans were ineffective. Many sites (47/74, 64%) reported staff missing work due to possible illness with the highest provider proportion of COVID-19 exposures and infections among nurses.

Conclusion: Despite having disaster plans in place, ED pandemic preparedness and response continue to be a challenge. Global emergency research networks are vital for generating and disseminating large-scale event data, which is particularly important during a pandemic.
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http://dx.doi.org/10.5811/westjem.2021.3.50358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463065PMC
August 2021

Impediments to and impact of checklists on performance of emergency interventions in primary care: an simulation-based randomized controlled trial.

Scand J Prim Health Care 2021 Dec 13;39(4):438-447. Epub 2021 Sep 13.

Department of Clinical Sciences at Lund (IKVL), Lund University, Lund, Sweden.

Objective: Medical crises occur rather seldom in the primary care setting, but when they do, initial management impacts on morbidity and mortality. Factors that impede the performance of emergency interventions in primary care have not been studied through in-situ simulation. Checklists reportedly improve crisis management.

Design: This randomized controlled trial evaluated emergency intervention performance during two scenarios (hypoglycemia-coma and anaphylaxis-cardiac arrest) simulated at primary care centers, and whether checklist access improved performance.

Setting: Twenty-two primary care centers in Southern Sweden participated in the study.

Subjects: A total of 347 personnel performed 100 simulations, 45 with and 55 without checklist access.

Main Outcome Measures: Time and impediments to performance of five emergency interventions in each scenario.

Results: On 28 of the 37 occasions when the adrenalin auto-injector was employed, the administration technique was incorrect. In 9 of 49 scenarios, teams had trouble locating the 30% glucose solution. Median time to supplemental oxygen administration during the first scenario was 186 s compared with 96 s during the second scenario ( < 0.001). Checklist access had no significant impact on time to performance of emergency interventions, aside from shorter time to adequate glucose or glucagon administration (median times 632 s with, 756 s without checklist access;  = 0.03).

Conclusion: Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting. Simply providing checklist access does not improve the performance of emergency interventions.KEY POINTSLittle is known about the factors that affect the performance of emergency interventions in the primary care setting.Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting.Simply providing crisis checklist access does not improve the performance of emergency interventions in the primary care setting.
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http://dx.doi.org/10.1080/02813432.2021.1973250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725847PMC
December 2021

Physical activity and fat-free mass during growth and in later life.

Am J Clin Nutr 2021 11;114(5):1583-1589

Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with African Regional Agreement for Research/International Atomic Energy Agency, Rabat, Morocco.

Background: Physical activity may be a way to increase and maintain fat-free mass (FFM) in later life, similar to the prevention of fractures by increasing peak bone mass.

Objectives: A study is presented of the association between FFM and physical activity in relation to age.

Methods: In a cross-sectional study, FFM was analyzed in relation to physical activity in a large participant group as compiled in the International Atomic Energy Agency Doubly Labeled Water database. The database included 2000 participants, age 3-96 y, with measurements of total energy expenditure (TEE) and resting energy expenditure (REE) to allow calculation of physical activity level (PAL = TEE/REE), and calculation of FFM from isotope dilution.

Results: PAL was a main determinant of body composition at all ages. Models with age, fat mass (FM), and PAL explained 76% and 85% of the variation in FFM in females and males < 18 y old, and 32% and 47% of the variation in FFM in females and males ≥ 18 y old, respectively. In participants < 18 y old, mean FM-adjusted FFM was 1.7 kg (95% CI: 0.1, 3.2 kg) and 3.4 kg (95% CI: 1.0, 5.6 kg) higher in a very active participant with PAL = 2.0 than in a sedentary participant with PAL = 1.5, for females and males, respectively. At age 18 y, height and FM-adjusted FFM was 3.6 kg (95% CI: 2.8, 4.4 kg) and 4.4 kg (95% CI: 3.2, 5.7 kg) higher, and at age 80 y 0.7 kg (95% CI: -0.2, 1.7 kg) and 1.0 kg (95% CI: -0.1, 2.1 kg) higher, in a participant with PAL = 2.0 than in a participant with PAL = 1.5, for females and males, respectively.

Conclusions: If these associations are causal, they suggest physical activity is a major determinant of body composition as reflected in peak FFM, and that a physically active lifestyle can only partly protect against loss of FFM in aging adults.
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http://dx.doi.org/10.1093/ajcn/nqab260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8574623PMC
November 2021

Energy compensation and adiposity in humans.

Curr Biol 2021 Oct 27;31(20):4659-4666.e2. Epub 2021 Aug 27.

Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN, Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Kénitra, Morocco.

Understanding the impacts of activity on energy balance is crucial. Increasing levels of activity may bring diminishing returns in energy expenditure because of compensatory responses in non-activity energy expenditures. This suggestion has profound implications for both the evolution of metabolism and human health. It implies that a long-term increase in activity does not directly translate into an increase in total energy expenditure (TEE) because other components of TEE may decrease in response-energy compensation. We used the largest dataset compiled on adult TEE and basal energy expenditure (BEE) (n = 1,754) of people living normal lives to find that energy compensation by a typical human averages 28% due to reduced BEE; this suggests that only 72% of the extra calories we burn from additional activity translates into extra calories burned that day. Moreover, the degree of energy compensation varied considerably between people of different body compositions. This association between compensation and adiposity could be due to among-individual differences in compensation: people who compensate more may be more likely to accumulate body fat. Alternatively, the process might occur within individuals: as we get fatter, our body might compensate more strongly for the calories burned during activity, making losing fat progressively more difficult. Determining the causality of the relationship between energy compensation and adiposity will be key to improving public health strategies regarding obesity.
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http://dx.doi.org/10.1016/j.cub.2021.08.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551017PMC
October 2021

Daily energy expenditure through the human life course.

Science 2021 08;373(6556):808-812

Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco.

Total daily energy expenditure ("total expenditure") reflects daily energy needs and is a critical variable in human health and physiology, but its trajectory over the life course is poorly studied. We analyzed a large, diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 years. Total expenditure increased with fat-free mass in a power-law manner, with four distinct life stages. Fat-free mass-adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to 60 years), even during pregnancy; then declines in older adults. These changes shed light on human development and aging and should help shape nutrition and health strategies across the life span.
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http://dx.doi.org/10.1126/science.abe5017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370708PMC
August 2021

The role of occupational physical activity on longevity - Authors' reply.

Lancet Public Health 2021 08;6(8):e545

Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo 0806, Norway; Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway. Electronic address:

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http://dx.doi.org/10.1016/S2468-2667(21)00155-9DOI Listing
August 2021

Physical activity behaviours in adolescence: current evidence and opportunities for intervention.

Lancet 2021 07 21;398(10298):429-442. Epub 2021 Jul 21.

Population and Public Health Sciences, Pennington Biomedical Research Center, Baton Rouge, LA, USA.

Young people aged 10-24 years constitute 24% of the world's population; investing in their health could yield a triple benefit-eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10-14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. In this Series paper, we present the most up-to-date global evidence on adolescent physical activity and discuss directions for identifying potential solutions to enhance physical activity in the adolescent population. Adolescent physical inactivity probably contributes to key global health problems, including cardiometabolic and mental health disorders, but the evidence is methodologically weak. Evidence-based solutions focus on three key components of the adolescent physical activity system: supportive schools, the social and digital environment, and multipurpose urban environments. Despite an increasing volume of research focused on adolescents, there are still important knowledge gaps, and efforts to improve adolescent physical activity surveillance, research, intervention implementation, and policy development are urgently needed.
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http://dx.doi.org/10.1016/S0140-6736(21)01259-9DOI Listing
July 2021

Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study.

Br J Sports Med 2021 Jul 22. Epub 2021 Jul 22.

Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Purpose: To determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea.

Methods: Data regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020.

Results: Out of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500-1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses.

Conclusion: Adults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.
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http://dx.doi.org/10.1136/bjsports-2021-104203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300550PMC
July 2021

Bi-directional prospective associations between sedentary time, physical activity and adiposity in 10-year old Norwegian children.

J Sports Sci 2021 Aug 30;39(15):1772-1779. Epub 2021 Mar 30.

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

There is an adverse cross-sectional association between sedentary time, physical activity (PA) and adiposity, but weak and inconsistent estimates raise question to the direction of associations. The present study aims to examine whether the prospective association between sedentary time, different PA intensities and indicators of adiposity is bi-directional. The Active Smarter Kids Study obtained data from 869 ten-year-old children with valid measurements for sedentary time, PA, and adiposity at baseline and follow-up. Time spent sedentary and PA was measured by accelerometry, adiposity was assessed by three different measures: body mass index (BMI), waist circumference (WC) and sum of four skinfolds (S4SF). Neither overall PA nor time spent sedentary predicted lower BMI or WC at follow-up, but the time spent in moderate-and-vigorous PA (MVPA) and vigorous PA (VPA) predicted lower S4SF at follow-up among boys (MVPA  - 0.066 [95% CI -0.105, -0.027]  = 0.001). Baseline BMI and WC predicted less overall PA, MVPA and VPA in boys. All adiposity measures predicted more time spent sedentary at follow-up in boys. The results suggest that overall PA and sedentary time do not predict future adiposity. Baseline adiposity may rather predict more sedentary time and less higher intensity activity.
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http://dx.doi.org/10.1080/02640414.2021.1898114DOI Listing
August 2021

No association between maternal exercise during pregnancy and the child's weight status at age 7 years: The MoBa study.

Scand J Med Sci Sports 2021 Oct 16;31(10):1991-2001. Epub 2021 Jul 16.

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

Introduction: Maternal lifestyle during pregnancy may affect the development of overweight and obesity in the child. We examined whether maternal exercise during pregnancy is associated with offspring overweight and obesity in childhood. A secondary aim was to examine whether the association is affected by the child's physical activity level.

Materials And Methods: This study is based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa), including 44 352 pregnancies and children (n = 32 304 in week 17 and n = 32 419 in week 30 in the final adjusted model). Maternal exercise during pregnancy was self-reported in gestational weeks 17 and 30. We conducted linear and logistic regression separately for girls and boys, and outcomes were the child's body mass index (BMI) and weight status (overweight/obese) at age 7 years. We further examined the additive joint association between maternal exercise during pregnancy and the child's leisure time physical activity on weight status at age 7 years.

Results: In total, 12.4% of the children were classified as overweight or obese, and 1.7% as obese. The results suggest no association between maternal exercise in both gestational weeks 17 and 30 and the weight status of the child at age 7 years. The association between maternal exercise and the child's weight status at age 7 years appears not to be affected by the child's physical activity level.

Conclusion: Maternal exercise level during pregnancy does not appear to be associated with the child's BMI or odds of being overweight or obese in childhood.
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http://dx.doi.org/10.1111/sms.14015DOI Listing
October 2021

The association between length of stay in the emergency department and short-term mortality.

Intern Emerg Med 2021 Jun 10. Epub 2021 Jun 10.

Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.

The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short-term mortality in patients admitted to the EDs of two large University hospitals in Sweden. All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n = 639,385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7- and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Mortality rate was highest in highest triage priority level (7-day mortality 5.24%, and 30-day mortality 9.44%), and decreased by lower triage priority group. For patients with triage priority levels 2-4, prolonged ED-LOS was associated with increased mortality, especially for lowest priority level, OR for priority level 4 and highest quintile of ED-LOS 30-day mortality 1.49 (CI 95% 1.20-1.85). For patients with highest triage priority level the opposite was at hand, with decreasing mortality risk with increasing quintile of ED-LOS for 7-day mortality, and lower mortality for the two highest quintile of ED-LOS for 30-day mortality. In patients not admitted to in-hospital care higher ED-LOS was associated with higher mortality. Our data suggest that increased ED-LOS could be associated with slightly increased short-term mortality in patients with lower clinical urgency and dismissed from the ED.
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http://dx.doi.org/10.1007/s11739-021-02783-zDOI Listing
June 2021

Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults: A prospective cohort study.

J Sport Health Sci 2021 May 23. Epub 2021 May 23.

GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo 45071, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid 28029, Spain.

Purpose: To examine the associations of accelerometer-derived steps volume and intensity with hospitalizations and all-cause mortality in older adults.

Methods: This prospective cohort study involved 768 community-dwelling Spanish older adults (78.8 ± 4.9 years, mean ± SD; 53.9% females) from the Toledo Study for Healthy Aging (2012-2017). The number of steps per day and step cadence (steps/min) were derived from a hip-mounted accelerometer worn for at least 4 days at baseline. Participants were followed-up over a mean period of 3.1 years for hospitalization and 5.7 years for all-cause mortality. Cox proportional hazards regression models were used to estimate the individual and joint associations between daily steps and stepping intensity with hospitalizations and all-cause mortality.

Results: Included participants walked 5835 ± 3445 steps/day (mean ± SD) with an intensity of 7.3 ± 4.1 steps/min. After adjusting for age, sex, body mass index (BMI), education, income, marital status and comorbidities, higher step count (hazard ratio (HR) = 0.95, 95% confidence intervals (95%CI: 0.90-1.00, and HR = 0.87, 95%CI: 0.81-0.95 per additional 1000 steps) and higher step intensity (HR = 0.95, 95%CI: 0.91-0.99, and HR = 0.89, 95%CI: 0.84-0.95 per each additional step/min) were associated with fewer hospitalizations and all-cause mortality risk, respectively. Compared to the group having low step volume and intensity, individuals in the group having high step volume and intensity had a lower risk of hospitalization (HR = 0.72, 95%CI: 0.52-0.98) and all-cause mortality (HR = 0.60, 95%CI: 0.37-0.98).

Conclusion: Among older adults, both high step volume and step intensity were significantly associated with lower hospitalization and all-cause mortality risk. Increasing step volume and intensity may benefit older people.
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http://dx.doi.org/10.1016/j.jshs.2021.05.004DOI Listing
May 2021

The bidirectional associations between leisure time physical activity change and body mass index gain. The Tromsø Study 1974-2016.

Int J Obes (Lond) 2021 08 18;45(8):1830-1843. Epub 2021 May 18.

School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.

Objectives: To examine whether leisure time physical activity changes predict subsequent body mass index (BMI) changes, and conversely, whether BMI changes predict subsequent leisure time physical activity changes.

Methods: This prospective cohort study included adults attending ≥3 consecutive Tromsø Study surveys (time: T1, T2, T3) during 1974-2016 (n = 10779). If participants attended >3 surveys, we used the three most recent surveys. We computed physical activity change (assessed by the Saltin-Grimby Physical Activity Level Scale) from T1 to T2, categorized as Persistently Inactive (n = 992), Persistently Active (n = 7314), Active to Inactive (n = 1167) and Inactive to Active (n = 1306). We computed BMI change from T2 to T3, which regressed on preceding physical activity changes using analyses of covariance. The reverse association (BMI change from T1 to T2 and physical activity change from T2 to T3; n = 4385) was assessed using multinomial regression.

Results: Average BMI increase was 0.86 kg/m (95% CI: 0.82-0.90) from T2 to T3. With adjustment for sex, birth year, education, smoking and BMI at T2, there was no association between physical activity change from T1 to T2 and BMI change from T2 to T3 (Persistently Inactive: 0.89 kg/m (95% CI: 0.77-1.00), Persistently Active: 0.85 kg/m (95% CI: 0.81-0.89), Active to Inactive: 0.90 kg/m (95% CI: 0.79-1.00), Inactive to Active 0.85 kg/m (95% CI: 0.75-0.95), p = 0.84). Conversely, increasing BMI was associated with Persistently Inactive (odds ratio (OR): 1.17, 95% CI: 1.08-1.27, p < 0.001) and changing from Active to Inactive (OR: 1.16, 95% CI: 1.07-1.25, p < 0.001) compared with being Persistently Active.

Conclusions: We found no association between leisure time physical activity changes and subsequent BMI changes, whereas BMI change predicted subsequent physical activity change. These findings indicate that BMI change predicts subsequent physical activity change at population level and not vice versa.
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http://dx.doi.org/10.1038/s41366-021-00853-yDOI Listing
August 2021

Striking the Right Balance: Evidence to Inform Combined Physical Activity and Sedentary Behavior Recommendations.

J Phys Act Health 2021 05 14;18(6):631-637. Epub 2021 May 14.

Background: Crucial evidence gaps regarding: (1) the joint association of physical activity and sedentary time with health outcomes and (2) the benefits of light-intensity physical activity were identified during the development of recommendations for the World Health Organization Guidelines on physical activity and sedentary behavior (SB). The authors present alternative ways to evidence the relationship between health outcomes and time spent in physical activity and SB and examine how this could be translated into a combined recommendation in future guidelines.

Methods: We used compositional data analysis to quantify the dose-response associations between the balance of time spent in physical activity and SB with all-cause mortality. The authors applied this approach using 2005-2006 National Health and Nutrition Examination Survey accelerometer data.

Results: Different combinations of time spent in moderate- to vigorous-intensity physical activity, light-intensity physical activity, and SB are associated with similar all-cause mortality risk level. A balance of more than 2.5 minutes of moderate- to vigorous-intensity physical activity per hour of daily sedentary time is associated with the same magnitude of risk reduction for all-cause mortality as obtained by being physically active according to the current recommendations.

Conclusion: This method could be applied to provide evidence for more flexible recommendations in the future with options to act on different behaviors depending on individuals' circumstances and capacity.
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http://dx.doi.org/10.1123/jpah.2020-0635DOI Listing
May 2021

Can the ECG be used to estimate age-related survival?

QJM 2021 May 10. Epub 2021 May 10.

Department of Emergency Medicine, Hospital of South West Jutland and Department of Emergency Medicine, Odense University Hospital, Denmark.

Background: There are few reports of the relationship between ECG findings and the age-related survival of acutely ill patients.

Aim: This study compared the one-year survival curves of patients attending two Danish emergency departments (ED) with normal and abnormal ECGs. Patients were divided into age groups from 20 to 90 years of age, and an abnormal ECG was defined as low QRS voltage (i.e., lead I+II <1.4 mV) or QTc interval prolongation >434 ms.

Methods: A retrospective register-based observational study on 35,496 patients attending two Danish EDs, with 100% follow-up for one year.

Results: ECG abnormality increases linearly with age, and between 30 and 70 years of age. Patients aged 20-29 years with ECG abnormalities are more than four times more likely to die within a year than patients of the same age with a normal ECG. An individual with an abnormal ECG has the same risk of dying within a year as an individual with a normal ECG who is 10 years older. After 70 years of age this tight relationship ends, but for younger individuals with an abnormal ECG the increase in mortality is even higher.

Conclusion: An ECG may be a simple practical estimate of age-related survival. For a patient under 70 years, an abnormal QRS voltage or a prolonged QTc interval may increase one-year mortality to that of a patient approximately 10 years older.
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http://dx.doi.org/10.1093/qjmed/hcab134DOI Listing
May 2021

Associations between Device-measured Physical Activity and Cardiometabolic Health in the Transition to Early Adulthood.

Med Sci Sports Exerc 2021 10;53(10):2076-2085

School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, AUSTRALIA.

Purposes: The aims of this study were to investigate the cross-sectional and prospective associations between accelerometer-measured physical activity and cardiometabolic health in the transition to adulthood.

Methods: Data from the 1993 Pelotas (Brazil) Birth Cohort were analyzed (n = 2280). Moderate-to-vigorous intensity physical activity (MVPA) (measured using a triaxial accelerometer) and cardiometabolic health (total fat mass, blood glucose, non-high-density lipoprotein cholesterol, triglycerides, and mean resting blood pressure) were examined at age 18 and 22 yr.

Results: Overall, inverse dose-response associations between MVPA and cardiometabolic health at age 18 and 22 yr were observed in cross-sectional analyses of data from men and women. Prospective analyses showed that, in general, MVPA declined, and cardiometabolic health worsened in this 4-yr period in both men and women. Cardiometabolic health at age 22 yr reflected both MVPA at age 18 yr (β, -0.007; 95% confidence interval [CI], -0.014 to 0.000) and changes in MVPA from 18 to 22 yr (β, -0.030; 95% CI, -0.043 to -0.016) in men, but only changes in MVPA in women (β, -0.035; 95% CI, -0.058 to -0.011). In analyses of change over time, men who improved MVPA by 20 to 30 min·d-1 showed significant improvements in cardiometabolic health over 4 yr. The magnitude of association was slightly stronger for MVPA in 10-min bouts than for MVPA accumulated in bouts of 1 min, especially in women.

Conclusions: Moderate-to-vigorous intensity physical activity is an important predictor of cardiometabolic health in early adulthood. Strategies to prevent declines in MVPA at this life stage are required to prevent deteriorating cardiometabolic health profiles.
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http://dx.doi.org/10.1249/MSS.0000000000002696DOI Listing
October 2021

Dietary risk versus physical inactivity: a forced comparison with policy implications?

Lancet 2021 05;397(10286):1709-1710

Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia; School of Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.

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http://dx.doi.org/10.1016/S0140-6736(21)00801-1DOI Listing
May 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

Occupational physical activity and longevity in working men and women in Norway: a prospective cohort study.

Lancet Public Health 2021 06 28;6(6):e386-e395. Epub 2021 Apr 28.

Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway; Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway. Electronic address:

Background: Studies suggest that high occupational physical activity increases mortality risk. However, it is unclear whether this association is causal or can be explained by a complex network of socioeconomic and behavioural factors. We aimed to examine the association between occupational physical activity and longevity, taking a complex network of confounding variables into account.

Methods: In this prospective cohort study, we linked data from Norwegian population-based health examination surveys, covering all parts of Norway with data from the National Population and Housing Censuses and the Norwegian Cause of Death Registry. 437 378 participants (aged 18-65 years; 48·7% men) self-reported occupational physical activity (mutually exclusive groups: sedentary, walking, walking and lifting, and heavy labour) and were followed up from study entry (between February, 1974, and November, 2002) to death or end of follow-up on Dec 31, 2018, whichever came first. We estimated differences in survival time (death from all causes, cardiovascular disease, and cancer) between occupational physical activity categories using flexible parametric survival models adjusted for confounding factors.

Findings: During a median of 28 years (IQR 25-31) from study entry to the end of follow-up, 74 203 (17·0%) of the participants died (all-cause mortality), of which 20 111 (27·1%) of the deaths were due to cardiovascular disease and 29 886 (40·3%) were due to cancer. Crude modelling indicated shorter mean survival times among men in physically active occupations than in those with sedentary occupations. However, this finding was reversed following adjustment for confounding factors (birth cohort, education, income, ethnicity, prevalent cardiovascular disease, smoking, leisure-time physical activity, body-mass index), with estimates suggesting that men in occupations characterised by walking, walking and lifting, and heavy labour had life expectancies equivalent to 0·4 (95% CI -0·1 to 1·0), 0·8 (0·3 to 1·3), and 1·7 (1·2 to 2·3) years longer, respectively, than men in the sedentary referent category. Results for mortality from cardiovascular disease and cancer showed a similar pattern. No clear differences in survival times were observed between occupational physical activity groups in women.

Interpretation: Our results suggest that moderate to high occupational physical activity contributes to longevity in men. However, occupational physical activity does not seem to affect longevity in women. These results might inform future physical activity guidelines for public health.

Funding: The Norwegian Research Council (grant number 249932/F20).
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http://dx.doi.org/10.1016/S2468-2667(21)00032-3DOI Listing
June 2021
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