Människan är skapt till att vara i rörelse och fysiskt aktiv och genom rörelse hålls kroppens cirkulation igång, samt även att genom rörelse bidrar det till syreförsörjning till kroppens olika organ (Sundberg & Jansson, 2015). Forskning har påvisat starka evidens på fördelarna med regelbunden fysisk aktivitet och hälsostatus (både fysiskt och psykiskt), samt även visat sig vara sjukdomsförebyggande (Sundberg & Jansson, 2015; Andersson, Hovland, Kjellman, Taube & Martinsen, 2015). Att fysisk inaktivitet och långvarigt stillasittande utgör en riskökning till fysisk och psykisk ohälsa är ganska välkänt (Høgsbro, Davidsen & Sørensen, 2018). En yrkesgrupp som består utav stor del stillasittande arbete är yrkesförare, och en del utav den yrkesgruppen är lastbilschaufförer (Arbetsmiljöverket, 2018). I Sverige finns det omkring 90 000 yrkesförare (Statistiska centralbyrån, 2010). Enligt Rutter, Savelberg, Biddle & Kremer (2013) bör fokus vändas till stillasittande som beteende samt hur detta i sig utgör en hälsorisk. Rutter et al. (2013) menar att hälsoriskerna med långvarigt stillasittande inte kan minskas enbart genom 30 minuter måttlig fysisk aktivitet, utan man bör se till stillasittande som ett hälsobeteende eller livsstil. Exempelvis långa perioder stillasittandes framför TV, datorn, i bil eller på arbetsplatsen. Parallellt med hälsofrämjande insatser till att öka den fysiska aktiviteten bör man även uppmuntra till avbrott i långvarigt stillasittande. Genom att avbryta stillasittande med korta 5 minuters pauser minskas riskerna som ett stillasittande beteende medför. Studien visar på tydliga skillnader mellan långfärds och distributionschaufförer, där de som kör långfärdskörningar alla känner någon form av smärta i kroppen, men av de som kör distributionskörningar så upplever 44% av de svarande ingen smärta. / Human is Created to be in motion and physically active, and through movement the body’s circulation is kept up, and also through movement it contributes to the oxygen supply for the body’s various organs (Sundberg & Jansson, 2015). Research has shown strong evidence of the benefits of regular physical activity and health status (both physical and mental), as well as disease prevention (Sundberg & Jansson, 2015; Andersson, Hovland, Kjellman, Taube & Martinsen, 2015). The fact that physical inactivity and prolonged sedentary poses a risk increase to physical and mental health issues is quite well knows (Høgsbro, Davidsen & Sørensen, 2018). A professional group that consists of a great deal of sedentary work is professional drivers, and a part of that professional group is truck drivers (Arbetsmiljöverket, 2018). In Sweden, there are about 90,000 professional drivers (Statistiska Centralbyrån, 2010). According to Rutter, Savelberg, Biddle & Kremer (2013), the focus should be on sedentary behavior and how this in itself constitutes a health risk. Rutter et al. (2013) believe that the health risks of long-term sedentary behavior cannot be reduced solely by 30 minutes of moderate physical activity, but that sedentary behavior should be considered as a health behavior or lifestyle. For example, long periods of sitting still in front of the TV, the computer, in the car or in the workplace. In parallel with health-promoting efforts to increase physical activity, interruptions in long-term sedentary care should also be encouraged. By interrupting a sedentary session with short 5-minute breaks, the risks of sedentary behavior are reduced. The study shows clear differences between long-distance and distribution drivers, where those who drive long-distance hauls all feel some form of pain in their body, but those who run distribution hauls 44% of respondents experience no pain.

Sammanfattning: Bakgrund: Stillasittande och fysisk inaktivitet har ökat bland barn och ungdomar i Sverige. Detta skapar storakonsekvenser för både den fysiska och psykiska hälsan. Fysioterapeuter som arbetar med barn och ungdomar hargod erfarenhet kring barn och ungdomars fysiska och psykisk hälsa. Därför vill vi undersöka dessa fysioterapeuterssyn på stillasittande samt vilka behov av fysioterapi de upplever hos barn och ungdomar. Syfte: Syftet med denna studie var att belysa fysioterapeuters erfarenheter av barn och ungdomars stillasittandeoch fysisk inaktivitet samt fysioterapeuternas tankar om behovet av fysioterapi i skolan. Metod: Kvalitativ intervjustudie med induktiv ansats. Fem enskilda intervjuer utfördes med fysioterapeutersom arbetar med barn och ungdomar. Intervjuerna analyserades genom kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra kategorier: “Fysisk aktivitet är ingen självklarhet för barn”, “Barn hamnarutanför vården”, “Skolfysioterapeuten skulle kunna ha ett dynamiskt samarbete medvården” och “Skolfysioterapeutens kompetens kan öka barns hälsa”. Fysioterapeuterna som intervjuades sågstillasittande och fysisk inaktivitet som ett betydande problem för barn och ungdomars hälsa. Resultatet visade påatt fysioterapi som profession har god kunskap för att arbeta hälsofrämjande via skolan. Slutsats: Barn och ungdomars ohälsa ökar, i takt med ett ökat stillasittande och fysisk inaktivitet. Enskolfysioterapeut skulle kunna utföra behandling av motoriska svårigheter och psykisk ohälsa samt bidra till attutveckla det hälsofrämjande arbete i skolan.

Physical inactivity is a growing public health problem in the 21st century. A large proportion of the adult and adolescent population is not achieving recommended levels of physical activity which has significant consequences for both the individual and our society. With no evidence that the levels of physical inactivity will improve in the future, traditional methods of addressing this problem have evidently proven ineffective. A relatively new and promising approach to this problem that has become increasingly important in recent years is smartphone-based behavioral interventions to promote physical activity and other health-related behaviors. While several studies have shown many positive and promising results with this approach, other studies have also shown that the method is not completely understood. For instance, research shows that many of the health and fitness applications available today do not adequately adhere to behavior change strategies or health-related research, suggesting that these applications are not reaching their fullest potential. The goal of this study was to develop and evaluate an application to promote physical activity that was aligned with such research. A high-fidelity prototype based on the Behaviour Change Wheel was developed in Adobe XD and later evaluated by four participants. The outcome of the evaluation indicated that the developed prototype was well received overall, and participants believed it would trigger the desired behavior change of an increase in physical activity. However, due to the study limitations of unrepresentative participants and evaluation environment, time frame and application levels, nothing was truly proven in this regard. Further improvement of the prototype and future studies are needed to evaluate the prototype more accurately. / Fysisk inaktivitet är ett växande hälsoproblem för vårt samhälle under 2000-talet. En stor andel av vuxna och ungdomar uppnår inte rekommenderade hälsonivåer för fysiska aktivitet vilket har påtagliga konsekvenser för både individ och samhälle. Utan några forskningsbevis på att nivåerna för fysisk inaktivitet kommer att förbättras i framtiden har traditionella metoder för att motverka detta problem skenbarligen visats sig vara ineffektiva. Ett relativt nytt och lovande tillvägagångssätt för problemet som blivit alltmer relevant under de senaste åren är smartphonebaserade beteendeinterventioner för att främja fysisk aktivitet och andra hälsorelaterade beteenden. Medan ett flertal studier visat många positiva påföljder och lovande resultat med detta tillvägagångssätt, har andra studier samtidigt visat att metoden inte är helt förstådd och otillräckligt efterforskad. Bland annat visar forskning att många av dagens tillgängliga hälso- och träningsapplikationer inte optimalt följer riktlinjer för vare sig beteendeförändringsstrategier eller hälsorelaterad forskning, vilket antyder att dessa applikationer inte uppnår sin fulla potential. Målet med denna studie var att utveckla och utvärdera en applikation för att främja fysisk aktivitet som var baserad på sådan forskning. En prototyp av hög funktionsnivå baserad på The Behaviour Change Wheel utvecklades i Adobe XD och utvärderades av fyra deltagare. Resultatet från utvärderingen pekade mot att den utvecklade prototypen var väl uppskattad av deltagarna som även ansåg att prototypen skulle framkalla den önskade beteendeförändringen för ökad fysisk aktivitet. Emellertid, på grund av studiebegränsningarna med bland annat icke-representativa deltagare och utvärderingsförhållanden, tidsram samt applikationens funktionsnivå, kunde inte något absolut bevis framläggas i detta avseende. Ytterligare förbättringar av prototypen och framtida studier är nödvändiga för att utvärdera prototypen mer exakt.

Fysisk inaktivitet och stillasittande är ett problem i dagens samhälle. Det här resulterar i en risk för fysisk och psykisk ohälsa. Genom att träna regelbundet hämmar det risker såsom förtidig död, kardiovaskulära sjukdomar, depression, ångest likväl fysisk och psykisk hälsa. För att en individ skall utföra fysisk aktivitet regelbundet behöver det utföras inom optimala förutsättningar som bidrar till att motivationen för fysisk aktivitet bibehålls.  Syftet med studien var att undersöka motivation till träning i relation till WHO:s rekommendationer till fysisk aktivitet. Urvalet var studenter i åldrarna 18–50 år i södra Sverige. Vi använde BREQ-2 för att undersöka om det fanns en relation med WHO:s rekommendationer för fysisk aktivitet. Det här var en kvantitativ studie som utgår från BREQ-2 som är baserad på självbestämmande teorins fem regleringar. Egna frågor baserade på WHO:s rekommendationer för fysisk aktivitet för vuxna applicerades på enkätundersökningen. Resultatet tyder på att studenter drivs främst av identifierad och integrerad reglering. Det finns skillnad mellan könen inom motivation varav största skillnaden finns inom introjicerad reglering. Av de deltagande studenterna var det endast fåtal som uppnådde WHO:s rekommendationer vilket motsvarar 54,5%. Det fanns en signifikans mellan självbestämmande i relation till att uppnå WHO:s riktlinjer. / Physical inactivity and sedentary behavior are an problem in society. This results in an increased risk for physical and psychological health. Exercising on a regular basis decreases the risks such as premature death, cardiovascular diseases, depression, anxiety, and physical and psychological health. For an individual to perform physical activity regularly, it needs to be performed within optimal conditions to maintain the motivation for physical activity. The aim of the study was to examine motivation for physical activity in relation to World health organization´s (WHO’s) recommendations for physical activity. The target group is student between 18 and 50 years in southern Sweden. We used BREQ-2 to investigate whether there is a relationship with the WHO's recommendations for physical activity. This was a quantitative study based on BREQ-2 which is based on self- determination theories and five regulations. Own questions based on the WHO´s recommendations for physical activity for adults were applied to the survey.  The results indicate that students are primarily driven by identified and intrinsic regulation. There is a difference between the sex in motivation, of which the biggest difference is in introjected regulation. Of the participating students, only a few achieved the WHO's recommendations, which corresponds to 54.5%. There was a significance between self-determination in relation to achieving the WHO guidelines.

No description available.

The dose-response relationship between physical activity (PA), disease and mortality has primarily been obtained from self-report questionnaires in Western populations. A major limitation of self-reported PA is the likelihood of measurement error and these recordings cannot account for all 24-h activities, thus negating the influence of sedentary time and daily light intensity activity. Modern-day studies using objective measures of PA are highly controversial in the description of PA, as well as reliable wear time of these objective devices to accurately assess PA behaviour. The aim of the research presented in this thesis was to ascertain the associations between seven-day objectively measured PA (expressed as time spent in four different metabolic equivalent of task (MET) categories), cardiovascular disease risk factors (24-h ambulatory blood pressure and central obesity), chronic stress (General Health Questionnaire total score and serum cortisol) and DNA damage (leukocyte telomere length) in a cohort of African and Caucasian school teachers recruited from the Dr Kenneth Kaunda Education District in the North West Province of South Africa. All parameters were objectively measured (the GHQ was only added for thoroughness on measures of cognitive perceived stress) in the study population. The Africans (n=96) were younger than the Caucasians (n=107) (48.33 versus 51.06 years, p=0.024), but presented with slightly higher waist circumferences, significantly higher 24-h ambulatory systolic blood pressure (SBP, p≤0.000), diastolic blood pressure (DBP, p≤0.000) and mean arterial pressure (MAP, p≤0.000); significantly higher perceived stress scores (GHQ total scores, p=0.001) and significantly shorter telomeres (p≤0.000). The hypertensive participants in the total group (Africans and Caucasians combined) recorded 2.2 hours (12.4%) more daily awake sedentary time than the normotensive participants (p=0.004) and sedentary time was also a slightly better predictor of hypertension than moderate and vigorous activity time (Odds ratio=1.00, p=0.006). Irrespective of race and sex, 24-h SBP and DBP measurements were respectively associated with daily awake sedentary time (ß=0.17, p=0.018 and ß=0.18, p=0.020), light activity time (ß=-0.15, p=0.043 and ß=-0.16, p=0.041), waist circumference (ß=0.45, p≤0.000 and ß=0.33, p≤0.000) and log serum gamma glutamyl transferase (γ-GT, alcohol use) (ß=0.18, p=0.018 and ß=0.24, p=0.004). An older age (ß=-0.28, p≤0.000), higher alcohol consumption (ß=-0.21, p=0.003) and increased central obesity (ß=-0.17, p=0.017) were associated with shorter telomeres. Attenuated cortisol levels (ß=-0.12, p=0.068) showed a tendency towards associations with longer telomeres that may indicate possible cortisol down regulation to protect against DNA damage. Time spent in the different MET-categories showed no direct associations with either cortisol or telomere length. However, a sensitivity analysis indicated that daily light intensity activity time was significantly correlated with lower waist circumference (r=-0.21, p=0.004); a parameter associated with both cortisol (ß=-0.22, p=0.003) and telomere length (ß=-0.17, p=0.017). The thorough recording of PA during the true awake time of 24-h cycles over a period of seven days ensured that the beneficial effect of light intensity activities, as well as the detrimental effect of sedentary time, was highlighted by this study. The average awake time of all ethnic and sex groups were around 17 hours per day, which was more than most previous studies using objective measures of PA. The exclusion of participants who did not comply through wearing the Actiheart for a full seven days (n=143, 40%) did, however, have a negative impact on sample size that may have affected the statistical power for uncovering some significant associations and the high participant burden of the Actiheart device became clear. Therefore, the researchers used the data of the full seven-day recordings to also determine the minimum number of consecutive days the Actiheart device could be worn to accurately estimate energy expenditure and PA. The two-day combination of Wednesday-to-Thursday did not differ from the weekly average TEE, as well as for all MET-categories in all ethnic and sex groups. This two-day combination is practically convenient and would lessen participant burden. Future researchers are urged to test this combination in other populations to standardize Actiheart wear time. It can be concluded from the findings in this study that less daily awake sedentary time, more light intensity activity time, as well as lower alcohol consumption favour improved health as it is beneficial to 24-h ambulatory blood pressure and helps to maintain a healthy waist circumference, which ultimately influence telomere shortening. Furthermore, the two-day combination of Wednesday-to-Thursday seems to be sufficient to accurately estimate weekly energy expenditure and habitual PA with the Actiheart apparatus. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2015

The dose-response relationship between physical activity (PA), disease and mortality has primarily been obtained from self-report questionnaires in Western populations. A major limitation of self-reported PA is the likelihood of measurement error and these recordings cannot account for all 24-h activities, thus negating the influence of sedentary time and daily light intensity activity. Modern-day studies using objective measures of PA are highly controversial in the description of PA, as well as reliable wear time of these objective devices to accurately assess PA behaviour. The aim of the research presented in this thesis was to ascertain the associations between seven-day objectively measured PA (expressed as time spent in four different metabolic equivalent of task (MET) categories), cardiovascular disease risk factors (24-h ambulatory blood pressure and central obesity), chronic stress (General Health Questionnaire total score and serum cortisol) and DNA damage (leukocyte telomere length) in a cohort of African and Caucasian school teachers recruited from the Dr Kenneth Kaunda Education District in the North West Province of South Africa. All parameters were objectively measured (the GHQ was only added for thoroughness on measures of cognitive perceived stress) in the study population. The Africans (n=96) were younger than the Caucasians (n=107) (48.33 versus 51.06 years, p=0.024), but presented with slightly higher waist circumferences, significantly higher 24-h ambulatory systolic blood pressure (SBP, p≤0.000), diastolic blood pressure (DBP, p≤0.000) and mean arterial pressure (MAP, p≤0.000); significantly higher perceived stress scores (GHQ total scores, p=0.001) and significantly shorter telomeres (p≤0.000). The hypertensive participants in the total group (Africans and Caucasians combined) recorded 2.2 hours (12.4%) more daily awake sedentary time than the normotensive participants (p=0.004) and sedentary time was also a slightly better predictor of hypertension than moderate and vigorous activity time (Odds ratio=1.00, p=0.006). Irrespective of race and sex, 24-h SBP and DBP measurements were respectively associated with daily awake sedentary time (ß=0.17, p=0.018 and ß=0.18, p=0.020), light activity time (ß=-0.15, p=0.043 and ß=-0.16, p=0.041), waist circumference (ß=0.45, p≤0.000 and ß=0.33, p≤0.000) and log serum gamma glutamyl transferase (γ-GT, alcohol use) (ß=0.18, p=0.018 and ß=0.24, p=0.004). An older age (ß=-0.28, p≤0.000), higher alcohol consumption (ß=-0.21, p=0.003) and increased central obesity (ß=-0.17, p=0.017) were associated with shorter telomeres. Attenuated cortisol levels (ß=-0.12, p=0.068) showed a tendency towards associations with longer telomeres that may indicate possible cortisol down regulation to protect against DNA damage. Time spent in the different MET-categories showed no direct associations with either cortisol or telomere length. However, a sensitivity analysis indicated that daily light intensity activity time was significantly correlated with lower waist circumference (r=-0.21, p=0.004); a parameter associated with both cortisol (ß=-0.22, p=0.003) and telomere length (ß=-0.17, p=0.017). The thorough recording of PA during the true awake time of 24-h cycles over a period of seven days ensured that the beneficial effect of light intensity activities, as well as the detrimental effect of sedentary time, was highlighted by this study. The average awake time of all ethnic and sex groups were around 17 hours per day, which was more than most previous studies using objective measures of PA. The exclusion of participants who did not comply through wearing the Actiheart for a full seven days (n=143, 40%) did, however, have a negative impact on sample size that may have affected the statistical power for uncovering some significant associations and the high participant burden of the Actiheart device became clear. Therefore, the researchers used the data of the full seven-day recordings to also determine the minimum number of consecutive days the Actiheart device could be worn to accurately estimate energy expenditure and PA. The two-day combination of Wednesday-to-Thursday did not differ from the weekly average TEE, as well as for all MET-categories in all ethnic and sex groups. This two-day combination is practically convenient and would lessen participant burden. Future researchers are urged to test this combination in other populations to standardize Actiheart wear time. It can be concluded from the findings in this study that less daily awake sedentary time, more light intensity activity time, as well as lower alcohol consumption favour improved health as it is beneficial to 24-h ambulatory blood pressure and helps to maintain a healthy waist circumference, which ultimately influence telomere shortening. Furthermore, the two-day combination of Wednesday-to-Thursday seems to be sufficient to accurately estimate weekly energy expenditure and habitual PA with the Actiheart apparatus. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2015

Une mesure précise de l’activité physique en conditions de vie libre est nécessaire pour une meilleure compréhension de ses relations avec la santé. Le premier objectif de ce travail thèse a été de valider l’Actiheart (qui combine la mesure de la fréquence cardiaque et du mouvement par accélérométrie) par rapport à l’eau doublement marquée (EDM). Nous montrons un bon niveau de concordance entre la dépense énergétique liée à l’activité physique (DEAP) estimée par l’Actiheart et l’EDM. Une individualisation de la relation entre la fréquence cardiaque et de la DEAP par un test d’effort est nécessaire pour une estimation fiable de la DEAP au niveau individuel et pour évaluer des changements de DEAP tels qu’induits par une intervention. En laboratoire, nous montrons que la précision de l’Actiheart est activité dépendante. Ceci nécessite la mise en place de leur reconnaissance par de nouveaux capteurs et modèles mathématiques. L’adiponectine est une hormone du tissu adipeux qui a un rôle dans le métabolisme énergétique et dont la sécrétion diminue avec l’obésité. Les effets de l’activité physique sont en revanche contradictoires dans la littérature. Le second objectif de ce travail a été d’évaluer l’effet de l’activité physique et d’une intervention avec contrôle du poids sur les taux plasmatiques d’adiponectine. Nous montrons que l’adiponectine totale et à haut poids moléculaire sont associées négativement à la variation du niveau d’activité physique. D’autres travaux sont cependant nécessaires pour comprendre les mécanismes qui sous-tendent cette modulation de l’adiponectine plasmatique qui ne semble pas liée à des variations de synthèse dans le tissu adipeux ou musculaire. / Accurate measurements of physical activity in free living are needed to establish what dose of physical activity is necessary for obtaining a specific health benefits. The first aim of this work was to validate the Actiheart (which combines heart rate and accelerometry sensors) with doubly labeled water (DLW). We show a good level of concordance between physical activity energy expenditure (PAEE) estimated by Actiheart and DLW. Individualization of the relationship between heart rate and PAEE by an incremental test is needed for an accurate estimate of the PAEE at the individual level and to evaluate changes induced by an intervention. In laboratory, we show that the accuracy of Actiheart is activitydependent. This requires the establishment of their recognition from new sensors and mathematical models. Adiponectin, hormone secreted by adipose tissue, has a role in energy metabolism and its secretion decreases with obesity. However the effects of physical activity remain in contradiction in published studies. The second objective of this work was to evaluate the effect of physical activity and intervention with weight control on plasma adiponectin. We show that the total and high molecular weight adiponectin were negatively associated with modifications of the physical activity level. Further work is however necessary to understand the mechanisms underlying this modulation of plasma adiponectin which does not seem related to changes in synthesis in adipose tissue or muscle.

Purpose The purpose of this study was to investigate the effects of physical exercise on different skills that affect e-sports performance for e-sportsmen at amateur level in the game Overwatch. This is to gain knowledge about how e-sports training could be developed and streamlined. Methods The study is of the explorative research type since it deals with a topic that haven’t previously been broadly investigated. The method used was a quantitative exploratory method. The design was an intervention study. Results The study has not been able to demonstrate that skills affecting e-sports performance have changed through physical training. However, it is possible to read that the study participants who received the training intervention are more susceptible to and aware of changes in these skills compared to the study participants in the control group. Conclusions The purpose of the study has not been answered because the design was inadequate. However, the study may form the basis for further research. A number of important basic assumptions have been identified during the work. Based on these lessons a discussion took place, about how design deficiencies can be addressed and what is important to consider in future studies in the field. / Syfte Syftet med denna studie var att undersöka vilka effekter fysisk träning har på olika färdigheter som påverkar e-sportprestation hos e-sportare på amatörnivå i spelet Overwatch. Detta för att få kunskap om hur träning inom e-sport skulle kunna utvecklas och effektiviseras. Metod Studien är av typen explorativ forskning då den behandlar ett ämne som inte undersökts i större utsträckning tidigare. Metoden som tillämpades var en kvantitativ explorativ metod. Designen var en interventionsstudie. Resultat Studien har inte kunnat påvisa att färdigheter som påverkar e-sportprestation har förändrats i och med fysisk träning. Däremot går det att avläsa att de studiedeltagare som fick genomgå träningsinterventionen är mer mottagliga för och medvetna om förändringar rörande dessa färdigheter jämfört med studiedeltagarna i kontrollgruppen. Slutsatser Syftet med studien har inte kunnat besvaras i och med att designen varit bristfällig. Studien kan dock ligga till grund för vidare forskning. Ett antal viktiga grundförutsättningar har identifierats under arbetet. Utifrån dessa lärdomar diskuterades hur designbristerna kan åtgärdas och vad som är viktigt att tänka på vid framtida studier inom området.

Background Bikesharing is a versatile intervention, that enables cheap and convenient cycling for urban populations, and according to recent literature, has a positive impact on health, safety and the economy. Many of these impacts are based on the assumption of a modal shift induced by bikesharing, i.e. implementing a Bicycle Sharing System (BSS) will increase population cycling. However, the evidence is inconclusive. The aim of this study was to evaluate if the intervention of implementing a BSS increases cycling. The study was conducted using bicycle count data from Helsinki between 2014 to 2018. Methods A controlled interrupted time series design was used in combination with segmented regression as the method. An intervention series and a control series were analysed separately. The slopes (trend) and intercepts (level) of pre-intervention (2014&2015) segments were compared with post-intervention segments (2016-2018). The same analysis was performed in both intervention series and control series.  ResultsThe results from the intervention series showed an increase of 105% in the level of the outcome after the implementation of the intervention. Simultaneously, the control series showed that the underlying trend of cycling remained largely unchanged during the whole study period (level increased by 3%). Stratified analysis supported these results in both intervention and control series.   Conclusion The analysis of the intervention series revealed, that the level of the outcome increased sharply after the intervention, implying that the intervention had an immediate effect. However, the lack of statistical significance in the analysis of the slopes made it impossible to determine if the effect was sustained.