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INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based on the revised definition of the European Working Group on Sarcopenia in Older People 2. Binomial logistic and multivariate linear regression models as well as dose-response analyses were applied and adjusted for demographics, accelerometer wear time, lifestyle factors, and chronic health conditions. RESULTS: Oldest-old adults with higher total volumes of moderate to vigorous physical activity (MVPA) (OR=0.74, 95% CI 0.62 to 0.89) showed a lower likelihood for a probable sarcopenic condition in the primary sample. Likewise, patterns of higher accumulated time spent in MVPA bouts of less than 10 minutes (OR=0.78, 95% CI 0.64 to 0.95) and MVPA bouts of at least 10 minutes (OR=0.78, 95% CI 0.63 to 0.98) were also related with lower odds of probable sarcopenia. A 2.1 times (95% CI 1.01 to 4.35) higher likelihood for confirmed sarcopenia was observed among participants who spent 60 minutes more per day in sedentary behavior (SB). Furthermore, 2.9 times (95% CI 1.05 to 8.02) greater odds of severe sarcopenia were identified following each 0.1 higher active-to-sedentary transition probability (ASTP). Focusing on individual sarcopenic components, higher total activity counts, higher MVPA, higher light intensity physical activity (LIPA), lower SB, and lower ASTP were related with better gait speed. CONCLUSION: The total volume of MVPA, whether accumulated in short sporadic bouts or prolonged bouts, was associated with lower odds of probable sarcopenia. Higher LIPA, lower SB, and a less fragmented activity pattern might also be related with a lower likelihood of sarcopenia status and better physical performance among oldest-old adults.

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Bakgrund: Efter Pandemrix-vaccinationen år 2009 i Sverige insjuknade ett stort antal unga individer i den koniska sjukdomen narkolepsi. Syfte: Kartlägga aktivitetsvanor, stillasittande, tilltro till egen förmåga att klara fysisk aktivitet samt undersöka samband mellan aktivitetsnivå och tilltro till egen förmåga att klara fysisk aktivitet. Metod: Undersökningsgruppen var 120 individer över 18 år, från Narkolepsiföreningen, som drabbats i samband med Pandemrix-vaccinationen år 2009. Datainsamling genomfördes via enkät.   Resultat: 47,1 procent uppnådde WHO:s rekommenderade aktivitetsnivå. 25,2 procent var fysiskt aktiva mindre än en gång i månaden eller aldrig. Genomsnittlig stillasittandetid var sju timmar och nio minuter/dag. Medianen för tilltro till egen förmåga att klara fysisk aktivitet var 19 på en skala mellan 9-36. Ett signifikant måttligt samband mellan tilltro till egen förmåga att klara fysisk aktivitet och aktivitetsnivå förelåg. Konklusion: Studiens resultat talar för att narkolepsidrabbade bör öka sin aktivitetsnivå och för att uppnå det även öka tilltro till egen förmåga att klara fysisk aktivitet. / Backgroud: After the Pandemrix-vaccination in 2009 a sudden increase in childhood narcolepsy was observed in Sweden. Scientific research focusing on the level of physical activity within this group is scarce. Purpose: Identifying the level of physical activity and physical exercise, sedentary behavior, self-efficacy to perform physical activity, as well as examine the correlation between physical activity level and self-efficacy to perform physical activity. Method: 120 individuals, over 18 years of age, who developed narcolepsy due to the Pandemrix-vaccination and were members of the Swedish Narcolepsy Association participated in the study. The data collection was conducted through a survey. Results: 47.1 percent of the participants achieved the WHO recommendations for physical activity. 25.2 percent were physically active less than once a month or never. The duration of the participants average time of sedentary behavior was seven hours and nine minutes per day. The median for self-efficacy to perform physical activity was 19 on a scale between 9-36. There was a significant moderate correlation between the participants self-efficacy to perform physical activity and their level of physical activity . Conclusion: The results of this study indicates that individuals suffering from narcolepsy should increase their level of physical activity as well as increase their self-efficacy to perform physical activity.

En raison des progrès technologiques, les comportements sédentaires (souvent devant un écran) sont devenus les activités de loisir préférées pour beaucoup d’enfants, au lieu de s’engager dans le jeu actif, des sports ou d’autres activités requérant de l’effort physique. L’utilisation de transport actif est aussi en déclin, la majorité des enfants se rendant à l’école en voiture ou dans d’autres moyens de transport passifs. Pourtant, l’inactivité et la sédentarité constituent des facteurs de risque pour de multiples problèmes de santé physique et mentale. Tel que décrit dans le premier chapitre, les bienfaits de l’activité physique sur le bien-être sont bien documentés et les risques associés aux comportements sédentaires sont de plus en plus étudiés. Néanmoins, la plupart des études ne regardent ces deux aspects que séparément et ne s’intéressent qu’à l’impact immédiat sur une dimension spécifique du bien-être. Le but de cette thèse doctorale était donc d’étudier le rôle que l’activité physique et les comportements sédentaires, à la fin de la maternelle, jouent sur le bien-être physique, cognitif et psychosocial au début de l’adolescence (deux périodes de transition importantes pour les enfants). Le premier article (Chapitre II) a examiné les associations prospectives entre la participation aux activités physiques pendant les loisirs, à l’âge de 6 ans, et le rendement scolaire à l’âge de 12 ans. Les résultats montrent que les enfants qui participent davantage aux sports et à d’autres activités physiques structurées et non structurées présentent de meilleurs résultats scolaires et un engagement en classe plus élevé six ans plus tard que les enfants qui s’adonnent moins à ces activités. Le deuxième article (Chapitre III) a examiné les liens prospectifs entre un mode de vie qui tient compte, simultanément, de la participation à des activités physiques pendant les loisirs, de l’utilisation de transport actif et du temps consacré aux comportements sédentaires (ordinateur, télévision et jeux vidéo), à l’âge de 6 ans, et des indicateurs reliés au rendement scolaire et au bien-être physique et psychosocial, à l’âge de 12 ans. Les résultats montrent que les enfants qui mènent un mode de vie plus actif/moins sédentaire avant de commencer la scolarité présentent, ultérieurement, des habitudes de vie plus saines (plus d’activité physique et moins de temps d’écran) et moins de troubles émotifs et de victimisation, comparativement aux enfants menant un mode de vie moins actif/plus sédentaire. Dans les deux articles, les associations spécifiques pour chaque genre ont également été explorées. Les résultats des analyses fondées sur le genre montrent que même si tant les filles que les garçons bénéficient d’être plus actifs/moins sédentaires, chaque sous-groupe éprouve les bienfaits différemment. Une discussion des principaux résultats et des implications est présentée dans le dernier chapitre. En somme, cette thèse souligne l’importance de promouvoir un mode de vie actif dès un âge précoce et de développer des communautés qui offrent aux enfants de multiples occasions de se maintenir actifs. Ceci permettra de prévenir les nombreux risques associés à l’inactivité et la sédentarité et de contribuer au bien-être des jeunes, à court et à long terme. / Due to advances in technology, sedentary behaviors (which typically involve screens) have become the preferred leisure activity for many children, instead of engaging in active play, sports, or other activities requiring physical effort. Due to urban sprawl, the use of active transportation is also in decline and most children travel to school by car or other passive means of transportation. However, physical inactivity and sedentariness are both risk factors for multiple physical and mental health problems. As described in the first chapter, the protective benefits of physical activity on well-being are well documented and the risks associated with sedentary behaviors are increasingly being studied. Nevertheless, most studies look at these two aspects separately and focus solely on the immediate impact on a specific sphere of well-being. The aim of this doctoral thesis was therefore to study, during two important transition periods in development, the links between physical activity and sedentary behavior in kindergarten and physical, cognitive, and psychosocial well-being while children transition out of elementary school. The first article (Chapter II) examined the prospective associations between participation in leisure-time physical activity at age 6 and academic performance at age 12. The results suggest that children who participate more in sports and other structured and unstructured physical activities perform better in school and present a higher classroom engagement six years later, than children who are less involved in these activities. The second article (Chapter III) examined the prospective links between a lifestyle that takes into account, at the same time, participation in leisure-time physical activity, use of active transportation, and time spent on sedentary behaviors (computer, television, and video games) at age 6, and several indicators related to academic performance and physical and psychosocial well-being at age 12. The results reveal that children who lead a more active/less sedentary lifestyle before starting school present healthier lifestyles (more physical activity and less screen time), fewer emotional disorders and less victimization later in life, compared to children leading a less active/more sedentary lifestyle. In both articles, gender-specific associations were also explored. The results of the gender-based analyses suggest that even if both girls and boys benefit from being more active/less sedentary, each gender experiences these benefits differently. A discussion of the main findings and implications is presented in the last chapter. In summary, this thesis highlights the importance of promoting an active lifestyle from an early age and the need of developing communities that provide children with multiple opportunities to stay physically active. This will help prevent the many risks associated with inactivity and sedentariness among youth and thus contribute to their well-being, both in the short and long term.

Physical inactivity is well known for its effects on increasing health risks contributing to mortality and morbidity. Restrictions imposed due to covid 19 pandemic have immobilized communities worldwide, resulting in remote working and distance learning. Literature evidence directs towards Covid-19 pandemic related physical inactivity and increased sedentary behavior (SB) in the general population, and very little research is carried out on the remote workers in communities that shifted from workplaces to homes. The aim of the study is to examine if working from home before and during Covid 19 - pandemic is associated with changes in physical activity and sedentary behavior among adults. The data was acquired from a cross-sectional Swedish population-based study (n= 1035). Physical Activity (PA) was reported in METs/w (metabolic equivalent minutes per week), and intensity was grouped as Vigorous, Moderate and Light PA. The amount of Work or Studied from home (WSFH) was reported in percentages. Light PA level was higher among the group >50% WSFH than the ≤ 50% group during pandemic and SB was higher among ≤ 50% WSFH group during pandemic. Demographical variations among the WSFH groups showed significant associations in the occupation and education level. In conclusion, the study showed that those who worked or studied more from homes have been physically active in walking (Light PA) and had a lower sedentary time than others. There were no significant difference in physical activity levels  due to the changes in the amount of pandemic-based work or study from home, during the pandemic.

Nowadays, prolonged sitting among office workers is a widespread problem, which is highly related to several health problems. Many proposals have been reported and evaluated to address this issue. However, motivating and engaging workers to change health behavior to a healthier working life is still a challenge. In this project, a specific application has been deployed for real-time monitoring and alerting office workers for prolonged sitting. The proposed system consists of three distinct parts: The first one is an android smartwatch, which was used to collect sensor data e.g., accelerometer and gyro data, with a custom android wear app. The second one is an android application, which was developed to act as a gateway for receiving the smartwatch’s data and sending them to IBM Bluemix cloud with MQTT protocol. The final part is a Node-Red cloud application, which was deployed for storing, analyzing and processing of the sensor data for activity detection i.e., sitting or walking/standing. The main purpose of the last one was to return relevant feedback to the user, while combining elements from gaming contexts (gamification methods), for motivating and engaging office workers to a healthier behavior. The system was firstly tested for defining appropriate accelerometer thresholds to five participants (control group), and then evaluated with five different participants (treatment group), in order to analyze its reliability for prolonged sitting detection. The results showed a good precession for the detection. No confusing between sitting and walking/standing was noticed. Communication, storage and analysis of the data was successfully done, while the push notifications to the participants, for alerting or rewarding them, were always accurate and delivered on time. Every useful information was presented to the user to a web-based dashboard accessed through a smartphone, tablet or a PC.     The proposed system can easily be implemented at a real-life scenario with office workers. Certainly, there is a lot space for improvement, considering mostly the type of data registered at the system, the method for sitting detection, and the user interface for presenting relevant information. / Numera är förlängt sittande bland kontorsarbetare ett utbrett problem som är väldigt relaterat till flera hälsoproblem. Många förslag har rapporterats och utvärderas för att ta itu med denna fråga. Tydligen är det fortfarande en utmaning att motivera och engagera arbetstagare för att förändra deras hälsobeteende till hälsosammare arbetsliv. I detta projekt har en särskild applikation använts för realtidsövervakning och varnar kontorsarbetare för förlängt sittande. Det föreslagna systemet består av tre olika delar: Den första är en android smartwatch, som användes för att samla sensordata t.ex. accelerometer och gyrodata, med en anpassad android wear app. Den andra är en en androidapplikation som fungerade som en gateway för att ta emot smartwatchens data och skickar datan till IBM Bluemix-Cloud med MQTT-protokollet. Den sista delen är en Node-RED Cloud-Applikation som användes för lagring, analysering och behandling av sensordata för aktivitetsdetektering. Detta innebär sittande eller gå/stående med det huvudsakliga ändamålet att returnera relevant återkoppling till användaren, samtidigt som man kombinerar element från spelkontekster (gamification metoder), för att motivera och engagera arbetarna till ett hälsosammare beteende. Systemet testades först för att definiera lämpliga accelerometertrösklar till fem deltagare (kontroll grupp) och utvärderades sedan med fem olika deltagare (behandingsgrupp) för att analysera dess tillförlitlighet för långvarig sittdetektering. Resultaten visade en bra precession för detektionen. Ingen förvirring mellan att sitta och gå / stående märktes. Kommunikation, lagring och analys av data gjordes framgångsrikt, medan push-meddelandena till deltagarna, för att varna eller belöna dem, var alltid korrekta och levererade i tid. All användbar information presenterades för användaren på en webbaserad dashboard som nås via en smartphone surfplatta eller en dator. Det föreslagna systemet kan enkelt implementeras i ett verkligt scenario med kontorsarbetare. Visst finns det mycket utrymme för förbättring om man tänker på majoriteten av data som registrerats i systemet, metoden för sittande detektion och användargränssnittet för presentering av relevant information.

<p dir="ltr">Background. Although depression is a risk factor for cardiovascular disease (CVD), few clinical trials in people without CVD have examined the effect of depression treatment on CVD-related outcomes. It’s unknown if successful depression treatment improves indicators of CVD risk, such as CVD-relevant health behaviors, traditional CVD risk factors, and CVD events. </p><p dir="ltr">Methods. We examined data from eIMPACT trial, a phase II randomized controlled trial conducted from 2015-2020. Depressive symptoms, CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed. Incident CVD events over four years were identified using a statewide health information exchange. </p><p dir="ltr">Results. The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). CVD-relevant health behaviors did not mediate any intervention effects on traditional CVD risk factors. Twenty-two participants (10%) experienced an incident CVD event. The likelihood of an CVD event did not differ between the intervention group (12.1%) and the usual care group (8.3%; HR = 1.45, 95% CI: 0.62-3.40, p = 0.39). </p><p dir="ltr">Conclusions. Successful depression treatment alone improves self-reported sleep quality but is not sufficient to lower CVD risk of people with depression. Alternative approaches may be needed reduce CVD risk in depression. </p><p dir="ltr">Trial Registration: ClinicalTrials.gov Identifier: NCT02458690 </p><p dir="ltr">Keywords: depression, cardiovascular disease, blood pressure, lipids, medication adherence, sedentary behavior, sleep quality, collaborative care, internet interventions, clinical trial</p>

ABSTRACT Purpose: The purpose of this study was to examine the relationship between self-reported sedentary time (ST) and the cumulative risk of preserved ejection fraction heart failure (HFpEF) and reduced ejection fraction heart failure (HFrEF) using a diverse cohort of U.S. adults 45-84 years of age. Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we identified 6,814 subjects (52.9% female). All were free of baseline cardiovascular disease. Cox regression was used to calculate the hazard ratios (HR) associated with baseline ST and risk of overall heart failure (HF), HFpEF, and HFrEF. Weekly self-reported ST was dichotomized based on the 75th percentile (1,890 min/wk). Results: During an average of 11.2 years of follow-up there were 178 first incident HF diagnoses; 74 HFpEF, 69 HFrEF and 35 with unknown EF. Baseline ST >1,890 min/wk was significantly associated with an increased risk of HFpEF (HR [95% CI]; 1.87 [1.13 – 3.09], p= 0.01), but not HFrEF (HR [95% CI]; 1.30 [0.78 – 2.15], p= 0.32). The relationship with HFpEF remained significant in separate fully adjusted models including either waist circumference (HR [95% CI]; 2.16 [1.23 – 3.78], p < 0.01) or body mass index (HR [95% CI]; 2.17 [1.24 – 3.80], p < 0.01). Additionally, every 60 minute increase in weekly ST was associated with a significant 3% increased risk of HFpEF (HR [95% CI]; 1.03 [1.01 – 1.05], p < 0.01). Conclusions: Sedentary time > 1,890 min/wk (~4.5 h/d) is a significant independent predictor of HFpEF, but not HFrEF.