Physical activity impacts health and disease in multiple body tissues including the intervertebral discs. Fluid flow within the disc is an indicator of disc health that can be observed using diffusion weighted magnetic resonance imaging. We monitored activity levels of 26 participants, age 35 to 55 yrs, using Actigraph accelerometers for four days to evaluate vigorous-intensity activity, moderate to vigorous-intensity activity, and sedentary time. Participants underwent structural and diffusion weighted magnetic resonance imaging to evaluate intervertebral disc health and fluid flow. They also underwent bone density scans, carotid artery ultrasounds, a treadmill test, and a physical exam for pain, range of motion, and instability. These measures were used to correlate MRI indicators of intervertebral disc health with participant activity. Participants with any vigorous-intensity physical activity compared with no vigorous-intensity activity had significantly greater L5/S1 apparent diffusion coefficient values (p = 0.002), corresponding to higher freedom of diffusive movement for cellular nutrients and metabolic waste. Sagittal T2 values in the L5/S1 were also higher (p = 0.004), corresponding to higher water content in the discs. Higher apparent diffusion coefficients were also found in participants with more than 30 minutes compared with less than 30 minutes of daily moderate to vigorous physical activity (p = 0.03), and in participants with less than 67% awake time as sedentary time compared with more than 67% sedentary time (p = 0.03). Increased dynamic loading through physical activity and decreased static loading from sedentary time benefit intervertebral disc health. Physical activity, particularly vigorous activity, is beneficial in helping maintain intervertebral disc health.

Sedentary time and physical inactivity have negative impacts on health and health costs as well as an impact on workplace wellbeing. There is evidence that people are more sedentary and engage in less physical activity on work days. Additionally, sedentary behavior has been found to increase distress and negative mood. Activity trackers such as Fitbits are a useful way to collect and intervene on sedentary behavior and potentially impact other factors of workplace wellbeing in real time and promote self-monitoring. The reminder to move prompts that are now part of Fitbit models provide an innovative and simple way to intervene on workplace sedentary behavior with hourly movement prompts. This study examined the impact of an intervention on sedentary time at work with Fitbit reminders to move and what impact the intervention had on other factors of workplace wellbeing including depression, positive and negative affect, job stress, and productivity. Participants were university employees who wore a Fitbit device for three weeks and completed pre-and post-study measures. For the first week, the Fitbit displayed only the watch screen with no access to other data. This was done to establish baseline data. For the second week, the Fitbit device and Fitbit app allowed for self-monitoring by displaying the activity being tracked, including steps, distance, calories expenditure, and stairs walked. For the third week, the sedentary time reduction was implemented by activating the Fitbit application reminder to move. This caused the Fitbit to vibrate at the 50-minute mark of the hour if the participant had not moved 250 steps in that time. Results show that having the reminders to move prompt activated decreased sedentary time at work and increased steps throughout the day on work days. These changes in sedentary time significantly contributed to decreases in depression. From the start of the study to after the intervention, on average participants reported significantly less depression, negative affect, and stress and more positive affect, affect balance, social functioning, physical functioning, and productivity at work. The benefits of in the moment self-monitoring and an intervention around sedentary time with Fitbits on factors of workplace wellbeing are discussed as well as limitations, and future directions.

The emergency of malnutrition, in all of its forms, and physical inactivity among children and adolescents as serious public health challenges, especially in resource-limited low- and middle-income countries is concerning and requires attention. Data on the prevalence of unhealthy weight status and levels of physical inactivity among children and adolescents in these low- and middle-income countries are limited, not systematically collected nor are they well documented. Accurate prevalence estimates, and an informed understanding of the relationships among movement behaviours and weight status of children and adolescents, are required to facilitate evidence-informed interventions and public health policies in these countries. The main purposes of this dissertation were to examine relationships between lifestyle behaviours and weight status among primary schoolchildren in Mozambique; compare body mass indices and movement behaviours of Mozambican schoolchildren to those of children from other countries; and use these findings to highlight important data gaps that exist in low- and middle-income countries. First, the Active Healthy Kids Global Alliance’s Report Card development methodology was used to conduct thorough narrative literature searches, identify data gaps and research needs which subsequently informed research questions and primary data collection. A published protocol that was developed for the multinational cross-sectional International Study of Childhood Obesity, Lifestyle and the Environment was adopted and used for primary data collection among urban and rural schoolchildren in Mozambique (n=683), to facilitate data comparability. Anthropometric (weight, height, percent body fat, bioelectric impedance, mid-upper-arm circumference, waist-circumference) and accelerometry (nocturnal sleep, sedentary time, various intensities of physical activity) data were objectively measured by trained personnel. Data about lifestyle behaviours (diet and movement behaviours), demographics and environmental (home, neighbourhood, school) factors associated with child weight status were collected using context-adapted questionnaires. As part of this dissertation, six manuscripts were developed and submitted for publication in peer-reviewed scientific journals. Overall, the narrative literature searches revealed a dearth of information about prevalences of unhealthy weight status, and key lifestyle behaviours among children and adolescents in low- and middle-income countries. Results from data collected in Mozambique showed overweight/obesity to be an emerging public health concern, especially among urban children (11.4%), while thinness still persists and is more prevalent among rural schoolchildren (6.3%). Moderate- to vigorous-intensity physical activity, active transport and mother’s body mass index were found to be important modifiable correlates of weight status for Mozambican children. Distinct differences in the prevalences and correlates of lifestyle behaviours (sleep and physical activity) were observed between urban and rural children in Mozambique. The findings showed that mean moderate- to vigorous-intensity physical activity was lower (82.9±29.5 minutes/day) among urban compared to rural Mozambican children (96.7±31.8 minutes/day). Compared to children from 12 other countries, on average, children from Mozambique had lower body mass indices, higher daily moderate- to vigorous-intensity physical activity, lower daily sedentary time and comparable sleep duration. For example, rural Mozambican children had lower mean BMI z-scores (-0.5±0.9) than the rest of the sample (0.4±1.3), 46 more minutes of daily moderate- to vigorous-intensity physical activity, and 99 less minutes of daily sedentary time than the other children. Furthermore, linear distributions of study site-specific body mass index (positive), minutes of daily moderate- to vigorous-intensity physical activity (negative), and daily sedentary time (positive) by country human development index were observed. Compared to others, children from the urban Mozambican site closely resembled those from Nairobi Kenya on body mass index and movement behaviours, whereas those from rural Mozambique were distinctly different from the rest of the sample on many indicators. Findings from this dissertation highlight the importance of including participants from low, medium, high, and very high-income countries in multinational studies investigating contextual and environmental factors related to childhood weight status. The findings revealed important differences between urban and rural children supporting the need to include both in study samples and especially in low- and middle-income countries where the majority of people live in rural areas. Finally, findings from this dissertation have demonstrated that despite the reported global progress in the availability of data about obesity and related factors among children and adolescents, gaps still exist and need to be filled in low- and middle-income countries.

This thesis aimed at developing and evaluating a tailored behavioural sleep medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome (OSAS) and overweight. Participants with moderate or severe OSAS (apnea-hypopnea index ≥15) and obesity (Studies I-II) or overweight (Studies III-IV), treated with continuous positive airway pressure (CPAP) (Studies I-II) or admitted to CPAP treatment (Studies III-IV), were recruited from the sleep clinic at Uppsala University Hospital, Sweden. Semi-structured individual interviews were analysed using qualitative content analysis (Study I). Data on moderate-to-vigorous physical activity (MVPA) and sedentary time were collected with three measurement methods and analysed regarding the level of measurement agreement (Study II). Potential disease-related and psychological correlates for the amount of MVPA, daily steps and sedentary time were explored using multiple linear regression (Study III). Physical activity and eating behaviour changes were examined after a six month behaviour change trial (Study IV). A tailored behavioural sleep medicine intervention targeting physical activity and healthy eating in combination with first- time CPAP treatment was compared with CPAP treatment and advice on the association between weight and OSAS. According to participants’ conceptions, a strong incentive is needed for a change in physical activity and bodily symptoms, external circumstances and thoughts and feelings influence physical activity engagement (Study I). Compared with accelerometry, the participants overestimated the level of MVPA and underestimated sedentary time when using self-reports (Study II). The participants spent 11 hours 45 minutes (71.6% of waking hours) while sedentary. Fear of movement contributed to the variation in steps and sedentary time. Body mass index was positively correlated to MVPA (Study III). The experimental group increased intake of fruit and fish and reduced more weight and waist circumference compared with controls. There were no changes in physical activity (Study IV). The novel tailored behavioural sleep medicine intervention combined with first-time CPAP facilitated eating behaviour change, with subsequent effects on anthropometrics, but it had no effects on physical activity and sedentary time. Fear of movement may be a salient determinant of sedentary time, which has to be further explored in this population. The results confirm sedentary being a construct necessary to separate from the lower end of a physical activity continuum and highlight the need of developing interventions targeting sedentary behaviours specifically.

Bakgrund: Datorspel kan ge en ökad dagtrötthet och försämrad sömnkvalitet hos individer som spelar mer än 2h/dag. Fysisk aktivitet har en akut positiv inverkan på många delar i sömnen såsom sömnkvalitet och dagtrötthet. Syftet med studien var att kartlägga den fysiska aktivitetsnivån och sömnsvårigheter hos datorspelande vuxna, samt undersöka ett eventuellt samband mellan fysisk aktivitet och sömnsvårigheter.  Metod: Författarna genomförde en icke experimentell kvantitativ tvärsnittsstudie med vuxna individer som spelade datorspel minst 2h/dag. 116 svar inkluderades till frågeställning 1 (internt bortfall till frågeställning 2 & 3 n = 20). En webbenkät publicerades i tre svenska Facebook-grupper inriktade mot datorspel för att kartlägga deltagarnas sömn samt fysisk aktivitet. Sömnen mättes med Insomnia Severity Index (ISI) och den fysiska aktiviteten mättes med International Activity Questionnaire Short Form (IPAQ-SF). Resultat: 70% av studiens respondenter hade “Inga kliniska sömnsvårigheter” enligt ISI och 59% bedömdes ha en hög aktivitetsgrad enligt IPAQ-SF. Det förekom inget signifikant samband mellan respondenternas sömnbesvär och fysiska aktivitet.  Diskussion: Förekomsten av sömnbesvär och antal deltagare som uppfyllde kriterierna för insomni var jämförbar med den svenska populationen. Vidare var respondenternas aktivitetsgrad högre än vad som tidigare setts i den svenska befolkningen. För att kunna se ett tydligare samband mellan dessa faktorer är bedömningen att det skulle krävas ett större urval med respondenter. / Background: Computer games can negatively impact sleep in individuals who play more than 2 hours/day. Physical activity can improve many parts of sleep such as sleep quality and less daytime fatigue. The purpose of the study was to map the level of physical activity and sleep difficulties in computer-gaming adults, and to investigate whether there is a correlation between physical activity and sleep difficulties. Method: The authors conducted a non-experimental quantitative cross-sectional study with computer-gaming adults who played at least 2 hours/day. 116 answers were included to question 1 (internal dropout to question 2 & 3 n = 20). A web-survey was published in three Swedish computer game-oriented Facebook groups to map the participants' sleep and physical activity. Sleep was measured with the Insomnia Severity Index (ISI) and physical activity was measured with the International Activity Questionnaire Short Form (IPAQ-SF) Results: 70% of the study respondents had “No clinical sleep difficulties” according to ISI and 59% were classified to have a high activity level according to IPAQ-SF. There was no significant association between the respondents' sleep difficulties and physical activity. Discussion: The occurrence of sleep difficulties and the number of participants who met the criteria for insomnia was comparable to the Swedish population. Furthermore, the respondents' degree of physical activity was higher than previously seen in the Swedish population. In order to be able to see a clearer connection between these factors, the assessment is that a larger selection of respondents would be required.

Background: 24-hour movement behaviors, including moderate-to-vigorous physical activity (MVPA), sedentary time (ST), and sleep duration, have important implications for health across the lifespan. However, no studies exist that have examined the integration of these 24-hour movement behaviors in Latin America. The purpose of this study was to examine the prevalence of meeting the Canadian 24-Hour Movement Guideline recommendations and sociodemographic correlates of meeting the guidelines in adults from eight Latin American countries. Methods: This was a multi-national cross-sectional study of 2338 adults aged 18 to 64 years from the Latin American Study of Nutrition and Health. MVPA and ST data were collected using accelerometers. Sleep duration was self-reported using a daily log. Socio-demographic correlates included sex, age, education level, and marital status. Meeting the 24-hour movement guidelines was defined as: ≥150 min/week of MVPA; ≤8 h/day of ST; and between 7 and 9 h/day of sleep. Logistic regression models were estimated on pooled data. Results: The prevalence of adults who met the MVPA, ST, sleep duration, and integrated recommendations was 48.3, 22.0, 19.4, and 1.6%, respectively. Overall, being a woman (OR: 0.72; 95%CI: 0.55,0.93) and having a middle (0.63; 0.47,0.85) or high education level (0.31; 0.17,0.56) was associated with lower odds of meeting all three of the 24-hour movement guideline recommendations. Being married (1.70; 1.25,2.29) was associated with greater odds of meeting all three recommendations. Being a woman (0.46; 0.39,0.55), aged 50-64 years (0.77; 0.60,0.97), and married (0.79; 0.65,0.96) were associated with lower odds of meeting the MVPA recommendation. Having a middle (0.64; 0.50,0.80) or high (0.36; 0.23,0.55) education level was associated with lower odds and being married (1.86; 1.46,2.36) was associated with greater odds of meeting the ST recommendation. Being a woman (0.63; 0.51,0.78) was associated with lower odds; whereas being aged 50-64 years (1.40; 1.04,1.88) and having a middle education level (1.37; 1.09,1.73) were associated with greater odds of meeting the sleep duration recommendation. Conclusions: Overall, the proportion of Latin American adults achieving healthy levels of 24-hour movement behaviors was low. Further efforts are needed to promote more MVPA, less ST, and sufficient sleep in Latin American adults. Trial registration: Clinical Trials NCT02226627. Retrospectively registered on August 27, 2014. / Universidad de Costa Rica / Revisión por pares

The purpose of this study is to examine rural children's sedentary time during school days vs non-school days Currently, childhood obesity research has focused predominantly on urban-dwelling children. However, existing literature indicates that rural children have higher rates of obesity than their urban counterparts. There is a current lack of evidence investigating the obesogenic behaviors of rural children, such as physical activity levels, sleep duration, sedentary behaviors and diet. With this project, I aim to observe sedentary time (time spent sitting, screen time etc.) as research has shown that independent of physical activity, sedentary time is associated with weight gain. A secondary aim of this research is to test the Structured Days Hypothesis which states that children engage in less-favorable obesogenic behaviors (e.g., prolonged sitting, higher screen time) during non-school versus school-days due to the removal of ‘structure' during non-school days.

High levels of sedentary behaviour (SB) and low levels of physical activity (PA) in primary school children are a health concern especially for the South Asians (SA) because of increased cardiovascular risk. The study investigated ethnic differences in movement behaviours among primary school children in three studies: 1) inclinometer and accelerometer measured movement behaviours in White British (WB) vs. SA 6-8-year-old children; 2) qualitative studies with children, parents and teachers explored barriers and facilitators to reducing SB; and, 3) accelerometer measured movement behaviours in children aged 8-11-years. The inclinometer outcomes were: total SB, SB from bouts >30 minutes and breaks in SB, while accelerometry considered: SB, light PA and moderate to-vigorous PA and counts per minute. 525 children, eight parents and six teachers participated. No ethnic differences were identified in inclinometer outcomes except for SB breaks. SA children had 25 fewer breaks compared to WB. Accelerometry identified higher SB for SA children vs. WB in study one but no ethnic differences in study three; a pattern for higher SB/lower PA for SA children vs. WB was consistent in studies. Reasons for engagement in SB included: knowledge and beliefs about SB, child characteristics, cultural norms, parenting, educational system and the built environment. A large proportion of movement behaviour interventions components were related to education and policy. Children’s levels of SB were similar to office workers regardless of ethnicity. Interventions to reduce SB need to consider SB breaks and PA, especially for SA children who were less active and more sedentary than WB.

Bakgrund: Folkhälsomyndighetens rapport (2022) beskriver hur Sveriges regioner arbetar med FaR. Där framkommer en rad utmaningar, framförallt att metoden är underanvänd i södra Sverige och att få regioner nämner uppföljning av friskvården. Emellertid saknas det studier och underlag för hur friskvården arbetar med FaR. Det är därför angeläget att ta reda på hur friskvårdsanläggningar arbetar med uppföljning av metoden. Syfte: Syftet med studien var att undersöka träningsinstruktörers, i södra Sverige, upplevelser av och perspektiv på arbetet med FaR. Metod: I studien användes en kvalitativ studiedesign. Datainsamlingen gjordes med hjälp av semistrukturerade intervjuer där nio deltagare med varierande arbetserfarenheter av FaR (2–22 år) intervjuades. Intervjuerna analyserades med en kvalitativ konventionell innehållsanalys. Resultat: Resultatet visade att träningsinstruktörerna hade goda erfarenheter av metoden, att det finns många hälsofördelar samt att det skulle kunna generera ekonomisk vinning om FaR användes mer. Vid analysen utkristalliserades tre övergripande teman “För en grundläggande hälsa behöver vi fysisk aktivitet”, “Kunskap och resurser för en bättre folkhälsa” och “Betydelsen av och arbetet som träningsinstruktör”. Konklusion: Det framkommer i studien att samtliga av de träningsinstruktörer som ingått i undersökningen arbetar med uppföljning i någon form. Vad gäller aktiviteter finns ett brett utbud i form av gym och gruppträning. Den övergripande inställningen är att metoden bör användas i större utsträckning samt engagera fler aktörer från regionen för en bättre samverkan. Träningsinstruktörerna lägger stor vikt i den evidens som finns kring den fysiska aktivitetens effekter på hälsan. / Background: The Public Health Agency's report (2022) describes how Sweden's regions work with PaP. A number of challenges emerge, above all that the method is underused in southern Sweden and that few regions mention health care follow-up. However, there is a lack of studies and data on how health care works with PaP. It is therefore important to find out how wellness facilities work with follow-up of the method. Purpose: The aim of the study was to examine experiences and perspectives of training instructors in southern Sweden on the work with PaP. Method: The study followed a qualitative study design. The data collection was done using semi-structured interviews where nine participants with varying work experience of PaP (2-22 years) were interviewed. The interviews were analyzed using a qualitative conventional content analysis. Result: The results showed that participating training instructors had good experiences using the method, that there are multiple health benefits and that it could generate financial gain if PaP was used more. During the analysis, three overarching themes arose: "For basic health we need physical activity", "Knowledge and resources for better public health" and "The importance of, and the work as a training instructor". Conclusion: It appeared in the study that all the training instructors included in the survey, work with follow-up appointments in some form. In terms of activities, there is a wide range in the form of gyms and group training. The overall approach is that the method should be used to a greater extent and engage more companies from the region for improved collaboration. The training instructors attach great importance to the evidence available regarding effects of physical activity on health.

Inledning: I dagens moderna, välutvecklade och allt mer digitaliserade samhälle ges människor en ökad möjlighet till att leva sina liv betydligt mer stillasittande än tidigare. Allt mer forskning pekar idag på att långvarigt stillasittande som enskild riskfaktor är en bidragande orsak till utvecklingen av ohälsa samt vällevnadssjukdomar såsom diabetes, hjärt- och kärlsjukdomar samt fetma. Syfte: Syftet med litteraturöversikten är att undersöka hur ett stillasittande beteende som enskild riskfaktor påverkar vuxna människors hälsa samt belysa vilka faktorer som bidrar till ett stillasittande beteende. Metod: För att besvara syftet har en litteraturöversikt gjorts utifrån tio vetenskapliga originalartiklar. Sökningarna har gjorts via databaserna Pubmed, Cinahl och PsycARTICLES. Artiklarna granskades och analyserades sedan med hjälp av Whittemore och Knafl (2005) analysmetod. Resultat: Längre stunder av stillasittande hade en tydlig koppling mellan flera fysiologiska effekter i kroppen. När pauser togs genererade det i flera hälsofrämjande effekter så som ett ökat upptag av glukos i blodet, ökad kaloriförbrukning samt minskat BMI. Hos de personer som var mindre stillasittande sågs även en minskad risk av att dö i t.ex. hjärt- och kärlsjukdomar. Riskfaktorer så som en dålig arbetsmiljö, vart en bor samt ett förhöjt BMI sågs ha negativa effekter som ledde till ett ökat stillasittande. Slutsats: Att så mycket som 60 % av den vakna tiden spenderas stillasittande kan ses som en riskfaktor för att i förlängningen kunna utveckla vällevnadssjukdomar. Viktiga aspekter som sågs för att motverka detta var att regelbundet ta kortare pauser för att avbryta längre stunder av stillasittande.Trots att en hälsosam nivå av fysisk aktivitet uppnås är det inte tillräckligt om resten av dagen spenderas stillasittande. Detta utgör ett behov av nya tydligare och uppnåeliga riktlinjer för hur personer bör begränsa sitt stillasittande. / Introduction: In today's modern, well-developed and increasingly digitized society, people are given the opportunity to live much more sedentary lives than before. More research today indicates that long-term sedentary as a single risk factor is a contributing factor in developing illness and public health diseases such as diabetes, cardiovascular disease and obesity. Aim: The aim of the literature review is to investigate how sedentary behavior as an individual risk factor affects adult human health as well as highlight the factors that contributes to sedentary behavior. Method: In order to respond to the aim, an integrated literature survey has been conducted based on ten scientific original articles. The searches have been made through the databases Pubmed, Cinahl and PsycARTICLES. The articles were then examined and analyzed using the Whittemore and Knafl (2005) analytical method. Results: Longer moments of sedentary had a clear connection between several physiological effects in the body. When breaks were taken, it generated several health-promoting effects such as increased blood glucose absorption, increased calorie consumption, and reduced BMI. In those who were less seated, there was also a reduced risk of dying in e.g. Heart disease. Risk factors such as a poor work environment, where one lives, and an elevated BMI, were found to have adverse effects that led to increased sedentary behaviors. Conclusion: As much as 60% of the waking time is spent sedentary this is considered a risk factor in order to develop public health diseases in the long run. Important aspects that were seen to counteract this were to regularly take shorter breaks to interrupt longer moments of sedentary. Although a healthy level of physical activity is achieved, it is not enough if the rest of the day is spend sedentary. This constitutes a need for new, clearer and achievable guidelines for how people should limit their sedentary behavior.