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ABSTRACT: OBJECTIVE: To examine how cardiorespiratory fitness and self-perceived stress are associated with burnout and depression. To determine if any relationship between stress and burnout/depression is mitigated among participants with high fitness levels. METHODS: 197 participants (51% men, mean age=39.2 years) took part in the study. The Åstrand bicycle test was used to assess cardorespiratory fitness. Burnout was measured with the Shirom-Melamed Burnout Questionnaire (SMBQ), depressive symptoms with the Hospital Anxiety and Depression Scale (HAD-D). A gender-matched stratified sample was used to ensure that participants with varying stress levels were equally represented. RESULTS: Participants with moderate and high fitness reported fewer symptoms of burnout and depression than participants with low fitness. Individuals with high stress who also had moderate or high fitness levels reported lower scores on the SMBQ Tension subscale and the HAD-D than individuals with high stress, but low fitness levels. CONCLUSION: Better cardiovascular fitness seems to be associated with decreased symptoms of burnout and a better capacity to cope with stress. PRACTICAL IMPLICATIONS: Promoting and measuring cardiorespiratory fitness can motivate employees to adopt a more physically active lifestyle and thus strengthen their ability to cope with stress exposure and stress-related disorders.
Patient Education and Counseling 04/2013; · 2.31 Impact Factor
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ABSTRACT: OBJECTIVE:: To determine the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) among a group of female athletes and compare with an age-matched group of female nonathletes. To study lifestyle factors that could play a role in the development of ID and IDA and compare these factors between the groups. DESIGN:: A controlled clinical trial. SETTING:: A senior high school for athletes in Gothenburg, Sweden. PARTICIPANTS:: All female athletes at a senior high school for top-level athletes were offered to take part. Fifty-seven female athletes accepted to participate in the study. The control group consisted of a random sample of 130 age-matched nonathlete students, 92 accepted to participate in the study. INTERVENTION:: Intervention was not an actual part of this study but those with ID and IDA were treated with iron by the regular school doctor. MAIN OUTCOME MEASURES:: Iron deficiency anemia and ID were determined by levels of hemoglobin, serum iron, total iron-binding capacity, transferrin saturation, and serum ferritin. RESULTS:: The main result of the study is the finding that ID and IDA are common among young adolescent female athletes and that there was no difference between female athletes and nonathletes. In the athlete group, 30 of 57 individuals (52%) had ID compared with 43 of 92 individuals (48%) in the nonathlete group (P > 0.3). Comparisons of the 2 groups showed no significant difference in hemoglobin (P > 0.30). In total, we found that 5 of 57 athletes (8.6%) had IDA compared with 3 of 92 nonathletes (3.3%), the difference being not statistically significant (P = 0.24). CONCLUSIONS:: The main finding of this study is that ID and IDA are common among female adolescents but not more common among athletes than nonathletes. The results are despite factors that should favor a better iron status in the athlete group, such as better iron intake and less menstrual bleeding. Other factors, which might have impact on iron balance, must therefore be considered.
Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 08/2012; · 1.50 Impact Factor
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ABSTRACT: BACKGROUND: The individual physical activity level is an independent risk factor for cardiovascular disease and death, as well as a possible target for improving health outcome. However, today[ACUTE ACCENT]s widely adopted risk score charts, typically do not include the level of physical activity. There is a need for a simple risk assessment tool, which includes a reliable assessment of the level of physical activity. The aim of this study was therefore, to analyse the association between the self-reported levels of physical activity, according to the Saltin-Grimby Physical Activity Level Scale (SGPALS) questionnaire, and cardiovascular risk factors, specifically focusing on the group of individuals with the lowest level of self-reported PA. METHODS: We used cross sectional data from the Intergene study, a random sample of inhabitants from the western part of Sweden, totalling 3588 (1685 men and 1903 women, mean age 52 and 51). Metabolic measurements, including serum-cholesterol, serum-triglycerides, fasting plasma-glucose, waist circumference, blood pressure and resting heart rate, as well as smoking and self-reported stress were related to the self-reported physical activity level, according to the modernized version of the SGPALS 4-level scale. RESULTS: There was a strong negative association between the self-reported physical activity level, and smoking, weight, waist circumference, resting heart rate, as well as to the levels of fasting plasma-glucose, serum-triglycerides, low-density lipoproteins (LDL), and self-reported stress and a positive association with the levels of high-density lipoproteins (HDL). The individuals reporting the lowest level of PA (SGPALS, level 1) had the highest odds-ratios (OR) for having pre-defined levels of abnormal risk factors, such as being overweight (men OR 2.19, 95% CI: 1.51-3.19; women OR 2.57, 95 % CI: 1.78-3.73), having an increased waist circumference (men OR 3.76, 95 % CI: 2.61-5.43; women OR 2.91, 95% CI: 1.94-4.35) and for reporting stress (men OR 3.59, 95 % CI: 2.34-5.49; women OR 1.25, 95% CI: 0.79-1.98), compared to the most active individuals, but also showed increased OR for most other risk factors analyzed above. CONCLUSION: The self-reported PA-level according to the modernized Saltin-Grimby Physical Activity Level Scale, SGPALS, is associated with the presence of many cardiovascular risk factors, with the most inactive individuals having the highest risk factor profile, including self-reported stress. We propose that the present SGPALS may be used as an additional, simple tool in a routine risk assessment in e.g. primary care, to identify inactive individuals, with a higher risk profile.
BMC Public Health 08/2012; 12(1):693. · 2.00 Impact Factor
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ABSTRACT: While long-term endurance exercise is known to increase cardiac biomarkers, only a few studies on short-term exercise and these markers have been reported. The aim of this study was to investigate the acute effects of a one-hour bicycle spinning on cardiac biomarkers in healthy individuals.
Serum levels of high-sensitive troponin T (TnT), creatinine kinase MB fraction (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatinine kinase (CK) and myoglobin were measured at baseline, 1 and 24 hour after one hour of spinning exercise in ten healthy and fit (age 31.0 ± 6.6 years) individuals.
TnT doubled one hour post-exercise (All values ≤ 5 - 9.7 ± 6.0 ng/L, p < 0.001). Two individuals had TnT levels above upper reference limit, URL (20.7 and 20.2 ng/L, URL = 12 ng/L). Myoglobin levels increased 72% one hour post-exercise (38 ± 20 - 66 ± 41 mg/L, p < 0.02). TnT and myoglobin levels returned to baseline 24 hour post-exercise. Serum levels of CK-MB, NT-proBNP and CK were not significantly changed.
A single-bout of one-hour bicycle spinning transiently increases TnT and myoglobin in healthy subjects. Some subjects even have TnT release above URL. Thus, recently performed exercise also of short duration should be taken into consideration in the evaluation of acute chest pain with release of cardiac TnT.
Scandinavian cardiovascular journal: SCJ 02/2012; 46(1):2-6. · 1.07 Impact Factor
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ABSTRACT: Patients who continue to suffer from severe and disabling angina pectoris, despite optimum treatment in terms of conventional pharmacological therapy and/or revascularization procedures, have been termed as having refractory angina pectoris. The future group of patients with refractory angina pectoris will be different from today's patients and represent a 'moving target' as risk factors, efficacy of treatment and indications continue to change. Spinal cord stimulation (SCS) is today considered as first-line treatment of refractory angina pectoris, by the European Society of Cardiology, with an anti-ischemic effect. There is strong evidence for SCS giving symptomatic benefits (decrease in anginal attacks), improved quality of life and improvement of functional status. In addition, SCS seems to be cost effective with a 'break-even' after approximately 15-16 months.
Future Cardiology 11/2011; 7(6):825-33.
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Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 09/2011; 21(5):460. · 1.50 Impact Factor
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ABSTRACT: Healthcare professionals play a central role in health promotion and lifestyle information towards patients as well as towards the general population, and it has been shown that own lifestyle habits can influence attitudes and counselling practice towards patients. The purpose of this study was to explore the participation of healthcare workers (HCWs) in a worksite health promotion (WHP) programme. We also aimed to find out whether HCWs with poorer lifestyle-related health engage in health-promotion activities to a larger extent than employees reporting healthier lifestyles.
A biennial questionnaire survey was used in this study, and it was originally posted to employees in the public healthcare sector in western Sweden, one year before the onset of the WHP programme. The response rate was 61% (n = 3207). In the four-year follow-up, a question regarding participation in a three-year-long WHP programme was included, and those responding to this question were included in the final analysis (n = 1859). The WHP programme used a broad all-inclusive approach, relying on the individual's decision to participate in activities related to four different themes: physical activity, nutrition, sleep, and happiness/enjoyment.
The participation rate was around 21%, the most popular theme being physical activity. Indicators of lifestyle-related health/behaviour for each theme were used, and regression analysis showed that individuals who were sedentary prior to the programme were less likely to participate in the programme's physical activities than the more active individuals. Participation in the other three themes was not significantly predicted by the indicators of the lifestyle-related health, (body mass index, sleep disturbances, or depressive mood).
Our results indicate that HCWs are not more prone to participate in WHP programmes compared to what has been reported for other working populations, and despite a supposedly good knowledge of health-related issues, HCWs reporting relatively unfavourable lifestyles are not more motivated to participate. As HCWs are key actors in promoting healthy lifestyles to other groups (such as patients), it is of utmost importance to find strategies to engage this professional group in activities that promote their own health.
BMC Public Health 01/2011; 11:448. · 2.00 Impact Factor
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ABSTRACT: This study analyzes longitudinal associations between self-reported leisure-time physical activity (PA) and perceived stress, burnout and symptoms of depression and anxiety.
Cohort data collected in 2004 and 2006 from health care and social insurance workers in western Sweden (2694 women; 420 men) were analyzed. Cox regression was conducted to examine associations between baseline levels of PA and mental health (MH) problems 2 years later.
Cross-sectional analysis show that individuals reporting either light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) were less likely to report high levels of perceived stress, burnout and symptoms of depression and anxiety, as compared to individuals reporting a sedentary lifestyle. The risks of symptoms of depression, burnout, and high stress levels at follow-up were significantly lower for those reporting LPA or MVPA at baseline. For symptoms of anxiety, an activity level corresponding to MVPA was required.
Participation in PA appeared to lower the risk of developing MH problems two years later. This relationship involved LPA and MVPA regarding feelings of depression, burnout and perceived stress, and exclusively MVPA regarding feelings of anxiety. The implications of these findings are important, as preventive strategies for psychosocial stress and mental health problems are needed.
Preventive Medicine 11/2010; 51(5):373-7. · 3.22 Impact Factor
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ABSTRACT: The Knee Self-Efficacy Scale (K-SES) has good reliability, validity, and responsiveness for patients' perceived knee-function self-efficacy during rehabilitation after an anterior cruciate ligament (ACL) injury. Preoperative knee-function self-efficacy has also been shown to have a predictive ability in terms of outcome 1 y after ACL reconstruction.
To evaluate a new clinical rehabilitation model containing strategies to enhance knee-function self-efficacy.
A randomized, controlled study.
Rehabilitation clinic and laboratory.
40 patients with ACL injuries.
All patients followed a standardized rehabilitation protocol. Patients in the experimental group were treated by 1 of 3 physiotherapists who had received specific training in a clinical rehabilitation model. These physiotherapists were also given their patients' self-efficacy scores after the initial and 4-, 6-, and 12-mo follow-ups, whereas the 5 physiotherapists treating the patients in the control group were not given their patients' self-efficacy scores.
The K-SES, the Tegner Activity Scale, the Physical Activity Scale, the Knee Injury and Osteoarthritis Outcome Score, and the Multidimensional Health Locus of Control.
Twenty-four patients (12 in each group) completed all follow-ups. Current knee-function self-efficacy, knee symptoms in sports, and knee quality of life improved significantly (P = .05) in both groups during rehabilitation. Both groups had a significantly (P = .05) lower physical activity level at 12 mo than preinjury. No significant differences were found between groups.
In this study there was no evidence that the clinical rehabilitation model with strategies to enhance self-efficacy resulted in a better outcome than the rehabilitation protocol used for the control group.
Journal of sport rehabilitation 05/2010; 19(2):200-13. · 1.07 Impact Factor
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ABSTRACT: Case report.
An unusual and previously not reported case of upper thoracic disc herniation combined with acute chest pain, is presented.
Disc herniation in the thoracic spine is rare. There are only a few cases of thoracic disc herniation in top athletes presented in the literature. The clinical presentation of a thoracic disc herniation can vary widely depending on its location and morphologic characteristics. Clinically, the acute symptoms may be severe.
A 24-year-old soccer player with acute left-sided chest pain that started in the middle of a soccer game has been followed clinically and with MRI examinations for 3 years.
MRI of the thoracic spine showed a left-sided paramedial disc herniation at T2-T3 level and the right-sided paramedial disc herniation at T3-T4 level. The player was prescribed initial rest and subsequent physical rehabilitation. He had no further symptoms during rehabilitation to full training, and could resume play and remained symptom free for the rest of the season.The following season, the player experienced a similar sudden thoracic pain episode during training. This time the chest pain was right-sided. A new MRI of the thoracic spine showed unchanged findings. The initial rehabilitation was similar to the one used in the first episode. After 15 months with no symptoms during normal life the player was allowed to increase the intensity of training gradually and after 2 years the patient played soccer at elite level again. However, 3 years later the symptoms relapsed and the player ended his career after another rehabilitation period.
In conclusion, it is important to consider thoracic disc herniation as acute chest pain in athletes and that the long-term prognosis of this entity is not always good.
Spine 06/2009; 34(10):E359-62. · 2.08 Impact Factor
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ABSTRACT: Patients who continue to suffer from lasting and severely disabling angina pectoris despite optimum drug treatment and who are not suitable candidates for invasive procedures, suffer from a condition referred to as "chronic refractory angina pectoris". Based on the available data, spinal cord stimulation, SCS, is considered as the first-line additional treatment for these patients by the European Society of Cardiology. However, no systematic review of randomised controlled studies has yet been published. A systematic literature research, 1966-2003, as part of the Swedish Board of Health and Welfare (SBU) report on long-standing pain, and an additional research covering the years 2003-2007, were carried out. Acute studies, case reports and mechanistic reviews were excluded, and the remaining 43 studies were graded for study quality according to a modified Jadad score. The eight medium- to high-score studies formed the basis for conclusions regarding the scientific evidence (strong, moderately strong or limited) for the efficacy of SCS. There is strong evidence that SCS gives rise to symptomatic benefits (decrease in anginal attacks) and improved quality of life in patients with severe angina pectoris. There is also a strong evidence that SCS can improve the functional status of these patients, as illustrated by the improved exercise time on treadmill or longer walking distance without angina. In addition, SCS does not seem to have any negative effects on mortality in these patients (limited scientific evidence). The complication rate was found to be acceptable.
Pain 12/2008; 140(3):501-8. · 5.78 Impact Factor
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ABSTRACT: The knee self-efficacy scale (K-SES) has been shown to have good reliability, validity and responsiveness during rehabilitation for patients' perceived self-efficacy of knee function. Determinants of self-efficacy of knee function 1 year after ACL reconstruction have been found to be the patients' internal locus of control and knee symptoms in sports and recreation. The predictive ability of perceived self-efficacy of knee function measured by the K-SES has not been studied in terms of patient outcome after an ACL reconstruction. The purpose of this study was to explore the potential for pre-operative self-efficacy of knee function measured by the K-SES to predict patient outcome in terms of physical activity, knee symptoms and muscle function 1 year after an ACL reconstruction. Thirty-eight patients were evaluated for outcome in terms of physical activity with the Tegner activity scale and the physical activity scale (PAS), knee symptoms with the Lysholm knee scoring scale and the knee injury and osteoarthritis outcome score (KOOS) and knee function with ability tests for muscle function 1 year after ACL reconstruction. Multiple regression and logistic multiple regression analysis were used to evaluate the K-SES as a possible predictor of outcome. The patients' present perceived self-efficacy of knee function (K-SES(Present)) pre-operatively was a significant predictor (P = 0.016) of the patients returning to their intensity and frequency of physical activity (PAS) 1 year after ACL reconstruction, when adjusted for age, gender and pre-injury physical activity level (Tegner(Pre-injury)) (odds ratio = 2.1). The patients' perceived future self-efficacy of knee function (K-SES(Future)) pre-operatively was a significant predictor (P = 0.045) of their self-rated knee function in sports/recreational activities (KOOS(Sports/recreation)) at the 1-year follow-up, when adjusted for age, gender and Tegner(Pre-injury )(R (2 )=0.25). The pre-operative K-SES(Future) was also a significant predictor (P = 0.023) of the patients' knee-related quality of life (KOOS(Qol)), at the 1-year follow-up, when adjusted for age, gender and Tegner(Pre-injury) (R (2 )=0.23). The pre-operative K-SES(Future) was furthermore a significant predictor of an acceptable outcome 1 year after surgery, on the Lysholm knee scoring scale (P = 0.003, odds ratio = 1.7), as well as on KOOS(Sports/recreation) (P = 0.002, odds ratio = 1.6) and knee-related quality of life (KOOS(Qol)) (P = 0.037, odds ratio = 1.4), when adjusted for age, gender and Tegner(Pre-injury). The pre-operative K-SES(Future) was also a significant predictor (P = 0.04) of an acceptable outcome 1 year after surgery, on the one-leg hop for distance (odds ratio = 2.2), when adjusted for age, gender and Tegner(Pre-injury). In conclusion, this study indicates that patients' perceived self-efficacy of knee function pre-operatively is of predictive value for their return to acceptable levels of physical activity, symptoms and muscle function 1 year after ACL reconstruction.
Knee Surgery Sports Traumatology Arthroscopy 03/2008; 16(2):118-27. · 2.21 Impact Factor
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ABSTRACT: Esophageal disease may mimic acute anginal pain. However, the prevalence of gastroesophageal reflux in the acute setting of patients with clinically unstable angina (UA) pectoris is not known. The aim of this study was to determine the co-existence of coronary artery disease (CAD) and gastroesophageal reflux in UA, and to study the feasibility of esophageal investigation in the chest pain unit.
22 patients with clinical UA and confirmed CAD were monitored by continuous vector cardiography and pH-measurement during 24 h of observation. Symptoms of chest pain and episodes of ischemia and reflux were recorded.
11 patients (50%) showed abnormal gastroesophageal reflux and another three (14%) had an increased number of reflux episodes. pH-measurements and esophageal manometry were well tolerated. Few chest pain episodes were recorded during the study period, and no association between chest pain, reflux, and ischemia could be shown.
Esophageal reflux is common in patients with UA and established CAD. As reflux-related chest pain may imitate angina pectoris, it is clinically important that gastroesophageal examination in patients with UA seems to be feasible and well tolerated in the 'acute setting'.
Acute Cardiac Care 02/2008; 10(1):37-42.
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ABSTRACT: To explore physical and psychological measures believed to determine patients' perceived self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury.
An explorative descriptive study.
A total of 116 patients with an anterior cruciate ligament deficient or reconstructed knee.
At one visit; 12 months post-injury/reconstruction, patients reported their perceived self-efficacy on the Knee Self-Efficacy Scale. Thirty-nine other measures related to self-efficacy were also documented. A linear regression model was applied to identify determinants of perceived self-efficacy.
40% of the variance in the complete Knee Self-Efficacy Scale was explained by the Lysholm score, Knee Injury and Osteoarthritis Outcome ScoreSport/Recreation, Internal Locus of Control and Locus of Control by Chance. The variance in patients' present perceived self-efficacy was explained to 41% by the same measures. Perceived self-efficacy of future capability was explained to 38% by the variance in the Lysholm score, Knee Injury and Osteoarthritis Outcome ScoreSport/Recreation, TegnerPresent level and Internal Locus of Control.
Self-reported symptoms/functions and Internal Locus of Control were the most important determinants of self-efficacy in patients with an anterior cruciate ligament injury. In order to strengthen self-efficacy, these determinants should be considered by the clinicians involved in the rehabilitation.
Journal of Rehabilitation Medicine 08/2007; 39(6):486-92. · 2.05 Impact Factor
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Scandinavian Journal of Medicine and Science in Sports 11/2006; 16(5):376-7. · 2.87 Impact Factor
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ABSTRACT: Evidence for the proper management of ischemic heart disease (IHD) in the general population is well established, but recommendations for physical activity and competitive sports in these patients are scarce. The aim of the present paper was to provide such recommendations to complement existing ESC and international guidelines on rehabilitation and primary/secondary prevention.
Due to the lack of studies in this field, the current recommendations are the result of consensus among experts. Sports are classified into low/moderate/high dynamic and low/moderate/high static, respectively.
Patients with a definitive IHD and higher probability of cardiac events are not eligible for competitive sports (CS) but for individually designed leisure time physical activity (LPA); patients with definitive IHD and lower probability of cardiac events as well as those with no IHD but with a positive exercise test and high risk profile (SCORE > 5%) are eligible for low/moderate static and low dynamic (IA-IIA) sports and individually designed LPA. Patients without IHD and a high risk profile+ a negative exercise-test and those with a low risk profile (SCORE < 5%) are allowed all LPA and competitive sports with a few exceptions.
Individually designed LPA is possible and encouraged in patients with and without established IHD. Competitive sports may be restricted for patients with IHD, depending on the probability of cardiac events and the demands of the sport according to the current classification.
European Journal of Cardiovascular Prevention and Rehabilitation 05/2006; 13(2):137-49. · 2.63 Impact Factor
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ABSTRACT: The objective of the study was to determine the prevalence of iron deficiency and iron deficiency anemia among elite women soccer players. Hemoglobin, serum iron, serum total iron binding capacity, and ferritin were determined in 28 female soccer players called up for the national team. Of the investigated female soccer players, 57% had iron deficiency and 29% iron deficiency anemia 6 months before the FIFA Women's World Cup. It is concluded that iron deficiency and iron deficiency anemia is common in female soccer players at the top international level. Some might suffer from relative anemia and measurement of hemoglobin alone is not sufficient to reveal relative anemia. Regular monitoring of hemoglobin concentration and iron status is necessary to institute iron supplementation when indicated.
International journal of sport nutrition and exercise metabolism 01/2006; 15(6):689-94. · 2.01 Impact Factor
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European Heart Journal 02/2005; 26(2):105-6. · 10.48 Impact Factor
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Lakartidningen 05/2004; 101(15-16):1394-7.
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ABSTRACT: Spinal cord stimulation (SCS) has been used since 1985 as additional symptom-relieving treatment for patients with severe angina pectoris despite optimal conventional medical and invasive treatment. SCS has antiischemic effects and is safe and effective in long-term use. Several patients with coronary artery disease also suffer from disorders that necessitate the use of a cardiac permanent pacemaker (PPM). The combination of SCS and PPM has previously been considered hazardous because of possible false inhibition of the PPM. To assess if thoracic SCS and PPM can be safely combined in patients with refractory angina pectoris, 18 patients treated with both SCS and PPM were tested. The PPM settings were temporarily modified to increase the probability of interference, while the SCS intensity (used in bipolar mode) was increased to the maximum level tolerated by the patient. Any sign of inhibition of the ventricular pacing was recorded by continuous ECG monitoring. With the aid of a questionnaire, symptoms of interference during long-term treatment were evaluated. No patient had signs of inhibition during the tests. Reprogramming of the pacemaker because of the test results was not needed in any of the patients. The long-term follow-up data revealed no serious events. This study indicates that bipolar SCS and PPM can be safely combined in patients with refractory angina pectoris. However, individual testing is mandatory to ascertain safety in each patient. A testing procedure for patients in need of SCS and PPM is suggested in this article.
Pacing and Clinical Electrophysiology 12/2003; 26(11):2134-41. · 1.35 Impact Factor
