Circulating Matrix Metalloproteinase-9 Is Associated with Cardiovascular Risk Factors in a Middle-Aged Normal Population

Background: Elevated levels of circulating matrix metalloproteinase-9 (MMP-9) have been demonstrated in patients with established coronary artery disease (CAD). The aim of this study was to analyse levels of MMP-9 in a population free from symptomatic CAD and investigate their associations with cardiovascular (CV) risk factors, including C-reactive protein (CRP).   Methods: A cross-sectional study was performed in a population based random sample aged 45–69 (n = 345, 50% women). MMP-9 levels were measured in EDTA-plasma using an ELISA-method. CV risk factors were measured using questionnaires and standard laboratory methods. Results: Plasma MMP-9 was detectable in all participants, mean 38.9 ng/mL (SD 22.1 ng/mL). Among individuals without reported symptomatic CAD a positive association (p&lt;0.001) was seen, for both men and women, of MMP-9 levels regarding total risk load of eight CV risk factors i.e. blood pressure, dyslipidemia, diabetes, obesity, smoking, alcohol intake, physical activity and fruit and vegetable intake. The association was significant also after adjustment for CRP, and was not driven by a single risk factor alone. In regression models adjusted for age, sex, smoking, alcohol intake and CRP, elevated MMP-9 levels were independently positively associated with systolic blood pressure (p = 0.037), smoking (p&lt;0.001), alcohol intake (p = 0.003) and CRP (p&lt;0.001). The correlation coefficient between MMP-9 and CRP was r = 0.24 (p&lt;0.001).   Conclusions: In a population without reported symptomatic CAD, MMP-9 levels were associated with total CV risk load as well as with single risk factors. This was found also after adjustment for CRP  Original Publication: Peter Garvin, Lennart Nilsson, John Carstensen, Lena Jonasson and Margareta Kristenson, Circulating Matrix Metalloproteinase-9 Is Associated with Cardiovascular Risk Factors in a Middle-Aged Normal Population, 2008, PLoS ONE, (3), 3, e1774. http://dx.doi.org/10.1371/journal.pone.0001774 Licensee: Public Library of Science (PLoS) http://www.plos.org/</p

Physical activity on prescription : Studies on physical activity level, adherence and cardiovascular risk factors

Physical activity is one of the most important public health determinants, and the health care sector is highlighted as a central setting in the promotion of physical activity in the population as well as at an individual level. One method that has attracted attention over recent years, is physical activity prescribed by doctors or other health care professionals, even though there is insufficient evidence to determine that any method of promoting physical activity in the health care setting is superior to another. It is therefore important to investigate whether physical activity on prescription leads to a more physically active lifestyle and to possible health benefits in clinical settings. This thesis investigated the effectiveness of individualized physical activity on prescription making use of two studies with different design and conducted within two different clinical settings. The study populations included patients in general primary health care centres (n=481, 75% female, mean age 50 years [12 81]) and elderly insufficiently physically active individuals with overweight and abdominal obesity recruited from a population based ongoing prospective cohort study (n=101, 57% female, 67-68 years). The main finding was that individualized prescriptions of physical activity increases physical activity level for at least six months. Physical activity on prescription can be suitable as conventional treatment in an ordinary primary health care setting to promote a more physically active lifestyle. Self-reported physical activity level, stages of change and quality of life increased significantly, and the adherence to physical activity on prescription was 65%, which is as good as adherence to other treatments of chronic diseases. In elderly people with overweight physical activity on prescription is an effective method to increase physical activity level, as significantly higher improvements were seen in the intervention group (two to three times higher) than in the control group regardless of assessment method. Individualized physical activity on prescription also improves body composition and reduces cardiometabolic risk factors in older insufficient physical active overweight individuals. This thesis shows that individualized physical activity on prescription (PAP) is effective in clinical settings. - PAP can be carried out as a part of routine care and is effective in promoting physical activity. - Adherence to PAP in primary health care settings is as good as adherence to other treatments of chronic diseases. - Self-reported quality of life, both regarding physical and mental aspects increased 6 months after receiving PAP. - PAP increased physical activity level three times more than in a control group. - PAP reduced several cardiometabolic risk factors in elderly women and men with low physical activity level, overweight and abdominal obesity. Therefore, physical activity on prescription has a potential to become an important method for promoting physical activity in a public health perspective, thus improving health and quality of life, and decreasing disease burden both for individuals as well as for the health care system

The SED-GIH: A Single-Item Question for Assessment of Stationary Behavior—A Study of Concurrent and Convergent Validity

The unfavorable health consequences of prolonged time spent sedentary (stationary) make accurate assessment in the general population important. However, for many existing questionnaires, validity for identifying stationary time has not been shown or has shown low validity. This study aimed to assess the concurrent and convergent validity of the GIH stationary single-item question (SED-GIH). Data were obtained in 2013 and 2014 from two Swedish cohorts. A total of 711 men and women provided valid accelerometer data (Actigraph GT3X+) and were included for concurrent validity analyses. A total of 560 individuals answered three additional commonly used sedentary questions, and were included for convergent validity analysis. The SED-GIH displayed a significant correlation with total stationary time (rs = 0.48) and time in prolonged stationary time (rs = 0.44). The ROC analysis showed an AUC of 0.72 for identifying individuals with stationary time over 600 min/day. The SED-GIH correlated significantly with other previously used questions (r = 0.72&ndash;0.89). The SED-GIH single-item question showed a relatively high agreement with device-assessed stationary behavior and was able to identify individuals with high levels of stationary time. Thus, the SED-GIH may be used to assess total and prolonged stationary time. This has important implications, as simple assessment tools of this behavior are needed in public health practice and research

Promoting physical activity - an established part of the clinical practice?

Introduction Insufficient physical activity is a considerable risk factor for mortality and premature death. The healthcare has a unique role in health promotion as they reach a large part of the population. The evidence based recommendation is that the healthcare sector should offer “counseling with the adjunct of exercise on prescription or a pedometer, as well as special follow-up” to promote patients physical activity. Despite this, physical activity is underutilized in prevention and treatment of disease, for reasons not fully known.     Purpose/Method We aimed to study the attitudes of different healthcare professionals in the hospital setting, towards the importance of physical activity and its clinical use at different levels. The study comprised 264 (78% women) health care professionals at the cardiac department/outpatient cardiac center in Stockholm (response rate 91%). Data was obtained in 2013, by questionnaire. Containing 28 multiple choice questions on participants attitudes towards physical activity behavior change, the perceived importance of such measures, practical implementation and possible barriers for implementation.   Results All participants stated importance of physical activity promotion within healthcare. Forty-seven percent reported that they promoted physical activity in clinical practice, however only a minority fulfilled the evidence based recommendations (n=65), as brief advice (n=165) or counseling (n=111) were most common. Sixty-one percent aimed to improve the use of physical activity promotion, factors hampering were inadequate knowledge, follow-up possibilities and length of patient visits. Less than half group reported insufficient routines (46%), goals (37%) and lack of management support (42%).   Conclusion          Although health professionals generally are positive towards promoting physical activity, just a small proportion actually use the evidence based methods in clinical practice. To improve the promotion of physical activity in patients there is need for further implementation strategies at all levels to create a well-functioning structure, clear goals and routines. Our study suggests, that implementation should focus at education, logistics for follow-up and increased amount of time with direct patient care. 

Follow-up of individualised physical activity on prescription and individualised advice in patients with hip or knee osteoarthritis : A randomised controlled trial.

OBJECTIVE: Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. DESIGN: Randomised, assessor-blinded, controlled trial. SETTING: Primary care. SUBJECTS: Patients with clinically verified hip or knee osteoarthritis, &lt;150 min/week with moderate or vigorous physical activity, aged 40-74. INTERVENTION: The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. MAIN MEASURES: Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. RESULTS: There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74-130) minutes/week at baseline to 214 (95% CI 183-245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103-157) to 176 (95% CI 145-207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by -514 (95% CI -567-462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was -852 (95% CI -900-804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5-8.2) and in the prescription group by 14.7 points (95% CI 14.3-15.1) from baseline to 24 months (p = 0.024 between groups). CONCLUSIONS: There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis

P08-10 Clustering of unhealthy lifestyle factors in occupational groups in the Swedish workforce

BACKGROUND: The physical activity pattern of the population, as well as the tasks of different occupational groups, have changed over the past decades. Hence, studies within and between different occupational groups, and not just between white and blue collar workers, are central for current risk group analyses. The aim was to study clustering of unhealthy lifestyle factors in different occupational groups in a large sample of men and women from the Swedish working population. METHODS: 72,855 individuals aged 18-75 years (41% women) from the Swedish working population who participated in a nationwide occupational health service screening between 2014-2019 were included in this cross-sectional descriptive study. Nine different occupational groups were identified based on the International Standard Classification of Occupation 2008. Exercise, diet, smoking habits and perceived health were self-reported. Cardiorespiratory fitness was estimated using a submaximal cycle test. Blood pressure and BMI was assessed through physical examination. Logistic regression modelling assessed OR (95%CI) for clustering of unhealthy lifestyle factors, defined as ‘3 of the following; low exercise, poor diet, daily smoking, poor perceived health, low fitness, high blood pressure and high BMI in the different occupational groups. RESULTS: The OR (95% CI) for clustering of unhealthy lifestyle factors were, compared to managers that served as reference, 1.00 (0.89-1.11) for professionals, 1.25 (1.11-1.39) for associate professionals, 1.93 (1.71-2.18) for clerical support workers, 2.40 (2.14-2.70) for service and sales workers, 1.63 (1.29-2.05) for agricultural, forestry and fishery workers, 2.23 (1.99-2.49) for craft and related trades workers, 2.52 (2.25-2.83) for plant and machine operators, and assemblers, and 2.62 (2.26-3.05) for elementary occupations. Comparing occupational groups within ‘service and sales workers’ and ‘plant and machine operators, and assemblers’, revealed significantly higher OR for professionals in care workers (OR2.92 (2.55-3.34)) and in drivers (OR 3.32(2.86-3.87)) compared to each of the main occupational groups. CONCLUSION: There were large variations in clustering of unhealthy lifestyle-related factors between as well as within different white and blue collar occupations. This study suggest that targeted measures of health promotion are foremost needed in blue collar occupations, however with some white collar sub-occupations being at similar need as blue collar occupations

P05-04 Physical activity level and sedentary time prior to cardiac ward admission among patients with cardiovascular disease and its association to all-cause mortality

The abstract was not presented at the conference due to covid pandemic, but published in the meeting abstracts.</p