Birgitta Nordgren - Academia.edu (original) (raw)

Papers by Birgitta Nordgren

Research paper thumbnail of Cardiovascular Autonomic Function Changes and Predictors During a 2-Year Physical Activity Program in Rheumatoid Arthritis: A PARA 2010 Substudy

Frontiers in Medicine

Background: Chronic inflammation leads to autonomic dysfunction, which may contribute to the incr... more Background: Chronic inflammation leads to autonomic dysfunction, which may contribute to the increased risk of cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA). Exercise is known to restore autonomic nervous system (ANS) activity and particularly its parasympathetic component. A practical clinical tool to assess autonomic function, and in particular parasympathetic tone, is heart rate recovery (HRR). The aim of this substudy from the prospective PARA 2010 study was to determine changes in HRR post-maximal exercise electrocardiogram (ECG) after a 2-year physical activity program and to determine the main predictive factors associated with effects on HRR in RA.Methods: Twenty-five participants performed physiotherapist-guided aerobic and muscle-strengthening exercises for 1 year and were instructed to continue the unsupervised physical activity program autonomously in the next year. All participants were examined at baseline and at years 1 and 2 with a maximal ...

Research paper thumbnail of FRI0647-HPR Physical Activity and Aerobic Capacity Assessment - A Survey among Patients with Rheumatic Disease in Sweden, Ireland, and Denmark

Annals of the Rheumatic Diseases, 2016

Background: Despite its positive effects on health outcomes, insufficient levels of physical acti... more Background: Despite its positive effects on health outcomes, insufficient levels of physical activity (PA) have been found in the arthritis population. In addition, lower aerobic capacity adds to the patient's risk for cardiovascular disease. Increasing PA is thus important for this group and the use of objective and self-reported measures of PA should be encouraged as self-monitoring and evaluation of PA support promotion of healthy PA behaviours. Objectives: To investigate the familiarity with objective and self-reported PA and aerobic capacity assessments and to identify barriers for their implementation in patients with rheumatic disease in Sweden, Ireland and Denmark. Methods: Patients with rheumatic disease were invited through each country's patient organisations to participate in a cross-sectional, observational study using online survey methodology. Results: A total of 791 patients (87% female) responded (579 Danish, 90 Irish and 122 Swedish) with Rheumatoid Arthritis (42%), Ankylosing Spondylitis (14%), Psoriatic Arthritis (25%) as main diagnoses. 99% of the patients reported pain during the past week in hand (62%), leg (60%), arm (58%), foot (51%), back (49%) and/or neck (36%). A total of 25% reported large limitations in moderate daily activities and 24% in climbing stairs. Use of biological disease modifying anti rheumatic drugs (Bio-DMARDS) was reported by 28% and non-biological DMARDS by 47%. Two thirds found it important to measure PA and approximately half stated they do not receive information regarding the same. Moderate levels of familiarity with simple body-worn sensor (mean 5.47/10; SD 4.04) to measure PA was found. Familiarity was lower with paper questionnaires (4.09/10; SD 3.69), complex body-worn sensors (3.70/10; SD 3.87), digital diaries (3.07/10; SD 3.53), paper diaries (3.45/10; SD 3.64) and digital questionnaires (3.46/10; SD 3.67) to measure PA. There was no statistically significant association between diagnosis, physical limitation or localisation of pain in relation to the familiarity of the above measures of PA (p>0.05), however, patients on Bio-DMARDS were more familiar with simple (p=0.016) and complex sensors (p=0.003), digital questionnaires (p=0.009) and diaries (p=0.006). 34% reported that their aerobic capacity had been tested whilst 57% reported no testing. Barriers for patients with rheumatic disease for measuring PA were reported by 43% and access to device (25%), uncertainty of handling the results (14-17%) and cost of device (10%) were most common. Conclusions: Although most patients with rheumatic diseases in our sample perceived measures of PA as important, familiarity and information of their use was largely lacking. Also, aerobic capacity assessment occurred infrequently. To motivate behavioural change towards a more physically active lifestyle and to support individuals' independence of health care, health professionals should facilitate awareness and knowledge of PA measures, encourage their patients to regularly self-monitor PA and more often offer PA and aerobic capacity testing to their patients.

Research paper thumbnail of 1Division of Physiotherapy, Department of Neurobiology, Care Sciences andtwo formulas better predicted maximal heart rate and conserheumatoid arthritis

Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test t... more Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test t in people with Conclusions: Despite the fact that the Fox-walk test overestimated VO2max substantially, the test is a promising method Nordgren et al. BMC Musculoskeletal Disorders 2014, 15:305

Research paper thumbnail of Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test and the Astrand cycle test in people with rheumatoid arthritis

Background: Aerobic capacity tests are important to evaluate exercise programs and to encourage i... more Background: Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to have a physically active lifestyle. Submaximal tests, if proven valid and reliable could be used for estimation of maximal oxygen uptake (VO 2max). The purpose of the study was to examine the criterion-validity of the submaximal self-monitoring Fox-walk test and the submaximal Åstrand cycle test against a maximal cycle test in people with rheumatoid arthritis (RA). A secondary aim was to study the influence of different formulas for age predicted maximal heart rate when estimating VO 2max by the Åstrand test. Methods: Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, participated in the study. They performed the Fox-walk test (775 meters), the Åstrand test and the maximal cycle test (measured VO 2max test). Pearson's correlation coefficients were calculated to determine the direction and strength of the association between the tests, and paired t-tests were used to test potential differences between the tests. Bland and Altman methods were used to assess whether there was any systematic disagreement between the submaximal tests and the maximal test. Results: The correlation between the estimated and measured VO 2max values were strong and ranged between r = 0.52 and r = 0.82 including the use of different formulas for age predicted maximal heart rate, when estimating VO 2max by the Åstrand test. VO 2max was overestimated by 30% by the Fox-walk test and underestimated by 10% by the Åstrand test corrected for age. When the different formulas for age predicted maximal heart rate were used, the results showed that two formulas better predicted maximal heart rate and consequently a more precise estimation of VO 2max. Conclusions: Despite the fact that the Fox-walk test overestimated VO 2max substantially, the test is a promising method for self-monitoring VO 2max and further development of the test is encouraged. The Åstrand test should be considered as highly valid and feasible and the two newly developed formulas for predicting maximal heart rate according to age are preferable to use when estimating VO 2max by the Åstrand test.

Research paper thumbnail of Long-term health-enhancing physical activity in rheumatoid arthritis - the PARA 2010 study

BMC Public Health, 2012

Background: People with rheumatoid arthritis (RA) suffer increased risk of disability andprematur... more Background: People with rheumatoid arthritis (RA) suffer increased risk of disability andpremature mortality. Healthenhancing physical activity (HEPA) could be one importantfactor to reduce this risk. Rising health care costs call for the development and evaluation ofnew modes of rehabilitation, including physical activity in settings outside the health caresystem. Methods/Design: This cohort study targets 450 patients with RA that do not currently meet HEPA recommendations, recruited from six hospitals reporting to the Swedish Rheumatology Quality Registers (SRQ). We have developed a two-year real-life intervention program including a minimum of twice-weekly circuit training, moderately intense physical activity the remaining days of the week and group meetings to support behavior change every other week. Our hypothesis is that increased physical activity and exercise will improve perceived health, reduce pain and fatigue, increase muscle function and aerobic capacity, impact psychosocial factors and prevent future cardiovascular events. Research questions regard outcomes, retention rates, dose-response matters and the exploration of responder characteristics. This protocol outlines recruitment procedure, design, assessment methods and the intervention program of the study. Discussion: The PARA 2010 project is designed to expand the knowledge on HEPA in RA by a progressive approach regarding population, setting, intervention, time frames and outcome measures. To our knowledge this is the first long-term HEPA program based on Social Cognitive Theory, and performed in a real life environment to demonstrate if this new setting can promote increased and maintained physical activity in people with RA.

Research paper thumbnail of OP0222-HPR Physical capacity contributes marginally in explaining variations of fatigue in persons moderately affected by rheumatoid arthritis

THURSDAY, 14 JUNE 2018, 2018

The highest category of disease duration for the cohort was between 2-5 years with 40% (n=16) pat... more The highest category of disease duration for the cohort was between 2-5 years with 40% (n=16) patients. 30% (n=12) of the respondents were aware of the 'know your numbers' concept. 27.5% (n=11) knew their cholesterol while 80% did not know their last blood sugar. The majority 90% (n=36) did not know their BMI. Only 25% of the respondents knew their DAS score. 50% knew the significance of the numbers. 40% (n=16) reported that no one had informed them about the numbers. 95% (n=38) of the participants showed interest in knowing their numbers and 27.5% (n=11) suggested that a written record explained and regularly updated would be appropriate whilst 35% (n=14) proposed that a multidisciplinary input would be useful in regularly informing them of the numbers. Conclusions: Although cardiovascular disease risk assessment and the management has improved in RA. There still remains a gap in patient engagement and activation in taking responsibility in knowing the risks and what they mean. It is well documented that patients with increased level of activation are more likely to engage in positive health behaviours resulting better outcomes. Our study has shown that although patients do not know much about their biomedical data they are interested in knowing about them. Knowing their biomedical may encourage them to take more ownership of their health even leading to more self-managing their RA.

Research paper thumbnail of Treatment of Provoked Vulvodynia: A Systematic Review

The Journal of Sexual Medicine, 2022

Research paper thumbnail of Physical activity, body functions, activity and general health perception in rheumatoid arthritis

Physical activity, body functions, activity and general health perception in rheumatoid arthritis

Research paper thumbnail of FRI0734-HPR Physical activity and aerobic capacity assessment – a survey among rheumatology health professionals in four european countries

FRIDAY, 15 JUNE 2018

Background: Regular physical activity (PA) is associated with improvements in health outcomes, su... more Background: Regular physical activity (PA) is associated with improvements in health outcomes, such as quality of life, aerobic fitness, pain, stiffness and inflammation in people with inflammatory joint disease (IJD) (1,2). Current practice in the management of patients with inflammatory arthritis emphasises the importance of health professionals (HP's) in assessing PA and aerobic capacity. Objectives: The objectives of this study were to identify how HPs working with IJDs measure PA and aerobic capacity. Methods: Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an online survey. Descriptive statistics was undertaken (SPSS v21and SASv9.4) to describe data aggregates and range and to identify sub-classes of groups with respect to use of PA measures. Results: Three hundred and twenty two (n=322, 75% female) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%), and Belgium (n=178, 55.3%). The majority of respondents (n=286, 92%) reported it was important to measure PA in people with IJDs. The mean number of years qualified was 20.08 (SD 9.37) and years working in Rheumatology was 12.29 (SD 8.27), with 32.3% reporting half of their workload coming from people who have inflammatory arthritis. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. Moderate levels of confidence were reported in using a simple body-worn sensor (mean 6.15/10; SD 3.63) and paper questionnaire (6.85/10; SD 3.62) to measure PA, with lower levels of confidence in using a complex body-worn sensor (3.80/10; SD 3.55) and digital diary (4.22/10; SD 3.67). When assessing aerobic capacity 58% were very familiar/somewhat familiar using a bicycle ergometer, 44% a treadmill and 56% other aerobic capacity tests. Low levels of confidence were reported in instructing their patients in performing aerobic capacity tests (4.54/10; SD 3.74) and in interpreting the results (4.79/10; SD 3.58). A large majority were interested in further education around measuring PA (83%) and aerobic capacity measurement (74%), with an online module favoured for both. Conclusions: The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There is strong interest in further education around measuring PA.

Research paper thumbnail of THU0650-HPR Physical Activity and Aerobic Capacity Assessment - A Survey among Health Professionals in Sweden, Ireland and Denmark

Annals of the Rheumatic Diseases

Background Regular physical activity (PA) is associated with improvements in health outcomes, suc... more Background Regular physical activity (PA) is associated with improvements in health outcomes, such as quality of life, aerobic fitness, and disease-related characteristics, including pain, stiffness and inflammation, in people with inflammatory arthritis. Current practice in the management of patients with inflammatory arthritis emphasises the importance of Health Professionals (HP's) in assessing PA and aerobic capacity. To ensure baseline knowledge on PA and aerobic capacity assessment among HP's, it is important to identify if knowledge and training gaps exist. Objectives Investigate the awareness and use of objective and subjective measures of PA and aerobic capacity and to identify barriers for implementation of such methods in Health Professionals (Physiotherapist; Occupational Therapist; Nurse) working in the field of rheumatology in Sweden, Ireland and Denmark. Methods Health Professional's in Rheumatology were invited to participate in a cross-sectional, descriptive, observational study using an online survey methodology. Separate ethics approval was received in each country. Descriptive statistics and chi-square tests were used to analyse the data using SPSS v22. Results One hundred and forty four (144) HP's responded (50 Denmark, 28 Ireland and 66 Sweden), with 93% being female. Results found the mean number of years qualified to be 20.08 (SD 9.37) and years working in Rheumatology to be 12.29 (SD 8.27), with 61% reporting half of their workload coming from people who have inflammatory arthritis. The majority of respondents (96%) believe it is important to measure PA. Moderate levels of confidence were reported in using a simple body-worn sensor (mean 6.15/10; SD 3.63) and paper questionnaire (6.85/10; SD 3.62) as ways in monitoring PA, with lower levels of confidence in using a complex body-worn sensor (3.80/10; SD 3.55) and digital diary (4.22/10; SD 3.67). There was no statistically significant association between longer years qualified, more years working with people with inflammatory arthritis, age or gender in relation to the importance in measuring PA. When assessing aerobic capacity 58% were very familiar/somewhat familiar using a bicycle ergometer, 44% a treadmill and 56% other aerobic capacity tests. Low levels of confidence were reported in instructing their patients in performing aerobic capacity tests (4.54/10; SD 3.74) and in interpreting the results (4.79/10; SD 3.58). A large majority would be interested in further education around measuring PA (83%) and aerobic capacity measurement (74%), with an online module favoured for both. Conclusions The majority of Health Professionals surveyed believe it is important to measure PA however, levels of confidence are moderate to low when using various devices/ways. Regarding aerobic capacity tests low levels of familiarity were reported for both performing and interpreting results. There is strong interest in further education around measuring PA and aerobic capacity measurement highlighting a need to develop education and training for HP's in this area. Disclosure of Interest None declared

Research paper thumbnail of SAT0754-HPR ”a necessary investment in future health”. perceptions of physical activity maintenance among people with ra participating in an outsourced health-enhancing physical activity program

Poster Presentations

Background: No official published figures are available regarding the annual use of NSAIDs in Alb... more Background: No official published figures are available regarding the annual use of NSAIDs in Albania. Nonsteroidal anti-inflammatory drugs are used primarily to manage different pain conditions, less commonly they are used for their antipyretic effect. Although generally well tolerated, conventional NSAIDs have been associated with a wide range of adverse effects. The most common of which are gastrointestinal tract (GIT) side effects like: dyspepsia, abdominal pain, heartburn, and the most serious life-threatening gastrointestinal (GI) ulceration. Objectives: To investigate patient awareness of the proper use and frequency of side effects in nonsteroidal anti-inflammatory drugs (NSAIDs) patients in Albania. Methods: This study was a prospective 15 question interview of patients purchasing medications, during randomized 1 hour/day pharmacy visits over a one month study period (May 2015). The study was conducted in 4 community pharmacies located in the city of Tirana (capital of Albania). Two hundred and ten patients were included in this study. Results: Overall NSAIDs use during last year was 63%: Ibuprofene and diclofenac was the most used NSAIDs. The majority of patients (58%) reported having side effects upon NSAIDs-use; gastrointestinal upset was the most frequently reported side effect. Patients' awareness regarding proper NSAIDs use was poor, and pharmacist role in counseling was inadequate. However, user ability to discover the most common side effect to the drug seemed not to be affected. Conclusions: Nonsteroidal anti-inflammatory drugs use awareness and knowledge of probable serious side effects and how to handle them was not adequate. This probably reflected on high incidence of side effects. Nonsteroidal antiinflammatory drugs are available on prescription as well as over the counter drugs. Pharmacist involvement in education of patients using them is highly recommended and much needed to help decrease frequency of side effects. However this is a small scale study and further studies need to be done. References: [1] Langman MJ. Risks of anti-inflammatory drug-associated damage. Inflamm Res 1999; 48: 236-238. [2] Garcia Rodriquez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs.

Research paper thumbnail of FRI0575-HPR "A Gift from Heaven' or 'This was not for Me" - A Mixed Methods Approach to Describe Experiences of Physical Activity Participation among Persons with Rheumatoid Arthritis

Annals of the Rheumatic Diseases, 2014

Background A large proportion of persons with rheumatoid arthritis (RA) do not meet recommendatio... more Background A large proportion of persons with rheumatoid arthritis (RA) do not meet recommendations on health-enhancing physical activity (HEPA) (1). We performed a complex theory-based intervention in a group format at public gyms, aiming to support behavior change towards HEPA (2). To evaluate the intervention from a user perspective, a combination of quantitative and qualitative methods was applied. Objectives The aim of this mixed methods study was to explore and describe how persons with RA perceive their participation in the first year of a two-year program targeting adoption and maintenance of HEPA. Methods Data collection was performed by a postal survey to 211 of 220 intervention participants and by interviews with a sub-group of 35 purposefully selected informants. A total of 191 participants (91%) responded to the survey; mean age was 60 years and 81% were women. Survey data were analyzed by descriptive statistics and the interviews were analyzed by qualitative content analysis. Results Increased physical activity compared to the previous year was reported by 165 participants (86%) with circuit training and everyday physical activity performed regularly or periodically during the year by 78% and 92%, respectively. The behavioral support most frequently used was: responding to weekly text messages about performed physical activity (96% regularly), participating in support group sessions (73% regularly or periodically), and use of pedometer (58% regularly or periodically). The highest valued intervention components were: circuit training, physical activity in daily life, both rated median 5 on a 1-5 scale with 5 representing “Very valuable”, responding to text messages, coach support and expert lectures on RA-related topics, all rated median 4. A question on recommending the program to someone with a similar condition was rated median 5 (“Yes, definitely”). The content analysis of the interviews resulted in five categories: 1) “Starting point”, concerning previous experiences and current expectations on the program, 2) “Get going”, concerning intervention components that facilitated adoption of HEPA, 3) “Cashing in”, describing perceived gains from HEPA, 4) “Keep it going', concerning components that supported maintained HEPA and 5) `Trouble shooting”, describing individual obstacles to reach HEPA and suggestions for improvement of a future HEPA program. The suggestions mainly concerned more individualization in all aspects of the program. Conclusions The results indicate that self-monitoring by text messages and pedometers as well as professional coaching are perceived useful to facilitate HEPA in RA. Physical activity programs targeting maintained HEPA should be tailored to individuals' different needs concerning setting, exercise form and behavioral support. References Demmelmaier I, Bergman P, Nordgren B, Jensen I, Opava C. Current and maintained health-enhancing physical activity in rheumatoid arthritis – a cross-sectional study. Arthritis Care & Research. 2013;65(7):1166-76. Nordgren B, Fridén C, Demmelmaier I, Bergström G, Opava C. Long-term health-enhancing physical activity in rheumatoid arthritis. BMC Public Health. 2012;12(397). Acknowledgements The Swedish Research Council, Combine Sweden, the Swedish Rheumatism Association, the National Postgraduate School of Health Care Sciences at Karolinska Institutet, the Strategic Research Program in Health Care Research at Karolinska Institutet and the Swedish Rheumatology Quality Registers. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4282

Research paper thumbnail of FRI0567-HPR Criterion Validation of the Submaximal AStrand Bicycle Test to Estimate Aerobic Capacity in People with Rheumatoid Arthritis

Annals of the Rheumatic Diseases, 2014

Background Aerobic capacity tests are important to evaluate exercise programs and to encourage in... more Background Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to a physically active lifestyle. Maximum aerobic tests in a laboratory setting are expensive and not always feasible for people with rheumatoid arthritis (RA) (1). Submaximal tests, if proven valid and reliable, could thus be an alternative to maximum tests. The Åstrand submaximal bicycle test has been extensively used in clinic and research in people with RA, but never tested for validity and reliability in this population (2). Objectives To test the validity of the Åstrand submaximal test for estimation of aerobic capacity, by exploring the correlation with the measured maximum oxygen uptake (measured VO2max) in people with RA. Methods Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, activity limitation according to the Stanford Health Assessment Questionnaire 0.412 (0.42) and Disease Activity Score 28 2.4 (0.42), participated in the study. The subjects performed the Åstrand test and the measured VO2max test (Alpha version 4.5, Jaeger, KFA-2028-01) at the same test occasion. According to the Åstrand-nomograms the VO2max was estimated using heart rate (HR) measurements from a single stage and adjusted for age or for maximal HR. Results The correlation between VO2max estimated by the Åstrand test corrected for age and the measured VO2max test was r =0.82 (p<0.001) when expressed in l/min and r =0.68 (p<0.001) when expressed in ml kg–1 min–1, No systematic over- or underestimations were present although a majority of cases were underestimated. The correlation between VO2max estimated by the Åstrand test corrected for maximum HR and the measured VO2max test was r =0.82 (p<0.001) when expressed in l/min and r =0.65 (p<0.001) when expressed in ml kg–1 min–1. No systematic over- or under estimations were present. Conclusions The Åstrand test could be considered a valid instrument to estimate VO2max in physically active people with RA that are able to perform a submaximal cycle test during six minutes References Eurenius E, Brodin N, Opava CH. Clinical applicability of of two tests of aerobic fitness in patients with rheumatoid arthritis. Adv Physiother 2007(9):97-104. Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7(2):218-21. Acknowledgements The Swedish Rheumatism Association, the National Postgraduate School of Health Care Sciences at Karolinska Institutet. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5536

Research paper thumbnail of FRI0578-HPR Who makes it to the base? characteristics of people with ra eligible for a physical activity intervention compared to those not eligible. the para 2010-study

Annals of the Rheumatic Diseases

Background Physical activity (PA) is important to preserve functioning and avoid co morbidity in ... more Background Physical activity (PA) is important to preserve functioning and avoid co morbidity in people with RA. To better understand how to tailor PA programs it is important to identify characteristics of those eligible versus those who are not. However, recruitment processes prior to PA programs are often poorly described in people with RA. Objectives The objective of our study, including a large well defined sample of individuals with RA at target for a PA trial, was to compare those that were finally included in the trial with those that were not as regards socio-demographic, disease-related, and psychosocial factors and current PA levels. Methods In this cross-sectional survey 3152 individuals (1), of which 12 were excluded due to participation in another study, below age 75 years and independent in daily activities (HAQ>2) answered questionnaires on socio-demographic, disease-related, and psychosocial factors and current PA levels. Differences between individuals making it to the baseline assessments of the trial and those who did not were analyzed in three steps. Results In a first step, 1932 individuals were identified as eligible for the trial as they were interested, not enough physically active and had good Swedish language skills. They were mainly female, younger, better educated, having higher income and more likely to live with children, had better social support for exercise and higher outcome expectations on PA compared to the 1208 that were not eligible. In a second step, 286 individuals consented to participate. They were better educated and had higher income, more social support for exercise, less fear avoidance beliefs and higher outcome expectations on PA compared to the 1646 that declined participation. Reasons for declining were ‘training centre too distant’, ‘no time due to family, work or other reasons’, ‘too expensive’, ‘feel very well and not in need for exercise’, ‘bothered by injury/co morbidity’, ‘RA too active/disabling’, ‘no energy’. In a third step, 244 individuals showed up for baseline assessments and reported less fatigue compared to the 42 that did not show up for assessments. Reasons for withdrawal included ‘dislike training center’, ‘prefer yoga’, ‘changed mind about participation’, ‘recent cancer diagnosis’, ‘recent foot injury’, ‘foot ulcer’, ‘aortic aneurysm’, ‘too expensive’, ‘time constraints’ and logistic problems related to time or place of assessments or training. Conclusions To our knowledge this is the first study to describe the entire selection procedure from a target sample for a PA trial to baseline assessment in individuals with RA. Our results indicate that factors other than those related to the disease seem to determine participation and largely resemble those seen in the general population. Based on our results caregivers may be able to identify factors that are essential for supporting PA in people with RA that are reluctant to participate in various programs. References Demmelmaier I et al. Current and maintained health-enhancing physical activity in rheumatoid arthritis - the PARA 2010 study. Arthritis Care Res 2013 Jan 17 [Epub ahead of print] Acknowledgements We would like to acknowledge the contribution of the rheumatology clinics at Danderyd Hospital, Stockholm, Karolinska University Hospital, Solna and Huddinge, Linköping University Hospital, Linköping and Norrköping, Mälarsjukhuset, Eskilstuna, östersund Hospital, Sunderby Hospital, Luleå, and the Swedish Rheumatology Quality Registers. Disclosure of Interest None Declared

Research paper thumbnail of A survey across four European countries to determine rheumatology health professionals’ awareness of physical activity measures in people with inflammatory joint diseases

BMJ Open

A survey across four European countries to determine rheumatology health professionals' awareness... more A survey across four European countries to determine rheumatology health professionals' awareness of physical activity measures in people with inflammatory joint diseases.

Research paper thumbnail of “A Necessary Investment in Future Health”: Perceptions of Physical Activity Maintenance Among People With Rheumatoid Arthritis

Physical Therapy

Objective A few studies with a qualitative design have addressed physical activity (PA) maintenan... more Objective A few studies with a qualitative design have addressed physical activity (PA) maintenance in people with rheumatoid arthritis (RA), but none of them focused specifically on maintenance of PA according to public health recommendations. The purpose of this study was to describe perceptions of PA maintenance during the second year of an outsourced 2-year support program among people with RA. Methods For this descriptive design with a qualitative inductive approach, semi-structured interviews were conducted with 18 participants with RA (3 men and 15 women). Variation in age, disease duration, activity limitation, pain, levels of PA, and PA maintenance was targeted through strategic sampling. Qualitative content analysis was used, and a pattern of theme, subthemes, and categories was constructed based on the participants’ perceptions of PA maintenance. Results A main overarching theme, “A necessary investment in future health”—with 3 subthemes of dedication, awareness, and affi...

Research paper thumbnail of Associations between fatigue and physical capacity in people moderately affected by rheumatoid arthritis

Rheumatology International

To explore the contribution of physical capacity in explaining variations in fatigue among people... more To explore the contribution of physical capacity in explaining variations in fatigue among people with rheumatoid arthritis (RA). This study included participants recruited for a physical activity intervention. Data were collected from the Swedish Rheumatology Quality Registers, from questionnaires on fatigue, activity limitation, perceived health, pain and anxiety/ depression and from physical capacity tests (lower limb function, grip strength, and aerobic capacity). We used logistic regression to estimate the association between severe fatigue (≥ 50, visual analogue scale 0-100) and (A) independent variables related to disease and disease impact and (B) model A plus physical capacity tests. Pooled odds ratio tests compared model fit. Out of the 269 participants (mean age 60 years, mean disease activity score [DAS28] 2.8), severe fatigue was reported by 35%. The three variables which were statistically significantly associated with severe fatigue (p < 0.05) in both models were perceived health, pain and anxiety/depression. Anxiety/depression demonstrated the largest effect size with odds ratios of 2.43 (95% CI 1.20, 4.94) in model A and 2.58 (95% CI 1.25, 5.32) in model B. The likelihood ratio test indicated that model B was a better fit to the data than model A with Χ 2 (df 3) = 2.65, p = 0.048. Severe fatigue in people with RA is associated with self-rated health, pain and anxiety/depression rather than with physical capacity. Future studies should be prospective, use multidimensional assessments of fatigue to explore the influence of physical capacity and control for possible influence of comorbidities associated with fatigue.

Research paper thumbnail of Pain sensitivity at rest and during muscle contraction in persons with rheumatoid arthritis: a substudy within the Physical Activity in Rheumatoid Arthritis 2010 study

Arthritis Research & Therapy

Background: We aimed to explore pressure pain sensitivity and the function of segmental and pluri... more Background: We aimed to explore pressure pain sensitivity and the function of segmental and plurisegmental exerciseinduced hypoalgesia (EIH) in persons with rheumatoid arthritis (RA) compared with healthy control subjects (HC). Methods: Forty-six participants with RA (43 female, 3 male) and 20 HC (16 female, 4 male) participated in the study. Pressure pain thresholds, suprathreshold pressure pain at rest, and segmental and plurisegmental EIH during standardised submaximal contractions were assessed by algometry. Assessments of EIH were made by performing algometry alternately at the contracting (30% of the individual maximum) right m. quadriceps and the resting left m. deltoideus. Results: Participants with RA had higher sensitivity to pressure pain (RA, 318 kPa; HC, 487 kPa; p < 0.001), suprathreshold pressure pain 4/10 (RA, 433 kPa; HC, 638 kPa; p = 0.001) and suprathreshold pressure pain 7/10 (RA, 620 kPa; HC, 851 kPa; p = 0.002) than HC. Segmental EIH (RA, 0.99 vs 1.27; p < 0.001; HC, 0.89 vs 1.10; p = 0.016) and plurisegmental EIH (RA, 0.95 vs 1.36; p < 0.001; HC, 0.87 vs 1.31; p < 0.001) increased significantly during static muscle contraction in both groups alike (p > 0.05). Conclusions: Our results indicate a generally increased pain sensitivity but normal function of EIH among persons with RA and offer one possible explanation for pain reduction observed in this group of patients following clinical exercise programmes.

Research paper thumbnail of Impaired left atrial dynamics and its improvement by guided physical activity reveal left atrial strain as a novel early indicator of reversible cardiac dysfunction in rheumatoid arthritis

European journal of preventive cardiology, 2018

Research paper thumbnail of An Outsourced Health-enhancing Physical Activity Program for People with Rheumatoid Arthritis: Study of the Maintenance Phase

The Journal of Rheumatology

Objective.To describe changes of health-enhancing physical activity (HEPA), health perception, an... more Objective.To describe changes of health-enhancing physical activity (HEPA), health perception, and functioning during the second year of a 2-year support program, determine aspects of adherence and response, and describe perceptions of the program.Methods.Out of 220 individuals with rheumatoid arthritis (RA), 177 participated in the followup. Group support, strength training, and moderate-intensity aerobic activity were encouraged. Data collection included HEPA, perceived health, functioning, and perceptions of the program. Participants with unchanged/improved general health perception and at least 2 of aerobic capacity, grip strength, or timed standing were considered responders.Results.Current and maintained HEPA decreased from 82% to 75% (p = 0.0141) and from 41% to 27% (p < 0.0001) during the second year. Minor declines in quality of life and activity limitation occurred (p = 0.0395 and 0.0038, respectively), while outcome expectations for benefits of physical activity increa...

Research paper thumbnail of Cardiovascular Autonomic Function Changes and Predictors During a 2-Year Physical Activity Program in Rheumatoid Arthritis: A PARA 2010 Substudy

Frontiers in Medicine

Background: Chronic inflammation leads to autonomic dysfunction, which may contribute to the incr... more Background: Chronic inflammation leads to autonomic dysfunction, which may contribute to the increased risk of cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA). Exercise is known to restore autonomic nervous system (ANS) activity and particularly its parasympathetic component. A practical clinical tool to assess autonomic function, and in particular parasympathetic tone, is heart rate recovery (HRR). The aim of this substudy from the prospective PARA 2010 study was to determine changes in HRR post-maximal exercise electrocardiogram (ECG) after a 2-year physical activity program and to determine the main predictive factors associated with effects on HRR in RA.Methods: Twenty-five participants performed physiotherapist-guided aerobic and muscle-strengthening exercises for 1 year and were instructed to continue the unsupervised physical activity program autonomously in the next year. All participants were examined at baseline and at years 1 and 2 with a maximal ...

Research paper thumbnail of FRI0647-HPR Physical Activity and Aerobic Capacity Assessment - A Survey among Patients with Rheumatic Disease in Sweden, Ireland, and Denmark

Annals of the Rheumatic Diseases, 2016

Background: Despite its positive effects on health outcomes, insufficient levels of physical acti... more Background: Despite its positive effects on health outcomes, insufficient levels of physical activity (PA) have been found in the arthritis population. In addition, lower aerobic capacity adds to the patient's risk for cardiovascular disease. Increasing PA is thus important for this group and the use of objective and self-reported measures of PA should be encouraged as self-monitoring and evaluation of PA support promotion of healthy PA behaviours. Objectives: To investigate the familiarity with objective and self-reported PA and aerobic capacity assessments and to identify barriers for their implementation in patients with rheumatic disease in Sweden, Ireland and Denmark. Methods: Patients with rheumatic disease were invited through each country's patient organisations to participate in a cross-sectional, observational study using online survey methodology. Results: A total of 791 patients (87% female) responded (579 Danish, 90 Irish and 122 Swedish) with Rheumatoid Arthritis (42%), Ankylosing Spondylitis (14%), Psoriatic Arthritis (25%) as main diagnoses. 99% of the patients reported pain during the past week in hand (62%), leg (60%), arm (58%), foot (51%), back (49%) and/or neck (36%). A total of 25% reported large limitations in moderate daily activities and 24% in climbing stairs. Use of biological disease modifying anti rheumatic drugs (Bio-DMARDS) was reported by 28% and non-biological DMARDS by 47%. Two thirds found it important to measure PA and approximately half stated they do not receive information regarding the same. Moderate levels of familiarity with simple body-worn sensor (mean 5.47/10; SD 4.04) to measure PA was found. Familiarity was lower with paper questionnaires (4.09/10; SD 3.69), complex body-worn sensors (3.70/10; SD 3.87), digital diaries (3.07/10; SD 3.53), paper diaries (3.45/10; SD 3.64) and digital questionnaires (3.46/10; SD 3.67) to measure PA. There was no statistically significant association between diagnosis, physical limitation or localisation of pain in relation to the familiarity of the above measures of PA (p>0.05), however, patients on Bio-DMARDS were more familiar with simple (p=0.016) and complex sensors (p=0.003), digital questionnaires (p=0.009) and diaries (p=0.006). 34% reported that their aerobic capacity had been tested whilst 57% reported no testing. Barriers for patients with rheumatic disease for measuring PA were reported by 43% and access to device (25%), uncertainty of handling the results (14-17%) and cost of device (10%) were most common. Conclusions: Although most patients with rheumatic diseases in our sample perceived measures of PA as important, familiarity and information of their use was largely lacking. Also, aerobic capacity assessment occurred infrequently. To motivate behavioural change towards a more physically active lifestyle and to support individuals' independence of health care, health professionals should facilitate awareness and knowledge of PA measures, encourage their patients to regularly self-monitor PA and more often offer PA and aerobic capacity testing to their patients.

Research paper thumbnail of 1Division of Physiotherapy, Department of Neurobiology, Care Sciences andtwo formulas better predicted maximal heart rate and conserheumatoid arthritis

Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test t... more Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test t in people with Conclusions: Despite the fact that the Fox-walk test overestimated VO2max substantially, the test is a promising method Nordgren et al. BMC Musculoskeletal Disorders 2014, 15:305

Research paper thumbnail of Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test and the Astrand cycle test in people with rheumatoid arthritis

Background: Aerobic capacity tests are important to evaluate exercise programs and to encourage i... more Background: Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to have a physically active lifestyle. Submaximal tests, if proven valid and reliable could be used for estimation of maximal oxygen uptake (VO 2max). The purpose of the study was to examine the criterion-validity of the submaximal self-monitoring Fox-walk test and the submaximal Åstrand cycle test against a maximal cycle test in people with rheumatoid arthritis (RA). A secondary aim was to study the influence of different formulas for age predicted maximal heart rate when estimating VO 2max by the Åstrand test. Methods: Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, participated in the study. They performed the Fox-walk test (775 meters), the Åstrand test and the maximal cycle test (measured VO 2max test). Pearson's correlation coefficients were calculated to determine the direction and strength of the association between the tests, and paired t-tests were used to test potential differences between the tests. Bland and Altman methods were used to assess whether there was any systematic disagreement between the submaximal tests and the maximal test. Results: The correlation between the estimated and measured VO 2max values were strong and ranged between r = 0.52 and r = 0.82 including the use of different formulas for age predicted maximal heart rate, when estimating VO 2max by the Åstrand test. VO 2max was overestimated by 30% by the Fox-walk test and underestimated by 10% by the Åstrand test corrected for age. When the different formulas for age predicted maximal heart rate were used, the results showed that two formulas better predicted maximal heart rate and consequently a more precise estimation of VO 2max. Conclusions: Despite the fact that the Fox-walk test overestimated VO 2max substantially, the test is a promising method for self-monitoring VO 2max and further development of the test is encouraged. The Åstrand test should be considered as highly valid and feasible and the two newly developed formulas for predicting maximal heart rate according to age are preferable to use when estimating VO 2max by the Åstrand test.

Research paper thumbnail of Long-term health-enhancing physical activity in rheumatoid arthritis - the PARA 2010 study

BMC Public Health, 2012

Background: People with rheumatoid arthritis (RA) suffer increased risk of disability andprematur... more Background: People with rheumatoid arthritis (RA) suffer increased risk of disability andpremature mortality. Healthenhancing physical activity (HEPA) could be one importantfactor to reduce this risk. Rising health care costs call for the development and evaluation ofnew modes of rehabilitation, including physical activity in settings outside the health caresystem. Methods/Design: This cohort study targets 450 patients with RA that do not currently meet HEPA recommendations, recruited from six hospitals reporting to the Swedish Rheumatology Quality Registers (SRQ). We have developed a two-year real-life intervention program including a minimum of twice-weekly circuit training, moderately intense physical activity the remaining days of the week and group meetings to support behavior change every other week. Our hypothesis is that increased physical activity and exercise will improve perceived health, reduce pain and fatigue, increase muscle function and aerobic capacity, impact psychosocial factors and prevent future cardiovascular events. Research questions regard outcomes, retention rates, dose-response matters and the exploration of responder characteristics. This protocol outlines recruitment procedure, design, assessment methods and the intervention program of the study. Discussion: The PARA 2010 project is designed to expand the knowledge on HEPA in RA by a progressive approach regarding population, setting, intervention, time frames and outcome measures. To our knowledge this is the first long-term HEPA program based on Social Cognitive Theory, and performed in a real life environment to demonstrate if this new setting can promote increased and maintained physical activity in people with RA.

Research paper thumbnail of OP0222-HPR Physical capacity contributes marginally in explaining variations of fatigue in persons moderately affected by rheumatoid arthritis

THURSDAY, 14 JUNE 2018, 2018

The highest category of disease duration for the cohort was between 2-5 years with 40% (n=16) pat... more The highest category of disease duration for the cohort was between 2-5 years with 40% (n=16) patients. 30% (n=12) of the respondents were aware of the 'know your numbers' concept. 27.5% (n=11) knew their cholesterol while 80% did not know their last blood sugar. The majority 90% (n=36) did not know their BMI. Only 25% of the respondents knew their DAS score. 50% knew the significance of the numbers. 40% (n=16) reported that no one had informed them about the numbers. 95% (n=38) of the participants showed interest in knowing their numbers and 27.5% (n=11) suggested that a written record explained and regularly updated would be appropriate whilst 35% (n=14) proposed that a multidisciplinary input would be useful in regularly informing them of the numbers. Conclusions: Although cardiovascular disease risk assessment and the management has improved in RA. There still remains a gap in patient engagement and activation in taking responsibility in knowing the risks and what they mean. It is well documented that patients with increased level of activation are more likely to engage in positive health behaviours resulting better outcomes. Our study has shown that although patients do not know much about their biomedical data they are interested in knowing about them. Knowing their biomedical may encourage them to take more ownership of their health even leading to more self-managing their RA.

Research paper thumbnail of Treatment of Provoked Vulvodynia: A Systematic Review

The Journal of Sexual Medicine, 2022

Research paper thumbnail of Physical activity, body functions, activity and general health perception in rheumatoid arthritis

Physical activity, body functions, activity and general health perception in rheumatoid arthritis

Research paper thumbnail of FRI0734-HPR Physical activity and aerobic capacity assessment – a survey among rheumatology health professionals in four european countries

FRIDAY, 15 JUNE 2018

Background: Regular physical activity (PA) is associated with improvements in health outcomes, su... more Background: Regular physical activity (PA) is associated with improvements in health outcomes, such as quality of life, aerobic fitness, pain, stiffness and inflammation in people with inflammatory joint disease (IJD) (1,2). Current practice in the management of patients with inflammatory arthritis emphasises the importance of health professionals (HP's) in assessing PA and aerobic capacity. Objectives: The objectives of this study were to identify how HPs working with IJDs measure PA and aerobic capacity. Methods: Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an online survey. Descriptive statistics was undertaken (SPSS v21and SASv9.4) to describe data aggregates and range and to identify sub-classes of groups with respect to use of PA measures. Results: Three hundred and twenty two (n=322, 75% female) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%), and Belgium (n=178, 55.3%). The majority of respondents (n=286, 92%) reported it was important to measure PA in people with IJDs. The mean number of years qualified was 20.08 (SD 9.37) and years working in Rheumatology was 12.29 (SD 8.27), with 32.3% reporting half of their workload coming from people who have inflammatory arthritis. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. Moderate levels of confidence were reported in using a simple body-worn sensor (mean 6.15/10; SD 3.63) and paper questionnaire (6.85/10; SD 3.62) to measure PA, with lower levels of confidence in using a complex body-worn sensor (3.80/10; SD 3.55) and digital diary (4.22/10; SD 3.67). When assessing aerobic capacity 58% were very familiar/somewhat familiar using a bicycle ergometer, 44% a treadmill and 56% other aerobic capacity tests. Low levels of confidence were reported in instructing their patients in performing aerobic capacity tests (4.54/10; SD 3.74) and in interpreting the results (4.79/10; SD 3.58). A large majority were interested in further education around measuring PA (83%) and aerobic capacity measurement (74%), with an online module favoured for both. Conclusions: The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There is strong interest in further education around measuring PA.

Research paper thumbnail of THU0650-HPR Physical Activity and Aerobic Capacity Assessment - A Survey among Health Professionals in Sweden, Ireland and Denmark

Annals of the Rheumatic Diseases

Background Regular physical activity (PA) is associated with improvements in health outcomes, suc... more Background Regular physical activity (PA) is associated with improvements in health outcomes, such as quality of life, aerobic fitness, and disease-related characteristics, including pain, stiffness and inflammation, in people with inflammatory arthritis. Current practice in the management of patients with inflammatory arthritis emphasises the importance of Health Professionals (HP's) in assessing PA and aerobic capacity. To ensure baseline knowledge on PA and aerobic capacity assessment among HP's, it is important to identify if knowledge and training gaps exist. Objectives Investigate the awareness and use of objective and subjective measures of PA and aerobic capacity and to identify barriers for implementation of such methods in Health Professionals (Physiotherapist; Occupational Therapist; Nurse) working in the field of rheumatology in Sweden, Ireland and Denmark. Methods Health Professional's in Rheumatology were invited to participate in a cross-sectional, descriptive, observational study using an online survey methodology. Separate ethics approval was received in each country. Descriptive statistics and chi-square tests were used to analyse the data using SPSS v22. Results One hundred and forty four (144) HP's responded (50 Denmark, 28 Ireland and 66 Sweden), with 93% being female. Results found the mean number of years qualified to be 20.08 (SD 9.37) and years working in Rheumatology to be 12.29 (SD 8.27), with 61% reporting half of their workload coming from people who have inflammatory arthritis. The majority of respondents (96%) believe it is important to measure PA. Moderate levels of confidence were reported in using a simple body-worn sensor (mean 6.15/10; SD 3.63) and paper questionnaire (6.85/10; SD 3.62) as ways in monitoring PA, with lower levels of confidence in using a complex body-worn sensor (3.80/10; SD 3.55) and digital diary (4.22/10; SD 3.67). There was no statistically significant association between longer years qualified, more years working with people with inflammatory arthritis, age or gender in relation to the importance in measuring PA. When assessing aerobic capacity 58% were very familiar/somewhat familiar using a bicycle ergometer, 44% a treadmill and 56% other aerobic capacity tests. Low levels of confidence were reported in instructing their patients in performing aerobic capacity tests (4.54/10; SD 3.74) and in interpreting the results (4.79/10; SD 3.58). A large majority would be interested in further education around measuring PA (83%) and aerobic capacity measurement (74%), with an online module favoured for both. Conclusions The majority of Health Professionals surveyed believe it is important to measure PA however, levels of confidence are moderate to low when using various devices/ways. Regarding aerobic capacity tests low levels of familiarity were reported for both performing and interpreting results. There is strong interest in further education around measuring PA and aerobic capacity measurement highlighting a need to develop education and training for HP's in this area. Disclosure of Interest None declared

Research paper thumbnail of SAT0754-HPR ”a necessary investment in future health”. perceptions of physical activity maintenance among people with ra participating in an outsourced health-enhancing physical activity program

Poster Presentations

Background: No official published figures are available regarding the annual use of NSAIDs in Alb... more Background: No official published figures are available regarding the annual use of NSAIDs in Albania. Nonsteroidal anti-inflammatory drugs are used primarily to manage different pain conditions, less commonly they are used for their antipyretic effect. Although generally well tolerated, conventional NSAIDs have been associated with a wide range of adverse effects. The most common of which are gastrointestinal tract (GIT) side effects like: dyspepsia, abdominal pain, heartburn, and the most serious life-threatening gastrointestinal (GI) ulceration. Objectives: To investigate patient awareness of the proper use and frequency of side effects in nonsteroidal anti-inflammatory drugs (NSAIDs) patients in Albania. Methods: This study was a prospective 15 question interview of patients purchasing medications, during randomized 1 hour/day pharmacy visits over a one month study period (May 2015). The study was conducted in 4 community pharmacies located in the city of Tirana (capital of Albania). Two hundred and ten patients were included in this study. Results: Overall NSAIDs use during last year was 63%: Ibuprofene and diclofenac was the most used NSAIDs. The majority of patients (58%) reported having side effects upon NSAIDs-use; gastrointestinal upset was the most frequently reported side effect. Patients' awareness regarding proper NSAIDs use was poor, and pharmacist role in counseling was inadequate. However, user ability to discover the most common side effect to the drug seemed not to be affected. Conclusions: Nonsteroidal anti-inflammatory drugs use awareness and knowledge of probable serious side effects and how to handle them was not adequate. This probably reflected on high incidence of side effects. Nonsteroidal antiinflammatory drugs are available on prescription as well as over the counter drugs. Pharmacist involvement in education of patients using them is highly recommended and much needed to help decrease frequency of side effects. However this is a small scale study and further studies need to be done. References: [1] Langman MJ. Risks of anti-inflammatory drug-associated damage. Inflamm Res 1999; 48: 236-238. [2] Garcia Rodriquez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs.

Research paper thumbnail of FRI0575-HPR "A Gift from Heaven' or 'This was not for Me" - A Mixed Methods Approach to Describe Experiences of Physical Activity Participation among Persons with Rheumatoid Arthritis

Annals of the Rheumatic Diseases, 2014

Background A large proportion of persons with rheumatoid arthritis (RA) do not meet recommendatio... more Background A large proportion of persons with rheumatoid arthritis (RA) do not meet recommendations on health-enhancing physical activity (HEPA) (1). We performed a complex theory-based intervention in a group format at public gyms, aiming to support behavior change towards HEPA (2). To evaluate the intervention from a user perspective, a combination of quantitative and qualitative methods was applied. Objectives The aim of this mixed methods study was to explore and describe how persons with RA perceive their participation in the first year of a two-year program targeting adoption and maintenance of HEPA. Methods Data collection was performed by a postal survey to 211 of 220 intervention participants and by interviews with a sub-group of 35 purposefully selected informants. A total of 191 participants (91%) responded to the survey; mean age was 60 years and 81% were women. Survey data were analyzed by descriptive statistics and the interviews were analyzed by qualitative content analysis. Results Increased physical activity compared to the previous year was reported by 165 participants (86%) with circuit training and everyday physical activity performed regularly or periodically during the year by 78% and 92%, respectively. The behavioral support most frequently used was: responding to weekly text messages about performed physical activity (96% regularly), participating in support group sessions (73% regularly or periodically), and use of pedometer (58% regularly or periodically). The highest valued intervention components were: circuit training, physical activity in daily life, both rated median 5 on a 1-5 scale with 5 representing “Very valuable”, responding to text messages, coach support and expert lectures on RA-related topics, all rated median 4. A question on recommending the program to someone with a similar condition was rated median 5 (“Yes, definitely”). The content analysis of the interviews resulted in five categories: 1) “Starting point”, concerning previous experiences and current expectations on the program, 2) “Get going”, concerning intervention components that facilitated adoption of HEPA, 3) “Cashing in”, describing perceived gains from HEPA, 4) “Keep it going', concerning components that supported maintained HEPA and 5) `Trouble shooting”, describing individual obstacles to reach HEPA and suggestions for improvement of a future HEPA program. The suggestions mainly concerned more individualization in all aspects of the program. Conclusions The results indicate that self-monitoring by text messages and pedometers as well as professional coaching are perceived useful to facilitate HEPA in RA. Physical activity programs targeting maintained HEPA should be tailored to individuals' different needs concerning setting, exercise form and behavioral support. References Demmelmaier I, Bergman P, Nordgren B, Jensen I, Opava C. Current and maintained health-enhancing physical activity in rheumatoid arthritis – a cross-sectional study. Arthritis Care & Research. 2013;65(7):1166-76. Nordgren B, Fridén C, Demmelmaier I, Bergström G, Opava C. Long-term health-enhancing physical activity in rheumatoid arthritis. BMC Public Health. 2012;12(397). Acknowledgements The Swedish Research Council, Combine Sweden, the Swedish Rheumatism Association, the National Postgraduate School of Health Care Sciences at Karolinska Institutet, the Strategic Research Program in Health Care Research at Karolinska Institutet and the Swedish Rheumatology Quality Registers. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4282

Research paper thumbnail of FRI0567-HPR Criterion Validation of the Submaximal AStrand Bicycle Test to Estimate Aerobic Capacity in People with Rheumatoid Arthritis

Annals of the Rheumatic Diseases, 2014

Background Aerobic capacity tests are important to evaluate exercise programs and to encourage in... more Background Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to a physically active lifestyle. Maximum aerobic tests in a laboratory setting are expensive and not always feasible for people with rheumatoid arthritis (RA) (1). Submaximal tests, if proven valid and reliable, could thus be an alternative to maximum tests. The Åstrand submaximal bicycle test has been extensively used in clinic and research in people with RA, but never tested for validity and reliability in this population (2). Objectives To test the validity of the Åstrand submaximal test for estimation of aerobic capacity, by exploring the correlation with the measured maximum oxygen uptake (measured VO2max) in people with RA. Methods Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, activity limitation according to the Stanford Health Assessment Questionnaire 0.412 (0.42) and Disease Activity Score 28 2.4 (0.42), participated in the study. The subjects performed the Åstrand test and the measured VO2max test (Alpha version 4.5, Jaeger, KFA-2028-01) at the same test occasion. According to the Åstrand-nomograms the VO2max was estimated using heart rate (HR) measurements from a single stage and adjusted for age or for maximal HR. Results The correlation between VO2max estimated by the Åstrand test corrected for age and the measured VO2max test was r =0.82 (p<0.001) when expressed in l/min and r =0.68 (p<0.001) when expressed in ml kg–1 min–1, No systematic over- or underestimations were present although a majority of cases were underestimated. The correlation between VO2max estimated by the Åstrand test corrected for maximum HR and the measured VO2max test was r =0.82 (p<0.001) when expressed in l/min and r =0.65 (p<0.001) when expressed in ml kg–1 min–1. No systematic over- or under estimations were present. Conclusions The Åstrand test could be considered a valid instrument to estimate VO2max in physically active people with RA that are able to perform a submaximal cycle test during six minutes References Eurenius E, Brodin N, Opava CH. Clinical applicability of of two tests of aerobic fitness in patients with rheumatoid arthritis. Adv Physiother 2007(9):97-104. Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7(2):218-21. Acknowledgements The Swedish Rheumatism Association, the National Postgraduate School of Health Care Sciences at Karolinska Institutet. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5536

Research paper thumbnail of FRI0578-HPR Who makes it to the base? characteristics of people with ra eligible for a physical activity intervention compared to those not eligible. the para 2010-study

Annals of the Rheumatic Diseases

Background Physical activity (PA) is important to preserve functioning and avoid co morbidity in ... more Background Physical activity (PA) is important to preserve functioning and avoid co morbidity in people with RA. To better understand how to tailor PA programs it is important to identify characteristics of those eligible versus those who are not. However, recruitment processes prior to PA programs are often poorly described in people with RA. Objectives The objective of our study, including a large well defined sample of individuals with RA at target for a PA trial, was to compare those that were finally included in the trial with those that were not as regards socio-demographic, disease-related, and psychosocial factors and current PA levels. Methods In this cross-sectional survey 3152 individuals (1), of which 12 were excluded due to participation in another study, below age 75 years and independent in daily activities (HAQ>2) answered questionnaires on socio-demographic, disease-related, and psychosocial factors and current PA levels. Differences between individuals making it to the baseline assessments of the trial and those who did not were analyzed in three steps. Results In a first step, 1932 individuals were identified as eligible for the trial as they were interested, not enough physically active and had good Swedish language skills. They were mainly female, younger, better educated, having higher income and more likely to live with children, had better social support for exercise and higher outcome expectations on PA compared to the 1208 that were not eligible. In a second step, 286 individuals consented to participate. They were better educated and had higher income, more social support for exercise, less fear avoidance beliefs and higher outcome expectations on PA compared to the 1646 that declined participation. Reasons for declining were ‘training centre too distant’, ‘no time due to family, work or other reasons’, ‘too expensive’, ‘feel very well and not in need for exercise’, ‘bothered by injury/co morbidity’, ‘RA too active/disabling’, ‘no energy’. In a third step, 244 individuals showed up for baseline assessments and reported less fatigue compared to the 42 that did not show up for assessments. Reasons for withdrawal included ‘dislike training center’, ‘prefer yoga’, ‘changed mind about participation’, ‘recent cancer diagnosis’, ‘recent foot injury’, ‘foot ulcer’, ‘aortic aneurysm’, ‘too expensive’, ‘time constraints’ and logistic problems related to time or place of assessments or training. Conclusions To our knowledge this is the first study to describe the entire selection procedure from a target sample for a PA trial to baseline assessment in individuals with RA. Our results indicate that factors other than those related to the disease seem to determine participation and largely resemble those seen in the general population. Based on our results caregivers may be able to identify factors that are essential for supporting PA in people with RA that are reluctant to participate in various programs. References Demmelmaier I et al. Current and maintained health-enhancing physical activity in rheumatoid arthritis - the PARA 2010 study. Arthritis Care Res 2013 Jan 17 [Epub ahead of print] Acknowledgements We would like to acknowledge the contribution of the rheumatology clinics at Danderyd Hospital, Stockholm, Karolinska University Hospital, Solna and Huddinge, Linköping University Hospital, Linköping and Norrköping, Mälarsjukhuset, Eskilstuna, östersund Hospital, Sunderby Hospital, Luleå, and the Swedish Rheumatology Quality Registers. Disclosure of Interest None Declared

Research paper thumbnail of A survey across four European countries to determine rheumatology health professionals’ awareness of physical activity measures in people with inflammatory joint diseases

BMJ Open

A survey across four European countries to determine rheumatology health professionals' awareness... more A survey across four European countries to determine rheumatology health professionals' awareness of physical activity measures in people with inflammatory joint diseases.

Research paper thumbnail of “A Necessary Investment in Future Health”: Perceptions of Physical Activity Maintenance Among People With Rheumatoid Arthritis

Physical Therapy

Objective A few studies with a qualitative design have addressed physical activity (PA) maintenan... more Objective A few studies with a qualitative design have addressed physical activity (PA) maintenance in people with rheumatoid arthritis (RA), but none of them focused specifically on maintenance of PA according to public health recommendations. The purpose of this study was to describe perceptions of PA maintenance during the second year of an outsourced 2-year support program among people with RA. Methods For this descriptive design with a qualitative inductive approach, semi-structured interviews were conducted with 18 participants with RA (3 men and 15 women). Variation in age, disease duration, activity limitation, pain, levels of PA, and PA maintenance was targeted through strategic sampling. Qualitative content analysis was used, and a pattern of theme, subthemes, and categories was constructed based on the participants’ perceptions of PA maintenance. Results A main overarching theme, “A necessary investment in future health”—with 3 subthemes of dedication, awareness, and affi...

Research paper thumbnail of Associations between fatigue and physical capacity in people moderately affected by rheumatoid arthritis

Rheumatology International

To explore the contribution of physical capacity in explaining variations in fatigue among people... more To explore the contribution of physical capacity in explaining variations in fatigue among people with rheumatoid arthritis (RA). This study included participants recruited for a physical activity intervention. Data were collected from the Swedish Rheumatology Quality Registers, from questionnaires on fatigue, activity limitation, perceived health, pain and anxiety/ depression and from physical capacity tests (lower limb function, grip strength, and aerobic capacity). We used logistic regression to estimate the association between severe fatigue (≥ 50, visual analogue scale 0-100) and (A) independent variables related to disease and disease impact and (B) model A plus physical capacity tests. Pooled odds ratio tests compared model fit. Out of the 269 participants (mean age 60 years, mean disease activity score [DAS28] 2.8), severe fatigue was reported by 35%. The three variables which were statistically significantly associated with severe fatigue (p < 0.05) in both models were perceived health, pain and anxiety/depression. Anxiety/depression demonstrated the largest effect size with odds ratios of 2.43 (95% CI 1.20, 4.94) in model A and 2.58 (95% CI 1.25, 5.32) in model B. The likelihood ratio test indicated that model B was a better fit to the data than model A with Χ 2 (df 3) = 2.65, p = 0.048. Severe fatigue in people with RA is associated with self-rated health, pain and anxiety/depression rather than with physical capacity. Future studies should be prospective, use multidimensional assessments of fatigue to explore the influence of physical capacity and control for possible influence of comorbidities associated with fatigue.

Research paper thumbnail of Pain sensitivity at rest and during muscle contraction in persons with rheumatoid arthritis: a substudy within the Physical Activity in Rheumatoid Arthritis 2010 study

Arthritis Research & Therapy

Background: We aimed to explore pressure pain sensitivity and the function of segmental and pluri... more Background: We aimed to explore pressure pain sensitivity and the function of segmental and plurisegmental exerciseinduced hypoalgesia (EIH) in persons with rheumatoid arthritis (RA) compared with healthy control subjects (HC). Methods: Forty-six participants with RA (43 female, 3 male) and 20 HC (16 female, 4 male) participated in the study. Pressure pain thresholds, suprathreshold pressure pain at rest, and segmental and plurisegmental EIH during standardised submaximal contractions were assessed by algometry. Assessments of EIH were made by performing algometry alternately at the contracting (30% of the individual maximum) right m. quadriceps and the resting left m. deltoideus. Results: Participants with RA had higher sensitivity to pressure pain (RA, 318 kPa; HC, 487 kPa; p < 0.001), suprathreshold pressure pain 4/10 (RA, 433 kPa; HC, 638 kPa; p = 0.001) and suprathreshold pressure pain 7/10 (RA, 620 kPa; HC, 851 kPa; p = 0.002) than HC. Segmental EIH (RA, 0.99 vs 1.27; p < 0.001; HC, 0.89 vs 1.10; p = 0.016) and plurisegmental EIH (RA, 0.95 vs 1.36; p < 0.001; HC, 0.87 vs 1.31; p < 0.001) increased significantly during static muscle contraction in both groups alike (p > 0.05). Conclusions: Our results indicate a generally increased pain sensitivity but normal function of EIH among persons with RA and offer one possible explanation for pain reduction observed in this group of patients following clinical exercise programmes.

Research paper thumbnail of Impaired left atrial dynamics and its improvement by guided physical activity reveal left atrial strain as a novel early indicator of reversible cardiac dysfunction in rheumatoid arthritis

European journal of preventive cardiology, 2018

Research paper thumbnail of An Outsourced Health-enhancing Physical Activity Program for People with Rheumatoid Arthritis: Study of the Maintenance Phase

The Journal of Rheumatology

Objective.To describe changes of health-enhancing physical activity (HEPA), health perception, an... more Objective.To describe changes of health-enhancing physical activity (HEPA), health perception, and functioning during the second year of a 2-year support program, determine aspects of adherence and response, and describe perceptions of the program.Methods.Out of 220 individuals with rheumatoid arthritis (RA), 177 participated in the followup. Group support, strength training, and moderate-intensity aerobic activity were encouraged. Data collection included HEPA, perceived health, functioning, and perceptions of the program. Participants with unchanged/improved general health perception and at least 2 of aerobic capacity, grip strength, or timed standing were considered responders.Results.Current and maintained HEPA decreased from 82% to 75% (p = 0.0141) and from 41% to 27% (p < 0.0001) during the second year. Minor declines in quality of life and activity limitation occurred (p = 0.0395 and 0.0038, respectively), while outcome expectations for benefits of physical activity increa...