Physical activity and Sports Medicine with focus on prevention

Research focus

Our research focus is in the area of physical activity, physical exercise and sports medicine. We study the link between physical activity and health, the effect of exercise interventions on habitual physical activity levels, and the prevention of sports injuries. Our research combines epidemiology, method development and intervention research.

Our vision is to increase health, especially among individuals with risk factors, disabilities or injuries through high quality epidemiological and intervention/implementation research in the area physical activity and sports medicine.

Research projects/activities 

The BETA project

The BETA-study is a joint project with Professor Ståhle, Associate professor Franzén and Associate professor Hagströmer.

The project aims to translate basic neuroscience into applied research and clinical understanding and implements the evaluation methods and training program into clinical practice. We hypothesize that a new conceptual framework for balance training, emphasizing critical aspects of balance control specifically related to disease symptoms through highly challenging, progressive and varied exercises, will improve balance and gait performance in elderly with osteoporosis or Parkinson’s disease. We predict that increased balance control following training will lead to increased levels of physical activity and an improved health related quality of life. We have been successful in receiving grants for conducting the study as well as for PhD students and postdocs. 

Our group is responsible for the physical activity and preventive arm of the project, including one PhD student, Håkan Nero. In addition we are developing and testing methods for assessment of physical activity, such as using accelerometry, in individuals with impaired gait. 

Principal investigators: Ståhle, Franzén, Hagströmer

ABC study (Attitude, Behavior and Change)

The Attitude, Behavior and Change study (ABC)  is a cross-sectional and longitudinal research project on health behaviors with data collection by questionnaire and physical activity monitoring. The study includes a random sample of around 1 500 adults, 18-74 years, selected from the Swedish population register, with data collected in 2001/2002 and 2007/2008. A follow-up of the sample is in planning.

The study was originally initiated by Associate professor Michael Sjöström at the Department of Biosciences and Nutrition, Karolinska Institutet and is now a collaborative project between the two departments.

For the first time, physical activity and sedentary behavior was measured using objective methodology, giving results that is thought provoking. The findings from this project have revealed both international and national publicity. We have for example been invited to present at conferences and symposium. The methodology used has been set as a standard for assessment of physical activity levels in the European Union (the ALPHA project). The Swedish news Rapport and Vetenskapens värld have reported from the study. 

Principal investigators: Hagströmer, Sjöström

Screening of athletes, sport injury registration and prevention (2013-2016)

The long term goal of this project is to reduce the risk, for adolescent elite athletes, to sustain injuries (overuse and acute), recurrent injury and pain that reduces participation in sports and thereby enhance increased awareness, performance and health. Further on, a long term goal is to reduce health care costs. Ultimately, the goal is to deepen the knowledge on how to make adolescent sport participation on elite level more safe and healthy by scientifically develop theoretical as well as clinical models regarding risk factors and injury prevention

The short term goals are to increase the understanding of the injury panorama and to study risk factors for injuries in different sports and to improve the knowledge in injury prevention in coaches and medical staff. We also foresee a need to develop medical teams located at the Swedish National Sports High Schools, in order to facilitate quick and safe diagnosis and rehabilitation of injuries.

Approximately 500 adolescent elite athletes in handball, athletics, cross-country skiing, orienteering, down-hill skiing, American football, wakeboard, bowling, cycling, golf, triathlon, and canoeing, from 20 Swedish National Sports High Schools are enrolled in the study. A prospective design is applied following the athletes over 1-2 years. Baseline data are collected at the start of each semester and incidence and prevalence data on injuries, training volume and intensity are collected by using self-reporting weekly web-based questionnaire. In addition, the athletes undergo a movement screening (9+screening battery) once every semester, to collect data on asymmetries and dysfunctions. Data collection will end in December 2015.

The project is financed by The Swedish National Centre for Research in Sports, Karolinska Institutet and the Swedish Sports Confederation.

Principal investigator: Heijne
Co-investigator: Frohm

Hormonal influences on physical exercise

The overall aim of this project is to study the effect of oral contraceptives on postural control, muscle strength and premenstrual symptoms (PMS) in moderately physically active women of fertile age. Oral contraceptives are used to similar extent by athletes as by a nonathletic population. Still, there is lack of studies investigating the effect of oral contraceptives on physical performance and on the effect of PMS symptoms. Earlier studies have showed oral contraceptives to be protective for sports injuries but the mechanism for this is still not fully elucidated. Possible explanations could be hormonal influence on muscles, tendons and ligaments.

A further aim of this project is to study mRNA and protein levels of sex hormone receptors in skeletal muscle tissue of women during three different phases of the menstrual cycle. Expression of estrogen receptors in human skeletal muscles on both mRNA and protein levels have recently been described. However, levels of sex hormone receptors in skeletal muscle during the menstrual cycle have not earlier been studied.

The project is a collaboration between The Division of Physiotherapy (Associate professor Cecilia Fridén), the Division of Obstetrics and Gynecology (Professor Angelica Lindén- Hirschberg), Karolinska Institutet and the Division of Obstetrics and Gynecology (Professor Torbjörn Bäckström), Umeå University Hospital. The project has one PhD student, Linda Ekenros.

The project is financed by Swedish National Centre for Research in Sports and the Swedish Research Council

Principal investigator: Fridén

Group leader

Senior lecturer

Maria Hagströmer

Phone: 08-524 888 36
Organizational unit: Division of Physiotherapy

Group members

Cecilia Fridén, Associate professor

Annette Heijne, Associate professor

Ing-Mari Dohrn, Postdoc

Håkan Nero, PhD student

Linda Ekenros, PhD student

Anna Frohm, Postdoc

Elin Johansson, PhD 

Philip von Rosén, PhD student

Frida Flodström, MSc

Alexander Fällman, MSc

Susanna Aufwerber, PhD student

Andrea Porserud, MSc

Collaborators and partners

We have on-going research collaboration at local (KI), national and international levels. We have for example been part of two large EU-funded projects (HELENA-study and the ALPHA-study) and one large international project (IPS).

 Examples of current collaboration:

  • Dr. Berrigan at National Institutes of Health, Bethesda, USA.
    A continuation of my post-doctoral work there.Two manuscripts in pipeline, using the NHANES and Swedish datasets.
  • Professor Patrick Kolsteren and PhD Carl Lachat at Gent University. 
    The Burkina Faso study. A randomized controlled trial that assess the effect of maternal supplementation and mother’s physical activity levels on birth outcome measures.
  • Professor Claude Marcus at CLINTEC, KI.
    The Early STOPP study.
  • Professor Irene Jensen and PhD Lydia Kwak at IMM, KI
    Work-site health promotion, prevention of life style related diseases.
  • Associate professor Liselotte Schäfer Elinder at PHS, KI.
    A health programme for community residences.
  • PhD Maria Bäck, Sahlgrenska, Gothenburg.
    Effect of physical exercise on patients 80+ with coronary-heart disease - a RCT.
  • Professor Carl-Johan Sundberg, Department of Physiology and Pharmacology, KI.
    The YOG Legacy Project- Childhood Obesity Prevention, Physical Activity Promotion.
  • Professor Mark E Batt, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom.
    The nine test screening battery - Normative values on recreational athletes.
  • Assistant professor Grethe Myklebust, Oslo Sport Trauma and Research Centre, Oslo, Norway
    Prevention of injury and illness among athletes.
  • Riksidrottsförbundet (The Swedish Sports Confederation).

Financial support

Ongoing funding

  • The Swedish Research council (the BETA project)
  • Loo och Hans Osterman (the BETA project)
  • National School in Health Care Sciences (the BETA project)
  • The Swedish National Centre for Research in Sports (the Sport injury prevention project)
  • KID-funding (the Early Stopp study, physical activity arm)
  • Åke Wiberg Foundation

Selected scientific publications 

Calibration and Validation of a Wrist- and Hip-Worn Actigraph Accelerometer in 4-Year-Old Children.
Johansson E, Larisch L, Marcus C, Hagströmer M
PLoS ONE 2016 ;11(9):e0162436

Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes.
von Rosen P, Frohm A, Kottorp A, Fridén C, Heijne A
Scand J Med Sci Sports 2016 Aug;():

Injuries and Associated Risk Factors Among Adolescent Elite Orienteerers: A 26-Week Prospective Registration Study.
von Rosen P, Heijne A, Frohm A
J Athl Train 2016 Apr;51(4):321-8

Objectively Assessed Physical Activity and its Association with Balance, Physical Function and Dyskinesia in Parkinson's Disease.
Nero H, Benka Wallén M, Franzén E, Conradsson D, Ståhle A, Hagströmer M
J Parkinsons Dis 2016 Oct;6(4):833-840

A two- and five-year follow-up of clinical outcome after ACL reconstruction using BPTB or hamstring tendon grafts: a prospective intervention outcome study.
Heijne A, Hagströmer M, Werner S
Knee Surg Sports Traumatol Arthrosc 2015 Mar;23(3):799-807

Calibration and cross-validation of a wrist-worn Actigraph in young preschoolers.
Johansson E, Ekelund U, Nero H, Marcus C, Hagströmer M
Pediatr Obes 2015 Feb;10(1):1-6

A 6 year longitudinal study of accelerometer-measured physical activity and sedentary time in Swedish adults.
Hagströmer M, Kwak L, Oja P, Sjöström M
J Sci Med Sport 2015 Sep;18(5):553-7

Objectively measured physical activity in two-year-old children - levels, patterns and correlates.
Johansson E, Hagströmer M, Svensson V, Ek A, Forssén M, Nero H, et al
Int J Behav Nutr Phys Act 2015 Jan;12():3

Accelerometer Cut Points for Physical Activity Assessment of Older Adults with Parkinson's Disease.
Nero H, Benka Wallén M, Franzén E, Ståhle A, Hagströmer M
PLoS ONE 2015 ;10(9):e0135899

Expression of sex steroid hormone receptors in human skeletal muscle during the menstrual cycle.
Ekenros L, Papoutsi Z, Fridén C, Dahlman Wright K, Lindén Hirschberg A
Acta Physiol (Oxf) 2016 Jul;():

Hop performance and leg muscle power in athletes: Reliability of a test battery.
Kockum B, Heijne A
Phys Ther Sport 2015 Aug;16(3):222-7

Levels and patterns of physical activity and sedentary behavior in elderly individuals with mild to moderate Parkinson’s disease. Benka-Wallén M, Nero H, Franzen E, Hagströmer M. Physical Therapy Journal. 2015;95:1135-41

Oral contraceptives do not affect muscle strength and hop performance in active women.
Ekenros L, Hirschberg A, Heijne A, Fridén C
Clin J Sport Med 2013 May;23(3):202-7

Reports (In Swedish)

Schäfer Elinder L, Hagströmer M, Nyberg G, Ekblom-Bak E. Fysisk aktivitet och stillasittande. Delrapport i Folkhälsorapport 2011. Folkhälsan i Stockholm, idag och imorgon. Stockholms läns landsting. 2011.

Kwak L, Hagströmer M, Schäfer-Elinder L, Lohela M, Jensen I. Metoder för företagshälsovården; att främja goda matvanor och fysisk aktivitet på arbetsplatser. Enheten för interventions- och implementeringsforskning, Institutet för miljömedicin (IMM). Karolinska Institutet. Stockholm. 2012.

Heinemans N, Hagströmer M. Hagberg J, Norman Å, Schäfer Elinder L, Österåkerprojektet – en deltagarstyrd intervention i skolan för att främja goda matvanor och fysisk aktivitet. Centrum för epidemiologi och samhällsmedicin. Stockholms läns landsting. 2013.

Bergström H, Gråhed I, Hagströmer M, Elinder LS. Hälsofrämjande gruppbostad. Planering, genomförande och utvärdering av ett hälsofrämjande program. Stockholms läns landsting, centrum för epidemiologi och samhällsnutrition (CES). Rapport 2013:5.

Benka-Wallén M, Ståhle A, Hagtrömer M, Franzen E, Roaldsen KS. Motionsvanor och erfarenheter av motion hos äldre. Rapport. Myndighetens för samhällsskydd och beredskap (MSB). 2013

Books and book chapters (In Swedish)

Fridén C, Nordgren B, Åhlund S. Graviditet, hälsa och träning. Studentlitteratur, 2011

Hagströmer M, Hassmén P. Att bedöma och styra fysisk aktivitet. Ur: Ståhle A (Ed). FYSS 2008. Fysisk aktivitet vid sjukdomsprevention och sjukdomsbehandling. Statens Folkhälsoinstitutet. 2008. (översatt till engelska, norska och vietnamesiska 2010, 2011 respektive 2013).

Hagströmer M, Nyberg G. Barn, fysisk aktivitet och hälsa. Ur: Beckung E, Rösblad B (Ed). Sjukgymnastik för barn och ungdomar. Studentlitteratur. 2013.

Hagströmer M. Fysisk aktivitet och hälsa. Kapitel i boken Omvårdnadens höjder, webbdelen Folkhälsa/vuxna. Studentlitteratur. 2013.