Carl Johan Sundberg

Background: Physical inactivity negatively affects health and is associated with type 2 diabetes, cardiovascular disease, cognitive dysfunction and shorter life span. Despite the growing body of evidence for detrimental effects, the population is increasingly sedentary and currently sitting nine to ten hours per day

the pattern is seen across all age groups. This harmful development must be mitigated to combat the increasing epidemic of lifestyle-related diseases in society. Stair walking has the potential to incentivize people to be more physically active seamlessly integrated into everyday life. Objectives: To investigate whether six months of daily stair walking (200 stair steps daily) in addition to walking on level ground (75 minutes per week) versus only walking on level ground (150 minutes per week) - in a time-effective manner - confers greater blood pressure reduction as well as greater improvement in aerobic fitness, strength, cardiovascular risk factor control and self-assessed health parameters. Work plan: Study subjects will be screened for inclusion through an online screening tool. Participants are both men and women 40-70 years old with increased cardiometabolic risk defined by hypertension, abdominal obesity and sedentary lifestyle (less than 4000 steps per day). Study subjects (n=400) will be randomized into two groups: 1) daily stair walking plus half the weekly recommended walking on level ground and 2) recommended weekly walking on level ground alone. Activity levels will be monitored regularly. Subjects will be followed for six months. Measured outcomes are blood pressure, aerobic fitness, strength, cardiovascular risk factor control and self-assessed health parameters. Significance: If stair walking is a feasible and time-effective physical activity it could improve individual health through a simplistic training alternative that can be seamlessly integrated into everyday life. It could inform infrastructure planning by ensuring that stairs are readily available and promoted for pedestrians. Healthcare costs could be decreased by keeping vulnerable groups more physically active thus reducing the growing burden of lifestyle-related diseases. Positive findings have population-level scalability and could corroborate the European Society of Cardiology s guidelines on both individual prevention and strong policy suggestions on physical activity when planning/building new landscaping.

Research questionsPrimary: Does physical exercise have an effect on depression in adolescents?Secondary: Is there a correlation between changes in the degree of depression, in fitness and in strength towards biomarkers for neuroinflammation and neuroprotection? What is the cost-effectiveness compared with regular care? How are young people´s lifestyles affected by and how to increase adherence to exercise?Data and MethodMaterial: 122 adolescents with mild to moderate depression in CAMHS specialist care in Halmstad, Kungsbacka, Stockholm and Malmö who participated in at least three sessions and still depressed.Methods: Randomised multicenter study with active control group.Inclusion after psychiatric interview (K-SADS-PL) with psychiatrist. Control group with group leisure activity where the positive effect of social activation is controlled for. Measurement at baseline, after intervention at 3 months and at 6 months (RCT) and after one year (open phase) of investigator assessed depressive symptoms and function via interview CDRS-R and C-GAS, fitness via submaximal VO2 max test, three tests on muscle strength, nine biomarkers for neuroprotection and inflammation, questionnaire for cost assessment to parents and for quality of life to adolescents and qualitative interviews with both adolescents, parents and group leaders. Self-report of symptoms every two weeks during the intervention and every month thereafter.ImplementationGroup activity for 12 weeks with 60 minutes x3 per week of either physical exercise or calm leisure activity in a group. Training group with the same structure has been used for several years. Leisure group has been tested in a pilot study during 2021. Data collection via surveys is web-based. Interviews for depression and qualitatively takes place via video link to minimize the number of assessors and simplify for participants. A centre has experience in methods, weekly video link meetings with local monitors are planned for support in the implementation. Reliability in the primary outcome measure was good when co-estimating prior to the pilot study.RelevancePhysical exercise for depression in adolescents is promising but the quality of evidence is inadequate due to method shortcomings. Thus, National guidelines do not recommend physical exercise for depression. This RCT addresses the shortcomings in today´s knowledge base and can answer the question of whether group training should be included in care for young people with depression.

Post covid condition (PCC) affects approximately 10% of people infected with SARS-CoV-2. With half a billion confirmed COVID-19 cases globally, the magnitude of the expected Post COVID healthcare problem is enormous. No treatment options to date have shown efficacy.We hypothesize that part of PCC is a chronic inflammation involving the endothelium started by COVID-19 and treatable by the anti-inflammatory effects of hyperbaric oxygen (HBO2). HBO2 delivered by inhalation of 100% oxygen in a hyperbaric chamber in daily treatments over several weeks, has several anti-inflammatory effects. It is used for chronic inflammatory conditions such as osteomyelitis, radiation cystitis and acute flares of ulcerative colitis. The purpose of this proposal is to investigate biomarkers, epigenetic signatures and response to HBO2 in a clinical trial that may explain mechanisms of the post COVID condition and enable future precision medicine.Aims: To investigate biomarkers, redox-balance and epigenetic profile of patients with PCCTo determine the efficacy of HBOT on endothelial dysfunction, objective physical performance, autonomic dysfunction, restorative sleep.To investigate if the effect of HBOT in PCC in a clinical trial correlates with age, gender and epigenetic signatures. Preliminary results from our clinical trial on 31 acute covid-19 indicates effect from HBO but treatment may need individual tailoring. To date we have treated 20 PCC patients, aiming for a total of 80 participants.

Support for physical activity is necessary to sustain health after stroke and transient ischemic attack (TIA). Still, rehabilitation services are not available to many of those who potentially would benefit due to barriers related to accessibility. While telerehabilitation is a promising strategy to support physical activity, there is a gap of knowledge regarding the implementation of technology that meet the needs of people post stroke or TIA in order to foster adherence and engagement in physical activity.Purpose is to improve health and wellbeing after stroke or TIA by increasing the access to physical activity through telerehabilitation. This will be accomplished by building on a national collaboration within secondary stroke prevention and through testing of an existing telerehabilitation program (ENAbLE) developed in Australia.The ENAbLE program seeks to strengthen physical functioning and self-efficacy for exercise through home-based physical exercise and to equip the person with knowledge and confidence to sustain physical activity through behavior change techniques. The program will be accessible via a recent developed mobile application which will be used to reinforce autonomy and patient-therapist partnership.We will first evaluate if the ENAbLE program can be delivered as intended through a pilot RCT to determine the feasibility, processes, end-users experiences and preliminary effects of the program in urban and rural regions of Sweden. We will thereafter initiate a full-scale RCT to investigate the effects of the ENAbLE program on risk factors for recurrent stroke, well-being and its cost-effectiveness across Sweden.The project will draw on socio-technical theory, depicting technologies as part of a dynamic system in order to explore its potential use in rehabilitation. The ENAbLE program offers a sustainable strategy to support exercise and physical activity which could benefit a large group of people with stroke and TIA regardless of where they live.