He refuses to sit still

Text: Cecilia Odlind, first published in Swedish in Medicinsk Vetenskap no 3, 2017.

When Carl Johan Sundberg holds lectures in Almedalen there are no chairs in the auditorium.

“Physical inactivity and sitting still are linked to a higher risk of cardiovascular diseases, diabetes and several other diseases”, he explains.

Carl Johan Sundberg has held numerous lectures on the theme, written books and is researching the effects of exercise. And he practises what he preaches, Carl Johan Sundberg rarely sits still. Every moment of the day is planned and used effectively. I ask what drives him:

“My inner demons”, he answers ironically.

But he does not tell us more about any demonic driving forces.

“No, I want to know how the human body functions. It’s very exciting to try to understand this”, says Carl Johan Sundberg.

In his doctoral thesis the plan was to study how blood pressure control functions during weightlessness. Carl Johan Sundberg conducted human physiological experiments at Johnson Space Center in Houston in America, but when the space shuttle Challenger crashed in 1986 the entire research programme was postponed for several years. Consequently he started to develop an interest in how activity in the genes changes during physical activity and how this is linked to performance and health.

“It has been proven that exercising is good for us, but how does it really work? What happens in the cells which gives all these positive effects?”

Carl Johan’s research group has tried to find out more about this in an ingenious experiment in which human subjects exercise one leg but not the other. They have been able to ascertain that exercise leads to changed concentration of approximately 3,400 RNA variants, DNA copies.

“Exercise changes the activity of many genes. It leads to higher or lower production of certain proteins and probably explains a large part of the positive effects”, says Carl Johan Sundberg.

“Obviously some would benefit more from their exercise if they spent more time on one or the other type of exercise, but we don’t know enough right now to give such advice. The fact that approximately 50 per cent is genetically conditioned, that is sure, the major question is which genes and complex gene combinations regulate this and how”, he says.Another issue which he is interested in is how to exercise in the best way. We already know that generally it is good to combine at least 150 minutes of endurance and fitness training with two sessions of weight training every week. It is probably also good for health to vary the pace. However, Carl Johan Sundberg’s research group has also shown that there is a high level of variation in terms of how people respond to exercise. There is a large effect on some people while for others the rewards are low. Hereditary components explain approximately half of these differences.

Based on too little facts

The genetic tests alone which are sold now and which claim to answer which exercise you should do are not reliable and are based on too little facts, he claims.

“But the vision is to be able to provide customised advice in the future.

Another research question is how physical activity can affect the process when you are sick. For example, it has been ascertained that people who are physically active regularly have a lower risk of both breast and colon cancer.

“But can you also reduce the risk of relapse by increasing the amount of exercise if you fall ill? That’s more unclear. We’re planning a major study which will examine this and in that case how it can be explained”, he says.

Carl Johan Sundberg also works within several other research fields. Together with several other researchers, in a recently started project his group will examine how patients can contribute to providing as much knowledge as possible before the meeting with the doctor. Approximately 8,000 patients who come to the cardiology emergency ward at Danderyd Hospital with chest pain will answer questions on a tablet about discomfort and other important medical history information through a specifically developed program. There are now approximately 10,000 questions in the program and a typical patient answers approximately 350 of these over 60 minutes. The questions can be answered from home or during the waiting time at the emergency ward. After 18 months the researchers will evaluate whether the information provided by patients would have been able to result in a different handling and in this way affect the outcome.

“Now the doctor’s appointment is often short and the doctor doesn’t have the time to find out all information. And after all patients know the most about their symptoms. If the questions in the program are asked correctly, the answers should be able to help the doctor to make a securer diagnosis and provide the correct treatment as early as possible”, says Carl Johan Sundberg.

A strong driving force

His enthusiasm in the project is probably linked to his willingness to constantly improve the system and procedures in healthcare and the research community. Carl Johan Sundberg has a strong driving force and this resulted in him starting Euroscience Open Forum, ESOF in 2004. It is a science meeting which gathers approximately 4,500 participants – researchers, politicians, journalists and other actors every other year.

“I think that over the years we have been able to impact important issues related to, for example, ethics, career paths and financing by highlighting them at these meetings”, says Carl Johan Sundberg.

Another example of his willingness to systematically improve is his chairmanship of the Professional Associations for Physical Activity, Sweden (Yrkesföreningar för fysisk aktivitet, YFA), a sub-association of the Swedish Society of Medicine. The most important work there has been to develop FYSS, a handbook which collects information about and in detail describes which type and dose of physical activity is ideal for patients with different types of illnesses. The book is used by many different professional groups and is based on the collective knowledge of each disease.

However, the latest research is often the least interesting in the long-run, according to Carl Johan Sundberg.

“It’s often interpreted too positively. It’s only when several repeated well-controlled studies, independent of each other, show the same thing that you can be sure about the correctness of the results. In some cases it’s necessary to merge several studies to large meta-analyses so that you can make statistically safe conclusions”, he says.

However, often the media still reports new individual study results as though they were the truth.

“I think that journalists do a disservice to society when they uncritically publish research news without putting them into a context”, he says.

Content of press releases

Behind the news there are often press releases which universities publish together with new studies. Carl Johan Sundberg’s involvement in the issue has resulted in an ongoing research project in which one of his colleagues has examined how well the content of press releases from several universities, including Karolinska Institutet, conforms to the research results.

“For example, we have examined whether headings and conclusions are correct, whether it is stated clearly if it involves results of studies on humans or tests on animals and whether potential bias has been reported. We’re now in the process of compiling the results”, he says.

However, there are problems even within the academy. An unreasonably large proportion of all scientific studies which are published within the medical field, over 95 per cent, report differences or effects.

“It’s naturally a problem that so few ‘negative’ studies are published. But it’s difficult to publish such studies, journals prefer to report positive findings”, says Carl Johan Sundberg.

The research is neither conducted as well as it could really be performed, he claims.

“Cheating is not really the major problem, but that too small and poorly controlled studies are performed”.

Slightly depressing according to him.

“But you just need to continue talking about the problems, otherwise they can never be fixed. The scientific method is still the best way we have for understanding the reality. At a time when solid facts are criticised hastily, this is crucial for us to have a good society in which ideologies and power ambitions cannot prevail”, says Carl Johan Sundberg.

Text: Cecilia Odlind, first published in Swedish in Medicinsk Vetenskap no 3, 2017.