Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population. Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data. Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population. Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

ObjectivesTo investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age.DesignA 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]–standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5).SettingNational Childhood Obesity Center, Stockholm, Sweden.ParticipantsChildren 6 to 16 years of age who started treatment between 1998 and 2006.InterventionBehavioral treatment of obesity.Main Outcome MeasureChange in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant.ResultsA total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, −0.4 [95% CI, −0.55 to −0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, −0.7 [95% CI, −0.80 to −0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]).ConclusionsBehavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.

Aims: Physical activity (PA) used as prevention and treatment of disease has created a need for effective tools for measuring patients’ PA level. Our aim was therefore to assess the validity of two PA questions and their three associated answer modes. Methods: Data on PA according to the PA questions and Actigraph GT3X+ accelerometers, aerobic fitness ( VO₂max), cardiovascular biomarkers, and self-rated general health were collected in 365 Swedish adults (21–66 years). The PA questions ask about weekly PA via categories (Categorical), an open-ended answer (Open), or specified day by day (Table). Results: The Categorical mode, compared with the Open mode, correlated (Spearman’s rho) significantly more strongly ( p<0.05) with accelerometer PA (0.31 vs. 0.18) and VO₂max (0.27 vs. 0.06), and the level of BMI (–0.20 vs. –0.02), waist circumference (–0.22 vs. –0.03), diastolic blood pressure (–0.16 vs. 0.08), glucose (–0.18 vs. 0.04), triglycerides (–0.31 vs. –0.07), and general health (0.35 vs. 0.19). The validity of the Categorical and Table modes were similar regarding VO₂max and accelerometry, but the Categorical mode exhibited more significant and stronger correlations with cardiovascular biomarkers. The capacity of the PA questions to identify insufficiently physically active individuals ranged from 0.57 to 0.76 for sensitivity and from 0.47 to 0.79 for specificity. Conclusions: The Categorical mode exhibits the strongest validity and Open mode the weakest. The PA questions may be used on a population level, or as a tool for determining patents’ appropriateness for treatment.

Exercise can relieve both depressive and anxiety disorders and it is therefore of importance to establish movement patterns of mildly to moderately affected sufferers to estimate the treatment potential. The aim is to describe the physical activity patterns of people affected by mild to moderate depressive and/or anxiety symptoms using objective measures of physical activity. The design of the study was cross-sectional using data from 165 people aged 18–65 years, with mild to moderate depressive and/or anxiety disorder symptoms (scoring ≥10 on the PHQ-9). Diagnoses were made using Mini International Neuropsychiatric Interview (MINI) and symptom severity was measured with the Montgomery-Åsberg Depression Rating Scale (MADRS). The participants wore accelerometers for a week to evaluate physical activity patterns. No statistically significant differences were detected between different diagnoses, though depressed participants tended to be less active and more sedentary. Only one-fifth of the sample followed public health guidelines regarding physical activity. Each one point increase in MADRS was associated with a 2.4 minute reduction in light physical activity, independent of moderate-to-vigorous physical activity and sedentary time. MADRS was positively associated with number of sedentary bouts. The physical activity pattern of people with depressive and/or anxiety disorders was characterized by large amounts of sedentary time and low fulfillment of physical activity guidelines. There is therefore a large treatment potential for this group by increasing exercise. The results suggest that instead of focusing exclusively on high intensity exercise for treating depressive and anxiety disorders, health care providers might encourage patients to reduce sedentary time by increasing light physical activity and decreasing the number of sedentary bouts, though further studies are needed that can determine directionality.

Purpose To further develop the Ekblom Bak-test prediction equation for estimation of VO₂max from submaximal cycle ergometry. Methods The model group (117 men and 100 women, aged 48.3 ± 15.7 and 46.1 ± 16.8 years, VO₂max 46.6 ± 11.1 and 40.4 ± 9.6 mL kg⁻¹ min⁻¹, respectively) and the cross-validation group (60 men and 55 women, aged 40.6 ± 17.1 and 41.6 ± 16.7 years, VO₂max 49.0 ± 12.1 and 43.2 ± 8.9 mL min⁻¹ kg⁻¹, respectively) performed 4 min of cycling on a standard work rate (30 W) directly followed by 4 min on a higher work rate. Heart rate (HR) at each work rate was recorded. Thereafter, participants completed a graded maximal treadmill test for direct measurement of oxygen uptake. The new prediction equation was cross-validated and accuracy compared with the original Ekblom Bak equation as well as by the Åstrand test method. Results The final sex-specific regression models included age, change in HR per-unit change in power (ΔHR/ΔPO), the difference in work rates (ΔPO), and HR at standard work rate as independent variables. The adjusted R ² for the final models were 0.86 in men and 0.83 in women. The coefficient of variation (CV) was 8.7 % and SEE 0.28 L min⁻¹. The corresponding CV and SEE values for the EB-test₂₀₁₂ and the Åstrand tests were 10.9 and 18.1 % and 0.35 and 0.48 L min⁻¹, respectively. Conclusion The new EB-test prediction equation provides an easy administered and valid estimation of VO₂max for a wide variety of ages (20–86 years) and fitness levels (19–76 mL kg⁻¹ min⁻¹).

The aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described. We conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary ( 3 METS); and Body Mass Index standard deviations score, BMIsds. Total sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -.23, P < .01). A negative association between BMIsds and sleep duration was found (-.10, p < .01). Short sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.