Dorthe Stensvold

Purpose: Physical activity (PA) levels declined during the COVID-19 pandemic, contributing to reduced fitness and quality of life. eHealth tools may help increase PA. In a six-month randomized controlled trial, we evaluated Activity Quotient (AQ), an innovative eHealth tool designed to promote PA and improve peak oxygen uptake (V̇O ₂ peak), compared with standard advice on national PA recommendations in physically inactive adults recovering from COVID-19. Methods: Seventy-seven participants with previous COVID-19 infection were randomized 1:1 to either receive: 1) an eHealth-guided exercise intervention (n=38), using AQ to motivate for a PA dose that led to > 100 weekly AQs, or 2) a control group (n=39) advised to follow standard PA recommendations. V̇O ₂ peak scaled for fat-free mass (FFM) was the primary outcome, assessed in a subsample of participants who completed clinical assessment (n=33; eHealth group n=16, control n=17), while secondary outcomes included physical and mental scores of health-related quality of life (HRQoL). Linear mixed-effects models were used to analyze the effects of the intervention. Results: Participants (79% women) were 41.4±10.0 years and had a BMI of 28.8±5.9 kg/m². Among 33 participants who completed clinical assessment, V̇O ₂ peak increased 4.9 mL•kgFFM ^-1 •min ^-1 (95%CI 1.2 to 8.7, p =0.0134) more in the eHealth group compared with controls. Mental HRQoL increased by 9.8 points (95% CI 2.5 to 17.0, p =0.009) more in the eHealth group compared with controls. No between-group difference was observed in physical score of HRQoL. Conclusions: A six-month eHealth-guided exercise intervention using AQ was more effective than standard PA advice in improving V̇O ₂ peak and mental HRQoL among physically inactive adults recovering from COVID-19. These findings highlight the potential of AQ as an effective and feasible approach for post-COVID rehabilitation.

Introduction: Falls are a major cause of injury-related morbidity, mortality, and healthcare utilisation among older adults, with the greatest burden occurring in those aged ≥80 years. Multicomponent exercise programmes that include balance and resistance exercises reduce falls, whereas the effect of resistance training delivered as a standalone fall-prevention intervention remains uncertain. Existing resistance-training trials have generally been small, underpowered for fall outcomes, and have produced inconsistent findings, despite reduced muscle strength being an important modifiable risk factor in the oldest old. The resistance training prescription used in these studies has not always aligned with recommendations for optimal strength adaptations in terms of intensity or progressive overload, which may explain this uncertain efficacy. Therefore, this study aims to determine whether 12 months of high-intensity progressive resistance training reduces fall rates in community-dwelling adults aged ≥80 years with reduced muscle strength. Methods and analysis: This single-centre, randomised controlled trial conducted in Trondheim, Norway, includes 241 community-dwelling adults aged ≥80 years with reduced muscle strength. Participants are randomly assigned (1:1) to either standard care with written physical activity guidance or a twice-weekly high-intensity progressive resistance training intervention for 12 months. The primary outcome is the rate of falls over 12 months. Secondary outcomes include time to first fall, fall-related injuries, muscular function, physical performance, balance, body composition, cardiometabolic health, cognition, and participant-reported outcomes. Cost-effectiveness is assessed from a healthcare perspective over the 12-month intervention period using costs and quality-adjusted life years. Analyses follow the intention-to-treat principle, using negative binomial regression for the primary outcome. The first participant was included on 30 March 2023, and the last participant was included on 29 September 2025. The 12-month intervention period is expected to be completed by September 2026. Ethics and dissemination: The study has received approval from the Regional Committee for Medical and Health Research Ethics in Norway (REK; reference number 462261). All participants provided written informed consent before participating. Findings will be shared via peer-reviewed publications, conference presentations, and communication with stakeholders and the public. Trial registration number: ClinicalTrials.gov ( NCT05691166 ), registered 11 January 2023. Available at: https://clinicaltrials.gov/study/NCT05691166

Aims: To evaluate the association between cardiorespiratory fitness (CRF), directly measured as peak oxygen uptake (VO2peak), and the risk of major adverse cardiovascular events (MACE) in older Norwegian adults. Methods and results: A total of 1547 individuals aged 70–77 years (784 women) from the Generation 100 Study, examined in 2012 and 2013, were studied. We defined MACE as the first occurrence of acute myocardial infarction, stroke, heart failure, or cardiovascular death. Sex- and cohort-specific VO2peak categories (20% least fit, 80% fit) were established based on baseline VO2peak and changes over one year. Associations between baseline VO2peak, 1-year fitness trajectories, and MACE were assessed using competing risk regression to estimate subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs). During follow-up (median, 10.0 years; IQR, 9.2–10.0 years), 294 individuals experienced MACE (185 men, 109 women). Higher baseline VO2peak was inversely associated with MACE in both sexes. Compared with unfit participants, those with a VO2peak ≥26.0 mL/kg/min in men and ≥22.2 mL/kg/min in women had lower risk of MACE (men: sHR, 0.76; 95% CI, 0.54–0.99; women: sHR, 0.59; 95% CI, 0.39–0.90). Compared with those who remained unfit over one year, men and women who remained fit had 36% (sHR, 0.64; 95% CI, 0.42–0.99) and 42% lower risk (sHR, 0.58; 95% CI, 0.33–0.99), respectively. Conclusion: In older Norwegian adults, higher CRF was inversely associated with long-term risk of MACE. Although external validation is needed, the cohort-specific lowest quintile VO2peak cut-points of 26.0 mL/kg/min in men and 22.2 mL/kg/min in women may aid cardiovascular risk stratification in older adults.

Introduction: Reduced cardiorespiratory fitness (CRF) is associated with chronic pain, but longitudinal population-based evidence is limited. Whether CRF can prevent pain worsening or promote improvement is unclear. Objective: This study investigated (1) the cross-sectional association between estimated CRF (eCRF) and chronic pain, (2) the longitudinal association between eCRF and changes in pain severity over 11 years, and (3) whether changes in eCRF are associated with changes in pain severity. Method: Data were collected from the Trøndelag Health Study (HUNT) in Norway. Cross-sectional analyses included 18,837 adults from HUNT3 (2006–08), and longitudinal analyses followed participants to HUNT4 (2017–19), stratified by baseline pain status: no or mild (n = 11,517) or moderate/severe chronic pain (n = 5312). Cardiorespiratory fitness was estimated using a validated nonexercise algorithm and categorized into sex- and age-specific quintiles. Logistic regression estimated odds ratios with 95% confidence intervals. Results: Cross-sectionally, higher eCRF was associated with lower odds of chronic pain, with the largest difference between the highest and the lowest quintiles (women: OR 0.56, 95% CI 0.49–0.64; men: OR 0.64, 95% CI 0.53–0.78). Longitudinally, among participants with no or mild pain, both high baseline eCRF and maintained high eCRF were associated with lower odds of pain worsening. Among those with chronic pain, maintaining or increasing eCRF was associated with greater odds of pain reduction, whereas high baseline eCRF showed a nonsignificant trend in the same direction. Conclusion: Higher eCRF was associated with lower odds of chronic pain and with more favorable changes in pain severity in the general population.

The lasting effects of exercise on brain health in older adults are poorly documented. The aim of this study was to assess the long-term, post-intervention effects 4 years after a 5-year exercise intervention on brain volumes and cognitive abilities in older adults. A total of 106 older adults (70-77 years at baseline) from the randomized controlled trial (RCT) Generation 100 study randomized into high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), or a control group following national physical activity guidelines for 5 years were included. Post-intervention assessment was performed 9 years after inclusion. Brain magnetic resonance imaging (MRI) and exercise characteristics were acquired at baseline and after 1, 3, 5, and 9 years. Cognitive abilities were assessed with verbal list learning, pattern separation, and odor identification tests at baseline and 9 years. Linear mixed models were used to examine the interaction between exercise group and time on brain volumes. The analyses were repeated, including self-reported exercise behaviors (intensity and duration) as covariates. To examine the general effect of exercise intensity independent of group, a separate model was run across all participants with self-reported exercise intensity as independent variable. For cognition, linear regressions examined associations between exercise group and self-reported exercise intensity on cognitive scores at 9 years, and hippocampal volume loss over time on cognitive scores at 9 years. Whether baseline peak oxygen uptake (VO_2peak) predicted brain volumes and cognitive scores at 9 years was tested with linear regression. The time × group interaction revealed greater hippocampal volume loss in the HIIT compared with the control group 4 years after the intervention ended, similar to what was found during the intervention. We did not find that self-reported exercise behavior was associated with hippocampal volume over time. Across all participants, greater hippocampal volume loss was associated with poorer verbal memory at 9 years. The test scores on verbal memory and pattern separation did, however, not differ between the groups, but the MICT, and trending for the HIIT group, had higher odor identification scores at 9 years. Higher baseline VO_2peak predicted larger cortical volume and better pattern separation score at 9 years across intervention groups, in line with what was observed during the intervention. The control group, which followed the national physical activity guidelines, had the lowest hippocampal volume loss over time, even 4 years after the end of a 5-year exercise intervention in fit older adults. Furthermore, higher baseline VO_2peak provided protective effects on both cortical volume and pattern separation ability across almost a decade, independent of exercise group. ClinicalTrials.gov NCT01666340 (registered 16 August 2012).

Background: Physical activity (PA) has been associated with a reduced risk of severe COVID-19 outcomes. However, the relationship between cardiorespiratory fitness (CRF) and the risk of SARS-CoV-2 infection and COVID-19 hospitalization has not been thoroughly investigated. We aimed to investigate the association of estimated CRF (eCRF) and leisure-time PA (LTPA) with risk of SARS-CoV-2 infection and COVID-19 related hospitalization in a general population of Norwegian adults. Methods: This cohort study included 48,821 adults participating in the population based Trøndelag Health Study (the HUNT Study). Individual data on pre-pandemic (2017–2019) eCRF and LTPA were linked to COVID-19 registries from February 2020 through September 2022. eCRF was categorized into sex-and-age specific quintiles based on V̇O _2peak (mL/kg/min) and LTPA was categorized based on metabolic equivalent hours per week (MET h/wk): inactive (0-3.5 MET h/wk), insufficiently active (> 3.5 to 7.5 MET h/wk), and sufficiently active (> 7.5 MET h/wk). Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association of eCRF and LTPA with SARS-CoV-2 infection and COVID-19 hospitalization. Results: Age averaged 53.6 years (SD 16.8) and 53.9% were women. During 2.6 years of follow-up there were 5991 SARS-CoV-2 infections and 218 COVID-19 related hospitalizations. Fitness and LTPA categories did not associate with risk of infection. However, adults with the highest eCRF had significantly lower risk of hospitalization compared to adults with the lowest eCRF (IRR, 0.54, 95% CI, 0.34–0.86). Similarly, sufficiently active adults (> 7.5 MET h/wk) prior to the pandemic had significantly lower risk of being hospitalized compared to inactive adults (IRR, 0.60, 95% CI, 0.47–0.83). Conclusions: Higher eCRF and LTPA were not associated with risk of SARS-CoV-2 infection. In contrast, adults with high eCRF and LTPA were associated with a lower risk of COVID-19 related hospitalization compared to adults with low fitness and inactive lifestyles.

Background: Early prevention of sarcopenia through exercise is vital to health, independence and mortality risk in older adults; however, there is a scarcity of evidence concerning the long‐term effects of aerobic exercise alone. We tested the primary hypothesis that a 5‐year decline in key defining components of sarcopenia is less in an aerobic exercise group compared with a control group. Secondly, we tested the same hypothesis using a model of ‘clinically defined sarcopenia’. Methods: Norwegian community dwelling older adults ( n = 1567; aged 70–75 years at inclusion) participated in the Generation 100 Study. They were randomized in a 1:1:2 ratio—stratified by sex and cohabitation status to either moderate intensity continuous training (MICT, n = 387) or high intensity interval training (HIIT, n = 400), or to a control group following the Norwegian physical activity guidelines (CON, n = 780). Key defining components of sarcopenia were grip strength (kilograms), skeletal muscle index (kg/m ² ) and gait speed (m/s). Clinically defined sarcopenia was based on the European Working Group on Sarcopenia in Older People and recent normative data for the Norwegian population. An intention to treat linear mixed model and an ordinal logistic regression mixed model were used to examine the effects of aerobic exercise on sarcopenia on the 1, 3 and 5 years follow‐up. p values for the main hypothesis were adjusted using the Benjamini–Hochberg correction. Results: Mean age across groups was 72 years of age, including ~50% women, ~50% with higher education, 86%–90% with good or very good health and 73%–76% considered physically active. Compared with CON, grip strength declined less for HIIT at Year 1 (estimated difference of 0.98 kg; p < 0.001) and Year 3 (estimated difference of 0.03 kg; p = 0.016). At Year 3, HIIT increased their gait speed by 0.01 m/s (estimated difference between HIIT vs. CON of 0.03 m/s; p = 0.016). At Year 5, all groups declined from baseline (CON −0.07; MICT −0.10 and HIIT −0.04 m/s). Participants determined as having ‘clinically defined sarcopenia’ at baseline, Years 3 and 5 were: 22%, 58% and 63% (CON); 20%, 55% and 67% (MICT) and 19%, 50% and 56% (HIIT). Odds for developing clinically defined sarcopenia were significantly lower for HIIT (OR = 0.51; p = 0.018 at Year 3; OR = 0.47; p = 0.009 at Year 5) as compared with CON. No effects were found for MICT. Conclusions: The study demonstrates that in addition to having a protective cardiovascular effect, HIIT also has a beneficial effect on muscle strength and physical performance in a relatively healthy population of older adults.

Intestinal dysbiosis has been linked to metabolic disorders, including insulin resistance and type 2 diabetes mellitus (T2DM). T2DM typically follows a prediabetic stage, during which insulin resistance develops. During the early stages of T2DM, its development can be corrected, thus potentially preventing or delaying the onset of the disease. This secondary, exploratory, cross-sectional comparison study aimed to contrast the gut microbiome of individuals with elevated fasting blood glucose to that of individuals with glucose levels within the normal range. This study involved 65 older adults (ages 76–83 years) enrolled from the randomized controlled trial entitled the “Generation 100 Study”, all of whom consented to provide their gut microbiome samples. We employed a high-throughput sequencing of the bacterial 16S rRNA gene to obtain metagenomic microbial profiles for all participants. These profiles were then correlated with clinical measures. Overall, microbial alpha diversity was significantly reduced in the high glucose group. We have also observed distinct patterns of microbial beta diversity between high and normal glucose groups. At the phylum level, we found that Synergistes, Elusimicobia, Euryarchaeota, Verrucomicrobia, and Proteobacteria were all significantly decreased in participants with high blood glucose. Additionally, P. copri (ASV 909561) was significantly elevated (10-fold increase) in the high glucose groups, suggesting that it may serve as an early T2DM marker. In contrast to prior reports on the Fusobacterium genus, we found that it was significantly increased in the normal glucose group, with a significant 151-fold increase compared to the high glucose group. Directly linking gut microbiota profiles with clinical indicators such as fasting blood glucose and T2DM diagnosis allows the identification of specific microbial features associated with glucose dysregulation, providing preliminary population-level evidence to guide future translational research. Our results indicate significant changes in the microbiome that may provide valuable insights for early intervention in pre-diabetic states.

I ntestinal dysbiosis has been linked to metabolic disorders, including insulin resistance and Type 2 Diabetes Mellitus (T2DM). T2DM typically follows a prediabetic stage, during which insulin resistance develops. During early stages of T2DM, its development can be corrected, thus potentially preventing or delaying the onset of the disease. This study aimed to compare the gut microbiome of individuals with elevated fasting blood glucose to that of individuals with glucose levels within the normal range. This study involved 65 older adults (ages 76–83 years) enrolled from the randomized controlled trial entitled the “Generation 100 Study”, all of whom consented to provide their gut microbiome samples. We employed a high-throughput sequencing of the bacterial 16S rRNA gene to obtain metagenomic microbial profiles for all participants. These profiles were then correlated with clinical measures. Overall, microbial alpha diversity was significantly reduced in the high glucose group. We have also observed distinct patterns of microbial beta diversity between high and normal glucose groups. At the phylum level, we found that Synergistes, Elusimicobia, Euryarchaeota, Verrucomicrobia, and Proteobacteria were all significantly decreased in participants with high blood glucose. Additionally, P. copri (ASV 909561) was significantly elevated (10-fold increase) in the high glucose groups, suggesting that it may serve as an early T2DM marker. In contrast to prior reports on the Fusobacterium genus, we found that it was significantly increased in the normal glucose group, with a significant 151-fold increase compared to the high glucose group. Our results indicate significant changes in the microbiome that may provide valuable insights for early intervention in pre-diabetic states.