Pontus Henriksson

Background: People with intellectual disabilities experience a disproportionate burden of preventable health conditions, often linked to low levels of physical activity and poor dietary habits. Although digital health interventions hold considerable promise for addressing these challenges, many existing solutions remain difficult to use for this population due to limited accessibility. Co-design is increasingly advocated to develop digital health solutions that better align with users’ needs, yet there is limited empirical guidance for co-design processes with people with intellectual disabilities. Objective: This study aimed to explore experiences of a co-design process for developing a digital intervention for health promotion for people with intellectual disabilities, from the perspectives of members of the co-design team involved in different roles across the process. Methods: A qualitative study design was used based on 5 retrospective reflection meetings conducted in southeastern Sweden following a co-design process of 17 workshops. Eight purposively selected members of the multidisciplinary co-design team, including 4 researchers, 2 user experience designers, 1 support worker, and 1 coresearcher with intellectual disability, participated in different constellations. Reflection meetings were held between February and March 2026, and transcribed data were analyzed inductively and interpreted in relation to established co-design frameworks. Results: The findings reflect the team members’ experiences of the co-design process and point to a number of factors that appeared to support participation and collaboration. These included an extensive preparatory phase focused on recruitment and relationship building, the importance of working concretely and visually already during predesign, and the role of convivial relational practices in supporting confidence, voice, and collaboration. Time demands were mainly related to the iterative and participatory nature of co-design rather than to intellectual disability per se. Ethical considerations related to compensation were also highlighted, particularly in relation to recognizing coresearchers’ contributions on equal terms. Conclusions: By examining experiences of the co-design process, this study contributes methodological insights into how digital intervention development can be made more accessible, participatory, and responsive to the needs of people with intellectual disabilities. The findings suggest that enabling meaningful co-design with people with intellectual disabilities requires flexible interpretation of existing co-design frameworks, sustained attention to relational collaboration throughout the process while recognizing the ongoing importance of collaboration with support workers, and adaptation of methods rather than a need for development of entirely new ones. Supporting a sense of collaboration and conviviality over time, alongside addressing ethical issues of compensation for coresearchers’ work, may be critical for producing digital interventions for health promotion that are both usable and inclusive.

Objective: To analyze the associations between cardiorespiratory fitness (CRF) indicators and cardiovascular health, assessed through the Life’s Essential 8 (LE8) score, in individuals with coronary artery disease (CAD). Patients and methods: This cross-sectional study included individuals (aged 50-75 years) with stable CAD were enrolled in the Heart-Brain randomized controlled trial ( NCT06214624 ) from April 2022 to June 2024. Participants underwent a cardiopulmonary exercise test until volitional exhaustion. CRF indicators included peak oxygen consumption (VO _2peak ), time to exhaustion (TTE), ventilatory anaerobic threshold (VAT), peak oxygen pulse, 60-s heart rate recovery (HRrec) and oxygen uptake efficiency slope (OUES). LE8 score (range 0-100) was calculated as the unweighted average of 8 variables: physical activity, sleep, diet, nicotine exposure, glucose, lipids, body mass index, and blood pressure, as defined by the American Heart Association. We used linear regression models adjusted for sex, age, and education. Results: 102 individuals were included (21 females). VO _2peak (β _std =0.67, P <.001) and TTE (β _std =0.64, P <.001) showed strong positive associations with LE8 total score, followed by VAT (β _std =0.43, P <.001) and HRrec (β _std =0.26, P =.01). No associations were found for OUES (β _std =-0.08, P =.54) and peak oxygen pulse (β _std =-0.05, P =.72). Conclusion: Maximal and submaximal indicators of CRF were positively associated with LE8 in individuals with CAD, yet maximal indicators showed the strongest associations. Notably, TTE demonstrated a similar strength of association with LE8 as VO _2peak . These findings have important clinical and research implications as they support TTE as a simpler (than the gold-standard VO _2peak ), yet informative, marker of cardiovascular health in individuals with CAD. Clinical trials registration number: NCT06214624, https://clinicaltrials.gov/study/NCT06214624 Abstract presentation: Preliminary results of this study were previously presented as an abstract at the “XI EXERNET Symposium (Salud y bienestar a través del ejercicio: abordajes innovadores en la Red EXERNET), Seville, Spain, October 24–25, 2025”.

People with intellectual disabilities experience poorer health than the general population, largely due to preventable non‐communicable diseases. Although randomized controlled trials (RCTs) are the gold standard for evaluating health promotion interventions, they are rarely conducted with young people with intellectual disabilities because of inadequate research procedures. This methodological paper draws empirical insights from a research program and relevant literature involving co‐design and an upcoming RCT of a digital health promotion intervention. Using the core RCT components, randomization, control, and trial procedures as an analytical framework, the paper integrates empirical experience and literature to examine challenges in conducting inclusive RCTs. Participation and accessibility emerged as overarching methodological considerations influencing recruitment, retention, engagement, statistical power, generalizability, and overall trial validity. Empirical experiences illustrated how relational, organizational, and methodological adaptations can address these challenges in practice. By combining evidence from the literature with empirically grounded strategies developed across the research program, this paper advances more inclusive and feasible RCT methodology for research involving young people with intellectual disabilities.

BACKGROUND People with intellectual disabilities experience a disproportionate burden of preventable health conditions, often linked to low levels of physical activity and poor dietary habits. Although digital health interventions hold considerable promise for addressing these challenges, many existing solutions remain difficult to use for this population due to limited accessibility. Co-design is increasingly advocated to develop digital health solutions that better align with users’ needs, yet there is limited empirical guidance for co-design processes with people with intellectual disabilities. OBJECTIVE This study aimed to explore experiences of a co-design process for developing a digital intervention for health promotion for people with intellectual disabilities, from the perspectives of members of the co-design team involved in different roles across the process. METHODS A qualitative study design was used based on 5 retrospective reflection meetings conducted in southeastern Sweden following a co-design process of 17 workshops. Eight purposively selected members of the multidisciplinary co-design team, including 4 researchers, 2 user experience designers, 1 support worker, and 1 coresearcher with intellectual disability, participated in different constellations. Reflection meetings were held between February and March 2026, and transcribed data were analyzed inductively and interpreted in relation to established co-design frameworks. RESULTS The findings reflect the team members’ experiences of the co-design process and point to a number of factors that appeared to support participation and collaboration. These included an extensive preparatory phase focused on recruitment and relationship building, the importance of working concretely and visually already during predesign, and the role of convivial relational practices in supporting confidence, voice, and collaboration. Time demands were mainly related to the iterative and participatory nature of co-design rather than to intellectual disability per se. Ethical considerations related to compensation were also highlighted, particularly in relation to recognizing coresearchers’ contributions on equal terms. CONCLUSIONS By examining experiences of the co-design process, this study contributes methodological insights into how digital intervention development can be made more accessible, participatory, and responsive to the needs of people with intellectual disabilities. The findings suggest that enabling meaningful co-design with people with intellectual disabilities requires flexible interpretation of existing co-design frameworks, sustained attention to relational collaboration throughout the process while recognizing the ongoing importance of collaboration with support workers, and adaptation of methods rather than a need for development of entirely new ones. Supporting a sense of collaboration and conviviality over time, alongside addressing ethical issues of compensation for coresearchers’ work, may be critical for producing digital interventions for health promotion that are both usable and inclusive. CLINICALTRIAL

Obstructive Sleep Apnea (OSA) affects 1 billion people globally, with a male-to-female ratio of 2:1. While obesity is a major risk factor, sex differences in fat distribution may influence OSA risk. This study examined the relationship between visceral (VAT), subcutaneous (ASAT), and total abdominal fat (TAAT) and OSA severity in patients with type 2 diabetes (T2DM). We enrolled 164 T2DM patients (97 males, 67 females) from the EPSONIP-Sleep study; 151 had complete MRI and polygraphy data. OSA severity was evaluated by home respiratory polygraphy. Linear regression assessed AHI, logistic regression assessed moderate-to-severe OSA, and the Kruskal–Wallis test compared AHI across VAT-z/ASAT-z strata. In males, VAT, ASAT, and TAAT were associated with AHI in unadjusted analyses (β = 1.3, p = 0.009; β = 1.5, p = 0.010; β = 0.85, p = 0.009, respectively). ASAT (OR = 1.23/L, 95% CI 1.01–1.49, p = 0.049) and TAAT (OR = 1.10/L, 95% CI 1.00–1.22, p = 0.02), but not VAT, were associated with moderate-to-severe OSA. No statistically significant associations were detected in females. Associations were attenuated after BMI adjustment. AHI did not differ across VAT-z/ASAT-z strata ( p = 0.430). Sex differences influenced the relationship between fat and OSA severity. In males, abdominal fat volumes were associated with higher OSA severity in unadjusted analyses, but not after BMI adjustment. No statistically significant associations were detected in females. These findings should be interpreted cautiously given the modest sample size.

BACKGROUND: Young athletes and adolescents with high cardiorespiratory fitness appear to have a higher risk of atrial fibrillation (AF), but the extent to which this reflects causal effects or shared genetic, behavioral, and environmental factors remains uncertain. METHODS: This cohort study with sibling control analysis comprised Swedish men who participated in mandatory military conscription examinations from 1972 to 1995 and completed cardiorespiratory fitness testing. The outcomes were AF and non-AF cardiovascular disease (CVD; eg, stroke and ischemic heart disease), defined as a composite end point of diagnosis or death in the National Patient Register and the Cause of Death Register, until December 31, 2023. Flexible parametric regressions estimated standardized cumulative risk differences (RDs) by deciles of fitness. RESULTS: Among 1 124 049 men (mean age, 18.3 years), 45 179 (4.0%) experienced an AF event and 96 404 (8.6%) had a non-AF CVD event at a median age of 54.8 and 54.4 years. In population-wide analysis controlling for measured confounders, compared with the lowest decile of fitness, the highest decile had a small excess in AF that exceeded the reduction in non-AF CVD during early adulthood, whereas the reduction in non-AF CVD became larger from 45 years of age onwards. In full-sibling comparisons controlling for shared familial factors, the age-dependent trade-off disappeared entirely, leaving no age window with a net cardiovascular disadvantage. Already from 35 years of age, the reduction in non-AF CVD was larger (RD, −0.11% [95% CI, −0.21% to −0.01%]) than the excess in AF (RD, 0.06% [95% CI, −0.01% to 0.12%]). By 65 years of age, the gap further widened, with an even larger reduction in non-AF CVD (RD, −3.91% [95% CI, −5.40% to −2.42%]) compared with the excess in AF (RD, 2.30% [95% CI, 1.15%–3.45%]). CONCLUSIONS: High adolescent cardiorespiratory fitness is associated with a small excess in AF risk during early adulthood that is outweighed by larger reductions in non-AF CVD after controlling for familial confounders. These findings support population-level efforts to improve youth cardiorespiratory fitness and provide reassurance about the safety and benefits of high fitness levels.

Introduction Adolescence is a critical period marked by physiological and psychological changes that influence long-term health. Establishing healthy behaviours, particularly regular physical activity, is essential during this stage; however, around 80% of young people do not meet the WHO’s physical activity recommendations. Digital technologies offer promising opportunities to promote health among youth, yet most physical activity mobile applications (apps) lack scientific validation and usability. Unlike psychology, which has validated repositories to guide users in selecting mental health apps, physical activity lacks validated repository platforms, especially for adolescents. The project has a twofold aim: (1) to co-design a website, named the TeenFit website, that facilitates the selection of physical activity apps tailored to each adolescent’s individual needs and preferences and (2) to investigate the barriers and facilitators for the implementation of the TeenFit website in real-world settings. Methods and analysis Adolescents and other stakeholders (ie, caregivers, educators, and health professionals) will be engaged in the development of the TeenFit website app finder through a participatory design approach that involves three workshops, encompassing both a development phase and an implementation phase. Approximately 10–12 participants per group will take part in smaller working groups to collaboratively contribute to the co-design of the TeenFit website. TeenFit will include physical activity apps available in the Spanish market, developed in both English and Spanish. These applications are currently being identified through two ongoing systematic reviews. In addition to qualitative data gathered during the audio- and video-recorded workshops, quantitative data will be collected on participants’ co-design experiences and the acceptability of the TeenFit website. Data analysis will involve descriptive statistics, qualitative content analysis for describing participants’ perspectives on what aspects (ie, content, features and layout) are important for the design of the website and reflexive thematic analysis to identify barriers and facilitators to implementation. Ethics and dissemination The study was approved by the Research Ethics Committee in the province of Málaga (Spain) (REC ref: SICEIA-2024-003172). Research findings will be disseminated primarily via national and international conferences and publication in peer-reviewed journals. Patient and public involvement will inform further dissemination activities.

Background: Extant digital multiple health behavior change interventions have shown promise in various populations; however, evidence for a broader approach among the general population is lacking. Moreover, existing interventions often contain several components but are typically assessed as a whole, meaning it remains unclear to what extent individual components contribute to intervention effects and how they may interact to influence health outcomes. Objective: This study estimates the effects of 6 components of a digital health behavior change intervention on alcohol, diet, physical activity, and smoking outcomes among individuals searching for help online. Methods: A double-blind randomized factorial trial design with 6 two-level factors was used. Adults from the general public in Sweden who were seeking help to change their behaviors were recruited through web searches and social media. Participants were eligible if they were 18 years or older and had at least one health behavior classified as unhealthy. Effects of 6 components were estimated: screening/feedback, goal-setting/planning, motivation, skills/know-how, mindfulness, and self-authored SMS text messages. Primary outcomes were weekly alcohol consumption and frequency of heavy episodic drinking, average daily fruit and vegetable consumption, weekly moderate-to-vigorous physical activity, and 4-week point-prevalence smoking. Results: A total of 5419 individuals were randomized. Overall, the screening/feedback component was the most effective for changing health behaviors, along with goal-setting/planning and motivation to change. In particular, there was evidence that screening/feedback increased average daily portions of fruit and vegetables at 2 months (mean difference 0.17, compatibility interval [CoI] 0.09-0.25, probability of effect [POE] >99.9%) and at 4 months (mean difference 0.13, CoI 0.04-0.21, POE 99.9%) and reduced the frequency of heavy episodic drinking at 4 months (incidence rate ratio 0.91, CoI 0.81-1.03, POE 94.2%). Components also interacted to further improve health outcomes, most notably the combination of screening/feedback with motivation to change, which further increased fruit and vegetable consumption (2 months: mean difference 0.20, CoI 0.09-0.30, POE >99.9%; 4 months: mean difference 0.17, CoI 0.05-0.29, POE 99.8%). Conclusions: The results from this study contribute to the development of more effective interventions by providing novel insights into the effects of individual and pairwise components of complex digital health behavior change interventions. Trial Registration: ISRCTN Registry ISRCTN16420548; http://www.isrctn.com/ISRCTN16420548 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-061024