Elisabeth Edvardsen

• Søraas, Arne Vasli Lund; Engvig, Andreas; Alnæs, Dag; Karim, Lana Nagmadin; Danilova, Elena & Istre, Mette Stausland [Show all 17 contributors for this article] (2026). Interstitial fluid rejuvenation through young-donor plasma exchange in cognitively impaired patients: a pilot safety and feasibility study. GeroScience. ISSN 2509-2715. doi: 10.1007/s11357-026-02435-0. Full text in Research Archive Show summary

  Heterochronic parabiosis improves physiological and cognitive function in aging rodents; these benefits appear to be derived from the removal of aged blood plasma components and the addition of younger ones. In humans, removing plasma from older individuals with Alzheimer’s disease (AD) and replacing it with saline and albumin delayed cognitive deterioration in a large clinical trial. However, mimicking heterochronic parabiosis in humans by removing large volumes of a patient’s blood plasma and replacing it with plasma from young and healthy donors has not been tested. Here, we have performed a pilot study to characterize the feasibility and safety of such a procedure, replacing between 16 and 26 L of patient blood plasma with young (ages 18–24) donor blood plasma for twelve patients who recently received a diagnosis of mild cognitive impairment with biomarker evidence of AD. The dose and time interval between plasma exchanges was tailored to maximize equilibration of donor plasma components into the interstitial fluid, with the aim of achieving what we term interstitial rejuvenation. We explored three permutations of a plasma exchange protocol with different treatment intensities and doses, each performed on three to five patients. We present data on safety, feasibility, patient burden, resource use of the treatments, preliminary measurements of clinical variables, and short-term cognitive trajectories in the patients. The procedures were feasible, and the adverse events observed were consistent with known risks of plasma exchange, supporting further investigation of treatment efficacy in a larger controlled trial. This safety and feasibility study was first registered 22 December 2023 at ClinicalTrials.gov and given the identifier NCT06234436.

• Johansen, Sara Hassing; Edvardsen, Elisabeth; Raastad, Truls; Ruud, Ellen; Deng, Wei Hai & Bratteteig, Mari [Show all 10 contributors for this article] (2026). Associations Between Physical Fitness and Fatigue in Adolescent Childhood Cancer Survivors: The PACCS Study. Pediatric Blood & Cancer. ISSN 1545-5009. doi: 10.1002/1545-5017.70478. Full text in Research Archive
• Edvardsen, Elisabeth; Anderssen, Sigmund Alfred; Borchsenius, Fredrik; Holme, Ingar Morten K; Nordsletten, Lars & Skjønsberg, Ole Henning (2026). Long-Term Effects of High-Intensity Training following Lung Cancer Surgery - A Five-Year Follow-Up of a Randomized Controlled Trial. Medicine & Science in Sports & Exercise. ISSN 0195-9131. Publish Ahead of Print. doi: 10.1249/MSS.0000000000003984. Full text in Research Archive
• Negaard, Helene Francisca Stigter; Haugnes, Hege Sagstuen; Fosså, Sophie Dorothea; Gjerset, Gunhild Maria; Edvardsen, Elisabeth & Larsen, Karl-Otto [Show all 10 contributors for this article] (2026). Deterioration in Physical Fitness and Changes in Body Composition After Cisplatin-Based Chemotherapy for Metastatic Testicular Cancer. Clinical Genitourinary Cancer. ISSN 1558-7673. 24(2). doi: 10.1016/j.clgc.2026.102507. Full text in Research Archive
• Klungerbo, Vibeke; Døhlen, Gaute; Holmstrøm, Henrik; Edvardsen, Elisabeth; Matthews, Norunn Iren Lindbak & Möller, Thomas (2026). What Limits Cardiorespiratory Fitness in Adolescents with Fontan Circulation: An Integrated Hemodynamic and Pulmonary Perspective. Pediatric Cardiology. ISSN 0172-0643. doi: 10.1007/s00246-026-04231-1. Full text in Research Archive Show summary

  Cardiorespiratory fitness (CRF) is strongly associated with morbidity and mortality in patients with Fontan circulation. However, the factors influencing CRF during adolescence remain incompletely understood. The primary aim of this study was to investigate the associations between CRF and ventricular function represented by end-diastolic pressure (VEDP), the transpulmonary pressure gradient (TPG), somatic growth (height) and pulmonary diffusing capacity (DLCO/VA). The secondary aim was to assess the prevalence of exercise oscillatory ventilation (EOV) and its physiological associations. In this national, cross-sectional study, 44 adolescents (median age 16.6 years) with Fontan circulation underwent cardiopulmonary exercise testing, heart catheterization and pulmonary function assessment. Peak oxygen uptake (V̇O₂peak) was modelled as the dependent variable in a multiple linear regression with VEDP, TPG, height, and DLCO/VA as predictors. Logistic regression was used to identify physiological associations of EOV. The multiple regression model for absolute V̇O₂peak explained 61% of the overall variance. Lower VEDP and greater height were independently associated with higher V̇O₂peak. When V̇O₂peak was expressed relative to body mass, TPG also became associated with higher V̇O₂peak, while greater height and lower VEDP remained associated. This model explained 30% of the variance. DLCO/VA was not independently associated with V̇O₂peak. EOV was observed in 50% of patients but showed no association with V̇O₂peak, hemodynamic, or pulmonary variables. In adolescents with Fontan circulation, lower resting VEDP and somatic growth were associated with higher CRF, reflecting more efficient hemodynamics. Pulmonary diffusing impairment and EOV were common but not significantly associated with lower CRF.

• Johansen, Sara Hassing; Reinertsen, Kristin Valborg; Wisløff, Torbjørn; Sæter, Mali; Sarvari, Sebastian & Kiserud, Cecilie E. [Show all 11 contributors for this article] (2025). Effects of aerobic exercise on late effects and quality of life in long-term breast cancer survivors: A randomized controlled trial. JNCI Cancer Spectrum. 9(6). doi: 10.1093/jncics/pkaf102. Full text in Research Archive Show summary

  Background Breast cancer survivors (BCSs) are at increased risk of late effects. While research has reported positive effects of exercise therapy on fatigue and health-related quality of life (HRQoL) among short-term BCSs, evidence in long-term survivors remains scarce. Methods The CAUSE (CArdiovascUlar Survivors Exercise) trial was a 2-armed randomized controlled trial. Long-term BCSs were assigned to 5 months of thrice-weekly supervised aerobic exercise or usual care. Late effects and HRQoL were assessed by Chalder Fatigue Questionnaire, European Organization for Research and Treatment of Cancer QLQ-BR23 and QLQ-C30 questionnaires, and Scale for Chemotherapy-Induced Long-term Neurotoxicity at baseline (T0), post-intervention (T1), and 1-year follow-up (T2). Results In total, 140 BCSs (mean age 59.0 ± 6.4 years, 11 ± 1 years post-treatment) were included. Loss to follow-up at T1 was 6% and 19% in the exercise- and usual care group, respectively. From T0 to T1, the exercise group significantly improved total fatigue (between groups mean difference [MD] = –3.0, P < .001), body image (MD = 6.7, P = .043), physical- (MD = 3.2, P ≤ .001), role- (MD = 9.6, P = .019), and cognitive function (MD = 3.4, P = .038), insomnia (MD = –9.0, P = .017), and global health/QoL (MD = 5.3, P ≤ .001) compared to usual care. The exercise benefits were more pronounced in BCSs experiencing versus not experiencing late effects at baseline. At 1-year follow-up, most improvements regressed toward baseline values. Conclusion Aerobic exercise significantly improves fatigue, body image, physical-, role-, and cognitive function, insomnia, and HRQoL in long-term BCSs. These findings suggest that exercise therapy should be a core component of managing late effects and enhancing HRQoL in long-term BCSs. Clinical trial registration URL: https://www.clinicaltrials.gov/. Registration number: NCT04307407

• Klungerbo, Vibeke; Hirth, Asle; Fredriksen, Per Morten; Holst, Rene; Edvardsen, Elisabeth & Holmstrøm, Henrik [Show all 7 contributors for this article] (2025). Reference models for individualized assessment of cardiorespiratory fitness in children and adolescents with congenital heart disease: a retrospective multicentre study. European Journal of Pediatrics. ISSN 0340-6199. 184. doi: 10.1007/s00431-025-06270-x. Full text in Research Archive Show summary

  Cardiopulmonary Exercise Testing (CPET) is considered the gold standard assessment of peak oxygen uptake (peak), and consequently, cardiorespiratory fitness (CRF). Common practice in children with congenital heart diseases (CHD) is to compare individual test results to reference values in healthy children. This approach does not account for the diversity of heart defects and may also be demotivating for children with CHD. This retrospective multicentre study aimed to establish individualized CRF reference models specific to children with CHD, to facilitate a better understanding and management of their condition. A total of 1475 CPETs until exhaustion were performed in 943 children and adolescents at two hospitals in Norway. The children and adolescents were categorized into three groups: simple defects (VSD, ASD, CoA, LVOTO; n = 497, 38% female), moderate defects (TGA, Fallot; n = 299, 41% female), and univentricular defects with a Fontan circulation (n = 147, 42% female). Multivariable mixed-effects models with individuals as random intercepts were used to develop group-specific reference models for CRF. Estimated predictive models including covariance matrices for each group and outcome are provided, allowing for the generation of reference values with confidence intervals for clinical and research applications. Conclusion: Treadmill-based reference models for maximal and submaximal CRF variables in the most prevalent types of CHD are presented. Using individualized reference values has the potential to improve clinical decision-making for children with CHD and to enhance their sense of mastery. A web-based calculator is available for quick and easy clinical use.

• Akerø, Aina; Edvardsen, Elisabeth; Finstad, Pål Leyell; Skrede, Bjørn; Østerhaug, Mia & Backman, Sol Anna Sofia Kristina [Show all 8 contributors for this article] (2025). Air travel and cystic fibrosis: An algorithm to assess the risk of In-Flight Hypoxemia. Journal of Cystic Fibrosis. ISSN 1569-1993. 24(5), p. 963–969. doi: 10.1016/j.jcf.2025.05.004. Full text in Research Archive
• Johansen, Sara Hassing; Wisløff, Torbjørn; Edvardsen, Elisabeth; Kollerud, Sofie Taugbøl; Jensen, Johanne Sofia Steen & Agwu, Ginika [Show all 9 contributors for this article] (2025). Effects of Systemic Anticancer Treatment on Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis. JACC: CardioOncology. 7(2), p. 96–106. doi: 10.1016/j.jaccao.2024.11.004. Full text in Research Archive Show summary

  Background: Poor cardiorespiratory fitness (CRF) is associated with a higher symptom burden and an increased prevalence of long-term treatment–related cardiovascular disease risk factors in cancer survivors. However, the magnitude of systemic therapy–related CRF impairment remains unclear. Objectives: The aim of this study was to evaluate the effects of systemic anticancer treatment on CRF and identify physiological determinants underpinning CRF impairment. Methods: A systematic literature search was performed in PubMed, Embase, CINAHL, SPORTDiscus, and the Cochrane Library. The primary endpoint was the change in CRF, measured by peak oxygen consumption (Vo2peak), from before to after systemic treatment. Secondary endpoints included post-treatment differences in Vo2peak between cancer survivors and noncancer control subjects, along with physiological determinants of Vo2peak. Two meta-regressions were conducted to examine the association between CRF and cardiac output and arteriovenous oxygen difference. Results: A total of 44 studies were included, comprising 27 prospective trials (61%; n = 1,234 cancer survivors, median age 52.4 years) and 17 cross-sectional studies (39%; n = 1,372 cancer survivors, median age 54.0 years; n = 1,923 noncancer control subjects, median age 56.0 years). Systemic anticancer treatment was associated with a significant decrease in Vo2peak (weighted mean difference −2.13 mL·kg−1·min−1; 95% CI: −2.76 to −1.50 mL·kg−1·min−1). No significant differences were observed between patient subgroups (esophagogastric, breast, and colon or rectal cancers). At a median follow-up of 2 years (range: 6 weeks to 12 years) post-therapy, cancer survivors had a significantly lower Vo2peak (weighted mean difference −6.39 mL·kg−1·min−1; 95% CI: −7.60 to −5.18 mL·kg−1·min−1) compared with noncancer control subjects. Reduced arteriovenous oxygen difference was associated with lower Vo2peak (β = 2.55; 95% CI: 2.05-3.06; P

• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Ihle-Hansen, Hege Beate & Hagen, Milada [Show all 7 contributors for this article] (2025). Changes in fatigue after first-ever ischemic stroke and their associations with changes in physical fitness, body composition, and physical activity. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 34(6). doi: 10.1016/j.jstrokecerebrovasdis.2025.108297. Full text in Research Archive Show summary

  Objectives: The objectives of the present study were 1) to describe changes in fatigue from 3 to 12 months poststroke and compare different patterns of fatigue changes with respect to concurrent changes in physical fitness, body composition, and activity levels, and 2) to explore whether changes in fatigue are associated with changes in physical fitness, body composition, and physical activity levels in patients recovering from first-ever ischemic stroke. Materials and methods: In this longitudinal observational study, we assessed 72 patients (mean age 62 years, 36 % females) at 3 and 12 months after first-ever ischemic stroke. Fatigue was measured with the 7-item Fatigue Severity Scale. Physical fitness, body composition and physical activity were assessed using cardiopulmonary exercise testing, physical function tests, Dual-energy X-ray Absorptiometry, and accelerometers. Results: Fatigue levels was stable between 3 and 12 months post-stroke in 44 (61 %) patients, decreased in 14 (19 %), and increased in another 14 (19 %). Patients with increased fatigue levels showed a greater decrease in cardiorespiratory fitness, as measured directly by peak oxygen uptake, compared to those with decreased fatigue. Robust regression analysis, adjusted for age and sex, indicated that each kilogram of lean body mass gained from 3 to 12 months post-stroke was significantly associated with a 0.3-point reduction in fatigue during the same timeframe (B= -0.32; 95 %CI [-0.51, -0.12]). Conclusion: There was considerable individual variation in changes to fatigue, physical fitness, body composition, and physical activity levels between 3 and 12 months following a first-ever ischemic stroke. Increased fatigue was linked to a greater concurrent decline in cardiorespiratory fitness, while lean body mass was associated with decreases in fatigue.

• Edvardsen, Elisabeth; Nilsen, Tormod Skogstad; Novo, Robert; Curry, Michael; Adams, Scott C. & Matsoukas, Konstantina [Show all 11 contributors for this article] (2025). Exercise Testing Characteristics, Safety, and Quality in Patients with Cancer: A Systematic Review. Mayo Clinic Proceedings: Innovations, Quality & Outcomes (MCP:IQ&O). 9(4). doi: 10.1016/j.mayocpiqo.2025.100628. Full text in Research Archive
• Johansen, Sara Hassing; Sæter, Mali; Sarvari, Sebastian; Reinertsen, Kristin Valborg; Edvardsen, Elisabeth & Wisløff, Torbjørn [Show all 18 contributors for this article] (2025). Effects of Aerobic Exercise on Cardiorespiratory Fitness and Cardiovascular Risk Factors in Long-Term Breast Cancer Survivors: A Randomized Controlled Trial. JACC: CardioOncology. 7(4), p. 414–426. doi: 10.1016/j.jaccao.2025.04.006. Full text in Research Archive
• Edvardsen, Elisabeth; Ruud, Ellen; Rueegg, Corina Silvia; Kvidaland, Haakon Kristian; Torsvik, Ingrid Kristin & Bovim, Lars Peder Vatshelle [Show all 11 contributors for this article] (2025). Physical Fitness and Physical Activity in Adolescent Childhood Cancer Survivors and Controls: The PACCS Study. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 57(10), p. 2286–2293. doi: 10.1249/MSS.0000000000003758. Full text in Research Archive Show summary

  Objectives This study aimed to compare physical fitness, function, and physical activity (PA) in adolescent childhood cancer survivors (CCSs) to age- and sex-matched controls and across different cancer diagnoses. Methods This multicenter cross-sectional study (Physical Activity among Childhood Cancer Survivors) included CCSs aged 9–18 yr (≥1-yr after cancer treatment) and age- and sex-matched controls. Physical fitness tests included cardiorespiratory fitness (V̇O2max) and muscular strength (maximal isometric handgrip, knee extension, and chest press). Physical function tests included a 1-min sit-to-stand test (STS) and countermovement jump (CMJ). PA was measured by accelerometer for 7 d. We used linear mixed-effects models to compare outcomes between CCSs and controls, and across diagnostic groups. Results We included 157 CCSs and 113 controls aged 13.4 ± 2.6 yr (mean ± SD). Cancer types were leukemia (n = 78), central nervous system (CNS) tumors (n = 18), lymphoma (n = 16), and other solid tumors (n = 45). CCSs had lower V̇O2max (marginal mean (95% confidence interval), 41.7 (38.4–45.0) vs 46.4 (42.9–49.8) mL·kg−1·min−1; P < 0.001), knee-extension strength (35.4 (34.1–36.8) vs 38.2 (36.7–39.7) kg, P = 0.003), chest-press strength (30.0 (28.4–31.6) vs 32.8 (31.0–34.7) kg, P = 0.007), STS repetitions (57.5 (55.8–59.3) vs 60.0 (58.0–62.0) P = 0.017), and CMJ height (22.1, (20.5–23.8) vs 24.9 (23.2–26.6) cm, P < 0.001). PA levels and sedentary time were similar in both groups (8513 (7993–9034) vs 9000 (8404–9596) steps per day, P = 0.174, respectively). Survivors of CNS tumors had the lowest values for V̇O2max, muscular strength, physical function, and PA. Conclusions Despite no significant difference in PA levels, adolescent CCSs had 4.2% to 11% lower physical fitness and function compared with controls, where survivors of CNS tumors performed the poorest.

• Novo, Robert T.; Thomas, Samantha M.; Khouri, Michel G.; Alenezi, Fawaz; Herndon, James E & Michalski, Meghan [Show all 11 contributors for this article] (2024). Machine Learning-Driven Phenogrouping and Cardiorespiratory Fitness Response in Metastatic Breast Cancer. JCO Clinical Cancer Informatics. 8. doi: 10.1200/CCI.24.00031. Full text in Research Archive Show summary

  Purpose The magnitude of cardiorespiratory fitness (CRF) impairment during anticancer treatment and CRF response to aerobic exercise training (AT) are highly variable. The aim of this ancillary analysis was to leverage machine learning approaches to identify patients at high risk of impaired CRF and poor CRF response to AT. Methods We evaluated heterogeneity in CRF among 64 women with metastatic breast cancer randomly assigned to 12 weeks of highly structured AT (n = 33) or control (n = 31). Unsupervised hierarchical cluster analyses were used to identify representative variables from multidimensional prerandomization (baseline) data, and to categorize patients into mutually exclusive subgroups (ie, phenogroups). Logistic and linear regression evaluated the association between phenogroups and impaired CRF (ie, ≤16 mL O2·kg–1·min–1) and CRF response. Results Baseline CRF ranged from 10.2 to 38.8 mL O2·kg–1·min–1; CRF response ranged from –15.7 to 4.1 mL O2·kg–1·min–1. Of the n = 120 candidate baseline variables, n = 32 representative variables were identified. Patients were categorized into two phenogroups. Compared with phenogroup 1 (n = 27), phenogroup 2 (n = 37) contained a higher number of patients with none or >three lines of previous anticancer therapy for metastatic disease and had lower resting left ventricular systolic and diastolic function, cardiac output reserve, hematocrit, lymphocyte count, patient-reported outcomes, and CRF (P

• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Mack, Ulrich & Lerdal, Anners (2024). Cardiorespiratory fitness, physical activity, and fatigue three months after first-ever ischemic stroke. Topics in Stroke Rehabilitation. ISSN 1074-9357. 31(8), p. 817–827. doi: 10.1080/10749357.2024.2333191. Full text in Research Archive Show summary

  Background: Research on cardiorespiratory fitness (CRF) in relation to physical activity (PA) and fatigue after stroke is limited. Increased knowledge of interrelationships between these factors can help optimize rehabilitation strategies and improve health-outcomes. Objectives: We aimed to: 1) evaluate CRF, PA, and fatigue, 2) characterize patients with impaired versus non-impaired CRF, and 3) examine associations of CRF with PA and fatigue, three months after first-ever ischemic stroke. Methods: In this cross-sectional study CRF was measured as peak oxygen uptake (VO2peak) by cardiopulmonary exercise testing. PA was measured using accelerometers. Fatigue was assessed with the 7-item Fatigue Severity Scale (FSS). Results: The sample (n=74, mean age 64±13 years, 36% women) had a mean VO2peak of 27.0±8.7 (86% of predicted). Fifty-one percent met the World Health Organization’s recommendation of ≥150 min of moderate PA/week. Mean steps-per-day was 9316±4424 (113% of predicted). Thirty-five percent of the sample had moderate-to-high fatigue (FSS≥4), mean FSS score was 3.2±1.8. Patients with impaired CRF (VO2peak＜80% of predicted) had higher body-fat-percent (p＜0.01), less moderate-to-vigorous PA (MVPA) (p＜0.01) and a trend toward higher fatigue (p=0.053) compared to the non-impaired. Backward regression analysis showed that higher CRF was associated with more MVPA (unstandardized beta [95% CI]: 0.38 [0.15, 0.63], p=0.002) and less fatigue (unstandardized beta [95% CI]: -3.9 [-6.4, -1.6], p=0.004). Conclusions: Stroke patients had lower CRF compared to reference values. Impaired CRF was mainly related to overweight. Higher CRF was associated with more MVPA and less fatigue. Exercise after stroke may be especially beneficial for patients with impaired CRF.

• Larsson, Petra; Torre, Maria Julia Bidonde; Olsen, Unni Solveig Johansen; Gay, Caryl; Lerdal, Anners & Ursin, Marie Helene [Show all 8 contributors for this article] (2023). Association of post-stroke fatigue with physical activity and physical fitness: A systematic review and meta-analysis. International Journal of Stroke. ISSN 1747-4930. 18(9), p. 1063–1070. doi: 10.1177/17474930231152132. Full text in Research Archive Show summary

  Background: It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide the development of targeted exercise interventions to treat PSF. Aims: Our systematic review and meta-analysis aimed to investigate PSF’s associations with PA and fitness. Summary of review: Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, which reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched MEDLINE, Embase, AMED, CINAHL, PsycINFO, ClinicalTrials.gov, and World Health Organization’s International Clinical Trials Registry Platform from inception to November 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n = 4721 participants, 55% male), and three study protocols were included. We used random-effects meta-analysis to pool data for PA and fitness outcomes, and vote-counting of direction of association to synthesize data that could not be meta-analyzed. We found moderate-certainty evidence of a weak association between higher PSF and impaired fitness (meta r = –0.24; 95% confidence interval (CI) = –0.33, –0.15; n = 905, 7 studies), and very low-certainty evidence of no association between PSF and PA (meta r = –0.09; 95% CI = –0.34, 0.161; n = 430, 3 studies). Vote-counting showed a higher proportion of studies with associations between higher PSF and impaired fitness (pˆ = 0.83; 95% CI = 0.44, 0.97; p = 0.22, n = 298, 6 studies), and with associations between higher PSF and lower PA (pˆ = 0.75; 95% CI = 0.51, 0.90; p = 0.08, n = 2566, 16 studies). Very low- to moderate-certainty evidence reflects small study sample sizes, high risk of bias, and inconsistent results. Conclusions: The meta-analysis showed moderate-certainty evidence of an association between higher PSF and impaired fitness. These results indicate that fitness might protect against PSF. Larger prospective studies and randomized controlled trials evaluating the effect of exercise on PSF are needed to confirm these findings.

• Grønningsæter, Lasse; Estensen, Mette-Elise; Skulstad, Helge; Langesæter, Eldrid & Edvardsen, Elisabeth (2023). Cardiorespiratory fitness in women after severe pre-eclampsia. Hypertension in Pregnancy. ISSN 1064-1955. 42(1), p. 1–10. doi: 10.1080/10641955.2023.2245054. Full text in Research Archive Show summary

  Aims: To objectively study cardiorespiratory fitness (CRF) and physical activity (PA) and to evaluate limiting factors of exercise intolerance associated with poor CRF after severe pre-eclampsia. Methods: In this single-centre, cross-sectional study, CRF was measured as peak oxygen uptake (VO2peak) during a cardiopulmonary exercise test (CPET) on a treadmill in women 7 years after severe pre-eclampsia. Ninety-six patients and 65 controls were eligible to participate. Cardiac output (CO) was measured by impedance cardiography. PA was measured using accelerometers. Results: In 62 patients and 35 controls (mean age 40 ± 3 years), the VO2peak (in mL·kg–1·min–1) values were 31.4 ± 7.2 and 39.1 ± 5.4, respectively (p<0.01). In the patients, the COpeak was (9.6 L·min-1), 16% lower compared to controls (p<0.01). Twelve patients (19%) had a cardiac limitation to CPET. Twenty-three (37%) patients and one (3%) control were classed as unfit, with no cardiopulmonary limitations. The patients demonstrated 25% lower PA level (in counts per minute; p<0.01) and 14% more time being sedentary (p<0.01), compared with the controls. Twenty-one patients (34%) compared with four (17%) controls did not meet the World Health Organization’s recommendations for PA (p=0.02). Body mass index and PA level accounted for 65% of the variability in VO2peak. Conclusion: Significantly lower CRF and PA levels were found in patients on long-term follow-up after severe pre-eclampsia. CPET identified cardiovascular limitations in one third of patients. One third appeared unfit, with adiposity and lower PA levels. These findings highlight the need for clinical follow-up and exercise interventions after severe pre-eclampsia.

• Engan, Britt; Diab, Simone; Brun, Henrik; Raastad, Truls; Torsvik, Ingrid Kristin & Omdal, Tom Roar [Show all 11 contributors for this article] (2023). Systolic myocardial function measured by echocardiographic speckle-tracking and peak oxygen consumption in pediatric childhood cancer survivors—a PACCS study. Frontiers in Cardiovascular Medicine. 10. doi: 10.3389/fcvm.2023.1221787. Full text in Research Archive Show summary

  Background: Cancer therapy-related cardiotoxicity is a major cause of cardiovascular morbidity in childhood cancer survivors. The aims of this study were to investigate systolic myocardial function and its association to cardiorespiratory fitness in pediatric childhood cancer survivors. Methods: In this sub-study of the international study “Physical Activity and fitness in Childhood Cancer Survivors” (PACCS), echocardiographic measures of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were measured in 128 childhood cancer survivors aged 9–18 years and in 23 age- and sex-matched controls. Cardiorespiratory fitness was measured as peak oxygen consumption achieved on treadmill and correlated to myocardial function. Results: Mean LV-GLS was reduced in the childhood cancer survivors compared to the controls, −19.7% [95% confidence interval (CI) −20.1% to −19.3%] vs. −21.3% (95% CI: −22.2% to −20.3%) (p = 0.004), however, mainly within normal range. Only 13% of the childhood cancer survivors had reduced LV longitudinal strain z-score. Mean RV-LS was similar in the childhood cancer survivors and the controls, −23.2% (95% CI: −23.7% to −22.6%) vs. −23.3% (95% CI: −24.6% to −22.0%) (p = 0.8). In the childhood cancer survivors, lower myocardial function was associated with lower peak oxygen consumption [correlation coefficient (r) = −0.3 for LV-GLS]. Higher doses of anthracyclines (r = 0.5 for LV-GLS and 0.2 for RV-LS) and increasing time after treatment (r = 0.3 for LV-GLS and 0.2 for RV-LS) were associated with lower myocardial function. Conclusions: Left ventricular function, but not right ventricular function, was reduced in pediatric childhood cancer survivors compared to controls, and a lower left ventricular myocardial function was associated with lower peak oxygen consumption. Furthermore, higher anthracycline doses and increasing time after treatment were associated with lower myocardial function, implying that long-term follow-up is important in this population at risk.

• Oberholzer, Laura; Montero, David; Robach, Paul; Siebenmann, Christoph; Ryrsøe, Camilla Koch & Bonne, Thomas C. [Show all 19 contributors for this article] (2023). Determinants and reference values for blood volume and total hemoglobin mass in women and men. American Journal of Hematology. ISSN 0361-8609. 99(1), p. 88–98. doi: 10.1002/ajh.27162. Full text in Research Archive Show summary

  Blood volume (BV) is an important clinical parameter and is usually reported per kg of body mass (BM). When fat mass is elevated, this underestimates BV/BM. One aim was to study if differences in BV/BM related to sex, age, and fitness would decrease if normalized to lean body mass (LBM). The analysis included 263 women and 319 men (age: 10–93 years, body mass index: 14–41 kg/m2) and 107 athletes who underwent assessment of BV and hemoglobin mass (Hbmass), body composition, and cardiorespiratory fitness. BV/BM was 25% lower (70.3 ± 11.3 and 80.3 ± 10.8 mL/kgBM) in women than men, respectively, whereas BV/LBM was 6% higher in women (110.9 ± 12.5 and 105.3 ± 11.2 mL/kgLBM). Hbmass/BM was 34% lower (8.9 ± 1.4 and 11.5 ± 11.2 g/kgBM) in women than in men, respectively, but only 6% lower (14.0 ± 1.5 and 14.9 ± 1.5 g/kgLBM)/LBM. Age did not affect BV. Athlete's BV/BM was 17.2% higher than non-athletes, but decreased to only 2.5% when normalized to LBM. Of the variables analyzed, LBM was the strongest predictor for BV (R2 = .72, p < .001) and Hbmass (R2 = .81, p < .001). These data may only be valid for BV/Hbmass when assessed by CO re-breathing. Hbmass/LBM could be considered a valuable clinical matrix in medical care aiming to normalize blood homeostasis.

• Andries, Aristomo; Ørstavik, Kristin; Rueegg, Corina Silvia; Eng, Sindre Rike; Edvardsen, Elisabeth & Allen, Sara Maria [Show all 10 contributors for this article] (2022). Polyneuropathy in Adolescent Childhood Cancer Survivors: The PACCS Study. Pediatric Neurology. ISSN 0887-8994. 140. doi: 10.1016/j.pediatrneurol.2022.11.012. Full text in Research Archive Show summary

  Background: Childhood cancer survivors (CCS) are at risk of polyneuropathy due to chemotherapy, but studies in young survivors are scarce and diagnosis is challenging. We aimed to study the presence of polyneuropathy and the possible effect of cumulative doses of chemotherapeutic agents in a representative group of adolescent survivors. Methods: CCS aged nine to 18 years and age- and sex-matched controls were recruited from the cross-sectional Physical Activity and Fitness among Childhood Cancer Survivors (PACCS) study. CCS with various cancer diagnoses who had ended cancer treatment one year or more before study were included. Polyneuropathy was evaluated clinically and with nerve conduction studies (NCSs) in three motor and five sensory nerves. We used mixed-effects linear regression models to compare CCS and controls, and investigate possible associations between cumulative chemotherapy doses and NCS amplitudes. Results: A total of 127 CCS and 87 controls were included, with 14% CCS having probable or confirmed polyneuropathy. NCS amplitudes were lower in survivors compared with controls in all nerves. The largest mean difference was 3.47 μV (95% confidence interval [CI], 2.18 to 4.75) in the tibial plantar medial sensory and 1.91 mV (95% CI, 0.78 to 3.04) in the tibial motor nerve. The cumulative dose of platinum derivatives was associated with lower tibial motor nerve amplitude (−0.20; 95% CI, −0.35 to −0.04 mV for 100 mg/m2 dose increase) but not in other nerves. We found no significant associations between vinca alkaloids cumulative dose and amplitudes. Conclusions: CCS without clinical signs or symptoms of polyneuropathy may have subtle nerve affection. The clinical long-term impact of this novel observation should be evaluated in larger, longitudinal studies.

• Michalski, Meghan; Rowed, Kylie; Lavery, Jessica A; Moskowitz, Chaya S; Capaci, Catherine & Stene, Guro Birgitte [Show all 10 contributors for this article] (2022). Validity of Estimated Cardiorespiratory Fitness in Patients With Primary Breast Cancer. JACC: CardioOncology. 4(2), p. 210–219. doi: 10.1016/j.jaccao.2022.05.003. Full text in Research Archive Show summary

  Background Estimated peak oxygen consumption (Vo2peak) is widely used in oncology; however, estimated Vo2peak equations were developed in noncancer settings. Objectives The aim of this study was to evaluate the validity of estimated Vo2peak in women with primary breast cancer and to develop oncology-specific estimated Vo2peak equations. Methods Vo2peak was directly measured (TrueOne 2400, Parvo Medics) during 380 cardiopulmonary exercise tests in women previously treated for breast cancer (mean age: 59 ± 10 years; 3.1 ± 1.2 years post-therapy). The American College of Sports Medicine (ACSM), the Fitness Registry and the Importance of Exercise National Database (FRIEND), and heart failure (HF)-FRIEND equations were used to estimate Vo2peak. New equations were developed using patient and peak (Oncpeak) or submaximal (Oncsub) exercise test characteristics. Results The median differences between measured and estimated Vo2peak were 7.0 mL O2·kg−1·min−1, 3.9 mL O2·kg−1·min−1, and −0.2 mL O2·kg−1·min−1 for ACSM, FRIEND, and HF-FRIEND, respectively. The number of estimated Vo2peak values within ±3.5 mL O2·kg−1·min−1 of the measured values was 70 (18%), 164 (43%), and 306 (81%) for ACSM, FRIEND, and HF-FRIEND, respectively. The Oncpeak and OncSub models included body mass index, age, a history of chemotherapy or radiation, the peak measured heart rate, and the treadmill grade and/or speed. The median differences between measured and estimated Vo2peak were 0.02 mL O2·kg−1·min−1 (Oncpeak) and −0.2 mL O2·kg−1·min−1 (Oncsub). Eighty-six percent (n = 325) and 76% (n = 283) estimated Vo2peak values were within ±3.5 mL O2·kg−1·min−1 of the measured Vo2peak values for Oncpeak and Oncsub, respectively. Conclusions HF-FRIEND or oncology-specific equations could be applied to estimate Vo2peak in patients previously treated for breast cancer in settings where cardiopulmonary exercise tests are not available. (Trial Comparing the Effects of Linear Versus Nonlinear Aerobic Training in Women With Operable Breast Cancer

• Möller, Thomas; Klungerbo, Vibeke; Diab, Simone; Holmstrøm, Henrik; Edvardsen, Elisabeth & Grindheim, Guro [Show all 11 contributors for this article] (2021). Circulatory Response to Rapid Volume Expansion and Cardiorespiratory Fitness in Fontan Circulation. Pediatric Cardiology. ISSN 0172-0643. doi: 10.1007/s00246-021-02802-y. Full text in Research Archive Show summary

  The role of dysfunction of the single ventricle in Fontan failure is incompletely understood. We aimed to evaluate hemodynamic responses to preload increase in Fontan circulation, to determine whether circulatory limitations in different locations identified by experimental preload increase are associated with cardiorespiratory fitness (CRF), and to assess the impact of left versus right ventricular morphology. In 38 consecutive patients (median age = 16.6 years, 16 females), heart catheterization was supplemented with a rapid 5-mL/kg body weight volume expansion. Central venous pressure (CVP), ventricular end-diastolic pressure (VEDP), and peak systolic pressure were averaged for 15‒30 s, 45‒120 s, and 4‒6 min (steady state), respectively. CRF was assessed by peak oxygen consumption (VO2peak) and ventilatory threshold (VT). Median CVP increased from 13 mmHg at baseline to 14.5 mmHg (p < 0.001) at steady state. CVP increased by more than 20% in eight patients. Median VEDP increased from 10 mmHg at baseline to 11.5 mmHg (p < 0.001). Ten patients had elevated VEDP at steady state, and in 21, VEDP increased more than 20%. The transpulmonary pressure difference (CVP‒VEDP) and CVP were consistently higher in patients with right ventricular morphology across repeated measurements. CVP at any stage was associated with VO2peak and VT. VEDP after volume expansion was associated with VT. Preload challenge demonstrates the limitations beyond baseline measurements. Elevation of both CVP and VEDP are associated with impaired CRF. Transpulmonary flow limitation was more pronounced in right ventricular morphology. Ventricular dysfunction may contribute to functional impairment after Fontan operation in young adulthood.

• Scott, Jessica M.; Thomas, Samantha M.; Herndon, James E.; Douglas, Pamela S.; Yu, Anthony F. & Rusch, Valerie [Show all 15 contributors for this article] (2021). Effects and tolerability of exercise therapy modality on cardiorespiratory fitness in lung cancer: a randomized controlled trial. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 12(6), p. 1456–1465. doi: 10.1002/jcsm.12828. Full text in Research Archive Show summary

  Background: Poor cardiorespiratory fitness (CRF) is a cardinal feature of post-treatment primary lung cancer. The most effective exercise therapy regimen to improve CRF has not been determined. Methods: In this parallel-group factorial randomized controlled trial, lung cancer survivors with poor CRF (below age–sex sedentary values) were randomly allocated to receive 48 consecutive supervised sessions thrice weekly of (i) aerobic training (AT)—cycle ergometry at 55% to >95% of peak oxygen consumption (VO2peak); (ii) resistance training (RT)—lower and upper extremity exercises at 50–85% of maximal strength; (iii) combination training (CT)—AT plus RT; or (iv) stretching attention control (AC) for 16 weeks. The primary endpoint was change in CRF (VO2peak, mL O2·kg−1·min−1). Secondary endpoints were body composition, muscle strength, patient-reported outcomes, tolerability (relative dose intensity of exercise), and safety. Analysis of covariance determined change in primary and secondary endpoints from baseline to post-intervention (Week 17) with adjustment for baseline values of the endpoint and other relevant clinical covariates. Results: Ninety patients (65 ± 9 years; 66% female) were randomized (AT, n = 24; RT, n = 23; CT, n = 20; and AC, n = 23) of the planned n = 160. No serious adverse events were observed. For the overall cohort, the lost-to-follow-up rate was 10%. Mean attendance was ≥75% in all groups. In intention-to-treat analysis, VO2peak increased 1.1 mL O2·kg−1·min−1 [95% confidence interval (CI): 0.0, 2.2, P = 0.04] and 1.4 mL O2·kg−1·min−1 (95% CI: 0.2, 2.5, P = 0.02) in AT and CT, respectively, compared with AC. There was no difference in VO2peak change between RT and AC (−0.1 mL O2·kg−1·min−1, 95% CI: −1.2, 1.0, P = 0.88). Favourable improvements in maximal strength and body composition were observed in RT and CT groups compared with AT and AC groups (Ps < 0.05). No between-group changes were observed for any patient-reported outcomes. Relative dose intensity of exercise was lower in RT and CT compared with AT (Ps < 0.05). Conclusions: In the context of a smaller than planned sample size, AT and CT significantly improved VO2peak in lung cancer survivors; however, the tolerability-to-benefit ratio was superior for AT and hence may be the preferred modality to target impaired CRF in post-treatment lung cancer survivors.

• Ulvestad, Mariann; Godang, Kristin; Durheim, Michael; Kongerud, Johny S.; Lund, May-Brith & Bollerslev, Jens [Show all 7 contributors for this article] (2021). Effect of high-intensity training on bone health and body composition in lung transplant recipients: A secondary analysis of a randomized controlled trial. Clinical Transplantation. ISSN 0902-0063. p. 1–9. doi: 10.1111/ctr.14375. Full text in Research Archive Show summary

  Background: Loss of bone mineral and skeletal muscle mass is common after lung transplantation (LTx), and physical activity (PA) may prevent further deterioration. We aimed to assess the effects of 20-week high-intensity training (HIT) on body composition, bone health, and PA in LTx recipients, 6–60 months after surgery. Methods: In a randomized controlled trial, 51 LTx recipients underwent Dual-energy X-ray absorptiometry (DXA), and PA level and sedentary time were objectively recorded by accelerometers for seven consecutive days. Of these, 39 participants completed the study, including 19 participants in the HIT group and 20 participants in the standard care group. Results: Following the intervention, ANCOVA models revealed a nonsignificant between-group difference for change in lean body mass (LBM) and bone mineral density (BMD) of the lumbar spine of 0.4% (95% CI = −3.2, 1.5) (p = .464) and 1.0% (95% CI=−1.3, 3.4) (p = .373), respectively. Trabecular bone score (TBS) of the lumbar spine (L1-L4), however, increased by 2.2 ± 5.0% in the exercise group and decreased by −1.6 ± 5.9% in the control group, giving a between-group difference of 3.8% (95% CI=0.1, 7.5) (p = .043). There were no between-group differences in PA or sedentary time. Conclusion: High-intensity training after LTx improved TBS significantly, but not PA, LBM or BMD.

• Ulvestad, Mariann; Durheim, Michael; Kongerud, Johny; Hansen, Bjørge Herman; Samersaw-Lund, May Brit & Edvardsen, Elisabeth (2020). Cardiorespiratory Fitness and Physical Activity following Lung Transplantation: A National Cohort Study. Respiration. ISSN 0025-7931. 99(4), p. 316–324. doi: 10.1159/000506883. Full text in Research Archive Show summary

  Background: Low cardiorespiratory fitness and inactivity are common after lung transplantation (LTx). The causes of exercise intolerance are incompletely understood. Objectives: The aim of this study was to objectively assess cardiorespiratory fitness and physical activity, evaluate causes of exercise intolerance, and explore clinical factors associated with cardiorespiratory fitness after bilateral LTx (BLTx). Materials and Methods: Peak oxygen uptake (V∙O2peak) and exercise-limiting factors were evaluated by a treadmill cardiopulmonary exercise test (CPET) 6–60 months after BLTx. Physical activity was measured with accelerometers, and results were compared with Norwegian normative data and the World Health Organization’s (WHO) recommendations for physical activity. Results: In 54 included BLTx recipients (mean age 50 ± 15 years, 50% females), V∙O2peak (mL × kg–1 × min–1) was 21.8 ± 7.7 for men and 22.4 ± 6.2 for women, corresponding to 57 ± 17 and 70 ± 12% of predicted, respectively. Three patients (6%) met criteria for normal V∙O2peak. Deconditioning limited V∙O2peak in 22 patients (41%), while ventilatory limitation and abnormal gas exchange were observed in 14 (26%) and 20 (37%) patients, respectively (some had more than 1 finding). Forty-three patients (86%) did not meet the WHO physical activity recommendations. There was a moderate correlation between V∙O2peak and physical activity (r = 0.642, p < 0.01). Body mass index, physical activity, forced expiratory volume after 1 second, sex, and hemoglobin together accounted for 73% of the variability in V∙O2peak. Conclusions: Low cardiorespiratory fitness was observed in the majority of BLTx recipients. Both deconditioning and cardiopulmonary limitations were common findings. Nearly 90% were classified as being inactive according to physical activity recommendations. CPET appears to identify a deconditioned subgroup of BLTx recipients for whom exercise training may be especially beneficial.

• Ulvestad, Mariann; Durheim, Michael; Kongerud, Johny; Samersaw-Lund, May Brit & Edvardsen, Elisabeth (2020). Effect of high-intensity training on peak oxygen uptake and muscular strength after lung transplantation: A randomized controlled trial. The Journal of Heart and Lung Transplantation. ISSN 1053-2498. 39(9), p. 1–9. doi: 10.1016/j.healun.2020.06.006. Full text in Research Archive Show summary

  BACKGROUND: Peak oxygen uptake (VO2peak) remains low after lung transplantation (LTx). We evaluated the effect of high-intensity interval training (HIIT) on VO2peak, muscular strength, health-related quality of life (HRQOL), pulmonary function, and physical function after LTx. METHODS: In this randomized controlled trial, 54 participants were enrolled from 6 to 60 months after LTx. The HIIT group (n = 25) followed a supervised HIIT program, consisting of endurance and strength trainings 3 times a week for 20 weeks. The control group (n = 29) received usual care. The primary outcome was a change in VO2peak measured by cardiopulmonary exercise testing. The secondary outcomes were changes in 1-repetition maximum (1RM) for arm press and leg press, HRQOL (36-Item Short-Form Health Survey [SF-36]), pulmonary function (forced expiratory volume in 1 sec, diffusing capacity of the lungs for carbon monoxide), and physical function (1RM in handgrip, 15-sec stair run, and 30-sec chair stand). RESULTS: A total of 46 participants completed the study, including 23 of 25 in the intervention group. For the primary outcome, the intention-to-treat analysis revealed a non-significant between-group difference for change in VO2peak of 0.7 ml/(kg.min) (95% CI = ‒0.3, 1.8) (p = 0.17). The between-group differences for 1RM arm press and leg press and mental aspect of SF-36 were 4.9 kg (95% CI = ‒0.1, 9.9) (p = 0.05), 11.6 kg (95% CI = 0.1, 23.0) (p < 0.05), and 5.7 kg (95% CI = 0.9, 10.4) (p = 0.02), respectively. There were no between-group differences in pulmonary function or physical function. When excluding participants with an attendance of <70% (n = 16), the between-group difference for VO2peak was 1.2 ml/(kg.min) (95% CI = 0.1, 2.4) (p = 0.032). CONCLUSIONS: HIIT improved muscular strength and HRQOL but did not improve VO2peak more than usual care after LTx. However, with acceptable adherence, HIIT appears to have beneficial effects on VO2peak.

• Engan, Mette; Jansrud, Ida; Stensrud, Trine; Gundersen, Hilde; Edvardsen, Elisabeth & Clemm, Hege Havstad (2020). Pust opp Stolzen. Norsk idrettsmedisin. ISSN 0806-9328. Full text in Research Archive
• Scott, Jessica M.; Stene, Guro Birgitte; Edvardsen, Elisabeth & Jones, Lee W. (2020). Performance status in cancer: Not broken, but time for an upgrade? Journal of Clinical Oncology. ISSN 0732-183X. 38(25), p. 2824–2829. doi: 10.1200/JCO.20.00721. Full text in Research Archive
• Myrdal, Ole Henrik; Diep, Phoi Phoi; Ruud, Ellen; Brinch, Lorentz; Massey, Richard J & Edvardsen, Elisabeth [Show all 9 contributors for this article] (2020). Determinants of cardiorespiratory fitness in very long-term survivors of allogeneic hematopoietic stem cell transplantation: a national cohort study. Supportive Care in Cancer. ISSN 0941-4355. 29(4). doi: 10.1007/s00520-020-05644-1. Full text in Research Archive Show summary

  Purpose: Survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk for cardiopulmonary adverse events. Data on long-term effects on cardiorespiratory fitness are limited. To address the gap in knowledge, we aimed to determine peak oxygen uptake (V̇O2peak) and identify associations between cardiorespiratory fitness and clinical characteristics, self-reported physical activity, cardiac, and pulmonary function. Methods: In a nationwide, single-center cross-sectional study, 90 survivors [aged median (range) 35 (17–54) years, 56% females] were examined, 17 (6–26) years after allo-HSCT. Myeloablative conditioning comprised busulfan/cyclophosphamide or cyclophosphamide only. Methods included pulmonary function tests, echocardiography, and cardiopulmonary exercise test. Results: Chronic graft-versus-host disease (cGVHD) was found in 31% of the subjects, of whom 40% had bronchiolitis obliterans syndrome (BOS). Seventy-one percent of the survivors did not meet WHO recommendations for physical activity and 42% were overweight. Reduced gas diffusion (DLCO) and systolic ventricular dysfunction (LVEF) were found in 44% and 31%, respectively. For the group, mean (95% CI), V̇O2peak was 36.4 (34.7–38.0) mL/min/kg [89 (85–93)% of predicted]. V̇O2peak was low at 43%. Cardiopulmonary factors and deconditioning were equally common limitations for exercise. In a multiple linear regression model, low V̇O2peak was associated with low DLCO, low LVEF, BOS, overweight, and inactivity. Conclusion: Half of the survivors had reduced cardiorespiratory fitness median 17 years after allo-HSCT. Cardiopulmonary factors and deconditioning were equally common limitations to exercise. We encourage long-term cardiopulmonary monitoring of allo-HSCT survivors and targeted advice on modifiable lifestyle factors.

• Thorsen, Lene; Haugnes, Hege Sagstuen; Fosså, Sophie Dorothea; Brydøy, Marianne; Tandstad, Torgrim & Wisløff, Torbjørn [Show all 13 contributors for this article] (2020). Thromboembolic events after high-intensity training duringcisplatin-based chemotherapy for testicular cancer: Casereports and review of the literature. International Journal of Cancer. ISSN 0020-7136. 147(11), p. 3189–3198. doi: 10.1002/ijc.33151. Full text in Research Archive Show summary

  The randomized “Testicular cancer and Aerobic and Strength Training trial” (TAST‐trial) aimed to evaluate the effect of high‐intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin‐based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high‐intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST‐trial.

• Torvanger, Ole; Os, Audun; Skjønsberg, Ole Henning & Edvardsen, Elisabeth (2020). Cardiorespiratory fitness on a treadmill in an adult cystic fibrosis population. BMJ Open sport & exercise medicine. 6(1). doi: 10.1136/bmjsem-2020-000765. Full text in Research Archive Show summary

  Objectives: (1) To describe the cardiorespiratory fitness (CRF) in an adult cystic fibrosis population related to sex and age, (2) to evaluate the cause of low CRF and (3) to study the association between peak oxygen uptake (VO2peak) and forced expiratory volume in 1 s (FEV1). Methods: A total of 204 cardiopulmonary treadmill exercise tests (CPETs) performed by 116 patients were included. VO2peak, gas exchange, heart rate, oxygen saturation and ventilatory variables were measured. A low CRF was defined as a VO2peak <80% of predicted, ventilatory limitation was defined as a breathing reserve <15%, exercise hypoxaemia was defined as an oxygen saturation <88% and ventilation-perfusion mismatch was defined as a minute ventilation/ventilatory equivalent for carbon dioxide slope ≥34. In patients who had performed three or more CPETs, the annual change in FEV1 and VO2peak were calculated using linear regression. Results: The VO2peak was 40.6±11.5 and 35.2±8.9 mL kg−1 min−1, which was 87±23 and 93±20 in percentage of predicted for men and women, respectively. VO2peak was moderately affected by age, for men (r=−0.36, p<0.001) and women (r=−0.53, p<0.001), respectively. In 45 of 101 tests where CRF was low, no cardiorespiratory limiting factors were identified. The correlation coefficient between VO2peak and FEV1 was r=0.64 (p<0.001). In participants with a low CRF, FEV1 ranged from 20% to 112% of predicted. Conclusions: The correlation between VO2peak and FEV1 was moderate. The majority of the tests resulted in a VO2peak within normal limits. Interestingly, 44% of the tests with a low VO2peak could be explained by deconditioning. Thus, exercise therapy may be beneficial for these patients.

• Engan, Mette; Jansrud, Ida; Stensrud, Trine; Gundersen, Hilde; Edvardsen, Elisabeth & Clemm, Hege Havstad (2020). Changes in pulmonary function and feasibility of portable continuous laryngoscopy during maximal uphill running. BMJ Open sport & exercise medicine. 6(1), p. 1–6. doi: 10.1136/bmjsem-2020-000815. Full text in Research Archive Show summary

  Objective: To evaluate changes in pulmonary function and feasibility of portable continuous laryngoscopy during maximal uphill running. Methods: Healthy volunteers participated in an uphill race. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained before and 5 and 10 min after finishing the race. Capillary blood lactate concentration ([BLa-]) and Borg score for perceived exertion were registered immediately after the race. One participant wore a portable video-laryngoscope during the race, and the video was assessed for technical performance. Results: Twenty adult subjects participated with a mean (SD) age of 40.2 (9.7) years. Mean (SD) race duration and post-exercise [BLa-] was 13.9 (2.3) min and 10.7 (2.1) mmol/L, respectively, and the median (range) Borg score for perceived exertion was 9 (5–10). Mean percentage change (95% CI) 5 and 10 min post-exercise in FEV1 were 6.9 (3.7 to 10.2) % and 5.9 (2.7 to 9.0) %, respectively, and in FVC 5.2 (2.3 to 8.1) % and 4.7 (1.6 to 7.9) %, respectively. The recorded video of the larynx was of good quality. Conclusions: Maximal aerobic field exercise induced bronchodilatation in the majority of the healthy non-asthmatic participants. It is feasible to perform continuous video-laryngoscopy during heavy uphill exercise.

• Berntsen, Kristin Schjander; Edvardsen, Elisabeth; Hansen, Bjørge Hermann; Flatø, Berit; Sjaastad, Ivar & Sanner, Helga (2019). Cardiorespiratory fitness in long-term juvenile dermatomyositis: A controlled, cross-sectional study of active/inactive disease. Rheumatology. ISSN 1462-0324. 58(3), p. 492–501. doi: 10.1093/rheumatology/key342. Full text in Research Archive Show summary

  Objectives. To compare cardiorespiratory fitness (CRF) expressed as maximal oxygen uptake (VO2max) between patients with long-term JDM and controls and between patients with active and inactive disease, as well as to explore exercise limiting factors and associations between CRF and disease variables. Methods. JDM patients (n=45) and age- and gender-matched controls (n=45) performed a cardiopulmonary exercise test (CPET) on a treadmill until exhaustion. Physical activity was measured by accelerometers. Disease activity, damage and muscle strength/function were assessed by validated tools. Clinically inactive disease was defined according to PRINTO criteria. Results. The mean disease duration was 20.8 (S.D. 11.9) years and 29/45 (64%) patients had inactive disease. A low VO2max was found in 27% of patients vs 4% of controls (P = 0.006). The mean VO2max and maximal ventilation (VEmax) were lower in patients with active and inactive disease compared with controls. Patients with active disease also had lower maximal voluntary ventilation (MVV) compared with controls and lower VEmax and MVV compared with those with inactive disease. Patients with inactive disease had lower physical activity levels compared with controls. VO2max correlated negatively with disease damage in patients with inactive disease and positively with muscle strength/function in patients with active disease. Conclusion. CRF was lower in JDM patients, both with active and inactive disease, compared with controls after a mean 20 years disease duration. Cardiopulmonary exercise test results suggested different limiting factors contributing to the reduced CRF according to disease activity, including deconditioning in inactive disease and reduced ventilatory capacity in active disease. Further research is needed to verify this.

• Risum, Kristine; Edvardsen, Elisabeth; Selvaag, Anne Marit G; Dagfinrud, Hanne & Sanner, Helga (2019). Measurement properties and performance of an eight-minute submaximal treadmill test in patients with juvenile idiopathic arthritis: A controlled study. Pediatric Rheumatology. 17. doi: 10.1186/s12969-019-0316-7. Full text in Research Archive Show summary

  Background Poor cardiorespiratory fitness is previously reported in patients with juvenile idiopathic arthritis (JIA) measured both by maximal and submaximal exercise tests, but a submaximal exercise test with acceptable measurement properties is currently lacking for both clinical and research purposes in this patient population. The objectives of this study were to evaluate the measurement properties and performance of a submaximal treadmill test in patients with JIA, and to compare the results with those obtained in controls. Methods Fifty-nine patients (50 girls), aged 10–16 years, with oligo- (n = 30) and polyarticular (n = 29) JIA, and 59 age- and sex-matched controls performed an eight-minute submaximal treadmill test for estimating peak oxygen uptake (VO2peak) followed by a maximal treadmill test measuring VO2peak directly. During the submaximal treadmill test, the study participants walked with no inclination at a speed between 3.2–7.2 km/h for four minutes, and then continued to walk at the same speed for four minutes with five % inclination. VO2peak was directly measured during a continuous graded exercise test on treadmill until exhaustion. Thirty-seven patients participated in the evaluation of the reliability. Criterion validity and reliability were evaluated with interclass correlation coefficient (ICC); measurement errors by Bland-Altman plot, standard error of measurement and smallest detectable change. Results In patients with JIA, the ICC (95% CI) for criterion validity was acceptable at group level 0.71 (0.51, 0.82), but not at individual level. The test-retest reliability and inter-rater reliability were acceptable at individual (0.84 (0.71, 0.91) and 0.92 (0.83, 0.96), respectively) and group levels (0.91 (0.83, 0.96) and 0.96 (0.91, 0.98), respectively). The measurement errors (for test-retest reliability/inter-rater reliability) were large. Bland-Altman plots showed no systematic differences, but a large variability for both the validity and reliability. The performance of and estimated VO2peak from the submaximal test were not associated with disease variables and were comparable between patients and controls. Conclusion The submaximal treadmill test is valid for use in patients with JIA on group level, but not on individual level. The reliability is acceptable. Due to large measurement errors, the submaximal treadmill test is not optimal for use in daily clinical practice to estimate VO2peak in individual patients.

• Nilsson, Birgitta Blakstad; Bunæs-Næss, Heidi Agnor; Edvardsen, Elisabeth & Stenehjem, Aud Eldrid (2019). High-intensity interval training in haemodialysis patients: a pilot randomised controlled trial. BMJ Open sport & exercise medicine. 5. doi: 10.1136/bmjsem-2019-000617. Full text in Research Archive
• Mjøs, Ingunn; Thorsen, Einar; Hausken, Trygve; Lied, Einar; Nilsen, Roy Miodini & Brønstad, Ingeborg [Show all 8 contributors for this article] (2019). The effect of low dose marine protein hydrolysates on short-term recovery after high intensity performance cycling: A double-blinded crossover study. Journal of the International Society of Sports Nutrition (JISSN). 16(1). doi: 10.1186/s12970-019-0318-3. Full text in Research Archive Show summary

  Background: Knowledge of the effect of marine protein hydrolysate (MPH) supplementation to promote recovery after high intensity performance training is scarce. The aim of this study was to examine the effect of MPH supplementation to whey protein (WP) and carbohydrate (CHO): (CHO-WP-MPH), on short-term recovery following high intensity performance, compared to an isoenergetic and isonitrogenous supplement of WP and CHO: (CHO-WP), in male cyclists. Methods: This was a double-blinded crossover study divided into three phases. Fourteen healthy men participated. In phase I, an incremental bicycle exercise test was performed for establishment of intensities used in phase II and III. In phase II (9–16 days after phase 1), the participants performed first one high intensity performance cycling session, followed by nutrition supplementation (CHO-WP-MPH or CHO-WP) and 4 hours of recovery, before a subsequent high intensity performance cycling session. Phase III (1 week after phase II), was similar to phase II except for the nutrition supplementation, where the participants received the opposite supplementation compared to phase II. Primary outcome was difference in time to exhaustion between the cycling sessions, after nutrition supplementations containing MPH or without MPH. Secondary outcomes were differences in heart rate (HR), respiratory exchange ratio (RER), blood lactate concentration and glucose. Results: The mean age of the participants was 45.6 years (range 40–58). The maximal oxygen uptake (mean ± SD) measured at baseline was 54.7 ± 4.1 ml∙min− 1∙kg− 1. There were no significant differences between the two nutrition supplementations measured by time to exhaustion at the cycling sessions (meandiff = 0.85 min, p = 0.156, 95% confidence interval (CI), − 0.37, 2.06), HR (meandiff = 0.8 beats pr.min, p = 0.331, 95% CI, − 0.9, 2.5), RER (meandiff = − 0.05, p = 0.361, 95% CI -0.07 – 0.17), blood lactate concentration (meandiff = − 0.24, p = 0.511, 95% CI, − 1.00, 0.53) and glucose (meandiff = 0.23, p = 0.094, 95% CI, − 0.05, 0.51). Conclusions: A protein supplement with MPH showed no effects on short-term recovery in middle-aged healthy male cyclists compared to a protein supplement without MPH.

• Berntsen, Sveinung; Edvardsen, Elisabeth; Gerbi, Shlomi; Pollestad, Magnhild Louise & Anderssen, Sigmund Alfred (2019). Do obese children achieve maximal heart rate during treadmill running? Sports. 7(1). doi: 10.3390/sports7010026. Full text in Research Archive Show summary

  Objective: Maximal heart rate (HR) is commonly defined as the highest HR obtained during a progressive exercise test to exhaustion. Maximal HR is considered one of the criteria to assess maximum exertion in exercise tests, and is broadly used when prescribing exercise intensity. The aim of the present study was to compare peak HR measurements during maximal treadmill running and active play in obese children and adolescents. Design: Comparison of peak heart rate during active play vs. maximal treadmill running in 39 (7–17 years old, 18 males) obese children and adolescents. Methods: Heart rate was recorded during intensive active play sessions, as well as during a progressive running test on a treadmill until exhaustion. HR, respiratory exchange ratio (RER), and oxygen uptake were continuously measured during the test. The criteria for having reached maximal effort was a subjective assessment by the technician that the participants had reached his or her maximal effort, and a RER above 1.00 or reporting perceived exertion (RPE) above 17 using the Borg-RPE6–20-Scale. Results: Thirty-four children had a RER ≥1.00, and 37 reported a RPE ≥ 17. Thirty-two children fulfilled both criteria. During active play, peak HR was significantly (p < 0.0001) increased (4%) (mean and 95% confidence intervals; 204 (201, 207) beats/min), compared to during maximal treadmill running (196 (194, 199) beats/min), respectively. Conclusion: The results of the present study indicate that peak heart rate measurements during progressive running to exhaustion in obese children and adolescents cannot necessarily be determined as maximal heart rate.

• Risum, Kristine; Edvardsen, Elisabeth; Godang, Kristin; Selvaag, Anne Marit G; Hansen, Bjørge Hermann & Molberg, Øyvind [Show all 10 contributors for this article] (2018). Physical Fitness in Patients With Oligoarticular and Polyarticular Juvenile Idiopathic arthritis diagnosed in the era of biologics: A controlled cross-sectional study. Arthritis care & research. ISSN 2151-464X. 71(12), p. 1611–1620. doi: 10.1002/acr.23818. Full text in Research Archive
• Vainshelboim, Baruch; Lima, Ricardo; Edvardsen, Elisabeth & Myers, Jonathan (2018). Cardiorespiratory fitness, incidence and mortality of lung cancer in men: A prospective cohort study. Journal of Science and Medicine in Sport. ISSN 1440-2440. doi: 10.1016/j.jsams.2018.10.002. Full text in Research Archive Show summary

  Objectives: To evaluate the association between cardiorespiratory fitness (CRF), lung cancer incidence and cancer mortality in men. Design: Prospective cohort study. Methods: Maximal exercise testing was performed in 4920 men (59.2 ± 11.4 years) free from malignancy at baseline. Multivariate Cox hazard models adjusted for established cancer risk factors including smoking were analyzed for lung cancer incidence and cancer mortality among those who were diagnosed with lung cancer. Population attributable risks (PAR) of low CRF (<5 METs) were determined. Results: During 12.7 ± 7.5 years follow-up, 105 (2.1%) participants were diagnosed with lung cancer and 83 (79%) of those died from cancer after 3.6 ± 4.6 years from diagnosis. CRF was inversely and independently associated with cancer outcomes. A 1-MET increase and categories of moderate and high CRF were associated with 10%, 47% and 65% reduction in lung cancer incidence (p = 0.002), and 13%, 58% and 76% reduction in cancer mortality (p = 0.002), respectively. Also, individuals who were diagnosed with lung cancer and were at moderate or high CRF categories at baseline exhibited longer survival time (p < 0.001). The PARs% for lung cancer incidence and cancer mortality were 8.7% and 18.5%, respectively. Conclusions: Higher CRF is associated with lower lung cancer incidence in men. Among individuals who were diagnosed with lung cancer, higher CRF was associated with reduced cancer mortality and longer survival time. These results support the protective benefits of higher CRF in the prevention of lung cancer outcomes. Eliminating low CRF as a risk factor would potentially prevent considerable lung cancer morbidity and mortality.

• Myrdal, Ole Henrik; Kanellopoulos, Adriani; Christiansen, Jon Runar; Ruud, Ellen; Edvardsen, Elisabeth & Kongerud, Johny [Show all 8 contributors for this article] (2018). Risk factors for impaired pulmonary function and cardiorespiratory fitness in very long-term adult survivors of childhood acute lymphoblastic leukemia after treatment with chemotherapy only*. Acta Oncologica. ISSN 0284-186X. 57(5), p. 658–664. doi: 10.1080/0284186X.2017.1423177. Full text in Research Archive Show summary

  Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk of late treatment-related side-effects. Data regarding prevalence and risk factors for impairments in pulmonary function and cardiorespiratory fitness are limited, and reported findings are inconsistent and inconclusive. Material and methods: In a cross-sectional study, 116 ALL survivors (median 5 years at diagnosis, 29 years at follow-up, 53% females) were examined, median 23 years after treatment with chemotherapy only. Individual cumulative doses of cytostatic agents were calculated. Methods included blood tests, echocardiography, pulmonary function tests and cardiorespiratory exercise test. Results: Females had lower % predicted gas diffusing capacity (DLCO) than males (mean [SD] 84 [13] versus 97 [14], p < .001). Impairment in DLCO was found in 34% females versus 7% males, p < .001. In a multiple linear regression model, female gender, body mass index (BMI) and smoking were risk factors for reduced % predicted DLCO, with a borderline significant effect of left ventricular ejection fraction (LVEF). Impaired cardiorespiratory fitness was found in 42% of the survivors, with a borderline increased risk in females, p = .06. Smoking and BMI were risk factors for reduced % predicted VO2peak. Subjects exposed to anthracyclines had lower LVEF% and % predicted VO2peak than those not exposed, (mean [SD] 56.2 [4.3] versus 59.2 [5.2], p = .01 and 86.9 [18.4] versus 92.8 [18.4], p = .03, respectively). Conclusions: Impairments in pulmonary function and cardiorespiratory fitness are common in very long-term survivors of childhood ALL. Risk factors are female gender, BMI and smoking. In order to preserve pulmonary function and cardiorespiratory fitness, we suggest increased attention and targeted advice on modifiable lifestyle factors such as smoking, inactivity and overweight.

• Thorsen, Lene; Kirkegaard, Camilla; Loge, Jon Håvard; Kiserud, Cecilie E.; Johansen, Merethe Lia & Gjerset, Gunhild Maria [Show all 10 contributors for this article] (2017). Feasibility of a physical activity intervention during and shortly after chemotherapy for testicular cancer. BMC Research Notes. 10(214). doi: 10.1186/s13104-017-2531-y. Full text in Research Archive Show summary

  Background Given the risk of developing acute and long-term adverse effects in patients receiving cisplatin-based chemotherapy for testicular cancer (TC), risk-reducing interventions, such as physical activity (PA), may be relevant. Limited knowledge is available on the challenges met when conducting PA intervention trials in patients with TC during and shortly after chemotherapy. The aims of the present feasibility study are therefore to determine patient recruitment, compliance and adherence to a PA intervention. Results Patients with metastatic TC referred to cisplatin-based chemotherapy were eligible. They followed an individual low-threshold PA intervention, including counseling from a personal coach during and 3 months after chemotherapy. Outcomes were recruitment rate, compliance rate and adherence to the intervention including preferences for type of PA and barriers for PA. During 8 months 12 of 18 eligible patients were invited, all consented, but three dropped out. Walking and low intensity activities were preferred and nausea and feeling unwell were the most often reported barriers towards PA. Discussion In order to achieve adequate recruitment, compliance and complete data in future PA intervention trials, close cooperation with treating physicians, individual PA plans and availability of personalized coaching are required.

• Aadland, Eivind; Solbraa, Ane; Resaland, Geir Kåre; Steene-Johannessen, Jostein; Edvardsen, Elisabeth & Hansen, Bjørge Hermann [Show all 7 contributors for this article] (2017). Reference values for and cross-validation of time to exhaustion on a modified Balke protocol in Norwegian men and women. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 27(11), p. 1248–1257. doi: 10.1111/sms.12750. Full text in Research Archive Show summary

  The aims of the present study were to provide reference values for time to exhaustion (TTE) on a modified Balke treadmill protocol, and to perform a cross‐validation of TTE as a measure of maximal oxygen consumption (VO2max), in Norwegian men and women 20–85 years of age. Reference values for TTE were derived from a national sample of 765 subjects. An additional sample of 119 subjects was included in the cross‐validation (total n = 884), where prediction equations for VO2max was established. A decline in TTE was seen with increased age. Prediction of VO2max in an independent dataset (n = 319) resulted in a R2 = 0.78 and standard error of the estimate = 4.55 mL/kg/min. The observed–predicted bias was small (mean difference <1.24 mL/kg/min), whereas random error was considerable (95% limits of agreement ± 7.11–9.70 mL/kg/min) across age in both men and women. Despite limitations concerning the prediction of VO2max on an individual level, TTE from the Balke protocol is a good measure of aerobic fitness in adults across a range of settings, and could be evaluated according to the suggested reference values.

• Edvardsen, Elisabeth; Akerø, Aina; Skjønsberg, Ole Henning & Skrede, Bjørn (2017). Pre-flight evaluation of adult patients with cystic fibrosis: a cross-sectional study. BMC Research Notes. 10(84), p. 1–8. doi: 10.1186/s13104-017-2386-2. Full text in Research Archive Show summary

  Background: Air travel may imply a health hazard for patients with cystic fibrosis (CF) due to hypobaric environment in the aircraft cabin. The objective was to identify pre-flight variables, which might predict severe hypoxaemia in adult CF patients during air travel. Methods: Thirty adult CF-patients underwent pre-flight evaluation with spirometry, arterial oxygen tension (PaO2), pulse oximetry (SpO2) and cardiopulmonary exercise testing (CPET) at sea level (SL). The results were related to the PaO2 obtained during a hypoxia-altitude simulation test (HAST) in which a cabin altitude of 2438 m (8000 ft) was simulated by breathing 15.1% oxygen. Results: Four patients fulfilled the criteria for supplemental oxygen during air travel (PaO2 HAST < 6.6 kPa). While walking slowly during HAST, another eleven patients dropped below PaO2 HAST 6.6 kPa. Variables obtained during CPET (PaO2 CPET, SpO2 CPET, minute ventilation/carbon dioxide output, maximal oxygen uptake) showed the strongest correlation to PaO2 HAST. Conclusions: Exercise testing might be of value for predicting in-flight hypoxaemia and thus the need for supplemental oxygen during air travel in CF patients.

• Dyrstad, Sindre Mikal; Edvardsen, Elisabeth; Hansen, Bjørge Hermann & Anderssen, Sigmund Alfred (2017). Waist circumference thresholds and cardiorespiratory fitness. Journal of Sport and Health Science. ISSN 2095-2546. 8(1), p. 17–22. doi: 10.1016/j.jshs.2017.03.011. Full text in Research Archive Show summary

  Purpose This study's purpose was to examine whether established risk categories of waist circumference (WC)—normal, high risk, and very high health risk—reflected significant differences in cardiorespiratory fitness (CRF) and physical activity (PA) level. Methods CRF was directly measured as maximal oxygen uptake during a progressive graded treadmill test to exhaustion in 722 individuals (349 women) aged 20–85 years. WC was measured between the lower rib and the iliac crest. Objectively measured PA was assessed using an accelerometer. Results Men in the normal risk group (WC < 94 cm) had a 31% higher CRF and 43% higher level of moderate-to-vigorous PA than men in the very high risk group (with a WC > 102 cm). Corresponding numbers for women within normal (WC < 80 cm) and very high risk group (WC > 88 cm) were 25% and 18% (p <0.05). There was a high negative correlation between CRF and WC in men (r = −0.68), and a moderate correlation for women (r = −0.49; p <0.001). For each cm increase in WC, CRF was reduced by 0.48 and 0.27 mL/kg/min in men and women, respectively (p <0.001). Conclusion The recommended WC thresholds for abdominal obesity reflected significant differences in CRF for both men and women, and could serve as a useful instrument for estimating health-related differences in CRF.

• Haakstad, Lene Annette Hagen; Edvardsen, Elisabeth & Bø, Kari (2016). Effect of regular exercise on blood pressure in normotensive pregnant women. A randomized controlled trial. Hypertension in Pregnancy. ISSN 1064-1955. 35(2), p. 170–180. doi: 10.3109/10641955.2015.1122036. Full text in Research Archive Show summary

  Objective: To evaluate the effect of regular exercise on maternal arterial blood pressure (BP) at rest and during uphill walking, in healthy former inactive pregnant women. Methods: A single-blind, single-center, randomized controlled trial including 61 out of 105 healthy, inactive nulliparous pregnant women, initially enrolled in a controlled trial studying the effect of 12 weeks of aerobic exercise (60 min 2/week) on maternal weight gain. Primary outcome was the mean adjusted difference in change in resting systolic and diastolic BP from baseline to after intervention. Secondary outcome was the mean adjusted difference in change in systolic BP during uphill treadmill walking at critical power. Measurements were performed prior to the intervention (gestation week 17.6 ± 4.2) and after the intervention (gestation week 36.5 ± 0.9). Results: At baseline, resting systolic and diastolic BP was 115/66 ± 12/7 and 115/67 ± 10/9 mmHg in the exercise (n = 35) and control group (n = 26), respectively. After the intervention, resting systolic BP was 112 ± 8 mmHg in the exercise group and 119 ± 14 mmHg in the control group, giving a between-group difference of 7.5 mmHg (95% CI 1.5 to 12.6, p = 0.013). Diastolic BP was 71 ± 9 and 76 ± 8 mmHg, with a between-group difference of 3.9 mmHg (95% CI −0.07 to 7.8, p = 0.054). During uphill treadmill walking at critical power, the between-group difference in systolic and diastolic BP was 5.9 mmHg (95% CI −4.4 to 16.1, p = 0.254) and 5.5 mmHg (95% CI –0.2 to 11.1, p = 0.059), respectively. Conclusions: Aerobic exercise reduced resting systolic BP in healthy former inactive pregnant women.

• Edvardsen, Elisabeth; Skjønsberg, Ole Henning; Holme, Ingar Morten K; Nordsletten, Lars; Borchsenius, Fredrik & Anderssen, Sigmund Alfred (2015). High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax. ISSN 0040-6376. 70(3), p. 244–250. doi: 10.1136/thoraxjnl-2014-205944. Full text in Research Archive Show summary

  Background: Many patients with lung cancer are deconditioned with poor physical fitness. Lung resection reduces physical fitness further, impairing the patient's ability to function in daily life. Methods: We conducted a single-blind randomised controlled trial of high-intensity endurance and strength training (60 min, three times a week, 20 weeks), starting 5–7 weeks after surgery. The control group received standard postoperative care. The primary outcome was the change in peak oxygen uptake measured directly during walking until exhaustion. Other outcomes included changes in pulmonary function, muscular strength by one-repetition maximum (1RM), total muscle mass measured by dual energy X-ray absorptiometry, daily physical functioning and quality of life (QoL). Results: The intention-to-treat analysis of the 61 randomised patients showed that the exercise group had a greater increase in peak oxygen uptake (3.4 mL/kg/min between-group difference, p=0.002), carbon monoxide transfer factor (Tlco) (5.2% predicted, p=0.007), 1RM leg press (29.5 kg, p<0.001), chair stand (2.1 times p<0.001), stair run (4.3 steps, p=0.002) and total muscle mass (1.36 kg, p=0.012) compared with the controls. The mean±SD QoL (SF-36) physical component summary score was 51.8±5.5 and 43.3±11.3 (p=0.006), and the mental component summary score was 55.5±5.3 and 46.6±14.0 (p=0.015) in the exercise and control groups, respectively. Conclusions: In patients recently operated for lung cancer, high-intensity endurance and strength training was well tolerated and induced clinically significant improvements in peak oxygen uptake, Tlco, muscular strength, total muscle mass, functional fitness and QoL. This study may provide a basis for exercise therapy after lung cancer surgery.

• Dyrstad, Sindre Mikal; Anderssen, Sigmund Alfred; Edvardsen, Elisabeth & Hansen, Bjørge Hermann (2015). Cardiorespiratory fitness in groups with different physical activity levels. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 26(3), p. 291–298. doi: 10.1111/sms.12425. Full text in Research Archive
• Edvardsen, Elisabeth; Anderssen, Sigmund Alfred; Borchsenius, Fredrik & Skjønsberg, Ole Henning (2015). Reduction in cardiorespiratory fitness after lung resection is not related to the number of lung segments removed. BMJ Open sport & exercise medicine. 1(1). doi: 10.1136/bmjsem-2015-000032. Full text in Research Archive
• Edvardsen, Elisabeth; Hem, Erlend Jan & Anderssen, Sigmund Alfred (2014). End criteria for reaching maximal oxygen uptake must be strict and adjusted to sex and age: a cross-sectional study. PLOS ONE. 9(1:e85276). doi: 10.1371/journal.pone.0085276. Full text in Research Archive
• Byrkjeland, Rune; Edvardsen, Elisabeth; Njerve, Ida Unhammer; Arnesen, Harald; Seljeflot, Ingebjørg & Solheim, Svein (2014). Insulin levels and HOMA index are associated with exercise capacity in patients with type 2 diabetes and coronary artery disease. Diabetology & Metabolic Syndrome. 6(1). doi: 10.1186/1758-5996-6-36. Full text in Research Archive
• Halvorsen, Silje; Haakstad, Lene Annette Hagen; Edvardsen, Elisabeth & Bø, Kari (2013). Effect of aerobic dance on cardiorespiratory fitness in pregnant women: A randomised controlled trial. Physiotherapy. ISSN 0031-9406. 99(1), p. 42–48. doi: 10.1016/j.physio.2011.11.002. Full text in Research Archive Show summary

  Objective: To evaluate the effectiveness of aerobic dance on cardiorespiratory fitness in pregnant women. Design: Randomised controlled trial. Participants: Sixty-two primiparous women with a mean age of 30.6 [standard deviation (SD) 3.7] years randomised to exercise (n = 34) and (n = 28) control groups. Intervention: Two aerobic dance classes per week and 30 minutes of daily self-imposed physical activity for 12 weeks. Main outcome measure: Cardiorespiratory fitness, assessed using a submaximal treadmill test to establish oxygen uptake (VO2) (ml/kg/minute) at three different levels of blood lactate. Levels 1, 2 and 3 were calculated and defined as 0.5, 1.0 and 1.5 mmol/l above resting blood lactate level, respectively. Results: The women in the exercise group attended a mean of 20 (SD 12) out of 24 aerobic dance classes. Both groups had a small significant decrease in VO2 between baseline and post-intervention: the exercise group decreased from 25.8 (SD 3.3) to 24.5 (SD 3.8) ml/kg/minute and the control group decreased from 25.8 (SD 3.1) to 24.5 (SD 2.5) ml/kg/minute at Level 3 (anaerobic threshold) (mean difference in change at Level 3 = 0.1, 95% confidence interval −1.4 to 1.7; P = 0.89). There were no differences in change between the groups at any level. Conclusion: A 12-week aerobic dance programme had no effect on cardiorespiratory fitness in pregnant women.

• Edvardsen, Elisabeth; Hansen, Bjørge Hermann; Holme, Ingar Morten K; Dyrstad, Sindre Mikal & Anderssen, Sigmund Alfred (2013). Reference Values for Cardiorespiratory Response and Fitness on the Treadmill in a 20-to 85-Year-Old Population. Chest. ISSN 0012-3692. 144(1), p. 241–248. doi: 10.1378/chest.12-1458. Full text in Research Archive Show summary

  Background: Existing reference values for clinical exercise testing have been derived from small nonrandom samples, lacking women and older individuals and some with poor or no maximal end criteria. The objective was to study the cardiorespiratory response during maximal exercise in a representative predominantly Caucasian sample of men and women. Methods: Nine hundred four randomly sampled men and women, 20 to 85 years old, exercised on a treadmill to exhaustion. Oxygen uptake (V . o2), heart rate (HR), BP, blood lactate concentration, and ventilatory variables were measured. Results: Seven hundred fifty-nine participants met the criteria for an acceptable maximal V . o2 ( V . o2max) based on a respiratory exchange ratio ≥ 1.10 or a Borg score ≥ 17. In the 20- to 29-year-old age group, V . o2max (mL/kg/min) was 40.3 (± 7.1) in women and 48.6 (± 9.6) in men. A linear decline (8% per decade) was observed after age 30 years in both sexes. Maximal HR decreased with age by ± 6.3 beats/min per decade. The maximal oxygen pulse was 33% lower in women and decreased significantly with age in both sexes by 5% and 3% per decade for women and men, respectively. Women’s maximal ventilation was 66% that of men and decreased with age after 40 to 49 years in both sexes. Breathing reserve was higher and blood lactate was lower in women than in men. Conclusions: This study establishes reference values for V . o2max (absolute, relative to body weight and fat-free weight), maximal HR, oxygen pulse, BP, ventilation, breathing reserve, respiratory exchange ratio, and blood lactate concentration during maximal exercise on treadmill in a large population.

• Ariansen, Inger; Edvardsen, Elisabeth; Borchsenius, Fredrik; Abdelnoor, Michael; Tveit, Arnljot & Gjesdal, Knut (2011). Lung function and dyspnea in patients with permanent atrial fibrillation. European journal of internal medicine. ISSN 0953-6205. 22(5), p. 466–470. doi: 10.1016/j.ejim.2011.06.010. Full text in Research Archive
• Berntsen, Sveinung; Edvardsen, Elisabeth; Carlsen, Kai-Håkon; Pollestad, Magnhild Louise & Carlsen, Karin C. Lødrup (2011). Effects of posture on lung function in obese children. Clinical Respiratory Journal. ISSN 1752-6981. 5(4), p. 252–257. doi: 10.1111/j.1752-699X.2010.00227.x. Full text in Research Archive
• Edvardsen, Elisabeth; Ingjer, Frank & Bø, Kari (2011). Fit Women Are Not Able to Use the Whole Aerobic Capacity During Aerobic Dance. Journal of Strength and Conditioning Research. ISSN 1064-8011. 25(12), p. 3479–3485. doi: 10.1519/JSC.0b013e3182176748. Full text in Research Archive Show summary

  This study compared the aerobic capacity during maximal aerobic dance and treadmill running in fit women. Thirteen well-trained female aerobic dance instructors aged 30 ± 8.17 years (mean ± SD) exercised to exhaustion by running on a treadmill for measurement of maximal oxygen uptake ([latin capital V with dot above]O2max) and peak heart rate (HRpeak). Additionally, all subjects performed aerobic dancing until exhaustion after a choreographed videotaped routine trying to reach the same HRpeak as during maximal running. The p value for statistical significance between running and aerobic dance was set to <=0.05. The results (mean ± SD) showed a lower [latin capital V with dot above]O2max in aerobic dance (52.2 ± 4.02 ml·kg-1·min-1) compared with treadmill running (55.9 ± 5.03 ml·kg-1·min-1) (p = 0.0003). Further, the mean ± SD HRpeak was 182 ± 9.15b·min-1 in aerobic dance and 192 ± 9.62 b·min-1 in treadmill running, giving no difference in oxygen pulse between the 2 exercise forms (p = 0.32). There was no difference in peak ventilation (aerobic dance: 108 ± 10.81 L·min-1 vs. running: 113 ± 11.49 L·min-1). In conclusion, aerobic dance does not seem to be able to use the whole aerobic capacity as in running. For well endurance-trained women, this may result in a lower total workload at maximal intensities. Aerobic dance may therefore not be as suitable as running during maximal intensities in well-trained females.

View all works in NVA

• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Ihle-Hansen, Hege Beate & Lerdal, Anners (2025). Physical Activity And Its Association With Physical Performance In The First Month Following First-Ever Ischemic Stroke (NORFAST). International Journal of Stroke. ISSN 1747-4930. Full text in Research Archive Show summary

  This study explored association between physical activity and physical performance in the first month following stroke and found that more time spent in moderate-to-vigorous physical activity was associated with male sex. We found no statistically significant associations between moderate-to-vigorous physical activity and physical performance or age, nor between daily step count and physical performance, age or sex. Small sample size may have affected the results.

• Bergvad, Ingvild Buset; Gay, Caryl; Aamodt, Arild; Edvardsen, Elisabeth; Furnes, Ove Nord & Kise, Nina Jullum [Show all 9 contributors for this article] (2025). Factors associated with physical activity in men and women with severe knee OA. Full text in Research Archive
• Larsson, Petra; Lerdal, Anners; Gay, Caryl; Ursin, Marie Helene; Mack, Ulrich & Edvardsen, Elisabeth (2023). Physical activity and cardiorespiratory fitness three months following stroke. Full text in Research Archive
• Nilsen, Tormod Skogstad; Sæter, Mali; Sarvari, Sebastian; Reinertsen, Kristin Valborg; Johansen, Sara Hassing & Edvardsen, Elisabeth Rustad [Show all 17 contributors for this article] (2023). Effects of Aerobic Exercise on Cardiorespiratory Fitness, Cardiovascular Risk Factors, and Patient-Reported Outcomes in Long-Term Breast Cancer Survivors: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 12. doi: 10.2196/45244. Full text in Research Archive Show summary

  Background Anthracycline-based chemotherapy has been mainstay of adjuvant breast cancer therapy for decades. Although effective, anthracyclines place long-term breast cancer survivors at risk of late effects, such as reduced cardiorespiratory fitness and increased risk of cardiovascular disease. Previous research has shown beneficial effects of exercise training on cardiorespiratory fitness, but the effects of exercise on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes in long-term survivors are less clear. Whether previous exposure to breast cancer therapy modulates the effects of exercise is also unknown. Objective The primary aim of the CAUSE (Cardiovascular Survivors Exercise) trial is to examine the effect of aerobic exercise on cardiorespiratory fitness in anthracycline-treated long-term breast cancer survivors. Secondary aims are to examine effects of exercise training on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes, and to compare baseline values and effects of exercise training between similar-aged women with and those without prior breast cancer. A third aim is to examine the 24-month postintervention effects of aerobic exercise on primary and secondary outcomes. Methods The CAUSE trial is a 2-armed randomized controlled trial, where 140 long-term breast cancer survivors, 8-12 years post diagnosis, are assigned to a 5-month nonlinear aerobic exercise program with 3 weekly sessions or to standard care. Seventy similar-aged women with no history of cancer will undergo the same exercise program. Cardiorespiratory fitness measured as peak oxygen consumption (VO2peak), limiting factors for VO2peak (eg, cardiac function, pulmonary function, hemoglobin mass, blood volume, and skeletal muscle characteristics), cardiovascular risk factors (eg, hypertension, diabetes, dyslipidemia, obesity, physical activity level, and smoking status), and patient-reported outcomes (eg, body image, fatigue, mental health, and health-related quality of life) will be assessed at baseline, post intervention, and 24 months post intervention. Results A total of 209 patients were included from October 2020 to August 2022, and postintervention assessments were completed in January 2023. The 24-month follow-up will be completed in February 2025. Conclusions The findings from the CAUSE trial will provide novel scientific understanding of the potential benefits of exercise training in long-term breast cancer survivors. Trial Registration ClinicalTrials.gov NCT04307407; https://clinicaltrials.gov/ct2/show/NCT04307407 International Registered Report Identifier (IRRID) DERR1-10.2196/45244

• Lie, Hanne Cathrine; Anderssen, Sigmund Alfred; Rueegg, Corina Silvia; Raastad, Truls; Grydeland, May & Thorsen, Lene [Show all 21 contributors for this article] (2022). The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study. JMIR Research Protocols. 11(3). doi: 10.2196/35838. Full text in Research Archive Show summary

  Methods Results Discussion References Abbreviations Copyright Abstract Background: Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. Objective: The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). Methods: The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. Results: Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. Conclusions: The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation.

• Andries, Aristomo; Ørstavik, Kristin; Rueegg, Corina Silvia; Eng, Sindre; Edvardsen, Elisabeth & Allen, Sara-Maria [Show all 10 contributors for this article] (2022). Polynevropati hos barnekreftoverlevere. Full text in Research Archive
• Larsson, Petra; Skogestad, Ingrid Johansen; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene & Mack, Ulrich [Show all 9 contributors for this article] (2021). Association between fatigue and physical fitness three months after stroke. Full text in Research Archive
• Mjøs, Ingunn; Thorsen, Einar; Hausken, Trygve; Lied, Einar; Nilsen, Roy Miodini & Brønstad, Ingeborg [Show all 8 contributors for this article] (2020). Correction: The effect of low dose marine protein hydrolysates on short-term recovery after high intensity performance cycling: A double-blinded crossover study. Journal of the International Society of Sports Nutrition (JISSN). 17. doi: 10.1186/s12970-019-0324-5. Full text in Research Archive
• Risum, Kristine; Edvardsen, Elisabeth; Selvaag, Anne Marit; Molberg, Øyvind; Dagfinrud, Hanne & Sanner, Helga (2018). Kardiorspiratorisk form hos pasienter med juvenile idiopatisk artritt- en kontrollert tverrsnittsstudie. Full text in Research Archive
• Risum, Kristine; Edvardsen, Elisabeth; Selvaag, Anne Marit; Molberg, Øyvind; Dagfinrud, Hanne & Sanner, Helga (2018). Criterion validity and reliability of a submaximal treadmill test in juvenile idiopathic arthritis patients. Full text in Research Archive
• torvanger, ole; Os, Audun; Skjønsberg, Ole Henning & Edvardsen, Elisabeth (2018). Cardiorespiratory Fitness on a Treadmill in an adult Norwegian Cystic Fibrosis Population . Full text in Research Archive
• Jensenius, Alexander Refsum; Sparbo, Njål; Sen, Sagar & Edvardsen, Elisabeth (2018). Breath, breathing and the sensing of breathing. Full text in Research Archive
• Risum, Kristine; Edvardsen, Elisabeth; Selvaag, Anne Marit; Molberg, Øyvind; Dagfinrud, Hanne & Sanner, Helga (2016). Cardiorespiratory Fitness in Children with Juvenile Idiopathic Arthritis Treated in the Biological Era is Comparable with Controls: a Cross-Sectional Study. Full text in Research Archive
• Husøy, Anders; Bettum, Tora J; Frydenberg, Hanne; Lofterød, Trygve; Edvardsen, Elisabeth & Fjeldheim, Frøydis Nyborg [Show all 12 contributors for this article] (2016). Physical exercise in newly diagnosed breast cancer patients may counteract a decrease in cardiovascular capacity during adjuvant treatment. Full text in Research Archive
• Frydenberg, Hanne; Bettum, Tora J; Lofterøed, Trygve; Edvardsen, Elisabeth; Flote, Vidar Gordon & Finstad, Sissi Espetvedt [Show all 11 contributors for this article] (2014). Cardiorespiratory fitness (VO2max) before, during and after adjuvant treatment in breast cancer patients. Full text in Research Archive
• Anderssen, Sigmund Alfred; Edvardsen, Elisabeth; Hansen, Bjørge Hermann; Holme, Ingar Morten K & Dyrstad, Sindre Mikal (2014). Response. Chest. ISSN 0012-3692. 146(1), p. e30–e31. doi: 10.1378/chest.14-0712. Full text in Research Archive
• Berntsen, Sveinung; Carlsen, Kai-Håkon; Carlsen, Karin C Lødrup; Edvardsen, Elisabeth; Kolsgaard, Magnhild & Anderssen, Sigmund Alfred (2014). Do obese children achieve maximal heart rate during treadmill running? Full text in Research Archive
• Dyrstad, Sindre Mikal; Hansen, Bjørge Hermann; Edvardsen, Elisabeth & Anderssen, Sigmund Alfred (2014). Self-reported physical activity and differences in maximal oxygen uptake, waist circumference and accelerometer-measured physical activity. Full text in Research Archive
• Edvardsen, Elisabeth; Hansen, Bjørge Hermann & Anderssen, Sigmund Alfred (2013). Reference Values For Anaerobic Threshold And VE/VCO2 Slope On The Treadmill In A 20-85-year-old Population. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 45(5), p. 574–574. Full text in Research Archive
• Dyrstad, Sindre Mikal; Edvardsen, Elisabeth; Hansen, Bjørge Hermann & Anderssen, Sigmund Alfred (2012). Relationship between self-reported physical activity, objectively measured physical activity and physical fitness. Full text in Research Archive
• Edvardsen, Elisabeth; Hansen, Bjørge Hermann & Anderssen, Sigmund Alfred (2012). Classical End-criteria With Impact On Maximal Oxygen Uptake In A Population. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 44, p. 292–292. Full text in Research Archive
• Edvardsen, Elisabeth (2015). Cardiopulmonary exercise testing in health and disease: cardiorespiratory fitness in adults in Norway and in lung cancer patients undergoing surgery. Norges idrettshøgskole. ISSN 9788250205222. Full text in Research Archive Show summary

  Paper IV: Tatt ut av filen i Brage p.g.a. copyright-restriksjoner. / Not in the file in Brage because of copyright issues.

View all works in NVA