Aron Onerup

Scopus Publications

Potential for risk reduction of chronic health conditions through lifestyle in childhood cancer survivors
Aron Onerup, Qi Liu, Shizue Izumi, Stephanie B. Dixon, Rebecca M. Howell, et al.
Nature Communications, 2026
Childhood cancer survivors are at high risk for treatment-related chronic health conditions. How much of this risk can be attributed to lifestyle is not known. In this study, we assess associations between lifestyle and a range of chronic health conditions and estimate lifestyle-specific population attributable fractions for chronic health conditions in survivors and compare them to those of radiotherapy and chemotherapy. Here we show that unhealthy lifestyle is associated with higher risk for subsequent hypertension, dyslipidemia, diabetes, heart attack, heart failure, valvular disease, joint replacement, anxiety, depression, and impaired physical and mental quality of life. Disease proportions attributed to unhealthy lifestyle exceed those of chemotherapy and radiotherapy for hypertension, diabetes, joint replacement, anxiety, depression, and impaired physical and mental quality of life. Unlike previous cancer treatment exposures, lifestyle can be modified. We need to further develop and implement effective lifestyle interventions in childhood cancer survivors, promoting healthy weight and physical activity.
Standards for reporting research methods, interventions, and Outcomes in Surgical Prehabilitation studies (SOS-Prehab)
Chelsia Gillis, Daniel I McIsaac, Daniel Santa Mina, Stéphanie Chevalier, Gabriele Baldini, et al.
British Journal of Surgery, 2026
Background Prehabilitation, a process of building physiological reserve before surgery to improve postoperative outcomes, is a complex, multimodal intervention that requires rigorous evaluation in clinical trials. Incomplete reporting by such trials obscures essential intervention components and delivery contexts, hindering comparability and interpretability. This, in turn, limits clinical implementation and the replication or refinement of interventions by researchers. The aim of this study was to develop a reporting checklist for RCTs of prehabilitation. Methods A modified two-round Delphi process using the EQUATOR framework with 53 international experts across exercise, nutrition, psychological, and perioperative care disciplines was conducted. An initial checklist of candidate items was adapted from existing reporting standards, contextualized for prehabilitation, and iteratively refined through expert voting. Items rated eight to nine on a nine-point scale by ≥70% of participants in round two were classified as ‘essential’ and those rated seven were considered ‘important’. Results The final checklist comprised 40 items. Sixteen items were classified as ‘essential’ and 24 items were classified as ‘important’ for guiding comprehensive reporting of prehabilitation interventions. These items span key domains including intervention components, delivery methods, adherence, participant characteristics, and outcome measures. High agreement among experts underscores the checklist’s relevance and usability. Conclusion Adoption of Standards for reporting research methods, interventions, and Outcomes in Surgical Prehabilitation studies (SOS-Prehab), alongside methodological and outcome-reporting items of CONSORT could improve transparency, completeness, and interpretability of prehabilitation trials. This could enable better reproducibility, robust evidence synthesis, and accelerate translation into clinical practice and policy.
Potential of Exercise for Prevention of Cardiovascular Disease in Survivors of Childhood Hodgkin Lymphoma
Jacc Cardiooncology, 2026
Peri-operative counselling to increase physical activity of patients after bariatric surgery: findings and implications of a terminated trial
Monika Fagevik Olsén, Elizabeth Dean, Aron Onerup, Eva Angenete, Ville Wallénius, et al.
European Journal of Physiotherapy, 2026
Beyond P Values
Fariba Abbassi, Matthias Pfister, Julia Braun, Eva Angenete, Eva Haglind, et al.
Annals of Surgery, 2025
Objective: To estimate the Minimal Important Difference (MID) of the Comprehensive Complication Index® (CCI®) in patients undergoing abdominal surgery. Background: The CCI® is a validated metric that quantifies cumulative surgical morbidity. While the CCI® is a sensitive endpoint to detect treatment effects, a statistically significant effect does not necessarily translate into clinical relevance. Relevant differences from the patients’ perspective are best captured by the MID. Methods: Individual patient data were extracted from surgical studies reporting CCI® at 30 days and using Patient Reported Outcome Measures (PROMs) with established MIDs at baseline and 30 days. To determine the MID for the CCI® we used an anchor-based approach as recommended by methods guidelines. A PROM was selected as an anchor only if the Spearman correlation coefficient between its change in score (baseline to 30 d postoperative) and the CCI® was ≥|0.30|. We used linear regression to estimate the MID of the CCI® across different anchors, and triangulation to determine a single MID. Results: Data were extracted from three published randomized controlled trials (RCTs) and one prospective observational study (n=1583 patients) in major abdominal surgery. In colorectal surgery cohorts, two sub-scores of the Short Form-36, two sub-scores of the Multidimensional Fatigue Inventory-20, the EuroQol-5-Dimension Index Score, and the EuroQol Visual Analog Scale showed a correlation with the CCI® of ≥|0.30|. This resulted in MID estimates for the CCI® ranging from 6.1 to 22.2. In hepato-pancreato-biliary surgery, one sub-score of the Short Form-36, and two sub-scores of the PROM Information System-29 questionnaire qualified as anchors providing MID estimates ranging from 6.2 to 13.8. Conclusion: We propose a mean difference of 12 points in the CCI® between treatment groups as a relevant difference in patients undergoing abdominal surgery. This MID provides an important foundation for sample size calculations and interpretation of RCTs and large real world observational studies.
Body Mass Index, Physical Activity, and Subsequent Neoplasm Risk Among Childhood Cancer Survivors
Lenat Joffe, Sedigheh Mirzaei, Shalini Bhatia, Himani Darji, Kirsten K. Ness, et al.
JAMA Oncology, 2025
ImportanceHigh body mass index (BMI) and low physical activity levels are risk factors for adult-onset cancers. Limited data exist on their relationship with subsequent neoplasms among childhood cancer survivors.ObjectiveTo evaluate associations between time-varying BMI/physical activity and subsequent neoplasm risk among childhood cancer survivors.Design, Setting, and ParticipantsThis retrospective cohort analysis included 5-year childhood cancer survivors diagnosed younger than 21 years of age between 1970 and 1999, enrolled in the Childhood Cancer Survivor Study (CCSS), with follow-up through September 2019 at pediatric tertiary care hospitals in the US and Canada. The data analysis was performed between March 2021 and July 2024.ExposuresSelf-reported time-varying BMI and maximum reported physical activity (metabolic equivalent of task h/wk [MET-h/wk]) before any subsequent neoplasm development; first assessed at cohort entry and up to 6 times thereafter.Main Outcomes and MeasuresCumulative incidence by physical activity level and relative rates (RRs) by physical activity and time-varying BMI categories, adjusted for demographic and clinical variables, were estimated for any, subtype (hematologic, solid organ, central nervous system [CNS], skin), and specific (breast, thyroid, colorectal, meningioma) subsequent neoplasms using piecewise exponential models.ResultsOf 25 658 enrolled CCSS participants, 22 716 had BMI data before subsequent neoplasm development and met eligibility criteria for this study (46.3% female; median [range] attained age, 33.7 [5.7-67.3 years]). Among 22 716 survivors, 2554 subsequent neoplasms occurred among 2156 individuals (56.7% female; median [range] age at subsequent neoplasm diagnosis, 37.4 [13.7-63.3] years). Survivors reporting lower physical activity had higher 30-year subsequent neoplasm cumulative incidence: 18.6% (95% CI, 17.0-20.3) for 0 MET-h/wk vs 10.9% (95% CI, 9.9-12.1) for 15-21 MET-h/wk. Obese BMI was associated with increased incidence rates of solid organ (RR, 1.22; 95% CI, 1.01-1.46), CNS (RR, 1.47; 95% CI, 1.12-1.95), and skin (RR, 1.30; 95% CI, 1.13-1.50) subsequent neoplasms. Higher physical activity (15-21 MET-h/wk) demonstrated a protective association for any (RR, 0.61; 95% CI, 0.53-0.71), solid organ (RR, 0.65; 95% CI, 0.52-0.83), CNS (RR, 0.50; 95% CI, 0.35-0.70), and skin (RR, 0.72; 95% CI, 0.60-0.86) subsequent neoplasms. BMI and physical activity were specifically associated with subsequent meningiomas and thyroid carcinomas, but not with breast or colorectal cancers, nor hematologic subsequent neoplasms.Conclusions and RelevanceAmong childhood cancer survivors in this cohort study, obesity was associated with an increased risk for multiple subsequent neoplasm types, while higher physical activity was associated with reduced subsequent neoplasm risk. Lifestyle interventions should be considered in future subsequent neoplasm prevention research.
Is this the road to health? - The person in precision health
Stefan Nilsson, Helena Hansson, Philip Moons, Aron Onerup, Markus Saarijärvi, et al.
European Journal of Cardiovascular Nursing, 2025
Precision health and person-centred care (PCC) represent complementary approaches to improve healthcare. Precision health emphasizes personalized prevention and the early detection of disease, leveraging a data-driven biopsychosocial approach. PCC emphasizes patient autonomy, values, and holistic well-being. Integrating these paradigms can enhance healthcare by aligning advanced, data-driven precision with the individual engagement of PCC. This synthesis supports tailored treatments, patient participation, and equity while addressing challenges like workforce capacity, digitalisation, and health disparities. Successfully combining these models promises a responsive healthcare system, advancing both clinical outcomes and research methodologies through shared principles and innovative practices.
Movement efficiency in survivors of childhood acute lymphoblastic leukemia: a report from the St. Jude lifetime cohort study
Aron Onerup, Sedigheh Mirzaei S., Matthew D. Wogksch, Chelsea G. Goodenough, Genevieve Lambert, et al.
Journal of Cancer Survivorship, 2025
Purpose Movement efficiency, a measure of neuromuscular biomechanics, may be modified by physical activity. We aimed to assess the risk of and risk factors for low movement efficiency in survivors of childhood acute lymphoblastic leukemia (ALL). Methods Participants underwent an assessment of activity energy expenditure (AEE) with actigraphy, and the gold standard doubly labeled water, where the differences between elimination rates of oxygen and hydrogen from body water are evaluated over a week. Movement efficiency was assessed using the raw residuals of a linear regression between AEEs from accelerometers and doubly labeled water. Elastic-net logistic regressions were used to identify demographic, treatment, and functional variables associated with movement efficiency. Results The study cohort included 256 non-cancer controls and 302 ALL survivors (48% female), categorized as efficient (N = 24), normal (N = 245), or inefficient (N = 33) based on their movement efficiency. There was no difference in the odds for poor movement efficiency between survivors (n = 33, 10.9%) compared to controls (n = 23, 9.0%, odds ratio [OR]: 1.19, 95% confidence interval [CI]: 0.67, 2.10; p = 0.55). In survivors, neuropathy was associated with a higher risk of being inefficient compared to efficient (OR 4.30, 95% CI 1.03–17.96), while obesity (≥ 30 kg/m2) had a protective association (OR 0.18, 95% CI 0.04–0.87). Conclusions Neuropathy was associated with a higher risk of poor movement efficiency in survivors of childhood ALL. Implications for cancer survivors These results further highlight impairments associated with treatment-induced neuropathy in survivors of childhood ALL.
Supervised Physical Activity Interventions in Children and Adolescents with Cancer Undergoing Treatment—A Systematic Review
Nadja Battanta, Krystyna Lange, Sabine V. Kesting, Daniela Marx-Berger, Philip Heesen, et al.
Current Oncology, 2025
Background: A cancer diagnosis and its treatment often disrupt a child’s and adolescent’s normal level of physical activity, which plays a vital role in their development and health. They are therefore often less physically active during treatment than before the diagnosis or compared to healthy peers. Today, there is no comprehensive overview of the safety, feasibility, clinical effectiveness, and potentially long-lasting impact of physical activity (PA) interventions in this population. Methods: We conducted a systematic review in PubMed according to PRISMA guidelines to evaluate studies on PA interventions during cancer treatment in children and adolescents up to 25 years of age. We used the Joanna Briggs Institute’s critical appraisal tools to assess the risk of bias. Due to the heterogeneity in interventions and outcomes, we used descriptive approaches only to present the results. Results: Half of the 21 included studies were randomized controlled trials (10/21). PA interventions were found to be safe and feasible when tailored to the patient’s age, treatment phase, and clinical condition. Most studies reported improvements in physical fitness, strength, and quality of life, with some reductions in fatigue. Variability in interventions and outcomes, along with small sample sizes and heterogeneous patient populations, made it difficult to draw clear conclusions. Conclusions: PA appears to be a feasible and, in terms of injuries, safe adjunct to cancer treatment in children and adolescents. Despite promising trends, further large-scale, multicenter trials with standardized protocols are needed to better establish the long-term benefits and optimal interventions.
The burden of cardiovascular disease and risk for subsequent major adverse cardiovascular events in survivors of childhood cancer: a prospective, longitudinal analysis from the St Jude Lifetime Cohort Study
Rawan A Hammoud, Qi Liu, Stephanie B Dixon, Aron Onerup, Daniel A Mulrooney, et al.
Lancet Oncology, 2024
Long-term results of a short-term home-based pre- and postoperative exercise intervention on physical recovery after colorectal cancer surgery (PHYSSURG-C): a randomized clinical trial
Aron Onerup, Ying Li, Kevin Afshari, Eva Angenete, Hanna de la Croix, et al.
Colorectal Disease, 2024
Lifestyle and Subsequent Malignant Neoplasms in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort Study
Aron Onerup, Sedigheh Mirzaei, Shalini Bhatia, Maria Åberg, Megan E. Ware, et al.
Cancers, 2024
Associations between BMI in youth and site-specific cancer in men—A cohort study with register linkage
Aron Onerup, Kirsten Mehlig, Agnes af Geijerstam, Elin Ekblom‐Bak, Hans‐Georg Kuhn, et al.
Obesity, 2024
Lifestyle and subsequent meningioma in childhood cancer survivors: A report from the St. Jude Lifetime Cohort study
Aron Onerup, Sedigheh Mirzaei S., Shalini Bhatia, Megan E. Ware, Lenat Joffe, et al.
Cancer Reports, 2024
Cardiorespiratory fitness and BMI measured in youth and 5-year mortality after site-specific cancer diagnoses in men—A population-based cohort study with register linkage
Aron Onerup, Kirsten Mehlig, Elin Ekblom‐Bak, Lauren Lissner, Mats Börjesson, et al.
Cancer Medicine, 2023
Associations between cardiorespiratory fitness in youth and the incidence of site-specific cancer in men: A cohort study with register linkage
Aron Onerup, Kirsten Mehlig, Agnes af Geijerstam, Elin Ekblom-Bak, Hans Georg Kuhn, et al.
British Journal of Sports Medicine, 2023
Survival in relation to time to start of curative treatment of colon cancer: A national register-based observational noninferiority study
Daniel Rydbeck, David Bock, Eva Haglind, Eva Angenete, Aron Onerup
Colorectal Disease, 2023
The effect of nonsupervised physical activity before and after breast cancer surgery on quality of life: Results from a randomized controlled trial (PhysSURG-B)
Jenny Heiman, Aron Onerup, David Bock, Eva Haglind, Roger Olofsson Bagge
Scandinavian Journal of Surgery, 2022
Physical activity supports cardiovascular fitness and muscle strength and has positive effects on quality of life among cancer survivors
Lakartidningen, 2022
Association between self-assessed preoperative level of physical activity and postoperative complications – An observational cohort analysis within a randomized controlled trial (PHYSSURG-C)
Aron Onerup, Eva Angenete, David Bock, Eva Haglind
European Journal of Surgical Oncology, 2022
Effect of Short-term Homebased Pre- and Postoperative Exercise on Recovery after Colorectal Cancer Surgery (PHYSSURG-C): A Randomized Clinical Trial
Aron Onerup, John Andersson, Eva Angenete, David Bock, Mats Börjesson, et al.
Annals of Surgery, 2022
Comment on "the Impact of Prehabilitation on Patient Outcomes in Hepatobiliary, Colorectal, and Upper Gastrointestinal Cancer Surgery: A PRISMA-accordant Meta-analysis"
Aron Onerup, Eva Angenete, Eva Haglind
Annals of Surgery, 2021
Comment on "effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery with High Risk for Postoperative Complications: Results of a Randomized Clinical Trial"
Aron Onerup, Eva Angenete, Eva Haglind
Annals of Surgery, 2021
Correspondence regarding ‘Delay to elective colorectal cancer surgery and implications for survival: A systematic review and meta-analysis’
Aron Onerup, Daniel Rydbeck, David Bock, Eva Haglind, Eva Angenete
Colorectal Disease, 2021
Corrigendum: “Effects of a home-based exercise program on the insulin-like growth factor axis in patients operated for colorectal cancer in Sweden: Results from the randomised controlled trial PHYSSURG-C” (Growth Hormone & IGF Research (2020) 51 (27–33), (S1096637420300113), (10.1016/j.ghir.2020.01.005))
Aron Onerup, Sven-Egron Thörn, Eva Angenete, David Bock, Elin Grybäck Gillheimer, et al.
Growth Hormone and IGF Research, 2021
Recovery after breast cancer surgery following recommended pre and postoperative physical activity: (PhysSURG-B) randomized clinical trial
J Heiman, A Onerup, C Wessman, E Haglind, R Olofsson Bagge
British Journal of Surgery, 2021
Correction to: The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): study protocol for a randomised controlled trial (Trials, (2017), 18, 1, (212), 10.1186/s13063-017-1949-9)
Aron Onerup, Eva Angenete, David Bock, Mats Börjesson, Monika Fagevik Olsén, et al.
Trials, 2020
Effects of a home-based exercise program on the insulin-like growth factor axis in patients operated for colorectal cancer in Sweden: Results from the randomised controlled trial PHYSSURG-C
Aron Onerup, Sven-Egron Thörn, Eva Angenete, David Bock, Elin Grybäck Gillheimer, et al.
Growth Hormone and IGF Research, 2020
The use of a non-inferiority analysis to establish a safe timeframe for prehabilitation
Aron Onerup, David Bock
European Journal of Surgical Oncology, 2019
Self-assessed preoperative level of habitual physical activity predicted postoperative complications after colorectal cancer surgery: A prospective observational cohort study
Aron Onerup, Eva Angenete, Pierre Bonfre, Mats Börjesson, Eva Haglind, et al.
European Journal of Surgical Oncology, 2019
Physical activity on prescription in accordance with the Swedish model increases physical activity: A systematic review
Aron Onerup, Daniel Arvidsson, Åse Blomqvist, Eva-Lotte Daxberg, Lennart Jivegård, et al.
British Journal of Sports Medicine, 2019
Översikt visar på evidens för fysisk aktivitet på recept
Lakartidningen, 2018
The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): Study protocol for a randomised controlled trial
Aron Onerup, Eva Angenete, David Bock, Mats Börjesson, Monika Fagevik Olsén, et al.
Trials, 2017
Is preoperative physical activity related to post-surgery recovery?—a cohort study of colorectal cancer patients
Aron Onerup, David Bock, Mats Börjesson, Monika Fagevik Olsén, Martin Gellerstedt, et al.
International Journal of Colorectal Disease, 2016
Physical activity and exercise lower blood pressure in individuals with hypertension: Narrative review of 27 RCTs
Mats Börjesson, Aron Onerup, Stefan Lundqvist, Björn Dahlöf
British Journal of Sports Medicine, 2016
Is preoperative physical activity related to post-surgery recovery? A cohort study of Patients with breast cancer
Hanna Nilsson, Ulf Angerås, David Bock, Mats Börjesson, Aron Onerup, et al.
BMJ Open, 2016
The preoperative level of physical activity is associated to the postoperative recovery after elective cholecystectomy - A cohort study
Aron Onerup, Ulf Angerås, David Bock, Mats Börjesson, Monika Fagevik Olsén, et al.
International Journal of Surgery, 2015
Aerob fysisk aktivitet sänker blodtrycket vid hypertonic
Lakartidningen, 2015
Aerobic physical activity lowers blood pressure in hypertension
Lakartidningen, 2015

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Scopus Publications