In schizophrenia, subtle aberrations in the brain cause functional disturbances like psychotic symptoms and social disability. There are, however, also disturbances outside the CNS indicating a systemic manifestation in the disease. The aim of the present thesis was to gain deeper understanding of the pathophysiological mechanisms underlying schizophrenia with a particular interest in peripheral and systemic manifestations with relevance for the increased risk of obesity and metabolic complications seen in the disease. Therefore, resting energy expenditure (REE), physical capacity, and relevant body composition variables were measured in patients with schizophrenia and in healthy controls. Also niacin skin flush response and electrodermal activity (EDA) were studied. Patients with schizophrenia exhibited significantly lower REE expressed as kJ/kg, and also lower values compared with predicted levels than the controls. The difference could not be attributed to medication or variations in body composition between the two groups. There was a gender difference with the lowest levels found in male patients. Male patients exhibited significantly lower physical capacity in terms of predicted maximal oxygen uptake capacity and faster increase in respiratory quotient than male controls. The oral niacin test revealed a significantly delayed skin flush reaction in patients compared with controls. The patients also exhibited lower EDA response. There was a significant association in response patterns for the niacin and the EDA tests in the patients, but not in controls. In a test-retest study in patients there was acceptable stability for EDA measures but low test-retest stability for niacin variables. The previously found association in responses for the two tests was, however, replicated. The results gain support for the concept of schizophrenia as a disease with systemic manifestations including metabolic dysregulation. The findings add to the understanding of the weight gain and the increased risk for cardiovascular morbidity seen in this condition.

Chronic obstructive pulmonary disease, COPD, places a substantial burden of disability on the growing number of patients and causes large costs for the society. Tobacco smoke is the most important risk factor. Progressive exertional dyspnea is the major symptom which leads to diminished physical and social activities, reduced physical capacity and decreased health related quality of life, HRQoL. The aim of this thesis was to evaluate different physical training modalities in patients with COPD with regard to physical capacity and HRQoL. Patients with moderate to severe COPD were included in the studies. In the first intervention, 20 patients trained on a treadmill with or without supplemental oxygen, three times per week, during eight weeks. In the second intervention, 30 patients were randomised to high-intensity group training either in water or on land, and 13 patients were included in a control group. The patients in the water and land groups trained three times per week during three months and once a week during the following six months. Oxygen supplementation during physical training did not enlarge the positive effects of the same training with air in patients with exercise-induced hypoxaemia. Both groups improved the distance walked after training. High-intensity group training in water and on land was found to be effective with regard to walking distance and HRQoL compared to the control group. Training in water seemed to be of greater benefit compared to training on land concerning walking distance and experienced physical health when the training was accomplished three times per week. The thigh muscle strength increased after training in both the water and the land group. The muscle endurance in knee extension was low in the majority of the patients and was not improved after the training intervention. An evaluation of the long-term effects of physical group training and the effects of decreased training frequency showed that training with low frequency (once a week) during six months did not seem to be sufficient to maintain the level achieved after a three months period of higher frequency training (three times per week). However, the two periods combined seemed to prevent decline in physical capacity and HRQoL compared to baseline. The conclusion is that physical training is of benefit for patients with COPD with regard to physical capacity and HRQoL. Training can be performed individually or in groups, with high intensity, in water and on land. It is also concluded that the training can, under controlled conditions, be performed without supplemental oxygen even in patients with exercise-induced hypoxaemia.

The aim of the current work was to analyze the structure of training in the four – year Olympic cycle (2001 – 2004), the achieved results and to assess the dynamics of sportsmen`s physical and functional abilities over the period. The dynamics of the physical and functional abilities over the annual cycle of training was analyzed on an example of A.Z. and E.K., the most efficient Lithuanian modern pentathlonists. We analyzed physical load in 2001 – 2004 and the results achieved in the same year, the dynamics of physical development, such as body mass, muscle and fat mass, lung volume, muscular power in different zones of energy production. The efficiency on anaerobic alactic energy production mechanisms was determined by measuring single muscle contraction power (SMCP) and anaerobic alactic muscular power (AAMP). The functional capacity of the circulatory and respiratory systems was assessed by the Roufier index (RI). By fixing the speed on a running-track, pulse rate and lactate concentration in blood we determined the intensity of bioenergetic processes at the anaerobic metabolism threshold limit. Also, aerobic capacity at the critical intensity limit and anaerobic metabolism threshold limit were determined. The physical development indices of these sportsmen changed little over the annual cycle of training. In both sportsmen, muscular power under short work remained stable at the level years and showed little change throughout the competition period up to its culmination... [to full text]

The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions. This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells.  What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system. If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual.  This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual. / digitalisering@umu

Nugaros skausmas gydomas taikant kompleksines reabilitacijos priemones, tačiau ir po jų taikymo kai kuriem pacientams išlieka vidutinio intensyvumo skausmas ir gyvenimo kokybė pagerėja ne visose srityse. Šio darbo tikslas yra nustatyti, kuriose sveikatos srityse po sėkmingo II reabilitacijos etapo įveikimo, išlieka tam tikri apribojimai ir nustatyti individualios kineziterapijos programos poveikį su sveikata susijusiai gyvenimo kokybei ir skausmo intensyvumui. / Back pain is treated through complex rehabilitation measures, however, some of health indicators remains unchanged. The goal of this study is to determine which health indicators remains impaired at the end of 2nd stage of rehabilitation, and to determine the effectiveness of individual physical therapy programme for quality of life and pain intensity.

Esclerose sistêmica (ES) é uma doença autoimune caracterizada por fibrose cutânea associada a envolvimento visceral, levando a diminuição da capacidade física, limitação no desempenho das atividades de vida diária e prejuízo na qualidade de vida. O transplante autólogo de células-tronco hematopoéticas (TACTH) vem sendo estudado como uma alternativa terapêutica para pacientes com ES, proporcionando melhora do acometimento cutâneo e ao menos estabilização do quadro pulmonar. O objetivo deste estudo é avaliar o impacto do TACTH no acometimento da pele, capacidade funcional e qualidade de vida em pacientes com ES. Trata-se de um estudo longitudinal e prospectivo, conduzido no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Os pacientes com ES submetidos ao TACTH foram avaliados inicialmente, e reavaliados 6 e 12 meses após o tratamento. A avaliação consistiu dos seguintes itens: acometimento da pele, avaliado pelo escore modificado de Rodnan (mRSS), função pulmonar (capacidade vital forçada, CVF e capacidade de difusão do monóxido de carbono, DLCO), força muscular respiratória (pressão inspiratória máxima - PImáx, e pressão expiratória máxima - PEmáx), mobilidade tóraco-abdominal pela cirtometria, avaliação funcional dos membros superiores (força de preensão das mãos, amplitude de movimento pela goniometria, distância finger-to-palm - FTP, questionários Disabilities of the arm, shoulder and hands - DASH, e Cochin hand functional scale - CHFS), abertura oral, teste de caminhada de seis minutos (TC6) e questionário de qualidade de vida Medical Outcomes Study - 36 item short-form (SF-36). Vinte e sete pacientes com ES foram avaliados antes e 6 meses após o transplante, e 22 desses pacientes foram adicionalmente avaliados aos 12 meses pós-transplante. Quando comparadas com os valores iniciais, pré-transplante, observou-se melhora significativa das variáveis mRSS, PImáx, PEmáx, cirtometria, força de preensão das mãos dominante e não-dominante, amplitudes de movimento articulares, FTP das mãos dominante e não-dominante, DASH, CHFS, abertura oral, distância percorrida no TC6, domínios capacidade funcional, aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais e saúde mental do SF-36 e medidas sumárias de componentes físico e mental do SF-36, após o transplante. Houve estabilização da função pulmonar após o transplante. Houve correlação significativa entre o mRSS e medidas de amplitude de movimento de punho, entre a capacidade física avaliada pelo TC6 e o componente físico do SF-36 e entre o questionário DASH e o componente físico do SF-36. Em conclusão, o TACTH promove melhora significativa do acometimento da pele, da capacidade funcional e da qualidade de vida de pacientes com ES, até pelo menos 1 ano de seguimento após o transplante. Embora a função pulmonar tenha apenas se estabilizado, os pacientes apresentaram significativa melhora da capacidade física. / Systemic sclerosis (SSc) is an autoimune disease characterized by skin fibrosis, associated with internal organ involvement, leading to decreased physical capacity, limitations in daily life activities and impairment of quality of life. Autologous hematopoietic stem cell transplantation (AHSCT) has been studied as an alternative treatment for patients with severe SSc, and promotes improvement of skin involvement and, at least, pulmonary function stabilization. The aim of this study is to evaluate the impact of AHSCT in skin involvement, functional capacity and quality of life in SSc patients. This is a prospective and longitudinal study, conducted at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, University of São Paulo. SSc patients were evaluated before, and 6 and 12 months after transplant for skin involvement by modified Rodnan skin score (mRSS), pulmonary function (forced vital capacity, FVC, carbon monoxide diffusion capacity, DLCO), respiratory muscle strength (maximal inspiratory pressure - MIP, and maximal expiratory pressure - MEP), thoracoabdominal mobility by cirtometry, functional evaluation of upper limbs (hand grip strength, range of motion by goniometry, finger-to-palm distance - FTP, Disabilities of the arm, shoulder and hands questionnaire - DASH, and Cochin hand functional scale questionnaire - CHFS), mouth opening, six-minute walk test (6MWT) and quality of life by the Medical Outcomes Study - 36 item short-form (SF-36). Twenty-seven patients were evaluated before and at 6 months after transplant, 22 of which were additionally evaluated at 12 months after transplant. When compared to pre-transplant evaluations, patients presented significant improvement of mRSS, MIP, MEP, cirtometry, hand grip strength, range of motion measurement, FTP distance, DASH, COCHIN, mouth opening, distance in 6MWT, physical functioning, role-physical, bodily pain, general health, vitality, social functioning and mental health domains of SF-36, and summary measures of the SF-36 Physical Component score and Mental Component score after AHSCT. The pulmonary function stabilized after transplant. Significant correlations were observed between skin involvement and range of motion measures, physical capacity and quality of life, and DASH and quality of life. In conclusion, AHSCT significantly improves the functional status of SSc patients in the first year of follow-up. Although the pulmonary function remained stable after AHSCT, there was significant increase in the physical capacity of patients.

Bakgrund För patienter med kranskärlssjukdom rekommenderas hjärtrehabilitering och regelbunden fysisk träning som en viktig del av behandlingen. Dessa patienter är ofta påverkade både fysiskt och psykologiskt av sin sjukdom vilket kan vara utmanande för en hälsoförändring. Självförmåga är ett viktigt begrepp i hälsoförändringsarbetet och har visat sig vara en stark prediktor för fysisk aktivitet hos dessa individer. Hjärtrehabilitering har visats inverka positivt på denna, men det finns bristfällig evidens för vilken typ av träning som har bäst effekt på dessa patienters självförmåga och även om denna skiljer sig mellan könen.  Syfte Syftet med studien är att visa patienters fysiska kapacitet efter tolv veckors hjärtrehabilitering, deras självförmåga till fysisk aktivitet och eventuella korrelation mellan dessa variabler, samt skillnader mellan könen.  Metod Data gällande styrka i övre och nedre extremitet samt konditionsvärde och ESES-skattning för 56 patienter som nyligen genomgått hjärtrehabilitering sammanställdes och analyserades från ett pågående forskningsprojekt.  Resultat Män hade högre fysisk kapacitet än kvinnor, men kvinnor skattade sin självförmåga något högre. Det fanns ett signifikant samband (p<0,001) mellan kvinnors självförmåga och styrka, och det observerades en korrelation mellan självförmåga och styrka för män (p=0,0501).  Konklusion Den här studiens resultat visar att styrka har tydligt större koppling än kondition till självförmåga för fysisk aktivitet hos framförallt kvinnliga hjärtpatienter efter avslutad hjärtrehabilitering. Detta kan peka mot att mer fokus kan behövas riktas mot styrka i hjärtrehabilitering. / Background It is recommended that patients with coronary artery disease undergo cardiac rehabilitation and regular physical exercise as part of the treatment. These patients are often physically and psychologically affected by their disease which can make a health change challenging. Self-efficacy is an important concept in the area of health behaviour change and has been shown to strongly predict physical activity among these patients. Heart rehabilitation has been shown to positively impact said self-efficacy, but there is a lack of evidence regarding whether and if so what type of exercise that most influences it, and if there are any gender differences in this concern. Purpose The aim of the study was to investigate the physical capacity, self-efficacy for physical activity and the potential correlation between these variables among patients who had undergone a 12-week heart rehabilitation, plus any correlation between these variables. Furthermore, the possible gender differences regarding said questions were examined.  Method Data regarding upper and lower extremity strength as well as aerobic capacity and self-efficacy score for 56 patients who had recently undergone cardiac rehabilitation and who participated in an ongoing research project was compiled and analysed. Results Men had higher physical capacity than women, but women rated their self-efficacy slightly higher. There was a significant correlation (p <0.001) between women's self-efficacy and strength, and a correlation was seen between self-efficacy and strength for men (p = 0.0501).  Conclusion The results of this study show that strength is clearly more closely linked to self-efficacy than aerobic capacity among individuals after completing cardiac rehabilitation, and especially among females. This may indicate that more focus could be needed to be directed towards strength training in cardiac rehabilitation.

INTRODUÇÃO: O benefício de um programa de treinamento físico em pacientes com insuficiência cardíaca tem sido bastante documentado. Contudo, pouco se conhece a respeito dos benefícios de um programa de treinamento fisco nãosupervisionado na qualidade de vida, capacidade física e no controle neurovascular, após uma fase inicial de treinamento físico supervisionado. Foi ainda objetivo deste estudo, analisar a efetividade de um programa de atividade física na redução dos níveis de catecolaminas plasmáticas, NT-ProBNP e Interleucina 6 em pacientes com disfunção ventricular na vigência de betabloqueadores. MÉTODOS: Trinta pacientes (idade 54±1,7 anos) com disfunção ventricular esquerda acentuada foram inicialmente selecionados para o estudo. Os pacientes foram divididos em 2 grupos: o grupo controle (n=12); e o grupo treinamento físico (n=18). No início do estudo todos tiveram a qualidade de vida avaliada pelo questionário de Minnesota, e foram dosados os níveis de Interleucina 6, NT-ProBNP, e catecolamina plasmática. A atividade nervosa simpática muscular foi registrada diretamente no nervo fibular através da técnica da microneurografia. O fluxo sangüíneo muscular em antebraço foi avaliado pela técnica da pletismografia de oclusão venosa. Ambos os procedimentos foram registrados em repouso e durante o exercício isométrico a 30% da contração voluntária máxima. A capacidade física foi avaliada por meio da ergoespirometria. O grupo treinamento foi submetido inicialmente a quatro meses de treinamento físico supervisionado composto por 3 sessões de 60 minutos por semana, mantendo uma freqüência cardíaca correspondente a 10% abaixo do ponto de descompensação respiratória determinado pela ergoespirometria. Após a fase de treinamento físico supervisionado, os pacientes foram orientados a realizar quatro meses adicionais de treinamento físico de forma não-supervisionada, na mesma freqüência e intensidade determinadas durante a fase de treinamento supervisionado. A medida da qualidade de vida, atividade nervosa simpática muscular, fluxo sangüíneo muscular e análise laboratorial foram repetidas em 4 meses em ambos os grupos e no oitavo mês apenas no grupo submetido ao treinamento físico. RESULTADOS: Após os quatro primeiros meses, o grupo treinado apresentou melhora na qualidade de vida comparado ao grupo controle (39±6 vs 42±5 pontos; p=0,014). A atividade nervosa simpática muscular em repouso e durante o exercício isométrico a 30% da contração voluntária máxima também apresentaram melhora (47±5 vs 73±6 impulsos/ 100 bat; p=0,0052) e (61±5 vs 77±6 impulsos/ 100 bat; p=0,034), respectivamente. O fluxo sangüíneo muscular em antebraço em repouso aumentou no grupo treinado (1,96±0,11 vs 1,51±0,12 ml/min/100 ml tecido; p=0,015). Quatro meses de treinamento físico não-supervisionado foram efetivos na manutenção dos benefícios na qualidade de vida (52±6 vs 36±6 vs 33±5 pontos; p=0,0001), no fluxo sangüíneo muscular em antebraço, tanto em repouso (1,62±0,47 vs 1,93±0,56 vs 2,18±0,63 ml/min/100 ml tecido; p=0,03) como durante o exercício isométrico (2,04±0,11 vs 2,69±0,18 vs 2,74 ±0,2 ml/min/100 ml tecido; p=0,0016) e na capacidade física (71±9 vs 84±9 vs 88±9 Watts; p=0,0073). Não houve diferença nas medidas seriadas de NTProBNP, Interleucina 6 e de catecolaminas plasmáticas. CONCLUSÕES: O treinamento físico não-supervisionado por quatro meses, após uma fase de treinamento físico supervisionado, foi efetivo na manutenção dos benefícios na qualidade de vida, capacidade física e no fluxo sangüíneo muscular em antebraço. Não houve diferença nas medidas laboratoriais dos pacientes com disfunção ventricular esquerda treinados por oito meses / INTRODUCTION: The benefits of a physical training program in patients with heart dysfunction have been well described. However little is know about the response of a home-based exercise training in quality of life, physical capacity and neurovascular control in patients with heart failure, after a initial four months supervised training. The second objective of this study was to analyze the effectiveness of a exercise program on catecholamine, NT-ProBNP and Interleukin 6 in patients with heart dysfunction receiving beta-blockers. METHODS: Thirty patients (age 54±1,7 years) with severe heart dysfunction were initially enrolled in the protocol. They were divided in two groups; a control group (n=12) and a exercise group (n=18). Initially, both group had the measuring of quality of life by Minnesota questionnaire, Interleukin 6, NT-ProBNP and catecholamine. Muscle sympathetic nerve activity was recorded directly from fibular nerve using the technique of microneurography. Forearm blood flow was measured by venous plethysmography. Both procedures were recorded at rest and during 30% of maximal isometric contraction. The exercise group was submitted initially to fourmonths supervised exercise training program consisted of three 60 min exercise XXIX sessions per week, at heart rate levels that corresponded up to 10% below the respiratory compensation point. After the supervised period, the exercise group was instructed to perform an additional four-months home-based exercise training in the same frequency and intensity they had usually done. The quality of life, muscle sympathetic nerve activity, forearm blood flow and laboratory analysis were repeated at four months in both groups and only in the exercise group at eight months. RESULTS: After the initial 4 months the exercise group improved the quality of life compared to the control group (39±6 vs 42±5 units; p=0,014). The muscle sympathetic nerve activity at rest and during 30% of the maximum isometric contraction was also improved (47±5 vs 73±6 bursts/100 heart beat; p=0,0052) and (61±5 vs 77±6 bursts/100 heart beat; p=0,0276), respectively. The forearm blood flow at rest reduced in the exercise group (1,96±0,11 vs 1,51±0,11ml/min/100 ml tissue; p=0,015). An additional 4 month home-based exercise training was effective on the maintenance of the benefits on quality of life ( 52±6 vs 36±6 vs 33±5 points; p=0,0001), forearm blood flow at rest (1,62±0,47 vs 1,93±0,56 vs 2,18±0,63 ml/min/100 ml tissue; p=0,03), and during 30% of the maximum isometric contraction (2,04±0,11 vs 2,69±0,18 vs 2,74 ±0,2 ml/min/100 ml tissue; p=0,0016) and on physical capacity (71±9 vs 84±9 vs 88±9 Watts; p=0,0073). There was no difference on the measurements of NT-ProBNP, Interleukin 6 and catecholamine. CONCLUSIONS: A home-based exercise training for four months, after a supervised phase, was effective on the maintenance of the benefits of quality of life, physical capacity and forearm blood flow. There was no difference on the laboratorial measurements after an eight months physical training on patients with heart dysfunction

Syfte och frågeställningar Studiens syfte är att undersöka relationen mellan ungdomsmålvakters resultat i vanligt förekommande standardtester som är avsedda att mäta fysisk kapacitet och deras prestation i matchlika aktioner. Syftet är också att undersöka om resultaten skiljer sig mellan målvakter i två olika ålderskategorier. Frågeställningar: Vad är korrelation mellan resultat i standardtester och matchlika aktioner? Skiljer sig resultaten mellan ungdomsmålvakter på U17 och U19 nivå? Metod För att svara på studiens frågeställningar skapades ett testbatteri innehållande fysiska tester designade för fotbollsmålvakter, utifrån deras rörelsemönster och aktioner (verklighetsnära tester), som jämförs med tester som används av dagens fotbollsklubbar (standardtester). Med hjälp av aktuellt forskningsläge tillsammans med information som mottagits från tränare och målvakter, utfördes 6 tester, på 15 målvakter, som registrerades med mätinstrument och höghastighetskameror. Resultatet analyserades med dubbelsidig t-test för att finna en statistisk signifikans mellan två åldersgrupper och Spearmans test för att finna en korrelation mellan standard- och verklighetsnära testerna. Resultat Resultatet från t-testet visade ingen signifikant skillnad mellan U17:s och U19:s målvakter på samtliga tester (p> 0,05). Spearmans test visade ingen statistiskt signifikant korrelation mellan testerna. Slutsats Både standard- och verklighetsnära testerna har sina fördelar men är syftet att utvärdera målvaktens fysiska kapacitet i matchlika situationer genom tester, bör dessa vara utformade utifrån målvaktens agerande under match. Enligt resultaten från denna studie visar detta att man inte enbart kan använda standardtester utan dessa bör kompletteras med tester specifikt utformade för måvakter. / Aim The aim of the study is to investigate the relationship between youth goalkeepers' results in commonly used standard tests that are intended to measure physical capacity and their performance in match-like actions. The purpose is also to investigate whether the results differ between goalkeepers in two different age categories. Research questions: What is the correlation between results in standard tests and match-like actions? Do the results differ between youth goalkeepers at U17 and U19 level? Method To answer the study's questions, a test battery was created containing physical tests designed for football goalkeepers based on their movement patterns and actions (match-like actions) compared to tests used by today's football clubs (standard tests). With the help of research, together with information we received from coaches and goalkeepers, 6 tests were designed and performed, on 15 goalkeepers, which were recorded with measuring instruments and high-speed cameras. The results were analyzed with two tailed t-test to find a statistical significance between the two age groups and Spearman's test to find a correlation between the standard and realistic tests. Results The results of the t-test show no significant difference between the U17 and U19 goalkeepers on all tests (p> 0.05). Spearman's test shows that there was no statistic significant correlation between the tests. Conclusions Both standard and realistic tests have their advantages, but if the purpose is to evaluate the goalkeeper's physical capacity in match-like actions through tests, should these be designed based on the goalkeeper's actions during the match. According to the results of this study, this shows that you should not just use standard tests, but these should be supplemented with tests specifically designed for goalkeepers.

Although musculoskeletal disorders (MSDs) and other health complaints are an occupational problem for ambulance personnel, there is a lack of knowledge regarding work-related factors associated with MSDs and other health complaints. The overall aim of this thesis was to investigate the relationships between occupational demands, individual characteristics and health-related outcomes among ambulance personnel. A random sample of 234 female and 953 male ambulance personnel participated in a national questionnaire survey on work-related factors, and musculoskeletal and other health complaints. Physical demands was associated with activity limitation due to neck-shoulder and low-back complaints among the female personnel. Among the male personnel, physical demands was associated with low-back complaints and activity limitation due to low-back complaints. Psychological demands was significantly associated with neck-shoulder complaints, sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Worry about work conditions was associated with musculoskeletal disorders and sleeping problems, headache and stomach symptoms. A local sample of 26 ambulance personnel was followed during a 24-hour work shift and for the next two work-free days. Subjective stress- and energy levels, and cortisol levels were measured at regular intervals, and heart rate was registered continuously by electrocardiogram (ECG). Autonomic reactivity to standardized tests before (pre-work) and at the end of the work shift (post-work) was also investigated. For the whole group, baseline values of heart rate were higher pre-work than post-work, but autonomic reactivity did not differ. Increased reactivity to the mental test, modest deviation in heart rate variability (HRV) pattern during the late night hours at work and higher morning cortisol values during work than during leisure time were observed in personnel with many health complaints, but not among their co-workers without or with few complaints. Ambulance personnel with many health complaints also reported higher psychological demands and tended to be more worried about work conditions. Heart rate (HR), lactate level (LL) and perceived exertion (RPE) were investigated in 17 female and 48 male ambulance personnel during a simulated standardized work task “carry a loaded stretcher”. The ambulance personnel had to carry the loaded stretcher (920 N) up and down three flights of stairs twice. The high physiological strain (HR, LL, RPE) for the male, and near or at maximal strain for the female ambulance personnel, implied the importance to identify what kind of physical capacity is most important for ambulance personnel. Therefore, the explained variance of developed fatigue by tests of cardiorespiratory capacity, muscular strength and endurance, and coordination was investigated. The results showed that VO2max and isometric back endurance were important predictors for development of fatigue when carrying a loaded stretcher. The influence of body size on the relationships between maximal strength and functional performance was investigated in a methodological study. The results confirm that the assessment of physical performance could be confounded by the body weight. Therefore, the models for explaining development of fatigue when carrying the loaded stretcher were adjusted for height and weight. Including height in the models significantly increased the explained variance of accumulated lactate among female, but not among male personnel. Lactate levels were higher among short compared to tall female personnel. Weight had no effect on any of the models. In conclusion, the national survey showed that self-reported physical demands was a risk factor of having MSDs, and that self-reported psychological demands and worry about work were important risk factors of having MSDs and other health complaints. Stress monitoring of ambulance personnel during work and leisure time showed that physiological and subjective stress markers did not show any differences between the 24-hour ambulance work shift and leisure time afterwards. However, ambulance personnel with many health complaints had certain physiological changes during the work shift in comparison with the next two work-free days. The physiological and subjective responses during carrying a loaded stretcher, especially among the female ambulance personnel, showed that female and male ambulance personnel could be exposed to internal exposures at different levels when performing the same work task. A better understanding of the relationships between occupational demands and health-related outcomes require further studies on age- and gender matched groups in long-term perspective studies.