Background Overweight and obesity in childhood is associated with physical, psychological and social consequences. Physical inactivity is regarded as one of the main factors that have contributed to the increase in childhood obesity through out the world. Overweight and obesity as well as physical activity level are shown to track from childhood to adolescence and adulthood, thereby influencing not only the current health status but also long-term health. The general purpose of this thesis was to evaluate the effect of a 2-year family-based lifestyle intervention on physical activity and metabolic health among children with overweight and obesity. Methods Children with overweight or obesity living in northern Sweden were recruited to the study. In total 105 children, mean age 10.5 years (SD±1.09), were randomized into either an intervention or a control group. The intervention group was offered as a 2-year family-based lifestyle intervention; the 1st year consisted of 14 group sessions and during the 2nd year the intervention was web-based. The control group did not participate in any intervention sessions, but performed all measurements. Physical activity was measured in all children using SenseWear Pro2 Armband (SWA) during 4 consecutive days before, in the middle and after the intervention, data regarding anthropometrics and blood values were collected in the same periods. Twenty-two of the children wore SWA during 14 days before the intervention in order to validate energy expenditure (EE) estimated by SWA against EE measured with double labelled water. Results The SWA, together with software version 5.1, proved to be a valid device to accurately estimate EE at group level of overweight and obese children. There were no statistically significant differences between the groups neither before nor after the intervention regarding physical activity and screen-time. All children significantly decreased their time being active ≥3 METs during the study period. After the study period, significantly fewer in the control group achieved the national physical activity recommendation, and they had significantly increased their screen-time. However, these changes were not seen within the intervention group. The intervention group had a significantly lower apolipoprotein B/A1 compared to the control group at 1-year measurement; no other significant differences were found regarding metabolic markers. No statistical difference was found between the groups regarding body mass index after the 2-year study period. Conclusion Even though a comprehensive program, the 2-year family-based lifestyle intervention had limited effects on physical activity and metabolic health in overweight and obese children. SWA is a device that can be used in future studies to measure energy expenditure among free-living overweight or obese children. / SELFH

ABSTRACT Background: There are many studies of stretching and its effects on the body. Research shows that stretching can have both positive and negative effects on the body. Meantime there are no qualitative studies on stretching and how the opinion of stretching is among soccer players. Female soccer players are a group that is rapidly growing and that is injured to a great extent. Purpose: To describe stretching exercising female soccer players’ opinion of stretching. Method: Ten stretching exercising female soccer players over fifteen years of age from two teams were interviewed in a semi-structured interview. The recordings were analyzed through a qualitative content analysis containing a process of abstraction. Results: The participants’ said that there are specific body- and surrounding factors that affects them to exercise stretching. The participants say that when they exercise stretching they follow a specific pattern. They also said that they have been given to little and that they would like more information of stretching. The participants’ talk about the knowledge they have about stretching from their own experiences of exercising stretching. Conclusion: The participants’ opinion of stretching varies like results found in previous research. This study also shows that the participants’ would like more information about stretching and that they find that other people largely affect them to exercise stretching. Further research is needed about to be able to generalize the results found in this study and to deepen the understanding of the topic.

Syftet med studien var att undersöka hur patienter upplevde en sjukgymnasts metodik i samband med utlärningen av hemträningsprogram de fått ordinerade i rehabiliterande syfte för sina skador. Dessutom undersöktes hur väl sjukgymnastens metodik gällande hemträningsprogram stämde överens med tidigare forsknings rekommendationer, och ifall samband kunde ses mellan patienternas följsamhet och de faktorer som påverkar den. Undersökningen var en modifierad fallstudie och genomfördes med relativt högt strukturerade telefonintervjuer. Undersökningsgruppen bestod av sju patienter som alla hade ordinerats hemträningsprogram ifrån samma sjukgymnast, för olika typer av skador. Resultatet av studien visade på att patienterna upplevde mottagningens metodik som väl fungerande. Sjukgymnastens metodik stämde även väl överens med tidigare forskningsrekommendationer för en hög följsamhet utav träningsprogrammen bland patienterna. Samband mellan patienternas följsamhet och tidigare forsknings rekommendationer visade sig vara starka. / The purpose of this study was to examine how patients experienced the methodology concerning the home exercise programmes they have been prescribed by a physiotherapist in rehabilitation purpose due to their injuries. Furthermore it was examined how well the methodology regarding the home exercise programmes made by the physiotherapist agreed with recommendations according to previous research studies, and if a connection could be drawn to the patients’ determination to comply with the exercise programmes. The study was a modification of a case study and it was conducted by relatively high structured telephone interviews. The target group for the study consisted of seven patients, all which had been prescribed with home exercise programmes by the same physiotherapist due their different injuries. The result of the study implies that the patients experienced the methodology of the physiotherapist reception as well-functioning. The methodology of the physiotherapist was also fall in line with what previous recommendations from scientific studies regards important in order to achieve a high compliance of the exercise programmes among the patients. The connection between the compliance of the patients and recommendations made based on previous studies appears to be highly related.

Sammanfattning: Alltfler människor blir alltmer fysiskt inaktiva och riskerar därmed att drabbas av vällevnadssjukdomar. Personer med reumatoid artrit (RA) är mer fysiskt inaktiva än befolkningen i stort. Trots den medicinska utvecklingen får personer med RA nedsatt ledrörlighet, muskelfunktion och balans. Att öka deras fysiska aktivitetsnivå skulle kunna förbättra dessa parametrar samt minska deras risk att drabbas av vällevnadssjukdomar i framtiden. Syfte: Syftet var dels att kartlägga nivån av självskattad fysisk aktivitet, hälsa och tilltro till egen förmåga hos personer med nydebuterad RA dels att undersöka samband fysisk aktivitetsnivå och hälsa respektive tilltro till egen förmåga. Metod: I en tvärsnittsstudie skickades enkäter ut till 88 personer med nydebuterad RA. Samtliga hade insjuknat mellan 2003 och 2005 och deltog i tidig artrit mottagningen på Reumatologiska kliniken på Universitetssjukhuset i Örebro. Resultat: 61 personer (69 %) svarade på enkäten. 50 % riskerar försämrad hälsa och risk att drabbas av vällevnadssjukdomar på grund av låg nivå av fysisk aktivitet. Låga, men i några fall signifikanta samband hittades mellan fysisk aktivitetsnivå och hälsa respektive tilltro till egen förmåga. Ju mer fysiskt aktiv man skattade att man var desto bättre hälsa upplevde man inom områdena rollfunktion – fysiska orsaker, smärta, allmän hälsa, social funktion och den psykiska dimensionen (r=0.27-0.37). Ju högre man hade graderat sin fysiska aktivitetsnivå desto högre tilltro hade man till att kunna hantera andra symptom som till exempel trötthet, nedstämdhet och besvikelse (r=0.28-0.39). Sökord: Reumatoid artrit, fysisk aktivitet, hälsa, egen förmåga

The main purposes of this thesis were to evaluate a high-intensity functional weight-bearing exercise pro­gramme, regarding its applicability (attendance, achieved intensity, adverse events) as well as its effect on physical functions and activities of daily living (ADL) among older people living in residential care facilities, with a special focus on people with dementia. Furthermore, a main purpose was to systematically review the applicability and effects of physical exercise on physical functions, cognitive functions, and ADL among people with dementia. A high-intensity functional weight-bearing exercise programme that includes lower-limb strength and balance exercises in standing and walking, was evaluated in a randomised controlled trial among 191 older people, dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ten or more. One hundred (52.4%) of the participants had dementia. Participants were randomised to an exercise programme or a control activity, consisting of 29 supervised sessions over 3 months, as well as to an intake of a protein-enriched energy supplement or a placebo drink immediately after each session. The effect on physical functions was evaluated using the Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in a leg press machine measuring lower-limb strength. The effect on ADL was evaluated using the Barthel Index. These outcome measures were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. The evaluation of the applicability of the high-intensity functional weight-bearing exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and all except two adverse events were assessed as minor or temporary and none led to manifest injury or disease. No statistically significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, the applicability of the programme was not associated with the participants’ cognitive function. Significant long-term effects of the exercise programme were seen regarding functional balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. Age, sex, depression, dementia disorder, nutritional status, and level of functional balance capacity did not influence the effect on functional balance of the high-intensity functional weight-bearing exercise programme. There were no significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a significantly smaller proportion of participants in the exercise group had deteriorated regarding indoor mobility at 3 and 6 months. For people with dementia, there was a significant difference in overall ADL performance in favour of the exercise group at 3 months, but not at 6 months. In a systematic review, randomised controlled trials, evaluating the effects of physical exercise among people with dementia, were identified according to pre-defined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodological quality. Ten studies were included in the review and the majority of the participants were older people with Alzheimer’s disease living in residential care facilities. Four studies reached “moderate” methodological quality and six “low”. The results showed that among older people with Alzheimer’s disease in residential care facilities, combined functional weight-bearing exercise over 12 months at an intended moderate intensity seems applicable for use regarding attendance and adverse events and there is some evidence that the exercise improves walking performance and reduces ADL decline. Furthermore, there is some evidence that walking exercise over 16 weeks performed individually, where the participant walks as far as possible during the session, reduces decline in walking performance, but adverse events need to be evaluated. In conclusion, among older people who are dependent in ADL, living in residential care facilities, and have an MMSE score of 10 or more, a high-intensity functional weight-bearing exercise programme is applicable for use and has positive long-term effects on functional balance, gait ability, and lower-limb strength and seems to reduce ADL decline related to indoor mobility. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. In people with dementia, the exercise programme may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. The positive results regarding applicability and effects of combined functional weight-bearing exercise among people with dementia is confirmed when the scientific literature is systematically reviewed. It seems to be important that exercise interventions among people with dementia last for at least a few months and that the exercises are task-specific and intended to challenge the individual’s physical capacity. Whether physical exercise can improve cognitive functions among people with dementia remains unclear. There is a need for more exercise studies of high methodological quality among people with dementia disorders.

Syfte: Syftet var att finna skillnader och samband i self-efficacy (SE) – med avseende på typ av artroplastik, kön och ålder – inför två förflyttningar. Detta för att se vilka patienter som kan vara i större behov av att stärka SE postoperativt. Metod: Studien gjordes på inneliggande patienter som genomgått en höft- eller knäartroplastik. Ett för undersökningen framställt frågeformulär undersökte de 117 deltagarnas SE inför att sätta sig upp på sängkanten samt gå med hjälpmedel. Deltagarna skattade SE inför förflyttningarna första eller andra dagen efter operationen. Resultat: Deltagare som hade genomgått en knäartroplastik skattade signifikant högre SE inför att sätta sig upp på sängkanten än de som hade genomgått en höftartroplastik. Männen skattade signifikant högre SE inför båda momenten jämfört med kvinnorna. Det fanns en låg korrelation mellan stigande ålder och låg SE inför att gå med hjälpmedel. Konklusion: Resultaten tyder på att SE inför förflyttningarna skiljer sig mellan patienter. Detta bör behandlande sjukvårdspersonal ta hänsyn till i ett postoperativt skede för att undvika immobiliseringskomplikationer hos patienterna.

Abstract Background: Plantar fasciitis is the most common heel injury and is a long-term pain syndrom in the attachment of the plantar fascia to the calcaneus bone. The condition is treated mainly in primary care, but there is currently no treatment guideline for the treatment of plantar fasciitis in Sweden. The purpose of this study was to investigate which treatment that occurred in primary care in Dalarna, Gävleborg and Västmanland counties, which treatments that were most common alone and in combination with each other. The aim was also to investigate if the four most commonly used treatment methods as physical therapists said they had used were supported in the literature, and if there was any difference between county employees and private physical therapists in the choice of treatment method. Method: 100 physiotherapists in primary care in Dalarna, Gävleborg and Västmanland counties, received a questionnaire by mail. 80 of the 100 physiotherapists were county employees and 20 were private employees. They were asked about what treatment methods they used for plantar fasciitis, both individual treatments and combination treatments. A comparison was made between county employees and private employees' choice of treatments and the four individual most frequently used treatments were examined on the basis of recent research. Results: 65 physiotherapists answered the survey, of which 61 of them treated patients with plantar fasciitis. The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The first three treatments named above were also those most commonly used in combination with each other. This was true for physiotherapists in county as well as in private employment. There is some evidence that these three treatments relieve pain particularly in short term. Conclusion: The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The conclusion drawn from the evidence currently available to taping, stretch of the plantar fascia and insoles is that it should be a part of the treatment plan for patients with plantar fasciitis. Further research is needed where larger studies and follow-up studies over a longer time is made. Studies of the most common combination treatments should be made, to mimic how they are used in everyday clinical practice. / Sammanfattning Bakgrund: Plantar fasciit är den vanligaste hälskadan och är ett långvarigt smärttillstånd i plantaraponeurosens infästning i calcaneus. Tillståndet behandlas framförallt inom primärvården där det idag saknas en behandlingsriktlinje för behandling av plantar fasciit. Syftet med studien var att undersöka vilka behandlingsmetoder som förekom inom primärvården i Dalarnas-, Gävleborgs- och Västmanlands län, vilka behandlingar som var vanligast och vilka som förekom i kombination med varandra. Syftet var även att undersöka om de fyra vanligast använda behandlingsmetoderna som sjukgymnasterna uppgav sig använda hade stöd i litteraturen samt om det var någon skillnad mellan landstingsanställda och privata sjukgymnasters val av behandlingsmetod. Metod: 100 sjukgymnaster inom primärvåden i Dalarnas-, Gävleborgs- och Västmanlands län, 80 landstingsanställda och 20 privatanställda, fick en enkät per e-post. Där frågades de om vilka behandlingsmetoder som användes vid plantar fasciit, både enskilda behandlingar och kombinationsbehandlingar. En jämförelse gjordes mellan landstingsanställdas och privatanställdas val av behandlingsmetoder och de fyra enskilt mest frekvent använda behandlingarna granskades utifrån senaste forskningen. Resultat: 65 sjukgymnaster svarade på enkäten varav 61 av dem behandlade patienter med plantar fasciit. De fyra mest frekvent använda behandlingarna var tejpning, stretch av plantarfascian, råd om inlägg samt råd om byte av skor. De tre förstnämnda behandlingsmetoderna var även de som var vanligast i kombination med varandra och vanligast för både landstingsanställda och privatanställda sjukgymnaster. Det finns visst stöd i litteraturen för dessa tre behandlingsmetoder som smärtlindrande, framförallt på kort sikt. Konklusion: De fyra mest frekvent använda behandlingarna var tejpning, stretch av plantarfascian, råd om inlägg samt råd om byte av skor. Slutsatsen dras utifrån den evidens som för närvarande finns att tejpning, stretch av plantarfascian samt råd om inlägg i dagsläget rekommenderas ingå i behandlingen av plantar fasciit. Ytterligare forskning behövs dock där större studier samt uppföljningsstudier under längre tid görs. Även studier av de vanliga kombinationsbehandlingarna bör göras, för att efterlikna hur de används i den kliniska vardagen.

Introduction: Occupational drivers of terrain vehicles are exposed to several risk factors associated with musculoskeletal symptoms in the lower back as well as in the neck and upper limbs. Vibration has been suggested to be a main risk factor. These drivers are exposed to both whole-body vibration (WBV) and hand-arm vibration (HAV). Aim: This study establishes the association between driving terrain vehicles and musculoskeletal disorders (MSDs) in the neck and upper limbs as well as hand-arm vibration syndrome (HAVS). In addition, this study examines the effect on muscles in the neck and upper limbs of the type of vibration exposure that occurs in occupational driving of terrain vehicles. Methods and results: In Paper I, a cross-sectional questionnaire study on occupational drivers of terrain vehicles, increased Prevalence Odds Ratios (POR) were found for numbness, sensation of cold and white fingers (POR 1.5-3.9) and for MSDs in the neck (POR 2.1-3.9), shoulder (POR 1.8-2.6) and wrist (POR 1.7-2.6). For the shoulders, neck and elbow, there appears to be a pattern of increased odds with increasing exposure time. In Paper II, an experimental study on the trapezius muscle, which included 20 men and 17 women, the mean frequency of the electromyography signal (EMGMNF) decreased significantly more in a three minute sub-maximal contraction without vibration (-3.71Hz and -4.37Hz) compared to with induced vibration (-3.54Hz and -1.48Hz). In Paper III, a higher initial increase of the mean of the root-mean-square of the electromyography signal (EMGRMS) was seen in a three minute sub-maximal contraction with vibration exposure compared to without vibration (0.096% vs. 0.045%). There was a larger mean EMGMNF decrease for NV compared to V in the total three minutes, and a larger decrease also in the first time period was seen for the NV compared to V. A small gender effect was also noticed. In Paper IV, the combination of HAV and WBV was studied in laboratory settings and resulted in a higher trapezius EMGRMS compared to the HAV and WBV separately. Conclusion: Occupational drivers of terrain vehicles are likely to experience symptoms related to HAVS and musculoskeletal symptoms in the neck and upper limbs. Local vibration does not seem to have any negative acute effects on trapezius muscle fatigue. Vibration exposure seems to cause an initial increase in muscle activity in the trapezius that could be related to recruitment on new motor-units. A combination of HAV and WBV causes a larger muscular demand on the trapezius muscle.

Patellofemoral pain (PFP) is believed to be associated with deficits in coordination between the different heads of the quadriceps muscle; however, considerable debate exists in the literature regarding the presence of such a deficit. Discrepancies between studies may be explained by differences in experimental tasks, such as whether the task is performed with open (OKC) or closed kinetic chain (CKC), or whether the activity is voluntary or triggered. Particular interest has been directed toward the function of the vastus medialis obliquus (VMO), which is a short muscle with limited ability to exert torque across the knee joint, but probably has a particular role in controlling patellofemoral joint position. Another short muscle that may influence knee joint position control is popliteus (POP), which is located in the back of the knee. This thesis investigates task specific activity of quadriceps in CKC versus OKC and studies the relative activity between the four heads of the quadriceps in PFP subjects compared to controls without knee pain in voluntary activity (CKC and OKC) and postural responses to balance perturbations. In addition, this thesis investigates the presumed function of POP for control of joint position in postural tasks in healthy individuals. All subjects were of normal weight and height and between 18 and 40 years. Quadriceps activity was tested for isometric with identical joint configuration in CKC and OKC, and it was performed as a reaction time task. Balance perturbations were elicited by unpredictable anterior and posterior translations of the support surface. Function of POP was investigated in unpredictable support surface translations and in self induced provocations to balance by moving the arms. Muscle activity was recorded with electromyography (EMG). Optic kinematic analysis was used to obtain specific movement responses to perturbations of balance. The quadriceps muscles were activated differently in CKC and OKC. VMO was activated earlier and to a greater degree in CKC. Rectus femoris was activated earlier and to a greater degree in OKC. PFP subjects reacted slower in both CKC and OKC, but there was no difference between groups in the relative activity between the different heads of the quadriceps. In the unpredictable support surface translation in the anterior direction, PFP subjects responded with earlier onset of VMO and with greater trunk and hip flexion in the anterior translation. POP activation in response to support surface translations in both directions occurred before all other muscles measured. In the self-initiated provocations of balance, POP was activated after the initiation of the balance provocation. This thesis concludes that quadriceps activity was task specific. The lack of difference between groups in OKC and CKC, and the difference between groups in postural responses suggest that variations in motor behaviour may occur only in tasks habitually performed. Differences in muscle activation patterns may be related to compensatory strategies to unload the quadriceps muscles and the patellofemoral joint. Furthermore, this thesis suggests that POP muscle may have a particular role in active control of the knee joint.

<p>Fysisk aktivitet kan förebygga och minska åldersrelaterade fysiologiska och psykologiska förändringar. Effekterna av funktionell träning för äldre är dåligt studerat. I Sörmland pågår ett fallpreventionsprojekt som syftar till att halvera antalet höftfrakturer till år 2012. Studiens syfte var att undersöka om äldres balans, benstyrka och self-efficacy, en persons grad av självtillit att utföra en specifik aktivitet framgångsrikt, påverkades av att göra fem uppresningar från sittande till stående två gånger om dagen under fyra veckor. En intervention genomfördes med 23 deltagare på ett servicehus/äldreboende. Test genomfördes innan och efter interventionen. Mätinstrumenten var Timed Up and Go (TUG) för balans, Falls Efficacy Scale Swedish version (FES(s)) för self-efficacy och 30- seconds chair stand för benstyrka. Komparativ statistik med parametriskt test användes för att analysera skillnader inom gruppen. Resultatet av interventionen visade en signifikant ökad balans och benstyrka, men oförändrad self-efficacy. Författarna rekommenderar att servicehuset/äldreboendet bibehåller rutinen med fem uppresningar två gånger om dagen, men ytterligare studier med större deltagarantal, längre interventionstid, en kontrollgrupp och uppföljning behövs för att styrka och generalisera resultatet till fler verksamheter.</p> / <p>Physical activity can prevent and reduce age-related physiological and psychological changes. The effects of functional training on older people are poorly studied. A prevention programme in the county of Sörmland is underway, which aims to halve the number of hip fractures by 2012. The aim of this study was to examine whether the balance, leg strength and self-efficacy, a person's degree of self-confidence to perform a specific task successfully, of elderly persons was affected by performing five sitting-to-standing exercises twice a day during a four weeks period. An intervention was received by 23 participants in a service/residential home. Testing was conducted before and after the intervention. The measuring tools used were Timed Up and Go (TUG) for balance, Falls Efficacy Scale Swedish version (FES(s)) for self-efficacy and 30- seconds chair stand for leg strength. Comparative statistics with parametric test were used to analyze differences within the group. The results showed significant increased balance and leg strength, however self-efficacy was unchanged. The authors recommend that the service/residential home maintain the routine of five sitting-to-standing exercises twice a day, although further studies with a more participants, longer intervention time, a control group and follow up are needed to verify and generalize the results to other areas.</p>