Bakgrund: Tio till tjugo procent av akuta skador på ligamenten kring fotleden resulterar ikronisk fotledsinstabilitet, vilket innebär en instabilitetskänsla, stukningstendens, smärta ochsvullnad i fotleden. Det är värdefullt att som fysioterapeut ha kunskap om vilkenrehabiliteringsmetod som förbättrar balans i syfte att öka stabiliteten i foten. Syfte: Sammanställa litteraturen och bedöma det vetenskapliga underlaget gällande effektenpå balansen hos individer med kronisk fotledsinstabilitet genom träning med balansbräda.Detta ställs upp i två sammanvägningar: balansbräda jämfört med styrketräning, ochbalansbräda jämfört med ingen behandling. Metod: En systematisk litteratursökning efter randomiserade kontrollerade studier utfördes idatabaserna PubMed, Uppsala universitetsbibliotek, samt Cochrane Library. Totaltinkluderades åtta studier med sammanlagt 286 deltagare. Samtliga studier kvalitetsgranskadesenligt PEDro-skalan, och GRADEstud användes för bedömning av det sammanvägdaresultatets tillförlitlighet. Resultat: Signifikant förbättring av balans kopplat till styrketräning samt balansträning medbalansbräda, men liten fördel för en kombination för de båda kopplat till statisk balans. Kvalitetsgranskning enligt PEDro visade på att sex studier hade en måttlig kvalité och tvåstudier hade hög kvalité. Utifrån evidensbedömningen anses det föreligga en lågtillförlitlighet till det vetenskapliga underlaget för styrketräning med motståndsband förfotleden samt balansträning med balansbräda. Konklusion: Både styrketräning för relevant muskulatur och balansträning med balansbrädaförbättrar balansen efter ett ≥4 veckor långt protokoll med ≥3 träningssessioner/vecka.Evidensen talar för att båda rehabiliteringsmetoder ger liknande utfall, men fler studierbehövs för att bekräfta resultatet då de sammanvägda resultaten har låg tillförlitlighet. / Background: Ten to twenty percent of acute ankle injuries result in chronic ankle instability,which results in instability in the foot, distorsion tendency, and pain and swelling around theankle. Thus it´s valuable for physiotherapists to have knowledge regarding whichrehabilitation methods yield the most positive effect on balance in order to increase stabilityin the foot. Purpose: To compile the literature and assess the evidence regarding the effects on balanceof people diagnosed with chronic ankle instability through rehabilitation with awobble-board. This is set up in two comparisons: wobble-board compared tostrength-training, and wobble-board compared to no treatment. Method: A systematic literature search for randomized controlled trials was done inPubMed, Uppsala University Library, and CochraneLibrary. A total of eight studies wereincluded in this review, with a total of 286 participants. Study quality was judged by using the PEDro-scale, and GRADEstud was used to assess the reliability of the combined results. Results: Significant improvement in balance related to resistance training and balancetraining with wobble-board, with a small advantage to training with a combination of the twowhen measuring static balance. Quality according to PEDro showed six studies of moderatequality and two studies of high quality. Grading of the evidence is deemed insufficient whenit comes to training with resistance bands and training with a wobble-board. Conclusion: Both strength-training for the relevant muscles and balance-training using thewobble-board improves the balance after a ≥4 week-long protocol with ≥3 sessions/week.The evidence shows that both methods give similar results, however further research isrequired to confirm the results because the reliability of the combined results was deemedinsufficient.

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Bakgrund: Vid medelåldern drabbas många individer av muskuloskeletala sjukdomar som kan förebyggas och rehabiliteras genom styrketräning. Studier har gjorts på vad som motiverar människor till fysisk aktivitet men är bristfällig gällande motivation till styrketräning. Syfte: Syftet med studien var att undersöka vilka faktorer som motiverar styrketränande personer i medelåldern till att styrketräna, samt att redogöra för hur kön, grupp- och individuell träning, träningsvolym och hur länge en person styrketränat påverkar motivationsfaktorerna. Metod: Femtiofem personer mellan 40-60 år besvarade ett digitalt frågeformulär om vad som motiverar dem till att styrketräna. En del av enkäten innehöll bakgrundsfrågor om deltagarna. Den andra delen innefattade en modifierad version av formuläret RM 4-FM. Resultat: Deltagarna drevs främst av inre motivation och identified regulation. Det fanns en signifikant skillnad i typ av motivation mellan könen, där kvinnorna skattade högre på frågor gällande identified regulation (p=.028). Det fanns ingen signifikant skillnad mellan personer som tränade individuellt eller i grupp (external regulation: p=.500, introjected regulation: p= .517, identified regulation: p=.391, intrinsic regulation: p=.918) och inget samband mellan antal tränade timmar per vecka (p=.109) eller hur länge en person har styrketränat (p=.663) med relative autonomy index (RAI. Konklusion: Resultaten ger insikt i att personer i medelåldern drivs mer av inre motivation till styrketräning och att kvinnor tenderar att motiveras mer av inre drivkrafter, men kan inte generaliseras till hela populationen. Fortsatt forskning krävs för att undersöka relationen mellan motivation och styrketräning hos personer i medelåldern. / Background: During the middle-age, it is common to obtain a variety of musculoskeletal conditions, however, strength training reduces the risk to obtain these complications. There are many studies with the goal to research motivational factors that contribute to physical activity, however, there are few studies that have similar objectives related to strength training.  Objective: The objective of this study was to better understand what motivates middle aged individuals to strength train.  Method: In this study, 55 participants between 40 to 60 years old, completed a questionnaire about motivational factors to strength training. The first part consisted of background questions and the second part, a modified version of the RM 4-FM questionnaire.  Results: The results from the questionnaire showed that a majority of the sample were driven by intrinsic motivation and more specifically identified regulation. Group comparisons showed that women on average scored higher on the questions related to identified regulation (p=.028). There were no significant differences between individuals who train individually or in group (external regulation: p=.500, introjected regulation: p= .517, identified regulation: p=.391, intrinsic regulation: p=.918) nor seen in correlation between training volume (p=.109) and training experience (p=.663) with RAI. Conclusion: The results of this study show that individuals who strength train are predominantly incentivised by intrinsic motivation and women tend to have a stronger intrinsic motivation than men, however further research is required to continue to explore the complex relationship between motivation and strength training habits.

The purpose of this design and development research was to investigate whether the ADDIE model can be used to design online modules that teach psychomotor skills. The overarching research question was: How can the ADDIE Model of Instructional Design be used to create an online module that teaches safe and effective movement for psychomotor skills? To examine the research question, an online strength program focusing on correct technique was designed and developed. The design phase involved creating storyboards and scripts for the development phase. The development phase involved creating videos, still, audio, and slides that were put together to form instructional sequences for each movement. A website was designed to accommodate the requirements of the course and all the instructional materials were uploaded to the website. This program was implemented using college students with no health problems. Each participant was assigned to either single joint movements or multiple joint movements. They recorded themselves pre and post instruction. Strength and conditioning interns overseen by a subject matter expert and a strength and conditioning enthusiast scored these videos. The results of the implementation revealed that both beginners and advanced learners made improvements to their movements. It was concluded from the results that it was possible to teach correct movement online and that designers need to be aware of the interaction between type of learner and the specific movements rather than the type of movement. Major themes that emerged were they were unsure if they were completing the movement correctly and preferred having a coach present to provide feedback, and several participants had trouble transferring the theory into practice. Problems the reviewers had were that the videos were difficult to score due to camera angles and some issues with the rubrics. An analysis of the review process revealed there were problems with the consistency and reliability of the scoring. An overall answer to the overarching research question was that it is possible to use the ADDIE model to create successful online instruction for strength movements. It was necessary to created guidelines for designers to follow when developing online psychomotor skills courses. / Ph. D.

Neural activation is thought to be essential for the expression of maximal muscle performance, but the exact contribution of neural mechanisms such as the level of agonist, antagonist and stabiliser muscle activation to muscle strength is not fully understood. Explosive neuromuscular performance, including the ability to initiate (the electromechanical delay, EMD) and develop force rapidly (termed, rate of force development, RFD) are considered essential for the performance of explosive sporting tasks and joint stabilisation and thus injury avoidance. The thesis aimed to improve our understanding of the contribution of neural factors to muscle performance, with a specific focus on explosive neuromuscular performance. The work in this thesis utilised a range of approaches to achieve this aim. Initially, the association between muscle activation and rate of force development and EMD was established. Comparison of unilateral and bilateral actions was then undertaken. Finally interventions with the aim to both negatively affect and improve muscle strength, which included fatigue and resistance training (RT), respectively was undertaken and the neural contributions to changes in performance established. Agonist activation during the early phase of voluntary force production was shown to be an important determinant of voluntary EMD, explaining 41% of its inter-individual variability. Agonist activation was an important determinant of early, but not late phase RFD. Use of bilateral actions resulted in a reduction in explosive strength, which was thought to be due to differences in postural stability between unilateral and bilateral strength tasks. The level of stabiliser activation was strongly related to the level of agonist activation during the early phase of explosive force development and had a high association with explosive force production. Task-specific adaptations following isoinertial RT, specifically, the greater increase in isoinertial lifting strength than maximal isometric strength were due to training-specific changes in the level of agonist activation. High-intensity fatigue achieved a more substantial decline in explosive than maximal isometric strength, and this was postulated to be due to neural mechanisms, specifically decreased agonist activation. This work provides an in depth analysis of the neural contributions to maximal muscle performance.

Water movement in the body is determined by the osmotic forces acting on the cell membrane. Ingestion of a highly-hypertonic glycerol solution resulting in high extracellular osmolality could drive water out of the intracellular space into the vascular space resulting in reduced muscle hydration and increased blood volume. The aim of this thesis was to study the effects of altered body water distribution during exercise. In chapter 3, ingestion of a 400 ml glycerol solution (1 g·kg-1 body mass) increased serum osmolality (309 mosmol·kg-1) which was associated with a 4.0% increase in blood volume due to a 7.2% increase in plasma volume, attributed to a shift of water from the intracellular space, resulting presumably in tissue dehydration. Glycerol ingestion was then used as a means of altering body water distribution in the other studies described in this thesis. Altered body water distribution had no acute effect on force production during quadriceps muscle isometric exercise (chapter 4), or handgrip strength (chapter 5). Regarding chronic effects (chapter 5), two groups of participants exercised handgrip and initiated recovery after ingestion of either a glycerol solution or placebo over a period of 8 weeks. Maximum handgrip strength increased in both groups and there was no statistically significant difference between the two groups. In chapters 6 and 7, the subjects performed a cycling exercise protocol to fatigue. In the glycerol trial, time to fatigue decreased compared with the iso-osmotic trial during an incremental VO2max test (chapter 6) and during cycling against a constant load at 100% VO2max intensity (chapter 7). In the glycerol trial, there was an accelerated increase in blood lactate and an accelerated increase in serum potassium (chapter 7), indicating altered muscle metabolism which may have contributed to the early development of fatigue.

A doença de Parkinson (DP) caracteriza-se por alterações deletérias no controle motor e, comumente, também produz prejuízos na regulação autonômica e função cardiovascular. O treinamento resistido traz benefícios motores para estes indivíduos, mas seus efeitos autonômicos e cardiovasculares ainda são desconhecidos. Assim, esta tese avaliou os efeitos do treinamento resistido sobre a regulação autonômica e a função cardiovascular de indivíduos com DP, comparando-os a indivíduos sem DP. Para tanto, 17 indivíduos sem DP (SDP, 67±10 anos) e 27 com DP (65±8 anos, estágios II-III da escala de Hoehn e Yahr modificado, estado \"on\" da medicação) foram estudados. Os indivíduos sem DP foram avaliados uma única vez e os com DP foram divididos aleatoriamente em dois grupos, grupo controle (DPCO: n=12) e treinamento resistido (DPTR: n=15 - 2 sessões/semana, 5 exercícios, 2-4 séries, 12-6 RM), e foram avaliados no início e no final das 12 semanas do estudo. No início do estudo, os indivíduos com DP apresentaram menor modulação parassimpática e maior modulação simpática e balanço simpatovagal cardíacos em repouso, além de pior resposta cardiovascular ao teste de se levantar e à manobra de Valsalva que os indivíduos sem DP. Ademais, apresentaram maior pressão arterial na posição deitada, maior débito cardíaco e menor resistência vascular periférica na posição sentada, menor descenso noturno da pressão arterial sistólica, maior frequência cardíaca de 24 horas e sono, e respostas cardiovasculares atenuadas ao exercício máximo. O treinamento resistido, no grupo DPTR, aumentou a força dinâmica máxima (88±23 vs. 108±27 kg, P < 0,05) e diminuiu a modulação simpática cardíaca (banda de baixa frequência da variabilidade da frequência cardíaca - deitado: 61±17 vs. 47±20 un; sentado: 60±11 vs. 46±15 un, P < 0,05) e a queda da pressão arterial sistólica ao teste de se levantar (-14±11 vs. -6±10 mmHg, P < 0,05), enquanto que nenhuma alteração foi observada no grupo DPCO. Nos demais parâmetros avaliados, não houve nenhum efeito do treinamento nos indivíduos com DP. Após as 12 semanas de estudo, o grupo DPTR apresentou modulação simpática cardíaca de repouso e resposta da pressão arterial sistólica ao teste de se levantar semelhantes aos indivíduos SDP e menores que o grupo DPCO (banda de baixa frequência da variabilidade da frequência cardíaca - deitado: 47±20 e 45±9 vs. 63±10 un e sentado: 46±15 e 49±10 vs. 61±13 un; redução da pressão arterial sistólica - 6±10 e -1±10 vs. -11±9 mmHg, respectivamente, P < 0,05). Em conclusão, em indivíduos com DP, o treinamento resistido diminuiu a modulação autonômica simpática cardíaca em repouso e a redução da pressão arterial sistólica ao teste de se levantar, igualando estas respostas às de indivíduos sem DP / Parkinson\'s disease (PD) is characterized by deleterious alterations in motor control, and it usually also presents with impairments on cardiovascular autonomic regulation and function. Resistance training promotes motor benefits in individuals with PD, but its autonomic and cardiovascular effects are still unknown. Thus, this thesis evaluated the effects of resistance training on cardiovascular autonomic regulation and function in subjects with PD, comparing them with subjects without PD. Seventeen subjects without PD (WPD, 67±10 years) and 27 with PD (65±8 years, stages II-III of modified Hoehn & Yahr scale, \"on\" state of medication) were studied. The subjects without PD were evaluated only once, while the subjects with PD were randomly divided into two groups, control (PDCO: n=12) and resistance training (PDRT: n=15 - 2 sessions/week, 5 exercises, 12-6 RM), and were evaluated at the beginning and after 12 weeks of study. At the beginning of the study, the subjects with PD presented, at rest, lower cardiac parasympathetic modulation and higher cardiac sympathetic modulation and sympathovagal balance as well as worse cardiovascular response to standing test and Valsalva Manoeuvre than individuals without PD. In addition, they had higher supine blood pressure, higher seated cardiac output, lower seated peripheral vascular resistance, lower nocturnal systolic blood pressure fall, higher 24 hours and nighttime heart rate and blunted cardiovascular responses to maximal exercise. Resistance training in the PDRT group increased maximal dynamic strength (88±23 vs. 108±27 kg, P < 0.05), decreased cardiac sympathetic modulation (low component of heart rate variability - supine: 61 ± 17 vs. 47 ± 20 nu and seated: 60 ± 11 vs. 46 ± 15 nu, P < 0.05) and systolic blood pressure decrease to standing test (-14±11 vs. -6±10 mmHg, P < 0.05), while no changes were observed in PDCO group. In the other parameters, there was no effect of training in the subjects with PD. After 12 weeks of the study, the PDRT group presented rest cardiac sympathetic modulation and systolic blood pressure response to standing test similar to WPD and lower than PDCO (low component of heart rate variability - supine: 47±20 and 45±9 vs. 63±10 nu and seated: 46±15 and 49±10 vs. 61±13 nu; systolic blood pressure reduction - -6±10 and -1±10 vs. -11±9 mmHg, respectively, P < 0.05). In conclusion, in individuals with PD, resistance training decreased rest cardiac sympathetic autonomic modulation and systolic blood pressure decrease to standing test, matching these responses to the ones observed in subjects without PD