Gymnastik- och idrottshögskolan, GIH

AIM: Recurrent pain of unknown origin is a major problem in children. The aim of the present review was to examine the hypothesis of negative stress as an aetiology of recurrent pain from different aspects.

METHODS AND RESULTS: Epidemiological studies, clinical experience and hormonal data give support for such a hypothesis. Negative stress as a tentative aetiology for recurrent pain is reviewed. Stress, muscular tension, the startle reaction and its tentative relation to pain is illuminated. Deviations of hormonal secretion supporting a stress aetiology is mentioned. The role of central sensitization for recurrent pain is discussed. Possible aetiological implications of recurrent pain as a local symptom or a general disorder are presented. Brain changes due to stress is shortly reviewed. Stress and pain in the clinic are highlighted. The importance of biological, psychological and social factors, as well as genetic elements, are-Ddiscussed.

CONCLUSION: Stress elicits neurobiological mechanisms. They may lead to many neurophysiological deviances. Increase of muscle tension and neuromuscular excitability and enhanced startle reaction may be of importance for recurring pain. The identification of stress as a primary cause of recurrent pain can have huge implications for understanding signs and treatment in clinical practice. This article is protected by copyright. All rights reserved.

Chronic negative stress may be the start of a progress of illness, that may end in serious troubles for the affected. In this Perspective we highlight the steps in such a progress, what we call a staircase of stress. This underlines the importance of recognition, understanding and therapeutic measures at an early stage of the stress disorders. 

BACKGROUND: Children with recurrent pain of negative chronic stress origin from different locations have a characteristic pattern of tender points in the temporal, trapezoid, great pectoral and abdominal muscles. We tested the hypothesis that the startle reaction is activated in these children and that some of the startle-activated muscles are related to the tender point pattern and the recurrent pain.

METHODS: In children/adolescents, aged 10-17 years, 19 with recurrent psychosomatic pain (PAIN) and 23 controls (CON) we measured and analysed resting activity and acoustic startle response with electromyography (EMG) for the muscles involved in the pattern of tender points and also the lumbar erector spinae.

RESULTS: The PAIN group showed higher resting activity and higher acoustic startle response values than the CON group for all six muscles together regarding the mean amplitude in the initial 200 ms, and during the burst of activity, and longer burst duration and shorter burst latency. For PAIN versus CON, all separate muscles showed generally higher values of EMG amplitudes and burst durations, and shorter latencies for the burst onset in all measures; with significance or strong trends for several parameters and muscles.

CONCLUSION: For the first time in children with recurrent psychosomatic pain, increased resting activity and potentiated startle response were demonstrated in the muscles involved in the stress tender point pattern.

SIGNIFICANCE: This study demonstrates in adolescents how recurrent pain of negative stress origin from the head, stomach, back and chest is related to increased startle reaction and increased muscular tension in these regions. This study contributes to the understanding of the mechanisms underlying the global burden of recurrent pain.

Återkommande stressutlöst smärta är ett närmast vardagligt fenomen. Avsaknaden av enkla test inom sjukvården för att diagnostisera stressutlöst smärta medför diagnostiska svårigheter och därmed svårigheter med handläggning. Ett grundläggande problem är att förståelse för den patofysiologiska processen bakom långvarig stressutlöst smärta saknas.

Tidigare studier från samma forskare har visat att barn och tonåringar med långvarig stressutlöst smärta diagnostiserad enligt fastställda kriterier utvecklar ett karakteristiskt mönster av ömma punkter (tender points) i muskler på platser för bland annat huvudvärk, skuldersmärtor och buksmärtor nära naveln. Dessa muskler ingår i startle-reflexen, en neuromuskulär försvarsreaktion som utlöses från en kärna i hjärnstammen. Startle-reflexen startar med en blinkreflex och följs på mindre än en tiondels sekund av framåtböjning av huvudet och en nedstigande böjningsreaktion av kroppen, som sträcker sig ned till benen. Stress kan bland annat via amygdala leda till förstärkt och lättare utlöst startle-reflex.

Vår hypotes var att startle-reflexen hos individer med stressutlöst smärta är mer lättutlöst och ger ett högre svar än hos friska. I en kontrollerad studie ingick 19 individer i åldern 10–17 år som hade stressutlöst återkommande smärta enligt fastställda kriterier. Gruppen jämfördes med 23 friska i jämförbar ålder, av motsvarande kön och utan smärtbesvär. Under likvärdiga, lugna förhållanden utlöstes startle-reflex vid upprepade starka auditiva signaler på 105 dB via hörlurar, och EMG registrerades från ögonblinkningsmuskeln (orbicularis oculi), tinningmuskel (temporalis), nacknära skuldermuskel (trapezius), stora bröstmuskeln (pectoralis major), bukmuskel (rectus abdominis) samt ryggmuskel (lumbala erector spinae).

I smärtgruppen var muskelspänningen signifikant förhöjd i ovan nämnda muskler. Startle-reflexen utlöstes också lättare och tidigare, var kraftigare och varade längre. Muskel­aktivitetsgraden efter ljudstimuli visade i smärtgruppen signifikant högre medelamplitud än i kontrollgruppen för alla sex muskler och de åtta upprepade startle-responserna sammantagna. Aktuell forskning om möjliga muskulära och centralnervösa smärtmekanismer presenteras i artikeln.

För första gången har ökad muskelspänning och förstärkt startle-reaktion påvisats med EMG hos barn/ungdomar med återkommande stressutlöst smärta i ett mönster som sammanfaller med mönstret av ömma punkter och smärtlokalisation. Vår förhoppning är att dessa fynd ska stimulera till fortsatt forskning och förbättra klinisk praxis.

Alfvén, G, Grillner, S, Andersson E. Eur J Pain. Epub 4 maj 2017. doi: 10.1002/ejp.1057

Background: Headache of stress etiology is a common, worldwide medical problem with high sick leave and large economic consequences. There is a need to improve the understanding of underlying neurobiological processes. Research show that headache of stress etiology often is one symptom in a complex of multiple pains and augmented widespread muscular tension with a specific pattern of tender points (1). 

Objective and Method: We will present in children with recurrent stress related pain, some hormonal changes and electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple pain including headache. 

Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 21 matched controls. Also, higher resting muscle activity was found in these children as well as increased cortisol and decreased oxytocin. 

Conclusion. Stressors evoke stress response for example in the amygdala, which can trigger and potentiate the startle reaction with amplified muscle excitability and tonus. These reactions and the increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of headache and other pain and must be heeded in the treatment of patients with pain related to stress.  

1.Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019;Jun4.doi:10.1111/apa.14884.

2.Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.

3.Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. 

Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).

For better understanding and better care of psychosomatic pain valid and reliable diagnostic criteria is a prerequisite. The startle reflex is of importance for the understanding of the stress induced pain and the increased excitability in several muscles. The pattern of increased muscle tension and tenderness that can be found in these patterns can be of valuable diagnostic support. Decreased oxytocin and increased cortisol is a sign of right brain dominance in stress and indicate psuchosomatic pain. The omega-3 and omega-6 changes are in indication metabolic pain mechanism of interest for future study. Treatment is reccomended to be guided by the knowledge here described.

We discuss the aetiology of recurrent abdominal pain of non-organic origin, according to the Rome Criteria for Functional Gastrointestinal Disorders and a psychogenic hypothesis. Stress activates the brain-gut axis, which is important for local gut symptoms, such as abdominal pain, but it also causes pain in other areas, including the head, back and chest. Our research has indicated that the startle reflex plays a dominant role in this stress-induced pain pattern, which is manifested in the whole body. Localised abdominal pain can be part of a general negative stress reaction that causes multiple pains in other areas of the body.

G. Alfvén1, E. Andersson2, 3

1. Clintec, Karolinska Institute, Stockholm, Sweden. 2. The Department of Neuroscience, Karolinska institute, Stockholm, Sweden. 3. The Swedish School of Sport and Health Sciences, Stockholm, Sweden.

Corresponding author:  G Alfvén (gosta.alfven@slmk.org) Karolinska Institute, Sweden

ABSTRACT 

Background: Recurrent pain of stress etiology is a common, worldwide problem with impaired quality of life and decreased school attendance. Research show that pain of stress etiology, often called psychosomatic pain, often is a complex of multiple pains, other symptoms and augmented widespread muscular tension with a specific pattern of tender points (1). 

Objective and Method: We will in a clinical context present electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple pain. 

Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 23 matched controls. Also, higher resting muscle activity was shown. We will also present data showing increased cortisol and decreased oxytocin and increased risk for developing fibromyalgia in children with psychosomatic pain. 

Conclusion. Stressors potentiated the startle reaction with increased muscle activity in rest and increased excitability. These reactions and increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of recurrent pain and must be heeded in the treatment of patients with pain related to stress.  

1. Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019; Jun4.doi:10.1111/apa.14884.

2. Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.

3. Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. 

Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).

G. Alfvén1, E. Andersson2, 3

1. Clintec, Karolinska Institute 2. Department of Neuroscience, Karolinska institute, 3. Swedish School of Sport and Health Sciences, -all Stockholm, Sweden.

Corresponding author:  G Alfvén (gosta.alfven@slmk.org) 

ABSTRACT 

Background: Negative stress is very common, always affecting brain and body resulting in different symptoms often called psychosomatic. To better understand stress, it is important to overcome the mind-body dichotomy and explore how they are connected. 

Objective and Method: We will present in children with recurrent stress related pain, some hormonal changes and electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple psychosomatic pain (1).  

Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 21 matched controls. Also, higher resting muscle activity was found in these children as well as increased cortisol and decreased oxytocin. 

Conclusion. Stressors evoke stress response for example in the amygdala, which can trigger and potentiate the startle reaction with amplified muscle excitability and tonus. These reactions and the increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of psychosomatic pain and must be heeded in the treatment of patients with pain related to stress.  

1.Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019;Jun4.doi:10.1111/apa.14884.

2.Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.

3.Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. 

Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).

Försäkringskassans rapport (DN Debatt 27/11 2015) visar att sjukfrånvaron fortsätter att öka och lovar att kraftsamla i sjukförsäkringshandläggningen. Men, precis som Försäkringskassan skriver, kommer det inte att räcka för att nå regeringens mål. Regeringens åtgärdsprograms program i sju punkter för att minska sjukfrånvaron saknar en viktig komponent. Det måste kompletteras med fysisk aktivitet som ett åttonde område för att trenden ska kunna brytas, skriver 13 debattörer.

Improved muscle strength and aerobic fitness are of great importance in many sports and are also associated with increased life expectancy and a reduced incidence of a number of diseases. In this chapter, we will discuss some of the factors that influence muscle strength and aerobic fitness, including sex-related factors. The way physical fitness is measured is also important when making comparisons. An increased understanding of the assessment of strength and aerobic fitness may inspire fruitful improvements in practical test and training programs in various sport and health contexts.

Startlereflexens betydelse för psykosomatisk smärta. En EMG-studie på barn med stressutlöst återkommande smärta. 

Startle-reflexen är en försvarsreflex som beror på upplevelsen av fara vid plötsligt stark stimulering och hänger i hop med flykt- och kampresponsen. I praktiken innebär den att man hajar eller hoppar till. Reflexen aktiveras vid överraskning. Den börjar med en blinkreflex i ögonen och följs på mindre än en tiondels sekund av framåtböjning av huvudet och en nedåtgående böjningsreaktion av kroppen som sträcker sig ned till benen.

Via muskelaktivitetsregistrering på ett flertal muskler i kroppen sågs under ljudstimuli i studiens smärtgrupp att reflexen utlöstes lättare och tidigare. Den var också kraftigare och varade längre jämfört med en motsvarande frisk kontrollgrupp.

Ett lyckosamt projekt för seniorer 65 år och äldre har sedan 2005 pågått på Gymnastik- och idrottshögskolan, GIH. Deltagarna tränar kostnadsfritt och utför hälsotester med GIH:s studenter på hälsopedagogprogrammet. Syftet är att utveckla metoder som kan bidra till ökad fysisk aktivitet och fysisk kapacitet som ett led i sänkta vård- och omsorgskostnader och ökat välmående hos de äldre.

The overall aim of this thesis was to study the myouelectric activity of all major muscles involved in the movements and stabilization of the trunk, pelvis and hips during training exercises, postures, motor tasks, maximal strength performance and locomotion. By use of ultra-sound, EMG electrodes could be guided safely and accurately into muscles situated even close to the spinal column, such as psoas, quadratus lumborum and deep parts of erector spinae.

     A task specific variation in activation levels were seen between muscle synergies, as well as between individual muscles within a synergy. Selective engagement of the abdominal muscles could be achieved in trunk flexion sit-ups, that is lifting only the upper trunk from the floor. An even higher activation of abdominal muscles was needed for static stabilization of the trunk and pelvis during hip flexion sit-ups, whereas single leg lifts were performed without involvement of the abdominal muscles. A selective activation of either the iliacus or psoas muscle was observed, for example in certain types of training exercises and in walking and running. Applying bending moments to the spine, resulted in a grading of the muscle activation response according to mechanical advantage, that is highest in the quadratus lumborum in lateral loading and in the superficial erector spinae in ventral loading. An exception was the most forward flexed position in standing where the superficial erector spinae "relaxed" but quadratus lumborum remained active. In general, the level of EMG in maximal efforts was maintained at the same high level irrespective of position in the range of motion, despite a marked variation in strength output. This position-dependency, as well as the strength values as such, varied in a specific way in groups of athletes, related to previous background.

     These data contribute to the understanding of muscle function and motor control of the trunk , pelvis and hips. They are also of relevance when evaluating and designing tests and training programs in rehabilitation and sport contexts as well as for improving biomechanical models of spinal loading.  

In public health contexts, increased physical activity habits and fitness (aerobic and strength capacities) are positively related for promoting health and preventing  and treating common diseases/problems, including obesity and overweight. A strongly graded inverse association between physical activity and obesity has been shown both for adults and children. However, a lower mortality risk has been shown for those with greater weight but good aerobic capacity than for those of recommended weight but less fit. On the basis of a health project with physical activity for persons with or without obesity, the paper discusses evidence-based methods for promoting physical activity. General guidelines for the amount of physical activity for persons are described, as are the numerous physiological and medical advantages of physical activity. The economic benefits are also illustrated. The paper exemplifies methods of measuring physical activity habits and physical fitness. These two factors must be observed when showing improvements in public-health contexts, including groups with obesity.

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in elderly people performing short-term resistance training (RET). Supervised progressive resistance training for 1 h three times a week over 8 weeks was performed by RET participants (71±1 years, range 65-80). Compared to a control group without training, the RET showed improvements on the measures used to indicate strength, power, glucose tolerance, and several parameters of muscle aerobic capacity. Strength training was performed in a gym with only robust fitness equipment. An isokinetic dynamometer for knee extensor strength permitted the measurement of concentric, eccentric, and static strength, which increased for the RET group (8-12% post- versus pre-test). The power (rate of force development, RFD) at the initial 0-30 ms also showed an increase for the RET group (52%). A glucose tolerance test with frequent blood glucose measurements showed improvements only for the RET group in terms of blood glucose values after 2 h (14%) and the area under the curve (21%). The blood lipid profile also improved (8%). From muscle biopsy samples prepared using histochemistry, the amount of fiber type IIa increased, and a trend towards a decrease in IIx in the RET group reflected a change to a more oxidative profile in terms of fiber composition. Western blot (to determine the protein content related to the signaling for muscle protein synthesis) showed a rise of 69% in both Akt and mTOR in the RET group; this also showed an increase in mitochondrial proteins for OXPHOS complex II and citrate synthase (both ~30%) and for complex IV (90%), in only the RET group. We demonstrate that this type of progressive resistance training offers various improvements (e.g., strength, power, aerobic capacity, glucose tolerance, and plasma lipid profile).

STUDY DESIGN: An intramuscular electromyographic study was performed on trunk rotations during sitting and standing. OBJECTIVE: The aim was to provide new information on activation levels for deep trunk muscles in various unresisted and resisted trunk rotations. SUMMARY AND BACKGROUND DATA: Frequent daily trunk twisting and decreased maximal strength during trunk rotation have been associated with low back pain or sciatic pain. However, the involvement of deep trunk muscles during different trunk rotations is relatively unknown. METHODS: Ten healthy subjects participated. Fine-wire electrodes were inserted, under ultrasound guidance, into psoas, quadratus lumborum, the superficial medial lumbar erector spinae (ES-s, multifidus) and its deep lateral portion (ES-d, iliocostalis), iliacus, rectus abdominis, obliquus externus, and obliquus internus. RESULTS: The highest involvement for all muscles was observed on the ipsilateral side, in maximal trunk twists with shoulder resistance, except obliquus externus, which showed a dominant contralateral side, and rectus abdominis, which was little activated in all rotations. In contrast, maximal trunk twist without shoulder resistance, i.e., freely performed, resulted generally in lower levels for all muscles involved and in a shift of side dominance for the lumbar muscles quadratus lumborum, psoas, and ES-s. CONCLUSIONS: During trunk rotations the activity patterns for various trunk muscles could drastically change, and even be the opposite, between the two body sides, within the same type of task, depending on several factors such as initial position, effort level, sitting or standing, and external shoulder resistance.

Background: Aerobic fitness is of great value for reducing risk of mortality and cardiovascular diseases. Objective: This study evaluated the performance in and correlations between a new test (five-minute pyramid test, 5MPT), the six-minute walk-test (6MWT) and maximal oxygen uptake (VO(2max)) among old and young adults. Methods: Forty-four habitually active adults (females and males), 23 old (64-79 years) and 21 young (20-32 years) participated. In the 5MPT, the participants moved back and forth along a short walkway (5.5 m) over boxes (height: 'old people' 0.42 m, 'young people' 0.62 m) arranged like an elongated step pyramid for 5 min. Power in the pyramid test (5MPT(power)) was calculated as the product of numbers of laps, body weight, gravity and highest box level divided by time. A 6MWT and a maximal cycle ergometer test for direct measurements of VO(2max) were also performed. In all tests heart rate, with on-line electrocardiography, and perceived exertion were recorded. Results: There was a strong correlation between the 5MPT(power) and VO(2max) for the entire group studied (r = 0.98), and each of the four subgroups old and young females and males separately (r = 0.78-0.98). Contrary to several earlier studies, especially involving people with various diseases, the present data showed that 6MWT cannot be used to predict VO(2max) among old females and young adults. The correlation with VO(2max) was weaker for the 6MWT than for the 5MPT(power). The relative performance values for the old compared to the young (ratio old/young × 100) were considerably lower in 5MPT(power) and VO(2max) (47-55%) than in distance and 'work' in the 6MWT (82-86%). Conclusions: The results, with age and gender variations, can be valuable information in health-fitness contexts, since measuring physical aerobic capacity is very significant in connection with risk evaluations of mortality and various diseases. The 5MPT is a rapid, functional, easy and inexpensive tool for predicting assessed maximal aerobic power.

The main purpose of our study was to compare systematically EMG levels in sub-maximal training exercises for the trunk and hip flexor muscles with those voluntarily attainable in corresponding situations. Six healthy subjects performed three types of standardized training exercises, whose static positions, movement velocity and range of motion were reproduced during maximal voluntary isokinetic strength tests. EMG was recorded with wire electrodes from the iliacus muscle and with surface electrodes from the rectus femoris, sartorius, rectus abdominis, obliquus externus and internus muscles. The relative EMG values demonstrated a task dependency which could differ between individual muscles. The maximal voluntary activation levels were relatively constant across conditions. Exceptions were present, particularly for the rectus femoris and iliacus muscles. These findings highlight the consequences of using different methods of normalizing EMG. The relative EMG values presented may serve as guidelines when selecting training exercises for specific trunk and hip flexor muscles in sports and rehabilitation.

The purpose of this study was to provide objective information on the involvement of different abdominal and hip flexor muscles during various types of common training exercises used in rehabilitation and sport. Six healthy male subjects performed altogether 38 different static and dynamic training exercises trunk and hip flexion sit-ups, with various combinations of leg position and support, and bi- and unilateral leg lifts. Myoelectric activity was recorded with surface electrodes from the rectus abdominis, obliquus externus, obliquus internus, rectus femoris, and sartorius muscles and with indwelling fine-wire electrodes from the iliacus muscle. The mean electromyogram amplitude, normalised to the highest observed value, was compared between static and dynamic exercises separately. The hip flexors were highly activated only in exercises involving hip flexion, either lifting the whole upper body or the legs. In contrast, the abdominal muscles showed marked activation both during trunk and hip flexion sit-ups. In hip flexion sit-ups, flexed and supported legs increased hip flexor activation, whereas such modifications did not generally alter the activation level of the abdominals. Bilateral, but not unilateral, leg lifts required activation of abdominal muscles. In trunk flexion sit-ups an increased activation of the abdominal muscles was observed with increased flexion angle, whereas the opposite was true for hip flexion sit-ups. Bilateral leg lifts resulted in higher activity levels than hip flexion sit-ups for the iliacus and sartorius muscles, while the opposite was true for rectus femoris muscles. These data could serve as a basis for improving the design and specificity of test and training exercises.

The purpose was to investigate the activation pattern of five major hip flexor muscles and its adaptation to changing speed and mode of progression. A total of 11 healthy subjects performed walking and running on a motor-driven treadmill at speeds ranging from 1.0 to 6.0 m s-1. Intramuscular fine-wire electrodes were used to record myoelectric signals from the iliacus, psoas, sartorius, rectus femoris and tensor fascia latae muscles. The basic pattern, with respect to number of activation periods, remained the same irrespective of speed and mode of progression. However, differences in the relative duration and timing of onset of activation occurred between individual muscles. Over the speed range in walking, a progressively earlier onset was generally seen for the activation period related to hip flexion. Changes in EMG amplitude were measured in the iliacus and psoas muscles and showed a marked increase and difference between walking and running at speeds above 2.0 m s-1. Thus, the alternating flexion-extension movements at the hip during locomotion appear to be governed by a rather fixed 'neural program' which normally only needs minor modulations to accomplish the adjustments accompanying an increase in speed of progression as well as a change from walking to running.

En god kondition och styrka har samband med förbättrad hälsa, minskad förekomst av flera folksjukdomar samt ökad livslängd. Fysiologiska tester kan vara stimulerande för äldre att följa utvecklingen av sin fysiska kapacitet och för olika aktörer som vill göra hälsoutvärderingar.

Fyisk aktivitet har dokumenterad effekt vid depression. Effekten är lika god som effekten av antidepressiva läkemedel eller kognitiv beteendeterapi (KBT) vid lindrig till måttlig depression. Dessutom är fysisk aktivitet i stort sett biverkningsfritt.

Aim. This study evaluates the results of and correlations between the six-minute walk-test (6MWT) and a maximal oxygen uptake (VO2max) test among physically active young adults.

Methods. Sixty-three adults (33 females and 30 males) aged 18-38 years participated. 6MWT and a maximal running treadmill test for measurements of VO2max were performed. 6MWT reliability was also evaluated.

Results. Mean distance in the 6MWT for the females was 848 (685-976) m and for the males 866 (704-1077) m. The gender differences were considerably less for the 6MWT (2%) than in the VO2max test, both normalized to body weight (21%) and in absolute form (35%). The mean values, for the female and male subjects in the VO2max were 46.7 and 58.9 ml/kg/min and 2.94 and 4.53 l/min, respectively. The data showed a very low, not significant, correlation (r=-0.02-0.32) between walking distance in the 6MWT and VO2max.

Conclusions: The 6MWT-distance for this physically active young adult group, which previously not has been studied, was considerably higher than in earlier reports for various other groups. In contrast to several prior studies, especially involving people with various diseases, the present data, on healthy active adults, showed that distance in the 6MWT cannot predict maximal oxygen uptake. The present results may be related to the low potential of walking as a locomotor form to tax the cardio-respiratory system sufficiently for this group. Since aerobic capacity is correlated with increased survival, these new data and given comparisons with previous reports are specially valuable when evaluating fitness in various sports and health contexts. 

SYFTE SAMT KORT BESKRIVNING AV HÄLSOPROJEKTET. Syftet med undersökningen var att i samarbete med hälso- och sjukvården och andra intressenter genomföra ett kostnadsfritt hälsoprojekt med fr.a. ledarledd fysisk aktivitet speciellt för personer med olika folksjukdomar men även friska i varierande åldrar. Sammanlagt 228 personer deltog för första gången i hela hälsoprojektet under en termin, dels hösten 2005 (114 deltagare) och dels våren 2006 (114 andra nya deltagare) med för- och eftertester. Initialt och i slutet av respektive termin utfördes varierande fysiologiska tester rörande kondition, styrka, rörlighet och balans samt GIH:s hälsoenkät om upplevd hälsa och olika levnadsvanor såsom fysisk aktivitet, kost, alkohol, rökning, sömn och tid för rekreation.

METODER. Deltagarna anmälde sig själva eller via hälso- och/eller sjukvårdspersonal på Stockholms vårdcentraler, psykiatriska mottagningar eller friskvårdsföretag. Utöver de sammanlagt 228 som medverkade i hela projektet var det fler som deltog i endast det initiala testerna och var närvarande till viss del under respektive termin. Således föll vissa deltagare bort under projektperioderna av olika anledningar. I denna rapport sammanställs data endast för dem som fullföljde projektet med deltagande vid såväl för- som eftertester (n=228, varav 46 män och 182 kvinnor). Bland dessa 228 deltagare (medelålder 57 år, 22-88 år) sågs vid det initiala testet att det endast var 5% som var fysiskt aktiva 30 minuter/dag samt att minst 2/3 var överviktiga och 1/3 obesa. Projekten utgjordes primärt av, 2 ggr/vecka, ledarledd fysisk aktivitet såsom stavgång, motionsgymnastik, vattengymnastik, styrketräning i gym samt i motionshall med den egna kroppen som belastning. Många andra typer av fysisk aktivitet/verksamheter utfördes även såsom afrikansk dans, yoga, massage, qigong, klättring, spinning, boxer size etc. I samband med den initiala hälsoenkätundersökningen och utförandet av de fysiologiska testerna genomfördes ett hälsosamtal. Hälsoprojekten utfördes inom undervisningen i regi av GIH-studenter under handledning av lärare/läkare på GIH samt externt.

RESULTAT. GIH:s HÄLSOENKÄT. Signifikant förbättring sågs för gruppen som helhet (n: 228) vid sluttestet jämfört med initialt under projektperioden för följande enkätparametrar: kroppslig hälsa; själslig hälsa; samtliga upplevelsefrågor kring såväl arbetsliv som fritid; sömn; tid för reflektion; tid för avkoppling; samt socialt nätverk. Särskilt hög signifikans sågs för majoriteten av frågorna kring fysiska aktivitetsvanor. Den enda frågan om fysisk aktivitetsvanor som inte förändrades signifikant för gruppen som helhet var frågan kring kroppslig ansträngningsgrad i det dagliga arbetet. Däremot sågs det dagliga stillasittandet minska signifikant. Spridda signifikanta förbättringar gällande kost noterades. Dessa var val av fettsnåla produkter; grönsaksintag; konsumtion av chips och jordnötter; samt kaffebröd. Ingen signifikant förändring sågs för frågor kring övriga kulturella vanor, regelbundenhet i måltider eller för frukt- och fiberintag. Konsumtion av choklad/godis, glass, läsk/saft samt kaffe, te, alkohol och tobak förändrades inte heller signifikant.

FYSIOLOGISKA TESTER. Val av olika fysiologiska tester var upp till GIH-studenterna som projektledare att själva välja ut. Därmed är här antalet testade lägre jämfört med dem som fyllde i hälsoenkäten, vilken generellt alla deltagare genomförde. Signifikant förbättring mellan efter- och förtest sågs för konditions och gångtesterna Åstrands cykelergometertest (l/min, 9%, n:74), gångtest (9%, n:89) samt steptest (14%, n:7), men inte för Åstrands test uttryckt i ml/kg x min (7%, n:65). Vid statisk ryggmuskeltest med bålen i horisontalläge utanför en bänk med fixerade ben sågs en signifikant förbättring med 62% för de 53 deltagare som utförde detta test. Av de olika buk- inklusive höftböjarmuskeltesterna, utförda som höftböjningssit-up med böjda ben och stöd, sågs en signifikant förbättring för alla dynamiska och statiska testerna sammantagna (68%, n:64) samt vid bentestet stående med höft- och knäleder i 90 graders vinkel stödjandes bålen mot en vägg (40%, n: 40). Bland styrketester för skuldra-, arm- och handmuskulatur sågs en signifikant förbättring i axelpress, dvs växelvisa sträckningar med en 2- eller 4kg´s hantel från axelhöjd till raka armar upp mot taket maximalt antal gånger, (55%, n:9); vid push-ups, då antalet armhävningar antingen utförda med knäna eller fötterna i golvet räknades, (136%, n:17); samt i gripstyrka höger hand (17%, n:113). En liten förbättring, dock signifikant (knappt 1%), sågs både för uppmätt vikt (n: 169) samt för BMI (n:154) beräknat på denna vikt mellan det initiala och slutliga hälsotestet. Detsamma gällde midje- (2%) och höftmått (1%) samt midje-/höftkvot (knappt 1%) med en signifikant förbättring för män och kvinnor sammantagna (n: minst 34). Ingen signifikant skillnad i uppmätt vilopuls noterades. En signifikant förbättring sågs för rörlighetstesterna stående bålflexion (24%, n:20) och majoriteten av sidböjningstester av bålen (6-12%, n: upp till 37). För det speciellt utformade skulderrörlighetstestet framkom inga klara generella förändringar. Balanstestet stående på ett ben där man registrerade antal nedtramp på en minut visade ingen signifikant förändring mellan för- och eftertest vare sig på höger (n:24) eller vänster ben (n=23).

SLUTKOMMENTAR. För ledare, hälso- och sjukvårdspersonal samt utövare inom varierande hälso-, idrotts-, arbets- eller rehabiliteringssammanhang kan det vara av vikt att få kunskaper om vilka typer av fysiologiska tester och hälsoenkätfrågor som kan påverkas av hälsoprojekt med ledarledd fysisk aktivitet och andra hälsofrämjande åtgärder. Av speciell vikt är att se om projekt som dessa kan resultera i ökade fysisk aktivitetsvanor och ökad fysisk kapacitet som båda är faktorer positivt korrelerade till en mängd folksjukdomar. I så fall stärks det faktum att liknande hälsofrämjande åtgärder med ledarledd fysisk aktivitet kan bidra till sjukdomsprevention och sjukdomsbehandling.

Olika skador i rörelseapparaten och hur man agerar vid akuta sjukdoms- eller olycksfall ingår. Den första delen innehåller bland annat en genomgång av skadetyper kroppsdel för kroppsdel, samt ett avsnitt om tejpning. I den andra delen har det gjorts ett urval av olika akuta sjukdoms- och skadetillstånd som kan förekomma i samband med fysisk aktivitet. På ett enkelt och sakligt sätt beskrivs skador och sjukdomar som av olika anledningar drabbar fysiskt aktiva personer och vilken/vilka åtgärder som ska sättas in när olyckan är framme. Du får veta vad du kan göra själv och vad som måste behandlas av läkare.

Ambitionen med detta kapitel är att på ett enkelt, sakligt och inspirerande sätt beskriva akuta sjukdoms- och skadetillstånd (inkl. missbruk) som kan förekomma i samband med fysisk aktivitet, och vilken eller vilka åtgärder som ska sättas in när olyckan är framme. [...]

Ambitionen med detta kapitel är att på ett enkelt, sakligt och inspirerande sätt beskriva akuta sjukdoms- och skadetillstånd (inkl. missbruk) som kan förekomma i samband med fysisk aktivitet, och vilken eller vilka åtgärder som ska sättas in när olikan är framme.

Background: Higher physical capacity is correlated with increased health. Knowledge in this area regarding psychiatric diseases is sparse. 

Purpose: The aim was to study aerobic and several strength capacities in a physical activity project for persons with depression or anxiety.

Methods: Eighty-four persons (56 women and 28 men) with depression or anxiety were recruited from psychiatric out-patient clinics in Stockholm. Their mean age and BMI was 46 (21-80) years and 26 (17-41) kg/m², respectively. 50% were sick-listed. 50% had BMI>25. Aerobic and strength tests were chosen by each subgroup´s project leaders. Directed physical activity was given, in groups 10-15, 1 hour twice/week during 8-12 weeks.

Results: Significant changes (p<0.05, of all n=84) between pre- and post tests were seen in submaximal cycle test (11% enhanced values, n=56) and distance of 6 minutes walk test (16%, n=15) as well as in strength tests for the back for the back (i.e. time in static horizontal belly-back, 40%, n=44), abdominal and hip flexors (i.e. number of hip flexion sit-ups, 45%, n=38), leg (i.e. standing with 90^O in hips and knees, 48%, n=56) and arm with shoulder muscles (i.e. number of raising weights alternately with the arms, 46%, n=32). Hand grip tests, BMI or blood pressure values did not change significantly.

Conclusions: Directed 8-12 weeks physical activity programs can improve physical fitness in individuals with depression or anxiety.

OBJECTIVE: The aim of this study was to provide new information on the myoelectrical activation of the quadratus lumborum, the deep lateral and the superficial medial lumbar erector spinae, the psoas, and the iliacus muscles in various motor tasks. DESIGN: An intramuscular electromyographic study was performed. BACKGROUND: The contribution of individual deep trunk muscles to the stability of the lumbar spine is relatively unknown in different tasks, including the flexion-relaxation phenomenon. METHODS: Seven healthy subjects participated. Fine-wire electrodes were inserted with a needle guided by ultrasound. RESULTS: The highest activity observed for quadratus lumborum and deep lateral erector spinae occurred in ipsilateral trunk flexion in a side-lying position and for superficial medial erector spinae during bilateral leg lift in a prone position. Quadratus lumborum and deep lateral erector spinae were activated when the flexion-relaxation phenomenon was present for superficial medial erector spinae, i.e. when its activity ceased in the latter part of full forward flexion of the trunk, held relaxed and kyphotic. CONCLUSIONS: In general, the activation of the investigated muscles showed a high degree of task specificity, where activation of a certain muscle was not always predictable from its anatomical arrangement and mechanical advantage.

The activation patterns of the psoas and iliacus muscles were investigated in 7 healthy adult subjects (4 men and 3 women) during a variety of motor tasks in standing, sitting and lying. Myoelectric activity was recorded simultaneously from the 2 muscles using thin wire electrodes inserted under guidance of high-resolution ultrasound. In general, both muscles were coactivated, albeit to different relative levels, particularly when hip flexor torque was required. Selective activation of the iliacus could, however, be seen to stabilize the pelvis in contralateral hip extension during standing. Psoas was found to be selectively involved in sitting with a straight back and in contralateral loading situations requiring stabilization of the spine in the frontal plane. During training exercises from a supine position, such as sit-ups, the contribution of the psoas and iliacus muscles could be varied by changing the range of motion as well as the position and support for the legs. Thus, the 2 anatomically different muscles of the iliopsoas complex were shown to have individual and task-specific activation patterns depending on the particular demands for stability and movement at the lumbar spine, pelvis and hip.

Maximal voluntary strength of the trunk muscles was measured in 57 male elite athletes (soccer players, wrestlers, tennis players, and gymnasts), 14 female elite gymnasts, and in a normal group of 87 conscripts. Mean ages in the different groups ranged from 18-22 yr. An isokinetic (constant velocity) technique was used to record maximal torque produced by trunk and hip muscles during flexion, extension, and lateral flexion over the range of motion. The constant angular velocities used were 15 deg.s-1 and 30 deg.s-1, respectively. Isometric strength was measured in a straight body position (0 deg. of flexion). The measurements were made with the subjects in a horizontal position with the pivot point at the hip and at the lumbar (L2-L3) level. All male athlete groups showed higher peak torque values than the normals. The differences were largest in hip extension and trunk flexion. The male gymnasts also showed significantly higher peak values in hip flexion as compared to all other categories. There was no difference in strength per kg body weight between female gymnasts and untrained males, except in trunk extension. The position for peak torque occurred earlier in the movements for the athletes, especially for the gymnasts in extension movements and for the tennis players in flexion movements. In isometric contractions essentially the same strength differences were present as in the slow isokinetic contractions. In lateral flexion wrestlers and tennis players showed significantly higher strength in movements toward the nondominant side. Thus, differences were present between the athletes and the normals, some of which appeared to be sport specific and related to long-term systematic training.(ABSTRACT TRUNCATED AT 250 WORDS)

It is well known that starvation causes insulin resistance. The mechanism is unclear but may relate disturbances in lipid metabolism i.e. incomplete mitochondrial FA oxidation and/or accumulation of lipid intermediates. Exercise results in increased substrate oxidation and may thus remove interfering lipid metabolites and reverse starvation-induced insulin resistance. However, the effect of acute exercise and starvation on insulin sensitivity is not known.

Purpose: The aim of this study was to investigate the effect of exercise on starvation-induced insulin resistance and to elucidate potential mechanisms.

Methods: Nine healthy lean subjects underwent 84h starvation on two occasions separated by at least 2 weeks. The starvation period was followed by either exercise (EX; 5x10 min intervals with 2-4 min rest, starting at 70 %VO₂ max) or an equal period of rest (NE). Before and after the starvation period (3h after exercise/rest) subjects were investigated with muscle biopsies, bloo samples and an intravenous glucose tolerance test. Muscle samples were used for measurement of mitochondrial respiration in permeabilized muscle fibers (Oroboros oxygraph), glycogen content and activation of signaling proteins.

Results: Insulin sensitivity was significantly higher in the EX group compared to the NE group (p<0.05). After starvation mitochondrial respiration was lower in both groups with complex I substrates whereas respiration with complex I+II substrates was higher in EX (p<0.05 vs. basal and NE). Muscle glycogen was decreased to 73% (NE) and 31% (EX) of the basal values. The EX group had a significant increased activation of AS160. Plasma FA increased 3-4 fold to 1.39±0.32(NE) and 1.80±0.49 (EX) (mmol/l) after starvation and plasma beta-hydroxybutyrate increased about 50-fold to 6.43±2.01(NE) and 7.12±1.59 (EX)(mmol/l).

Conclusion: Acute exercise reverses starvation-induced insulin resistance. Plasma FA and BOH were increased to similar extent after NE and EX and cannot explain the changes in insulin sensitivity. However, an increased substrate oxidation together with the observed increased capacity for mitochondrial FA oxidation after EX may be involved in the activation of AS160 and the reversal of starvation-induced insulin resistance.

The core values in the Nordic welfare model are health equality and social inclusion. Individuals with mental disorders and/or a history of substance use disorder are often excluded from the core value of equality. Psychosocial interventions such as physical activity and outdoor life can have several benefits for those suffering from mental disorders. Firstly, such interventions can have therapeutic effects. Secondly, they show benefits for somatic health and the risk of lifestyle-related diseases. Finally, they can provide an environment for experiencing self-efficacy, lead to improved quality of life, and promote the development and building of social relationships. This paper provides a critical review of current evidence for physical activity and outdoor life as psychosocial interventions in psychiatric and substance misuse treatment, with specific examples from Norway, Sweden and Denmark.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) expression, which can be measured in blood serum, has been found to increase with aerobic exercise. The link between BDNF level, physical exercise, and genetic status (Val66Met polymorphism) has not been well researched in older adults.

OBJECTIVE: To investigate the possible link between BDNF expression, acute aerobic exercise, and the Val66Met polymorphism in older adults.

METHOD: Twenty-three healthy older adults participated in one session of acute aerobic exercise. Their serum BDNF levels were measured both at baseline and post exercise. Saliva samples were collected to identify each individual's genetic status.

RESULTS: At baseline, the individuals' mean serum BDNF level was 16.03 ng/mL (Val66Val = 15.89 ng/mL; Val66Met = 16.34 ng/mL); post exercise, the individuals' mean serum BDNF level was 16.81 ng/mL (Val66Val = 16.14 ng/mL; Val66Met = 18.34 ng/mL).

CONCLUSION: One session of acute aerobic exercise significantly increased the individuals' mean serum BDNF level. Males had higher BDNF levels than females. There was a significant interaction between gender and BDNF expression post exercise and a significant between-group effect of gender. The Val66Met carriers had a more positive response to the acute aerobic exercise compared with the Val66Val carriers, although without a significant difference between the two groups.