Prediction of maximal back muscle strength from indices of body mass and fat-free body mass

Back Extensor Strength as a Potential Marker of Frailty Using Propensity Score Matching and Machine Learning

This study assessed the potential of back extensor strength as an alternative marker of frailty. A total of 560 farmers were included. Computed tomography scans measured fat and muscle mass volumes at the mid-L4 vertebral level. Back extensor strength was measured in a seated posture. Multivariate linear regression was used to analyze the associations between back extensor strength and trunk muscle/fat compositions. The participants were divided into two groups based on back extensor strength. Propensity score matching, multivariate logistic regression, and Extreme Gradient Boosting (XGBoost) were employed to evaluate the relationship between Fried's frailty criteria and back extensor strength. Back extensor strength exhibited positive associations with abdominal muscle volume (r = 1.12) as well as back muscle volume (r = 0.89) (p < 0.05). Back extensor strength was linked to more frail status, such as reduced grip strength, walking speed, and frequent self-reported exhaustion. Multivariate logistic regression indicated that back extensor strength was associated with higher frail status (OR = 0.990), and XGBoost analysis identified back extensor strength as the most important predictor (gain = 0.502) for frailty. The prediction models using grip strength produced similar results (OR = 0.869, gain = 0.482). These findings suggested the potential of back extensor strength as an alternative frailty marker.

Relationship between tongue pressure and back muscle strength in healthy elderly individuals

BACKGROUND

Aging is associated with a decrease in muscle mass and strength in swallowing muscles, as well as in whole-body muscles. A decrease in tongue pressure (TP) is related with whole-body function, and the trunk, including abdominal and back muscles, forms the core of the body. However, the direct relationship between TP and trunk muscle strength remains unclear.

AIMS

To clarify the association between back muscle strength, an indicator of trunk muscle strength, and TP in healthy elderly individuals.

METHODS

In all, 112 healthy community-dwelling individuals aged ≥ 60 years (men: 35, median age 74.0; women: 77, median age 69.0) were included. Body mass index (BMI), TP, and back muscle strength (BMS) were measured. Tooth loss pattern was evaluated by the Eichner classification. Participants were divided into two groups based on the median of the BMS and classified into three groups based on the Eichner index (Eichner A, B, and C). The effects of BMS and occlusal support on TP were analyzed.

RESULTS

In the low BMS group, there was a significant difference in TP between the Eichner B and Eichner C (p = 0.017) groups. However, in the high BMS group, occlusal support did not affect TP. Moreover, the explanatory factors for TP were BMS (β = 0.373, p = 0.001) and the Eichner index (β = 0.190, p = 0.036).

CONCLUSIONS

TP was correlated more with BMS than aging and occlusal support in healthy elderly individuals. This study indicated that the clinical evaluation of the whole body is important when assessing oral and swallowing function.

The influence of fatigue and chronic low back pain on muscle recruitment patterns following an unexpected external perturbation

Background

Chronic low back pain (CLBP) has been associated with altered trunk muscle responses as well as increased muscle fatigability. CLBP patients and fatigued healthy subjects could experience similar neuromuscular strategies to attempt to protect the spine. The current study examined muscle activation differences between healthy and CLBP subjects following a perturbation. In addition, the possible role of muscle fatigue was evaluated by investigating the healthy control subjects in a non-fatigued and a fatigued condition. Both experiments were combined to evaluate possible similar strategies between CLBP and fatigued samples.

Methods

Cross-sectional study where 24 CLBP subjects and 26 healthy subjects were evaluated. Both groups (CLBP vs. healthy) and both conditions (non-fatigued and a fatigued condition) were evaluated while a weight was suddenly dropped on a held tray. Erector spinae, multifidus, obliques and biceps brachii were recorded using surface electromyography. Variables describing the bursts timing and variables describing the amount of muscle activity (number of bursts and amplitude increase) post impact were studied. The analysis between groups and conditions was carried out using ANOVAs with repeated measurements for the muscle factor.

Results

CLBP subjects reacted similarly to healthy subjects regarding muscle activity post impact. However, the CLBP group showed temporal characteristics of muscle activity that were in between the fatigued and non-fatigued healthy group. Clear differences in muscle activity were displayed for healthy subjects. Fatigued healthy subjects presented more reduced activity after impact (upper limb and trunk muscles) than non-fatigued healthy subjects and different temporal characteristic in the same way than CLBP patients. This same temporal characteristic with CLBP and healthy fatigued people was a delay of the first burst of muscle activity after impact.

Conclusion

Though similar muscle pattern existed between CLBP and healthy people, CLBP temporal characteristics of muscle activity showed a pattern in between healthy people and fatigued healthy people. While the temporal muscle pattern dysfunction used by CLBP subjects could be related to maladaptive patterns, temporal and muscle activity characteristics used by healthy fatigued people may lead to back injuries.

Accuracy of Force Repeatability in Relation to its Value and the Subjects’ Sex

The purpose of the study was to determine the influence of force value and sex on force generation repeatability.

The total of 17 female and 24 male students performed 3 maximal voluntary contractions for maximal force (F

The force generation repeatability rose with the increase of triggered force in both sexes; between force target 49 N vs. 98 N and 147 N (

The influence of force value and a minor influence of sex on accuracy in generated forces might suggest that the control of muscle force by the central nervous system is similar in both sexes and the sex differences in muscle force generations are rather of muscle mass and structure.

Influences of Obesity on Job Demands and Worker Capacity

Evidence suggests that the growing prevalence of obesity in the workforce has resulted in an increase in the incidence and cost of musculoskeletal injuries. Obesity can modify job demands and affect worker capacity in terms of anthropometry and occupational biomechanics, which may place workers at greater risk of injury. This paper presents a review of studies quantifying the work-relevant impacts of obesity, specifically related to work task demands, capacities, and their potential imbalance. The increased body fat that accompanies obesity leads to larger anthropometric dimensions and inertial parameters, particularly in the trunk and thigh areas. Consequently, individuals who are obese adjust their work postures and motions as an accommodation. These changes may affect the biomechanical demands on the joints and increase the burden on the musculoskeletal system. Independent of job demands, obesity-related differences also occur with respect to strength, fatigue, and task performance. Directions for future research are provided, focusing on the need for workplace redesign to account for changing workforce demographics.

Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain

STUDY DESIGN

An experimental and comparative study of chronic low back pain (CLBP) patients and healthy controls.

OBJECTIVE

To use a motivation-independent electromyography (EMG) based test of back muscle capacity to determine whether back muscle deconditioning is present in CLBP patients and whether it is related to pain-related psychological variables.

SUMMARY OF BACKGROUND DATA

The verification of the deconditioning syndrome in CLBP patients might be biased by the use of performance-based measures to assess physical fitness, especially in patients having fear of injury. Also, the use of lumbar-specific measures of physical fitness, such as back muscle strength and endurance, might be more sensitive to physical deconditioning than more general assessments such as aerobic capacity.

METHODS

A time-limited submaximal fatigue test was performed by 27 nonspecific CLBP subjects (14 men) who had not had any surgery, and 31 healthy controls (17 men) while surface EMG signals were collected from back muscles. Motivation-independent EMG indices, which are sensitive to muscle fatigue or to activation patterns, were then computed and entered as input into previously developed regression equations to predict endurance (PTend) and strength (PStrength). Between-group comparisons were completed with patients divided in subgroups based on a median split of pain intensity, fear of movement, or pain catastrophizing scores.

RESULTS

Differences between healthy and CLBP subgroups were mainly observed when patients were divided using pain catastrophizing scores (PCS). High-PCS patients showed significantly lower PTend than low-PCS patients. Various EMG indices showed comparable results to PTend. However, some of them also pointed out that the PCS-low patients were more fatigue-resistant and showed different activation patterns comparatively to healthy subjects.

CONCLUSION

These results suggest that physical deconditioning that is specific to back muscle capacity was present in a subgroup of patients while the opposite was observed in another subgroup, pain catastrophizing being related to this outcome. These findings support previous theoretical models of pain/disability.

Longitudinal changes in strength of police officers with gender comparisons

Strength is a critical factor in the health and job performance of police officers. Using a retrospective longitudinal design, the purpose of this study was to identify differences in strength scores from initial recruitment to in-service tests and to compare gender differences. Strength changes were also compared in low- to high-strength groups. Strength scores included bench press, bench press/lean weight, and bench press/weight. Body weight, percent body fat, and bench press scores were retrieved for the 1990-1995 recruit classes and were paired to most recent scores on 2006 in-service fitness record. Sample included 327 police officers: 30 females and 297 males. Mean age at initial recruitment was 24.6 years and for in-service was 37.1 years. Average time between tests was 12.5 years. Over this period bench press and bench press/lean weight significantly increased for both gender groups (p <or= 0.05). Bench press/weight remained relatively consistent. When dividing the men's strength scores into five low- to high-strength groups, there tended to be an averaging effect over time with the strongest group changing least and the weakest group changing most. In conclusion, the results of this study did not follow expected strength trends, which reported annual declines in muscular strength in men and women. Overall, officers increased in strength well into their late 30s. The practical applications of this study include documented benefits gained from maintaining ongoing fitness training and testing, as well as the potentially positive role of weight gain on strength. Also, low- to high-strength groups did not change relative positions over time even with improvements in strength scores, demonstrating the importance of minimum selection criteria for police.

Age, weight, and the front abdominal power test as predictors of isokinetic trunk strength and work in young men and women

First we tested the reliability of two new field tests of core stability (plank to fatigue test [PFT] and front abdominal power test [FAPT]), as well as established measures of core stability (isokinetic trunk extension and flexion strength [TES and TFS] and work [TEW and TFW]) over 3 days in 8 young men and women (24.0 +/- 3.1 years). The TES, TFS, TFW, and FAPT were highly reliable, TEW was moderately reliable, and PFT were unreliable for use during a single testing session. Next, we determined if age, weight, and the data from the reliable field test (FAPT) were predictive of TES, TEW, TFS, and TFW in 50 young men and women (19.0 +/- 1.2 years). The FAPT was the only significant predictor of TES and TEW in young women, explaining 16 and 15% of the variance in trunk performance, respectively. Weight was the only significant predictor of TFS and TFW in young women, explaining 28 and 14% of the variance in trunk performance, respectively. In young men, weight was the only significant predictor of TES, TEW, TFS, and TFW, and explained 27, 35, 42, and 33%, respectively, of the variance in trunk performance. In conclusion, the ability of weight and the FAPT to predict TES, TEW, TFS, and TFW was more frequent in young men than women. Additionally, because the FAPT requires few pieces of equipment, is fast to administer, and predicts isokinetic TES and TEW in young women, it can be used to provide a field-based estimate of isokinetic TES and TEW in women without history of back or lower-extremity injury.

Toward the development of predictive equations of back muscle capacity based on frequency- and temporal-domain electromyographic indices computed from intermittent static contractions

BACKGROUND CONTEXT

Back muscles capacity is impaired in chronic low back pain patients but no motivation-free test exists to measure it. A functional endurance test (FET) was used to assess capacity of back muscles using surface electromyographic (EMG) indices as outcome measures.

PURPOSE

The main objective of the present study was to explore the possibility of combining different types of EMG indices to predict absolute endurance and strength.

STUDY DESIGN/SETTING

A cross-sectional study using a repeated measures design in laboratory setting.

METHODS

Healthy subjects (44 men and 29 women) performed maximal voluntary contractions (Strength criterion: extension moment at L5/S1) and a fatigue test involving intermittent static extension contractions to exhaustion (Tend endurance criterion: time to reach exhaustion). Surface EMG signals were collected from four pairs of back muscles. From the first 5 minutes (women) or 10 minutes (men) of EMG data, frequency- and temporal-domain analyses were applied to compute various EMG indices.

RESULTS

Strength values ranged from 153 to 508Nm, whereas Tend values ranged from 3 to 57 minutes across the subjects. Gender-specific multiple regression equations were developed, using the retained EMG indices from the four electrode sites, to predict Tend (men: R(2)=0.76, error=9%; women: R(2)=0.70, error=17%) and Strength (men: R(2)=0.72, error=9%; women: R(2)=0.25, error=13%).

CONCLUSIONS

It appears to be possible to predict the capacity of back muscles using an intermittent and time-limited (submaximal) fatigue task. Frequency- and temporal-domain EMG indices were shown to provide complementary information in this respect. This FET has potential to better infer back muscle capacity for realistic occupational tasks because more specific muscle fatigue mechanisms are involved.

Prediction of back strength using anthropometric and strength measurements in healthy females

OBJECTIVES

The purpose of this study was to develop a regression equation to predict back extensor maximal voluntary contraction (back strength) for females based on several anthropometric and strength measurements using a multiple regression technique.

BACKGROUND

Back strength is an important parameter in low back pain studies. However, the measurement of back strength is problematic in certain populations such as low back pain patients and pregnant women.

METHODS

Back strength was measured as both moment at L4/L5 and force. Ten anthropometric or strength measurements were chosen to develop the prediction equation. The data used for developing the models were from eighty non-pregnant female subjects, age 18-42 and with no history of back pain in the past year. Backwards stepwise analysis was performed in order to choose the best fit predictors. The predictive ability of each of the models was checked using the cross-validation technique on 20 other subjects.

FINDINGS

Two prediction models were developed for moment and force, respectively. The models explained 46.9% and 48.2% of the variance in back strength. No multicollinearity problem was found. The validation study showed that the observed back strength was highly correlated with the predicted back strength.

INTERPRETATION

Mass, height, trunk length, grip strength and quadriceps strength are the best predictors of back strength in this study. The models developed in this study can be used for both general female low back pain patients and the pregnancy population.

The value of electromyography of the lumbar paraspinal muscles in discriminating between chronic-low-back-pain sufferers and normal subjects

The authors studied the surface electromyographic (EMG) spectrum of the paraspinal muscles of 350 subjects. They were classified by their history as normal (n=175), chronic low back pain (n=145), or past history (n=30). They pulled upwards on a floor-mounted load cell at two-thirds of their maximum voluntary contraction for 30 s, while the EMG was measured from the paraspinal muscles at the L4/L5 level. From the EMG signal the root-mean-square (RMS) was calculated. Power spectrum analysis allowed calculation of the median frequency slope, the initial median frequency (IMF), modal frequency, peak amplitude and spectral width at half peak amplitude (half-width). All of the variables of the chronic group were significantly different from the normal group, except the median frequency slope, RMS slope and mode. Half-width, age and maximum voluntary contraction were shown to be independent predictors of back pain classification. Half-width classified the subjects with a sensitivity of 0.65 and a specificity of 0.75.

Isometric Strength and Dynamic Back Extensor Endurance are Unrelated in Children Ages 6–10 Years: A Pilot Study

This study assessed the correlation between back extensor isometric force and dynamic endurance in 69 children 6–10 years of age. Subjects were positioned prone with legs and hips supported and restrained on two folded 6-in. mats. 42 subjects (20 girls; 22 boys) performed three 5-sec. isometric back extension efforts against a calibrated dynamometer and peak force values were averaged. An additional 27 subjects (9 girls; 18 boys) also performed a dynamic (0°→45° flexion→0°) back extension test at a frequency of 20 per minute, and the number of repetitions was recorded. Both tests were repeated at a 1-wk. interval. Pearson correlations for the endurance, the isometric force test, and test-retest, and between the functional concentric endurance vs isometric force were .55, .79 (both p < .01), and .03, respectively. These tests have moderate to high reliability but they examine different aspects of back muscle fitness. They should not be used interchangeably to assess back extensor muscle fitness. Further investigation must determine whether different dynamic test frequencies and mat heights yield different results.

Chronic low back pain-associated paraspinal muscle dysfunction is not the result of a constitutionally determined "adverse" fiber-type composition

STUDY DESIGN

Investigative case control study.

OBJECTIVES

To determine whether excessive paraspinal muscle fatigue in chronic low back pain results from a paucity of muscle type I fiber content.

SUMMARY OF BACKGROUND DATA

Paraspinal muscle function is vital for spinal protection. Prospective studies suggest that excessive paraspinal muscle fatigability may increase risk of first-time low back pain. As contractile performance of the paraspinal muscles is governed by their constitutionally determined fiber composition, the question arises whether a constitutionally determined "adverse" composition could predispose to low back pain through impaired spinal protection.

METHODS

Thirty-five male patients with chronic low back pain were compared with 32 male control patients of similar age and anthropometry. During Sorensen and 60% of maximum voluntary isometric contraction fatigue tests, median frequency declines in the paraspinal muscle surface electromyograph signal were monitored and correlated with muscle histomorphometry.

RESULTS

Patients were weaker than controls during maximum voluntary isometric contractions (84.47 [28.44]vs. 98.74 [18.11] kg, respectively; P = 0.02) and more fatigable during their Sorensen tests (endurance time 105.29 [28.53]vs. 137.50 [40.38] sec, respectively; P < 0.01). There were no between-group differences in median frequency declines during the Sorensen (-0.37 [0.16]vs. -0.36 [0.12]%.sec) or 60% maximum voluntary isometric contraction (-0.42 [0.31]vs. -0.51 [0.29]%.sec) tests, for patients and controls, respectively. There were no between-group differences in the percent number of paraspinal muscle type I fibers (64 [11]vs. 64 [9]%) or the percent area occupied by type I fibers (67 [11]vs. 69 [9]%), for patients and controls, respectively. Type I and II muscle fiber narrow diameters were similar for both groups.

CONCLUSION

In the patients with chronic low back pain tested, their associated paraspinal muscle dysfunction was not the result of a constitutionally determined "adverse" fiber type composition.

Back strength cannot be predicted accurately from anthropometric measures in subjects with and without chronic low back pain

OBJECTIVES

(1) To develop a multiple regression equation using anthropometric measurements to predict back strength and (2) to estimate the effect of practice on the back strength results and back strength predictions.

DESIGN

Comparative study with repeated measures performed on three days.

BACKGROUND

The assessment of back muscle relative endurance (% maximal strength) requires the measurement of maximal back strength which is problematic with low back pain patients.

METHODS

The back strength (L5/S1 static extension moment), age and 26 anthropometric parameters were obtained from 83 male volunteers [42 healthy subjects and 41 chronic low back pain patients] aged between 20 and 60 years. A subsample of 20 healthy subjects and 20 patients were assessed through three days of testing to evaluate the variations of back strength with practice.

RESULTS

The final regression model (n=42 healthy subjects) explained 39% of the variance in back strength. Back strength increased with practice (Day1<Day2 & 3) for both healthy and patients groups. However, the error of prediction of back strength derived from the regression model showed a significant improvement with practice for the patients only.

CONCLUSIONS

Back strength cannot be predicted from simple anthropometric measures without important errors. The decrease of the error of prediction obtained for the patient group is indicative of a decreasing influence of psychological factors that are independent of motor learning because the effect of motor learning would have occurred on both groups if present.

RELEVANCE

The prediction of back strength would be useful to determine (1) the relative force level of a given exercise or (2) the preinjury back strength. Unfortunately, anthropometric measurements are not enough good predictors of back strength.

Active therapy for chronic low back pain part 1. Effects on back muscle activation, fatigability, and strength

DESIGN

Randomized prospective study of the effects of three types of active therapy on back muscle function in chronic low back pain patients.

OBJECTIVES

To quantify the effects of 3 months active therapy on strength, endurance, activation, and fatigability of the back entensor muscles.

SUMMARY OF BACKGROUND DATA

Many studies have documented an association between chronic low back pain and diminished muscular performance capacity. Few studies have quantified the changes in these measures following interventions using objective measurement techniques or related them to changes in clinical outcome.

METHODS

A total of 148 individuals (57% women) with chronic low back pain (age, 45.0 +/- 10.0 years; duration of low back pain, 10.9 +/- 9.5 years) were randomized to a treatment that they attended for 3 months: active physiotherapy, muscle reconditioning on devices, or low-impact aerobics. Before and after therapy, assessments were made of the following: trunk muscle strength (in flexion, extension, lateral bending, and axial rotation), erector spinae activation (maximal, and during forward bending movements), back extensor endurance (Biering-Sørensen test), and erector spinae fatigability (determined from changes in the median frequency of the surface electromyographic signal) during isometric and dynamic tests.

RESULTS

A total of 132 of 148 patients (89%) completed the therapy. Isometric strength in each movement direction increased in all groups post-therapy (P < 0.0008), most notably in the devices group. Activation of the erector spinae during the extension tests also increased significantly in all groups and showed a weak, but significant, relationship with increased maximal strength (P = 0.01). Pretherapy 55% of the subjects showed no relaxation of the back muscles at L5 when in the fully flexed position; no changes were observed in any group post-therapy. Endurance time during the Biering-Sørensen test increased significantly post-therapy in all groups (P = 0.0001), but there were no significant changes in EMG-determined fatigability. Fatigability of the lumbar muscles at L5 (EMG median frequency changes) during the dynamic test increased post-therapy (P = 0.0001) without group differences.

CONCLUSION

Significant changes in muscle performance were observed in all three active therapy groups post-therapy, which appeared to be mainly due to changes in neural activation of the lumbar muscles and psychological changes concerning, for example, motivation or pain tolerance.