Convergent Validity of Ratings of Perceived Exertion During Resistance Exercise in Healthy Participants: A Systematic Review and Meta-Analysis

Resistance exercise dose effects on muscle morphology, muscle function and quality of life in advanced-stage ovarian cancer survivors

AIM

Advanced-stage ovarian cancer survivors often have compromised muscle morphology (muscle mass and density), muscle function (muscle strength and physical function), and health-related quality of life (HRQoL). We recently reported improvements in these outcomes following resistance training. Information on the resistance exercise dose required to improve health-related outcomes is still lacking in this cancer group. Here we examined the exercise dose delivered and the effect of the delivered dose on changes in outcomes of interest.

METHODS

Twelve women with stage III or IV ovarian cancer completed a 12-week supervised resistance exercise intervention. Exercise metrics included compliance (exercise dose completed), dose modifications (sessions modified) and tolerance (rating of perceived exertion; RPE). Participants were allocated to lower (< 63%) or higher (> 63%) exercise compliance based on median split. Differences in change to muscle morphology, muscle function and HRQoL between compliance groups were investigated.

RESULTS

Median compliance and session RPE were 63.0% and 13 (somewhat hard), respectively. Dose reductions occurred in 92.7% of sessions. Both groups experienced improvements in muscle morphology and function. Higher compliance was associated with greater improvements in whole body lean mass (+ 1.3 kg vs. + 0.5 kg) and lower body strength (+ 50 kg vs. + 13 kg). Only the lower compliance group experienced a clinically significant improvement in 400-m walk time (-48.4 s vs. -9.4 s). Both groups experienced clinically meaningful improvements in social and cognitive functioning.

CONCLUSION

Relatively lower doses of resistance exercise may benefit advanced-stage ovarian cancer survivors. Exercise programs may need to be flexible and individualized to fit the needs of this cancer group.

Effects of resistance training vs high intensity interval training on body composition, muscle strength, cardiorespiratory fitness, and quality of life in survivors of breast cancer: a randomized trial

PURPOSE

Breast cancer treatments often lead to unfavourable changes in body composition, physical fitness, and quality of life (QoL). We compared the effects of resistance training (RT) and high-intensity interval training (HIIT) on these outcomes in survivors of breast cancer.

METHODS

Twenty-eight survivors of breast cancer, post-treatment (Stage I-III), aged 55.5 ± 8.8 years and body mass index 27.9 ± 5 kg/m2 were randomly allocated to a 12-week supervised RT (n = 14) or HIIT (n = 14) intervention, 3 days per week. Body composition (dual energy x-ray absorptiometry), upper and lower body muscle strength (1-repetition maximum), cardiorespiratory fitness (CRF) (Ekblom Bak Cycle Test), and QoL domains (EORTC QLQ-C30 and EORTC QLQ-BR45) were assessed at baseline and 12 weeks.

RESULTS

There were no significant differences between groups at baseline. Exercise attendance ranged from 81 to 85%. Between groups, there were significant differences (p ≤ 0.001) after 12 weeks in chest press strength for RT (mean difference [MD] = 4.7 kg) and CRF for HIIT (MD = 1.9 ml/min/kg). Within groups, there were significant improvements (p < 0.05) for % lean mass and % fat mass in both RT and HIIT, as well as for upper and lower body muscle strength, CRF, and QoL domains. No major adverse events were noted.

CONCLUSION

Both exercise groups improved body composition, physical fitness, and QoL domains over 12 weeks of RT or HIIT, although mode-specific benefits were apparent with more substantial improvements in lean mass and muscle strength with RT and reductions in % fat mass and improved CRF with HIIT. Tailored exercise programs should address the specific health needs of each patient.

Development and delivery of the rehabilitation interventions for older adults with an ankle fracture in the AFTER (Ankle Fracture Treatment Enhancing Rehabilitation) trial

OBJECTIVES

Describe the development and delivery of the interventions in the Ankle Fracture Treatment Enhancing Rehabilitation (AFTER) trial, a randomised controlled trial comparing the effectiveness of supervised versus self-directed rehabilitation for adults aged ≥50 years with an ankle fracture.

DESIGN

Intervention development.

SETTING

UK National Health Service (NHS) hospitals.

METHOD

We developed the interventions in stages. First, we reviewed two UK clinical guidelines and the existing research evidence. We then conducted a clinical practice survey (n = 59 physiotherapists) to inform a stakeholder meeting which identified key intervention components. Subsequently, we designed the interventions, tested them in a pilot trial (n = 61 participants), then refined them for the definitive AFTER trial.

RESULTS/FINDINGS

The definitive AFTER trial interventions start after randomisation, which occurs when the participant's cast/boot is removed and weightbearing and ankle movement restrictions are lifted. Participants allocated to self-directed rehabilitation receive a high-quality advice workbook, a progressively challenging self-directed exercise programme that they follow to self-manage their recovery, and strategies to encourage exercise adherence. Supervised rehabilitation participants receive a high-quality workbook, then 4 to 6 one-to-one face-to-face/remote sessions with a physiotherapist. The physiotherapist provides specific advice, home exercises, and uses strategies to facilitate adherence to prescribed exercises. The supervised rehabilitation intervention is tailored to individual participants during review sessions.

CONCLUSIONS

The definitive AFTER trial will provide high-quality evidence to guide rehabilitation provision for older adults with an ankle fracture. Results are anticipated in 2025.

TRIAL REGISTRATION NUMBER

ISRCTN registry (identifier: ISRCTN11830323). CONTRIBUTION OF THE PAPER.

Comparing the effectiveness of the FIFA 11+ warm-up and conventional warm-up in enhancing cyclist performance and mitigating injury risk

The Fédération internationale de football association (FIFA) 11 + warm-up program, initially tailored for soccer, has gathered attention for its effectiveness in reducing injury rates and enhancing performance in soccer players. This study aimed to compare the effects of an 8-week FIFA 11 + warm-up program with a conventional warm-up on injury prevention, performance, and fitness parameters in professional male cyclists. Eighty professional male cyclists, aged between 18 and 45 years and actively engaged in cycling activities, were included in this study. Pre-and post-intervention assessments following a structured 8-week warm-up program based on the FIFA 11 + protocol covered a range of performance and fitness parameters, including agility (T-test), flexibility (V Sit and Reach test), lower limb explosive power (Broad Jump test), cycling speed (3-kilometer cycling test), core muscle strength (plank tests), balance (Open and Closed Eyes tests), and exercise tolerance (Rate of Perceived Exertion or RPE), and injury incidence rates. Both warm-up programs showed improvements in agility, flexibility, lower limb explosive power, and 3-kilometer cycling performance. However, the FIFA 11 + program exhibited significantly greater enhancements in core muscle strength, balance, and exercise tolerance, as indicated by reduced perceived exertion, and injury reduction compared to the conventional warm-up. While both warm-up programs yielded positive outcomes for professional male cyclists, the FIFA 11 + warm-up program demonstrated superior effects on core muscle strength, balance, and exercise tolerance and injury prevention. These findings suggest that the FIFA 11 + warm-up may be a more effective addition to training routines for cyclists, offering enhanced performance and reduced injury risks compared to conventional warm-up.

Validation and Calibration for Embedding Rating of Perceived Exertion Into High-Intensity Interval Exercise in Adolescents: A Lab-Based Study

PURPOSE

Rating of perceived exertion (RPE) is a convenient and cost-effective tool that can be used to monitor high-intensity interval exercise (HIIE). However, no methodological study has demonstrated the validity of RPE in this context. Therefore, the aim of this study was to validate and calibrate RPE for monitoring HIIE in adolescents.

METHODS

RPE, heart rate (HR), and oxygen uptake (V˙O2) data were retrospectively extracted from 3 lab-based crossover studies, with a pooled sample size of 45 adolescents, performing either cycling-based or running-based HIIE sessions. Within-participant correlations were calculated for RPE-HR and RPE-V˙O2, and receiver operator characteristic curve analysis was used to establish RPE cut points.

RESULTS

The results showed that RPE-HR demonstrated acceptable criterion validity (r = .53-.74, P < .01), while RPE-V˙O2 had poor validity (r = .40-.48, P < .01), except for HIIE at 100% peak power (r = .59, P < .01). RPE cut points of 4 and 5 were established in corresponding to HR/V˙O2 based thresholds.

CONCLUSION

RPE has some utility in evaluating intensity during lab-based running or cycling HIIE in adolescents. Future studies should expand the validation and calibration of RPE for prescribing and monitoring HIIE in children and adolescents in field-based contexts.

How do rest-pause and sarcoplasma stimulating training models affect metabolic and psychoaffective responses in bodybuilding athletes compared to traditional training?

Introduction

Strength training (ST) is a strategy to enhance quality of life through increased strength, muscle hypertrophy, and functional capacity. Training systems are associated with manipulation of volume and intensity, generating different stimuli, such as Rest-Pause (RP) and Sarcoplasmic Stimulating Training (SST). These systems induce greater mechanical and physiological stress, leading to increased strength and muscle hypertrophy. However, the metabolic and psycho-affective effects of advanced systems in experienced practitioners remain inconclusive. The purpose of the study is to analyze the acute effects of RP, SST, and Traditional (TMS) systems on metabolic and psycho-affective responses in adult men.

Methods

This experimental crossover study assessed 15 subjects (30.38 ± 2.06 years; 88.40 ± 6.50 kg; 1.74 ± 0.07 cm) experienced in ST, evaluated under TMS, RP, and SST during flat bench press and leg press 45° exercises. Body composition, muscular strength via 1-RM testing, lactate concentration (LAC), and psycho-affective measures (Rating of Perceived Exertion-RPE; Visual Analog Scale-VAS; Feeling Scale-FS) were determined. Statistical analysis was performed using the Minitab software, with p ≤ 0.05, IC-95%).

Results

The finals results showed SST exhibited a 38.10% lower LAC concentration post-training session compared to TMS, while RP showed 37.20% lower LAC concentration than TMS post-session. Average RPE values for RP and SST were higher (8.50 ± 1.10 and 8.60 ± 0.90, respectively) than TMS (6.00 ± 1.10). VAS displayed higher average values for RP and SST (8.00 ± 2.00 and 8.00 ± 1.00, respectively) compared to TMS (5.00 ± 1.00), with affective ratings indicating positive values for TMS and values between 0 and -5 for RP (40%) and SST (60%) post-training sessions, suggesting that RP and SST induced less affective response than TMS.

Discussion

The results lead to the conclusion that manipulation of training volume and intensity led to higher RPE and pain (VAS). The data suggest that inappropriate prescription of these systems could lead to greater displeasure, leading us to hypothesize that a higher likelihood of discontinuation from strength training programs would occur, suggesting that greater repetition volumes (RP and SST) should be targeted at individuals with a higher training level.

Ratings of perceived effort during expiratory pressure tasks in healthy adults

PURPOSE

Expiratory muscle strength training (EMST) is a resistance exercise used to improve maximal expiratory pressure and airway protective functions (cough and swallow) in clinical populations. Although ratings of perceived exertion/effort (RPE) are commonly used in exercise prescription and monitoring, they have been underutilized in EMST and require investigation. Our study aims were to: (1) examine how healthy adults rate their effort using the EMST-150 device and MicroRPM respiratory manometer; (2) assess variability in RPE; and (3) compare RPE and relative expiratory pressures obtained from the two devices.

METHOD

Healthy adults completed thirty randomized expiratory maneuvers into a respiratory manometer and an EMST-150 device. RPE was measured using the Borg Category Ratio Scale. Linear mixed multilevel models were used for Aim 1 and 3, and coefficient of variation was used for Aim 2.

RESULTS

Twenty healthy adults (Median age: 24.5 years) participated. Results demonstrated a strong positive relationship between resistive load and perceived effort when using both devices. Intra-individual variability in perceived effort decreased as resistive load increased. Participants produced an average of 18.2 % lower expiratory pressure when blowing into the manometer (relative to their maximum) than when blowing into the EMST device.

DISCUSSION

Our results support the utilization of RPE in EMST research and clinical practice. The addition of RPE as a measure of intensity during respiratory exercise prescription may be used in future research to help refine EMST protocols and improve rehabilitation outcomes.

An Integrated Perspective of Effort and Perception of Effort

Effort and the perception of effort (PE) have been extensively studied across disciplines, resulting in multiple definitions. These inconsistencies block scientific progress by impeding effective communication between and within fields. Here, we present an integrated perspective of effort and PE that is applicable to both physical and cognitive activities. We define effort as the energy utilized to perform an action. This definition can be applied to biological entities performing various voluntary or involuntary activities, irrespective of whether the effort contributes to goal achievement. Then, we define PE as the instantaneous experience of utilizing energy to perform an action. This definition builds on that of effort without conflating it with other subjective experiences. We explore the nature of effort and PE as constructs and variables and highlight key considerations in their measurement. Our integrated perspective aims to facilitate a deeper understanding of these constructs, refine research methodologies, and promote interdisciplinary collaborations.

The relationship between prescribed ratings of perceived exertion and force production in repeated isometric contractions

Ratings of perceived exertion (RPE) are frequently used to monitor and prescribe exercise intensity. However, studies examining the shape and robustness of how feelings of effort map onto objective outputs are limited and report inconsistent results. To address this, we investigated whether (1) producing isometric forces according to RPE levels reliably leads to differences in force output, (2) if feelings of effort map linearly or non-linearly onto force output, and (3) if this mapping is robust when visual feedback and social facilitation are present. In a counterbalanced repeated measures design, N = 26 participants performed isometric handgrip contractions prescribed by ten levels of the Borg CR-10 scale. They did so either with or without the availability of concurrent visual feedback regarding their force production, and in the presence or absence of another person performing the same task simultaneously. We found that subjects reliably produced different force outputs that corresponded to each RPE level. Furthermore, concurrent visual feedback led to a linearization of force output, while in the absence of feedback, the produced forces could also be described by quadratic and cubic functions. Exploratory post-hoc analyses revealed that participants perceived moderate RPE levels to be more challenging to produce. By shedding light on the dynamic nature of the mapping between RPE and objective performance, our findings provide helpful insights regarding the utility of RPE scales.

Are incremental exercise relationships between rating of perceived exertion and oxygen uptake or heart rate reserve valid during steady-state exercises?

Background

Rating of perceived exertion (RPE) is considered a valid method for prescribing prolonged aerobic steady-state exercise (SSE) intensity due to its association with physiological indicators of exercise intensity, such as oxygen uptake (V̇O2) or heart rate (HR). However, these associations between psychological and physiological indicators of exercise intensity were found during graded exercise tests (GXT) but are currently used to prescribe SSE intensity even though the transferability and validity of the relationships found during GXT to SSE were not investigated. The present study aims to verify whether (a) RPE-HR or RPE-V̇O2 relations found during GXTs are valid during SSEs, and (b) the duration and intensity of SSE affect these relations.

Methods

Eight healthy and physically active males (age 22.6 ± 1.2 years) were enrolled. On the first visit, pre-exercise (during 20 min standing) and maximal (during a GXT) HR and V̇O2 values were measured. Then, on separate days, participants performed 4 SSEs on the treadmill by running at 60% and 80% of the HR reserve (HRR) for 15 and 45 min (random order). Individual linear regressions between GXTs' RPE (dependent variable) and HRR and V̇O2 reserve (V̇O2R) values (computed as the difference between maximal and pre-exercise values) were used to predict the RPE associated with %HRR (RPEHRR) and %V̇O2R (RPEV̇O2R) during the SSEs. For each relation (RPE-%HRR and RPE-%V̇O2R), a three-way factorial repeated measures ANOVA (α = 0.05) was used to assess if RPE (dependent variable) was affected by exercise modality (i.e., RPE recorded during SSE [RPESSE] or GXT-predicted), duration (i.e., 15 or 45 min), and intensity (i.e., 60% or 80% of HRR).

Results

The differences between RPESSE and GXT-predicted RPE, which were assessed by evaluating the effect of modality and its interactions with SSE intensity and duration, showed no significant differences between RPESSE and RPEHRR. However, when RPESSE was compared with RPEV̇O2R, although modality or its interactions with intensity were not significant, there was a significant (p = 0.020) interaction effect of modality and duration yielding a dissociation between changes of RPESSE and RPEV̇O2R over time. Indeed, RPESSE did not change significantly (p = 0.054) from SSE of 15 min (12.1 ± 2.0) to SSE of 45 min (13.5 ± 2.1), with a mean change of 1.4 ± 1.8, whereas RPEV̇O2R decreased significantly (p = 0.022) from SSE of 15 min (13.7 ± 3.2) to SSE of 45 min (12.4 ± 2.8), with a mean change of -1.3 ± 1.5.

Conclusion

The transferability of the individual relationships between RPE and physiological parameters found during GXT to SSE should not be assumed as shown by the results of this study. Therefore, future studies modelling how the exercise prescription method used (e.g., RPE, HR, or V̇O2) and SSE characteristics (e.g., exercise intensity, duration, or modality) affect the relationships between RPE and physiological parameters are warranted.

Acute fatigue-induced alterations in hamstring muscle properties after repeated Nordic hamstring exercises

This study aimed to investigate the impact of the Nordic hamstring exercises (NHE) on acute fatigue-induced alterations in the mechanical and morphological properties of hamstring muscles. The second aim was to define the blood flow and perfusion after NHE in recreational active volunteers. Twenty-two individuals volunteered to participate in the study. This study investigated fatigue outcomes: rate of perceived exertion (RPE) scale and average force generated during NHE; mechanical properties (stiffness); morphological properties (thickness, pennation angle, and fascicle length), and vascularity index (VI) of the semitendinosus (ST) and biceps femoris long head (BFLH) at baseline, immediately post-exercise and 1-h post-exercise. The NHE fatigue procedure consisted of six bouts of five repetitions. The results showed an increase in thickness and pennation angle of BFLH and ST immediately post-exercise and a decrease in thickness and pennation angle of BFLH and ST 1-h post-exercise. While the fascicle length of BFLH and ST decreased immediately post-exercise and increased 1-h post-exercise. The VI for two muscles increased immediately post-exercise and after 1-h post-exercise. Moreover, we found a relationship between RPE and average force, that is, as RPE increased during NHE, average force decreased. In conclusion, eccentric NHE exercises significantly and acutely affect BFLH and ST. The NHE fatigue protocol significantly affected the mechanical and morphological properties of BFLH and ST muscles, changing their thickness, fascicle length, pennation angle, and VI.

The implementation of a home-based isometric wall squat intervention using ratings of perceived exertion to select and control exercise intensity: a pilot study in normotensive and pre-hypertensive adults

PURPOSE

Isometric exercise (IE) and isometric wall squat (IWS) training have been shown to be effective methods of reducing arterial blood pressure. However, most IE interventions require methodologies and equipment that could present a barrier to participation. Therefore, this study aimed to examine the effectiveness of an accessible RPE prescribed IWS intervention.

METHODS

Thirty normotensive and pre-hypertensive adults were randomly assigned to a control group or one of two 4-week home-based IWS intervention groups: the first group conducted IWS exercise where intensity was prescribed and monitored using RPE (RPE-EX), whilst the other used a previously validated HR prescription method (HR-EX). Resting and ambulatory heart rate (HR) and blood pressure (BP) were measured pre- and post-intervention.

RESULTS

Minimum clinically important differences (MCID; - 5 mmHg) in SBP and/or DBP were shown in 100% of intervention participants. Statistically significant reductions were shown in resting seated BP (RPE-EX: SBP: - 9 ± 6, DBP: - 6 ± 4, MAP: - 6 ± 3 mmHg; HR-EX: SBP: - 14 ± 6, DBP: - 6 ± 4, MAP: - 8 ± 4 mmHg), supine BP (RPE-EX: SBP: - 8 (- 5), DBP: - 8 (- 7), MAP: - 8 (- 4) mmHg; HR-EX: SBP: - 5 (- 4), MAP - 5 (- 4) mmHg), and ambulatory SBP (RPE-EX: - 8 ± 6 mmHg; HR-EX: - 10 ± 4 mmHg) following the interventions. There were no statistically significant differences between intervention groups in the magnitude of BP reduction.

CONCLUSION

RPE prescribed IWS exercise can provide an effective and more accessible method for reducing BP at home, providing reductions comparable to the current HR-based prescription method.

Effect of resistance training programs differing in set structure on muscular hypertrophy and performance in untrained young men

Purpose: This study aimed to compare the effects on muscle hypertrophy and muscular performance of two resistance training (RT) programs that differed only in set structure: traditional set structure (TS) vs. rest redistribution set structure (RR). Methods: Thirty untrained young men were pair-matched and randomly assigned to a TS (n = 15) or an RR (n = 15) protocol based on individual baseline measures. Participants trained for 8 weeks using the same total body RT routines performed twice weekly. The TS protocol comprised four sets of 10 repetitions per exercise with 120-s interset rest, and the RR involved eight sets of five repetitions per exercise with 51-s interset rest. Participants were tested pre- and post-intervention for body composition, regional muscle thickness, upper- and lower-body muscle maximal strength [1-repetition maximum (1RM)], mean power output and velocity at 75% 1RM and muscular endurance (repetitions to failure at 70% 1RM). Results: Compared to baseline, both groups exhibited equally significantly decreased body fat mass (p < 0.05), increased fat-free mass (p < 0.001), muscle thickness (p < 0.05), upper and lower-body muscular maximal strength (p < 0.001) and endurance performance (p < 0.001). However, both groups only increase the lower-body power output (p < 0.001) but not the upper-body (p > 0.05). No significant differences existed between groups for all measurements (p > 0.05). Conclusion: These results suggest that RR and TS groups have similar effects for improving muscle hypertrophy and performance in untrained young men.

Next steps to advance general physical activity recommendations towards physical exercise prescription: a narrative review

Physical inactivity is a major health concern, associated with the development of several non-communicable diseases and with an increased mortality rate. Therefore, promoting active lifestyles has become a crucial public health necessity for enhancing overall health and quality of life. The WHO guidelines for physical activity (PA) present valuable contributions in this respect; however, we believe that greater specificity should be added or complemented towards physical exercise (PE) testing, prescription and programming in future recommendations. In this review article, we suggest simple and practical tools accessible to the entire population to improve the specificity of this approach, highlighting aspects of PE programming used by trained subjects. By adopting these suggestions, exercise professionals, clinicians and physical trainers can optimise the current general PA recommendations towards PE prescription to improve fitness status and encourage PE adherence in the general population.

Effects of PROtein enriched MEDiterranean Diet and EXercise on nutritional status and cognition in adults at risk of undernutrition and cognitive decline: the PROMED-EX Randomised Controlled Trial

INTRODUCTION

Undernutrition leading to unplanned weight loss is common in older age and has been linked to increased dementia risk in later life. Weight loss can precede dementia by a decade or more, providing a unique opportunity for early intervention to correct undernutrition and potentially prevent or delay cognitive impairment. The combined effects of diet and exercise on undernutrition have not yet been evaluated. The objective of this trial is to determine the effect of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline.

METHODS

One hundred and five participants aged 60 years and over at risk of undernutrition and with subjective cognitive decline will be recruited to participate in a 6-month, single-blind, parallel-group randomised controlled trial. Participants will be block randomised into one of three groups: group 1-PROMED-EX (diet+exercise), group 2-PROMED (diet only) and group 3-standard care (control). The primary outcome is nutritional status measured using the Mini Nutritional Assessment. Secondary outcomes include cognitive function, nutritional intake, body composition, physical function and quality of life. Mechanistic pathways for potential diet and exercise-induced change in nutritional status and cognition will be explored by measuring inflammatory, metabolic, nutritional and metabolomic biomarkers.

ETHICS AND DISSEMINATION

The study is approved by the UK Office for Research Ethics Committee (ref: 21/NW/0215). Written informed consent will be obtained from participants prior to recruitment. Research results will be disseminated to the public via meetings and media and the scientific community through conference presentations and publication in academic journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT05166564).

Aerobic physical exercise versus dual-task cognitive walking in cognitive rehabilitation of people with stroke: a randomized clinical trial

Introduction

Stroke is a neurological deficit caused by an acute focal injury to the central nervous system due to vascular injury that can result in loss of neurological function, lasting brain damage, long-term disability and, in some cases, death. The literature reports that aerobic physical exercise, as well as dual-task cognitive walking, are used for the cognitive recovery of people with stroke. We aimed to assess whether aerobic physical exercise influences post-stroke cognitive recovery, namely performance on selective and sustained attention. We tested the hypothesis that post-stroke aerobic physical exercise leads to more significant gains than post-stroke dual-task cognitive walking.

Methods

We used a Randomized Clinical Trial, single-blind, parallel group, to verify the existence of differences between two groups. A total of 34 patients with subacute to chronic stroke were divided into two groups to train three times a week for 12 weeks: the aerobic physical exercise (PE) group engaged in 20 min on a treadmill, 20 min on a stationary bicycle and 5 min on a desk bike pedal exerciser per session; the dual-task (DT) gait exercise group walked for 45 min while simultaneously performing cognitive tasks per session. All participants were assessed on cognitive functioning with the Mini-Mental State Examination (MMSE) and d2 Test of Attention before acute interventions and post interventions. We have also applied a Visual Analog Scale to monitor the participants' perceived difficulty, pre-, post-acute, and post-chronic interventions. Participants also responded to a Borg Scale of perceived exertion following the acute and the final session of chronic training.

Results

A mixed model ANOVA revealed a significant interaction effect with a large effect size for most of the cognitive variables under study. The variables associated with the d2 Test of Attention showed significant differences between the groups, mainly from T0 to T2. Also for MMSE, an ANOVA revealed a significant interaction effect with significant improvements from T0 to T2. Our results strongly suggest that aerobic physical exercise is more beneficial than dual-task cognitive-gait exercise since in the PE group, cognitive attention scores increase, and cognitive impairment and perception of exertion decrease, compared to the DT group.

Conclusion

These findings support that PE provides more significant benefits for patients post-stroke when compared to DT.

Ballistic Exercise Versus Heavy Resistance Exercise Protocols: Which Resistance Priming Is More Effective for Improving Neuromuscular Performance on the Following Day?

ABSTRACT

Nishioka, T and Okada, J. Ballistic exercise versus heavy resistance exercise protocols: which resistance priming is more effective for improving neuromuscular performance on the following day? J Strength Cond Res 37(10): 1939-1946, 2023-This study aimed to determine whether ballistic exercise priming (BEP) or heavy resistance priming (HRP) is more effective for improving ballistic performance after 24 hours. Ten resistance-trained men performed BEP and HRP conditions 72-144 hours apart in a randomized and counterbalanced order. Jumping performance was assessed before and 24 hours after the BEP and HRP sessions using 0 and 40% one-repetition maximum (1RM) squat jump (SJ), 0 and 40% 1RM countermovement jump (CMJ), and drop jump (DJ) reactive strength index (RSI). Statistical significance was accepted at p ≤ 0.05. In the BEP condition, 0% 1RM CMJ height (+3.62%) as well as theoretical maximum velocity (+5.14%) and theoretical maximum power (+2.55%) obtained from CMJ 24 hours after the priming session were significantly greater than those at the baseline ( p ≤ 0.05), but 0% 1RM SJ height and DJ RSI ( p > 0.05) were not greater than those at the baseline. In the HRP condition, the jump performances were not improved ( p > 0.05). The percentage change in 0% 1RM CMJ height in the BEP condition was significantly greater than that seen in the HRP condition ( p = 0.015) but did not differ for 0% 1RM SJ height and DJ RSI ( p > 0.05). These results suggest that the BEP is more effective than HRP in improving CMJ performance after 24 hours. Therefore, practitioners should consider prescribing resistance priming using low-load ballistic exercises rather than high-load traditional exercises when planning to enhance athlete performance on the following day.

Effects of progressive body-weight versus barbell back squat training on strength, hypertrophy and body fat among sedentary young women

The objective of this study was to compare the effects of progressive bodyweight training and barbell back squat on muscle strength, muscluar hypertrophy, and body fat percentage in sedentary young women. Thirteen sedentary young women (aged 19.77 ± 0.83 years, height 164.91 ± 6.01) were randomly assigned to either the progressive bodyweight group (n = 6, consisting of 10 levels of movements progressing from bilateral to unilateral) or the barbell squat group (n = 7, 60-80% 1RM). Both groups underwent two training sessions per week for 6 weeks. Measurements of muscle strength (isokinetic knee extensor and flexor muscle peak torque of each leg), muscle thickness (gluteus maximus, rectus femoris, and gastrocnemius muscles), and body fat percentage were taken at baseline and post-testing. Both groups showed a significant increase in isometric peak torque of the knee extensor and flexor (p < 0.05), but there were no significant between-group differences in isometric peak torque of the knee extensor and flexor (p > 0.05) or in the mean concentric peak torque of the knee H/Q ratio (p > 0.05). Both groups also showed significant increases in muscle thickness (p < 0.05), with no significant differences in Gastrocnemius, Rectus femoris and Gluteus maximus (p > 0.05). The percentage of body fat significantly decreased in the barbell group (pre: 28.66 ± 4.58% vs post: 24.96 ± 5.91%, p = 0.044), but not in the bodyweight group (pre: 24.18 ± 4.63% vs post: 24.02 ± 4.48%, p = 0.679). Our findings indicate that while both training methods increased maximum strength and muscle mass, barbell back squat training may be more effective in reducing body fat percentage.

Elite North American soccer performance in thermally challenging environments: An explorative approach to tracking outcomes

AIMS

The physiologic challenges related to performances in hot conditions calls for dedicated consideration when planning athlete training, although complete amelioration of the effects of heat may not be possible. We aimed to quantify within-subject correlations between different measures of environmental temperature and performance changes over multiple elite soccer competitions.

METHODS

Thirty-seven elite male soccer players (age: 26 ± 3.4 years, height: 171 ± 2 cm, body mass: 78 ± 7.1 kg) competed in North America over four seasons (range: 3 to 98 matches). Players wore global positioning system devices during games and reported differential-RPE immediately post game. Temperatures at kick-off, week average temperature, the difference between game-day and week average (DiffTemp), and heat index at kick-off were obtained. Within-player correlations were calculated using general linear models to quantify associations between fluctuations in temperature measures and physical and perceived outputs.

RESULTS

Correlations between total distance and the various temperature measures were trivial to small (range: -0.08 to 0.13, p=<0.001-0.02). Small negative correlations were found between all temperature measures except DiffTemp and high-speed running (HSR) (range: -0.17 to -0.14, p=<0.001). Most correlations between differential-RPE and temperature measures were trivial to small and not significant (r = 0.06 to 0.18 p = 0.03-0.92) although breathlessness-RPE and heat index showed a small significant association (P = 0.018).

CONCLUSION

Decrements in HSR appear to be associated with increased environmental temperature, however, these associations are small in magnitude.

Rating of perceived effort but relative to what? A comparison between imposed and self-selected anchors

PURPOSE

Collecting reliable and valid rating of perceived effort (RPE) data requires properly anchoring the scales' upper limits (i.e., the meaning of 10 on a 0-10 scale). Yet, despite their importance, anchoring procedures remain understudied and theoretically underdeveloped. Here we propose a new task-based anchoring procedure that distinguishes between imposed and self-selected anchors. In the former, researchers impose on participants a specific task as the anchor; in the latter, participants choose the most effortful task experienced or imaginable as the anchor. We compared the impact of these conceptually different anchoring procedures on RPE.

METHODS

Twenty-five resistance-trained participants (13 females) attended a familiarization and two randomized experimental sessions. In both experimental sessions, participants performed non-fatiguing and fatiguing isometric maximal voluntary contraction (MVC) protocols with the squat followed by the gripper or vice versa. After each MVC, participants reported their RPE on a 0-10 scale relative to an imposed anchor of the performed task (e.g., gripper MVCs anchored to a gripper MVC) or to a self-selected anchor.

RESULTS

In the non-fatiguing condition, imposed anchors yielded greater RPEs than self-selected anchors for both the squat [on average, 9.4 vs. 5.5; Δ(CI95%) = 3.9 (3.2, 4.5)] and gripper [9.4 vs. 3.9; Δ = 5.5 (4.7, 6.3)]. Similar results were observed in the fatiguing condition for both the squat [9.7 vs. 6.9; Δ = 2.8 (2.1, 3.5)] and gripper [9.7 vs. 4.5; Δ = 5.2 (4.3, 5.9)].

CONCLUSIONS

We found large differences in RPE between the two anchors, independent of exercises and fatigue state. These findings provide a basis for further development and refinement of anchoring procedures and highlight the importance of selecting, justifying, and consistently applying the chosen anchors.

Criteria-Based Rehabilitation Following Revision Hip Arthroscopy: A Clinical Commentary

Hip revision arthroscopy is becoming an increasingly popular surgery for those with unsatisfactory outcomes following primary hip arthroscopy. With the relatively uncommon but potentially increased difficulty of rehabilitation from this surgery, a lack of established research regarding rehabilitative programs remains. Therefore, the purpose of this clinical commentary is to propose a criterion-based progression that considers the intricacies present following a hip revision arthroscopy from early rehabilitation through return to sport. Criteria are presented clearly to promote objective progression through rehabilitation as opposed to relying on time since surgery as revision surgeries do not always follow traditional tissue healing time-frames. This criterion based progression promotes range of motion (ROM), strength, gait, neuromuscular control, load introduction and gradual return to play.

Level of Evidence

5.

Commonly Used Subjective Effort Scales May Not Predict Directly Measured Physical Workloads and Fatigue in Hispanic Farmworkers

In North America, Hispanic migrant farmworkers are being exposed to occupational ergonomic risks. Due to cultural differences in the perception and reporting of effort and pain, it was unknown whether standardized subjective ergonomic assessment tools could accurately estimate the directly measured their physical effort. This study investigated whether the subjective scales widely used in exercise physiology were associated with the direct measures of metabolic load and muscle fatigue in this population. Twenty-four migrant apple harvesters participated in this study. The Borg RPE in Spanish and the Omni RPE with pictures of tree-fruit harvesters were used for assessing overall effort at four time points during a full-day 8-h work shift. The Borg CR10 was used for assessing local discomfort at the shoulders. To determine whether there were associations between the subjective and direct measures of overall exertion measures, we conducted linear regressions of the percentage of heart rate reserve (% HRR) on the Borg RPE and Omni RPE. In terms of local discomfort, the median power frequency (MPF) of trapezius electromyography (EMG) was used for representing muscle fatigue. Then full-day measurements of muscle fatigue were regressed on the Borg CR10 changes from the beginning to the end of the work shift. The Omni RPE were found to be correlated with the % HRR. In addition, the Borg RPE were correlated to the % HRR after the break but not after the work. These scales might be useful for certain situations. In terms of local discomfort, the Borg CR10 were not correlated with the MPF of EMG and, therefore, could not replace direct measurement.

The Use of Elastic Bands in Velocity-Based Training Allows Greater Acute External Training Stimulus and Lower Perceived Effort Compared to Weight Plates

The objective was to compare the mean propulsive velocity (MPV), maximum power (PMAX), heart rate, and rate of perceived exertion (RPE) during the parallel squat using elastic bands (EB) or weight plates (WP) to load the bar. The effect of relative strength on the dependent variables was analysed. Additionally, the potential of the RPE to predict external load parameters was assessed. Eighteen trained volunteers squatted at 40%, 55%, 70%, and 85% of their one-repetition maximum with EB and WP (a total of eight sets) in random order. Dependent variables were measured at the first and last repetition (i.e., 10% velocity loss). Two identical sessions were conducted to assess the reliability of measurements. Compared to WP, EB allowed a significantly greater number of repetitions, MPV, and PMAX, and significantly lower RPE. The RPE of the first repetition was a significant predictor of the external load of the set. The RPE showed good repeatability and was not influenced by the relative strength of athletes. In conclusion, compared to WP, the use of EB allows for greater external load with reduced internal load responses in a wide spectrum of load-based intensities. The potential implications of these novel findings are discussed in the manuscript.

The WATER study: Which AquaTic ExeRcises increase muscle activity and limit pain for people with low back pain?

OBJECTIVE

Aquatic exercise therapy is used for the treatment and management of chronic low back pain (CLBP). However, to the authors' knowledge, no studies to date have compared muscle activity between different aquatic exercises performed by people with CLBP. As such, this study assessed and compared muscle activity, pain, perceived exertion and exercise intensity between different rehabilitative aquatic exercises.

DESIGN

Cross-sectional.

SETTING

A 25-m indoor swimming pool within a university building.

PARTICIPANTS

Twenty participants with non-specific CLBP.

ASSESSMENT

Twenty-six aquatic exercises in shallow water (1.25-m depth). Muscle activity was quantified bilaterally for the erector spinae, multifidus, gluteus maximus and medius, rectus abdominis, and external and internal obliques.

MAIN OUTCOMES

Mean and peak muscle activity, pain (visual analogue scale), perceived exertion (Borg scale) and exercise intensity (heart rate).

RESULTS

Hip abduction/adduction and extension/flexion exercises produced higher activity for gluteal muscles. Variations of squat exercises increased the activity of back extensors. Higher abdominal muscle activity was produced with exercises that made use of buoyancy equipment and included leg and trunk movements while floating on the back, and with some proprioceptive and dynamic lower limb exercises. Pain occurrence and intensity were very low, with 17 exercises being pain free.

CONCLUSIONS

This study provides evidence on trunk and gluteal muscle activity, pain, intensity and perceived exertion for people with CLBP performing aquatic exercises. The findings may be useful when prescribing exercises for rehabilitation, as physiotherapists seek to implement progression in effort and muscle activity, variation in exercise type, and may wish to target or avoid particular muscles. CONTRIBUTION OF THE PAPER.

Tailored exercise and manual therapy versus standardised exercise for patients with shoulder subacromial pain: a feasibility randomised controlled trial (the Otago MASTER trial)

OBJECTIVES

The aim of this study was to assess whether it was feasible to conduct a full trial comparing a tailored versus a standardised exercise programme for patients with shoulder subacromial pain.

DESIGN

Two-arm, patient-blinded and assessor-blinded, randomised controlled feasibility trial.

METHODS

Twenty-eight participants with shoulder subacromial pain were randomly allocated into one of two intervention groups-tailored or standardised exercise. Participants in the tailored exercise programme received exercises and manual therapy tailored to their scapular and shoulder movement impairments. Participants in the standardised exercise programme received progressive strengthening exercise. The primary outcome measures were (1) the participant recruitment rate; (2) the proportion of participants enrolled from the total number screened; (3) drop-out rates; and (4) adherence to the rehabilitation programme. Other outcome measures were: (5) pain levels; (6) Patient-Specific Functional Scale; (7) the Shoulder Pain and Disability Index; and (8) pain self-efficacy. We compared changes in pain and disability scores between groups using a repeated mixed-model analysis of variance. Since this is a feasibility study, we did not adjust alpha for multiple comparisons, and considered 75% CI as the probability threshold at 3-month follow-up. Health-related quality of life was assessed using the Short-Form 12 and quality-adjusted life years (QALYs) were estimated.

RESULTS

The recruitment rate was 3 participants per month, the proportion of participants enrolled was 23%, the drop-out rate was 14% and the overall adherence to the rehabilitation programme was 85%. No between-group differences were found for most outcome measures. Adverse events (n=2, only in the tailored group) were minor in nature and included skin injury or pain following taping.

CONCLUSIONS

Our feasibility trial showed that additional strategies are required for improving recruitment, enrolment and minimising drop-out of participants into the trial and making it feasible to conduct a full trial.

TRIAL REGISTRATION NUMBER

ANZCTR: 12617001405303.