Muscle Strength Preservation During Repeated Sets of Fatiguing Resistance Exercise: A Secondary Analysis

ABSTRACT

Nuzzo, JL. Muscle strength preservation during repeated sets of fatiguing resistance exercise: A secondary analysis. J Strength Cond Res 38(6): 1149-1156, 2024-During sustained or repeated maximal voluntary efforts, muscle fatigue (acute strength loss) is not linear. After a large initial decrease, muscle strength plateaus at approximately 40% of baseline. This plateau, which likely reflects muscle strength preservation, has been observed in sustained maximal isometric and repeated maximal isokinetic contractions. Whether this pattern of fatigue occurs with traditional resistance exercise repetitions with free weights and weight stack machines has not been overviewed. Here, the aim was to determine whether the number of repetitions completed across 4 or more consecutive repetitions-to-failure tests exhibits the same nonlinear pattern of muscle fatigue. A secondary analysis was applied to data extracted as part of a recent meta-analysis on repetitions-to-failure tests. Studies were eligible if they reported mean number of repetitions completed in 4-6 consecutive repetitions-to-failure tests at a given relative load. Twenty-nine studies were included. Overall, the results show that the number of repetitions completed in consecutive repetitions-to-failure tests at a given load generally decreases curvilinearly. The numbers of repetitions completed in sets 2, 3, 4, 5, and 6 were equal to approximately 70, 55, 50, 45, and 45% of the number of repetitions completed in set 1, respectively. Longer interset rest intervals typically attenuated repetition loss, but the curvilinear pattern remained. From the results, a chart was created to predict the number of repetitions across 6 sets of resistance exercise taken to failure based on the number of repetitions completed in set 1. The chart is a general guide and educational tool. It should be used cautiously. More data from a variety of exercises, relative loads, and interset rest intervals are needed for more precise estimates of number of repetitions completed during repeated sets of fatiguing resistance exercise.

Resistance Exercise Minimal Dose Strategies for Increasing Muscle Strength in the General Population: an Overview

Many individuals do not participate in resistance exercise, with perceived lack of time being a key barrier. Minimal dose strategies, which generally reduce weekly exercise volumes to less than recommended guidelines, might improve muscle strength with minimal time investment. However, minimal dose strategies and their effects on muscle strength are still unclear. Here our aims are to define and characterize minimal dose resistance exercise strategies and summarize their effects on muscle strength in individuals who are not currently engaged in resistance exercise. The minimal dose strategies overviewed were: "Weekend Warrior," single-set resistance exercise, resistance exercise "snacking," practicing the strength test, and eccentric minimal doses. "Weekend Warrior," which minimizes training frequency, is resistance exercise performed in one weekly session. Single-set resistance exercise, which minimizes set number and session duration, is one set of multiple exercises performed multiple times per week. "Snacks," which minimize exercise number and session duration, are brief bouts (few minutes) of resistance exercise performed once or more daily. Practicing the strength test, which minimizes repetition number and session duration, is one maximal repetition performed in one or more sets, multiple days per week. Eccentric minimal doses, which eliminate or minimize concentric phase muscle actions, are low weekly volumes of submaximal or maximal eccentric-only repetitions. All approaches increase muscle strength, and some approaches improve other outcomes of health and fitness. "Weekend Warrior" and single-set resistance exercise are the approaches most strongly supported by current research, while snacking and eccentric minimal doses are emerging concepts with promising results. Public health programs can promote small volumes of resistance exercise as being better for muscle strength than no resistance exercise at all.

Maximal Number of Repetitions at Percentages of the One Repetition Maximum: A Meta-Regression and Moderator Analysis of Sex, Age, Training Status, and Exercise

The maximal number of repetitions that can be completed at various percentages of the one repetition maximum (1RM) [REPS ~ %1RM relationship] is foundational knowledge in resistance exercise programming. The current REPS ~ %1RM relationship is based on few studies and has not incorporated uncertainty into estimations or accounted for between-individuals variation. Therefore, we conducted a meta-regression to estimate the mean and between-individuals standard deviation of the number of repetitions that can be completed at various percentages of 1RM. We also explored if the REPS ~ %1RM relationship is moderated by sex, age, training status, and/or exercise. A total of 952 repetitions-to-failure tests, completed by 7289 individuals in 452 groups from 269 studies, were identified. Study groups were predominantly male (66%), healthy (97%), < 59 years of age (92%), and resistance trained (60%). The bench press (42%) and leg press (14%) were the most commonly studied exercises. The REPS ~ %1RM relationship for mean repetitions and standard deviation of repetitions were best described using natural cubic splines and a linear model, respectively, with mean and standard deviation for repetitions decreasing with increasing %1RM. More repetitions were evident in the leg press than bench press across the loading spectrum, thus separate REPS ~ %1RM tables were developed for these two exercises. Analysis of moderators suggested little influences of sex, age, or training status on the REPS ~ %1RM relationship, thus the general main model REPS ~ %1RM table can be applied to all individuals and to all exercises other than the bench press and leg press. More data are needed to develop REPS ~ %1RM tables for other exercises.

Sex differences in skeletal muscle fiber types: A meta-analysis

Biopsies have been acquired from living men and women to determine proportions of Type I (slow-twitch) and II (fast-twitch) skeletal muscle fibers since the 1970s. Sex differences have been assumed but the literature has not been submitted to meta-analysis. Here, the aim was to generate effect sizes of sex differences in muscle fiber cross-sectional areas, distribution percentages, and area percentages. Data from 2875 men and 2452 women, who participated in 110 studies, were analyzed. Myofibrillar adenosine triphosphatase histochemistry was used in 71.8% of studies to classify fibers as Type I, II, IIA, and/or IIX; immunohistochemistry, immunofluorescence, or sodium dodecyl sulfate-polyacrylamide gel electrophoresis were used in 35.4% of studies to similarly classify myosin heavy chain (MHC) isoform content. Most studies involved biopsies from vastus lateralis (79.1%) in healthy individuals (92.7%) between 18 and 59 years old (80.9%). Men exhibited greater cross-sectional areas for all fiber types (g = 0.40-1.68); greater distribution percentages for Type II, MHC II, IIA, IIX fibers (g = 0.26-0.34); greater area percentages for Type II, IIA, MHC IIA, IIX fibers (g = 0.39-0.93); greater Type II/I and Type IIA/I fiber area ratios (g = 0.63, 0.94). Women exhibited greater Type I and MHC I distribution percentages (g = -0.13, -0.44); greater Type I and MHC I area percentages (g = -0.53, -0.69); greater Type I/II fiber area ratios (g = -1.24). These data, which represent the largest repository of comparative muscle fiber type data from living men and women, can inform discussions about biological sex and its impact on pathologies and sports performance (e.g., explaining sex differences in muscle strength and muscle endurance).

Eccentric Muscle Actions Add Complexity to an Already Inconsistent Resistance Exercise Nomenclature

An eccentric muscle action (or contraction) is defined as active muscle lengthening against resistance, which occurs when the force generated by the muscle is smaller than the resistance placed upon it. Eccentric resistance exercise, which involves multiple sessions of repeated eccentric muscle actions, improves muscle strength and other health outcomes. In response to this evidence, new exercise technologies have been developed to permit feasible completion of eccentric muscle actions outside of the laboratory. Consequently, participation in eccentric resistance exercise is projected to increase in the future, and communications about eccentric resistance exercise are likely to reach a wide audience, including students in the classroom, athletes in the weightroom, patients who receive telehealth services,  and journalists who report on study findings. Previous research has documented inconsistencies in how resistance exercises are named, but the role of eccentric resistance exercises has not been considered. Here, we explain how eccentric resistance exercises add further complexity to an already inconsistent resistance exercise nomenclature. Specifically, action words in exercise names typically describe the movement that occurs in the concentric phase (e.g., "press", "raise", "curl", "pull", "row"). This naming bias likely stems from the fact that traditional resistance exercise equipment, such as free weights and weight stack machines, does not typically accommodate for greater eccentric than concentric strength and thus emphasizes the concentric over eccentric phase. This naming bias is likely to hinder communications about eccentric resistance exercise. Thus, we encourage researchers and practitioners to discuss ways in which resistance exercises can be named more clearly and consistently.

Overview of muscle fatigue differences between maximal eccentric and concentric resistance exercise

Since the 1970s, researchers have studied a potential difference in muscle fatigue (acute strength loss) between maximal eccentric (ECCmax ) and concentric (CONmax ) resistance exercise. However, a clear answer to whether such a difference exists has not been established. Therefore, the aim of our paper was to overview methods and results of studies that compared acute changes in muscle strength after bouts of ECCmax and CONmax resistance exercise. We identified 30 relevant studies. Participants were typically healthy men aged 20-40 years. Exercise usually consisted of 40-100 isokinetic ECCmax and CONmax repetitions of the knee extensors or elbow flexors. Both ECCmax and CONmax exercise caused significant strength loss, which plateaued and rarely exceeded 60% of baseline, suggesting strength preservation. In upper-body muscles, strength loss at the end of ECCmax (31.4 ± 20.4%) and CONmax (33.6 ± 17.5%) exercise was similar, whereas in lower-body muscles, strength loss was less after ECCmax (13.3 ± 12.2%) than CONmax (39.7 ± 13.3%) exercise. Muscle architecture and daily use of lower-body muscles likely protects lower-body muscles from strength loss during ECCmax exercise. We also reviewed seven studies on muscle fatigue during coupled ECCmax -CONmax exercise and found similar strength loss in the ECC and CON phases. We also found evidence from three studies that more ECC than CON repetitions can be completed at equal relative loads. These results indicate that muscle fatigue may manifest differently between ECCmax and CONmax resistance exercise. An implication of the results is that prescriptions of ECC resistance exercise for lower-body muscles should account for greater fatigue resilience of these muscles compared to upper-body muscles.

Men and women differ in their interest and willingness to participate in exercise and sports science research

Unequal proportions of male and female participants in exercise research might be attributed, in part, to differences in interest and willingness to participate. We tested if men and women are equally interested and willing to undergo exercise research procedures and if they consider different factors when deciding to participate. Two samples completed an online survey. Sample 1 (129 men, 227 women) responded to advertisements on social media and survey-sharing websites. Sample 2 (155 men, 504 women) was comprised of undergraduate psychology students. In both samples, men were significantly more interested to learn their muscle mass amount, running speed, jump height, and ball throwing ability, and more willing to receive electrical shocks, cycle or run until exhaustion, complete strength training that causes muscle soreness, and take muscle-building supplements (all p ≤ 0.013, d = 0.23-0.48). Women were significantly more interested to learn their flexibility, and more willing to complete surveys, participate in stretching and group aerobics interventions, and participate in home exercise with online instruction (all p ≤ 0.021, d = 0.12-0.71). Women rated the following significantly more important when deciding to participate: study's implications for society; personal health status; confidence in own abilities; potential anxiety during testing; type of research facility; time to complete study; and invasiveness, pain/discomfort, and possible side effects of procedures (all p < 0.05, d = 0.26-0.81). Differences in interest and willingness to participate in research probably contribute to different proportions of men and women as participants in exercise research. Knowledge of these differences might help researchers develop recruitment strategies aimed at encouraging both men and women to participate in exercise studies.

Connective Adaptive Resistance Exercise (CARE) Machines for Accentuated Eccentric and Eccentric-Only Exercise: Introduction to an Emerging Concept

Eccentric resistance exercise emphasizes active muscle lengthening against resistance. In the past 15 years, researchers and practitioners have expressed considerable interest in accentuated eccentric (i.e., eccentric overload) and eccentric-only resistance exercise as strategies for enhancing performance and preventing and rehabilitating injuries. However, delivery of eccentric resistance exercise has been challenging because of equipment limitations. Previously, we briefly introduced the concept of connected adaptive resistance exercise (CARE)-the integration of software and hardware to provide a resistance that adjusts in real time and in response to the individual's volitional force within and between repetitions. The aim of the current paper is to expand this discussion and explain the potential for CARE technology to improve the delivery of eccentric resistance exercise in various settings. First, we overview existing resistance exercise equipment and highlight its limitations for delivering eccentric resistance exercise. Second, we describe CARE and explain how it can accomplish accentuated eccentric and eccentric-only resistance exercise in a new way. We supplement this discussion with preliminary data collected with CARE technology in laboratory and non-laboratory environments. Finally, we discuss the potential for CARE technology to deliver eccentric resistance exercise for various purposes, e.g., research studies, rehabilitation programs, and home-based or telehealth interventions. Overall, CARE technology appears to permit completion of eccentric resistance exercise feasibly in both laboratory and non-laboratory environments and thus has implications for researchers and practitioners in the fields of sports medicine, physiotherapy, exercise physiology, and strength and conditioning. Nevertheless, formal investigations into the impact of CARE technology on participation in eccentric resistance exercise and clinical outcomes are still required.

Letter writing assignment for exercise physiology students

Letters to the editor are an important part of democratic societies. In academic journals, letters serve as a form of postpublication review and thus permit continued discussion and debate of scientific ideas. However, letters and their importance are rarely taught to university students. Therefore, the aim of the present paper is to propose a lecture and an assignment that introduce the exercise physiology student to letters. The lecture includes an overview of the history of letters, the definition and purposes of letters, letter themes, examples of letters published in exercise physiology journals, and a search method for discovering letters. The student is then assigned a project comprised of two parts. Part 1 requires the student to independently discover a letter exchange in a scientific journal, including the original research article, the letter commenting on the article, and the reply to the letter. The student then writes a report that summarizes the exchange. The report includes an analysis of the letter's themes and the validity of the arguments made. Part 2 of the assignment requires the student to independently discover an article published in the past year that they believe requires comment. The student then writes a letter, commenting on the article. Students who write convincing letters can be encouraged to submit their letter to the journal. The assignment should help prepare the next generation of journal editors, reviewers, and readers for the task of preserving and participating in a practice that serves to refine knowledge.NEW & NOTEWORTHY Letters to the editor are a form of postpublication review and thus help to refine knowledge through discussion and debate, yet exercise physiology students are rarely introduced to letters in their formal education. Here, the author proposes a lecture and an assignment that the university educator can use to help students understand the importance of letters. In the assignment, the student, among other tasks, critiques an existing letter exchange and writes a letter for potential publication.

The Eccentric:Concentric Strength Ratio of Human Skeletal Muscle In Vivo: Meta-analysis of the Influences of Sex, Age, Joint Action, and Velocity

For decades, researchers have observed that eccentric (ECC) muscle strength is greater than concentric (CON) muscle strength. However, knowledge of the ECC:CON strength ratio is incomplete and might inform resistance exercise prescriptions. Our purposes were to determine the magnitude of the ECC:CON ratio of human skeletal muscle in vivo and explore if sex, age, joint actions/exercises, and movement velocity impact it. A total of 340 studies were identified through searches. It was possible to analyse 1516 ECC:CON ratios, aggregated from 12,546 individuals who made up 564 groups in 335 of the identified studies. Approximately 98% of measurements occurred on isokinetic machines. Bayesian meta-analyses were performed using log-ratios as response variables then exponentiated back to raw ratios. The overall main model estimate for the ECC:CON ratio was 1.41 (95% credible interval [CI] 1.38-1.44). The ECC:CON ratio was slightly less in men (1.38 [CI 1.34-1.41]) than women (1.47 [CI 1.43-1.51]), and greater in older adults (1.62 [CI 1.57-1.68]) than younger adults (1.39 [CI 1.36-1.42]). The ratio was similar between grouped upper-body (1.42 [CI 1.38-1.46]) and lower-body joint actions/exercises (1.40 [CI 1.37-1.44]). However, heterogeneity in the ratio existed across joint actions/exercises, with point estimates ranging from 1.32 to 2.61. The ECC:CON ratio was most greatly impacted by movement velocity, with a 0.20% increase in the ratio for every 1°/s increase in velocity. The results show that ECC muscle strength is ~ 40% greater than CON muscle strength. However, the ECC:CON ratio is greatly affected by movement velocity and to lesser extents age and sex. Differences between joint actions/exercises likely exist, but more data are needed to provide more precise estimates.

Muscle fatigue during maximal eccentric-only, concentric-only, and eccentric-concentric bicep curl exercise with automated drop setting

Connected adaptive resistance exercise (CARE) machines are new technology purported to adjust resistance exercise loads in response to muscle fatigue. The present study examined muscle fatigue (strength loss, fatigue perceptions) during maximal eccentric-only (ECC_max -only), concentric-only (CON_max -only), and coupled ECC-CON (ECC_max -CON_max ) bicep curl exercise on a CARE machine. Eleven men and nine women completed the three protocols in separate sessions and in random order. All protocols included 4 sets of 20 maximal effort muscle contractions. Strength loss was calculated as Set 4 set end load minus Set 1 highest load. The CARE machine's algorithm adjusted resistances automatically, permitting continued maximal effort repetitions without stopping. Consequently, all protocols caused substantial fatigue. Women were most susceptible to strength loss from exercise that included maximal efforts in the ECC phase, whereas men were most susceptible to strength loss from exercise that included maximal efforts in the CON phase. With ECC_max -only exercise, ECC strength loss (mean ± SD) was similar between men (55.9 ± 14.1%) and women (56.4 ± 10.8%). However, with CON_max -only exercise, men and women experienced 55.6 ± 6.2% and 35.3 ± 8.7% CON strength loss, respectively. With ECC_max -CON_max exercise, men experienced greater ECC (62.9 ± 7.7%) and CON (77.0 ± 5.3%) strength loss than women (ECC: 48.5 ± 15.7%, CON: 66.2 ± 12.1%). Heightened perceptions of fatigue and pain of the exercised limb were reported after all protocols. Women generally reported more biceps pain than men. The results illustrate CARE technology delivers ECC-only and accentuated ECC exercise feasibly. Acute responses to repeated maximal effort bicep curl exercise with such technology might differ between men and women depending on muscle contraction type.

Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations

ABSTRACT

Nuzzo, JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res 37(2): 494-536, 2023-Biological sex and its relation with exercise participation and sports performance continue to be discussed. Here, the purpose was to inform such discussions by summarizing the literature on sex differences in numerous strength training-related variables and outcomes-muscle strength and endurance, muscle mass and size, muscle fiber type, muscle twitch forces, and voluntary activation; strength training participation rates, motivations, preferences, and practices; and injuries and changes in muscle size and strength with strength training. Male subjects become notably stronger than female subjects around age 15 years. In adults, sex differences in strength are more pronounced in upper-body than lower-body muscles and in concentric than eccentric contractions. Greater male than female strength is not because of higher voluntary activation but to greater muscle mass and type II fiber areas. Men participate in strength training more frequently than women. Men are motivated more by challenge, competition, social recognition, and a desire to increase muscle size and strength. Men also have greater preference for competitive, high-intensity, and upper-body exercise. Women are motivated more by improved attractiveness, muscle "toning," and body mass management. Women have greater preference for supervised and lower-body exercise. Intrasexual competition, mate selection, and the drive for muscularity are likely fundamental causes of exercise behaviors in men and women. Men and women increase muscle size and strength after weeks of strength training, but women experience greater relative strength improvements depending on age and muscle group. Men exhibit higher strength training injury rates. No sex difference exists in strength loss and muscle soreness after muscle-damaging exercise.

Inconsistent Use of Resistance Exercise Names in Research Articles: A Brief Note

ABSTRACT

Nuzzo, JL. Inconsistent use of resistance exercise names in research articles: a brief note. J Strength Cond Res 35(12): 3518-3520, 2021-Academic fields require standard nomenclature to communicate concepts effectively. Previous research has documented resistance training exercises are named inconsistently. This inconsistent use has been observed among fitness professionals and within resistance training textbooks. The purpose of the current note was to explore inconsistent use of resistance training exercise names in scientific articles. Keyword searches were performed in PubMed to identify articles that referred to 4 different resistance training exercises. The search was limited to titles and abstracts of articles published between 1960 and 2020. For exercise 1, "shoulder press," "overhead press," and "military press" were searched. For exercise 2, "arm curl," "bicep curl," and "biceps curl" were searched. For exercise 3, "hamstring curl," "leg curl," and "knee curl" were searched. For exercise 4, "calf raise" and "heel raise" were searched. For exercise 1, 114 articles included "shoulder press" in their title or abstract, 42 articles included "overhead press," and 45 articles included "military press." For exercise 2, 244 articles included "arm curl," 37 articles included "bicep curl," and 177 articles included "biceps curl." For exercise 3, 24 articles included "hamstring curl," 159 articles included "leg curl," and 7 articles included "knee curl." For exercise 4, 68 articles included "calf raise" and 154 articles included "heel raise." The results are evidence of inconsistent use of resistance training exercise names in scientific articles. A possible solution to inconsistent use of exercise names in research articles, educational texts, and clinical practice is a system that includes a standard exercise naming pattern and guidelines for communicating exercise names.

Content Analysis of Patent Applications for Strength Training Equipment Filed in the United States Before 1980

ABSTRACT

Nuzzo, JL. Content analysis of patent applications for strength training equipment filed in the United States before 1980. J Strength Cond Res 35(10): 2952-2962, 2021-Strength training history is an emerging academic area. The aim of the current study was to describe quantitively the history of inventions for strength training equipment. Content analysis was conducted of patent applications for strength training equipment filed with the U.S. Patent and Trademark Office before 1980. Applications were identified using relevant keyword searches in Google Patents. A total of 551 patent applications were analyzed. The earliest application identified was filed in 1860. Applications never exceed 6 per year until 1961 after which applications increased substantially, with a peak of 54 in 1979. Men invented 98.7% of all strength training devices. Lloyd J. Lambert, Jr. was the most prolific inventor, with 10 inventions. Types of inventions included mobile units (34.5%), stationary machines (27.9%), dumbbells (16%), racks or benches (8.0%), barbells (6.7%), and Indian clubs (3.8%). Common features included seats or benches (18.7%), cable-pulley systems (15.1%), weight stacks (8.2%), weight trays (4.5%), and cams (2.2%). Common types of resistance included weights or plates (33.2%), springs (11.6%), friction (9.1%), elastic bands (5.3%), and hydraulic (3.8%). Proposed invention benefits included adjustable resistance (37.4%), inexpensive (36.1%), simple to use (32.8%), compact design or easy storage (27.0%), multiple exercise options (26.1%), safety and comfort (25.4%), effectiveness (23.6%), portability (20.5%), adjustable size (15.8%), sturdiness or durability (15.8%), home use (13.6%), and light weight (13.6%). Certain aspects of strength training equipment have evolved over time. However, overall purposes and benefits of inventions have remained constant (e.g., affordability, convenience, personalization, safety, and effectiveness).

History of Strength Training Research in Man: An Inventory and Quantitative Overview of Studies Published in English Between 1894 and 1979

ABSTRACT

Nuzzo, JL. History of strength training research in man: an inventory and quantitative overview of studies published in English between 1894 and 1979. J Strength Cond Res 35(5): 1425-1448, 2021-Limited scholarship exists on the history of strength training research. The current review advances existing qualitative and biographical work by inventorying all experimental studies and case reports published before 1980 on the effects of ≥1 week of strength training on human health and function. Data on authors, journals, citations, study samples, training interventions, study outcomes, and study themes were extracted and summarized. Three hundred thirty-nine strength training studies were published between 1894 and 1979. Studies included 14,575 subjects, with 10,350 undergoing strength training. Subjects were usually healthy (81.1% of articles), university students (51.0%), or aged 18-65 years (86.7%). Men comprised 70.0% of subjects. Interventions typically involved isoinertial only (64.6%) or isometric only (35.4%) training. Upper-body interventions were more common (35.4%) than lower-body interventions (27.4%). Duration and frequency of training were typically 4-8 weeks (55.3%) and 3 days per week (39.2%), respectively. Isometric maximal voluntary contractions (54.0%) and one repetition maximum (20.4%) were the most common muscle strength tests. Other common outcomes included limb girths (20.9%) and muscle endurance (19.5%). Common research themes were physiology (54.3%), physical fitness (28.9%), and injury/rehabilitation (20.4%). The 339 studies have been cited 21,996 times. Moritani and deVries' 1979 article on time course of neuromuscular adaptations is the most highly cited (1,815 citations). DeLorme (5 articles and 772 citations), Hellebrandt (4 articles and 402 citations), Rasch (9 articles and 318 citations), and Berger (12 articles and 1,293 citations) made the largest contributions. Research Quarterly published the most articles (27.4%). The history of strength training research is discussed in the context of the results.

The Case for Retiring Flexibility as a Major Component of Physical Fitness

Flexibility refers to the intrinsic properties of body tissues that determine maximal joint range of motion without causing injury. For many years, flexibility has been classified by the American College of Sports Medicine as a major component of physical fitness. The notion flexibility is important for fitness has also led to the idea static stretching should be prescribed to improve flexibility. The current paper proposes flexibility be retired as a major component of physical fitness, and consequently, stretching be de-emphasized as a standard component of exercise prescriptions for most populations. First, I show flexibility has little predictive or concurrent validity with health and performance outcomes (e.g., mortality, falls, occupational performance) in apparently healthy individuals, particularly when viewed in light of the other major components of fitness (i.e., body composition, cardiovascular endurance, muscle endurance, muscle strength). Second, I explain that if flexibility requires improvement, this does not necessitate a prescription of stretching in most populations. Flexibility can be maintained or improved by exercise modalities that cause more robust health benefits than stretching (e.g., resistance training). Retirement of flexibility as a major component of physical fitness will simplify fitness batteries; save time and resources dedicated to flexibility instruction, measurement, and evaluation; and prevent erroneous conclusions about fitness status when interpreting flexibility scores. De-emphasis of stretching in exercise prescriptions will ensure stretching does not negatively impact other exercise and does not take away from time that could be allocated to training activities that have more robust health and performance benefits.

Voluntary activation of knee extensor muscles with transcranial magnetic stimulation

We examined if transcranial magnetic stimulation (TMS) is a valid tool for assessment of voluntary activation of the knee extensors in healthy individuals. Maximal M-waves (M_max) of vastus lateralis (VL) were evoked with electrical stimulation of femoral nerve (FNS); M_max of medial hamstrings (HS) was evoked with electrical stimulation of sciatic nerve branches; motor evoked potentials (MEPs) of VL and HS were evoked with TMS; superimposed twitches (SIT) of knee extensors were evoked with FNS and TMS. In study 1, TMS intensity [69% output (SD: 5)] was optimized for MEP sizes, but guidelines for test validity could not be met. Agonist VL MEPs were too small [51.4% M_max (SD: 11.9); guideline ≥70% M_max] and antagonist HS MEPs were too big [16.5% M_max (SD: 10.3); guideline <10% M_max]. Consequently, the TMS estimated resting twitch [99.1 N (SD: 37.2)] and FNS resting twitch [142.4 N (SD: 41.8)] were different. In study 2, SITs at 90% maximal voluntary contraction (MVC) were similar between TMS [16.1 N (SD: 10.3)] and FNS [20.9 N (SD: 16.7)], when TMS intensity was optimized for this purpose, suggesting a procedure that combines TMS SITs with FNS resting twitches could be valid. In study 3, which tested the TMS intensity [56% output (SD: 18)] that evoked the largest SIT at 90% MVC, voluntary activation from TMS [87.3% (SD: 7.1)] and FNS [84.5% (SD: 7.6)] was different. In sum, the contemporary procedure for TMS-based voluntary activation of the knee extensors is invalid. A modified procedure improves validity but only in individuals who meet rigorous inclusion criteria for SITs and MEPs.NEW & NOTEWORTHY We discovered that the contemporary procedure for assessing voluntary activation of the knee extensor muscles with transcranial magnetic stimulation (TMS) is invalid. TMS activates too few agonist quadriceps motoneurons and too many antagonist hamstrings motoneurons to estimate the resting twitch accurately. A modified procedure, in which TMS-evoked superimposed twitches are considered together with the resting twitch from femoral nerve stimulation, is valid but only in select individuals who meet rigorous eligibility criteria.

Effects of postexercise blood flow occlusion on quadriceps responses to transcranial magnetic stimulation

For a fatigued hand muscle, group III/IV afferent firing maintains intracortical facilitation (ICF) without influencing corticospinal excitability. Exercise of larger muscles produces greater afferent firing. Thus, this study investigated if fatigue-related firing of group III/IV afferents from a large muscle group (quadriceps) modulates intracortical and corticospinal networks. In two sessions, participants (n = 18) completed a 2-min maximal voluntary isometric contraction (MVIC) of knee extensors with (OCC) or without (CON) postexercise blood flow occlusion to maintain afferent firing. Pre- and postexercise, single- and paired-pulse transcranial magnetic stimulation (TMS) elicited motor evoked potentials (MEPs) from vastus lateralis (VL), vastus medialis, and rectus femoris. Test pulse intensities evoked VL MEPs of ∼0.5 mV and were adjusted postexercise. The conditioning stimulus for ICF and short-interval intracortical inhibition (SICI) was constant and set to evoke ∼50% of maximum ICF. Muscle pain was also assessed (0-10 scale). Postexercise, muscle pain was greater for OCC than CON (Median = 8.6 vs. 2.3; P < 0.001). MEPs were depressed for CON (all muscles: Δ -24.3 to -34.1%; P ≤ 0.018) despite increased stimulus intensity (∼10%, P < 0.001), but both MEPs and intensity remained unchanged for OCC. ICF was depressed postexercise in OCC (VL and RF: Δ -59.8% and -28.8%, respectively P = 0.016-0.018) but not in CON (all muscles: Δ -3.8 to -44.3%, P = 0.726-1.0), but was not different between conditions (interactions: P = 0.143-0.252). No interactions were observed for SICI (all muscles: P ≥ 0.266). Group III/IV afferent firing counteracts the postcontraction depression of MEPs in quadriceps. However, intracortical inhibitory and facilitatory networks are not implicated in this response.NEW & NOTEWORTHY Maintained exercise-induced firing of group III/IV quadriceps muscle afferents counteracts known reductions in corticospinal excitability that occur with fatigue. However, the results suggest that this increased excitability is not underpinned by changes in intracortical facilitatory or inhibitory networks. These findings are not consistent with previous findings for hand muscle, which reported preserved intracortical facilitation with fatigue-related sustained group III/IV muscle afferent firing.

Sex Difference in Participation in Muscle-Strengthening Activities

Background

Previous data from the United States Centers for Disease Control and Prevention indicate men are more likely than women to participate in muscle-strengthening activities (e.g., resistance training). However, a recent review by Rhodes et al. concluded there is no reliable sex difference in participation. The purpose of the current paper was to review population-level surveys of participation in muscle-strengthening activities to clarify if a sex difference in participation exists.

Methods

Keyword searches (e.g., "resistance training participation") were performed in PubMed and Google Scholar to identify papers that surveyed a general adult population (N > 1,000) and reported an outcome of the proportion of the population meeting recommendations for "muscle-strengthening activities" (i.e., ≥ 2 times/wk) or participating in resistance training.

Results

Sixteen studies from 6 countries met the inclusion criteria. Irrespective of the measure of participation, population-levels of participation were typically higher in men than women. More men than women met recommendations for muscle-strengthening activities in England (men 34%; women 24%), Finland (men 18.1%; women 16.4%), Northern Ireland (men 25%; women 14%), Scotland (men 30%; women 25%), and the United States (men 34.8%; women 25.8%). For Australia, some studies showed no sex difference in participation, whereas other studies showed greater participation among men.

Conclusion

A sex difference exists in participation in muscle-strengthening activities. Low participation rates in both sexes indicate efforts to encourage participation in men and women are warranted. The results also highlight the need for rigorous definitions of "participation," as the lack of such definitions explains the mixed results reported previously.

Men's health in the United States: a national health paradox

A health paradox exists in the United States. Men have worse health outcomes than women, but national offices exist for promoting women's but not men's health. Two factors that might contribute to this paradox are: underappreciation for the number of health issues that affect men more than women and unawareness that men's health receives less attention than women's health. Therefore, the aim of this article was to summarize the data related to these two factors. First, using mostly government data, an inventory of health issues that are more common in males than females was generated, with prevalence rates listed. Second, results from two new scientometric analyses are presented: (a) number of times "men's health" and "women's health" appeared in titles or abstracts of papers in PubMed from 1970 to 2018; and (b) number of journals currently indexed in MEDLINE that specialize in men's or women's health. The epidemiological data illustrate numerous health issues are more prevalent in men than women, and scientometric data reveal men's health has been given less attention as a distinct field of biomedical research than women's health. This information can help to educate legislators, health officials, journalists, and the general public about the current paradox surrounding men's health in the United States.

Aerobic Exercise Reduces Pressure More Than Heat Pain Sensitivity in Healthy Adults

OBJECTIVES

The hypoalgesic effects of exercise are well described, but there are conflicting findings for different modalities of pain; in particular for mechanical vs thermal noxious stimuli, which are the most commonly used in studies of exercise-induced hypoalgesia. The aims of this study were 1) to investigate the effect of aerobic exercise on pressure and heat pain thresholds that were well equated with regard to their temporal and spatial profile and 2) to identify whether changes in the excitability of nociceptive pathways-measured using laser-evoked potentials-accompany exercise-induced hypoalgesia.

SUBJECTS

Sixteen healthy adults recruited from the University of New South Wales.

METHODS

Pressure and heat pain thresholds and pain ratings to laser stimulation and laser-evoked potentials were measured before and after aerobic cycling exercise and an equivalent period of light activity.

RESULTS

Pressure pain thresholds increased substantially after exercise (rectus femoris: 29.6%, d = 0.82, P < 0.001; tibialis anterior: 26.9%, d = 0.61, P < 0.001), whereas heat pain thresholds did not (tibialis anterior: 4.2%, d = 0.30, P = 0.27; foot: 0.44%, d = 0.02, P = 1). Laser-evoked potentials and laser heat pain ratings also changed minimally after exercise (d = -0.59 to 0.3, P > 0.06).

CONCLUSIONS

This is the first investigation to compare the effects of exercise on pressure and heat pain using the same stimulation site and pattern. The results show that aerobic exercise reduces mechanical pain sensitivity more than thermal pain sensitivity.

CORP: Measurement of upper and lower limb muscle strength and voluntary activation

Muscle strength, the maximal force-generating capacity of a muscle or group of muscles, is regularly assessed in physiological experiments and clinical trials. An understanding of the expected variation in strength and the factors that contribute to this variation is important when designing experiments, describing methodologies, interpreting results, and attempting to replicate methods of others and reproduce their findings. In this review (Cores of Reproducibility in Physiology), we report on the intra- and inter-rater reliability of tests of upper and lower limb muscle strength and voluntary activation in humans. Isometric, isokinetic, and isoinertial strength exhibit good intra-rater reliability in most samples (correlation coefficients ≥0.90). However, some tests of isoinertial strength exhibit systematic bias that is not resolved by familiarization. With the exception of grip strength, few attempts have been made to examine inter-rater reliability of tests of muscle strength. The acute factors most likely to affect muscle strength and serve as a source of its variation from trial-to-trial or day-to-day include attentional focus, breathing technique, remote muscle contractions, rest periods, temperature (core, muscle), time of day, visual feedback, body and limb posture, body stabilization, acute caffeine consumption, dehydration, pain, fatigue from preceding exercise, and static stretching >60 s. Voluntary activation, the nervous system’s ability to drive a muscle to create its maximal force, exhibits good intra-rater reliability when examined with twitch interpolation (correlation coefficients >0.80). However, inter-rater reliability has not been formally examined. The methodological factors most likely to influence voluntary activation are myograph compliance and sensitivity; stimulation location, intensity, and inadvertent stimulation of antagonists; joint angle (muscle length); and the resting twitch.

Elbow angle modulates corticospinal excitability to the resting biceps brachii at both spinal and supraspinal levels

NEW FINDINGS

What is the central question of this study? Corticospinal excitability to biceps brachii is known to modulate according to upper-limb posture. Here, cervicomedullary stimulation was used to investigate potential spinal contributions to elbow angle-dependent changes in corticospinal excitability at rest. What is the main finding and its importance? At more extended elbow angles, biceps responses to cervicomedullary stimulation were decreased, whereas cortically evoked responses (normalized to cervicomedullary-evoked responses) were increased. Results suggest decreased spinal excitability but increased cortical excitability as the elbow is placed in a more extended position, an effect that is unlikely to be attributable to cutaneous stretch receptor activation.

ABSTRACT

Corticospinal excitability to biceps brachii is known to modulate according to upper-limb posture. In study 1, our aim was to investigate potential spinal contributions to this modulation and the independent effect of elbow angle. Biceps responses to transcranial magnetic stimulation (motor evoked potentials; MEPs) and electrical cervicomedullary stimulation (cervicomedullary motor evoked potentials; CMEPs) were measured at five elbow angles ranging from full extension to 130 deg of flexion. In study 2, possible contributions of cutaneous stretch receptors to elbow angle-dependent excitability changes were investigated by eliciting MEPs and CMEPs in three conditions of skin stretch about the elbow (stretch to mimic full extension, no stretch or stretch to mimic flexion). Each study had 12 participants. Evoked potentials were acquired at rest, with participants seated, the shoulder flexed 90 deg and forearm supinated. The MEPs and CMEPs were normalized to maximal compound muscle action potentials. In study 1, as the elbow was moved to more extended positions, there were no changes in MEPs (P = 0.963), progressive decreases in CMEPs (P < 0.0001; CMEPs at 130 deg flexion ∼220% of full extension) and increases in the MEP/CMEP ratio (P = 0.019; MEP/CMEP at 130 deg flexion ∼20% of full extension). In study 2, there were no changes in MEPs (P = 0.830) or CMEPs (P = 0.209) between skin stretch conditions. Therefore, although results suggest a decrease in spinal and an increase in supraspinal excitability at more extended angles, the mechanism for these changes in corticospinal excitability to biceps is not cutaneous stretch receptor feedback.

Equity in Physical Activity: A Misguided Goal

Rates of participation in physical activity are often not the same between groups in a given demographic category. These differences have been termed 'inequities,' and major health organizations are advocating large-scale initiatives to create 'equity' in physical activity. The aim of this paper is to explain why equity in physical activity is a misguided goal. Equity is a misguided goal because it ignores absolute rates of physical activity (i.e., it is a metric of how one group compares with another), and because it is an automated goal that ignores sizes of 'gaps' between groups. Moreover, equity initiatives incorrectly assume that groups with relatively high physical activity rates are always at lower health risk; that non-targeted groups will remain static in their levels of physical activity; that individuals are part of only one demographic category; that complete equity can be achieved; that the causal relationship between equity initiatives and their desired outcome can be known; and that differences in physical activity rates between groups are due to differences in 'opportunity.' Due to these issues, health organizations should abandon the goal of equity. Instead, they should aim to increase physical activity in groups that are most sedentary and/or at greatest health risk to a level that is as high as is feasible and possible, irrespective of how that new level compares with other groups. This goal is objective and not based on the misguided premises that underpin the current equity narrative.

Effects of acute isometric resistance exercise on cervicomedullary motor evoked potentials

Cervicomedullary motor evoked potentials (CMEPs) in relaxed biceps brachii have been reported to facilitate after acute isometric exercise of the elbow flexors. This facilitation, which reflects either enhanced corticospinal transmission or increased motoneurone excitability, has only been documented in the limb posture used during exercise. In Experiment 1, we tested if these spinal changes "transfer" to a second posture. Fourteen individuals completed 12 sets of high-force isometric contractions of the elbow flexors with the forearm pronated. Before and after exercise, biceps CMEPs were acquired with the forearm either pronated or supinated. CMEPs in pronation and supination were facilitated after exercise, indicating transfer (57.5 ± 55.5% and 53.9 ± 54.9%, respectively; mean ± SD). In Experiment 2, we examined if exercise posture influences the effect that exercise has on CMEPs. A different sample of 14 individuals performed isometric exercise in 2 sessions. In one, exercise was performed in supination. In the other, exercise was performed in pronation. Exercise intensity and volume were the same as in Experiment 1, as were participant characteristics. CMEPs were unchanged after exercise in supination (13.6 ± 31.2%) and pronation (7.7 ± 41.5%). The absence of an effect differs from the finding of Experiment 1. Thus, effects of acute isometric resistance exercise on corticospinal transmission and/or motoneurone excitability are not as consistent as previously thought. When exercise induces this spinal change, the effect is not specific to the posture used for exercise. However, the change does not always occur, and the reasons for this remain unknown.

Worksite back and core exercise in firefighters: Effect on development of lumbar multifidus muscle size

BACKGROUND

Firefighting is a dangerous occupation with a high incidence of low back pain and injury. Abnormal back muscle function and morphology has been linked to low back pain and poor physical performance. The effect of exercise training on back muscle size and symmetry has not been investigated in firefighters.

OBJECTIVE

The purpose of this study was to assess the effect of worksite exercise training for eliciting lumbar multifidus muscle hypertrophy in firefighters.

METHODS

A cluster randomized controlled trial was conducted with healthy, career firefighters (n=64) from a medium-sized fire department. Participants were randomized by fire station to exercise training (n=36) (supervised back and core exercise performed on duty, 2X/week, 24 weeks) or control (n=28). The cross-sectional area (CSA) of the L4 and L5 lumbar multifidus muscle was assessed with ultrasonography at baseline and following the intervention.

RESULTS

At 24 weeks, no significant differences were noted between the groups in the adjusted (by baseline scores and body mass) L4 and L5 lumbar multifidus muscle CSA and asymmetry values.

CONCLUSIONS

A worksite exercise training program targeting the back and core is not effective for eliciting hypertrophy of the lumbar multifidus muscle in healthy firefighters.

Acute Strength Training Increases Responses to Stimulation of Corticospinal Axons

PURPOSE

Acute strength training of forearm muscles increases resting twitch forces from motor cortex stimulation. It is unclear if such effects are spinal in origin and if they also occur with training of larger muscles. With the use of subcortical stimulation of corticospinal axons, the current study examined if one session of strength training of the elbow flexor muscles leads to spinal cord changes and if the type of training is important.

METHODS

In experiment 1, 10 subjects completed ballistic isometric training, ballistic concentric training, and no training (control) on separate days. In experiment 2, 13 subjects completed ballistic isometric training and slow-ramp isometric training. Before and after training, transcranial magnetic stimulation over the contralateral motor cortex elicited motor-evoked potentials (MEPs) in the resting biceps brachii, and electrical stimulation of corticospinal tract axons at the cervicomedullary junction elicited cervicomedullary motor-evoked potentials (CMEPs). Motor-evoked potential and CMEP twitch forces were also measured.

RESULTS

In experiment 1, CMEPs and CMEP twitch forces were significantly facilitated after ballistic isometric training compared to control. In experiment 2, MEPs, MEP twitch forces, CMEPs, and CMEP twitch forces increased for 15 to 25 min after ballistic and slow-ramp isometric training.

CONCLUSION

Via processes within the spinal cord, one session of strength training of the elbow flexors increases net output from motoneurons projecting to the trained muscles. Likely mechanisms include increased efficacy of corticospinal-motoneuronal synapses or increased motoneuron excitability. However, the rate of force generation during training is not important for inducing these changes. A concomitant increase in motor cortical excitability is likely. These short-term changes may represent initial neural adaptations to strength training.

Arm posture-dependent changes in corticospinal excitability are largely spinal in origin

Biceps brachii motor evoked potentials (MEPs) from cortical stimulation are influenced by arm posture. We used subcortical stimulation of corticospinal axons to determine whether this postural effect is spinal in origin. While seated at rest, 12 subjects assumed several static arm postures, which varied in upper-arm (shoulder flexed, shoulder abducted, arm hanging to side) and forearm orientation (pronated, neutral, supinated). Transcranial magnetic stimulation over the contralateral motor cortex elicited MEPs in resting biceps and triceps brachii, and electrical stimulation of corticospinal tract axons at the cervicomedullary junction elicited cervicomedullary motor evoked potentials (CMEPs). MEPs and CMEPs were normalized to the maximal compound muscle action potential (Mmax). Responses in biceps were influenced by upper-arm and forearm orientation. For upper-arm orientation, biceps CMEPs were 68% smaller (P= 0.001), and biceps MEPs 31% smaller (P= 0.012), with the arm hanging to the side compared with when the shoulder was flexed. For forearm orientation, both biceps CMEPs and MEPs were 34% smaller (both P< 0.046) in pronation compared with supination. Responses in triceps were influenced by upper-arm, but not forearm, orientation. Triceps CMEPs were 46% smaller (P= 0.007) with the arm hanging to the side compared with when the shoulder was flexed. Triceps MEPs and biceps and triceps MEP/CMEP ratios were unaffected by arm posture. The novel finding is that arm posture-dependent changes in corticospinal excitability in humans are largely spinal in origin. An interplay of multiple reflex inputs to motoneurons likely explains the results.

Ultrasound measurements of lumbar multifidus and abdominal muscle size in firefighters

BACKGROUND

Firefighters have a high incidence of low back pain and injury.

OBJECTIVE

To describe lumbar multifidus and abdominal muscle size characteristics in firefighters and to compare these characteristics to normative reference ranges.

METHODS

In career firefighters without current low back pain (62 males, 7 females), ultrasonography was used to assess: L4 and L5 lumbar multifidus cross-sectional area (CSA), asymmetry, and thicknesses; and external oblique, internal oblique, and transverse abdominal thicknesses. Comparisons of mean values in firefighters were made to the normative 95% reference ranges for the general population and soldiers.

RESULTS

Mean values for lumbar multifidus and abdominal muscle size in firefighters fell within the 95% reference ranges for the general population and soldiers for all measurements, except L4 multifidus CSA in males and L5 multifidus CSA in females, which were larger in firefighters than the general population.

CONCLUSIONS

The majority of lumbar multifidus and abdominal muscle size measurements in firefighters are similar to the general population and soldiers. The larger lumbar multifidus CSA in firefighters compared with the general population warrants further study. These data provide a basis for future research using ultrasonography to assess muscle size in firefighters and other workers in physically-demanding occupations.

Words and Patterns That Comprise Resistance Training Exercise Names

Nuzzo, JL. Words and patterns that comprise resistance training exercise names. J Strength Cond Res 31(3): 826-830, 2017-Limited research exists on the language associated with resistance training. The purpose of this study was to identify the ways in which resistance training exercises are named. Names of 57 exercises were obtained from the National Strength and Conditioning Association's Exercise Technique Manual for Resistance Training. The analysis consisted of categorizing into themes all the words of the exercise names and then identifying naming patterns. Names of the 57 exercises were comprised 188 total words. Seven percent of the words described body position (e.g., "seated"), 1.1% described body position direction (e.g., "over"), 19.1% described a body part (e.g., "shoulder"), 1.1% were body part adjectives ("stiff"), 30.3% described action (e.g., "row"), 5.9% described action direction (e.g., "lateral"), 23.4% described equipment (e.g., "barbell"), 8% described equipment position (e.g., "incline"), and 4.3% were considered miscellaneous (e.g., "power"). Of the 57 exercise names, 22.8% contained a body position word, 3.5% contained a body position direction word, 54.4% contained a body part word, 3.5% contained a body part adjective word, 94.7% contained an action word, 19.3% contained an action direction word, 61.4% contained an equipment word, 26.3% contained an equipment position word, and 12.3% contained a miscellaneous word. These types of words were used inconsistently. Additionally, 35 different naming patterns were discovered among the 57 exercise names. Overall, the findings reveal that current strategies for naming exercises are inconsistent. The strength and conditioning field can use this information to move toward standardizing the way in which resistance training exercises are named.

The National Football League Scouting Combine from 1999 to 2014: normative reference values and an examination of body mass normalization techniques

The primary purpose of this study was to identify the most appropriate method for normalizing physical performance measures to body mass in American football players. Data were obtained from the population of players (n = 4,603) that completed the vertical jump, broad jump, 40-yd sprint, 20-yd shuttle, 3-cone drill, and bench press at the National Football League Scouting Combine from 1999 to 2014. Correlation coefficients were used to assess relationships between body mass and physical performance measures. For the entire group and each playing position, absolute (i.e., non-normalized) performance measures were significantly (p ≤ 0.05) correlated with body mass, indicating that normalization is warranted. Ratio scaling, however, was not appropriate for normalizing most performance measures because it merely reversed (and increased in magnitude) the significant correlations between body mass and performance. Allometric scaling with derived allometric parameters was appropriate for normalizing all performance measures because correlations between body mass and performance were near to zero and no longer statistically significant. However, the derived allometric parameters differed by playing position. Thus, when normalizing physical performance measures to body mass, strength and conditioning professionals should use allometric scaling with test- and position-specific allometric parameters. Additionally, in the current study, percentile rankings were generated to provide test- and position-specific normative reference values for the absolute measures. Until body mass normalization techniques are adopted more broadly, strength and conditioning professionals can use these normative references values to compare current players with those who have already participated in the Scouting Combine.

Systematic review of core muscle activity during physical fitness exercises

A consensus has not been reached among strength and conditioning specialists regarding what physical fitness exercises are most effective to stimulate activity of the core muscles. Thus, the purpose of this article was to systematically review the literature on the electromyographic (EMG) activity of 3 core muscles (lumbar multifidus, transverse abdominis, quadratus lumborum) during physical fitness exercises in healthy adults. CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, PubMed, SPORTdiscus, and Web of Science databases were searched for relevant articles using a search strategy designed by the investigators. Seventeen studies enrolling 252 participants met the review's inclusion/exclusion criteria. Physical fitness exercises were partitioned into 5 major types: traditional core, core stability, ball/device, free weight, and noncore free weight. Strength of evidence was assessed and summarized for comparisons among exercise types. The major findings of this review with moderate levels of evidence indicate that lumbar multifidus EMG activity is greater during free weight exercises compared with ball/device exercises and is similar during core stability and ball/device exercises. Transverse abdominis EMG activity is similar during core stability and ball/device exercises. No studies were uncovered for quadratus lumborum EMG activity during physical fitness exercises. The available evidence suggests that strength and conditioning specialists should focus on implementing multijoint free weight exercises, rather than core-specific exercises, to adequately train the core muscles in their athletes and clients.

Use of participant focus groups to identify barriers and facilitators to worksite exercise therapy adherence in randomized controlled trials involving firefighters

BACKGROUND

Firefighters are at increased risk for back injuries, which may be mitigated through exercise therapy to increase trunk muscle endurance. However, long-term adherence to exercise therapy is generally poor, limiting its potential benefits. Focus groups can be used to identify key barriers and facilitators to exercise adherence among study participants.

OBJECTIVE

To explore barriers and facilitators to worksite exercise therapy adherence among firefighters to inform future randomized controlled trials (RCTs).

METHODS

Participants enrolled in a previous RCT requiring twice-weekly worksite exercise therapy for 24 weeks were asked to take part in moderated focus group discussions centered on eight open-ended questions related to exercise adherence. Responses were analyzed qualitatively using a social ecological framework to identify key intrapersonal, interpersonal, and institutional barriers and potential facilitators to exercise adherence.

RESULTS

A total of 27 participants were included in the four focus group discussions, representing 50% of those assigned to a worksite exercise therapy group in the previous RCT, in which only 67% of scheduled exercise therapy sessions were completed. Lack of self-motivation was cited as the key intrapersonal barrier to adherence, while lack of peer support was the key interpersonal barrier reported, and lack of time to exercise during work shifts was the key institutional barrier identified.

CONCLUSION

Focus group discussions identified both key barriers and potential facilitators to increase worksite exercise therapy adherence among firefighters. Future studies should consider educating and reminding participants about the benefits of exercise, providing individual and group incentives based on exercise adherence and performance, providing outside monitoring of exercise adherence, varying the exercise routine, encouraging group exercise and competition, and scheduling exercise during each work shift.