Jonas Vinstrup

Electromyographic comparison of elastic resistance and machine exercises for high-intensity strength training in patients with chronic stroke

OBJECTIVE To investigate whether elastic resistance training can induce comparable levels of muscle activity as conventional machine training in patients with chronic stroke. DESIGN Comparative study. SETTING Outpatient rehabilitation facility. PARTICIPANTS Stroke patients (N=18) with hemiparesis (mean age, 57 ± 8y). INTERVENTIONS Patients performed 3 consecutive repetitions at 10 repetition maximum of unilateral knee extension and flexion using elastic resistance and conventional machine training. MAIN OUTCOME MEASURES Surface electromyography was measured in vastus lateralis, vastus medialis, biceps femoris, and semitendinosus and was normalized to maximal electromyography (% of max) of the nonparetic leg. RESULTS In the paretic leg, agonist muscle activity ranged from 18% to 24% normalized electromyography (% of max) (nEMG) during knee flexion and from 32% to 40% nEMG during knee extension. For knee extension, vastus lateralis nEMG was higher during machine exercise than during elastic resistance exercise (40% [95% confidence interval {CI}, 33-47] vs 32% [95% CI, 25-39]; P=.003). In the nonparetic leg, agonist muscle activity ranged from 54% to 61% during knee flexion and from 52% to 68% during knee extension. For knee flexion semitendinosus nEMG was higher (61% [95% CI, 50-71] vs 54% [95% CI, 44-64]; P=.016) and for knee extension vastus medialis nEMG was higher (68% [95% CI, 60-76] vs 56% [95% CI, 48-64]; P<.001) during machine exercise than during elastic resistance exercise. By contrast, antagonist coactivation was significantly higher during knee flexion when performed using elastic resistance compared with the machine. Lastly, there were no differences in perceived exertion between exercise modalities. CONCLUSIONS Machine training appears to induce slightly higher levels of muscle activity in some of the investigated muscles compared to elastic resistance during lower limb strength training in patients with chronic stroke. The higher level of coactivation during knee flexion when performed using elastic resistance suggests that elastic resistance exercises are more difficult to perform. This is likely due to a higher level of movement instability.

Electromyographic comparison of conventional machine strength training versus bodyweight exercises in patients with chronic stroke

Abstract Objective: To investigate whether bodyweight exercises can induce comparable levels of muscle activity as conventional machine exercises in chronic stroke patients. Methods: Eighteen patients performed three repetitions of bilateral- and unilateral machine leg press and the bodyweight exercises chair rise and hip thrust. Surface electromyography (EMG) was recorded from 10 lower extremity muscles and normalized to maximal EMG (nEMG) of the non-paretic leg. Results: For the paretic leg, the bodyweight exercises showed comparable levels of nEMG in 6 out of 10 muscles compared with the bilateral leg press. Vastus lateralis nEMG was higher during bilateral leg press compared with hip thrust (38% [95% CI 33–42] vs. 10% [95% CI 6–15], p < 0.0001) and chair rise (38% [95% CI 33–42] vs. 27% [95% CI 22–32], p < 0.0001). Vastus medialis nEMG was higher during bilateral leg press compared with hip thrust (34% [95%CI 27–40] vs. 8% [95% CI 2–15], p < 0.0001). Unilateral leg press showed higher nEMG compared with bilateral leg press in biceps femoris (28% [95% CI 23–34] vs. 19% [95% CI 13–24], p = 0.0009), gluteus maximus (32% [95% CI 23–41] vs. 25% [95% CI 16–34], p < 0.05), and vastus medialis (42% [95% CI 36–48] vs. 34% [95% CI 27–40], p = 0.0013). Discussion: In patients with chronic stroke, bodyweight exercises activate the majority of the lower limb muscles to comparable levels as bilateral leg press performed in machine. In addition, unilateral leg press was superior to the bilateral leg press and both bodyweight exercises.

Validity and reliability of elastic resistance bands for measuring shoulder muscle strength

Valid and reliable measurements of muscle strength are important in sport medicine. This study assesses concurrent validity and intrarater reliability (test–retest reliability) of elastic resistance bands for measuring shoulder muscle strength. Altogether, 50 healthy adults [mean age 36.0 (SD: 11.6), 29 women and 21 men] participated in testing and retesting 1–2 weeks later. The maximal elastic resistance (TheraBand) that each participant could hold for 3 s during standing bilateral shoulder abduction to 90° was converted into torque and validated against gold standard maximal voluntary isometric contraction (MVC) (Vishay force transducer) performed unilaterally while lying supine. The intrarater reliability of both tests were high; for the MVC and elastic band test, respectively, ICC(3,1) was 0.98 (95% CI: 0.97–0.99) and 0.99 (95% CI: 0.98–1.00), and measurement error was 4.8% (95% CI: 3.7–5.9) and 4.7% (95% CI: 3.1–6.2). For concurrent validity, ICC(3,1) was 0.96 (95% CI: 0.95–0.98) and measurement error was 8.1% (95% CI: 6.6–9.6), and the elastic band test explained 93% of the variance in the MVC test. However, the elastic band test produced systematically lower torque values than the MVC [56.5 (SD: 26.8) vs 66.5 (SD: 25.5) Nm, P < 0.01]. In conclusion, the test for shoulder muscle strength using elastic resistance bands has excellent validity and reliability, but produces systematically lower torque values than MVC. The reason for the lower torque values may be that the elastic band test has an initial concentric phase and is performed bilaterally and standing upright.

Reducing Physical Risk Factors in Construction Work Through a Participatory Intervention: Protocol for a Mixed-Methods Process Evaluation.

Background Previous research has shown that reducing physical workload among workers in the construction industry is complicated. In order to address this issue, we developed a process evaluation in a formative mixed-methods design, drawing on existing knowledge of the potential barriers for implementation. Objective We present the design of a mixed-methods process evaluation of the organizational, social, and subjective practices that play roles in the intervention study, integrating technical measurements to detect excessive physical exertion measured with electromyography and accelerometers, video documentation of working tasks, and a 3-phased workshop program. Methods The evaluation is designed in an adapted process evaluation framework, addressing recruitment, reach, fidelity, satisfaction, intervention delivery, intervention received, and context of the intervention companies. Observational studies, interviews, and questionnaires among 80 construction workers organized in 20 work gangs, as well as health and safety staff, contribute to the creation of knowledge about these phenomena. Results At the time of publication, the process of participant recruitment is underway. Conclusions Intervention studies are challenging to conduct and evaluate in the construction industry, often because of narrow time frames and ever-changing contexts. The mixed-methods design presents opportunities for obtaining detailed knowledge of the practices intra-acting with the intervention, while offering the opportunity to customize parts of the intervention.

Electromyographic evaluation of high-intensity elastic resistance exercises for lower extremity muscles during bed rest

PurposeProlonged hospital bed rest after severe injury or disease leads to rapid muscle atrophy and strength loss. Therefore, the main aim of this study was to evaluate the efficacy of lower extremity strengthening exercises using elastic resistance that can be performed while lying in a hospital bed.MethodsUsing a cross-sectional design, 22 healthy individuals performed three consecutive repetitions of 14 different lower extremity exercises using elastic resistance, with a perceived intensity corresponding to 8 on the Borg CR-10 scale. Surface electromyography was measured on 13 lower extremity muscles and normalized to the maximal EMG (nEMG). Likewise, exercise satisfaction was evaluated by a questionnaire.ResultsAll participants were able to perform all exercises without discomfort and generally rated them satisfactory. High levels of muscle activity were observed for all prime movers. For example, the “femoris muscle setting” exercise showed high levels of muscle activity for rectus femoris, vastus lateralis, and vastus medialis (79, 75, and 79% nEMG, respectively), while biceps femoris and semitendinosus were highly active during the prone knee flexion exercise with (72 and 71% nEMG, respectively) and without Kinesiology Tape (73 and 77% nEMG, respectively).ConclusionHigh levels of muscle activity in the lower extremities can be achieved using elastic resistance exercises performed when lying in a hospital bed. Even though performed on healthy individuals, the present study has the potential to provide a reference table of exercises to select from when individualizing and progressing strengthening exercises during the early rehabilitation of bedridden individuals.

Focusing on increasing velocity during heavy resistance knee flexion exercise boosts hamstring muscle activity in chronic stroke patients

Background. Muscle strength is markedly reduced in stroke patients, which has negative implications for functional capacity and work ability. Different types of feedback during strength training exercises may alter neuromuscular activity and functional gains. Objective. To compare levels of muscle activity during conditions of blindfolding and intended high contraction speed with a normal condition of high-intensity knee flexions. Methods. Eighteen patients performed unilateral machine knee flexions with a 10-repetition maximum load. Surface electromyography (EMG) was recorded from the quadrics and hamstring muscles and normalized to maximal EMG (nEMG) of the nonparetic limb. Results. For the paretic leg, the speed condition showed higher values of muscle activity compared with the normal and blindfolded conditions for both biceps femoris and semitendinosus. Likewise, the speed condition showed higher co-contraction values compared with the normal and blindfolded conditions for the vastus lateralis. No differences were observed between exercise conditions for the nonparetic leg. Conclusion. Chronic stroke patients are capable of performing heavy resistance training with intended high speed of contraction. Focusing on speed during the concentric phase elicited higher levels of muscle activity of the hamstrings compared to normal and blindfolded conditions, which may have implications for regaining fast muscle strength in stroke survivors.

Core Muscle Activity, Exercise Preference, and Perceived Exertion during Core Exercise with Elastic Resistance versus Machine

Objectives. To investigate core muscle activity, exercise preferences, and perceived exertion during two selected core exercises performed with elastic resistance versus a conventional training machine. Methods. 17 untrained men aged 26–67 years participated in surface electromyography (EMG) measurements of five core muscles during torso-twists performed from left to right with elastic resistance and in the machine, respectively. The order of the exercises was randomized and each exercise consisted of 3 repetitions performed at a 10 RM load. EMG amplitude was normalized (nEMG) to maximum voluntary isometric contraction (MVC). Results. A higher right erector spinae activity in the elastic exercise compared with the machine exercise (50% [95% CI 36–64] versus 32% [95% CI 18–46] nEMG) was found. By contrast, the machine exercise, compared with the elastic exercise, showed higher left external oblique activity (77% [95% CI 64–90] versus 54% [95% CI 40–67] nEMG). For the rectus abdominis, right external oblique, and left erector spinae muscles there were no significant differences. Furthermore, 76% preferred the torso-twist with elastic resistance over the machine exercise. Perceived exertion (Borg CR10) was not significantly different between machine (5.8 [95% CI 4.88–6.72]) and elastic exercise (5.7 [95% CI 4.81–6.59]). Conclusion. Torso-twists using elastic resistance showed higher activity of the erector spinae, whereas torso-twist in the machine resulted in higher activity of the external oblique. For the remaining core muscles the two training modalities induced similar muscular activation. In spite of similar perceived exertion the majority of the participants preferred the exercise using elastic resistance.

Accuracy of identification of low or high risk lifting during standardised lifting situations

Abstract The aim was to classify lifting activities into low and high risk categories (according to The Danish Working Environment Authority guidelines) based on surface electromyography (sEMG) and trunk inclination (tri-axial accelerometer) measurements. Lifting tasks with different weights, horizontal distance and technique were performed. The lifting tasks were characterised by a feature vector composed of either the 90th, 95th or 99th percentile of sEMG activity level and trunk inclinations during the task. Linear Discriminant Analysis and a subject-specific threshold scheme were applied and lifting tasks were classified with an accuracy of 65.1–65.5%. When lifts were classified based on the subject-specific threshold scheme from low and upper back accelerometers, the accuracy reached 52.1–58.1% and 72.7–78.1%, respectively. In conclusion, the use of subject-specific thresholds from sEMG from upper trapezius and erector spinae as well as inclination of the upper trunk enabled us to identify low and high risk lifts with an acceptable accuracy. Practitioner Summary: This study contributes to the development of a method enabling the automatic detection of high risk lifting tasks, i.e. exposure to high biomechanical loads, based on individual sEMG and kinematics from an entire working day. These methods may be more cost-effective and may complement observations commonly used by practitioners.

Influence of different attentional focus on EMG amplitude and contraction duration during the bench press at different speeds

ABSTRACT The purpose of this study was to investigate whether using different focus affects electromyographic (EMG) amplitude and contraction duration during bench press performed at explosive and controlled speeds. Eighteen young male individuals were familiarized with the procedure and performed the one-maximum repetition (1RM) test in the first session. In the second session, participants performed the bench press exercise at 50% of the 1RM with 3 different attentional focuses (regular focus on moving the load vs contracting the pectoralis vs contracting the triceps) at 2 speed conditions (controlled vs maximal speed). During the controlled speed condition, focusing on using either the pectoralis or the triceps muscles increased pectoralis normalized EMG (nEMG) by 6% (95% CI 3–8%; p = 0.0001) and 4% nEMG (95% CI 1–7%; p = 0.0096), respectively, compared with the regular focus condition. Triceps activity was increased by 4% nEMG (95% CI 0–7%; p = 0.0308) at the controlled speed condition during the triceps focus. During the explosive speed condition, the use of different focuses had no effect. The different attentional focus resulted in comparable contraction duration for the measured muscles when the exercise was performed explosively. Using internal focus to increase EMG amplitude seems to function only during conditions of controlled speed.

Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

Study Design: Cross‐sectional. Purpose of the Study: This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients. Methods: Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non‐paretic arm. Results: Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19‐40] vs 15% [95% CI: 5‐25] and FDS (37% [95% CI: 27‐48] vs 24% [95% CI: 13‐35]). For the musculature of both the FDS and ED, no dose‐response association was observed for resistance and muscle activity during the flexion exercise (P > .05). Conclusion: The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control. Level of Evidence: 4b.