Marius Steiro Fimland

Maximal Strength Training Enhances Strength and Functional Performance in Chronic Stroke Survivors

ObjectiveThis study aimed to demonstrate that maximal strength training improves muscle strength and to assess the effect of training on function, aerobic status, and quality-of-life among chronic stroke survivors. DesignTen patients acted as their own controls for 4 wks, before an 8-week training intervention. Patients trained 3 days/wk, with four sets of four repetitions at 85%–95% one repetition maximum in unilateral leg press and plantarflexion with an emphasis on maximal mobilization of force in the concentric phase. ResultsAfter training, leg press strength improved by 30.6 kg (75%) and 17.8 kg (86%); plantarflexion strength improved by 35.5 kg (89%) and 28.5 kg (223%) for the unaffected and affected limbs, respectively, significantly different from the control period (all P < 0.01). The 6-min walk test improved by 13.9 m (within training period; P = 0.01), and the Timed Up and Go test time improved by 0.6 secs (within training period; P < 0.05). There were no significant changes in walking economy, peak aerobic capacity, Four-Square Step Test, or health-related quality-of-life after training. ConclusionsMaximal strength training improved muscle strength in the most affected as well as in the nonaffected leg and improved Timed-Up-And-Go time and 6-min walk distance but did not alter Four-Step Square Test time, aerobic status, or quality-of-life among chronic stroke survivors.

A comparison of muscle activity and 1-RM strength of three chest-press exercises with different stability requirements

Abstract The purpose of this study was to compare one-repetition maximum (1-RM) and muscle activity in three chest-press exercises with different stability requirements (Smith machine, barbell, and dumbbells). Twelve healthy, resistance-trained males (age 22.7 ± 1.7 years, body mass 78.6 ± 7.6 kg, stature 1.80 ± 0.06 m) were tested for 1-RM of the three chest-press exercises in counterbalanced order with 3–5 days of rest between the exercises. One-repetition maximum and electromyographic activity of the pectoralis major, deltoid anterior, biceps, and triceps brachii were recorded in the exercises. The dumbbell load was 14% less than that for the Smith machine (P ≤ 0.001, effect size [ES] = 1.05) and 17% less than that for the barbell (P ≤ 0.001, ES = 1.11). The barbell load was ∼3% higher than that for the Smith machine (P = 0.016, ES = 0.18). Electrical activity in the pectoralis major and anterior deltoid did not differ during the lifts. Electrical activity in the biceps brachii increased with stability requirements (i.e. Smith machine <barbell <dumbbells; P ≤ 0.005; ES = 0.57, 1.46, and 2.00, respectively), while triceps brachii activity was reduced using dumbbells versus barbell (P = 0.007, ES = 0.73) and dumbbells versus Smith machine (P = 0.003, ES = 0.62). In conclusion, high stability requirements in the chest press (dumbbells) result in similar (pectoralis major and anterior deltoid), lower (triceps brachii) or higher (biceps brachii) muscle activity. These findings have implications for athletic training and rehabilitation.

Muscle force output and electromyographic activity in squats with various unstable surfaces.

Abstract Saeterbakken, AH and Finland, MS. Muscle force output and electromyographic activity in squats with various unstable surfaces. J Strength Cond Res 27(1): 130–136, 2013—The purpose of the study was to compare force output and muscle activity of leg and trunk muscles in isometric squats executed on stable surface (i.e., floor), power board, BOSU ball, and balance cone. Fifteen healthy men (23.3 ± 2.7 years, mass: 80.5 ± 8.5 kg, height: 1.81 ± 0.09 m) volunteered. The force output and electromyographic (EMG) activities of the rectus femoris, vastus medialis, vastus lateralis, biceps femoris, soleus, rectus abdominis, oblique external, and erector spinae were assessed. The order of the surfaces was randomized. One familiarization session was executed before the experimental test. Compared with stable surface (749 ± 222 N), the force output using power board was similar (−7%, p = 0.320) but lower for BOSU ball (−19%, p = 0.003) and balance cone (−24%, p ⩽ 0.001). The force output using BOSU ball and balance cone was approximately 13% (p = 0.037) and approximately 18% (p = 0.001) less than the power board. There were similar EMG activities between the surfaces in all muscles except for rectus femoris, in which stable squat provided greater EMG activity than did the other exercises (p = 0.004–0.030). Lower EMG activity was observed in the rectus femoris using balance cone compared with the BOSU ball (p = 0.030). In conclusion, increasing the instability of the surface during maximum effort isometric squats usually maintains the muscle activity of lower-limb and superficial trunk muscles although the force output is reduced. This suggests that unstable surfaces in the squat may be beneficial in rehabilitation and as a part of periodized training programs, because similar muscle activity can be achieved with reduced loads.

Occupational rehabilitation programs for musculoskeletal pain and common mental health disorders: study protocol of a randomized controlled trial

BackgroundLong-term sick leave has considerably negative impact on the individual and society. Hence, the need to identify effective occupational rehabilitation programs is pressing. In Norway, group based occupational rehabilitation programs merging patients with different diagnoses have existed for many years, but no rigorous evaluation has been performed. The described randomized controlled trial aims primarily to compare two structured multicomponent inpatient rehabilitation programs, differing in length and content, with a comparative cognitive intervention. Secondarily the two inpatient programs will be compared with each other, and with a usual care reference group.Methods/designThe study is designed as a randomized controlled trial with parallel groups. The Social Security Office performs monthly extractions of sick listed individuals aged 18–60 years, on sick leave 2–12 months, with sick leave status 50% - 100% due to musculoskeletal, mental or unspecific disorders. Sick-listed persons are randomized twice: 1) to receive one of two invitations to participate in the study or not receive an invitation, where the latter “untouched” control group will be monitored for future sick leave in the National Social Security Register, and 2) after inclusion, to a Long or Short inpatient multicomponent rehabilitation program (depending on which invitation was sent) or an outpatient cognitive behavioral therapy group comparative program. The Long program consists of 3 ½ weeks with full rehabilitation days. The Short program consists of 4 + 4 full days, separated by two weeks, in which a workplace visit will be performed if desirable. Three areas of rehabilitation are targeted: mental training, physical training and work-related problem solving. The primary outcome is number of sick leave days. Secondary outcomes include time until full sustainable return to work, health related quality of life, health related behavior, functional status, somatic and mental health, and perceptions of work. In addition, health economic evaluation will be performed, and the implementation of the interventions, expectations and experiences of users and service providers will be investigated with different qualitative methods.Trial registrationClinicalTrials.gov: NCT01926574.

Test-retest reliability of v-wave responses in the soleus and gastrocnemius medialis.

This study was designed to assess the reliability of the first volitional (V) wave, which can be used as a measure of efferent neural drive, while also reflecting reflex excitability. Ten subjects volunteered for one familiarization session followed by an experimental test session and an identical retest session spaced 3 to 8 days apart. V-waves were evoked in the tibial nerve during plantar flexion maximal voluntary isometric contractions (MVCs). Test-retest reliability was assessed using the intraclass correlation coefficient (ICC), along with standard error of measurement and 95% confidence intervals for the following variables: MVC force, surface electromyogram activity (EMG), and the peak-to-peak V-wave amplitude in soleus (SOL) and gastrocnemius medialis (GM). The superimposed M-wave (MSUP) accompanying V-wave stimulation was also obtained for normalization purposes. Substantial reliability was documented for V/MSUP in both SOL (ICC = 0.86) and GM (0.90), as well as for the non-normalized V-wave in SOL (0.92). Moderate reliability was displayed for the non-normalized V-wave response in GM (0.78). Substantial reliability was also established for EMG/MSUP (>0.82) and MVC force (0.98). This study provides novel evidence that V-wave responses can be consistently measured in the SOL and GM, thus advocating its continued use in future research.

Electromyographic Activity and 6RM Strength in Bench Press on Stable and Unstable Surfaces

Abstract Saeterbakken, AH and Fimland, MS. Electromyographic activity and 6RM strength in bench press on stable and unstable surfaces. J Strength Cond Res 27(4): 1101–1107, 2013—The purpose of the study was to compare 6-repetition maximum (6RM) loads and muscle activity in bench press on 3 surfaces, namely, stable bench, balance cushion, and Swiss ball. Sixteen healthy, resistance-trained men (age 22.5 ± 2.0 years, stature 1.82 ± 6.6 m, and body mass 82.0 ± 7.8 kg) volunteered for 3 habituation/strength testing sessions and 1 experimental session. In randomized order on the 3 surfaces, 6RM strength and electromyographic activity of pectoralis major, deltoid anterior, biceps brachii, triceps brachii, rectus abdominis, oblique external and erector spinae were assessed. Relative to stable bench, the 6RM strength was approximately 93% for balance cushion (p ⩽ 0.001) and approximately 92% for Swiss ball (p = 0.008); the pectoralis major electromyographic (EMG) activity was approximately 90% using the balance cushion (p = 0.080) and approximately 81% using Swiss ball (p = 0.006); the triceps EMG was approximately 79% using the balance cushion (p = 0.028) and approximately 69% using the Swiss ball (p = 0.002). Relative to balance cushion, the EMG activity in pectoralis, triceps, and erector spinae using Swiss ball was approximately 89% (p = 0.016), approximately 88% (p = 0.014) and approximately 80% (p = 0.020), respectively. In rectus abdominis, the EMG activity relative to Swiss ball was approximately 69% using stable bench (p = 0.042) and approximately 65% using the balance cushion (p = 0.046). Similar EMG activities between stable and unstable surfaces were observed for deltoid anterior, biceps brachii, and oblique external. In conclusion, stable bench press had greater 6RM strength and triceps and pectoralis EMG activity compared with the unstable surfaces. These findings have implications for athletic training and rehabilitation, because they demonstrate an inferior effect of unstable surfaces on muscle activation of prime movers and strength in bench press. If an unstable surface in bench press is desirable, a balance cushion should be chosen instead of a Swiss ball.

Structural brain changes after 4 wk of unilateral strength training of the lower limb

Strength training enhances muscular strength and neural drive, but the underlying neuronal mechanisms remain unclear. This study used magnetic resonance imaging (MRI) to identify possible changes in corticospinal tract (CST) microstructure, cortical activation, and subcortical structure volumes following unilateral strength training of the plantar flexors. Mechanisms underlying cross-education of strength in the untrained leg were also investigated. Young, healthy adult volunteers were assigned to training (n = 12) or control (n = 9) groups. The 4 wk of training consisted of 16 sessions of 36 unilateral isometric plantar flexions. Maximum voluntary isometric contraction torque was tested pre- and posttraining. MRI investigation included a T1-weighted scan, diffusion tensor imaging and functional MRI. Probabilistic fiber tracking of the CST was performed on the diffusion tensor imaging images using a two-regions-of-interest approach. Fractional anisotropy and mean diffusivity were calculated for the left and right CST in each individual before and after training. Standard functional MRI analyses and volumetric analyses of subcortical structures were also performed. Maximum voluntary isometric contraction significantly increased in both the trained and untrained legs of the training group, but not the control group. A significant decrease in mean diffusivity was found in the left CST following strength training of the right leg. No significant changes were detected in the right CST. No significant changes in cortical activation were observed following training. A significant reduction in left putamen volume was found after training. This study provides the first evidence for strength training-related changes in white matter and putamen in the healthy adult brain.

Sick-listed persons’ experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy: a qualitative focus group interview study

BackgroundOccupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons’ perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons’ experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy.MethodsTwenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach.ResultsAt the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process.ConclusionsThe occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse and uncertain for most participants. The providers of occupational rehabilitation program should balance this reorientation with specific steps towards return to work. Effect studies and long-term qualitative studies evaluating how this affects long-term work- and health outcomes are underway.

Leisure-time physical activity and disability pension: 9 years follow-up of the HUNT Study, Norway

The objective of this study was to prospectively examine the association between leisure‐time physical activity and risk of disability pension, as well as risk of disability pension because of musculoskeletal or mental disorders in a large population‐based cohort. Data on participants aged 20–65 years in the Norwegian Nord‐Trøndelag Health Study 1995–1997 (HUNT2) were linked to the National Insurance Database. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals for disability pension across physical activity categories. During a follow‐up of 9.3 years and 235 657 person‐years, 1266 of 13 823 men (9%) and 1734 of 14 531 women (12%) received disability pension. Compared with individuals in the inactive group, those in the highly active group had a 50% lower risk of receiving disability pension (HR for men: 0.50, 0.40–0.64; women: 0.50, 0.39–0.63). After comprehensive adjustment for potential confounders, the risk remained 32–35% lower (HR for men: 0.68, 0.53–0.86; women: 0.65, 0.51–0.83). The associations were stronger for disability pension due to musculoskeletal disorders than mental disorders. In summary, we observed strong inverse associations between leisure‐time physical activity and disability pension. Our findings strengthen the hypothesis that leisure‐time physical activity may be important for occupational health in reducing disability pension.

Effects of grip width on muscle strength and activation in the lat pull-down.

Abstract Andersen, V, Fimland, MS, Wiik, E, Skoglund, A, and Saeterbakken, AH. Effects of grip width on muscle strength and activation in the lat pull-down. J Strength Cond Res 28(4): 1135–1142, 2014—The lat pull-down is one of the most popular compound back exercises. Still, it is a general belief that a wider grip activates the latissimus dorsi more than a narrow one, but without any broad scientific support. The aim of the study was to compare 6 repetition maximum (6RM) load and electromyographic (EMG) activity in the lat pull-down using 3 different pronated grip widths. Fifteen men performed 6RM in the lat pull-down with narrow, medium, and wide grips (1, 1.5, and 2 times the biacromial distance) in a randomized and counterbalanced order. The 6RM strengths with narrow (80.3 ± 7.2 kg) and medium grip (80 ± 7.1 kg) were higher than wide grip (77.3 ± 6.3 kg; p = 0.02). There was similar EMG activation between grip widths for latissimus, trapezius, or infraspinatus, but a tendency for biceps brachii activation to be greater for medium vs. narrow (p = 0.09), when the entire movement was analyzed. Analyzing the concentric phase separately revealed greater biceps brachii activation using the medium vs. narrow grip (p = 0.03). In the eccentric phase, there was greater activation using wide vs. narrow grip for latissimus and infraspinatus (p ⩽ 0.04), and tendencies for medium greater than narrow for latissimus, and medium greater than wide for biceps (both p = 0.08), was observed. Collectively, a medium grip may have some minor advantages over small and wide grips; however, athletes and others engaged in resistance training can generally expect similar muscle activation which in turn should result in similar hypertrophy gains with a grip width that is 1–2 times the biacromial distance.