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.