Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients.

Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health-related quality of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate-to-high intensity combined resistance-endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6-month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5-multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate-to-high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273-1281 2017 AASLD.

¿Es perjudicial el ejercicio físico para el trasplantado de hígado? Revisión de la literature / Is physical exercise harmful to liver transplantation recipients? Review of literature

El trasplante hepático es un tratamiento que ha permitido mejorar de manera significativa la calidad de vida de los pacientes. Sin embargo, se debe ser más ambiciosos y buscar una mejora de su condición física a través de protocolos de entrenamiento que permitan una reincorporación total a las actividades de la vida diaria. Se buscaron artículos en los idiomas español e inglés, en las bases de datos PubMed y Cochrane, hasta el año 2014. Todos los artículos fueron revisados por 2 autores para determinar si eran apropiados para su inclusión. Se muestra una recopilación de estudios donde se consiguen mejoras en el estado físico de pacientes que han participado en programas de entrenamiento aeróbico, de fuerza, o en combinación de ambos, sin que esto suponga un riesgo para el injerto. No obstante, existe una falta de trabajos de alta evidencia científica, que establezcan una correcta programación del ejercicio, tutorizada por especialistas en la actividad física y el deporte

Liver transplantation is a treatment that significantly improves the patients’ quality of life. However, we should be more ambitious and seek an improvement in their fitness through training protocols allowing them to fully return to daily activities. English and Spanish-language articles on PubMed and the Cochrane Library were searched untill 2014. Articles were reviewed by 2 of the authors to determine if they were suitable for inclusion. It is shown a compilation of studies that included patients who have participated in aerobic, strength, or both combined training programs, without implying a risk for the graft function. There is a lack of studies with high scientific evidence that stablish a proper exercise program methodology, supervised by specialists in physical activity and sports

Is physical exercise harmful to liver transplantation recipients? Review of literature.

Liver transplantation is a treatment that significantly improves the patients' quality of life. However, we should be more ambitious and seek an improvement in their fitness through training protocols allowing them to fully return to daily activities. English and Spanish-language articles on PubMed and the Cochrane Library were searched untill 2014. Articles were reviewed by 2 of the authors to determine if they were suitable for inclusion. It is shown a compilation of studies that included patients who have participated in aerobic, strength, or both combined training programs, without implying a risk for the graft function. There is a lack of studies with high scientific evidence that stablish a proper exercise program methodology, supervised by specialists in physical activity and sports.

Core muscle activity in a series of balance exercises with different stability conditions.

Literature that provides progression models based on core muscle activity and postural manipulations is scarce. The purpose of this study was to investigate the core muscle activity in a series of balance exercises with different stability levels and additional elastic resistance. A descriptive study of electromyography (EMG) was performed with forty-four healthy subjects that completed 12 exercises in a random order. Exercises were performed unipedally or bipedally with or without elastic tubing as resistance on various unstable (uncontrolled multiaxial and uniaxial movement) and stable surfaces. Surface EMG on the lumbar multífidus spinae (LM), thoracic multífidus spinae (TM), lumbar erector spinae (LE), thoracic erector spinae (TE) and gluteus maximus (GM), on the dominant side of the body were collected to quantify the amount of muscle activity and were expressed as a % of the maximum voluntary isometric contraction (MVIC). Significant differences (p<.001) were found between exercises. The three unipedal standing exercises with additional elastic resistance generated the greatest EMG values, ranging from 19% MVIC to 30% MVIC. Postural manipulations with additional elastic resistance and/or unstable devices increase core muscle activity. An adequate exercise progression based on global core EMG could start with seated positions, progressing to bipedal standing stance (i.e., from either multiaxial or stable surface to uniaxial surface). Following this, unipedal standing positions may be performed (i.e., from either multiaxial or stable surface to uniaxial surface) and finally, elastic resistance must be added in order to increase EMG levels (i.e., from stable surface progressing to any of the used unstable surfaces).

Shoulder muscle activation during stable and suspended push-ups at different heights in healthy subjects.

OBJECTIVES: To analyze shoulder muscle activation when performing push-ups under different stability conditions and heights. STUDY DESIGN: Comparative study by repeated measures. SETTING: Valencia University laboratory. PARTICIPANTS: 29 healthy males participated. MAIN OUTCOME MEASURES: Subjects performed 3 push-ups each with their hands at 2 different heights (10 vs. 65 cm) under stable conditions and using a suspension device. Push-up speed was controlled and the testing order was randomized. The average amplitudes of the electromyographic root mean square of the long head of the triceps brachii (TRICEP), upper trapezius (TRAPS), anterior deltoid (DELT) and clavicular pectoralis (PEC) were recorded. The electromyographic signals were normalized to the maximum voluntary isometric contraction (MVIC). RESULTS: Suspended push-ups at 10 cm resulted in greater activation in the TRICEP (17.14 ± 1.31 %MVIC vs. 37.03 ± 1.80 %MVIC) and TRAPS (5.83 ± 0.58 %MVIC vs. 14.69 ± 1.91 %MVIC) than those performed on the floor. For DELT and PEC similar or higher activation was found performing the push-ups on the floor, respectively. Height determines different muscle activation patterns. CONCLUSIONS: Stable push-ups elicit similar PEC and higher DELT muscle activation, being greater at 10 cm; whereas suspended push-ups elicit greater TRAPS and TRICEP muscle activation, being greater at 65 cm.

Bench press and push-up at comparable levels of muscle activity results in similar strength gains.

Electromyography (EMG) exercise evaluation is commonly used to measure the intensity of muscle contraction. Although researchers assume that biomechanically comparable resistance exercises with similar high EMG levels will produce similar strength gains over the long term, no studies have actually corroborated this hypothesis. This study evaluated EMG levels during 6 repetition maximum (6RM) bench press and push-up, and subsequently performed a 5-week training period where subjects were randomly divided into 3 groups (i.e., 6RM bench press group, 6RM elastic band push-up group, or control group) to evaluate muscle strength gains. Thirty university students with advanced resistance training experience participated in the 2-part study. During the training period, exercises were performed using the same loads and variables that were used during the EMG data collection. At baseline, EMG amplitude showed no significant difference between 6RM bench press and band push-up. Significant differences among the groups were found for percent change (Δ) between pretest and posttest for 6RM (p = 0.017) and for 1 repetition maximum (1RM) (p < 0.001). Six repetition maximum bench press group and 6RM elastic band push-up group improved their 1RM and 6RM (Δ ranging from 13.65 to 22.21) tests significantly with similar gains, whereas control group remains unchanged. Thus, when the EMG values are comparable and the same conditions are reproduced, the aforementioned exercises can provide similar muscle strength gains.

Muscle activation during push-ups performed under stable and unstable conditions.

BACKGROUND/OBJECTIVE: The purpose of this study was to analyze muscle activation when performing push-ups under different stability conditions. METHODS: Physically fit young male university students (N = 30) performed five push-ups under stable conditions (on the floor) and using four unstable devices (wobble board, stability disc, fitness dome, and the TRX Suspension Trainer). The push-up speed was controlled using a metronome, and the testing order was randomized. The average amplitudes of the electromyographic (EMG) root mean square of the anterior deltoid (DELT), serratus anterior (SERRA), lumbar multifidus (LUMB), and rectus femoris (FEM) were recorded. The electromyographic signals were normalized to the maximum voluntary isometric contraction (MVIC). RESULTS: No significant differences were found for the DELT [F(4,112) = 1.978; p = 0.130] among the conditions. However, statistically significant differences were found among the different conditions for the SERRA [F(4,60) = 17.649; p < 0.001], LUMB [F(4,76) = 12.334; p < 0.001], and FEM [F(4,104) = 24.676; p < 0.001] muscle activation. The suspended device was the only condition that elicited higher LUMB and FEM activation compared to the other conditions. Push-ups performed on the floor showed lower SERRA activation than those performed with all unstable devices. CONCLUSION: Not all unstable devices enhance muscle activation compared to traditional push-ups.

Muscle activity levels in upper-body push exercises with different loads and stability conditions.

BACKGROUND: Exercises that aim to stimulate muscular hypertrophy and increase neural drive to the muscle fibers should be used during rehabilitation. Thus, it is of interest to identify optimal exercises that efficiently achieve high muscle activation levels. OBJECTIVE: The purpose of this study was to compare the muscle activation levels during push-up variations (ie, suspended push-ups with/without visual input on different suspension systems, and push-ups on the floor with/without additional elastic resistance) with the bench press exercise and the standing cable press exercise both performed at 50%, 70%, and 85% of the 1-repetition maximum. METHODS: Young fit male university students (N = 29) performed 3 repetitions in all conditions under the same standardized procedures. Average amplitude of the electromyogram (EMG) root mean square for the rectus abdominis, external oblique, sternocostal head of the pectoralis major, anterior deltoid, long head of the triceps brachii, upper trapezius, anterior serratus, and posterior deltoid was recorded. The EMG signals were normalized to the maximum voluntary isometric contraction. The EMG data were analyzed with repeated-measures analysis of variance with a Bonferroni post hoc. RESULTS AND CONCLUSIONS: Elastic-resisted push-ups induce similar EMG stimulus in the prime movers as the bench press at high loads while also providing a greater core challenge. Suspended push-ups are a highly effective way to stimulate abdominal muscles. Pectoralis major, anterior deltoid, and anterior serratus are highly elicited during more stable pushing conditions, whereas abdominal muscles, triceps brachii, posterior deltoid, and upper trapezius are affected in the opposite manner.

Test-retest reliability of the Star Excursion Balance Test in primary school children.

BACKGROUND: Dynamic balance has been considered a fundamental skill at all ages and is required for normal daily tasks, such as walking, running, or other sports activities. The Star Excursion Balance Test (SEBT) has been widely used in recent years to identify dynamic balance deficits and improvements and to predict the risk of lower extremity injury. However, no study has demonstrated the reliability of the SEBT in children while they are performing the test in a physical education session. Reliability is needed in all measurement tools in order to provide repeatable and consistent data. OBJECTIVE: To evaluate the reliability of the SEBT in primary school students in the school setting. METHODS: Twenty-four healthy children with typical development were tested twice, 2 weeks apart. The tests were conducted by the same single rater and were performed during the physical education class. The test was performed under standardized conditions during the 2 testing sessions and was performed by each subject with both limbs in the 3 directions (anterior, posteromedial, and posterolateral). Four practice trials were performed in each direction before selecting 3 additional distances reached. The best value of these 3 additional measured trials was selected. The paired t test was used to ensure the absence of any systematic bias. Intraclass correlation coefficient, standard error of measurement, 95% confidence intervals (CIs), and minimal change values were calculated to assess reliability and measurement error. RESULTS: The paired t tests revealed no significant differences between test-rest scores. Test-retest reliability for all distances reached was moderate to good. CONCLUSIONS: Reliability values suggest that the SEBT is suitable for primary school students. However, it may be more practical and feasible during extracurricular sports participation due to the time constraints and difficulties in using the test in the school setting.

Muscle Activation during Push-Ups with Different Suspension Training Systems.

The purpose of this study was to analyze upper extremity and core muscle activation when performing push-ups with different suspension devices. Young fit male university students (n = 29) performed 3 push-ups each with 4 different suspension systems. Push-up speed was controlled using a metronome and testing order was randomized. Average amplitude of the electromyographic root mean square of Triceps Brachii, Upper Trapezius, Anterior Deltoid, Clavicular Pectoralis, Rectus Abdominis, Rectus Femoris, and Lumbar Erector Spinae was recorded. Electromyographic signals were normalized to the maximum voluntary isometric contraction (MVIC). Electromyographic data were analyzed with repeated-measures analysis of variance with a Bonferroni post hoc. Based upon global arithmetic mean of all muscles analyzed, the suspended push-up with a pulley system provided the greatest activity (37.76% of MVIC; p < 0.001). Individually, the suspended push-up with a pulley system also provided the greatest triceps brachii, upper trapezius, rectus femoris and erector lumbar spinae muscle activation. In contrast, more stable conditions seem more appropriate for pectoralis major and anterior deltoid muscles. Independent of the type of design, all suspension systems were especially effective training tools for reaching high levels of rectus abdominis activation. Key PointsCompared with standard push-ups on the floor, suspended push-ups increase core muscle activation.A one-anchor system with a pulley is the best option to increase TRICEP, TRAPS, LUMB and FEM muscle activity.More stable conditions such as the standard push-up or a parallel band system provide greater increases in DELT and PEC muscle activation.A suspended push-up is an effective method to achieve high muscle activity levels in the ABS.

Muscle activation in young men during a lower limb aquatic resistance exercise with different devices.

Little research has been reported on the effects of using different devices with resistance exercises in a water environment. This study compared muscular activation of lower extremity and core muscles during leg adduction performed at maximum velocity with drag and floating devices of different sizes. A total of 24 young men (mean age 23.20 ± 1.18 years) performed 3 repetitions of leg adduction at maximum velocity using 4 different devices (ie, large/small and drag/floating). The maximum amplitude of the electromyographic root mean square of the adductor longus, rectus abdominis, external oblique on the dominant side, external oblique on the nondominant side, and erector lumbar spinae were recorded. Electromyographic signals were normalized to the maximum voluntary isometric contraction (MVIC). Unexpectedly, no significant (P > 0.05) differences were found in the neuromuscular responses among the different devices used; the average activation of agonist muscle adequate for neuromuscular conditioning was 40.95% of MVIC. In addition, external oblique activation is greater on the contralateral side to stabilize the body (average, 151.74%; P < 0.05). Therefore, if maximum muscle activation is required, the kind of device is not relevant. Thus, the choice should be based on economic factors.

Exercise and ankle sprain injuries: a comprehensive review.

Ankle sprains are common in team sports and sports played on courts, and often result in structural and functional alterations that lead to a greater reinjury risk. Specific exercises are often used to promote neuromuscular improvements in the prevention and rehabilitation of ankle injuries. This literature review summarizes the neuromuscular characteristics of common ankle sprains and the effectiveness of exercise as an intervention for improving neuromuscular function and preventing reinjury. Our review found that appropriate exercise prescription can increase static and dynamic balance and decrease injury recurrence. In particular, the addition of dynamic activities in the exercise program can be beneficial because of the anticipatory postural adjustments identified as a key factor in the injury mechanism.

Exercise intensity progression for exercises performed on unstable and stable platforms based on ankle muscle activation.

Ankle sprains are a common sports injury. The literature focuses on the application of neuromuscular training for the improvement of balance, injury prevention and rehabilitation. However, there is a dearth of knowledge about the appropriate prescription of exercises using unstable platforms and surfaces. The purpose of this study was to devise an ankle rehabilitation or training program with exercise progression based on the extent of muscle activation, employing platforms with different levels of stability and additional resistance. A descriptive study of electromyography (EMG) during ankle exercises was performed with a convenience sample of healthy subjects. Forty-four subjects completed 12 exercises performed in a random order. Exercises were performed unipedally or bipedally with or without elastic tubing as resistance on various unstable (uncontrolled multiaxial and uniaxial movement) and stable surfaces. Surface EMG from the tibialis anterior (TA), peroneus longus (PL) and soleus (SOL) were collected to quantify the amount of muscle activity. Significant differences were found between exercise conditions for PL (p<.001), TA (p=.011), and SOL (p<.001). The greatest EMG activity for all muscles occurred with an upright unipedal stance on a soft stability surface with resistance. The least EMG activity for the TA and SOL were in a seated position and for the PL in an erect bipedal position without resistance. Based on the level of ankle muscle activation, exercises for the ankle should progress from bilateral exercises on exercise balls (lowest intensity), to a unipedal position on a soft surface in combination with elastic tubing (highest intensity) in order to achieve progressively greater ankle muscle activation.

Neuromuscular responses during aquatic resistance exercise with different devices and depths.

Little research has been reported regarding the effects of using different devices and immersion depths during the performance of resistance exercises in a water environment. The purpose of this study was to compare muscular activation of upper extremity and core muscles during shoulder extensions performed at maximum velocity with different devices and at different depths. Volunteers (N = 24) young fit male university students performed 3 repetitions of shoulder extensions at maximum velocity using 4 different devices and at 2 different depths. The maximum amplitude of the electromyographic root mean square of the latissimus dorsi (LD), rectus abdominis, and erector lumbar spinae was recorded. Electromyographic signals were normalized to the maximum voluntary isometric contraction. No significant (p > 0.05) differences were found in the neuromuscular responses between the different devices used during the performance of shoulder extension at xiphoid process depth. Regarding the comparisons of muscle activity between the 2 depths analyzed in this study, only the LD showed a significantly (p ≤ 0.05) higher activity at the xiphoid process depth compared with that at the clavicle depth. Therefore, if maximum muscle activation of the extremities is required, the xiphoid depth is a better choice than clavicle depth, and the kind of device is not relevant. Regarding core muscles, neither the kind of device nor the immersion depth modifies muscle activation.

Impact of the s.w.e.a.T.™ water-exercise method on activities of daily living for older women.

Older women may have chronic or age-related conditions that increase the risk of falls or that limit their ability to remain active. It is unclear if a water-based exercise program provides a safe and effective alternative to land-based exercise. The purpose of this study was to evaluate the impact of a water-based exercise program method on land-based functional activities of daily living (ADL) for women 60 years and older. This study used a quasi- experimental, nonequivalent control group design. Sixty-six women (60-89 yr of age) self- selected to a water exercise (WEX) group (n = 48) or control (C) group (n = 18). The training consisted of a 16-week (45 min·day(-1), 3 d·wk(-1)) supervised WEX program that included 10 min of warm-up and warm down/stretching and 35 min training using the S.W.E.A.T.™ method in shallow water 1.0-1.2 m, with water temperature approximately 28-29°C. Participants were required to attendat least 94% of the sessions. Assessments for participants included ADL functional field tests. In comparison to the C group, WEX participantsimproved (p < 0.05) flexibility (8%), sit- to-stand (31%), walking speed (16%) and stride length (10%), agility (20%), stair climb (22%), arm curl (39%), and static (42-48%) balance, but not dynamic balance. Results indicate that the S.W.E.A.T.™ method applied to this water exercise program provides a well-rounded, safe, and effective exercise program where older women can improve functional ADL and static balance. Key PointsOlder women with a variety of health conditions participated in 16 weeks of exercise (92% adherence) with no injuries.The S.W.E.A.T.™ method applied to this water-based program was found to significantly improve several aspects of physical function, including postural balance.This shallow water program provided a well-rounded, safe and effective activity for women to improve functional ADL on land.

Concurrent validation of the OMNI-resistance exercise scale of perceived exertion with Thera-band resistance bands.

The concurrent validity of the OMNI-Resistance Exercise Scale (OMNI-RES) of perceived exertion for use with elastic bands was studied during isotonic resistance exercises. Twenty healthy, physically active subjects completed both familiarization and testing sessions. The criterion variables were myoelectric activity, recorded by electromyography, and heart rate, recorded by a heart rate monitor. The subjects performed 2 separate sets of 15 repetitions in each of the 2 testing sessions and for each of the exercises applied (i.e., frontal and lateral raises). One set was carried out with the separation between the hands gripping the elastic band allowing that 15 repetition maximum to be performed in the selected exercise, whereas the other set was carried out with the separation between hands at +50% of the previous grip. The perceived exertion rating for the active muscles and for the overall body, muscular activity, and heart rate were measured during the final repetition of each set. The results showed significant differences (p ≤ 0.001) in myoelectric activity, heart rate, and OMNI-RES scores between the low- and high-intensity sets and the intraclass correlation coefficient was 0.72-0.76. So it can be concluded that the OMNI-RES can be used for monitoring the intensity of exercises when elastic bands are used. This would allow the training stimulus dosage to be precisely controlled in both the session in progress and between different sessions, and allowing to differentiate between different levels of intensity according to the physical aptitudes and special physiological needs of the subjects.