The effect of the inclusion of trunk-strengthening exercises to a multimodal exercise program on physical activity levels and psychological functioning in older adults: secondary data analysis of a randomized controlled trial.

BACKGROUND: Engaging in multimodal exercise program helps mitigate age-related decrements by improving muscle size, muscle strength, balance, and physical function. The addition of trunk-strengthening within the exercise program has been shown to significantly improve physical functioning outcomes. Whether these improvements result in improved psychological outcomes associated with increased physical activity levels requires further investigation. We sought to explore whether the inclusion of trunk-strengthening exercises to a multimodal exercise program improves objectively measured physical activity levels and self-reported psychological functioning in older adults. METHOD: We conducted a secondary analysis within a single-blinded parallel-group randomized controlled trial. Sixty-four healthy older (≥ 60 years) adults were randomly allocated to a 12-week walking and balance exercise program with (n = 32) or without (n = 32) inclusion of trunk strengthening exercises. Each program involved 12 weeks of exercise training, followed by a 6-week walking-only program (identified as detraining). Primary outcome measures for this secondary analysis were physical activity (accelerometry), perceived fear-of-falling, and symptoms of anxiety and depression. RESULTS: Following the 12-week exercise program, no significant between-group differences were observed for physical activity, sedentary behaviour, fear-of-falling, or symptoms of anxiety or depression. Significant within-group improvements (adjusted mean difference [95%CI]; percentage) were observed in moderate-intensity physical activity (6.29 [1.58, 11.00] min/day; + 26.3%) and total number of steps per min/day (0.81 [0.29 to 1.33] numbers or + 16.3%) in trunk-strengthening exercise group by week 12. With respect to within-group changes, participants in the walking-balance exercise group increased their moderate-to-vigorous physical activity (MVPA) (4.81 [0.06 to 9.56] min/day; + 23.5%) and reported reduction in symptoms of depression (-0.26 [-0.49 to -0.04] points or -49%) after 12 weeks of the exercise program. The exercise-induced increases in physical activity levels in the trunk-strengthening exercise group were abolished 6-weeks post-program completion. While improvements in physical activity levels were sustained in the walking-balance exercise group after detraining phase (walking only). CONCLUSIONS: The inclusion of trunk strengthening to a walking-balance exercise program did not lead to statistically significant between-group improvements in physical activity levels or psychological outcomes in this cohort following completion of the 12-week exercise program. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ACTRN12613001176752), registered on 28/10/2013.

Trunk exercise training improves muscle size, strength, and function in older adults: A randomized controlled trial.

The aim of this study was to assess the effectiveness of a multimodal exercise program to increase trunk muscle morphology and strength in older individuals, and their associated changes in functional ability. Using a single-blinded parallel-group randomized controlled trial design, 64 older adults (≥60 years) were randomly allocated to a 12-week exercise program comprising walking and balance exercises with or without trunk strengthening/motor control exercises; followed by a 6-week walking-only program (detraining; 32 per group). Trunk muscle morphology (ultrasound imaging), strength (isokinetic dynamometer), and functional ability and balance (6-Minute Walk Test; 30 second Chair Stand Test; Sitting and Rising Test; Berg Balance Scale, Multi-Directional Reach Test; Timed Up and Go; Four Step Square Test) were the primary outcome measures. Sixty-four older adults (mean [SD]; age: 69.8 [7.5] years; 59.4% female) were randomized into two exercise groups. Trunk training relative to walking-balance training increased (mean difference [95% CI]) the size of the rectus abdominis (2.08 [1.29, 2.89] cm2 ), lumbar multifidus (L4/L5:0.39 [0.16, 0.61] cm; L5/S1:0.31 [0.07, 0.55] cm), and the lateral abdominal musculature (0.63 [0.40, 0.85] cm); and increased trunk flexion (29.8 [4.40, 55.31] N), extension (37.71 [15.17, 60.25] N), and lateral flexion (52.30 [36.57, 68.02] N) strength. Trunk training relative to walking-balance training improved 30-second Chair Stand Test (5.90 [3.39, 8.42] repetitions), Sitting and Rising Test (1.23 [0.24, 2.23] points), Forward Reach Test (4.20 [1.89, 6.51] cm), Backward Reach Test (2.42 [0.33, 4.52] cm), and Timed Up and Go Test (-0.76 [-1.40, -0.13] seconds). Detraining led to some declines but all outcomes remained significantly improved when compared to pre-training. These findings support the inclusion of trunk strengthening/motor control exercises as part of a multimodal exercise program for older adults.

The Effects of Various Cognitive Tasks Including Working Memory, Visuospatial, and Executive Function on Postural Control in Patients With Anterior Cruciate Ligament Injury.

Anterior cruciate ligament (ACL) rupture can impair balance performance, particularly during cognitive motor dual-tasks. This study aimed to determine the effects of various modalities of cognitive load (working memory, and visuospatial and executive function) on postural control parameters in individuals with ACL injury. Twenty-seven ACL-injured and 27 healthy participants were evaluated doing different cognitive tasks (silent backward counting, Benton's judgment of line orientation, and Stroop color-word test) while standing on a rigid surface or a foam. Each task was repeated three times and then averaged. Center of pressure variables used to measure postural performance included sway area and sway velocity in anterior-posterior and medial-lateral directions. Cognitive performance was also assessed by calculating errors and the score of cognitive tasks. A mixed model analysis of variance for center of pressure parameters indicated that patients had more sways than the healthy group. The interaction of group by postural difficulty by cognitive tasks was statistically significant for cognitive errors (p < .01), and patients with ACL injury indicated more cognitive errors compared to healthy controls while standing on the foam. The main effect of cognitive task was statistically significant for all postural parameters, representing reduced postural sways in both groups with all cognitive tasks. However, ACL-injured patients showed more cognitive errors in difficult postural conditions, suggesting that individuals with ACL injury may prioritize postural control over cognitive task accuracy and adopt the posture-first strategy to maintain balance under dual-task conditions.

Associations between trunk muscle morphology, strength and function in older adults.

Skeletal muscle plays an important role in performing activities of daily living. While the importance of limb musculature in performing these tasks is well established, less research has focused on the muscles of the trunk. The purpose of the current study therefore, was to examine the associations between functional ability and trunk musculature in sixty-four community living males and females aged 60 years and older. Univariate and multivariate analyses of the a priori hypotheses were performed and reported with correlation coefficients and unstandardized beta coefficients (ß) respectively. The univariate analysis revealed significant correlations between trunk muscle size and functional ability (rectus abdominis: six-minute walk performance, chair stand test, sitting and rising test; lumbar multifidus: timed up and go) as well as trunk muscle strength and functional ability (trunk composite strength: six-minute walk performance, chair stand test, Berg balance performance, sitting and rising test). After controlling for covariates (age and BMI) in the multivariate analysis, higher composite trunk strength (ß = 0.34) and rectus abdominis size (ß = 0.33) were associated with better performance in the sitting and rising test. The importance of incorporating trunk muscle training into programs aimed at improving balance and mobility in older adults merits further exploration.

The effect of exercise training on lower trunk muscle morphology.

BACKGROUND: Skeletal muscle plays an important role in maintaining the stability of the lumbar region. However, there is conflicting evidence regarding the effects of exercise on trunk muscle morphology. OBJECTIVE: To systematically review the literature on the effects of exercise training on lower trunk muscle morphology to determine the comparative effectiveness of different exercise interventions. DATA SOURCE AND STUDY SELECTION: A systematic search strategy was conducted in the following databases: PubMed, SportDiscus, CINAHL, the Cochrane Library and PEDro. We included full, peer-reviewed, prospective longitudinal studies, including randomized controlled trials and single-group designs, such as pre- to post-intervention and crossover studies, reporting on the effect of exercise training on trunk muscle morphology. STUDY APPRAISAL AND SYNTHESIS: Study quality was assessed with the Cochrane risk-of-bias tool. We classified each exercise intervention into four categories, based on the primary exercise approach: motor control, machine-based resistance, non-machine-based resistance or cardiovascular. Treatment effects were estimated using within-group standardized mean differences (SMDs). RESULTS: The systematic search identified 1,911 studies; of which 29 met our selection criteria: motor control (n = 12), machine-based resistance (n = 10), non-machine-based resistance (n = 5) and cardiovascular (n = 2). Fourteen studies (48 %) reported an increase in trunk muscle size following exercise training. Among positive trials, the largest effects were reported by studies testing combined motor control and non-machine-based resistance exercise (SMD [95 % CI] = 0.66 [0.06 to 1.27] to 3.39 [2.80 to 3.98]) and machine-based resistance exercise programmes (SMD [95 % CI] = 0.52 [0.01 to 1.03] to 1.79 [0.87 to 2.72]). Most studies investigating the effects of non-machine-based resistance exercise reported no change in trunk muscle morphology, with one study reporting a medium effect on trunk muscle size (SMD [95 % CI] = 0.60 [0.03 to 1.16]). Cardiovascular exercise interventions demonstrated no effect on trunk muscle morphology (SMD [95 % CI] = -0.16 [-1.14 to 0.81] to 0.09 [-0.83 to 1.01]). LIMITATIONS: We excluded studies published in languages other than English, and therefore it is possible that the results of relevant studies are not represented in this review. There was large clinical heterogeneity between the included studies, which prevented data synthesis. Among the studies included in this review, common sources of potential bias were random sequence generation, allocation concealment and blinding. Finally, the details of the exercise parameters were poorly reported in most studies. CONCLUSION: Approximately half of the included studies reported an increase in lower trunk muscle size following participation in an exercise programme. Among positive trials, studies involving motor control exercises combined with non-machine-based resistance exercise, as well as machine-based resistance exercises, demonstrated medium to large effects on trunk muscle size. Most studies examining the effect of non-machine-based resistance exercise and all studies investigating cardiovascular exercise reported no effect on trunk muscle morphology. However, these results should be interpreted with caution because of the substantial risk of bias and suboptimal reporting of exercise details in the included studies. Additional research, using methods ensuring a low risk of bias, are required to further elucidate the effects of exercise on trunk muscle morphology.