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POWER-TYPE STRENGTH TRAINING IN MIDDLE-AGED MEN AND WOMEN*
*Doctoral
dissertation presented on the 11th February 2005 at the Auditorium
of The Petrea Rehabilitation Centre, Peltolantie 3, Turku, Finland
by permission of Faculty of Medicine of the University of Kuopio,
Finland.
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Department of Physiology, University of Kuopio, Department of Physiology,
Finnish Institute of Occupational Health, Kuopio, Finland
| Published
(Online) |
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01
October 2005 |
© Journal of Sports Science
and Medicine (2005) 4, Suppl.9, 1 - 36
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This
review is based on the following original publications, which will be referred
to in the text as Studies 1-5:
1.
Surakka, J., Alanen, E., Aunola, S., Karppi, S-L. and Pekkarinen, H. (2005)
Effects of external light loading in power-type strength training on muscle
power of the lower extremities in middle-aged subjects. International
Journal of Sports Medicine (in press).
2. Surakka, J., Alanen, E., Aunola, S. and Karppi, S.L. (2001)
Isoresistive dynamometer measurement of trunk muscle velocity at different
angular phases of flexion and extension. Clinical Physiology 21,
504-511.
3. Surakka, J., Aunola, S., Alanen, E., Karppi, S.L. and Mäentaka,
K. (2004) Effect of training frequency on lumbar extension and flexion
velocity. Research in Sports Medicine 12, 95-113.
4. Surakka, J., Aunola, S., Nordblad, S., Karppi, S.L. and Alanen,
E. (2003) Feasibility of power-type strength training for middle-aged
men and women: self perception, musculoskeletal symptoms, and injury rates.
British Journal of Sports Medicine 37, 131-136.
5.
Surakka, J., Alanen, E., Aunola, S., Karppi, S.L. and Lehto, P. (2004)
Adherence to a power-type strength training programme in sedentary, middle-
aged men and women. Advances in Physiotherapy 6, 99-109
| ABSTRACT |
|
Muscle
strength declines with increasing age, and the power-type strength
characteristics decline even more drastically than the maximal muscle
strength. Therefore, it is important to design training programmes
specifically for sedentary middle-aged people to effectively improve
the power-type strength in leg and trunk muscles. To be suitable
for the target group, the exercise programmes should be feasible,
motivating and easy to practice. The aim of this study was to design
and investigate the effects and feasibility of a power-type strength
training programme in 226 middle-aged men and women, with 26 persons
as non-training controls. The subjects trained three times a week
during 22 weeks, in 12 groups with exercise classes of 10-20 subjects,
and using no or very little external equipment. All training sessions
were controlled and supervised by an professional instructor. Vertical
squat jump, standing long jump, 20 metre running time, maximal anaerobic
cycling power, maximal oxygen uptake, and angular trunk muscle flexion
and extension velocities were measured before and after the training
period to evaluate the training effects. Questionnaires concerning
employment, physical activity, smoking, musculoskeletal symptoms
and exercise motives were also filled in before and after the training
period. The greatest improvements were achieved in vertical squat
jump (18%) and in angular trunk flexion (14%) and extension (16%)
velocities. An external loading totalling 2.2 kg (attached) in ankles
increased the height in vertical squat jump by 23% and maximal anaerobic
cycling power by 12%, these improvements were significant compared
with subjects in no load training group (p = 0.03 in vertical squat
jump and p = 0.05 in maximal anaerobic cycling power). Exercise
induced injuries occurred in 19% of men and 6% of women. Low back
symptoms decreased in exercisers by 12% and knee symptoms (increased)
by 4% during the intervention. Of all subjects, 24% dropped out
during the training period. In summary, improvements were achieved
in several physiological performances reflecting the power-type
strength qualities, especially in vertical squat jump and trunk
muscle flexion and extension velocities. Improved perceived health
and fitness among the participants who completed the training programme,
and the relatively low number of injuries also indicate the feasibility
of the programme. The training programme is simple, and it also
seems to be practical among middle-aged, sedentary subjects. It
may be useful in preventing the decline of power-type strength characteristics
in middle-aged subjects.
KEY
WORDS: Adherence, feasibility, middle-aged, power-type strength,
training effects, training programme.
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| INTRODUCTION |
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Muscle
power, which is the product of the velocity and force of muscle
contraction, is needed for performing daily habitual tasks and activities.
Muscle strength declines with advancing age, starting at the beginning
of the sixth decade, and the power-type strength, i.e. the capacity
to produce explosive muscle force, declines more drastically than
the maximal muscle strength (Izquierdo et al., 1999;
Anton et al., 2004).
Mechanisms contributing to this development may include the loss
of Type II fast-twitch motor units (Lexell et al., 1988),
or intrinsic changes in muscle force and power production capacity
(Frontera et al., 2000).
The age-related strength decrease has been previously reported to
be faster in lower extremities than in the upper body (Asmunssen
and Heeboll-Nielsen, 1962;
Bemben et al., 1991).
Recently, Anton et al. (2004)
demonstrated similar age-related declines both in the arm and leg
muscles.
Strength and power-type strength training are recommended for middle-aged
and even elderly people for the purpose of maintaining the functional
capacity (Häkkinen et al., 1998;
Izquierdo et al., 1999;
Jozsi et al., 1999).
This is important especially with increasing age, in connection
with daily activities and even in prevention of falling (Bassey
et al., 1992;
Skelton et al., 2002).
People are commonly engaged in and familiar with endurance training
and resistance training. In natural human movements, however, several
physiological functions interact simultaneously, and therefore,
all the components of muscular performance should be trained equally.
It has been suggested (Häkkinen et al., 1998)
that strength training in combination with some explosive types
of exercises be recommended as a part of overall physical training
to maintain the functional capacity in middle-aged and elderly people.
For explosive muscle performance, the underlying factors are muscle
fibre type, muscle hypertrophy and enzymatic and neural adaptations.
It is also important to investigate the impact of power-type strength
training on the low back and knee muscles and joints, as well as
the injury risks and adherence and motivation to training. For being
effective in improving the explosive muscle performance, training
programmes should be designed so as to be motivating, easy to achieve,
effective concerning the time spent in exercises, low in expenses,
and they should give consideration to the exercise history and present
exercise activity, health status and musculoskeletal symptoms and
diseases of the individual. Even the socio-economic status and the
social and economic environment should be taken into account when
evaluating the actual possibilities for completing the planned programme.
The exercises should be integrated in everyday life and take place
on a regular basis.
Both in physical training and in the rehabilitation of middle-aged
people, the endurance type training is commonly used, e.g. walking,
jogging, cycling or swimming. The effects of endurance exercises
are well known, and various training modes are established and widely
adopted by non- athletic people. However, in everyday life the explosive
muscle qualities are also needed in various tasks and reactions,
e.g. prevention of falls. Training that affects the explosive muscle
qualities should therefore not be ignored, especially when it is
known that explosive type strength declines with ageing more drastically
than maximal muscle strength. However, physical training has been
shown to be effective in preventing the decline of muscle power
provided that the intensity, duration and frequency of training
is sufficient.
For decades, resistance training has been used for the purpose of
achieving strength and power, but this type of training needs special
training facilities and equipment. The purpose of this study was
to find out an alternative method for exercising the explosive muscle
characteristics that would use no or very little equipment, be simple
and effective, and feasible for middle-aged sedentary people. The
programme should also motivate the participant to continued physical
activity after the intervention.
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| REVIEW
OF THE LITERATURE |
Power-type
strength in leg and trunk muscles
Muscle actions are either isometric or dynamic. In isometric actions
the muscle length does not change, while dynamic contractions affect
the length. Dynamic muscle contractions can further be classified
into concentric and eccentric. In concentric contraction the muscle
length decreases and in eccentric contraction it increases. Human
movement is seldom based on purely isometric, concentric or eccentric
muscle contraction. Body segments are periodically organised to
impact forces, for instance, in running or jumping, where external
forces lengthen the muscle. In these phases, muscles act eccentrically,
and the concentric action follows for achieving positive work (Cavagna
et al., 1968).
A combination of eccentric and concentric muscle actions constitutes
what is called stretch shortening cycle (Komi, 1984;
Cavanagh, 1988). The eccentric
action influences the subsequent concentric phase so that the final
contraction is more powerful than a concentric action alone would
have been (Komi, 1984).
Strength is defined as the maximal amount of force a muscle can
generate in a specified movement at a specified movement velocity.
The power of muscle contraction is a measure of the total amount
of work that a muscle can produce in a given time period. This is
determined by the strength of the muscle contraction, by the distance
of contraction and the number of contractions in a time period.
A performance of daily activities requires both strength and power-type
strength, and therefore, muscle conditioning and strength training
should be supplemented by exercises with higher velocities. Typical
performances requiring explosive power-type strength include various
jumps, where the maximal strength level must exceed the load to
be moved (i.e. own body). The power-type strength is needed also
in high-velocity training requiring acceleration, fast running,
and rapid changes of direction (e.g. football, tennis).
Trunk muscles protect the spinal structures against potentially
harmful loads and sudden movements (Floyd and Silver, 1955;
Troup, 1986).
The measurements of trunk muscle velocity, acceleration and torque
are important for investigating the stress components of the spine
(Beimborn and Morrissey, 1988).
Muscle biopsies from diskectomy patients have revealed selective
atrophy of fast-twitch fibres in low back muscles (Mattila et al.,
1986;
Zhu et al., 1989),
with physical inactivity presented as one of the possible explanations.
Poor trunk muscle function is a potential risk factor for low back
disorders (Suzuki and Endo, 1983;
Lee et al., 1995).
Measurements in power-type strength training studies
Force production and velocity of the neuromuscular system are the
major elements of power-type strength. Vertical jump tests are widely
used to evaluate the power-type strength of lower extremities. Measurement
of the vertical jumping height is a simple and reliable (reproducibility
r = 0.92) method for measuring the explosive force of leg muscles
(Bosco et al., 1982;
Bosco et al., 1983).
The height of vertical jump correlates with 60 m sprint running
(Bosco et al., 1983),
and also with the maximal power of Wingate cycling test (Maud and
Shultz, 1986).
Margaria's (Margaria et al., 1966)
staircase running test is another simple and reliable test of anaerobic
power. Standing long jump has also been widely used in sports research
in measuring horizontal explosive force of leg muscles (Bosco et
al., 1983;
Vandewalle et al., 1987;
Manning et al., 1988;
Moir et al., 2004).
Twenty-metre sprint running is recommended as one of the methods
to measure maximal anaerobic performance (Rusko and Nummela, 1996;
Moir et al., 2004).
Rusko et al. (1993), Rusko and Nummela (1996),
and Nummela (1996)
developed a method that allows the evaluation of several determinants
of maximal anaerobic performance, including the changes in the force
of leg muscles and relative to speed in sprint running. Isokinetic
knee dynamometers have also been used to test the power of lower
extremities (Moffroid et al., 1969;
Osternig et al., 1977;
Madsen, 1996).
Several studies (Parnianpour et al., 1989;
Rytökoski et al., 1994;
Hutten and Hermens, 1997)
have shown the isoresistive dynamometer measurement of trunk muscle
flexion and extension strength and velocity to be reliable and valid.
Perceived health and fitness were assessed by using a five-point
Likert scale (poor, fairly poor, average, fairly good, good) that
has previously been used by, i.e., Moum, 1992
and Wolinsky and Johnson, 1992.
This method has shown to be reliable and consistent with the assessed
medical health and its functional consequences (Lundberg and Manderbacka,
1996;
Manderbacka, 1998).
Musculoskeletal disorders were inquired about by using the standardised
Nordic musculoskeletal questionnaire, which has shown to be a reliable
and valid method for that purpose (Kuorinka et al., 1987).
Effects of power-type strength training on leg muscles
Proteins are the major component constituting the contractile apparatus
of the muscle. There is a continuous process of protein synthesis
and degradation in the body (although the structure of the body
is stable). The half-life of proteins determines the rate of adaptation
to physical exercise training. The range of variation of the half-life
of proteins is from less than one hour to several weeks (Maughan
et al., 1997).
The contraction velocity of a muscle fibre is determined by the
isoform pattern of the contractile proteins. The muscle proteins
(i.e myosin heavy chains) Type I, Type IIa and Type IIb are the
prime determinants of the muscle contraction velocity. Type I represents
the slow and fatigue-resistant muscle contractions, while Type IIa
represents the fast, oxidative and fatigue-resistant muscle contractions
and Type IIb the fast, fatigable muscle contractions (Staron, 1997).
Upon initiation of training, changes in the types of muscle proteins
begin to take effect within a couple of training sessions (Staron
et al., 1994).
Heavy-resistance training promotes hypertrophy in all three fibre
types (I, IIa and IIb). The greatest growth is usually seen in Type
IIa, followed by Type IIb, and the least growth in Type I fibres.
Training with high velocity and at low loads does not lead to hypertrophic
changes in fibres. Transitions appear to occur within the Type II
subtypes, but there is no convincing evidence of transitions between
Types I and II (Deschenes and Kraemer, 2002).
Muscle training is the main contributor to strength and power gains
(Coyle et al., 1981;
Behm and Sale, 1993).
The influence of training is reflected both in neural adaptation
and muscle fibre composition (Komi, 1973;
Komi et al., 1978;
Moritani and DeVries, 1979;
Sale, 1988).
Ross et al. (2001)
also speculated in their review that the nerve conduction velocity
might reflect the adaptation of nerve structure, with increased
diameter of axon and myelination. This adaptation may decrease the
refractory period of the nerve, which possibly allows increased
impulse frequency and potentially increased muscle activation. A
major part of the improvements in untrained subjects during the
initial weeks in power-type strength training is probably due adaptations
of the neural system, such as increased motor unit firing frequency,
improved motor unit synchronization, increased motor unit excitability,
and increase in efferent motor drive. Also, a reduction of the antagonist
and improved co-activation of the synergist muscles may explain
part of the changes (Häkkinen, 1994).
In a study of Aagaard et al. (2002),
the major part of the training induced improvements after 14 weeks
of resistance training were explained by increases in efferent neural
drive.
Power-type strength performance can be improved almost by means
of any training method, provided that the training frequency and
loading intensity exceed the normal activation of the muscle (Kaneko
et al., 1983;
Moritani et al., 1987,
Häkkinen and Häkkinen, 1995;
Kraemer, 1997;
Häkkinen et al., 1998;
Izquierdo et al., 1999;
Jozsi et al., 1999;
Häkkinen et al., 2000;
Marx et al., 2001).
In investigating the strength and muscle power output in upper and
lower extremities in athletes engaged in various sports, Izquierdo
et al. (2002)
found that the maximal power output was produced at higher load
condition in lower extremities (45-60% of 1 repetition maximum)
than in upper extremities (30-45%). They suggested that the sports-related
differences might be explained, in addition to training background,
by differences in muscle cross-sectional area, fibre type distribution,
and by the different muscle mechanisms of the upper and lower extremities.
Kawamori and Haff discussed this finding in their review (2004)
and suggested that another possible explanation for the differences
may be the fact that during lower extremity exercises a larger part
of body mass must be lifted up, compared with the upper extremity
exercises. Several studies have shown enhancements in middle-aged
and in older subjects in maximal and fast force production (Häkkinen
and Häkkinen, 1995;
Häkkinen et al., 1998;
Izquierdo et al., 2001),
in explosive jumping performances (Häkkinen et al., 1998;
Häkkinen et al., 2000),
and isotonic muscle power output in lower extremities (Jozsi et
al., 1999).
Cavagna et al. (1971)
were the first who showed that the elastic component of leg muscles
provides the additional power that is required for sustaining the
maximal velocity during sprint running. Furthermore, in studies
of Mero et al. (1981)
and Chelly and Denis (2001)
multi-jump performances correlated highly with sprint running in
young subjects. Consequently, Mero et al. (1981)
proposed the drop jump test to be useful in predicting maximal running
speed. Also, Young et al. (1995)
found a high correlation between concentric squat jump performance
and maximal running speed. Sprint running and initial acceleration
represent a complex movement where the stretch-shortening cycle
is dependent of the adaptation of the neuromuscular system and strength
(Mero et al., 1981;
Mero and Komi 1986,
Cronin et al., 2000).
Cronin et al. (2000)
found that for stretch-shortening cycle actions of short duration,
such in sprint acceleration, the greater maximal strength will lead
to greater instantaneous power production. The same authors pointed
out that in concentric actions which need high initial power production,
such as vertical squat jump, the neuromuscular ability to produce
the highest amount of power per time unit is more important than
maximal strength. Stone et al. (2003)
concluded that improved maximal strength was the primary component
in improving the jumping power. Explosive exercises (Linnamo et
al., 2000)
and sprint training (Sleivert et al., 1995)
also seem to facilitate the neuromuscular system.
Three times a week of resistance training is generally recommended
for achieving enhancements in muscle strength and power in extremities
(Pollock et al., 1998;
Feigenbaum and Pollock, 1999).
Previous reports indicate that, to achieve training effects, the
minimum training frequency should be at least twice a week (Pate
et al., 1995;
DeMichele et al., 1997;
Feigenbaum and Pollock, 1999;
Kraemer et al., 2002).
Previous studies also show that detraining leads to a decrease in
strength and loss of training effect within a few weeks (Häkkinen
and Komi, 1983;
Narici et al., 1989;
Häkkinen et al., 2000).
One of the major exercise methods has been the use of heavy loads
to induce recruitment of high-threshold fast Type II motor units
by the size principle (Sale, 1988).
Another exercise method is to use light loads to maintain the specificity
of the exercise velocity and to maximise the mechanical power output.
Kaneko et al. (1983)
reported that 30% of maximal load resulted in the greatest improvement
in maximal mechanical power. There are several studies indicating
the specificity of power training (Komi et al., 1982;
Häkkinen and Komi, 1985;
Scutter et al., 1995).
Power-type strength training with lighter loads and higher shortening
velocities has been shown to increase the force output at higher
velocities, as well as the power development (Häkkinen and Komi,
1985).
Muscular power increased significantly when high training volume
and high-velocity exercises were used in training (Häkkinen and
Häkkinen, 1995;
Kraemer, 1997;
Marx et al., 2001).
Previous reports support specificity of exercise type, i.e. the
greatest training effects are achieved when the same type of training
is used both in training and testing (Caiozzo et al., 1981;
Kanehisa and Miyashita, 1983;
Häkkinen and Komi, 1985;
Ewing et al., 1990;
Colliander and Tesch, 1990;
1992;
Morrissey et al., 1995).
Experimental studies examining the effects of power-type strength
training in middle-aged, sedentary men and women have usually compared
the pre and post training effects of resistance training. Most of
the intervention studies evaluating the effects of power-type strength
and resistance training are conducted with younger and physically
active subjects. Moreover, randomised, controlled studies in this
field are sparse. Especially few are training interventions evaluating
both the training effects and the feasibility aspects, including
injuries, adherence and motivation. A summary of previous studies
with power-type strength training programmes in the training protocol
is presented in Table 1.
Effects
of power-type strength training on trunk muscles
Despite the large number of different exercise protocols for trunk
muscles, scientific research investigating the specific effects
of power-type strength training on trunk muscle velocity in healthy
subjects is lacking. However, several studies concerning the exercise
effects in low back patients have shown that improved muscular fitness,
trunk muscle strength and power or spinal flexibility may prevent
future low back pain and spinal disorders (Biering-Sorensen, 1983;
Suzuki and Endo, 1983;
Mayer et al., 1985;
Lahad et al., 1994;
Harreby et al., 1997;
Abenheim et al., 2000).
Trunk muscles should be trained by various types of exercises (aerobic,
strength and power training) in order to provide many-sided and
sufficient loading for lumbar muscles. In a recent study of Pedersen
et al. (2004)
the authors showed that exercises which focused on reactions to
various expected and unexpected sudden trunk loadings together with
coordination exercises can improve the response to sudden trunk
loading in healthy subjects, without an increase in pre-activation
and associated trunk muscle stiffness. Lumbar exercises are recommended
in chronic and even in sub-acute low back pain, but not in acute
phase (Abenheim et al., 2000).
According to previous reports, it appears that a training frequency
of 1-2 times a week elicits optimal gains in strength and power
in trunk muscles (Graves et al., 1990;
Tucci et al., 1992;
DeMichele et al., 1997;
Pollock et al., 1998).
Previous studies (Graves et al., 1990;
Pollock et al., 1989;
Tucci et al., 1992)
have investigated the effects of training frequency on increased
strength of lumbar extension muscles, which, unlike the other muscle
groups, have a large potential for strength gains. Improved lumbar
extension strength can be maintained up to 12 weeks with a very
low training frequency (1 session per 2 or 4 weeks), when the volume,
type and intensity of training are constant (Tucci et al., 1992).
Feasibility
of power-type strength training in middle-aged subjects
Ageing leads to a loss in muscle mass, a decrease of strength and
a decline of contractile velocity (Aniansson et al., 1981;
Frontera et al., 1991).
The main reason for age-related decrease in strength is muscle fibre
atrophy (Lexell et al., 1988)
and the decreased contractile velocity may be related to a reduction
of the relative proportion of fast Type II muscle fibres (Lexell
et al., 1988;
Proctor et al., 1995).
This process accelerates in the beginning of the sixth decade both
in men and women (Lexell, 1988; Häkkinen, 1994).
In a study among men and women aged between 20 and 84 years, Akima
et al. (2001) estimated that the leg extension and flexion strength
declined by 8% on decade in women and by 12% in men. Metter et al.
(1997) reported that the decrease of muscle power is 10% faster
than decrease of strength in ageing men. Savinainen et al. (2004)
investigated the changes in physical capacity (hand-grip-, trunk
flexion and extension strength and aerobic capacity) during a 16
year follow-up period and found a greater decrease of physical capacity
in men (ranging from 11.6% to 33.7%) than in women (ranging from
3.3% to 26.7%).
Muscle strength and the ability of the leg muscles to produce force
rapidly are of importance, especially with increasing age, in connection
with daily activities, and even in prevention of falling (Bassey
et al., 1992; Skelton et al., 2002). Samson et al. (2000) found that the decline of leg muscle
strength and functional mobility accelerated in women from the age
of 55 years onwards; in men the decline was more gradual. In healthy
urban population of 35-, 45- and 55-year-old men and women, the
vertical jumping height was 25% greater in 35-year-old men than
in 55-year-old men, but the 35-year-old men were only 15% stronger
in trunk muscles than 55-year-old men (Viljanen et al., 1991; Era et al., 1992). The average vertical jumping height was at least as
good in physically active subjects as in those who were 10 years
younger but physically inactive (Kujala et al., 1994). In the same study, the authors observed that mixed training
with varied types of exercises for the neuromuscular system enhanced
the jumping height most. Korhonen et al. (2003) showed in their
recent study that the age-related deterioration in sprint running
in former sprint athletes was associated with reduced stride length
and increased ground contact time.
For the purpose of maintaining functional capacity, strength and
power-type strength training are recommended for middle-aged and
elderly people (Häkkinen et al., 1998; Izquierdo et al., 1999). In strength training the minimum of two sessions a week
is recommended for the adult healthy population (ACSM, 1998; Feigenbaum
and Pollock, 1999; Kraemer et al., 2002). Probably the same frequency is also needed for maintaining
and enhancing the power-type strength characteristics.
Previous studies on supervised resistance training programmes (Tsutsumi
et al., 1997), controlled circuit weight training programmes (Norvell
and Belles, 1993) and anaerobic training programmes (Norris et al., 1990) indicate that these training modes are beneficial both
for physical and psychological health. The perception of physical
ability and perceived fitness have improved in physical training
interventions in adults, independently of the type of activity (Caruso
and Gill, 1992; Bravo et al., 1996). Studies evaluating the effects of power-type strength
training programmes in middle-aged and older subjects are sparse
(see Table 1).
For being effective in enhancing explosive muscle performance, the
training programmes designed for middle-aged and older subjects
should take into consideration, in addition to age and gender, the
existing musculoskeletal symptoms, previous injuries, and exercise
history. A population survey (Uitenbroek, 1996) showed that exercise-related injuries constitute a high
proportion of all injuries, particularly in men. The amount of previous
injuries and exposure time may also increase the risk for injuries
(Van Mechelen et al., 1992; 1996). Poor physical condition increases the risk of
training induced injuries (Lysens et al., 1991) and highly intensive fitness programmes may even have
non-beneficial effects on physical health among less fit subjects
in the form of injuries, increased muscle pain, muscle soreness
and other training-related inconveniences (Egwu, 1996). When an injury occurs, athletic and well-trained subjects
suffer more of post-injury mood disturbances (caused by the loss
of active training time) than less trained people (Little, 1969;
Smith, 1996).
Exercise programmes should to be safe enough for the exercisers
to avoid injuries and musculoskeletal consequences. This is especially
important in programmes designed for middle-aged, sedentary men
and women. Injuries and musculoskeletal symptoms also influence
the exercise motivation. Approximately 30% of adult population in
Finland (Helakorpi et al., 1998)
and the United States (Caspersen and Merrit, 1995) are sedentary.
Physical activity generally declines with age, with a temporary
increase in activity at the time of retirement (Bouchard et al.,
1994).
The decline is greatest when the activity is vigorous and unorganised,
and the decrease is greatest in men. Also, men are engaged more
often in vigorous physical activities than women (Caspersen et al.,
2000;
Sallis, 2000).
In Finland, physical activity declines in early adulthood and begins
to increase again at the age of 45-54 years (Helakorpi et al., 1998).
Physical activity can be promoted by various kinds of interventions.
In group-based exercise programmes the adherence has been highest
in interventions of short duration (Bij et al., 2002),
but the effects are usually temporary (Dishman and Buckworth, 1996).
In an aerobic exercise programme, the dropout rate was approximately
50% within six months (Robison and Rogers, 1994).
Adherence to physical activity is a complex interaction of personal,
behavioural and environmental conditions, including perceived health
and fitness, marital status, smoking, obesity, lack of time, previous
exercise behaviour, socio-economic status and neighbourhood (Grzywacz
and Marks, 2001;
Trost et al., 2002). The adherence is lower in high-intensity training, but
high training frequency is necessarily not associated with low adherence
(Perri et al., 2002). Future adherent behaviour in supervised training programmes
is positively influenced by previous physical activity, perceived
health and fitness, the spouse's support, agreements and training
facilities (Dishman et al., 1985).
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|
THEORETICAL FRAMEWORK OF THE STUDY |
Muscle
strength and power-type strength decrease with increasing age and
also with inactivity. The decrease accelerates at the onset of the
sixth decade both in men and women. The loss of muscle strength is
observed in all muscles in the body, but the loss may be earlier and
greater in the proximal part of leg muscles compared with arm and
trunk muscles, probably caused by a lower use of leg muscles compared
with the arms and trunk. Maintaining strength and power-type strength
capacities at increasing age is relevant for a number of reasons,
including prevention of falls, maintenance of joint mobility, and
performance of daily activities.
Training intervention studies, and especially randomised studies,
investigating the effects of power-type strength training on leg and
trunk muscles, and further evaluating the feasibility of the programme
in question are sparse. The results of exercise interventions where
explosive exercises have been used in groups of sedentary, as well
as athletic middle-aged and older people are promising. However, most
of the studies have been conducted with a small number of participants,
and the exercise mode has in most studies been strength or resistance
training combined with explosive exercises, rather than explosive
exercises alone (Table 1).
As far as we know, there are very few studies on purely power-type
strength training programmes in middle-aged and older men and women.
The feasibility of this type of training programme, including such
aspects as training motivation, training adherence, training induced
injuries, musculoskeletal symptoms, and the impact of perceived health
and fitness, should also be investigated by using reliable and validated
measurement methods.
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|
AIMS OF THE STUDY AND STUDY DESIGN |
|
Aims of the study
The general purpose of this study was to investigate the effects
of a power-type strength training programme on leg and trunk muscles,
and to examine the training responses in men and women with high,
moderate and low training activity. Additionally, the feasibility
of the power-type strength training programme for middle-aged, sedentary
men and women was evaluated. The following qualities were set for
the programme design: the programme should be simple and practical,
and it should encourage and motivate middle-aged men and women to
increase their overall physical activity by getting accustomed to
and adopting power-type strength training.
The individual studies were performed to specifically answer the
following questions:
- Does
the use of light external loading (totalling 2.2 kg) in lower
extremities increase the efficiency in power-type strength training
exercises? (Study 1)
- Which
training frequency is needed for improved angular velocity of
the trunk muscles in power-type strength training in middle-aged
men and women? (Study 2 and 3)
- What
is the influence of power-type strength training on perceived
health, musculoskeletal symptoms and injuries in middle-aged men
and women? (Study 4)
- What
is the adherence rate in men and women, and what are the reasons
for dropping out from the power-type strength training programme?
(Study 5)
Study
design
Two
hundred and fifty-two (252) subjects volunteered to the study. A
total of 171 participants completed the training programme, and
55 subjects dropped out during the training programme (Study 5).
The control group consisted of 26 non-exercising volunteers (Figure
1).
For evaluating the impact of light loads attached to the lower extremities,
the exercisers were divided into two subgroups, one with light loads
and one without any loads. The results of those exercisers whose
training attendance was at least twice a week (high training group)
were included in the analysis (Study 1).
For evaluating the training frequency vs. training response, the
participants were classified into three training frequency groups
according to their attendance at the exercises, and to a non-exercising
control group. The subjects with training attendance rate > 67%
(2-3 times a week) were classified as female and male high training
groups; the subjects with training attendance rate between 33% and
67% (1-2 times a week) were classified as female and male moderate
training groups, and the subjects with attendance rate < 33%
(less than once a week) or with at least six weeks of detraining
period at the end of the intervention were classified as female
and male low training groups. The numbers of subjects participating
in different physiological measurements are presented by the training
attendance groups in Table 2.
For analysing the effects of training frequency on trunk muscles,
the participants were classified into two training frequency groups
(Study 3). The design of the study is presented in Figure
1.
The physical performance measurements were performed and questionnaires
were answered one week before the training programme started, and
same procedure was carried out one week after the training programme
ended. The study was completed within two years: a new controlled
and supervised exercise class started once 10-20 subjects had been
measured, and the group continued training together for the whole
training period of 22 weeks. The training programme included three
progressive periods. The orientation period consisted of basic strength
and conditioning exercises (6 weeks). The second period consisted
of training for explosive strength and velocity (10 weeks), and
the last period consisted of velocity training (6 weeks).
|
| METHODS |
|
Subjects
To be eligible for the intervention, the participants should be
middle-aged, healthy and sedentary. All participants were examined
by a physician to be qualified to participate. Medical screening
included cardiovascular, neurological and musculoskeletal examinations.
The physical activity level was assessed by interviewing the subjects
(those who trained sports regularly, at least three times a week,
or had been training in the past five years were excluded from the
study).
Participants (n = 252) were recruited among the staffs of the local
university and polytechnic institutes, secondary schools and private
companies, or among the participants of retraining courses and the
members of a local association of the unemployed. The recruiting
information was the same for all. Brochures about the training intervention
were attached on billboards providing the following information:
"The aim of this study is to develop in practice power-type
strength exercises that are simple to perform and feasible for anybody.
Exercise sessions are supervised, and various physiological measurements
are carried out before and after the intervention". The groups
were also reached by e-mail and by visiting people at their jobs,
course centres and institutes with the purpose of recruiting volunteers
to the intervention. The subjects in the training group (men n =
86, women n = 140) and in the non-exercising control group (men
n = 11, women n = 15) were healthy and middle-aged, and most of
the subjects were sedentary (Table
3 and Table 4). All subjects
were informed of the purpose of the study before they gave their
written consent to participate in the study. The Ethical Committee
of the Research and Development Centre of the Social Insurance Institution
approved the study protocol.
Measurements
After the medical examination the following measurements were carried
out on four different days: Vertical squat jump, Trunk muscle performances
and all inquiries (Day 1); Maximal anaerobic cycling power (Day
2); Maximal oxygen uptake (Day 3); and Standing long jump and 20
metre running time (Day 4).
Vertical Squat Jump (Study 1)
Vertical Squat Jump (VSJ) (cm) was used to measure the explosive
force of leg muscles before and after the intervention. Participants
had three attempts in vertical squat jump, with 1-3 minutes' rest
between the attempts. The best value (cm) of the three trials was
included in the statistical analysis. VSJ was measured by using
a contact mat (Newtest powertimer®, Finland). The recorded flight
time (s) was transformed to centimetres (cm) (Bosco et al., 1982; 1983). Participants were barefoot, with knees flexed
at 100 degrees, and they held a wooden stick behind the neck to
standardise the position of arms and upper body.
20 metre Running Time (Study 1)
20 metre Running time (20mRT) (s) was measured with a flying start,
and the first 5 metres were omitted from the calculation of the
running time. Participants had three attempts in running speed,
with 1-3 minutes' rest between the attempts. The best result was
used in the statistical analysis.
Standing Long Jump (Study 4)
Standing Long Jump (SLJ) (cm) was used to measure the explosive
force of leg muscles in horizontal direction. Subjects jumped from
a standing position, swinging of arms and leg counter-movements
were permitted. Participants had three attempts. The best result
was used in the statistical analysis.
Maximal Anaerobic Cycling Power (Study 1)
The Maximal Anaerobic Cycling Power (MACP) (W) test is a cycle ergometer
modification of an anaerobic power test on a treadmill (Rusko et
al., 1993; Rusko and Nummela, 1996). MACP consisted of 3-8 cycling bouts lasting 20 s each
with a 100 s recovery between the bouts. The pedalling frequency
was constant, 90 rpm for men < 40 yrs and 86 rpm for women and
men > 40 yrs. The work rate of the initial bout was determined
by the subject's body weight and estimated physical fitness, supposing
that sedentary subjects were within the range of average maximal
oxygen uptake of population (or less). The load was increased by
30-60 W in general, depending on the subject's age, gender and physical
fitness. The work rate was increased after every recovery in equal
increments throughout the test. Cycling power, pedalling moment
and pedalling frequency were recorded and saved on a computer. A
cycling bout was accepted if the pedalling rate was not decreased
by 5% or more from the target speed. The subject continued the test
until he or she could not cycle at the target rate. The test ended
at the moment when the pedalling rate was decreased by 5%. To be
acceptable, the final bout was not to be shorter than 12 s. The
maximum of the moving average over the 5 s period of cycling power
was applied for describing the maximal anaerobic cycling power of
the subject. The cycle ergometer used in the test was RE 820 (Rodby
Elektroniks AB, Södertälje, Sweden), which was modified to give
power output of 1000 W with high pedalling rate.
Maximal oxygen uptake (Study 1)
Maximal oxygen uptake (VO2max) (ml·kg-1·min-1) was measured to evaluate
the subject's endurance capacity. A 2-min incremental exercise test
on the electromagnetically controlled cycle ergometer (Rodby Ergometer
RE 820®, Södertälje, Sweden) until volitional exhaustion or fatigue
of the lower limbs was employed for measuring the VO2max. The subjects
pedalled at a constant frequency of 60 rpm. The test was preceded
by a 4-min warm-up at 30 W to become familiar with the pedalling
frequency, mouthpiece and nose clips. Thereafter, work rate was
increased every 2nd min, with equal increments throughout the test.
The increments were individually determined (10-25 W) on the basis
of the subject's physical fitness to reach the maximum work rate
in approximately 12-15 min. The test continued until the subject
was unable to maintain pedalling frequency above 45 rpm. Respiratory
gas exchange variables were determined continuously with a breath-by-breath
method suing the SensorMedics Vmax 229® equipment. The VO2 values
were averaged over the breath-by-breath values of the 30-second
intervals. VO2max was recorded as the highest averaged value at
the maximum work rate. The corresponding heart rate and work rate
were recorded and represented their maximums. Subjects rated their
perceived exertion using the Borg scale 6-20 (Borg, 1982) and the amount of fatigue in their lower limbs on scale
1-5 every 4 minutes at the beginning and every 2 minutes later on
during the test and at the end of the test in order to evaluate
subjective feelings along the whole exercise test and the character
of subjective maximum.
Isometric and dynamic trunk Flexion and Extension torques and
angular velocities (Study 2, 3)
Isometric trunk flexion (IsomFL) (Nm) and extension (IsomEX) (Nm)
torques, and the trunk flexion (FLTorq) (Nm) and extension (EXTorq)
(Nm) torques during dynamic actions, and the angular velocities
during flexion (FLvel) (deg·s-1) and extension (EXvel)
(deg·s-1) were measured by using a triaxial, isoresistive
lumbar dynamometer (Isostation B-200®, Isotechnologies, Hillsborough,
NC, USA). The system allows simultaneous measurement of the velocity,
angular position and torque of the three spatial axes of the body
spine.
Questionnaires (Study 1, 4, 5)
Questionnaires were used to inquire about the physical activity,
smoking, employment status, motivation for exercising, and perceived
health, fitness and musculoskeletal disorders. The participants
filled in a questionnaire asking yes or no questions about the present
and previous physical activity (excluding school-time sports activities),
smoking (yes or no) and employment (yes or no).
Perceived health and fitness were assessed by using a five-point
Likert scale (poor, fairly poor, average, fairly good, good) used
by, among others, Moum (1992) and Wolinsky and Johnson (1992). This
method has shown to be reliable and consistent with the assessed
medical health and its functional consequences (Lundberg and Manderbacka,
1996; Manderbacka, 1998).
For the assessment of musculoskeletal disorders, the standardised
Nordic musculoskeletal questionnaire (Kuorinka et al., 1987) was used. The subjects were inquired about the presence
of neck, shoulder, low back, hip, knee and ankle symptoms during
the preceding six months. Further, the participants were in advance
instructed to report the instructor about any injuries occurring
during the training programme, and to describe the injuries in detail.
In order to minimise the number of missing reports, the participants
were given a questionnaire form for reporting the injuries. They
were also asked to evaluate whether the injury was acute or a result
of overuse.
Training
The power-type strength training programme was based on the general
training principle with the exercises performed with low loads,
but with high movement velocities. The aim was to activate the muscles
subject to training by various exercises to a high or maximal degree,
with a short activation time. This type of training leads to improvements
primarily in the earlier force portion of the force-time curve or
the higher velocity portions of the force-velocity curve (Häkkinen,
1994).
Training sessions were supervised and controlled by a qualified
instructor. The duration of the training programme was 22 weeks,
including 52 training sessions, which lasted 60 minutes each. The
targeted exercise frequency was three times a week. The training
programme (described in detail in original Studies 1, 3 and 5) was
progressive, with an emphasis on power-type strength training. The
programme included the following three periods: the first period
of 6 weeks consisted of basic physical exercises, the second period
of 10 weeks consisted of power-type strength training and the third
period of 6 weeks consisted of power-type strength and velocity
training. The purpose of the first period was to familiarise the
exercisers with physical training and to enhance muscle strength
and co-ordination skills. The second period consisted of power-type
strength training with submaximal and maximal intensity. The third
period consisted of power-type strength and high-velocity training
with maximal intensity. During the first exercise week the intensity
of training was determined individually for each participant on
the basis of maximal Number of Repetitions subjects performed during
60 s (NR). The maximal Number of Repetitions during 60 seconds was
calculated for various types of exercises. The exercises focused
on leg (approximately 60%) and trunk muscles (approximately 40%).
Training was carried out in male and female exercise classes of
10-20 subjects. After the first 6 week period exercisers were divided
into Light Load (LL) or into No Load (NOL) groups. Exercisers in
the LL group had 1.1 kg weights in each ankle during all exercises.
Each exercise class consisted of either LL or NOL exercisers.
Statistical
analyses
The
General Linear Models Procedure (GLM) of the Statistical Analysis
System (SAS/STAT, 1989) was applied to compare the changes between
the groups and to evaluate possible interaction between group and
gender, and for multiple comparisons between the groups. Mean changes
and lower and upper 0.95 confidence limits of the outcome variables
in three different training activity groups and the control group
were calculated by gender. Means, standard deviations and correlation
coefficients were calculated by standardised methods.
For the comparison of the changes in the Light Load (LL) and No
Load (NOL) groups (Study 1), the individual data for VSJ, 20mRT,
MACP and VO2max at the baseline and after the intervention were
presented in scatter-plots. The chi-square test was applied to examine
the distribution of the type of previous exercise activity (four
categories: endurance type, power-type, no exercise history, and
other leisure activity than endurance or power-type), and the pre-training
shoulder-neck, low back, hip, knee and ankle symptoms. The t-tests
were used to analyse the differences between the mean values of
the baseline measures and the changes in the LL and NOL groups.
The Linear Structural Relationships (LISREL) model was used to analyse
the flexion and extension movement velocities and the reliability
of the measurement (Study 2). The LISREL model facilitated understanding
the nature of the measured flexion and extension movement, movement
velocity and range.
For the analysis of the trunk muscle performances (Study 3), one-way
analysis of variance (Procedure GLM of the Statistical Analysis
System) was applied to compare the changes of the outcome measures
between two (high vs. low training) groups by gender. The chi-square
tests were applied to investigate the differences in low back symptoms,
perceived health, physical activity, and smoking between the groups.
Mean changes and lower and upper 0.95 confidence limits of the outcome
variables in three different training activity groups and the control
group were calculated by gender. Means, standard deviations and
correlation coefficients were calculated by standardised methods.
The chi-square test and the GLM procedure analysis were applied
to examine the distribution of the musculoskeletal symptoms, smoking,
employment, perceived health, perceived fitness, overall physical
activity (present and previous) and smoking between the groups.
To investigate whether there were any changes in perceived health,
in perceived fitness, or in the incidence of knee and low back symptoms
during the training programme, the marginal probabilities of two-dimensional
contingency tables were used and analysed by gender using Proc Catmod
SAS/STAT (Study 4). The chi-square tests and the GLM Procedure analysis
were applied to investigate the associations with training activity
and employment, smoking and age (Study 5).
|
| RESULTS |
|
Study subjects and training effects on leg muscle performances
in exercisers and non-training controls
One hundred and seventy-one (171) participants (64 men and 107 women)
completed the training programme. The control group consisted of
26 non-exercising volunteers (11 men and 15 women). Of the initial
group, 55 dropped out (22 men and 33 women) during the training
programme. The overall dropout rate in this study was 24%. The overall
training activity was 63% for those (n = 171) who completed the
programme. The baseline characteristics of the subjects are presented
in Table 3 and Table
4, including age, body mass index, perceived health and fitness,
jump performance, and knee and low back symptoms. At the baseline,
the exercisers (n = 171) did not differ from the non-exercising
controls (n = 18) or dropouts (n = 55).
In performances requiring power-type strength the most visible training
effects were observed in vertical squat jump with 18% improvement
in exercisers (15% in men and 20% in women), while in controls the
increase was 1% (no change in men and 2% increase in women). Trunk
flexion velocity improved in exercisers by 14% (13% in men and 15%
in women), whereas in controls the increase was 3% (5% in men and
1% in women). The improvement in extension velocity was 16% (15%
in men and 17% in women) in exercisers, while the increase in controls
was 5% (7% in men and 3% in women). The exercisers improved their
results in standing long jump by 4% (1% decrease in controls), 20
metre running time by 5% (no change in controls) and maximal anaerobic
cycling power by 6% (1% increase in controls). In maximal oxygen
uptake, which was measured for individual endurance capacity, a
4% improvement was observed in exercisers (2% decrease in controls).
The changes in the non-training control group were not significant
in any of the measurements. The pre- and post-intervention values
and the percentage changes of the vertical squat jump (cm), standing
long jump (cm), 20 metre running time (s) and maximal anaerobic
cycling power (W) for the different training activity groups in
men and women are presented in Table
5 and Table 6.
There were significant differences in changes between the groups
in vertical squat jump (F = 19.33, df = 3, p = 0.0001), in standing
long jump (F = 4.20, df = 3, p = 0.007), in maximal oxygen uptake
(F = 3.10, df = 3, p = 0.03), in 20 metre running time (F = 11.35,
df = 3, p = 0.0001), and in maximal anaerobic cycling power(F =
4.83, df = 3, p = 0.0003). In vertical squat jump the changes were
higher in all of the training groups compared with the controls
(p < 0.05). In 20 metre running time, the changes were greater
in the high and moderate training groups compared with the controls
(p < 0.05). In standing long jump, in maximal anaerobic cycling
power and in maximal oxygen uptake the changes were greater in the
high training group compared with the controls (p < 0.05). In
maximal anaerobic cycling power the changes were greater in the
high training group compared with the low training group (p <
0.05).
Mean changes and 0.95 confidence limits in vertical squat jump (Figure
2a), 20 metre running time (Figure
2b), standing long jump (Figure
2c), maximal anaerobic cycling power (Figure
2d), and maximal oxygen uptake (Figure
2e) are shown for the three training activity and control groups
and by gender.
No significant gender differences were observed in the changes of
vertical squat jump, standing long jump or in the maximal oxygen
uptake after the training programme. Women achieved greater changes
after the training in 20 metre running time (F = 10.62, df = 1,
p = 0.01), while men achieved greater changes after the training
in maximal anaerobic cycling test (F = 5.86, df = 1, p = 0.02).
Effects of external light load vs. no load on muscle power in
lower extremities (Study 1)
No significant differences were found between the light load and
no load groups concerning the type of previous exercise activity,
perceived health and fitness, and shoulder-neck, low back, hip,
knee and ankle symptoms at the baseline (Study 1), or immediately
after the intervention. No significant differences between the groups
were observed in body weight after the intervention. There were
no differences in exercise induced injuries between the light load
and no load groups. At baseline, no differences between the groups
were observed in vertical squat jump, 20 metre running time, maximal
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