Reliability of alternative trunk endurance testing procedures using clinician stabilization vs. traditional methods

Reliability of Field-Based Fitness Tests in Adults: A Systematic Review

BACKGROUND

Physical fitness is a powerful predictor of morbidity and mortality, and is therefore a useful indicator for public health monitoring. To assess physical fitness, field-based tests are time-efficient, inexpensive, have minimal equipment requirements, and can be easily administered to a large number of individuals.

OBJECTIVE

The objective of this systematic review was to examine the reliability of existing field-based fitness tests used in adults aged 19-64 years.

METHODS

A systematic search of two electronic databases (MEDLINE and Web of Science) was conducted from inception to 8 June 2021 by two independent researchers. Each study was classified as high, low, or very low quality according to the description of the participants, the time interval between measurements, the description of the results, and the appropriateness of statistics. Three levels of evidence (strong, moderate, and limited) were established according to the number of studies and the consistency of their findings. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO reference number, CRD42019118480).

RESULTS

Of 17,010 records identified, 129 original studies examining the reliability of field-based fitness tests in adults were considered eligible. The reliability was assessed of tests of cardiorespiratory fitness (33 studies: 30 of high quality), musculoskeletal fitness (92 studies: 78 of high quality), and motor fitness (22 studies, all of high quality). There was strong evidence indicating: (i) the high reliability of the cardiorespiratory fitness tests: 20-m shuttle run, 6-min step, and 6-min walk; (ii) the high reliability of the musculoskeletal fitness tests: handgrip strength, back-leg strength, Sorensen, trunk flexion sustained, 5-reps sit-to-stand, sit-and-reach and toe-touch, and moderate reliability bilateral side bridge and prone bridge tests; and (iii) the moderate reliability and low reliability, respectively, of the motor fitness tests T-test and single-leg stand. We found moderate evidence indicating the moderate or high reliability of the following tests: Chester, sit-up, partial curl-up, flexion-rotation trunk, timed stair ascent, pull-up, bent-arm hang, standing broad jump, hop sequence, trunk lift, timed-up-and-go, and hexagon agility. Evidence for the reliability of balance and gait speed tests was inconclusive. Other field-based fitness tests demonstrated limited evidence, mainly due to there being only few studies.

CONCLUSIONS

This review provides an evidence-based proposal of the more reliable field-based fitness tests for adults aged 19-64 years. Our findings identified a need for more high-quality studies designed to assess the reliability of field-based tests of lower and upper body explosive and endurance muscular strength, and motor fitness (i.e., balance and gait speed tests) in adults.

Muscle Activation in the Shoulder Girdle and Lumbopelvic-Hip Complex During Common Therapeutic Exercises

CONTEXT

Lumbopelvic-hip complex (LPHC) exercises are used to increase stabilization within the human body. Torso-elevated side support (TESS), foot-elevated side support (FESS), prone bridge plank (PBP), and V-sit are common LPHC exercises.

OBJECTIVE

To evaluate muscle activation in the shoulder girdle and LPHC during 4 LPHC exercises and evaluate the reasoning for termination.

STUDY DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Seventeen healthy participants (12 males and 5 females; age: 21.47 [3.16] y, height: 179.73 [8.92] cm, mass: 76.89 [11.17] kg).

MAIN OUTCOME MEASURES

Participants completed 2 repetitions of the TESS, FESS, PBP, and V-sit until failure. Surface electromyography of the middle deltoid, latissimus dorsi, middle trapezius, rectus abdominis, erector spinae, external oblique, and gluteus medius were recorded and normalized to maximum voluntary isometric contraction (MVIC). The duration of exercise and subjective reasoning for termination of exercise was completed following the 4 tasks.

RESULTS

The TESS and PBP had significantly greater middle deltoid muscle activation (TESS: 55.66% [24.45%] MVIC and PBP: 42.63% [18.25%] MVIC) compared with the FESS (10.10% [10.04%] MVIC) and V-sit (2.21% [1.94%] MVIC), P < .05. The TESS produced significantly greater external oblique activity (78.13% [32.32%] MVIC) than the PBP (54.99% [19.54%] MVIC), P < .05. Due to shoulder fatigue and pain, 41.1% and 17.0% of participants terminated the TESS, respectively. The PBP was terminated due to abdominal fatigue (41.1%) and upper-extremity fatigue (47.0%).

CONCLUSIONS

The V-sit resulted in isolated activity of the abdominal portion of the LPHC. The FESS had increased global co-contraction of the LPHC compared with the TESS. The PBP and TESS had significant muscle activation in the upper-extremity.

Lumbopelvic sagittal standing posture associations with anthropometry, physical activity levels and trunk muscle endurance in healthy adults

Background

Various factors, inherited and acquired, are associated with habitual spinal postures.

Objective

The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants.

Methods

In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2-22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected.

Results

LC and SS angles correlated significantly ( r = 0 . 80 , p < 0 . 001 ). Statistically significant differences for both LC ( p = 0 . 023 ) and SS ( p = 0 . 013 ) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC ( r =- 0 . 27 , p = 0 . 004 ); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant ( r =- 0 . 17 , p = 0 . 08 ). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC-SS) in standing and the participants' body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day.

Conclusion

The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.

Effects of a Worksite Supervised Adapted Physical Activity Program on Trunk Muscle Endurance, Flexibility, and Pain Sensitivity Among Vineyard Workers

OBJECTIVES

In viticulture, the prevalence of low back pain is particularly high among vineyard workers exposed to sustained and awkward postures. One promising setting for low back pain prevention resides in the implementation of workplace physical activity.

METHODS

This nonrandomized pilot study aims at evaluating the effects of a worksite supervised adapted physical activity program among 17 vineyard workers volunteered to enter either an intervention group (n = 10) or a control group (n = 7).The intervention group followed a physical activity program for 8 weeks involving (1) 15 minutes of warm-up every working day and (2) two weekly 1-hour adapted physical activity sessions targeting trunk muscle endurance and flexibility. The control group was advised to continue normal physical activity. Evaluations were carried out at weeks 0, 4, 8, and 12. Physical capacity was assessed using flexibility tests for the trunk, along with trunk muscle flexor and extensor endurance tests. Finally, pain sensitivity was evaluated by assessing pressure pain thresholds over 14 anatomical locations in the low back region.

RESULTS

For the intervention group, the endurance of the trunk extensor and flexor significantly increased from baseline to week 8 as well as the pressure pain thresholds. No change was observed for the control group over the same period.

CONCLUSIONS

These encouraging results in combination with the high adherence rate set interesting foundations for the promotion of worksite supervised adapted physical activity and, most likely, offer a new promising approach to prevent low back pain among vineyard workers.

Reliability and Practicality of the Core Score: Four Dynamic Core Stability Tests Performed in a Physician Office Setting

OBJECTIVE

Pilot study to determine the practicality and inter-rater reliability of the "Core Score," a composite measure of 4 clinical core stability tests.

DESIGN

Repeated measures.

SETTING

Academic hospital physician clinic.

PARTICIPANTS

23 healthy volunteers with mean age of 32 years (12 females, 11 males).

ASSESSMENT OF VARIABLES

All subjects performed 4 core stability maneuvers under direct observation from 3 independent physicians in sequence.

MAIN OUTCOME MEASURES

Inter-rater reliability and time necessary to perform examination.

RESULTS

The Core Score scale is 0 to 12, with 12 reflecting the best core stability. The mean composite score of all 4 tests for all subjects was 9.54 (SD, 1.897; range, 4-12). The intraclass correlation coefficients (ICC 1,1) for inter-rater reliability for the composite Core Score and 4 individual tests were 0.68 (Core Score), 0.14 (single-leg squat), 0.40 (supine bridge), 0.69 (side bridge), and 0.46 (prone bridge). The time required for a single examiner to assess a given subject's core stability in all 4 maneuvers averaged 4 minutes (range, 2-6 minutes).

CONCLUSIONS

Even without specialized equipment, a clinically practical and moderately reliable measure of core stability may be possible. Further research is necessary to optimize this measure for clinical application.

CLINICAL RELEVANCE

Despite the known value of core stability to athletes and patients with low back pain, there is currently no reliable and practical means for rating core stability in a typical office-based practice. This pilot study provides a starting point for future reliability research on clinical core stability assessments.

A comparison of two isometric tests of trunk flexor endurance

This study was performed to determine the test-retest reliability and the relationship between 2 tests of trunk flexor muscular endurance-a prone bridge and a modified V-sit. Hold times (in seconds) were measured on 60 healthy volunteers from a University community (17 men, 43 women). Both tests were performed at 1-week intervals. The test-retest reliability of each test was assessed with a subgroup of 10 participants during 3 additional testing sessions at 1-week intervals. One examiner collected all data. Intraclass correlation coefficients (2, 1) with the prone bridge were 0.95 and 0.71 with the modified V-sit. The mean hold time was 92.8 ± 44.4 seconds during the prone bridge and 141.7 ± 104.1 seconds during the modified V-sit. Pearson's correlation coefficients between the 2 tests ranged from r = 0.52 (men + women) to r = 0.87 (men only). Intersession reliability with a single examiner was higher with the prone bridge compared with that in the modified V-sit. Modifications to the V-sit resulted in a lower test-retest reliability than was previously reported. Correlations between prone bridge and modified V-sit test scores were low, which may be attributable to the differences in the level of trunk flexor muscle activation between the tests.

The assessment of function: How is it measured? A clinical perspective

Testing for outcome or performance can take many forms; including multiple iterations of self-reported measures of function (an assessment of the individual's perceived dysfunction) and/or clinical special tests (which are primarily assessments of impairments). Typically absent within these testing mechanisms is whether or not one can perform a specific task associated with function. The paper will operationally define function, discuss the construct of function within the disablement model, will overview the multi-dimensional nature of 'function' as a concept, will examine the current evidence for functional testing methods, and will propose a functional testing continuum. Limitations of functional performance testing will be discussed including recommendations for future research.