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Rehabilitation of neck-shoulder pain in women industrial workers: a randomized trial comparing isometric shoulder endurance training with isometric shoulder strength training.

OBJECTIVES: To study whether isometric shoulder endurance was more advantageous than isometric shoulder strength training in reducing pain and perceived exertion and to increase shoulder function through improved muscle endurance and strength. DESIGN: Randomized trial. SETTING: Three occupational health care centers. PARTICIPANTS: Women industrial workers with nonspecific neck-shoulder pain. The International Classification of Diseases, 10th Revision (ICD-10) diagnosis was "cervicobrachial syndrome" (M53.1). Thirty-eight patients completed the isometric shoulder endurance training and 31 patients completed the isometric shoulder strength training. INTERVENTION: Twelve weeks of training. MAIN OUTCOME MEASURES: Self-reported pain and rating of perceived exertion (RPE), arm motion performance test, shoulder muscle strength, shoulder muscle endurance, and shoulder functional tests, as well as follow-up after supervised training had ended. RESULTS: The isometric shoulder strength training resulted in an almost one-scale step decrease in RPE at work and a 5% to 15% improvement of arm motion performance compared with the endurance training. The isometric shoulder strength training more effectively improved left side shoulder abduction strength (p < .026), but no major differences were found for the other strength measurements. The isometric shoulder endurance training was not more successful than the strength training in the endurance test (p .51 to .81). CONCLUSIONS: Physical training programs for neck-shoulder pain may include isometric shoulder muscular strength exercise in addition to isometric shoulder endurance training, rather than endurance training only.

Exercise Therapy↗

The effects of strength training, cardiovascular training and their combination on flexibility of inactive older adults.

The purpose of this study was to investigate the effects of aerobic training, strength training and their combination on joint range of motion of inactive older individuals. Thirty-two inactive older men (65 - 78 yr) were assigned to one of four groups (n = 8 per group): control (C), strength training (ST), cardiovascular training (CT), and combination of strength and aerobic training (SA). Subjects in the S, A, and SA trained three times a week for 16 weeks. ST included 10 resistance exercises for the major muscle groups at an intensity of 55 - 80% of 1-RM and CT included walking/jogging at 50 - 80 % of maximal heart rate. Body weight and height, physical activity level and maximal oxygen uptake (.VO(2)max) were measured before the training period. Isokinetic (60 and 180 deg x sec(-1)) and concentric strength (1-RM in bench and leg press) were assessed prior to and at the end of the training period. Hip flexion, extension, abduction, and adduction, shoulder extension, flexion, and adduction, knee flexion, elbow flexion and sit-and-reach score were determined before and at 8 and 16 weeks of training. There were no differences between groups in .VO(2)max, body weight, and height (p < 0.05). ST and SA but not CT and C increased isokinetic and concentric strength at the end of the training period (p < 0.05). ST and SA increased significantly (p < 0.05) sit-and-reach performance, elbow flexion, knee flexion, shoulder flexion and extension and hip flexion and extension both at mid- and post-training. CT increased (p < 0.05) only hip flexion and extension at post training. Results indicate that resistance training may be able to increase range of motion of a number of joints of inactive older individuals possibly due to an improvement in muscle strength.

Aged↗

Training primary health care workers about drugs: a national survey of UK trainers' perceptions towards training.

Reports have consistently shown that non-specialist drug workers (whose working role is not specifically concentrated on dealing with drug-related issues) are reluctant to work with drug users. A number of explanations have been offered to account for this unwillingness including attitudinal factors, occupational constraints and a lack of motivation to learn about drug-related issues. Previously, it has been shown that training affects commitment to working with substance misusers, although failure to attract particular professional groups (e.g. general practitioners) into training courses has also been reported. No previous research has examined the views of trainers about training primary health care and health-related workers. This study of a (non-probability) sample of UK drug trainers (n = 145) assessed training activity for different health care workers, and trainers' differential perceptions of training needs and methods. GPs were the group least likely to become trained about drug issues. Training in attitudes towards drug using individuals was perceived to be more important than either skills or knowledge training for GPs, practice nurses, other nurses and probation officers. Experiential training methods were perceived to be more important than a didactic approach for training all health groups except GPs for whom lecture type instruction was believed to be equally appropriate. Seventy-nine percent of subjects reported providing training across drugs in alcohol or drugs, alcohol and tobacco. Most trainers who stated that certain professions required independent training believed that GPs should be trained separately from other groups.

Journal Article↗

Effects of back extensor strength training versus balance training on postural control.

PURPOSE: Aim of this study was to investigate effects of 1) regular back extensor strength training as opposed to balance training, and 2) the influence of the sequence of both training types on postural control, force, and muscle efficiency. METHODS: Twenty-six young, healthy subjects were investigated at baseline, 1 month and 2 months later. At each examination, subjects completed a posturographic, balance skill, and isometric maximum voluntary (MVC) back extension testing, including surface electromyographic (SEMG) recordings. After baseline evaluation, subjects were assigned to either daily strength training or balance training. After 1 month, the type of training was exchanged between groups. RESULTS: After 1 month, back extensor strengthening led to decreased postural stability on hard surface, whereas there were no change after balance skill training. Analysis of the low- and high-frequency components of the sway signal revealed that strength training increased control efforts as indicated by an increased high-frequency component in order to maintain postural stability and unchanged low-frequency component. Balance skill training, however, increased postural stability as indicated by a decreased low-frequency component. The control effort remained unchanged. After completing either sequence of training, all postural parameters remained unchanged in both groups. Muscular efficiency as measured by SEMG root mean square during a standardized motor skill task revealed improved muscle economy regardless of the type of training. Back extension torque improved in both groups. CONCLUSION: To avoid reduction of postural stability in rehabilitation processes, we recommend to include antagonist muscles in a comprehensive strength training regime or balance skill training.

Adult↗

Strength/endurance training versus endurance training in congestive heart failure.

PURPOSE: The aim of this study was to compare the effects of endurance training alone (ET) with combined endurance and strength training (CT) on hemodynamic and strength parameters in patients with congestive heart failure (CHF). METHODS: Twenty male patients with CHF were randomized into one of two training regimens consisting of endurance training or a combination of endurance and resistance training. Group ET had 40-min interval cycle ergometer endurance training three times per week. Group CT combined endurance and strength training with the same interval endurance training for 20 min, followed by 20 min of strength training. Left ventricular function was assessed at baseline and after 40 training sessions by echocardiography and radionuclide ventriculography. Work capacity was measured with cardiopulmonary exercise test (CPX) and lactate determination. Strength was measured with an isokinetic dynamometer. RESULTS: After 40 sessions, the ET group improved functional class, work capacity, peak torque, and muscular endurance. However, peak O2 remained unchanged. Left ventricular ejection fraction (LVEF) and fractional shortening (FS) decreased, whereas left ventricular end-diastolic diameter (LVED) increased. The CT group improved NYHA score, working capacity, peak O2, and peak lactate; peak torque and muscular endurance, LVEF, and FS increased, whereas LVED decreased. Compared with ET, CT was significantly (P < 0.05) better in improving LV function. CONCLUSION: Combined endurance/strength training was superior to endurance training alone concerning improvement of LV function, peak VO2, and strength parameters. It appears that for stable CHF patients, a greater benefit can be derived from this training modality.

Adult↗

Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial.

We examined the effects of a 6-month randomized program of endurance training (n = 14), resistance training (n = 17), or control conditions (n = 20) on insulin sensitivity in nonobese, younger women (18-35 yr). To examine the possible mechanism(s) related to alterations in insulin sensitivity, we measured body composition, regional adiposity, and skeletal muscle characteristics with computed tomography. We observed no changes in total body fat, sc abdominal adipose tissue, or visceral adipose tissue with endurance or resistance training. Insulin sensitivity, however, increased with endurance training (pre, 421 +/- 107; post, 490 +/- 133 mg/min; P < 0.05) and resistance training (pre, 382 +/- 87; post, 417 +/- 89 mg/min; P = 0.06). When the glucose disposal rate was expressed per kg fat-free mass (FFM), the improved insulin sensitivity persisted in endurance-trained (pre, 10.5 +/- 2.7; post, 12.1 +/- 3.3 mg/min x kg FFM; P < 0.05), but not in resistance-trained (pre, 9.7 +/- 1.9; post, 10.2 +/- 1.8 mg/min x kg FFM; P = NS) women. Muscle attenuation ratios increased (P < 0.05) in both endurance- and resistance-trained individuals, but this was not related to changes in insulin sensitivity. Moreover, the change in insulin sensitivity was not related to the increased maximum aerobic capacity in endurance-trained women (r = 0.24; P = NS). We suggest that both endurance and resistance training improve glucose disposal, although by different mechanisms, in young women. An increase in the amount of FFM from resistance training contributes to increased glucose disposal probably from a mass effect, without altering the intrinsic capacity of the muscle to respond to insulin. On the other hand, endurance training enhances glucose disposal independent of changes in FFM or maximum aerobic capacity, suggestive of an intrinsic change in the muscle to metabolize glucose. We conclude that enhanced glucose uptake after physical training in young women occurs with and without changes in FFM and body composition.

Adipose Tissue↗

Does strength training inhibit gains in range of motion from flexibility training in older adults?

Thirty-one untrained men between the ages of 50 and 74 (61 +/- 6 yr, mean +/- SD) were studied to compare the effects of strength and flexibility (SF) training, flexibility only (FO) training, and no training (inactive control group) on shoulder and hip range of motion. Fourteen of these subjects volunteered to participate in an SF training program three times per week for 10 wk. Ten others participated in an FO training program during this same time period, and the remaining seven subjects agreed to serve as an inactive control group by not participating in any regular exercise. The SF training consisted of a 3-min warm-up on a stationary bike, approximately 30 min of heavy resistance strength training, and about 10 min of static stretches performed before and after each training session. Maximal oxygen uptake (VO2max), percentage of body fat, and muscular strength (three-repetition maximum and peak isokinetic torque) were assessed before and after training for the SF group. Shoulder abduction, shoulder flexion, and hip flexion were measured with a universal goniometer in all groups before and after the training period. The FO training consisted of the identical warm-up and stretching exercises used in the SF training but without strength training. The results indicate that the FO group increased its range of motion in shoulder abduction to a significantly greater extent than the SF group (P < 0.001), and none of the changes in range of motion for the SF group was significantly different than the changes in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗

Resistance training and the enhancement of the gains in material-handling ability and physical fitness of British Army recruits during basic training.

The aim was to evaluate the efficacy of a modified British Army basic training that included resistance training in improving material-handling performance and physical fitness, and to compare the modified training directly with the normal basic training. Forty-three males [19.2 (2.6) years of age, 1764 (72) mm in height, 73.0 (10.6) kg in mass] and nine females [19.1 (2.2) years, 1641 (67) mm, 62.0 (7.2) kg] performed the modified basic training. Testing occurred in the week before and in the final week of the 11-week basic training. Improvements with the modified training were observed for all six material-handling tests, including 8-12% for maximal box lifting, 15-19% for repetitive lifting and carrying and 9-17% for loaded marching (all p < 0.01), and other established measures of aerobic fitness, strength and kinanthropometric characteristics. Significantly greater improvements were observed for the modified training compared with the normal training in maximal box lift to 1.45 m (12.4 versus 1.7%, p < 0.01), 3.2 km loaded march performance with 15 kg (8.9 versus 3.6%, p < 0.05), estimated fat-free mass (4.2 versus 1.5%, p < 0.001), predicted VO(2max) (1 min(-1)) (9.3 versus 4.1%, p < 0.01) and dynamic lift to 1.45 m (15.5 versus 0.2%, p < 0.001). It was concluded that the improvements in material-handling ability and other aspects of physical fitness brought about in recruits by British Army basic training can be enhanced by the use of a physical training programme that includes a carefully designed resistance training element. Of particular note are the improvements shown in performance on material-handling tasks that require muscular strength, as these represent many of the tasks that soldiers encounter in their military careers.

Adolescent↗

Neuromuscular adaptations during concurrent strength and endurance training versus strength training.

The purpose of this study was to investigate effects of concurrent strength and endurance training (SE) (2 plus 2 days a week) versus strength training only (S) (2 days a week) in men [SE: n=11; 38 (5) years, S: n=16; 37 (5) years] over a training period of 21 weeks. The resistance training program addressed both maximal and explosive strength components. EMG, maximal isometric force, 1 RM strength, and rate of force development (RFD) of the leg extensors, muscle cross-sectional area (CSA) of the quadriceps femoris (QF) throughout the lengths of 4/15-12/15 (L(f)) of the femur, muscle fibre proportion and areas of types I, IIa, and IIb of the vastus lateralis (VL), and maximal oxygen uptake (VO(2max)) were evaluated. No changes occurred in strength during the 1-week control period, while after the 21-week training period increases of 21% (p<0.001) and 22% (p<0.001), and of 22% (p<0.001) and 21% (p<0.001) took place in the 1RM load and maximal isometric force in S and SE, respectively. Increases of 26% (p<0.05) and 29% (p<0.001) occurred in the maximum iEMG of the VL in S and SE, respectively. The CSA of the QF increased throughout the length of the QF (from 4/15 to 12/15 L(f)) both in S (p<0.05-0.001) and SE (p<0.01-0.001). The mean fibre areas of types I, IIa and IIb increased after the training both in S (p<0.05 and 0.01) and SE (p<0.05 and p<0.01). S showed an increase in RFD (p<0.01), while no change occurred in SE. The average iEMG of the VL during the first 500 ms of the rapid isometric action increased (p<0.05-0.001) only in S. VO(2max) increased by 18.5% (p<0.001) in SE. The present data do not support the concept of the universal nature of the interference effect in strength development and muscle hypertrophy when strength training is performed concurrently with endurance training, and the training volume is diluted by a longer period of time with a low frequency of training. However, the present results suggest that even the low-frequency concurrent strength and endurance training leads to interference in explosive strength development mediated in part by the limitations of rapid voluntary neural activation of the trained muscles.

Adaptation, Physiological↗

Different skeletal muscle HSP70 responses to high-intensity strength training and low-intensity endurance training.

Heat shock protein, e.g. HSP70, can be induced in human skeletal muscle undergoing exercise training, and plays important role in adaptation to stress. This study was designed to investigate the effects of high-intensity strength training and low-intensity endurance training on the HSP70 response to exercise, bearing in mind whether HSP70 is induced in the well-trained muscle during low-intensity endurance training. Six well-trained rowers (male, aged 18 years) underwent a training program which consisted of 3 weeks high-intensity training (HIT) and 3 weeks low-intensity endurance training (ET), followed by 1 week of recovery each (R1 and R2, respectively). HSP70 (2.5 microg total protein loaded) was determined by Western blot with reference to a series of known amount of standard HSP70. HSP70 mRNA was analyzed by RT-PCR, and the relative percentage change was referred to the baseline level (before training). HSP70 increased significantly at the end of HIT (from 51 to 73 ng), decreased at the end of R1(66 ng), and remained unchanged throughout ET and R2. HSP70 mRNA increased significantly after HIT (257%) and decreased gradually afterwards (194%, 166%, and 119% for R1, ET, and R2, respectively). It can be concluded that: (1) HSP70 was induced by high-intensity training, but not by endurance training at low intensity, and (2) there was a discrepancy in terms of HSP70 regulation between the protein and mRNA levels, suggesting that posttranscriptional regulation may play a role in HSP70 expression in human skeletal muscle in response to exercise.

Adaptation, Physiological↗

The response of trained athletes to six weeks of endurance training in hypoxia or normoxia.

This study was performed to investigate the effect of training under simulated hypoxic conditions. Hypoxia training was integrated into the normal training schedule of 12 endurance trained cyclists. Athletes were randomly assigned to two groups and performed three additional training bouts per week for six weeks on a bicycle ergometer. One group (HG) trained at the anaerobic threshold under hypoxic conditions (corresponding to an altitude of 3200 m) while the control group (NG) trained at the same relative intensity at 560 m. Preceding and following the six training weeks, performance tests were performed under normoxic and hypoxic conditions. Normoxic and hypoxic .VO2max, maximal power output as well as hypoxic work-capacity were not improved after the training period. Testing under hypoxic conditions revealed a significant increase in oxygen saturation (SpO 2, from 67.1 +/- 2.3 % to 70.0 +/- 1.7 %) and in maximal blood lactate concentration (from 7.0 to 9.1 mM) in HG only. Ferritin levels were decreased from 67.4 +/- 16.3 to 42.2 +/- 9.5 microg/l (p < 0.05) in the HG and from 54.3 +/- 6.9 to 31.4+/- 8.0 microg/l (p = 0.17) in the NG. Reticulocytes were significantly increased in both groups by a factor of two. In conclusion, the integration of six weeks of high intensity endurance training did not lead to improved performance in endurance trained athletes whether this training was carried out in hypoxic or normoxic conditions.

Adult↗

"Living high-training low": effect of moderate-altitude acclimatization with low-altitude training on performance.

The principal objective of this study was to test the hypothesis that acclimatization to moderate altitude (2,500 m) plus training at low altitude (1,250 m), "living high-training low," improves sea-level performance in well-trained runners more than an equivalent sea-level or altitude control. Thirty-nine competitive runners (27 men, 12 women) completed 1) a 2-wk lead-in phase, followed by 2) 4 wk of supervised training at sea level; and 3) 4 wk of field training camp randomized to three groups: "high-low" (n = 13), living at moderate altitude (2,500 m) and training at low altitude (1,250 m); "high-high" (n = 13), living and training at moderate altitude (2,500 m); or "low-low" (n = 13), living and training in a mountain environment at sea level (150 m). A 5,000-m time trial was the primary measure of performance; laboratory outcomes included maximal O2 uptake (VO2 max), anaerobic capacity (accumulated O2 deficit), maximal steady state (MSS; ventilatory threshold), running economy, velocity at VO2 max, and blood compartment volumes. Both altitude groups significantly increased VO2 max (5%) in direct proportion to an increase in red cell mass volume (9%; r = 0.37, P < 0.05), neither of which changed in the control. Five-kilometer time was improved by the field training camp only in the high-low group (13.4 +/- 10 s), in direct proportion to the increase in VO2 max (r = 0.65, P < 0.01). Velocity at VO2 max and MSS also improved only in the high-low group. Four weeks of living high-training low improves sea-level running performance in trained runners due to altitude acclimatization (increase in red cell mass volume and VO2 max) and maintenance of sea-level training velocities, most likely accounting for the increase in velocity at VO2 max and MSS.

Acclimatization↗

Motor skill training and strength training are associated with different plastic changes in the central nervous system.

Changes in corticospinal excitability induced by 4 wk of heavy strength training or visuomotor skill learning were investigated in 24 healthy human subjects. Measurements of the input-output relation for biceps brachii motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation were obtained at rest and during voluntary contraction in the course of the training. The training paradigms induced specific changes in the motor performance capacity of the subjects. The strength training group increased maximal dynamic and isometric muscle strength by 31% (P < 0.001) and 12.5% (P = 0.045), respectively. The skill learning group improved skill performance significantly (P < 0.001). With one training bout, the only significant change in transcranial magnetic stimulation parameters was an increase in skill learning group maximal MEP level (MEP(max)) at rest (P = 0.02) for subjects performing skill training. With repeated skill training three times per week for 4 wk, MEP(max) increased and the minimal stimulation intensity required to elicit MEPs decreased significantly at rest and during contraction (P < 0.05). In contrast, MEP(max) and the slope of the input-output relation both decreased significantly at rest but not during contraction in the strength-trained subjects (P < or = 0.01). No significant changes were observed in a control group. A significant correlation between changes in neurophysiological parameters and motor performance was observed for skill learning but not strength training. The data show that increased corticospinal excitability may develop over several weeks of skill training and indicate that these changes may be of importance for task acquisition. Because strength training was not accompanied by similar changes, the data suggest that different adaptive changes are involved in neural adaptation to strength training.

Adaptation, Physiological↗

Interaction between resistance training and flexibility training in healthy young adults.

To test the hypothesis that increases in muscle strength and flexibility are developed by specific training programs, 43 healthy young adults were tested before and after 4 different interventions conducted twice a week for 12 weeks: (a) resistance training only (n = 13); (b) flexibility training only (n = 11); (c) resistance and flexibility training (n = 9); and (d) no intervention (n = 10). There was no change in either strength or flexibility in the control group (p > 0.05). Resistance training improved muscle strength either alone (+14%; effect size = 0.53; p < 0.001) or in combination with flexibility training (+16%; effect size = 0.66; p = 0.032), but did not change flexibility (p = 0.610). Flexibility increased with specific training alone (+33%; p < 0.001) or in combination with resistance training (+18%; p < 0.001). In conclusion, in young, healthy subjects, resistance training alone did not increase flexibility, but resistance training did not interfere with the increase in joint range of motion during flexibility training. These results support the concept that specific training should be employed in order to increase either muscle strength or flexibility.

Adult↗

Effect of strenuous strength training on the Na-K pump concentration in skeletal muscle of well-trained men.

This study examined how strenuous strength training affected the Na-K pump concentration in the knee extensor muscle of well-trained men and whether leg muscle strength and endurance was related to the pump concentration. First, the pump concentration, taken as 3H-ouabain binding, was measured in top alpine skiers since strength training is important to them. Second, well-trained subjects carried out strenuous eccentric resistance training either 1, 2, or 3 times.week-1 for 3 months. The Na-K pump concentration, the maximal muscle strength in a full squat lift (one repetition maximum, 1 RM), and the muscle endurance, taken as the number of full squat lifts of a mass of 70% of the 1 RM load, were measured before and after the training period. The mean pump concentration of the alpine skiers was 425 (SEM 11) nmol.kg-1 wet muscle mass. The subjects in part two increased their maximal strength in a dose-dependent manner. The muscle endurance increased for all subjects but independently of the training programme. From a mean starting value of 356 (SEM 6) nmol.kg-1 the mean Na-K pump concentration increased by 54 (SEM 15) nmol.kg-1 (+15%, P < 0.001) when the results for all subjects were pooled. The effect was larger for those who had trained twice a week than for those who had trained only once a week (P = 0.025), suggesting that the effect of strength training depended on the amount of training carried out. The muscle strength and endurance were not related to the pump concentration, suggesting that the pumping power of this enzyme did not limit the performance during heavy lifting. However, the individual improvements in the endurance test during the training period correlated with the individual changes in the pump concentration (rSpearman = 0.5; P = 0.01) which could mean that a common factor both increases the pump concentration and makes the muscles more adapted to repeated heavy lifting.

Adult↗

Effect of body training position on outcomes of an aerobic training study on individuals with quadriplegia.

The use of the supine training position to enhance aerobic training was evaluated in a 10-week upper-body exercise study. Fourteen subjects with quadriplegia (QD) were matched on initial peak power output (PO) values and then randomly assigned to either a supine (SUP, n = 7) or sitting (SIT, n = 7) training group. Peak VO2 and PO were measured pretraining and posttraining in both the supine and sitting positions. There were significant (p < .01) increases in peak VO2 (720 to 780 mL.min-1) and PO (29.3 to 33.3W) with training. Although the SIT group exhibited a small training effect size (0.1), while the SUP group exhibited a moderate effect size (0.6), the interaction between time and training group failed to reach significance (p = .07) because of a large injury level-related variation in VO2. The training effect achieved by the SUP group generalized to the sitting position, as their peak VO2 increased 80mL.min-1 in the sitting position. Endurance improved (p < .0001) in all subjects, with time to exhaustion increasing from 52min to 135min over the 10 weeks of training. The sum of 4 skinfolds decreased (p < .05) from 67.5 to 61.0mm. The lack of change in stroke volume at rest and at 50% of peak PO suggests that an inotropic adaptation of the heart, commonly observed in subjects without SCI, did not occur in this population. However, a 4.7bpm increase (p < .01) in resting heart rate (HR) and a near significant increase (p = .07) in peak HR from pretraining to posttraining suggests a training-induced chronotropic adaptation of the heart. Although improvements in aerobic capacity can be achieved by training in either supine or sitting positions, the training effect size was larger in the supine position. Improvements in SV were not observed in either training position; this may be because of low absolute workloads were used. Central cardiovascular adaptation may occur in subjects with QD but changes are reflected as chronotropic and not inotropic adaptations.

Adolescent↗