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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 37-46

Effects of combining core muscle activation with treadmill walk on endurance of trunk muscles: A pilot study


1 National Orthopaedic Hospital, Physiotherapy Department, P.M.B 3087 Dala, Kano, Nigeria
2 Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, PMB 3011, Kano, Nigeria
3 College of Medicine, University of Lagos, Lagos, Nigeria

Date of Submission31-Aug-2020
Date of Decision30-Oct-2020
Date of Acceptance20-Dec-2020
Date of Web Publication20-May-2021

Correspondence Address:
Dr. Olajide Olubanji Olowe
M.Sc Orthopaedic and Sports Physiotherapy (Assistant Director of Physiotherapy) National Orthopaedic Hospital, Physiotherapy Department P.M.B 3087 Dala, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njecp.njecp_33_20

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  Abstract 


Background: Abdominal bracing is one of the most effective techniques for core muscle training, which if combined with treadmill walk (TW) could provide trunk muscle endurance Trunk muscle endurance, despite being observed as an important factor and a huge component of core spinal stability, especially in holding up the spine during prolonged functional activity, prevention and rehabilitation of lumbar mechanical problems and performance enhancer in sports, the impacts of combining core muscle activation with TW exercises on trunk muscle endurance has not be succinctly investigated. Aims: The objective of this study was to determine the effect of combining abdominal bracing with TW on trunk muscles endurance. Materials and Methods: Eighteen apparently healthy young adults were randomized into three groups (TW without abdominal bracing, TW combined with abdominal bracing and control). McGill endurance test measures were carried out at baseline and after 6 weeks of intervention. All participants followed the assigned intervention protocols. Results: One way analysis of variance did not show a significant between-group difference in the postintervention endurance of trunk muscle among the three groups (P > 0.05). In the TW combined with the abdominal bracing group, paired-t test showed significant within-group difference in the form of an increase in the holding times (endurance) for the right lateral flexors (t = −3.758, P = 0.013), left lateral flexors (t = −4.096, P = 0.005), and extensors (t = −2.441, P = 0.050). Conclusion: Combining abdominal bracing with TW can be used to improve trunk muscle function through facilitation of trunk muscle endurance.

Keywords: Abdominal bracing, core stability muscle activation, treadmill walk, trunk muscle endurance


How to cite this article:
Olowe OO, Sokunbi GO, Okafor UC, Amusa AM. Effects of combining core muscle activation with treadmill walk on endurance of trunk muscles: A pilot study. Niger J Exp Clin Biosci 2021;9:37-46

How to cite this URL:
Olowe OO, Sokunbi GO, Okafor UC, Amusa AM. Effects of combining core muscle activation with treadmill walk on endurance of trunk muscles: A pilot study. Niger J Exp Clin Biosci [serial online] 2021 [cited 2021 Jun 14];9:37-46. Available from: https://www.njecbonline.org/text.asp?2021/9/1/37/316527




  Introduction Top


The “core trunk musculature” can be defined generally as the 29 pairs of muscles that support the lumbo-pelvic-hip complex to stabilize the spine, pelvis, and resulting kinetic chain during functional movements.[1] The core is also commonly referred to as the “power-house” or the foundation of all limb movement.[2] Core muscles have been suggested not only to protect the spine and hips from excessive force but also to play an important role in body stabilization and force generation during functional movements and sporting activities.[3] These muscles have been found in theory to create a foundation for movement through muscle contraction that provides direct support and increased intra-abdominal pressure to the inherently unstable spine.[4]

Core stability muscles can be generally described as local stabilizers and global stabilizers.[1] The local stabilizers comprise of multifidus, transversus abdominis, diaphragm, and pelvic floor muscles. The local stabilizers are located very close to the spine to ensure static and dynamic stability of the spine. The global stabilizers made up of other trunk muscles such as latissimus dorsi, rectus abdominis, obliques, and quadratus lumborum erector spinae muscles. The global stabilizers are mainly concerned with movements and dynamic stability of the spine.[5]

The relationship between trunk muscle endurance-related dysfunction on patients with spinal disorders and athletes have been reported.[6],[7],[8] Thus, optimizing strength and endurance capabilities of the local core muscles through isometric activation using core muscle activation either bracing or hollowing method has been theorized in the literature to be the basis for injury prevention.[2].Core training for effective functional movement through activation using bracing and hollowing methods has become a common exercise in the rehabilitation of spinal disorders as well as in health and fitness.

Abdominal bracing and abdominal hollowing techniques have been reported to be effective in activating core muscles of spinal stability.[2] Abdominal bracing is subtle in draw of the lower abdominal muscles. It is a form of core muscle activation exercise where the muscles surrounding the trunk are gently activated. Abdominal hollowing technique on other hand is more intense.[2] Intense abdominal muscle activation is usually accompanied with too much pressure within the trunk capable of causing Valsalva maneuver, lower back disc injury, overloading a weak pelvic floor causing or worsening pelvic floor problems including prolapse or incontinence.

It is of note that research has shown that gentle abdominal bracing and improvement in trunk muscle functions can facilitate recovery from injury and relieve chronic lower back pain.[9],[10],[11] Improvement in the trunk muscular strength, flexibility, endurance, coordination, balance, and movement efficiency are components necessary to achieve functional movement in patients with spinal disorders asides being integral to the performance- and sport-related skills.[8],[9],[12],[13] Trunk-related dysfunction in patients with low back pain (LBP) has been identified in literature which is reduced endurance of the back extensors[14],[15],[16],[17] and delayed essential feed-forward postural responses of deep abdominal muscles especially in patients with chronic LBP. In a similar vein, a positive relationship between the trunk muscle endurance and onset of lower limb-related injuries of athletic individuals without back pain has been reported.[13]

Some of the previous studies on the effects of core muscle activation exercises have been carried out on patients with back pain where pain and functional disability were used as outcome measures.[16],[17],[18] Many of such studies have attributed changes in pain and functional disability to changes in muscle functions such increase muscle strength, holding capacity, reduce fatigability, and reversal of muscle atrophy. However, pain-related dysfunction among participants in such studies could have inhibitory and limiting effects on the normal physiological responses of trunk muscles to exercises. Thus, positive changes recorded by these outcome measures in these studies might not be due to improvement in trunk muscle function as opined. The outcome might be different if participants in these studies were those without pain.

Pain severity and functional limitation as outcome measures reported in most of the previous studies are multidimensional clinical variables that could be possibly affected by other biopsychosocial variables.[19] Thus, there might be a need to add physiological variables as endurance, strength and flexibility along with clinical variables to establish the effects of rehabilitation exercises on trunk muscle performance in patients with spinal dysfunction.[20],[21],[22],[23],[24]

There appears to be an increase in trend of use of treadmill walk (TW) and overground walk in spinal rehabilitation and fitness training. TW exercises, due to convenience, safety, lack of complex technicality required for use and controllability, has become a common alternative to over-ground walking or running for daily fitness, clinical rehabilitation, and sport biomechanical research.[25],[26] However, it is not well established, at the moment whether TW and core muscle activation exercises in the form of abdominal bracing when carried out alone or in combination could improve the performance of trunk muscles. This study aimed to determine the effects of combining abdominal bracing with TW on trunk muscle endurance.


  Materials and Methods Top


Study design

A pre and posttest randomized control pilot study among apparently healthy individuals. The pilot study was carried out in preparation for a large randomized controlled trial in which TW and core muscle activation will be the main intervention.

Participants

Participants recruited for this study were male and female apparently healthy individuals within the age of 18 and 55 years. They were staff of the National Orthopaedic Hospital Dala and students attending Orthopaedics cast technology School Dala, Kano, who willingly gave their consent to be a part of the study. Consecutive sample was employed for the recruitment. The sample size of 18 participants was considered enough using Cohen's table. The participants were randomized into three groups of 6 participants each using sample size estimation from previous similar studies[15],[16],[17] with the equation, n = 2 (Za + Z1 − β) 2 σ[2][2],

Where n = sample size,

P < 0.05 was acceptable.

90% power was acceptable. Thus, Zα, = 1.96 (two-tailed) and Z1-β, = 1.2816.

The standard deviation, σ (based on the data in the published paper) was approximately 0.4. Thus, with an effect size (Δ) = 0.8.

The sample size for the present study was calculated to l be,

2 (10.51) (0.16)/0.64,

= 5.25.

Attrition rate of 20% was added, thus, a total of 21 participants were involved in this study.

Inclusion criteria

Apparently healthy individuals form the age of 18 years and above who were not actively engaged in sporting activities (not participated or currently participating in regular vigorous exercises or sporting activities of at least 60 min or more for three times weekly over the previous 6 months). Eligible participants were those with mild-to-moderate level of physical activities as measured with International Physical Activity Questionnaire (IPAQ) and those who were safe to carry out treadmill-based exercises.

Exclusion criteria

Participants with history of previous surgery to the spine and/or lower extremity and musculoskeletal conditions associated with pain and reduced mobility affecting the spine and/or extremities were excluded. Participants with Medical conditions that might affect the correct performance of the protocol of the exercises that was used in this study were excluded from the study.

Procedure

Ethical consideration

Ethical clearance was sought and obtained from the Research and Ethical Committee of National Orthopedic Hospital, Dala, Kano State (Ref: NOHD/RET/ETHIC/60) before the commencement of the study. Detail of what the study will require was written in the Participant's information sheet which was made available to all the participants. Participants were adults from 18 years that could comprehend English language and were given enough time to consult with their doctors and make informed decisions of their suitability to participate in the trial.

Preintervention assessment

The following preintervention assessment was carried on all the participants as follows:

Screening for inclusion criteria

Prior to randomization, prospective participants were screened for safety use of treadmill and for their level of physical activity

  1. Screening for safety to use treadmill exercises: Participants were screened for any cardiovascular abnormality such as elevated blood pressure and all acute musculoskeletal injuries or symptoms of physical limitations and cardiovascular complications that might affect the safety of carrying out treadmill based exercises using self-administered physical activity readiness questionnaire. Determination of safety with the use of treadmill with PAR-Q was carried out as described in the previous study[27]
  2. Screening for the physical activity level of the participants: Self-administered short form of IPAQ was used to determine participants' physical activity level. The scoring and the grading of participants physical activity level was as described by previous studies[28],[29],[30]
  3. Demographic variables: Data on the demographic variables of the participants such as age, gender history of recent injury to the spine and or extremities using researcher developed data collection form. Weight and height of the participants were measured using a bathroom weighing scale scale (Secca Germany) and a height meter (A Charder HM200P Portstad Portable Stadiometer (Charder Medical, Taiwan, ROC, 2007) to the nearest 0.1 kg and 0.1 m, respectively.


Randomization

Simple randomization procedure was followed by the use of computer-generated random number to determine the allocation sequence before the allocation of participants to the study group as described by.[20] The process of allocation concealment and the proper implementation of randomization was followed as alluded to by.[20],[21] Sequentially numbered Opaque, sealed envelopes, were used to achieve allocation concealment, of the groups randomized in the order of A (treadmill walk without abdominal bracing [TWWAB]), B (treadmill walking combined with abdominal bracing [TWAB]), and C (control).

The individuals that met eligibility criteria were randomized by an assistant who did not have the knowledge of treatment procedures in the Groups. The participants in Group A carried out TW without core muscle activation while the Participants in Group B carried out TW with core activation. Participants in Group C did not carry out any intervention. This group served as control.

Assessments and outcome measures

Trunk muscle endurance

The assessment of trunk muscle endurance was carried out with the use of McGill's Torso Muscular Endurance Test Battery by 2 experienced Researchers with postgraduate qualifications and more than 10 years' experience of assessment with McGill's Torso Muscular Endurance Test Battery. Interclass correlation coefficient ranging from 0.82 to 0.99 has been reported for the endurance test protocol of the McGill's Torso Muscular Endurance Test Battery.[24],[25] Detail of the trunk muscles endurance protocols is as described below:

  1. Trunk flexor endurance test


    • Purpose: The trunk flexor endurance test aimed to assess the muscular endurance of the deep core muscles, such as the transverse abdominis, and erector spinae. It is a timed test involving a static, isometric contraction of the spinal stabilizing muscles, which the individual maintains until they exhibit fatigue or can no longer hold the starting position
    • Starting point: The subjects start seated on an exercise mat placed on the floor with the hips and knees bent to 90°, with the hips, knees, and the second toe all aligned. Then the subject folds their arms across their chest, and they lean against a board positioned at a 60° incline, while the head maintains a neutral position. The feet may be anchored by a strap or manually
    • Procedure: The subjects were made to understand that they need to maintain this neutral spine position after the board is removed until they experience fatigue in the engaged abdominal muscles, or the back begins to arch, which leads to the termination of the test. The subject's goal is to maintain this position for as long as possible without the back-support assistance. A stopwatch was started when the board is removed, stopped when there is a noticeable change in the trunk or spinal position, and the final time was recorded


  2. Trunk lateral flexors endurance test


    • Purpose: This test involves static, isometric contractions of the lateral trunk muscles that stabilize the spine. The lateral trunk endurance test aimed to assess muscular endurance of the lateral core muscles such as the obliques, quadratus lumborum, and erector spinae muscles
    • Starting point: Subjects started in a position that requires them to lie on the floor on a mat on their side, extended legs, align the feet on top of each other or in a heel-to-toe position, the lower arm is placed under the body and the upper arm on the side of the body
    • Procedure: When the subject was ready, they assumed a full side-bridge position, keeping both legs extended, the sides of the feet on the floor, the elbow of the lower arm should be positioned directly under the shoulder with the forearm facing out, and the upper arm should be resting along the side of the body. The hips should be elevated off the mat and the body should be in straight alignment, and the body is only supported by the subject's feet and forearm. The goal of the test was to hold this position for as long as possible, with a stopwatch being started when the subject moves into the side-bridge position and terminated when this position is broken. This time was then recorded, and the test was also repeated on the opposite side following the same protocol


  3. Trunk extensor endurance test


    • Purpose: The test was used to assess the muscular endurance of the torso extensor muscles, such as the erector spinae, longissimus, and multifidi. Like its counterparts, this is a timed test involving a static, isometric contraction of the trunk extensor muscles that stabilize the spine
    • Starting point: Subject assumed the starting prone position, with the iliac crests at the front edge of the thigh pads of a tilt bed and the back of the ankles pressing firmly against the ankle pads, while supporting the upper body with the arms, which are placed on the available handles
    • Procedure: The subject's objective was to hold a horizontal, prone position for as long as possible, so when the subject is ready they lift their torso until it is parallel to the floor and in line with the legs, releases their grip on the handles, and crosses their arms over the chest. Once this position is assumed the stopwatch was started, but once they can no longer maintain this position the test was terminated, and time recorded.


Intervention

Exercise groups

Exercise intervention in this study was carried out by a researcher with more than 15 years' of clinical and research experience on the use of core muscles activation and TW exercises.

  • Group A: TWWAB


  • Participants in this group performed TW exercises using the Modified Bruce protocol ass described by.[22] 20 min per session, three times a week and for 6 weeks

  • Group B: TWAB


  • Participants in this group carryout abdominal bracing while walking on treadmill. The treadmill exercises using the Modified Bruce protocol as described in Group A above

    Prior walking on treadmill, participants were shown the location of the core stability muscles in as described by.[23] In crook lying position, they were trained on how to carry out abdominal bracing maneuver to activate core muscles as described by[24]

    Only those who are able to brace abdominal muscles effectively in crook lying, standing, and walking positions were allowed to progress to TW combined with abdominal bracing exercises

    Abdominal bracing for the activation of the core muscle was confirmed with palpation of the transversus abdominis muscles. Effective abdominal bracing for activation of core muscles in this study is described as the ability to achieve at least 40 mmHg deflection on the scale of pressure biofeedback unit (PBU) in crook lying position, sustained abdominal bracing for 10 s in 10 successive attempts[24],[25]

    Participants were asked to maintain abdominal bracing while walking on treadmill by very gently contract or tense the abdominal wall especially in the area below the belly button, keeping the inward curve in their lower back (avoid rounding their lower back), breathe normally throughout and not to hold their shoulders in elevated positions[26],[31]

  • Control group


    • Group C: The participants in this group did not carry out any intervention. However, any of the participants who indicated interest in carrying out any of the exercises were requested to present themselves after the completion of the study.


Blinding

Physiotherapist performing evaluation with the outcome measures was blinded to the participants' assigned intervention groups. The therapists' providing the intervention was blinded to pretreatment and posttreatment assessment scores before the analysis of the results.

Postintervention assessment

Trunk endurance scores were taken before and after six weeks of exercise protocols for group A and B, respectively, as well as those in Group C that served as Control.

Statistical analysis

The data analyses procedure was carried out using the SPSS 20th version software ((IBM Co., Armonk, NY, USA). Shapiro–Wilk test showed that all the data generated from the independent variables were normally distributed (P > 0.05). Means and standard deviation were used to summarize the data such as age, height, weight, and body mass index (BMI). Participants' gender was presented as frequency and percentage.

One-way analysis of variance (ANOVA) was used to analyze the difference in the trunk muscle endurance pre and postintervention. Paired t-test was used to analyze preintervention and postintervention differences in trunk endurance within the individual groups. The level of significance was set at 0.05.


  Results Top


Twenty one participants met the inclusion criteria and were randomized into the three groups of 2 interventions and a control, of 7 participants each. However, 18 participants completed the study and underwent post intervention assessments [Figure 1].
Figure 1: Participants' flow chart (n: Number of participants)

Click here to view


Demographic variables of the participants are presented in [Table 1]. The mean age of participants ranges from 23.6 (8.21) years in the control group to 32.16 (11.72) years in TWWAB group. The BMI average scores ranges from 22.08 (4.81) kg/m[2] in the control group to 25.48 (5.37) kg/m[2] in the TWAB group. Age, weight, and height did not show significant differences among the groups (P > 0.05).
Table 1: Participants' demographic variables

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The effect of TW with and without core muscle activation on holding time (endurance) for trunk flexors test is presented in [Table 2]. The trunk flexor endurance increased markedly in the 2 intervention groups. The post intervention means scores were 47.0 (16.29) s, 42.83 (7.19) s, and 46.16 (7.54) s for groups A B and C, respectively. One-way ANOVA did not show any significant difference in pre- and post-intervention scores of trunk flexor endurance among the participants (preintervention; F = 1.018, P = 0.385; post intervention: F = 1.292, P = 0.304). Comparison of trunk flexors endurance before and after intervention did not show significant difference in any of the group (P > 0.05).
Table 2: Effects of treadmill walking with and without core muscle activation on trunk flexors endurance

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The effect of TW with and without core muscle endurance on holding time for the right trunk lateral right flexors endurance test is presented in [Table 3].
Table 3: Effects of treadmill walking with and without core muscle activation on the endurance of the right trunk lateral flexors

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It shows that the mean preintervention scores for the right lateral flexors for Groups A, B, and C were 24.16 (9.94) s, 23.50 (10.96) s, and 29.16 (10.6) s, respectively. The postintervention means scores recorded for Groups A, B, and C were 39.50 (13.2) s, 43.50 (6.82) s, and 35.66 (2.6) s, respectively [Table 3]. One-way ANOVA did not show any significant difference in pre- and postintervention scores of trunk flexor endurance among the group (preintervention: F = 1.575, P = 0.239; postintervention: F = 0.832, P = 0.454).

Independent t-test showed a statistically significant increase in the right trunk flexors after 6 weeks of intervention only in the TW with core activation exercise group (t = −3.758, P = 0.013).

The effect of TW with and without core muscle activation on the endurance on of the left trunk lateral flexors is presented in [Table 4].
Table 4: Effects of treadmill walking with and without core muscle activation on the endurance of the left lateral flexors

Click here to view


It shows mean preintervention endurance scores of 29.50 (7.6) s, 28.50 (16.6) s, and 29.64 (6.79) s for Group A, B, and C, respectively. The post intervention means scores recorded was 37.33 (8.18) s, 38.33 (7.06) s, and 34.66 (7.99) s for Group A, B, and C, respectively.

One-way ANOVA did not show any significant difference in pre- and post-intervention scores of the trunk extensors endurance among the groups (preintervention: F = 0.792, P = 0.471; postintervention: F = 1.96, P = 1.75) (P > 0.05).

Independent t-test showed statistically significant increase in the left trunk flexors after 6 weeks of intervention only in the TW with core activation exercise group (t = −4.096, P = 0.009).

[Table 5] shows the effect of TW with and without core muscle activation on Trunk extensor muscle endurance.
Table 5: Effects of treadmill walking with and without core muscle activation on the endurance of trunk extensors

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Prior to intervention, trunk extensor endurance scores recorded were 37.16 (26.06) s, 38.50 ± 7.96 s, and 37.50 ± 12.98 s for Group A, B, and C, respectively. The postintervention means cores of 43.83 ± 38.19 s, 49.50 ± 33.53 s, and 45.50 ± 51.8 s were recorded for Groups A, B, and C respectively [Table 5]. One-way ANOVA did not show any significant difference in pre- and post-intervention scores of the trunk extensors endurance among the groups (preintervention: F = 1.98, P = 0.178; postintervention: F = 0.257, P = 0.777) (P > 0.05).

Independent t-test showed a statistically significant increase in the trunk extensor endurance score after 6 weeks of intervention only in the TW with core activation exercise group (t = −2.441, P = 0.005).


  Discussion Top


The objective of this study was to determine the effectiveness of TW with core muscle activation on the holding capacity of trunk muscles.

Findings from this study showed better effects in terms of improved holding capacity of trunk muscles in participants who underwent TW with core muscle activation than those in TW without core muscle activation and control.

It seems that there is a dearth of studies that had focused on the use of combining abdominal bracing with TW to facilitate core endurance or promote trunk muscle function, thus, limiting the comparison of the findings from this present study. Improved trunk muscle function through trunk holding capacity was considered as a strong influencer of spinal stability especially during functional movements as well as during the performance of physical activities.

The previous study carried out by Koumantakis et al.[32] on the effects of trunk muscle stabilization and general exercises showed that general exercise program reduced disability in the short term to a greater extent than a stabilization-enhanced exercise approach in patients with recurrent nonspecific LBP. The components of general exercises in their study did not include TW. However, the use of TW in the rehabilitation of patients with spinal dysfunction has been gaining popularity since endurance-related dysfunction in the form of reduced holding capacity of the back extensors[10],[11],[12] and delayed essential feed-forward postural responses of deep abdominal muscles in patients with LBP have been identified in literature.[14],[15],[16],[17]

The outcome of the present study is similar with that of a study conducted by Mia et al.,[33] who develop and validate core endurance intervention program and it implication on performance found improvement in core endurance holding times in both lateral flexors and trunk extensors though other exercises were performed to suit the preparation of the athletes indicating that their result could not be based on core activation alone and its effect on endurance.[29]

Other studies that have investigated combined effects of TW and trunk stabilization exercises. Both studies reported favorable outcome in terms of pain reduction and improvement in functions in postsurgical spinal patients with LBP.[34],[35] There are possibilities that the ongoing pain experience of the participants could have limiting factors on the normal muscular adaptation to endurance training of the participants in these studies functions. Thus, positive changes in these outcome measures might not be necessarily be interpreted to mean positive changes in spinal muscle functions contrary to previous studies involving chronic LBP in which changes in clinical variables were attributed to changes in muscle functions.[36],[37],[38] Thus, there is a need to assess the effects of these exercises in individuals without pain using physiological variables such as holding capacity (endurance), strength, flexibility of trunk muscles asides pain intensity, and functional disability as in the present study.

In some of the previous studies, participants underwent trunk muscle stabilization and TW one after the other.[34],[35],[39] In the present study, we theorized that optimization of trunk muscle performance could be achieved via simultaneous TW and abdominal bracing core muscle activation for the rehabilitation of spinal dysfunction and injury prevention.

Previous studies have demonstrated the importance of walking in fitness training and in alleviating spinal dysfunction for optimal performance, but there has not been a consensus on whether it is possible and demonstrable to carry out both exercises simultaneously and whether doing so will have more benefits than doing so in isolations.[3],[32],[40],[41] This lack of consensus might be connected to the fact that walking was perceived a means of improving physical activities alone without any effects on spinal segmental stability while core muscle activation was perceived to improve segmental spinal stability alone without any possible effects on trunk muscle endurance. However, findings from this present study indicating improved trunk endurance with both exercises carried out simultaneously could be used to argue that positive reinforcement may occur when both exercises are carried out simultaneously.

The benefit of core muscle activation in the form abdominal bracing on trunk endurance could be linked to improved pattern of activation, enhanced onset of activity in transversus and multifidus and decreased muscular fatigability[34] while the co-contraction of the abdominals and back extensors during TW will not only lead to increase strength and endurance of trunk muscle but will also produce increase segmental spinal stability.

This is a position that the outcome of this study has supported because there was a statistically significant difference in both lateral flexors and trunk extensor endurance in the group that performs TW with abdominal bracing core activation.

The present pilot study is limited in terms of the sample size. A larger sample size would enhance internal validity of the findings of this study and make it more generalizable. Human error could have risen from the use of clinical test as used in this study to measure trunk muscle endurance. Perhaps more valid instruments for monitoring sustained abdominal bracing such as electromyography (EMG) could have produced more valid results. EMG could not be employed for data collection in this study due to nonavailability and nonaffordability. The effects of the intervention as presented in this study could have been limited by the facts the final assessment was carried out after six weeks of intervention without the consideration to factor in the confounding variables of physical activity and exercise adherence as well as not having a group that carried out abdominal bracing alone to serve as control. Although the present study only serves as a pilot study.

Mid-intervention assessments, postintervention assessments and longer follow-up assessment will be useful to establish the short-term mid-term and long-term benefits of TW and core muscle activation in patients with spinal dysfunction and for injury prevention in healthy individuals. Prospective cohort Studies could be carried out to establish the possible preventive effects of LBP using a combination of TW and core muscle activation.


  Conclusion Top


It was thus concluded that trunk lateral flexors endurance and trunk extensor endurance could be facilitated for improved function using a combination of TW and core muscle activation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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