The Science
Building Unparalleled Musculoskeletal Health While Improving Balance And Reducing Fall Risk Factors
Our Program is based on a few key principles:
- Improving Bone Health through Osteogenic Loading and Static Contraction Training
- Reducing Fall Risk Factors via ongoing Balance Tests and custom Training Programs
- Coaching on all other Lifestyle Changes such as nutrition, diet, and environmental risk factors
Osteogenic Loading Is A Drug Free Way to Build Strong Bones
Osteogenic Loading Is To Bones, What Lifting Weights Is To Muscles!
Osteogenic loading is a method of stimulating new bone growth by applying brief yet high pressure loads to the bones, typically only achievable through specialized machines that can generate high forces, often at Multiples Of Bodyweight (MOB). This high load force signals bones’s building cells (osteoblasts) to increase bone mineral density, a process rooted in Wolff’s Law.
A good example is in Tennis Players. Tennis Players have denser bones on their dominant hitting forearm vs their non-dominant forearm from the impact load of hitting the ball. The opposite occurs in Astronauts who are in space for prolonged periods of time. They lose bone density and muscle mass due to the lack of gravity and load on bones. (Risk of Spaceflight-Induced Bone Changes – NASA)
Extending Your Functional Lifespan
This chart shows how Osteogenic Loading & Static Contraction Training can help build a stronger musculoskeletal foundation to help extend function through life. By starting a Bone Health Program early on you will build a higher Bone Mass which will help you in the long run as the average person starts to lose Bone Mass at a rate of 0.5% a year starting around the age of 30. At the age of 50 that number increases to 2% a year. By the age of 70 the rate of bone loss can continue especially for those that live sedentary lives, so starting a Bone Health Program early on is essential for longevity and maintaining your independence.
People who practice in weekly sessions can build stronger bones, muscle, and soft tissues. This helps to prevent musculoskeletal injuries while increasing overall strength for better mobility and reduces the risk of a Fall Fracture. Additionally, joint pain such as back pain and shoulder pain can be reduced and the side effect of all of this is an improvement in overall health
Simply put, Bone & Balance provides the opportunity to improve the quality of life as you age. More importantly it can help increase life expectancy and overall quality of life.
Scientific Principles & Clinical Research
Building Bone Density
Osteogenic loading is a rehabilitative method with a goal of improving bone density to prevent bone fractures. This can be seen as a brief, intensive resistance exercise for bone health. The basis of osteogenic loading stems from Wolff’s law, which shows that the force or loading on bone through its axis, can stimulate the bone’s natural function of increasing in density. Further study has shown that greater loads on bone can stimulate a greater effect of the body to respond and increase the density of bone, and can show immediate effects in the body via blood testing showing bone turnover markers. This high level of loading on bone would typically be seen in high-impact activity, which is not practical for therapy given the risk of injury potential. OL is an outpatient therapy that is typically used with ambulatory individuals who are able to engage in resistance exercise. Loading/exercise for bone density preservation and improvement is supported by bone health societies and organizations, including the International Osteoporosis Foundation, the National Osteoporosis Foundation, the National Osteoporosis Society of the United Kingdom, and the World Health Organization.
The Mechanostat Theory states that your bones have a built-in monitoring system that continuously measures the stress put on them. The theory is an extension of Wolff's Law which explains how bone adjusts its strength and shape to match the mechanical demands placed on it. In essence if you habitually place load your bones they get stronger. If they have long periods on non-load such as Astronauts in space you lose bone density.
Wolff's law, developed by the German anatomist and surgeon Julius Wolff (1836–1902) in the 19th century, states that bone in a healthy animal will adapt to the loads under which it is placed.[1] If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading.[2][3] The internal architecture of the trabeculae undergoes adaptive changes, followed by secondary changes to the external cortical portion of the bone,[4] perhaps becoming thicker as a result. The inverse is true as well: if the loading on a bone decreases, the bone will become less dense and weaker due to the lack of the stimulus required for continued remodeling.[5] This reduction in bone density (osteopenia) is known as stress shielding and can occur as a result of a hip replacement (or other prosthesis).[citation needed] The normal stress on a bone is shielded from that bone by being placed on a prosthetic implant.
Abstract
Objective:
To determine the efficacy of osteogenic loading (OL) specific therapy for bone mass density (BMD)
and musculoskeletal bone performance adaptations in both osteopenic and osteoporotic postmenopausal female
subjects.
Research design and methods: We randomly assigned from a single site patient pool 55 postmenopausal
patients to receive OL therapy consisting of axial bone loading through lower extremity and spinal erection kinetic
chains. The subjects selected (mean age of 69 (+/- 8.3 SD) years) were seen to have low BMD (T-Score of -1.0 or
lower) or were diagnosed with osteoporosis, but had not yet started any or had declined pharmacological
intervention. All subjects performed in a 24-week observational trial. The OL apparatus utilized isolates optimal
ranges of motion (i.e. ranges that humans reflexively assume to absorb impact in a fall) and had been previously
seen to increase BMD and functional loading in impact positions. The subjects were able to produce force/loading to
fatigue in the respective movements from baseline to post. We measured multiples-of-bodyweight (MOB) baselinepost, and randomly assigned a subgroup for baseline-post DXA scans.
Results:
The OL therapy intervention resulted in statistically significant increases in functional loading of bone
based on self-imposed loading to fatigue of 3.2 (+/-1.0 SD) MOB to 7.2 (+/-2.0 SD) MOB in hip/lower extremity
loading and 0.98 (+/-0.32 SD) MOB to 1.97 (+/-0.57 SD) MOB in the loading of the spine. A 131% and 126%
increase was recorded in musculoskeletal functional kinetic chain ability respectively. The DXA subgroup saw BMD
(g/cm2) increases of 14.9% (+/- 11.5% SD) in the hip, and 16.6% (+/- 12.2% SD) in the spine (p <0.01 in both
baseline-post dependant data sets).
Conclusions:
OL therapy as an adjunct to standard care, or as a preventative approach is both feasible and
effective for improving BMD for ambulatory individuals with below -1 T-scores. Further, the metrics of MOB force/
loading levels can be viewed as measures of functional bone performance (FBP); meaning that a metric showing
tolerable levels of force an individual can absorb into bone/kinetic chain relevant to protection against fracture during
the deceleration of a fall impact
David B Burr 1, A G Robling, C H Turner 2002 – Effects of Biomechanical Stress on Bones in Animals – Bone. 2002 May;30(5):781-6. doi: 10.1016/s8756-3282(02)00707-x.
Abstract: The signals that allow bone to adapt to its mechanical environment most likely involve strain-mediated fluid flow through the canalicular channels. Fluid can only be moved through bone by cyclic loading, and the shear stresses generated on bone cells are proportional to the rate of loading. The proportional relation between fluid shear stresses on cells and loading rate predicts that the magnitude of bone’s adaptive response to loading should be proportional to strain rate. For lower loading frequencies within the physiologic range, experimental evidence shows this is true. It is also true that the mechanical sensitivity of bone cells saturates quickly, and that a period of recovery either between loading cycles or between periods of exercise can optimize adaptive response. Together, these concepts suggest that short periods of exercise, with a 4-8 h rest period between them, are a more effective osteogenic stimulus than a single sustained session of exercise. The data also suggest that activities involving higher loading rates are more effective for increasing bone formation, even if the duration of the activity is short.
Click for more: David B Burr 1, A G Robling, C H Turner 2002 – Effects of Biomechanical Stress on Bones in Animals
A Ram Hong and Sang Wan Kim 2018 – Effects of Resistance on Bone Health – Endocrinol Metab (Seoul). 2018 Dec; 33(4): 435–444. Published online 2018 Nov 30. doi: 10.3803/EnM.2018.33.4.435
Abstract The prevalence of chronic diseases including osteoporosis and sarcopenia increases as the population ages. Osteoporosis and sarcopenia are commonly associated with genetics, mechanical factors, and hormonal factors and primarily associated with aging. Many older populations, particularly those with frailty, are likely to have concurrent osteoporosis and sarcopenia, further increasing their risk of disease-related complications. Because bones and muscles are closely interconnected by anatomy, metabolic profile, and chemical components, a diagnosis should be considered for both sarcopenia and osteoporosis, which may be treated with optimal therapeutic interventions eliciting pleiotropic effects on both bones and muscles. Exercise training has been recommended as a promising therapeutic strategy to encounter the loss of bone and muscle mass due to osteosarcopenia. To stimulate the osteogenic effects for bone mass accretion, bone tissues must be exposed to mechanical load exceeding those experienced during daily living activities. Of the several exercise training programs, resistance exercise (RE) is known to be highly beneficial for the preservation of bone and muscle mass. This review summarizes the mechanisms of RE for the preservation of bone and muscle mass and supports the clinical evidences for the use of RE as a therapeutic option in osteosarcopenia.
Click for more: A Ram Hong and Sang Wan Kim 2018 – Effects of Resistance on Bone Health
Tobias & Gould 2014 – Physical Activity and Bone: May The Force Be With You – Frontiers in Endrocrinology 03 Marcy 2014. doi: 103389/fendo.2014.00020
Abstract:
Physical activity (PA) is thought to play an important role in preventing bone loss and osteoporosis in older people. However, the type of activity that is most effective in this regard remains unclear. Objectively measured PA using accelerometers is an accurate method for studying relationships between PA and bone and other outcomes. We recently used this approach in the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine relationships between levels of vertical impacts associated with PA and hip bone mineral density (BMD). Interestingly, vertical impacts >4g, though rare, largely accounted for the relationship between habitual levels of PA and BMD in adolescents. However, in a subsequent pilot study where we used the same method to record PA levels in older people, no >4g impacts were observed. Therefore, to the extent that vertical impacts need to exceed a certain threshold in order to be bone protective, such a threshold is likely to be considerably lower in older people as compared with adolescents. Further studies aimed at identifying such a threshold in older people are planned, to provide a basis for selecting exercise regimes in older people which are most likely to be bone protective
Click for more: Tobias & Gould 2014 – Physical Activity and Bone: May The Force Be With You
Vainionpää & Korpelainen 2006 – Intensity of exercise is associated with bone density change in premenopausal women – Osteoporosis International volume 17, pages455–463(2006)
Abstract:
High-impact exercise is known to be beneficial for bones. However, the optimal amount of exercise is not known. The aim of the present study was to evaluate the association between the intensity of exercise and bone mineral density (BMD). We performed a 12-month population-based trial with 120 women (aged 35-40 years) randomly assigned to an exercise group or to a control group. The intensity of the physical activity of 64 women was assessed with an accelerometer-based body movement monitor. The daily activity was analyzed at five acceleration levels (0.3-1.0 g, 1.1-2.4 g, 2.5-3.8 g, 3.9-5.3 g, and 5.4-9.2 g). BMD was measured at the hip, spine (L1-L4), and radius by dual-energy x-ray absorptiometry. The calcaneus was measured using quantitative ultrasound. Physical activity that induced acceleration levels exceeding 3.9 g correlated positively with the BMD change in the hip area (p<0.05-0.001). L1 BMD change correlated positively with activity exceeding 5.4 g (p<0.05) and calcaneal speed of sound with the level of 1.1-2.4 g (p< 0.05). Baseline BMD was negatively associated with the BMD change at the hip. The intensity of exercise, measured as the acceleration level of physical activity, was significantly correlated with BMD changes. Bone stimulation is reached during normal physical exercise in healthy premenopausal women. In the hip area, the threshold level for improving BMD is less than 100 accelerations per day at levels exceeding 3.9 g.
Click for more: Vainionpää & Korpelainen 2006 – Intensity of exercise is associated with bone density change in premenopausal women
Kevin Deere ,1 Adrian Sayers 2012 – Habitual Levels of High, But Not Moderate or Low, Impact Activity Are Positively Related to Hip BMD and Geometry: Results From a Population-Based Study of Adolescents – Journal of Bone & Mineral Research, Vol 27, No 9, Sep 2012, pp1887-1895 doi: 10.1002./jbmr.1631
Abstract:
Whether a certain level of impact needs to be exceeded for physical activity (PA) to benefit bone accrual is currently unclear. To examine this question, we performed a cross-sectional analysis between PA and hip BMD in 724 adolescents (292 boys, mean 17.7 years) from the Avon Longitudinal Study of Parents and Children (ALSPAC), partitioning outputs from a Newtest accelerometer into six different impact bands. Counts within 2.1 to 3.1g, 3.1 to 4.2g, 4.2 to 5.1g, and >5.1g bands were positively related to femoral neck (FN) BMD, in boys and girls combined, in our minimally adjusted model including age, height, and sex (0.5–1.1g: beta ¼ 0.007, p ¼ 0.8; 1.1–2.1g: beta ¼ 0.003, p ¼ 0.9; 2.1–3.1g: beta ¼ 0.042, p ¼ 0.08; 3.1–4.2g: beta ¼ 0.058, p ¼ 0.009; 4.2–5.1g: beta ¼ 0.070, p ¼ 0.001; >5.1g: beta ¼ 0.080, p < 0.001) (beta ¼ SD change per doubling in activity). Similar positive relationships were observed between high-impact bands and BMD at other hip sites (ward’s triangle, total hip), hip structure indices derived by hip structural analysis of dual-energy X-ray absorptiometry (DXA) scans (FN width, cross-sectional area, cortical thickness), and predicted strength (cross-sectional moment of inertia). In analyses where adjacent bands were combined and then adjusted for other impacts, high impacts (>4.2g) were positively related to FN BMD, whereas, if anything, moderate (2.1–4.2g) and low impacts (0.5–2.1g) were inversely related (low: beta ¼ 0.052, p ¼ 0.2; medium: beta ¼ 0.058, p ¼ 0.2; high: beta ¼ 0.137, p < 0.001). Though slightly attenuated, the positive association between PA and FN BMD, confined to high impacts, was still observed after adjustment for fat mass, lean mass, and socioeconomic position (high: beta ¼ 0.096, p ¼ 0.016). These results suggest that PA associated with impacts >4.2g, such as jumping and running (which further studies suggested requires speeds >10 km/h) is positively related to hip BMD and structure in adolescents, whereas moderate impact activity (eg, jogging) is of little benefit. Hence, PA may only strengthen lower limb bones in adolescents, and possibly adults, if this comprises high-impact activity.
Effects of high-impact exercise on bone mineral density: a randomized controlled trial in premenopausal women – Aki Vainionpa & Raija Korpelainen 2004 – Osteoporos Int . 2005 Feb;16(2):191-7. doi: 10.1007/s00198-004-1659-5. Epub 2004 Jun 17.
Abstract:
The purpose of this randomized controlled study was to assess the effects of high-impact exercise on the bone mineral density (BMD) of premenopausal women at the population level. Materials and methods: The study population consisted of a random population-based sample of 120 women from a cohort of 5,161 women, aged 35 to 40 years. They were randomly assigned to either an exercise or control group. The exercise regimen consisted of supervised, progressive high-impact exercises three times per week and an additional home program for 12 months. BMD was measured on the lumbar spine (L1–L4), proximal femur, and distal forearm, by dual-energy X-ray absorptiometry at baseline and after 12 months. Calcaneal bone was measured using quantitative ultrasound. Results: Thirty-nine women (65%) in the exercise group and 41 women (68%) in the control group completed the study. The exercise group demonstrated significant change compared with the control group in femoral neck BMD (1.1% vs −0.4%; p=0.003), intertrochanteric BMD (0.8% vs −0.2%; p=0.029), and total femoral BMD (0.1% vs −0.3%; p=0.006). No exercise-induced effects were found in the total lumbar BMD or in the lumbar vertebrae L2–L4. Instead, L1 BMD (2.2% vs −0.4%; p=0.002) increased significantly more in the exercise group than in the control group. Calcaneal broadband ultrasound attenuation showed also a significant change in the exercise group compared with the control group (7.3% vs −0.6%; p=0.015). The changes were also significant within the exercise group, but not within the control group. There were no significant differences between or within the groups in the distal forearm. Conclusions: This study indicates that high-impact exercise is effective in improving bone mineral density in the lumbar spine and upper femur in premenopausal women, and the results of the study may be generalized at the population level. This type of training may be an efficient, safe, and inexpensive way to prevent osteoporosis later in life.
Stronger Joints & Less Pain
Davis's law is used in anatomy and physiology to describe how soft tissue models along imposed demands. It is similar to Wolff's law, which applies to osseous tissue. It is a physiological principle stating that soft tissue heal according to the manner in which they are mechanically stressed.[1]
It is also an application of the Mechanostat model of Harold Frost which was originally developed to describe the adaptational response of bones; however – as outlined by Harold Frost himself – it also applies to fibrous collagenous connective tissues, such as ligaments, tendons and fascia.[2][3] The "stretch-hypertrophy rule" of that model states: "Intermittent stretch causes collagenous tissues to hypertrophy until the resulting increase in strength reduces elongation in tension to some minimum level".[4] Similar to the behavior of bony tissues this adaptational response occurs only if the mechanical strain exceeds a certain threshold value. Harold Frost proposed that for dense collagenous connective tissues the related threshold values are around 23 Newton/mm2 or 4% strain elongation.[5]
Abstract
The present study aimed to investigate the effect of isometric training on the elasticity of human tendon structures. Eight subjects completed 12 wk (4 days/wk) of isometric training that consisted of unilateral knee extension at 70% of maximal voluntary contraction (MVC) for 20 s per set (4 sets/day). Before and after training, the elongation of the tendon structures in the vastus lateralis muscle was directly measured using ultrasonography while the subjects performed ramp isometric knee extension up to MVC. The relationship between the estimated muscle force and tendon elongation (L) was fitted to a linear regression, the slope of which was defined as stiffness of the tendon structures. The training increased significantly the volume (7.6±4.3%) and MVC torque (33.9±14.4%) of quadriceps femoris muscle. The L values at force production levels beyond 550 N were significantly shorter after training. The stiffness increased significantly from 67.5±21.3 to 106.2±33.4 N/mm. Furthermore, the training significantly increased the rate of torque development (35.8 ± 20.4%) and decreased electromechanical delay (−18.4±3.8%). Thus the present results indicate that isometric training increases the stiffness and Young's modulus of human tendon structures as well as muscle strength and size. This change in the tendon structures would be assumed to be an advantage for increasing the rate of torque development and shortening the electromechanical delay.
Abstract
Introduction
Osteoarthritis (OA) is the most common form of arthritic disease of the joint worldwide, with the knee joint being the most affected in the body. This study investigated the effects of isometric strengthening exercises on pain and disability among patients with knee osteoarthritis.
Methods
This randomized control trial research design was carried out at the Physiotherapy Departments of Nnamdi Azikiwe University Teaching Hospital, Nnewi, and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka in Anambra State, Nigeria. A total of 40 subjects, nine (22.5%) males and 31 (75.5%) females, were randomly assigned into exercise and control groups. Prior to intervention, the weight and height of each subject were measured. Pain intensity, active range of motion (AROM) and passive range of motion (PROM), and functional ability of both groups were recorded using the Numerical Pain Rating Scale (NPRS), universal goniometer, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. All participants in the exercise group performed isometric quadriceps and straight leg raise exercises, and the control group received no intervention whatsoever. After six weeks, the pain intensity, AROM, PROM, and functional ability scores were re-measured and documented.
Results
While comparing the pre-test and post-test scores using paired t-test, the exercise group showed a significant difference in each parameter (NPRS, AROM, PROM, and WOMAC = 0.000), while the control group showed no significant difference. Independent sample t-test outcome at six weeks (exercise and control groups) showed significant reduction of pain intensity (NPRS = 0.000), increased range of motion (AROM = 0.000, PROM = 0.003), as well as improvement in function (WOMAC = 0.000) at a significant level of p ˂ 0.05.
Conclusion
At the end of the six weeks, isometric strengthening exercises showed a significant effect on pain intensity, range of motion, and functional ability among subjects with knee osteoarthritis.
Abstract
Background Few interventions reduce patellar tendinopathy (PT) pain in the short term. Eccentric exercises are painful and have limited effectiveness during the competitive season. Isometric and isotonic muscle contractions may have an immediate effect on PT pain.
Methods This single-blinded, randomised cross-over study compared immediate and 45 min effects following a bout of isometric and isotonic muscle contractions. Outcome measures were PT pain during the single-leg decline squat (SLDS, 0–10), quadriceps strength on maximal voluntary isometric contraction (MVIC), and measures of corticospinal excitability and inhibition. Data were analysed using a split-plot in time-repeated measures analysis of variance (ANOVA).
Results 6 volleyball players with PT participated. Condition effects were detected with greater pain relief immediately from isometric contractions: isometric contractions reduced SLDS (mean±SD) from 7.0±2.04 to 0.17±0.41, and isotonic contractions reduced SLDS (mean±SD) from 6.33±2.80 to 3.75±3.28 (p<0.001). Isometric contractions released cortical inhibition (ratio mean±SD) from 27.53%±8.30 to 54.95%±5.47, but isotonic contractions had no significant effect on inhibition (pre 30.26±3.89, post 31.92±4.67; p=0.004). Condition by time analysis showed pain reduction was sustained at 45 min postisometric but not isotonic condition (p<0.001). The mean reduction in pain scores postisometric was 6.8/10 compared with 2.6/10 postisotonic. MVIC increased significantly following the isometric condition by 18.7±7.8%, and was significantly higher than baseline (p<0.001) and isotonic condition (p<0.001), and at 45 min (p<0.001).
Conclusions A single resistance training bout of isometric contractions reduced tendon pain immediately for at least 45 min postintervention and increased MVIC. The reduction in pain was paralleled by a reduction in cortical inhibition, providing insight into potential mechanisms. Isometric contractions can be completed without pain for people with PT. The clinical implications are that isometric muscle contractions may be used to reduce pain in people with PT without a reduction in muscle strength.
Lower Back Pain & Isometrics
Abstract
The purpose of the present study is to evaluate the effects of isometric exercise types on low back pain (LBP) patients. Isometric exercise types were mat exercise and I-Zer exercise. Subjects were divided into 3 groups: LBP control group, LBP mat exercise group, and LBP I-Zer exercise group in 23–25 aged men. Visual analogue scale (VAS) and electromyography (EMG) were used to evaluate the degree of pain and the muscle activity in LBP patients. Root mean square (RMS), median frequency (MDF), and mean frequency (MNF) were checked by EMG power spectrum analysis on longissimus thoracic (LT), iliocostalis lumborum (IL), mulitifidus (M), and rectus abdominis (RA). LBP mat exercise program and LBP I-Zer exercise program were conducted 5 sets once time, 3 times per week during 6 weeks. The two-way ANOVA with repeated measure was used to check the pain degree and muscle activity. The present results showed that muscle activity in the LBP I-Zer exercise group was increased compared to the LBP mat exercise group and LBP control group (P<0.05). LBP I-Zer exercise group and LBP mat exercise group showed increased mean frequency in LT, IL, M, and RA muscles than the LBP control group. Therefore, LBP patients performed isometric exercise may have positive effect to reduce pain degree and to increase muscle activity. Especially, LBP I-Zer exercise type showed more effectiveness in reducing pain degree and enhancing muscle activity.
LINK
Abstract
The study's goal was to determine the impact of isometric back endurance exercises on pain, function and trunk extensor muscles endurance. Methods: Total 60 male patients of ranging in age between 20 to 40 years ago were afflicted with chronic nonspecificlow back pain were divided into two groups, each with an equal number of participants, group A (experimental group) and group B (control group). Prior to the intervention, each subject's VAS, modified Oswestry disability index, and Biering Sorensen test scores were recorded. After that, both sets of participants got a 15-minute hot pack treatment. And then Isometric back endurance exercises were given to group A, as well as conventional exercises (stretching and strengthening exercises), and group B received conventional exercises (stretching and strengthening exercises only) 3 times each week for consecutively 6 weeks. The values of VAS, modified Oswestry disability index, and BieringSorensen test were again measured at the end of 6 weeks. Results: When the baseline values of both groups were compared, it was discovered that a highly significant improvement in pain, function and endurance in group A more than group B. Conclusion: In individuals with chronic low back pain, isometric back endurance exercises were found to be beneficial in decreasing pain and disability while also increasing back extensor endurance.
Isometric Loading For Performance
Abstract
This review used a narrative summary of findings from studies that focused on isometric strength training (IST), covering the training considerations that affect strength adaptations and its effects on sports related dynamic performances. IST has been shown to induce less fatigue and resulted in superior joint angle specific strength than dynamic strength training, and benefited sports related dynamic performances such as running, jumping and cycling. IST may be included into athletes' training regime to avoid getting overly fatigue while still acquiring positive neuromuscular adaptations; to improve the strength at a biomechanically disadvantaged joint position of a specific movement; to improve sports specific movements that require mainly isometric contraction; and when athletes have limited mobility due to injuries. To increase muscle hypertrophy, IST should be performed at 70-75% of maximum voluntary contraction (MVC) with sustained contraction of 3-30 s per repetition, and total contraction duration of>80-150 s per session for>36 sessions. To increase maximum strength, IST should be performed at 80-100% MVC with sustained contraction of 1-5 s, and total contraction time of 30-90 s per session, while adopting multiple joint angles or targeted joint angle. Performing IST in a ballistic manner can maximize the improvement of rate of force development.
Abstract
Isometric training is used in the rehabilitation and physical preparation of athletes, special populations, and the general public. However, little consensus exists regarding training guidelines for a variety of desired outcomes. Understanding the adaptive response to specific loading parameters would be of benefit to practitioners. The objective of this systematic review, therefore, was to detail the medium- to long-term adaptations of different types of isometric training on morphological, neurological, and performance variables. Exploration of the relevant subject matter was performed through MEDLINE, PubMed, SPORTDiscus, and CINAHL databases. English, full-text, peer-reviewed journal articles and unpublished doctoral dissertations investigating medium- to long-term (≥3 weeks) adaptations to isometric training in humans were identified. These studies were evaluated further for methodological quality. Twenty-six research outputs were reviewed. Isometric training at longer muscle lengths (0.86%-1.69%/week, ES = 0.03-0.09/week) produced greater muscular hypertrophy when compared to equal volumes of shorter muscle length training (0.08%-0.83%/week, ES = -0.003 to 0.07/week). Ballistic intent resulted in greater neuromuscular activation (1.04%-10.5%/week, ES = 0.02-0.31/week vs 1.64%-5.53%/week, ES = 0.03-0.20/week) and rapid force production (1.2%-13.4%/week, ES = 0.05-0.61/week vs 1.01%-8.13%/week, ES = 0.06-0.22/week). Substantial improvements in muscular hypertrophy and maximal force production were reported regardless of training intensity. High-intensity (≥70%) contractions are required for improving tendon structure and function. Additionally, long muscle length training results in greater transference to dynamic performance. Despite relatively few studies meeting the inclusion criteria, this review provides practitioners with insight into which isometric training variables (eg, joint angle, intensity, intent) to manipulate to achieve desired morphological and neuromuscular adaptations.
Abstract
Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.
Isometric Loading For Blood Pressure
In a large study published in the British Journal of Sports Medicine, researchers examined the recommendations for exercise to help lower blood pressure, which relied on older research that stressed aerobic or cardio exercises like cycling or running. The study also looked at the effects on blood pressure from high-intensity interval training, or HIIT, and isometric exercise.
The authors defined healthy resting blood pressure as below 130/85 mm Hg and high blood pressure as 140/90 mm Hg.
The study authors reviewed 270 trials with 15,827 participants between 1990 and 2023, and compared the results for isometric, HIIT, aerobic exercise, dynamic resistance training and a combination of the last two forms of exercise. Their findings were that isometric exercise led to the most significant reductions in systolic and diastolic blood pressure.
Abstract
More than 30 randomized controlled trials, supported by individual patient-level and group-level meta-analyses and a Delphi analysis of expert opinion, unequivocally show isometric resistance training (IRT) elicits antihypertensive benefits in healthy people and those with chronic illness. We aim to provide efficacy and safety evidence, and a guide for IRT prescription and delivery. Recommendations are made for the use of IRT in specific patient populations and appropriate methods for IRT delivery. Published data suggest IRT consistently elicits mean blood pressure reductions of 7.4/3.3 mmHg systolic blood pressure/diastolic blood pressure, equivalent to antihypertensive medication monotherapy. Blood pressure reductions of this size are associated with an approximate 13% to 22% reduction in major cardiovascular events. Moreover, IRT is safe in a range of patient populations. We suggest that IRT has the greatest potential benefit when used as an antihypertensive therapy in individuals unwilling and/or unable to complete aerobic exercise, or who have had limited adherence or success with it; individuals with resistant or uncontrolled hypertension, already taking at least two pharmacological antihypertensive agents; and healthy or clinical populations, as an adjunct to aerobic exercise and dietary intervention in those who have not yet attained control of their hypertension. IRT is efficacious and produces clinically meaningful blood pressure reductions (systolic blood pressure, 7 mmHg; diastolic blood pressure, 3 mmHg). IRT is safe and typical program delivery requires only about 17 min weekly. IRT should be used as an adjunct to other exercise modalities, in people unable to complete other types of exercise, or in resistant hypertension.
Abstract
Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.
ABSTRACT
Purpose: This study examined the effects of isometric handgrip training on resting arterial blood pressure, heart rate variability, and blood pressure variability in older adults with hypertension. Methods: Nine subjects performed four 2-min isometric handgrip contractions at 30% of the maximum voluntary contraction force, 3 d·wk1 for 10 wk, and eight subjects served as controls. Results: After training, there was a significant reduction in resting systolic pressure and mean arterial pressure. In addition, power spectral analysis of heart rate variability demonstrated that the low frequency: high frequency area ratio tended to decrease. Conclusions: It is concluded that isometric training at a moderate intensity elicits a hypotensive response and a simultaneous increase in vagal modulation in older adults with hypertension