The majority are not performing home-exercises correctly two weeks after their initial instruction—an assessor-blinded study

Abstract

Introduction. Time-under-tension (TUT) reflects time under load during strength training and is a proxy of the total exercise dose during strength training. The purpose of this study was to investigate if young participants are able to reproduce TUT and exercise form after two weeks of unsupervised exercises.Material and Methods. The study was an assessor-blinded intervention study with 29 participants. After an initial instruction, all participants were instructed to perform two weeks of home-based unsupervised shoulder abduction exercises three times per week with an elastic exercise band. The participants were instructed in performing an exercise with a predefined TUT (3 s concentric; 2 s isometric; 3 s eccentric; 2 s break) corresponding to a total of 240 s of TUT during three sets of 10 repetitions. After completing two weeks of unsupervised home exercises, they returned for a follow-up assessment of TUT and exercise form while performing the shoulder abduction exercise. A stretch sensor attached to the elastic band was used to measure TUT at baseline and follow-up. A physiotherapist used a pre-defined clinical observation protocol to determine if participants used the correct exercise form.Results. Fourteen of the 29 participants trained with the instructed TUT at follow-up (predefined target: 240 s ±8%). Thirteen of the 29 participants performed the shoulder abduction exercise with a correct exercise form. Seven of the 29 participants trained with the instructed TUT and exercise form at follow-up.Conclusion. The majority of participants did not use the instructed TUT and exercise form at follow-up after two weeks of unsupervised exercises. These findings emphasize the importance of clear and specific home exercise instructions if participants are to follow the given exercise prescription regarding TUT and exercise form as too many or too few exercise stimuli in relation to the initially prescribed amount of exercise most likely will provide a misinterpretation of the actual effect of any given specific home exercise intervention.

Diagnosis and treatment of anterior knee pain

“…Wang et al 55 found that optimising the vastus medialis (VM) size was critical to reducing osteoarthritic progression and decreasing the need for a total knee replacement. Recent evidence of the long-term outcome of treatment for adolescents with AKP, who are supposedly compliant with a multimodal exercise programme, is fairly poor, although the same authors found that the majority of adolescents did not perform the home exercises correctly 2 weeks after their initial instruction 56. It is hypothesised that the adolescents whose symptoms fail to improve will develop PFOA 57.…”

Prevention and rehabilitation of paediatric anterior cruciate ligament injuries

“…Treatment decisions are based on the functional knee stability measured through functional performance tests and the child's experience in their desired activities. There is substantial support in the literature that rehabilitation should be supervised [13], and performed exhaustively before a decision on further treatment is made for an ACL injured patient [39,45]. Preoperative rehabilitation is beneficial because it increases the likelihood of a successful outcome after ACL reconstruction -and is in many cases effective in restoring functional knee stability to a level that eliminates the need for a surgical ACL reconstruction [15,25,69].…”

Peer Review #1 of "Monitoring the training dose and acute fatigue response during elbow flexor resistance training using a custom-made resistance band (v0.1)"

“…After the physiotherapist provides the patient with initial instructions on how to perform the exercise, home-based trainees need to complete the entire training program on their own. Without the supervision of a therapist or help of an exercise monitoring system, and considering that the training is a long process that lasts weeks or months, one of the biggest challenges in home-based resistance training is that subjects do not follow their exercise prescription [9,10,11]. In particular, it has been shown that patients perform the exercises either too fast or too slow, resulting in too short or too long contraction time with too few or too many repetitions [12].…”

“…In particular, it has been shown that patients perform the exercises either too fast or too slow, resulting in too short or too long contraction time with too few or too many repetitions [12]. A study of 29 participants performing shoulder abduction exercises demonstrated that, at follow-up after two weeks of unsupervised home-based exercises, less than 25% of the participants followed the instructions for time-under-tension (TUT) and performed correctly the exercise [10]. The main concern for patients not receiving the prescribed exercise dosage is that decisions on further progression or cessation of a specific program are difficult.…”

“…Few studies have discussed how to segment sensor data based on muscle actions. Rathleff et al developed a custom-written MATLAB program to segment stretch-sensor data into concentric (CON), quasi-isometric, and ECC phases and calculated the TUT of each contraction phase [10,20]. However, it should be noted that in their program, the assessor who rated the data needed to manually select the start and end points of each contraction phase, which led to program inefficiency.…”