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Reliability and Agreement of the 10-Repetition Maximum Test in Breast Cancer Survivors


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The aim of this study was to evaluate the reliability and agreement between the test and retest of the 10-repetition maximum (10-RM) test for leg press and bench press in breast cancer survivors (BCS). Thirty-one BCS participated in this study, age 54.87 ± 5.7 years. All performed 10-RM tests and retests for the leg press 45° and the bench press. For reliability analyses, an intraclass coefficient correlation (ICC) and coefficient of variation (CV) were performed. The limits of agreement were calculated using a Bland-Altman plot with 95% CIs. For absolute and relative error of measurement, we used standard error of measurement and minimally detectable change. The result showed a high reliability for the bench press and leg press; ICC of 0.94 and 0.98, respectively. CV was <10% for both exercises. The systematic error were 1.5 kg (10%) and 6.1 (8%) for the bench press and leg press, respectively. The standard errors of measurements were 0.96 kg (6.08%) and 4.11 kg (5.27%) for the bench press and leg press, respectively. The minimally detectable changes were 2.72 kg (17.20%) and 5.62 kg (7.21%) for the bench press and leg press, respectively. In breast cancer survivors, the muscular strength measurement for the 10-RM test showed a high to very high rate of reliability and agreement, with acceptable error of measurement.
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published: 26 September 2019
doi: 10.3389/fonc.2019.00918
Frontiers in Oncology | 1September 2019 | Volume 9 | Article 918
Edited by:
Jisun Kim,
University of Ulsan, South Korea
Reviewed by:
Justin Y. Jeon,
Yonsei University, South Korea
Won Kim,
University of Ulsan, South Korea
Carlos Alexandre Vieira
Specialty section:
This article was submitted to
Women’s Cancer,
a section of the journal
Frontiers in Oncology
Received: 26 June 2019
Accepted: 03 September 2019
Published: 26 September 2019
Santos WDNd, Siqueira GDdJ,
Martins WR, Vieira A, Schincaglia RM,
Gentil P and Vieira CA (2019)
Reliability and Agreement of the
10-Repetition Maximum Test in Breast
Cancer Survivors. Front. Oncol. 9:918.
doi: 10.3389/fonc.2019.00918
Reliability and Agreement of the
10-Repetition Maximum Test in
Breast Cancer Survivors
Wanderson Divino Nilo dos Santos 1, Gabriel Dutra de Jesus Siqueira 1,
Wagner Rodrigues Martins 2, Amilton Vieira 2, Raquel Machado Schincaglia 3, Paulo Gentil 1
and Carlos Alexandre Vieira 1
1College of Physical Education and Dance, Federal University of Goias - UFG, Goiânia, Brazil, 2College of Physical
Education, University of Brasilia - UnB, Brasilia, Brazil, 3College of Nutrition, Federal University of Goias - UFG, Goiânia, Brazil
The aim of this study was to evaluate the reliability and agreement between the test and
retest of the 10-repetition maximum (10-RM) test for leg press and bench press in breast
cancer survivors (BCS). Thirty-one BCS participated in this study, age 54.87 ±5.7 years.
All performed 10-RM tests and retests for the leg press 45and the bench press. For
reliability analyses, an intraclass coefficient correlation (ICC) and coefficient of variation
(CV) were performed. The limits of agreement were calculated using a Bland-Altman plot
with 95% CIs. For absolute and relative error of measurement, we used standard error of
measurement and minimally detectable change. The result showed a high reliability for
the bench press and leg press; ICC of 0.94 and 0.98, respectively. CV was <10% for
both exercises. The systematic error were 1.5 kg (10%) and 6.1 (8%) for the bench press
and leg press, respectively. The standard errors of measurements were 0.96 kg (6.08%)
and 4.11 kg (5.27%) for the bench press and leg press, respectively. The minimally
detectable changes were 2.72 kg (17.20%) and 5.62 kg (7.21%) for the bench press and
leg press, respectively. In breast cancer survivors, the muscular strength measurement
for the 10-RM test showed a high to very high rate of reliability and agreement, with
acceptable error of measurement.
Keywords: muscle strength, muscular measurement, strength training, resistance training, cancer
The assessment of muscle strength has been used to monitor and prescribe strength training (1).
Muscular strength has been associated with high level of functional capacity and to decrease the risk
of death from all natural causes (2,3). The evaluation of muscle strength in breast cancer survivors
(BCS) is a significant issue, because breast cancer (BC) treatment could reduce muscle strength
after surgery and it may persist over the long-term (4). Therefore, in rehabilitation settings, the
assessment of muscular strength is an important strategy to guide exercise prescription in these
patients (5,6).
Muscular strength loss in BCS is one of the side effects of BC treatment (surgery, chemotherapy,
and radiotherapy), that could be explained by multiple factors such as: fatigue; lymphedema;
decreased in shoulder, elbow, and wrist mobility; pain in the shoulder joint; and psychological
changes such as kinesiophobia (713). These conditions could interfere with the reliability of
maximum force tests and the strength outcomes during resistance training (14). In addition, these
side effects of BC treatment pose a challenge for health professionals who work with resistance
training for BC patients or survivors.
Santos et al. Reliability and Agreement of the 10-Repetition Maximum Test
The one-repetition maximum test (1-RM) is considered the
“gold standard” to measure maximum muscle strength in a non-
laboratory setting. The 1-RM test is safe and has been applied in
studies with BCS and BC patients (1517). However, there is a
lack of data regarding the reliability of this measurement within
this population. To our knowledge, a single study presented only
the coefficient of variation (CV) data for the bench press and leg
press (18). Moreover, the 1-RM receive some criticism during a
rehabilitation scenario such as risk of injury (19).
As an alternative to the 1-RM test, some studies with BCS used
predictive formulas according to the results of multiple repetition
tests (5-10RM) to estimate the maximum strength by 1-RM (20
23). Another method to estimate dynamic muscle strength is the
repetition maximum test based on a goal of repetitions, as in
the 10-RM test. The 10-RM test has been used to evaluate the
load achieved in resistance training (RT) in different populations
(2430). Therefore, taking into consideration the characteristics
of BCS, it seems that there is a natural concern with muscular
strength tests for upper limbs, and maybe that could interfere
on reliability of measurement. For this reason, it is possible that
muscular strength for lower limbs could be more reliable than
upper limbs. In addition, there is little information on the data of
reliability and agreement of muscular strength tests in BCS, thus
the performance of reliability studies is necessary.
The objective of this study was therefore to evaluate the
reliability and agreement between the test and retest of the 10-
RM test in upper and lower limbs in BCS. Our hypothesis was
that the 10-RM test is reliable, and that the reliability is higher for
the lower limbs.
Design and Participants
In this reliability and agreement study, 31 BCS were included
between February and October 2017. The BCS were contacted
via phone calls and face-to-face interactions at the Mastology and
Oncology Ambulatory of the University Hospital of the Federal
University of Goias, Brazil. The eligibility criteria were: (1)
confirmed BC stages I to III; (2) between 40 and 65 years old; (3)
being in menopause (31); (4) not involved in any regular exercise
program for the last 6 months; (5) completed cancer-related
therapies including surgery, chemotherapy and/or radiotherapy
at least 6 months prior to enrolling; (6) currently undergoing
hormone therapy (tamoxifen or aromatase inhibitor); (7)
received medical clearance for exercise training. Patients were
excluded from the study if they had musculoskeletal limitations
that could compromise exercise performance and/or any
uncontrolled chronic disease that could represent a risk to
their health.
The study was approved by Research Ethics Committee of the
Federal University of Goias (CAAE: 50717115.4.0000.5083), and
by the Research Ethics Committee of the Clinical Hospital of the
Federal University of Goias (CAAE: 50717115.4.3001.5078). All
participants provided written consent.
After a measure of body composition, the participants answered
medical history and sociodemographic questionnaire and the
FIGURE 1 | Experimental design. IPAQ, International Physical Activity
Questionnaire; 10-RM, 10-repetition maximum.
International Physical Activity Questionnaire (IPAQ—short
version) (32). They then performed the 10-RM test at 2 different
days within 2– 4 days in between. At day 1, the participants were
familiarized with Leg press 45and Bench press exercises and
then performed the 10-RM test (Figure 1).
Anthropometry and Body Composition Assessments
Body mass index (BMI) was calculated based on body mass
and height [BMI =weight (kg)/height squared (m2)]. Fat and
lean mass were assessed using dual energy X-ray absorptiometry
(DXA) (General Electric Healthcare R
model, Madison, WI,
USA). Data were analyzed using GE Medical Systems LunarTM
software. A professional technician performed the assessments
of DXADuring the DXA, participants remained in a supine
position with their lower limbs relaxed, and the upper limbs were
positioned along the body with forearms pronated. DXAs were
calibrated and tested as recommended by the manufacturer. After
analysis of the entire body area, the total body mass, lean body
mass and fat mass were registered.
Ten Repetition Maximum Test
The 10-RM test and retests were performed by the leg press 45
(Rocha, Leg Press 45, Goias, Brazil) and bench press exercises
with free-weight, plate-loaded (Supplementary Material). Both
exercises techniques followed the recommendation from the
National Strength and Conditioning Association (NSCA) (33).
During the 10-RM test and retest, the participants were
informed and supervised by two experienced exercise science
professionals. The same exercise science professionals supervised
the measurements. The participants had three to five 10-RM
attempts for each exercise.
The warm-up consisted of one set of 10 repetitions with 50%
of the estimated 10-RM load, by rating of perceived exertion 5–6
(0–10) in the first day. For leg press, the warm-up represented
30–40% of their body mass. For bench press, we chose to
use only the weight of the barbell (the barbell weighted 6 kg)
to perfume the warm-up on the first day. The load used to
Frontiers in Oncology | 2September 2019 | Volume 9 | Article 918
Santos et al. Reliability and Agreement of the 10-Repetition Maximum Test
perform the warm-up during the 10-RM retest was based on the
maximum load achieved on the first day (10-RM test).
The 10-RM load was determined if they were able to complete
the 10th repetition but not be able to perform the 11th
repetition. If the volunteer were able to performed more than
10 repetitions, the load was increased by 5–10%. The resting
interval between each attempt was 3 min, and the resting inter val
between exercises was 5 min. The cadence was not controlled,
but participants were oriented to perform the concentric phase
as fast as possible but control the eccentric phase. Leg press 45
was performed first, followed by the bench press. All participants
performed the bench press until touching the barbell on the
sternum/breast. The 10-RM retest was performed 3–4 days later,
using the maximum load achieved on the 10-RM test as reference
to perform the first attempt (34).
Statistical Analyses
Descriptive statistics were presented as mean and standard
deviation (SD). The intraclass coefficient correlation (ICC) and
coefficient of variation (CV =SD divided by mean of test and
retest ×100) was used for evaluation of reliability (35). The ICC
form used was a two-way mixed effect, mean of k measurements
and consistency agreement (36). The ICC and CV are present
as mean and 95% of confidential interval (CI). The analyses
of measurement error, absolute and relative, of the 10-RM test
and retest was also investigated using the standard error of
measurement [(SEM); SEM absolute =SD of the mean test-retest
score divided by the square root of 1—ICC; SEM relative =SEM
absolute score divided by mean test-retest scores and multiplying
by 100] and minimally detectable change [(MDC); MDC absolute
=1.96 ×the square root of 2 ×SEM; MDC relative =
MDC absolute score divided by mean of test-retest scores and
multiplying by 100] (37). In addition, the limits of agreement
were calculated using a Bland–Altman plot with 95% CIs (38).
The Munro’s classification of reliability was used to interpret the
ICC coefficients: 0.50–0.69 reflects moderate correlation; 0.70–
0.89 reflects high correlation; and 0.90–1.00 indicates very high
correlation. Statistical analyses were performed using MedCalc
Software (version 18.11.6) and Statistical Package for the Social
Sciences Software (version 22).
The sociodemographic, cancer treatment status, and
anthropometric characteristics of the participants are presented
in Table 1.
Reliability and Agreement Between Test
and Retest of 10-RM
The comparison between 10-RM test and retest showed high to
very high reliability for the leg press 45and bench press. For
the leg press 45and bench press exercises the ICC were 0.98
and 0.94, respectively. CV was below 10% for both exercises. The
results of reliability are presented in Table 2.
The agreement between the 10-RM test and retest
demonstrated that the results from the retest showed higher
TABLE 1 | Characteristics.
Characteristics N=31
Age (year)—mean (SD) 54.87 (5.7)
Education—no. (%)
<8 years of the study 15 (48.4)
>8 years of the study 16 (51.6)
Self-reported race—no. (%)
Caucasian 20 (64.5)
Non Caucasian 11 (35.5)
Occupation—no. (%)
Homemaker or cleaner 6 (19.4)
Housewife 16 (51.6)
Nurse 1 (3.2)
Retired 5 (16.1)
Saleswoman 2 (6.5)
Teacher 1 (3.2)
Marital status—no. (%)
Single 7 (22.6)
Married 16 (51.6)
Divorced 4 (12.9)
Widow 4 (12.9)
Arterial hypertension—no. (%) 9 (29)
Diabetes—no. (%) 3 (9.7)
Months since cancer diagnosis—mean (SD) 40.68 (14.8)
Cancer stage—no. (%)
I 10 (32.3)
II 17 (54.8)
III 4 (12.9)
Breast surgery—no. (%)
Lumpectomy 1 (3.2)
Lymphadenectomy 1 (3.2)
Mastectomy and breast reconstruction 1 (3.2)
Mastectomy 13 (41.9)
Mastectomy and quadrantectomy 1 (3.2)
Quadrantectomy 13 (41.9)
Quadrantectomy and breast reconstruction 1 (3.2)
Months since breast surgery—mean (SD) 29.03 (15.4)
Axillary lymph nodes removed—mean (SD) 4.86 (4.3)
Chemotherapy—no. (%) 26 (83.9)
Adjuvant 14 (45.2)
Neoadjuvant 12 (38.7)
Missing data 5 (16.1)
Radiotherapy—no. (%) 28 (90.3)
Hormone therapy—no. (%)
Tamoxifen 27(87.1)
Aromatase inhibitors 4 (12.0)
Self-reported lymphedema—no. (%) 13 (41.9)
Anthropometry and body composition
Weight (kg)—mean (SD) 68.67(11.4)
Height (cm)—mean (SD) 157.08 (6.2)
BMI—mean (SD) 27.85(4.5)
Body fat (%)—mean (SD) 46.36(5.90)
Body fat mass (kg)—mean (SD) 31.18(8.33)
Body lean mass (kg)—mean (SD) 35.26(4.64)
Level physical activity (MET-h/wk)—mean (SD) 23.38 (26.40)
SD, standard deviation; BMI, body mass index; MET, metabolic equivalent of task.
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Santos et al. Reliability and Agreement of the 10-Repetition Maximum Test
TABLE 2 | Analysis of reliability and agreement between 10-RM test and retest.
Exercises 10-RM test
(mean ±SD)
10-RM retest
(mean ±SD)
(95% CI)
(95% CI)
Leg press (kg) 74.84 (28.50) 80.97 (29.70) 5.87 (3.19–8.55) 0.98 (0.96–0.99) 4.11 (5.27) 5.62 (7.21)
Bench press (kg) 15.03 (3.79) 16.55 (3.70) 7.27 (4.10–10.45) 0.94 (0.87–0.97) 0.96 (6.08) 2.72 (17.20)
10-RM, 10-repetition maximum; SD, standard deviation; kg, kilogram; CV, coefficient of variation; ICC, intraclass coefficient correlation; CI, confidential interval; SEM, standard error of
measurement; MDC, minimally detectable change; LOALB, limits of agreement lower boundary; LOAUB, limits of agreement upper boundary.
FIGURE 2 | Bland-Altman plot of 10-RM for the leg press 45(A) and the bench press (B). The dotted line represent the limits of agreement upper and lower
boundary. The continue line on the center of plot represent the systematic bias. The continue line on the Y axis represent the mean difference between 10-RM retest
and test, and on the X axis represent the mean of 10-RM retest and test.
load than the test situation performed at day 1 (systematic bias
values in Figures 2A,B are positives because the analysis were
performed with 10-RM retest as first method and 10-RM test
as second method for to build the Bland-Altman plots). The
Bland-Altman plots (Figure 2) showed the mean difference with
95% IC limits of agreement.
The relative difference between the test and the retest was
predicted in 8.3% (limits of agreement for upper and lower
boundary 28 and 11%) and 10.3% (limits of agreement for
upper and lower boundary 34 and 13%) for the leg press 45
and the bench press, respectively.
The relative and absolute SEM and MDC are presented in
Table 2.
This study aimed to evaluate the reliability and agreement
between the 10-RM test and retest for the leg press 45
and bench press exercises in BCS. We found a high to
very high rate of reliability and agreement with lower and
acceptable CV (CV <10%), SEM (absolute and relative) and
MDC (absolute and relative) between the 10-RM test and
retest for both the leg press 45. and bench press However,
a higher value was found in the 10-RM retest situation,
for both exercises. To our knowledge, this study is the
first to evaluate the 10-RM test reliability in BCS, and the
results suggest that 10-RM test could be used to measure
muscular strength.
In general, a few studies have previously reported the
reliability of test and retest 10-RM. In older people, Farinatti et al.
(27) described high reliability of the 10-RM test for the dumbbell
bench press (ICC 0.90; typical error 1.61 kg) and knee extension
(ICC 0.96; typical error 2.01 kg) in elderly healthy women (68 ±4
years old). Farinatti et al. (39) reported a high ICC for the barbell
bench press in young (22 ±2 years old) and elderly women (69
±7 years old) (0.91 and 0.90, respectively). For the leg press 45,
a high ICC (0.99) was reported in young healthy people (24 ±3
years old) (40). Monteiro et al. (41) also reported a high ICC for
the leg press 45(0.92) and the bench press (0.90) in adult women
(37.6 ±1.7 years old). Our study found a similar reliability to
those studies. Therefore, it seems that the 10-RM test reliability
for BCS is similar to that of healthy individuals of different ages.
The CV of 10-RM test showed be <10% for lower and upper
limbs. That was similar compare to 1-RM in BCS (18). Winter-
Stone et al. (18) reported CV of the 6.6 and 7.5% for the leg
press and chest press, respectively. We found a similar CV for
the leg press 45and bench press for 10-RM, 5.87 and 7.27%,
respectively. Moreover, our results suggest that lower limbs have
a better reliability than upper limb exercise, as we hypothesized.
It could be explain by lower capacity of lifting for upper limbs
compare to lower limbs, this may be result of sides effects of
breast cancer treatments.
The 10-RM retest achieved higher load than 10-RM test
situation, which may suggest some training effects either in
technique or muscle strength of the first exercise test. A
repeated strength measurement could provide a process of the
learning of task, improving the ability/skill to perform the
Frontiers in Oncology | 4September 2019 | Volume 9 | Article 918
Santos et al. Reliability and Agreement of the 10-Repetition Maximum Test
movement. Bernardi et al. (42) showed that skill acquisition to
perform maximal voluntary contraction allows better control
of neuromuscular system which could provide higher force
generation through the trials. Grosicki et al. (43) also found
higher value of 1-RM in the second trial than the first trial of
assessment in young adults and older people, women and men,
for leg press, leg extension and biceps curl. The same behavior
was observed by Amarante do Nascimento et al. (44). They found
that the second day of testing was higher than first day, but
similar with the third day in 1-RM load for bench press and leg
extension in elderly women (65 ±4 years old) (44). Thus, the
muscle strength values could be reached in the second or third
trial of measurement.
The 10-RM test could be useful in the real word for prescribing
or monitoring the load of the training. The use of percentage
of 1-RM test may present a large variability in the number of
repetition performance. Grosicki et al. (43) showed that using
60% and 80% of 1-RM test the participants were able to perform
28.8 (±9.2)/23.3 (±16.3) and 17 (±6.5)/12.8 (±7.8) repetitions
in younger and older women, respectively. Hence, the session of
training would be high or low effort, if use the percentage of 1-
RM test. Therefore, it seems that using the load reached from
10-RM test could be more precisely to prescribe and monitor
the number of repetitions during the training session, and that
may be one advantages of 10-RM test compared to 1-RM test.
Another advantage of 10RM test could be a better perception
of safety and acceptance in BCS, since there have been reported
knesiohpobia, fear of movement (11,45). In addition, repetition
to failure as 10-RM might be used to predict 1-RM loads for
the bench press/chest press (4648) and leg press 45/horizontal
(4749), with a low error of measurement. However, we did not
investigate the accuracy of the 10-RM load to predict a 1-RM
load in BCS. Future studies could investigate the accuracy of the
10-RM test to predict a 1-RM load in BC patients and BCS.
The study has important strengths. The tests were supervised
by two experienced exercise physiologists/professionals that
provided better control of the 10-RM test and guaranteed the
safety and confidence for the participants to perform higher load,
and the homogeneity of the tests. One limitation of the present
study included the lack of assessment of shoulder range of motion
during the bench press test. However, we think this limitation was
eliminated by the experienced physiologists.
In conclusion, muscular strength measurement using 10-
RM test has a good to excellent rate of reliability and
agreement, with acceptable error of measurement. Due to
lack of information about the reliability of 1-RM test in
BCS, 10-RM test could be an interesting alternative for
diagnosis and prescription in this population. Therefore, the
10-RM test may be used to evaluate the muscular strength
in BCS. The new studies with BC patients and BCS could
report the reliability of the maximum force production on
isoinertial exercises.
The datasets generated for this study are available on request to
the corresponding author.
The studies involving human participants were reviewed
and approved by Research Ethics Committee of the Federal
University of Goias (CAAE: 50717115.4.0000.5083), and by the
Research Ethics Committee of the Clinical Hospital of the
Federal University of Goias (CAAE: 50717115.4.3001.5078). The
patients/participants provided their written informed consent to
participate in this study.
WS and CV performed the study concept and design. WS
and GS supervised the muscle assessments. WS, RS, and WM
conducted the analyses. WS wrote the original draft of the
manuscript. AV, WM, PG, and CV wrote, reviewed, and edited
the manuscript.
PG receives a Research Grant from CNPq (304435/2018-0).
The Supplementary Material for this article can be found
online at:
1. Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression
and exercise prescription. Med Sci Sports Exerc. (2004) 36:674–88.
doi: 10.1249/01.MSS.0000121945.36635.61
2. Ruiz JR, Sui X, Lobelo F, Morrow JR, Jackson AW, Sjöström M, et al.
Association between muscular strength and mortality in men: prospective
cohort study. BMJ. (2008) 337:a439. doi: 10.1136/bmj.a439
3. Tanimoto Y, Watanabe M, Sun W, Sugiura Y, Tsuda Y, Kimura M, et al.
Association between sarcopenia and higher-level functional capacity in daily
living in community-dwelling elderly subjects in Japan. Arch Gerontol Geriatr.
(2012) 55:e9–13. doi: 10.1016/j.archger.2012.06.015
4. Hayes SC, Rye S, Battistutta D, DiSipio T, Newman B. Upper-body morbidity
following breast cancer treatment is common, may persist longer-term and
adversely influences quality of life. Health Qual Life Outcomes. (2010) 8:92.
doi: 10.1186/1477-7525-8-92
5. Feigenbaum MS, Pollock ML. Prescription of resistance
training for health and disease. Med Sci Sports Exerc.
(1999) 31:38–45. doi: 10.1097/00005768-199901000-
Frontiers in Oncology | 5September 2019 | Volume 9 | Article 918
Santos et al. Reliability and Agreement of the 10-Repetition Maximum Test
6. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA,
Pinto BM, et al. American college of sports medicine roundtable on exercise
guidelines for cancer survivors. Med Sci Sports Exerc. (2010) 42:1409–26.
doi: 10.1249/MSS.0b013e3181e0c112
7. Caro-Moran E, Fernandez-Lao C, Diaz-Rodriguez L, Cantarero-Villanueva I,
Madeleine P, Arroyo-Morales M. Pressure pain sensitivity maps of the neck-
shoulder region in breast cancer survivors. Pain Med. (2016) 17:1942–52.
doi: 10.1093/pm/pnw064
8. Ewertz M, Jensen AB. Late effects of breast cancer treatment
and potentials for rehabilitation. Acta Oncol. (2011) 50:187–93.
doi: 10.3109/0284186X.2010.533190
9. Hayes S, Battistutta D, Newman B. Objective and subjective upper body
function six months following diagnosis of breast cancer. Breast Cancer Res
Treat. (2005) 94:1–10. doi: 10.1007/s10549-005-5991-z
10. Lee TS, Kilbreath SL, Refshauge KM, Herbert RD, Beith JM. Prognosis of the
upper limb following surgery and radiation for breast cancer. Breast Cancer
Res Treat. (2008) 110:19–37. doi: 10.1007/s10549-007-9710-9
11. Lee D, Hwang JH, Chu I, Chang HJ, Shim YH, Kim JH. Analysis of factors
related to arm weakness in patients with breast cancer-related lymphedema.
Support Care Cancer. (2015) 23:2297–304. doi: 10.1007/s00520-014-2584-6
12. Montague ED. Adaptation of irradiation techniques to various types of
surgical procedures for breast cancer. Cancer. (1972) 29:557–60. doi: 10.1002/
13. Nesvold I-L, Dahl AA, Løkkevik E, Marit Mengshoel A, Fosså SD.
Arm and shoulder morbidity in breast cancer patients after breast-
conserving therapy versus mastectomy. Acta Oncol. (2008) 47:835–42.
doi: 10.1080/02841860801961257
14. Nuzzo JL, Taylor JL, Gandevia SC. CORP: Measurement of upper and lower
limb muscle strength and voluntary activation. J Appl Physiol. (2019) 126:513–
43. doi: 10.1152/japplphysiol.00569.2018
15. Battaglini C, Bottaro M, Dennehy C, Rae L, Shields E, Kirk D, et al. The effects
of an individualized exercise intervention on body composition in breast
cancer patients undergoing treatment. São Paulo Med J. (2007) 125:22–8.
doi: 10.1590/S1516-31802007000100005
16. Schmitz KH, Ahmed RL, Hannan PJ, Yee D, KH S, RL A, et al.
Safety and efficacy of weight training in recent breast cancer survivors
to alter body composition, insulin, and insulin-like growth factor
axis proteins. Cancer Epidemiol Biomarkers Prev. (2005) 14:1672–80.
doi: 10.1158/1055-9965.EPI-04-0736
17. Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, et al.
Physical activity and lymphedema (the PAL trial): assessing the safety of
progressive strength training in breast cancer survivors. Contemp Clin Trials.
(2009) 30:233–45. doi: 10.1016/j.cct.2009.01.001
18. Winters-Stone KM, Dobek J, Bennett JA, Nail LM, Leo MC, Schwartz A.
The effect of resistance training on muscle strength and physical function in
older, postmenopausal breast cancer survivors: a randomized controlled trial.
J Cancer Surviv. (2012) 6:189–99. doi: 10.1007/s11764-011-0210-x
19. Pollock ML, Carroll JF, Graves JE, Leggett SH, Braith RW, Limacher
M, et al. Injuries and adherence to walk/jog and resistance training
programs in the elderly. Med Sci Sports Exerc. (1991) 23:1194–200.
doi: 10.1249/00005768-199110000-00014
20. Courneya KS, McKenzie DC, Mackey JR, Gelmon K, Reid RD, Friedenreich
CM, et al. Moderators of the effects of exercise training in breast cancer
patients receiving chemotherapy: a randomized controlled trial. Cancer.
(2008) 112:1845–53. doi: 10.1002/cncr.23379
21. Courneya KS, McKenzie DC, Mackey JR, Gelmon K, Friedenreich CM,
Yasui Y, et al. Effects of exercise dose and type during breast cancer
chemotherapy: multicenter randomized trial. J Natl Cancer Inst. (2013)
105:1821–32. doi: 10.1093/jnci/djt297
22. Courneya KS, Mckenzie DC, Mackey JR, Gelmon K, Friedenreich CM, Yasui
Y, et al. Subgroup effects in a randomised trial of different types and doses of
exercise during breast cancer chemotherapy. Br J Cancer. (2014) 111:1718–25.
doi: 10.1038/bjc.2014.466
23. De Luca V, Minganti C, Borrione P, Grazioli E, Cerulli C, Guerra E,
et al. Effects of concurrent aerobic and strength training on breast
cancer survivors: a pilot study. Public Health. (2016) 136:126–32.
doi: 10.1016/j.puhe.2016.03.028
24. Barbalho M, Gentil P, Raiol R, Fisher J, Steele J, Coswig V. Influence of
adding single-joint exercise to a multijoint resistance training
program in untrained young women. J Strength Cond Res. (2018).
doi: 10.1519/JSC.0000000000002624. [Epub ahead of print].
25. Barbalho M, Coswig VS, Steele J, Fisher JP, Paoli A, Gentil P. Evidence
for an upper threshold for resistance training volume in trained women.
Med Sci Sports Exerc. (2019) 51:515–22. doi: 10.1249/MSS.00000000000
26. de Salles BF, Maior AS, Polito M, Novaes J, Alexander J, Rhea M, et al.
Influence of rest interval lengths on hypotensive response after strength
training sessions performed by older men. J Strength Cond Res. (2010)
24:3049–54. doi: 10.1519/JSC.0b013e3181ddb207
27. Farinatti PTV, Geraldes AAR, Bottaro MF, Lima MVIC, Albuquerque RB,
Fleck SJ. Effects of different resistance training frequencies on the muscle
strength and functional performance of active women older than 60 years.
J Strength Cond Res. (2013) 27:2225–34. doi: 10.1519/JSC.0b013e31827
28. Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength
training (10 RM) commenced immediately after fast-track total
knee arthroplasty: is it feasible? Disabil Rehabil. (2012) 34:1034–40.
doi: 10.3109/09638288.2011.629019
29. Kim H-S, Kim D-G. Effect of long-term resistance exercise on body
composition, blood lipid factors, and vascular compliance in the hypertensive
elderly men. J Exerc Rehabil. (2013) 9:271–7. doi: 10.12965/jer.130010
30. Pinto CL, Botelho PB, Carneiro JA, Mota JF. Impact of creatine
supplementation in combination with resistance training on lean
mass in the elderly. J Cachexia Sarcopenia Muscle. (2016) 7:413–21.
doi: 10.1002/jcsm.12094
31. WHO. Research on the menopause in the 1990s. Report of a WHO Scientific
Group. Geneva World Heal Organ. (1996) 866, 1–107.
32. Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira
LC, et al. International Physical Activity Questionnaire (IPAQ): study of
validity and reliability in Brazil. Rev Bras Atividade Física Saúde. (2001)
33. National Strength and Conditioning Association. Exercise Technique Manual
for Resistance Training. 3rd ed. Champaign, IL: Human Kineticcs (2016).
34. Heyward VH, Gibson AL. Advanced Fitness Assessment and Exercise
Prescription. 7th ed. Champaign, IL: Human Kineticcs (2014).
35. Atkinson G, Nevill AM. Statistical methods for assessing measurement error
(reliability) in variables relevant to sports medicine. Sport Med. (1998) 26:217–
38. doi: 10.2165/00007256-199826040-00002
36. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation
coefficients for reliability research. J Chiropr Med. (2016) 15:155–63.
doi: 10.1016/j.jcm.2016.02.012
37. Weir JP. Quantifying test-retest reliability using the intraclass
correlation coefficient and the SEM. J Strength Cond Res. (2005) 19:231.
doi: 10.1519/15184.1
38. Bland JM, Altman DG. Measuring agreement in method comparison studies.
Stat Methods Med Res. (1999) 8:135–60. doi: 10.1177/096228029900800204
39. Farinatti PTV, da Silva NSL, Monteiro WD. Influence of exercise order on the
number of repetitions, oxygen uptake, and rate of perceived exertion during
strength training in younger and older women. J Strength Cond Res. (2013)
27:776–85. doi: 10.1519/JSC.0b013e31825d9bc1
40. Lattari E, Rosa Filho BJ, Fonseca Junior SJ, Murillo-Rodriguez E, Rocha N,
Machado S, et al. Effects on volume load and ratings of perceived exertion
in individuals advanced weight-training after transcranial direct current
stimulation. J Strength Cond Res. (2018). doi: 10.1519/JSC.00000000000
02434. [Epub ahead of print].
41. Monteiro WD, Simão R, Polito MD, Santana CA, Chaves RB, Bezerra E, et al.
Influence of strength training on adult women’s flexibility. J Strength Cond
Res. (2008) 22:672–7. doi: 10.1519/JSC.0b013e31816a5d45
42. Bernardi M, Solomonow M, Nguyen G, Smith A, Baratta R. Motor unit
recruitment strategy changes with skill acquisition. Eur J Appl Physiol Occup
Physiol. (1996) 74:52–9. doi: 10.1007/BF00376494
43. Grosicki GJ, Miller ME, Marsh AP. Resistance exercise performance variability
at submaximal intensities in older and younger adults. Clin Interv Aging.
(2014) 9:209–18. doi: 10.2147/CIA.S55719
Frontiers in Oncology | 6September 2019 | Volume 9 | Article 918
Santos et al. Reliability and Agreement of the 10-Repetition Maximum Test
44. Amarante do Nascimento M, Borges Januário RS, Gerage AM,
Mayhew JL, Cheche Pina FL, Cyrino ES. Familiarization and reliability
of one repetition maximum strength testing in older women. J
Strength Cond Res. (2013) 27:1636–42. doi: 10.1519/JSC.0b013e31827
45. Karadibak D, Yavuzsen T, Saydam S. Prospective trial of intensive decongestive
physiotherapy for upper extremity lymphedema. J Surg Oncol. (2008) 97:572–
7. doi: 10.1002/jso.21035
46. Dohoney P, Chromiak JA, Lemire D, Abadie BR, Kovacs C. Prediction of
one repetition maximum (1-rm) strength from a 4-6 RM and a 7-10 RM
submaximal strength test in healthy young adult males. J Exerc Physiol Online.
(2002) 5:54–9.
47. Mayhew JL, Johnson BD, Lamonte MJ, Lauber D, Kemmler W. Accuracy of
prediction equations for determining one repetition maximum bench press
in women before and after resistance training. J Strength Cond Res. (2008)
22:1570–7. doi: 10.1519/JSC.0b013e31817b02ad
48. Reynolds JM, Gordon TJ, Robergs RA. Prediction of one repetition
maximum strength from multiple repetition maximum testing and
anthropometry. J Strength Cond Res. (2006) 20:584–92. doi: 10.1519/R-1
49. Kemmler WK, Lauber D, Wassermann A, Mayhew JL. Predicting maximal
strength in trained postmenopausal woman. J Strength Cond Res. (2006)
20:838–42. doi: 10.1519/00124278-200611000-00019
Conflict of Interest Statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
Copyright © 2019 Santos, Siqueira, Martins, Vieira, Schincaglia, Gentil and
Vieira. This is an open-access article distributed under the terms of the
Creative Commons Attribution License (CC BY). The use, distribution or
reproduction in other forums is permitted, provided the original author(s)
and the copyright owner(s) are credited and that the original publication in
this journal is cited, in accordance with accepted academic practice. No use,
distribution or reproduction is permitted which does not comply with these
Frontiers in Oncology | 7September 2019 | Volume 9 | Article 918
... Progressively lower the bar by bending the shoulders, followed by bending the elbows until the bar reaches one centimeter from the chest. Once the maximum flexion is achieved, they will extend the elbows and shoulders until they return to the initial position [37,84]. • Shoulder press. ...
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Background Breast cancer is a chronic disease with a large growth in its treatments, prognosis, improvements, side effects and rehabilitation therapies research. These advances have also highlighted the need to use physical exercise as a countermeasure to reduce the cardiotoxicity of pharmacological treatments, increase patients' strength and quality of life and improve body composition, physical condition and mental health. However, new investigations show the need for a closed exercise individualisation to produce higher physiological, physical and psychological benefits in remote exercise programs. To this end, the present study will use, in a novel way in this population, heart rate variability (HRV) as a measure for prescribing high-intensity training. Thus, the primary objective of this randomised clinical trial is to analyse the effects of a high-intensity exercise program daily guided by HRV, a preplanned moderate to high-intensity exercise intervention and a usual care group, in breast cancer patients after chemotherapy and radiotherapy treatments. Methods For this purpose, a 16-week intervention will be carried out with 90 breast cancer patients distributed in 3 groups (a control group, a moderate to high-intensity preplanned exercise group and a high-intensity exercise group guided by HRV). Both physical exercise interventions will be developed remotely and supervised including strength and cardiovascular exercises. Physiological variables, such as cardiotoxicity, biomarkers, lipid profile, glucose, heart rate and blood pressure; physical measures like cardiorespiratory capacity, strength, flexibility, agility, balance and body composition; and psychosocial variables, as health-related quality of life, fatigue, functionality, self-esteem, movement fear, physical exercise level, anxiety and depression will be measure before, after the intervention and 3 and 6 months follow up. Discussion Personalized high-intensity exercise could be a promising exercise intervention in contrast to moderate-intensity or usual care in breast cancer patients to reach higher clinical, physical and mental effects. In addition, the novelty of controlling HRV measures daily may reflect exercise effects and patients' adaptation in the preplanned exercise group and a new opportunity to adjust intensity. Moreover, findings may support the effectiveness and security of physical exercise remotely supervised, although with high-intensity exercise, to reach cardiotoxicity improvements and increase physical and psychosocial variables after breast cancer treatments. Trial registration nº NCT05040867 (
... However, since individuals were experienced with the applied exercises and devices, it is unlikely that loads have been underestimated. This premise is supported by studies showing good reproducibility in multiple RM tests performed by older individuals (Dos Santos et al., 2019;LeBrasseur et al., 2008). It is also worthy to mention that the intensity of AE was arbitrarily fixed at 60-65% VO 2 R. ...
Purpose: Albeit being a major determinant of exercise-related energy expenditure (EE), there is a lack of research on the excess post-exercise oxygen consumption (EPOC) after different exercise modalities in older adults. This study compared the EPOC after isocaloric bouts of resistance (RE) and aerobic (AE) exercise. Methods: The EE during exercise was determined through telemetric indirect calorimetry in ten physically active participants aged 63 to 82 years (5 women, 73 ± 6 years, 70.5 ± 9.9 kg, 161 ± 8 cm). The target EE in AE corresponded to values achieved during RE, and the EPOC was assessed for 30 min in the supine position. Results: The EE during AE and RE were 126.0 ± 30.7 kcal and 123.9 ± 30.6 kcal, respectively. The time to achieve the target EE was 2.3 times shorter in AE vs. RE. The EPOC magnitude was greater after AE (7.9 ± 2.4 L, 40.1 ± 11.1 kcal) than RE (5.9 ± 1.8 L, 26.9 ± 11.5 kcal). Conclusion: Older adults showed greater EPOC after isocaloric sessions of AE vs. RE. Additionally, AE had better temporal efficiency than RE to elicit a given EE.
... 10 repetitions maximum test (10RM): was used to evaluate muscle strength which the maximum weight a person can lift for 10 consecutive exercise repetitions [8]. ...
Background. Cancer-related fatigue is a persistent symptom in acute myeloid leukemia survivors, with associated decreased functional capacity, which further deteriorates their quality of life. The current study aimed to compare between the impact of aerobic training and resistive training on functional capacity in acute myeloid leukemia (AML) survivors. Fifty nine patients with AML from both sexes aged between 35 and 45 years,were selected from hematology department in (BLINDED FOR PEER REVIEW), where the study was conducted. Patients were randomly assigned into two groups; Group (A) underwent aerobic training in the form of cycling within 50-60% of maximum heart rate. Group (B) underwent resistive training conducted in the form of a series of exercises using free weights, and dumbbells. Sessions were carried out three times per week, for a total of eight weeks period. Six minute walk test (6MWT), 10 repetitions maximum test (10 RM). Ventilatory functions test, fatigue severity assessment (FAS) and quality of life (QoL) scales were measured in both groups before and after the study period. Results. Significant improvement in 6MWT, maximum oxygen consumption (VO2 max) and vital capacity in group (A), significant improvement in fatigue and QoL in both groups and significant improvement in 10 RM test in group (B). Conclusion. Both aerobic and resistive training significantly improved functional capacity in acute myeloid leukemia survivors with a more significant improvement due to aerobic training.
... (Gail & Künzell, 2014;Lawton, Cronin & McGuigan, 2014). Additionally, other work has shown reliability to be relatively stable across the number of repetitions in an RM test (Gail & Künzell, 2014;Lattari et al., 2020;McCurdy et al., 2004;Santos et al., 2019). The current results suggest that unless a 1RM value is specifically required, a 5RM test may be a viable option as although the test is still maximal, the absolute load will be lower and this may be important in certain populations (e.g., lower training age, participants with lower kettlebell swing skill). ...
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Background Research into the kettlebell swing has increased in the last decade. There has been a paucity of literature assessing an individual’s ability to perform the kettlebell swing exercise. The purpose of this study was to determine the test-retest reliability of the one and five repetition maximum (1RM and 5RM) kettlebell swing. Materials & Methods Twenty four recreational resistance-trained participants performed an isometric mid-thigh pull (IMTP) and two familiarization sessions followed by three test sessions for each RM load approximately one week apart, using a custom-built plate-loaded kettlebell. On each test occasion, subjects completed a series of warm-up sets followed by 3–4 progressively heavier kettlebell swings to a standardized height until 1RM or 5RM was reached. Test-retest reliability was calculated using the intra-class correlation (ICC) and typical error was represented as the coefficient of variation (CV%) with 90% confidence limits (90% CL). The smallest worthwhile change (SWC%) representing the smallest change of practical importance, was calculated as 0.2 × between-subject standard deviation. The relationship of kettlebell swing performance and maximum strength was determined by Pearson correlation with ±90% CL between the absolute peak force recorded during IMTP and 1RM or 5RM. Results Results demonstrated a high test-retest reliability for both the 1RM (ICC = 0.97, 90% CL [0.95–0.99]; CV = 2.7%, 90% CL [2.2–3.7%]) and 5RM (ICC = 0.98, 90% CL [0.96–0.99]; CV = 2.4%, 90% CL [1.9–3.3%]), respectively. The CV% was lower than the SWC for both the 1RM (SWC = 2.8%, 90% CL [1.9–3.5]) and 5RM (SWC = 2.9%, 90% CL [1.9–3.6]) kettlebell swing. The correlation between IMTP absolute peak force and the 1RM (r = 0.69, 90% CL 0.43–0.83) was large and very large for the 5RM (r = 0.75, 90% CL [0.55–0.87]). Conclusions These results demonstrate the stability of 1RM and 5RM kettlebell swing performance after two familiarization sessions. Practitioners can be confident that changes in kettlebell swing 1RM and 5RM performance of >3.6 kg represent a practically important difference, which is the upper limit of the 90% CL.
... Handgrip strength predicts future disability in older adults [155] and can discriminate between adults who are able and unable to perform heavy tasks with their hands [156]. 'Gold standard' evaluations of maximal upper and lower body muscular strength may also be incorporated, i.e., 1-repetition maximum (RM) tests [157], although, in some cases, tests that estimate 1RM, e.g., 10-RM test, may be more suitable [158]. All assessments should be selected based on the potential patient burden, time needed, safety, and relevance for informing the exercise prescription (i.e., specificity for exercise training). ...
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Addressing skeletal muscle mass loss is an important focus in oncology research to improve clinical outcomes, including cancer treatment tolerability and survival. Exercise is likely a necessary component of muscle-mass-preserving interventions for people with cancer. However, randomized controlled trials with exercise that include people with cancer with increased susceptibility to more rapid and severe muscle mass loss are limited. The aim of the current review is to highlight features of cancer-related skeletal muscle mass loss, discuss the impact in patients most at risk, and describe the possible role of exercise as a management strategy. We present current gaps within the exercise oncology literature and offer several recommendations for future studies to support research translation, including (1) utilizing accurate and reliable body composition techniques to assess changes in skeletal muscle mass, (2) incorporating comprehensive assessments of patient health status to allow personalized exercise prescription, (3) coupling exercise with robust nutritional recommendations to maximize the impact on skeletal muscle outcomes, and (4) considering key exercise intervention features that may improve exercise efficacy and adherence. Ultimately, the driving forces behind skeletal muscle mass loss are complex and may impede exercise tolerability and efficacy. Our recommendations are intended to foster the design of high-quality patient-centred research studies to determine whether exercise can counteract muscle mass loss in people with cancer and, as such, improve knowledge on this topic.
... It is defined as the maximum weight a subject can press with one repetition using a barbell lying in a supine position on a horizontal bench. While the predictive value of the measurement has not been investigated often in regards to sarcopenia, it is considered to be a gold standard measurement of muscle strength [44]. Strength training programs can be tailored to individuals' strength as a percentage of the 1RM chest press, which is important for exercise in older adults [45]. ...
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Background & aims Sarcopenia is characterized by the progressive loss of skeletal muscle mass and function, which reduces mobility and quality of life. Risk factors for sarcopenia include advanced age, physical inactivity, obesity, and chronic diseases such as cancer or rheumatoid arthritis. Omega-3 long chain polyunsaturated fatty acids (LC PUFAs) might be associated with a reduction in risk of sarcopenia due to their anti-inflammatory effects. Methods We conducted a systematic review and meta-analysis to quantify the effects of omega-3 LC PUFAs on muscle mass, volume and function parameters. The National Library of Medicine's MEDLINE/PubMed database was searched on 9th October 2020 for randomized controlled trials that used omega-3 LC PUFAs as an intervention with muscle-related endpoints. A snowballing search to identify additional studies was completed on 23rd April 2021. The meta-analysis was conducted using meta-essentials worksheet 3. Bias was assessed using the Jadad scale. Results 123 studies were identified with the systematic searches. Most studies were performed in disease populations, such as cancer or chronic obstructive pulmonary disease (COPD), or in healthy individuals after a fatiguing exercise bout. The endpoints lean body mass, skeletal muscle mass, mid-arm muscle circumference, handgrip strength, quadriceps maximal voluntary capacity (MVC), and 1-repetition maximum chest press were selected for meta-analysis based on the number of available studies; thus 66 studies were included in the quantitative synthesis. Using a random effects model and 2-tailed p-value, there was a significant relationship in favor of omega-3 LC PUFA supplementation for lean body mass (effect size 0.27, 95%CI 0.04 to 0.51), skeletal muscle mass (effect size 0.31, 95%CI 0.01 to 0.60) and quadriceps MVC (effect size 0.47, 95%CI 0.02 to 0.93). Conclusion The results indicate that there is a positive effect of omega-3 LC PUFA supplementation on overall body muscle mass and strength. Small study size and heterogeneity limit the applicability of these findings for sarcopenia prevention. Larger trials in populations at risk of sarcopenia would strengthen the evidence base.
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Background Aromatase inhibitors (AI) are frequently used to treat hormone-receptor-positive breast cancer, but they have multiple adverse effects (e.g., osteoporosis, arthralgia), resulting in premature therapy discontinuation/switch. Physical activity (PA) can attenuate these negative effects and improve quality of life (QoL). However, most cancer survivors fail to perform/sustain adequate PA levels, especially in the long-term. Theory-based interventions, using evidence-based behavior change techniques, aimed at promoting long-term behavior change in breast cancer survivors are effective, but remain scarce and fail to promote self-regulatory skills and better-quality motivations associated with sustained PA adoption. This paper describes the design of the PAC-WOMAN trial, which will test the long-term effectiveness and cost-effectiveness of two state of the art, group-based interventions encouraging sustained changes in PA, sedentary behavior, and QoL. Additional aims include examining the impact of both interventions on secondary outcomes (e.g., body composition, physical function), and key moderators/mediators of short and long-term changes in primary outcomes. Methods A 3-arm pragmatic randomized controlled trial, involving a 4-month intervention and a 12-month follow-up, will be implemented, in a real exercise setting, to compare: 1) brief PA counseling/motivational intervention; 2) structured exercise program vs. waiting-list control group. Study recruitment goal is 122 hormone-receptor-positive breast cancer survivors (stage I-III), on AI therapy (post-primary treatment completion) ≥ 1 month, ECOG 0–1. Outcome measures will be obtained at baseline, 4 months (i.e., post-intervention), 10 and 16 months. Process evaluation, analyzing implementation determinants, will also be conducted. Discussion PAC-WOMAN is expected to have a relevant impact on participants PA and QoL and provide insights for the improvement of interventions designed to promote sustained adherence to active lifestyle behaviors, facilitating its translation to community settings. Trial registration April 20, 2023 – NCT05860621. April 21, 2023 – April 27, 2023 – UMIN000050945.
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Objective: To determine the feasibility and acceptability of an mHealth, home-based exercise intervention among stage II-III colorectal cancer (CRC) survivors within 5-years post-resection and adjuvant therapy. Methods: This pilot randomized controlled trial of a 12-week mHealth, home-based exercise intervention, randomly assigned CRC survivors to a high-intensity interval training (HIIT) or moderate-intensity continuous exercise (MICE) prescription. The following assessments were carried out at baseline and end-of-study (EOS): handgrip strength, short physical performance battery (SPPB), PROMIS physical function, neuropathy total symptom score-6 (NTSS-6), Utah early neuropathy scale (UENS), cardiopulmonary exercise testing, anthropometrics, and body composition via BOD POD, modified Godin leisure-time activity questionnaire. Feasibility, as defined by number of completed prescribed workouts and rate of adherence to individualized heart rate (HR) training zones, was evaluated at EOS. Acceptability was assessed by open-ended surveys at EOS. Descriptive statistics were generated for participant characteristics and assessment data. Results: Seven participants were included in this pilot study (MICE: n = 5, HIIT: n = 2). Median age was 39 years (1st quartile: 36, 3rd quartile: 50). BMI was 27.4 kg/m2 (1st quartile: 24.5, 3rd quartile: 29.7). Most participants had stage III CRC (71%, n = 5). We observed an 88.6% workout completion rate, 100% retention rate, no adverse events, and qualitative data indicating improved quality of life and positive feedback related to ease of use, accountability, motivation, and autonomy. Mean adherence to HR training zones was 95.7% in MICE, and 28.9% for the high-intensity intervals and 51.0% for the active recovery intervals in HIIT; qualitative results revealed that participants wanted to do more/work-out harder. Conclusion: An mHealth, home-based delivered exercise intervention, including a HIIT prescription, among stage II-III CRC survivors' post-resection and adjuvant therapy was tolerable and showed trends towards acceptability.
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Purpose To prescribe resistance training (RT) using percentages of (%) maximal strength (Smax), it is prerequisite that (I) methods for testing Smax are valid and (II) the relationship between %Smax and the corresponding number of repetitions (NOR) is known. This has never been investigated in cancer survivors (CS) and was the purpose of the present study. Methods Twenty breast (58 ± 10y) and 20 prostate CS (68 ± 6y), 3.6 ± 2.4 months after primary therapy, completed one one-repetition maximum (1-RM) test, one hypothetical 1-RM (h1-RM) test and three RT sessions (three sets at six different strength machines (SM)). H1-RM was calculated using two commonly used equations (after Brzycki and Epley), resulting in three Smax values for each SM, which were then compared to each other (1-RM as a reference). Each RT session was performed at a different intensity (92%, 69% and 47% of 1-RM/h1-RM). CS performed repetitions to fatigue and the resulting NOR were compared to the predicted NOR. Results Smax values differed between 1-RM and h1-RM values for each SM and between h1-RM values for some SM. Differences between performed and predicted NOR occurred among all intensities and methods. Conclusion Different strength tests yield different results for Smax and a certain %1-RM/h1-RM does not necessarily correspond to a specific NOR in all individuals, which questions the use of (I) h1-RM tests for determining Smax and (II) prescribing RT intensities based on %1-RM/h1-RM which is still the most common method used for RT intensity prescription in healthy individuals and patient populations, including CS.
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Introduction Androgen deprivation therapy (ADT) and radiotherapy (RT) increase survival in selected patients with prostate cancer. Nevertheless, the side effects of these therapies are associated with an increased risk of accidental falls and fractures and a decreased quality of life. Preliminary evidence suggests that physical exercise can be a valid strategy to reduce the side effects of ADT and RT in men with prostate cancer. Despite this knowledge, most patients with prostate cancer are insufficiently active, and there is a lack of data on the safety and adherence to the recommended dose of physical exercise. This study protocol is designed to examine the feasibility and safety of a multicomponent experimental physical exercise intervention targeting psychophysical and cognitive functions and the quality of life in this population. Methods and analysis This is a pilot feasibility study. Twenty-five men currently treated with ADT and RT for prostate cancer will be invited to participate in a 20-week, multicomponent physical exercise intervention, including supervised and unsupervised exercise sessions and meeting the current recommendation for exercise in cancer. The primary outcomes are physical exercise feasibility (recruitment, adherence and drop-out rates) and safety (adverse events related and unrelated to the intervention). The secondary outcomes are muscle strength, balance, fatigue, symptoms of anxiety and depression, cognitive function, quality of life, and patient satisfaction. We will also record the number of accidental falls and fractures occurring during the intervention and at 1 year of follow-up. Ethics and dissemination The study has received ethics approval from The Area Vasta Nord Local Ethics Committee (Province of Reggio Emilia, 23 June 2020, Number 520/2020/SPER/IRCCSRE). Recruitment began in September 2020 and will be completed in September 2021. The results will be disseminated through scientific journals and conference presentations. Trial registration number NCT04500080 .
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Introduction: The purpose of the present study was to compare the effects of different volumes of resistance training (RT) on muscle performance and hypertrophy in trained women. Methods: The study included 40 volunteers that performed RT for 24 weeks divided in to groups that performed five (G5), 10 (G10), 15 (G15) and 20 (G20) sets per muscle group per session. Ten repetition maximum (10RM) tests were performed for the bench press, lat pull down, 45º leg press, and stiff legged deadlift. Muscle thickness (MT) was measured using ultrasound at biceps brachii, triceps brachii, pectoralis major, quadriceps femoris, and gluteus maximus. Results: All groups significantly increased all MT measures and 10RM tests after 24 weeks of RT (p<0.05). Between group comparisons revealed no differences in any 10RM test between G5 and G10 (p>0.05). G5 and G10 showed significantly greater 10RM increases than G15 for lat pulldown, leg press and stiff legged deadlift. 10RM changes for G20 were lower than all other groups for all exercises (p<0.05). G5 and G10 showed significantly greater MT increases than G15 and G20 in all sites (p<0.05). MT increased more in G15 than G20 in all sites (p<0.05). G5 increases were higher than G10 for pectoralis major MT, while G10 showed higher increases in quadriceps MT than G5 (p<0.05). Conclusions: Five to 10 sets per week might be sufficient for attaining gains in muscle size and strength in trained women during a 24-week RT program. There appears no further benefit by performing higher exercise volumes. Since lack of time is a commonly cited barrier to exercise adoption, our data supports RT programs that are less time consuming, which might increase participation and adherence.
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Background Spinal manipulation is the primary therapy utilised by chiropractors in the management of their patients. The skills required may feel foreign to chiropractic students as they need strength and endurance in movement patterns they may not have otherwise been exposed to. This may lead to injury while learning manipulative techniques. It is plausible to suggest that the implementation of a strength and conditioning program early in a practitioner’s career could reduce the incidence and progression of injuries. The study aims to test the effectiveness of a strength and conditioning program in reducing the risk of chiropractic students’ acquiring injuries while learning the skill of spinal manipulation. Methods This study will involve a prospective cohort of chiropractic students who are currently learning manual therapy at an undergraduate level. Participants will be eligible for inclusion if they are enrolled in 3rd or 4th-year chiropractic manual therapy units at Murdoch University chiropractic course. The intervention group will follow a 12-week strength and conditioning program comprised of preventative exercises that address each body region previously identified as being prone to injury. The control group will complete a 12-week walking program. The primary outcome is injury rate, measured via a short questionnaire. The secondary outcome will be strength, measured via submaximal strength tests. Discussion The prescribed exercises are aimed at improving the strength and endurance of those muscle groups involved in commonly taught manual therapy tasks. The resistance bands have been chosen as they are inexpensive, simple to implement for the purposes of the study, and acceptably safe. A video format was selected to allow ease of access for participants, provide a detailed description and a visual representation of the exercises to be performed. A questionnaire was designed as a means to assess the influence of the strength and conditioning program on injury rate and the impact this may have on the students’ ability to continue practicing. The International Physical Activity Questionnaire has been chosen to measure the participants level of activity before beginning the exercise program. Conclusion This research protocol will be the first large-scale study to investigate the effectiveness of a strength and conditioning program to reduce injuries within chiropractic students learning manual therapy. Trial registration Australia New Zealand Clinical Trials Registry (ACTRN12617001638325p). Electronic supplementary material The online version of this article (10.1186/s12998-018-0192-0) contains supplementary material, which is available to authorized users.
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Barbalho, M, Gentil, P, Raiol, R, Fisher, J, Steele, J, and Coswig, V. Influence of adding single-joint exercise to a multijoint resistance training program in untrained young women. J Strength Cond Res XX(X): 000-000, 2018-The aim of the present study was to investigate the effects of adding single-joint (SJ) exercises to a multijoint (MJ) resistance training (RT) program on muscle strength and anthropometric measures of young women. Twenty untrained women were divided into a group that performed only MJ exercises or a group that performed both SJ and MJ exercises (MJ + SJ). Before and after 8 weeks of training, the participants were tested for 10 repetition maximum (10RM). Flexed arm circumference and triceps and biceps skinfold thickness were also measured. Both groups significantly decreased biceps (-3.60% for MJ and -3.55% for MJ + SJ) and triceps skinfold (-3.05% for MJ and -2.98% for MJ + SJ), with no significant difference between them. Flexed arm circumference significantly increased in both groups; however, increases in MJ + SJ (4.39%) were significantly greater than MJ (3.50%). Increases in 10RM load in elbow extension (28.2% for MJ and 28.0% for MJ + SJ), elbow flexion (29.8% for MJ and 28.7% for MJ + SJ), and knee extension (26.92% for MJ and 23.86% for MJ + SJ) were all significant and not different between groups. The results showed that adding SJ exercises to an MJ RT program resulted in no benefits in muscle performance or anthropometric changes in untrained women.
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The aim of this study was investigate the effects of transcranial direct current stimulation (tDCS) on volume-load and ratings of perceived exertion. Fifteen young healthy individuals, aged between 20 and 30 years in advanced strength training were recruited. Test and retest of the 10 maximum repetitions (10RM) were performed to determine the reliability of load utilized. Subjects performed three experimental conditions in a randomized, double-blinded crossover design: anodic stimulation (a-tDCS), cathodic stimulation (c-tDCS) and sham (2 mA for 20 minutes targeting the dorsolateral prefrontal cortex cortex left). Immediately after the experimental conditions, subjects completed one set of maximum repetitions with 10RM load (volume-load) and answered to OMNI-RES (Post-stimulation) (level of significance p ≤ 0.05). The volume-load showed main effect for condition (F(2, 28)= 164.801; p<0.001). In post-stimulation, a-tDCS was greater than c-tDCS (p ≤ 0.001), and sham (p ≤ 0.001). For ratings of perceived exertion (OMNI-RES), the results showed main effect for condition (F(2, 28)=9.768; p ≤ 0.05). In post-stimulation, c-tDCS was greater than a-tDCS (p ≤ 0.05), and sham (p ≤ 0.05). We conclude that the use of a-tDCS may promote increased in volume-load for the LP45 exercise. Moreover, higher-volume loads are necessary to maximize muscle strength and anabolism.
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Objective: The aim of the present study was to report pressure pain sensitivity topographical maps of the frontal and dorsal parts of the shoulder region, and locate the pressure pain sensitive areas in breast cancer survivors compared with matched healthy control subjects. Methods: Twenty-two breast cancer survivors (BCS) and 22 matched control subjects participated. A numeric pain rating scale of the neck-shoulder area and pressure pain thresholds (PPTs) was assessed bilaterally over 28 points in the frontal and dorsal neck-shoulder area. Topographical pain sensitivity maps of the upper trapezius, pectoral, and anterior deltoid areas were computed. Results: A three-way analysis of variance was carried out to evaluate the differences in PPTs. The BCS reported spontaneous neck pain (mean ± SD 3.6 ± 2.8), pain in the affected shoulder (4.3 ± 2.7), and pain in the non-affected shoulder (0.9 ± 1.8). Additionally, the BCS exhibited bilaterally lower PPTs in all the measurement points as compared with the control subjects (P < 0.05). The PPTs were lower at the superior part of the trapezius muscle (P < 0.001), the musculotendinous insertion, the anterior part of the deltoid muscle (P < 0.001), and the tendon of the pectoral muscle (P < 0.001) as compared with the control subjects. Conclusions: The results suggest the sensitization processes in the BCS and give preliminary evidence to most sensitive areas in the superior part of the upper trapezius and musculotendinous insertion of the pectoral muscle.
Agreement between two methods of clinical measurement can be quantified using the differences between observations made using the two methods on the same subjects. The 95% limits of agreement, estimated by mean difference 1.96 standard deviation of the differences, provide an interval within which 95% of differences between measurements by the two methods are expected to lie. We describe how graphical methods can be used to investigate the assumptions of the method and we also give confidence intervals. We extend the basic approach to data where there is a relationship between difference and magnitude, both with a simple logarithmic transformation approach and a new, more general, regression approach. We discuss the importance of the repeatability of each method separately and compare an estimate of this to the limits of agreement. We extend the limits of agreement approach to data with repeated measurements, proposing new estimates for equal numbers of replicates by each method on each subject, for unequal numbers of replicates, and for replicated data collected in pairs, where the underlying value of the quantity being measured is changing. Finally, we describe a nonparametric approach to comparing methods.
Muscle strength - the maximal force generating capacity of a muscle or group of muscles - is regularly assessed in physiological experiments and clinical trials. An understanding of the expected variation in strength and the factors that contribute to this variation is important when designing experiments, describing methodologies, interpreting results, and attempting to replicate methods of others and reproduce their findings. In this review (Cores of Reproducibility in Physiology), we report on the intra- and inter-rater reliability of tests of upper- and lower-limb muscle strength and voluntary activation in humans. Isometric, isokinetic, and isoinertial strength exhibit good intra-rater reliability in most samples (correlation coefficients ≥ 0.90). However, some tests of isoinertial strength exhibit systematic bias that is not resolved by familiarization. With the exception of grip strength, few attempts have been made to examine inter-rater reliability of tests of muscle strength. The acute factors most likely to affect muscle strength and serve as a source of its variation from trial-to-trial or day-to-day include: attentional focus, breathing technique, remote muscle contractions, rest periods, temperature (core, muscle), time of day, visual feedback, body and limb posture, body stabilization, acute caffeine consumption, dehydration, pain, fatigue from preceding exercise, and static stretching >60 seconds. Voluntary activation - the nervous system's ability to drive a muscle to create its maximal force - exhibits good intra-rater reliability when examined with twitch interpolation (correlation coefficients > 0.80). However, inter-rater reliability has not been formally examined. Methodological factors most likely to influence voluntary activation are: myograph compliance and sensitivity; stimulation location, intensity, and inadvertent stimulation of antagonists; joint angle (muscle length); and the resting twitch.
Objectives: The aim of the study was to evaluate the effects of a combined aerobic and strength program on physiological and psychological parameters in female breast cancer survivors. Study design: Randomised controlled trial. Methods: 20 patients (age: 45.6 ± 2.7 yrs) surgically treated for breast cancer that had completed all cancer therapies at least 6 months before and with no contraindications to physical activity, were recruited and randomly assigned to an intervention group (n = 10) and a control group (n = 10). Intervention group patients attend to a 24-week combined aerobic and strength training program. Physiological (i.e. VO2max, bioelectrical impedance test, maximal strength of principal muscular groups) and psychological (i.e. functional assessment of chronic illness therapy-fatigue: FACIT-F) parameters were assessed at baseline and after 24 weeks. Results: After 24 weeks the intervention group showed significant improvement in VO2max (38.8%), strength of upper and lower limbs (ranging from 13 to 60%) and decrease in fat mass percentage (-6.3%). The FACIT-F showed significant increase in all of the three scores that can be derived (FACIT-F Trial outcome: 13%; FACT-G total score: 18%; FACIT-F total score: 15%) showing patient's quality of life (QOL) improvement. No significant change in all the parameters was found for the control group. Conclusion: These results show the positive effects of a combined aerobic and strength training program on breast cancer survivors and underline the importance of the early inclusion of structured physical activity in the rehabilitation protocol.
Objective: Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis. Discussion for researchers: There are 10 forms of ICCs. Because each form involves distinct assumptions in their calculation and will lead to different interpretations, researchers should explicitly specify the ICC form they used in their calculation. A thorough review of the research design is needed in selecting the appropriate form of ICC to evaluate reliability. The best practice of reporting ICC should include software information, "model," "type," and "definition" selections. Discussion for readers: When coming across an article that includes ICC, readers should first check whether information about the ICC form has been reported and if an appropriate ICC form was used. Based on the 95% confident interval of the ICC estimate, values less than 0.5, between 0.5 and 0.75, between 0.75 and 0.9, and greater than 0.90 are indicative of poor, moderate, good, and excellent reliability, respectively. Conclusion: This article provides a practical guideline for clinical researchers to choose the correct form of ICC and suggests the best practice of reporting ICC parameters in scientific publications. This article also gives readers an appreciation for what to look for when coming across ICC while reading an article.