The effect of yoga and stabilization exercises on trunk muscle endurance and flexibility in healthy adults

Uvod: Primerno vzdržljive in raztegljive mišice trupa predstavljajo ob ustrezni gibljivosti hrbtenice pomembno komponento sistema stabilnosti hrbtenice in medenice. Z vidika preprečevanja oziroma zmanjšanja tveganja za pojav bolečine v spodnjem delu hrbta se kot učinkoviti kažejo programi telesne vadbe za stabilizacijo hrbtenice in medenice. Na tem raziskovalnem področju se vse pogosteje pojavlja tudi hatha joga, za katero je značilno postopno izvajanje in stopnjevanje vadbe, usmerjeno tudi h krepitvi in uravnoteženju mišične vzdržljivosti ter gibčnosti telesa. Področje preventivnih vadb za krepitev zdravja hrbtenice in medenice je še vedno slabše razvito in raziskano. Namen: Namen doktorskega dela je bil izdelati strokovno in znanstveno utemeljen vadbeni program za izboljšanje in uravnoteženje vzdržljivosti in raztegljivosti mišic trupa ter gibljivosti hrbtenice. Poleg učinkov vadbenega programa so bili v raziskavi primerjani še rezultati novih testov vzdržljivosti mišic trupa, izvedenih na rimski klopi (testi RK), z rezultati uveljavljenih testov, ki jih predlaga avtor McGill (testi MG). Metode dela: Izvedena je bila nerandomizirana nadzorovana raziskava, v kateri so sodelovali zdravi odrasli brez bolečin in poškodb hrbtenice in medenice, ki pred vključitvijo v raziskavo niso izvajali vadb za krepitev mišic trupa in/ali izboljšanje gibčnosti trupa. Raziskava je potekala v dveh delih: (1) primerjava dveh skupin testov vzdržljivosti mišic trupa(2) analiza učinkovitosti vadbenega programa. V drugem delu raziskave so bili preiskovanci razdeljeni v dve skupini: vadbeno (VS), v kateri so 12 tednov, dvakrat na teden po 60 minut, izvajali hatha jogo, stopnjevano po načelih segmentne stabilizacije hrbtenice in medeniceali v primerjalno skupino (PS), v kateri so bili naprošeni, da med raziskavo ohranijo svoj trenutni življenjski slog. Ob vključitvi v raziskavo (PRED) in po končanem obdobju vadbe (PO) je bila testirana vzdržljivost in raztegljivost mišic trupa ter gibljivost prsno-ledvenega dela hrbtenice. V prvem delu raziskave je bila izvedena statistična analiza primerljivosti testov MG in RK, v drugem pa kvantitativna analiza sprememb merjenih spremenljivk (analiza PRED in PO, primerjava VS in PS) in analiza povezanosti teh sprememb z izbranimi značilnostmi življenjskega sloga preiskovancev. Rezultati: Testiranja vzdržljivosti mišic trupa s testi MG in RK se je udeležilo 68 preiskovancev (stari 31,9 (7,2) leta). Čas zadrževanja testnega položaja je bil pri treh od štirih testov RK pomembno daljši (p < 0,001) kot pri testih MG, izračuni razmerij vzdržljivosti so bili med MG in RK primerljivi (z izjemo razmerja med fleksorji in ekstenzorji trupap < 0,001), dva od treh testnih položajev RK sta bila ocenjena kot nekoliko manj naporna kot testa MG (p ? 0,001). V drugem delu raziskave je sodelovalo 72 preiskovancev (nVS = 36, stari 32,2 (6,8) letanPS = 36, stari 29,9 (7,8) leta). Preiskovanci VS so ob koncu dosegli statistično značilno boljšo vzdržljivost vseh testiranih mišic trupa (p < 0,01) ter razmerje med fleksorji in ekstenzorji trupa (p = 0,005). Izboljšala se je raztegljivost m. iliopsoas (p ? 0,001) in rezultat testa V-doseg sede (p = 0,001) ter gibljivost prsno-ledvenega dela hrbtenice (p < 0,05). V PS se je rezultat testa V-doseg sede pomembno (p = 0,031) poslabšal, druge spremembe v PS niso bile statistično značilne. Med skupinama VS in PS so bile statistično značilne razlike ugotovljene le pri testu V-doseg sede (p = 0,032) in rotacijah hrbtenice (p = 0,036). Večina sprememb merjenih spremenljivk je bila povezana le z udeležbo v vadbenem programu (p < 0,05), pri drugih značilnostih življenjskega sloga pa se kaže le nekaj posameznih povezanosti. Razprava in sklep: Testi RK kažejo nekatere primerljive značilnosti s testi MG, pri določenih značilnostih pa so se testi RK izkazali za boljše in uporabnejše. S hatha jogo, stopnjevano po načelih segmentne stabilizacije hrbtenice in medenice, lahko pomembno izboljšamo vzdržljivost mišic trupa ter nekatera razmerja njihove vzdržljivosti, raztegljivost nekaterih mišic ter gibljivost prsno-ledvenega dela hrbtenice. V prihodnje bi bilo smiselno spremljanje dolgoročnih učinkov predlaganega vadbenega programa na večjem vzorcu preiskovancev.Introduction: Adequate trunk muscle endurance and extensibility as also adequate spine mobility are considered to be an important components of the spine and pelvis stabilizing systemtherefore, a dysfunction in any of the above components increases the risk of low back pain or injury occurrence. To prevent or reduce the risk of low back pain occurrence, lumbopelvic stabilization exercises are shown to be effective, and also hatha yoga practice is increasingly appearing in the prevention research. In hatha yoga, exercises are gradually escalated, aims at improving and balancing the muscular endurance and body flexibility. Little prevention research on trunk muscle endurance and flexibility training exists. Purpose: The purpose of the doctoral thesis was to create a professional and scientifically based exercise program to improve and balance the trunk muscle endurance and extensibility as also the spine mobility. Furthermore, the objective of this study was also to verify if two groups of trunk muscle endurance tests show comparable results. Methods: A non-randomized control study was conducted. Participants were healthy adults without low back pain and injuries, who did not perform exercises to improve the trunk muscles endurance and/or flexibility before entering the study. The study was conducted in two phases: 1) comparison of two groups of trunk muscle endurance tests (standard tests as proposed by McGill (MG tests) vs alternative tests, performed at 45 degrees Roman chair (RC tests)2) the proposed exercise program effectiveness analysis. In phase 2, participants were divided into two groups: exercise group (EG), performed hatha yoga exercise program graded by the segmental stabilization of the spine and pelvis model (12 weeks, twice a week for 60 minutes)or control group (CG), in which participants were asked to maintain their current lifestyle during the study period. Upon inclusion in the study (PRE) and after the exercise period (POST), the trunk muscle endurance and extensibility as also the thoracolumbar spine mobility were measured. A statistical analysis of MG and RC tests comparison was performed in phase 1. The analysis of the measured variables changes (PRE-POST analysis, EG-CG comparison) and the association of those changes with the selected characteristics of the participants\u27 lifestyle (multiple regression analysis) were analysed in phase 2. Results: Sixty-eight subjects (aged 31.9 (7.2) years) participated in the study phase 1. As compared to MG tests, holding time was significantly (p < 0.001) longer in three of four RC tests, the calculations of endurance ratios were comparable in MG and RC (with the exception of the FL:EX ratiop < 0.001), and two of three test positions in RC tests were evaluated as slightly easier to perform than tests MG (p ⡤ 0.001). Seventy-two subjects (nEG = 36, aged 32.2 (6.8) yearsnCG = 36, aged 29.9 (7.8) years) participated in the study phase 2. After the exercise program, EG participants had a significantly better results in trunk muscles endurance (p < 0.01) and better FL:EX ratio (p = 0.005). The iliopsoas muscle extensibility (p ⡤ 0.001), V-Sit and Reach Test (p = 0.001) and the thoracolumbar spine mobility (p < 0.05) improved significantly in EG. The result of the V-Sit and Reach Test worsened significantly (p = 0.031) in CG, other changes in CG were not significant. Between both groups, significant differences were found only in the V-Sit and Reach Test (p = 0.032) and spine rotations (p = 0.036). Most of the changes in the measured variables were associated with participation in the exercise program (p < 0.05), while only a few individual associations were associated with other lifestyle characteristics. Discussion and conclusion: RC tests revealed some comparable characteristics and some potentially more feasible characteristics as tests MG. Hatha yoga practice, graded by segmental stabilization exercise model, results in significant improvement of trunk muscle endurance and some of their endurance ratios, improvement of the some muscle extensibility and the thoracolumbar spine mobility. In the future, the long-term effects of the proposed exercise program should be studied on a larger sample of subjects