Flexion Rotation Trunk Test To Assess Abdominal.19

FLEXION-ROTATION TRUNK TEST TO ASSESS
ABDOMINAL MUSCLE ENDURANCE: RELIABILITY,

LEARNING EFFECT, AND SEX DIFFERENCES
Downloaded from http://journals.lww.com/nsca-jscr by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCyw
EVARISTO BROTONS-GIL, MARIA P. GARCÍA-VAQUERO, NOELIA PECO-GONZÁLEZ, AND

CX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 09/15/2024
FRANCISCO J. VERA-GARCIA
Sports Research Center, Miguel Hernandez University of Elche, Elche, Alicante, Spain
ABSTRACT familiarization period before testing (at least 3 trials of prac-

Brotons-Gil, E, Garcı́a-Vaquero, MP, Peco-González, N, tice) to make learning effect negligible.
and Vera-Garcia, FJ. Flexion-rotation trunk test to assess KEY WORDS assessment, muscular fitness, spine, health
abdominal muscle endurance: Reliability, learning effect,
and sex differences. J Strength Cond Res 27(6): 1602–
INTRODUCTION
T
1608, 2013—Trunk endurance tests are generally performed
in sagittal or frontal plane. However, trunk field tests that he functional importance of the trunk musculature
measure the endurance of the rotator muscles are lacking. in performing thorax and pelvis movements (flex-
In view of this situation, we developed a flexion-rotation trunk ion, extension, bending, and twisting) and control-
test (FRT test) to assess the oblique abdominal muscle ling the stability of the spine against internal and
external forces (21,32,33), and the interest of many coaches
endurance. This new field test consists mainly in performing
and practitioners in training core/trunk stability to prevent
the maximum number of upper trunk flexion and rotation
low-back and lower-extremity injuries in athletes (12), have
movements (reps) possible in 90 seconds. The objectives
given rise to the development of a variety of tests to assess
of this study were to analyze the FRT test reliability and to the functions of these muscles in different settings inside and
examine the effect of both the repetition and sex on test outside the laboratory.
results. Fifty-one recreationally trained men (n = 35) and The assessment of trunk stability in field setting is very
women (n = 16) completed 4 trials of the FRT test (T1, T2, complex because it requires the combination of different
T3, and T4), separated by 7 days each. The scores increased measures, for example, trunk muscle strength and endurance
significantly between T1 and T3 (p , 0.001), showing a clear tests (3,6,20,28), lumbopelvic posture control assays (16,28,29).
learning effect, but the increase between T3 and T4 was only The use of trunk endurance field tests has become very pop-
4.25% (p = 0.108). The intraclass correlation coefficients ular, because trunk endurance has been identified as an impor-
(ICCs) between trials were $0.83 and the standard errors tant muscle capability for low-back health (1,17,18,20) and the
protocols are simple and relatively inexpensive. Most of the
of measurement (SEMs) #7.54 reps. The ICCs between tri-
trunk endurance tests evaluate the endurance of the flexor,
als increased, and SEMs decreased with test repetition,
extensor, or lateral bending muscles (3,6,20). However, we
reaching an ICC of 0.94 and an SEM of 6.46 reps between
have no knowledge of field tests that measure the endurance
T3 and T4. The comparison between sexes showed a higher of the trunk rotator muscles (e.g., oblique muscles).
abdominal endurance in men when compared with that in In throwing and striking sports (tennis, handball, hockey,
women (p = 0.003), and also a higher learning effect in golf, etc.), the trunk rotator muscle endurance is important
men, especially at the beginning of the study. These findings for both performance and the spine safety, because
suggest that, the FRT test is a reliable field protocol that muscular fatigue can hinder coordination, postural control,
differentiates between the abdominal endurance of men and and spine stability (8,19,27,31). In addition, a mechanical
women. However, it is necessary to perform an extensive study that analyzed the response of the trunk to loading in
different directions (32) found that participants had more
problems maintaining trunk stability under twisting torque
when compared with sagittal torque. Therefore, it is nec-
Address correspondence to Dr. Francisco J. Vera-Garcia, [email protected]. essary to develop new and reliable protocols to measure the
27(6)/1602–1608 function of the trunk rotator muscles in sport, fitness, phys-
Journal of Strength and Conditioning Research ical education, etc. Interestingly, although trunk rotation
Ó 2013 National Strength and Conditioning Association exercises are common in core training programs (e.g.,
the TM
1602 Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
the TM
Journal of Strength and Conditioning Research | www.nsca.com
this study was to examine the

FRT test reliability in field set-
tings (schools, fitness centers,
clinics, etc.). Because the repe-
tition of the protocol may
cause variations in the tech-
nique and cadence of the exe-

cution, which may improve the
test results, the learning or
training effect (9) was also ana-

lyzed throughout 4 testing ses-
sions. In addition, the
sensitivity of the FRT test to
compare the abdominal endur-
ance between men and women
was also assessed, given the
fact that in previous studies
men have obtained better re-
sults than women have in
dynamic abdominal endurance
tests (7,26,34).
METHODS
Experimental Approach to
the Problem
As commented before, trunk
Figure 1. Flexion-rotation trunk test consists of performing the maximum number of upper trunk flexion-rotation
muscle endurance measure-
movements possible in 90 seconds. A lateral view (A) and a posterior view (B) of the initial position (1) and of the
flexion-rotation position (2) of a test repetition are shown in these images. ments are usually part of the
evaluation of the trunk stability
(2,28), and their results could
cross-curl-up or cross-crunch, consisting in twisting and be used to establish risk factors related to low-back health
flexing the upper trunk simultaneously while lying in (1,17,18,20). Although there are different flexor, extensor,
supine) (11,15,35), the protocols used to measure the and lateral bending endurance tests (3,6,20), the FRT field
endurance of the oblique abdominal muscles are generally test allows us to evaluate the endurance of the rotator
based on trunk flexion motions without rotation, for muscles using a simple and fast protocol that does not need
example, timed (60–120 seconds) or cadence (20–30 rep- expensive equipment and is easy to use in sport, fitness ses-
etitions per minute) curl-up tests performed in supine: sions, and physical education classes. Because rotation in the
Partial Curl-Up Test (7,10,22,25,26), and Bench Trunk standing or sitting position with no external resistance gen-
Curl Test (13,14,35). erates low-moderate trunk activation levels (35), we devel-
In view of this situation, we developed a flexion-rotation oped a timed protocol in lying supine based on performing
trunk test (FRT test) to measure the abdominal muscle the maximum number of flexion-rotation movements (i.e.,
endurance through movements that combine trunk rotation cross-curl-ups) possible in 90 seconds (Figure 1). The sub-
and flexion in lying supine (Figure 1). The main purpose of ject’s score was the number of repetitions accomplished by
the subject in the 90-second
test administration. This dura-
tion was established based on
the study carried out by Knud-
TABLE 1. Mean and SD of the participant’s age, mass, and height.
son and Jhonston (14), compar-
n Age (y) Mass (kg) Height (cm) ing 3 different Bench Trunk
Curl Test durations (60, 90,
All participants 51 23.20 6 4.07 71.46 6 11.57 174.57 6 7.59 and 120 seconds) to evaluate
Men 35 23.97 6 4.45 77.75 6 7.57 178.46 6 4.66
Women 16 21.56 6 2.53 58.50 6 6.36 166.31 6 5.80 abdominal muscle endurance.
In this study, it was concluded
that unlike the 60-second test,
which according to the authors
VOLUME 27 | NUMBER 6 | JUNE 2013 | 1603
Flexion Rotation Trunk Test
the day for each participant

(between noon and 2:00 PM).
The trials were performed in
an acclimatized fitness room
(18–228 C) at the University
during the first 3 months of
the year. The participants were

encouraged to not change their
regular activity level at that
moment throughout the study

(mainly in relation to the trunk
muscles), to not perform a
workout session at least 15
hours before each recording
session, and to maintain a good
Figure 2. To standardize the location of the experimenter’s fists during the flexion-rotation trunk test, the
experimenter introduced the thumbs behind the subject’s knees. These images show the placing of the sleep routine and to not eat and
experimenter’s hands before (A) and after (B) introducing the thumbs behind the participant’s knees. drink excessively before testing.
Seven days before the first
trial, there was a familiarization
measures muscle power, the 90-second test showed a higher session in which the subjects were informed of the test
correlation with the 120-second test (r = 0.88; p = 0.01). execution rules and the recording schedule. In this session,
Based on these data, in timed curl-up tests, 90- or 120-sec- the participants did not perform the test, but they only
ond durations seem to be more adequate to measure abdom- carried out 10 repetitions to familiarize with the basic
inal endurance than 60-second duration; therefore, looking technique of the test.
for a higher time economy, we decided to use 90 seconds as
the duration for the FRT test. Test Description
Our main purposes in this investigation were to assess the As mentioned above, the FRT protocol is a timed cross-curl-
relative and absolute reliability (36) of the FRT test and to up test that consists of performing the maximum number of
know the number of trials needed to make learning effect trunk flexion and rotation movements possible in 90
negligible (9) before using the test in field settings. As Hop- seconds. To carry out the test, the subject was placed in
kins stated in a review of measures of reliability in sports a supine position on a semirigid mat, resting the sole of the
medicine and science (9), reasonable precision for estimates feet on the floor, with legs together and a knee flexion of 908
of reliability requires studies with approximately 50 partici- (Figure 1). A manual goniometer (Comed, Strasbourg,
pants and at least 3 administrations of the test. In this study, France) was used to standardize the knee position in each
we used a longitudinal design in which 51 volunteers per- subject and trial. The back and head were rested on the floor
formed the FRT test 4 times, separated by 7 days each. This and the arms were stretched out over the trunk, with the
allowed us to analyze both the consistency of the FRT test hands resting on the thighs, overlapping, with both thumbs
scores and the learning effect. interlocked. An experimenter held the subject’s knees in the
aforementioned position (Figure 1) and helped to avoid the
Subjects
modification of the lower limb position during the execution
Seventy volunteers initially took part in the study, of which 51
of the test. For this, the experimenter was kneeling at the feet
(35 men and 16 women) completed the 4 recording sessions
of the subject, pressing with the fists on the outer side of
(Table 1). The subjects were informed of the experimental
subject’s knees (Figure 2).
risks and signed an informed consent form before the inves-
In each repetition, the subject first carried out a trunk
tigation. Approval for the investigation was provided by the
flexion rotation until he or she touched with his or her hands
Ethic Committee of the University. People with known med-
the outer side of one of the experimenter’s fists (fifth knuckle;
ical problems, histories of spinal, shoulder or hip surgery, or
Figure 1), and then the counteraction, this is to say, the
episodes of back pain requiring treatment 12 months before
subject returned to the initial position, until he or she
this study were excluded. All the subjects were recreational
touched the mat with his or her head. During the execution
physically active, participating in aerobic, strength, and sport
of the test, the subject performed twists to one side and the
training with a workout frequency of 2–5 d$wk21.
other consecutively. Only those repetitions that were per-
Procedure formed correctly were counted, that is, those in which the
After a measurement schedule, each participant executed the hands touched the external side of the fist in the lifting of the
FRT test in 4 different sessions (T1, T2, T3, and T4), trunk, and in which the head touched the mat in the lower-
separated by 1 week each and conducted at the same time of ing of the trunk (Figure 1). The subject was not encouraged
the TM
the TM
51 0.83(0.72–0.90) 0.91(0.85–0.95) 0.94(0.89–0.96) 35 0.87(0.76–0.93) 0.89(0.80–0.95) 0.93(0.86–0.96) 16 0.63(0.20–0.85) 0.88(0.69–0.96) 0.93(0.81–0.98)

TABLE 2. The ICC with 95% CI, SEM, and pairwise comparisons between mean scores (Bonferroni post hoc) throughout the recording sessions (T1, T2, T3,
T3–T4
4.24
3.28
1.00
0.012
T2–T3
4.60
11.95
Women
Figure 3. Mean and SD of the participant’s flexion-rotation trunk test

T1–T2
scores (n = 51) in 4 trials (T1, T2, T3, and T4), separated by 7 days
7.44
4.22
1.00
each.
16
16
16
n
during testing. In addition, he or she was neither instructed

about the most efficient performance cadence nor informed
about his or her FRT test scores.
T3–T4
0.044
7.27
4.60
Statistical Analyses
All analyses were performed with SPSS version 20.0 (SPSS
*ICC = intraclass correlation coefficient; CI = confidence interval; SEM = standard error of measurement.
Inc., Chicago, IL, USA). Standard statistical methods were

used to calculate the mean and the SD of the FRT test scores
,0.000
T2–T3
7.65
9.59
(abdominal endurance) for each trial and sex. The relative

Men
intrarater reliability of the measure was determined using an

intraclass correlation coefficient (ICC; 2-way random effects
model). In addition, the absolute intrarater reliability was ana-
,0.000
T1–T2
lyzed by calculating the standard error of measurement

6.70
16.28
(SEM). The SEM was expressed both as number of repeti-

tions (SEM = SD of the difference scores between 2 trials/O2)
and as percentage of the mean value of the measurements
35
35
35
n
(SEM = mean of the difference scores between 2 trials 3

100/mean of the first trial). To analyze the changes in the
T3–T4
0.108
6.46
4.25
All participants
,0.000
T2–T3
6.79
10.21
,0.000
T1–T2
7.54
12.87
51
51
51
n
(repetitions)
ICC(95% CI)
SEM (%)
and T4).*
p Value
SEM
Figure 4. Mean and SD of men’s (n = 35) and women’s (n = 16)

flexion-rotation trunk test scores in 4 trials (T1, T2, T3, and T4),
separated by 7 days each.
reliability measures over time, separate calculations of ICC and a higher learning effect in men, especially at the beginning of
SEM were performed on consecutive pairs of trials: T1–T2, the study.
T2–T3, and T3–T4. A comprehensive review on the quanti- In relation to the reliability analyses (Table 2), the high
fication and use of ICC and SEM to assess relative and abso- ICCs (0.83–0.94) and the low SEMs (12.87–4.25%) obtained
lute reliability has been previously presented by Hopkins (9) between the different recording sessions show the high rela-
and Weir (36). Finally, an analysis of variance (ANOVA) with tive and absolute consistency of the measurements. The SEMs
repeated measures was calculated to assess the learning effect of the FRT test were similar (7,34) or even lower (7,22) to
throughout the trials (T1, T2, T3, and T4) and to explore the those found in previous abdominal endurance tests. In addi-
differences between sexes. Where applicable, post hoc analy- tion, the ICCs were similar to those obtained in other studies
ses were performed using the Bonferroni test. An alpha level of during trunk endurance field tests reliability analysis. Most
0.05 was considered significant for all analyses. field tests in the literature show ICCs .0.75: (a) dynamic
trunk flexion tests, for example, the Bench Trunk Curl Test
RESULTS with an ICC .0.79 (13,34) and the Partial Curl-Up Test with
Table 2 shows the absolute and relative reliability analysis an ICC .0.88 (10,22,25); (b) isometric trunk flexion tests,
results, along with the changes in the mean scores (Bonfer- such as the Flexor Endurance Test with an ICC .0.93
roni post hoc) of the FRT test across the trials. The ICCs (3,6,20); (c) isometric trunk extension tests, such as the
obtained between trials increased with the repetition of the Biering-Sorensen Test with an ICC .0.75 (3,5,6,20,30); and
test, in both the total sample and the men and women (d) isometric lateral flexion tests, such as the Side Bridge Test
groups. In the same way, SEMs tended to reduce throughout with an ICC .0.76 (3,20). However, it is difficult to establish
the study, reaching values of 7.27 repetitions for men and direct comparisons between studies because the ICC is sensi-
4.24 repetitions for women between T3 and T4. tive to the between-subject variability (9,36).
The ANOVA found significant differences for the FRT test The FRT test allows a reliable assessment of the flexor-
mean scores between trials (p , 0.001; h2 = 0.48): T1 = 70.8 6 rotator muscle endurance via a simple protocol that can be
15.4 repetitions; T2 = 79.9 6 20.1 repetitions; T3 = 88.1 6 easily applied outside the laboratory. Nevertheless, as pre-
24.0 repetitions; T4 = 91.8 6 26.1 repetitions (Figure 3). The sented in Figure 3, the test scores increased throughout the
number of repetitions obtained in the FRT test increased study, showing a clear learning effect that must be taken into
12.87% from T1 to T2 (p , 0.001) and 10.21% from T2 to account before using it in field settings. Improvements of the
T3 (p , 0.001). On the contrary, the increase between T3 and FRT test scores across the longitudinal study may have
T4 was low (4.25%) and not significant (p = 0.108). occurred because of changes in the technique and the cadence
In Figure 4, we can see the mean and SD of the results of test execution during the first recording sessions. It is also
obtained in the test for both sexes. The ANOVA showed probable that these improvements were related with motiva-
a higher abdominal endurance in men than in women (p = tion (9), as although we did not inform the individual of the
0.003; h2 = 0.17). Results in men increased between all the test score, he or she was able to count the number of repeti-
trials, although the increase in the number of repetitions from tions performed, in an attempt to improve his or her perfor-
T3 to T4 was only 4.60% (p = 0.044). On the other hand, the mance or beat his or her peers in future recordings.
increase in women was significant from T2 to T3 (p = 0.012), Interestingly, there seems to be an asymptotic function
but not between T1 and T2 or between T3 and T4 (Table 2). between trials and scores in the FRT test (Figures 3 and 4),
because the increase in the test scores along the 4 trials
DISCUSSION reduced progressively until the differences between T3 and
Although trunk muscle function should be assessed and T4 were very small (men: 4.60%, p = 0.044; women: 3.28%,
trained in all planes of motion for multidirectional compe- p = 1.00). According to these data, it would be necessary to
tence (12), field tests that measure the trunk rotator endur- perform the FRT test at least 3 times for the results to be
ance in the horizontal plane are lacking. The objective of this consistent and in this way control the learning effect of the
study was to analyze the reliability of a new field test, the test. We cannot establish direct comparisons between our
FRT test, based on the repetition of trunk flexion-rotation results and those of previous studies, because most researches
movements in lying supine, and also to examine the effect of that have analyzed the reliability of field tests measuring trunk
repetition and sex on test results. The data obtained in this muscle endurance only carried out 2 trials (test-retest), with
study indicate that the reliability of the test is good, but this the exception of studies such as those of Moreland et al. (22)
reliability depends on the number of times the test is or Cowley et al. (4), in which subjects performed 3 trials.
repeated, because throughout the recording sessions, abso- When comparing the FRT test results between sexes
lute and relative consistency of measurements increased and (Figure 4), we found higher trunk flexor-rotator endurance in
learning effect of the test (i.e., difference in mean scores men than in women (p = 0.003). Previous studies that used
between trials) reduced considerably. In addition, the com- dynamic trunk flexion tests to measure the abdominal endur-
parison between sexes showed a higher abdominal endurance also found these differences in favor of the men
ance in men when compared with that in women and also (7,26,34). But when isometric trunk flexion tests were used,
the TM
the TM
no differences between sexes were found (6,20). Other stud- one member of each pair would perform the test first (per-
ies that analyzed the effect of sex on performance in the Side forming partner), with the help of the other member of the
Bridge Test (trunk lateral flexion isometric endurance test) pair (testing partner), who would hold the legs of his or her
also found differences favoring the men (6,20). On the other partner and count the repetitions performed correctly; (b)
hand, the studies carried out with the Biering-Sorensen Test then, the roles would be inverted. Because the FRT test
(trunk extensor isometric endurance test) found differences duration is very short (90 seconds), a whole group or team
favoring women in studies of nonathletes (20) and similar could be measured in a few minutes. Nevertheless, because
results between men and women in studies with athletes (6). of the learning effect observed in this study, mainly in the
According to those studies, there seems to be an interaction group of men, it is advisable to perform an extensive famil-
between sex and training level that may modulate perfor- iarization period before testing (at least 3 trials of practice) to
mance in this type of field tests. Future studies should ana- make learning effect negligible.
lyze the results obtained by men and women in different
sports and with different training levels in the FRT test, ACKNOWLEDGMENTS
especially in sports in which the endurance of the trunk The authors wish to thank the University students who took
flexor-rotator muscles is important (e.g., tennis, judo). part in this study. This research was made possible by the
The differences between sexes were not only reduced to the financial support of Ministerio de Ciencia e Innovación
test scores but also to the increase in the results throughout (DEP2010-16493) and Generalitat Valenciana (ACOMP/
the 4 trials. Especially, it is worth pointing out the differences 2011/130), Spain.
between men and women when comparing T1 and T2, in
which we can see that men improved their scores in the
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FLEXION-ROTATION TRUNK TEST TO ASSESS

ABDOMINAL MUSCLE ENDURANCE: RELIABILITY,

EVARISTO BROTONS-GIL, MARIA P. GARCÍA-VAQUERO, NOELIA PECO-GONZÁLEZ, AND

ABSTRACT familiarization period before testing (at least 3 trials of prac-

1602 Journal of Strength and Conditioning Research

Journal of Strength and Conditioning Research | www.nsca.com

this study was to examine the

nique and cadence of the exe-

training effect (9) was also ana-

VOLUME 27 | NUMBER 6 | JUNE 2013 | 1603

the day for each participant

the year. The participants were

moment throughout the study

1604 Journal of Strength and Conditioning Research

Journal of Strength and Conditioning Research | www.nsca.com

51 0.83(0.72–0.90) 0.91(0.85–0.95) 0.94(0.89–0.96) 35 0.87(0.76–0.93) 0.89(0.80–0.95) 0.93(0.86–0.96) 16 0.63(0.20–0.85) 0.88(0.69–0.96) 0.93(0.81–0.98)

Figure 3. Mean and SD of the participant’s flexion-rotation trunk test

during testing. In addition, he or she was neither instructed

Inc., Chicago, IL, USA). Standard statistical methods were

(abdominal endurance) for each trial and sex. The relative

intrarater reliability of the measure was determined using an

lyzed by calculating the standard error of measurement

(SEM). The SEM was expressed both as number of repeti-

(SEM = mean of the difference scores between 2 trials 3

Figure 4. Mean and SD of men’s (n = 35) and women’s (n = 16)

VOLUME 27 | NUMBER 6 | JUNE 2013 | 1605

1606 Journal of Strength and Conditioning Research

Journal of Strength and Conditioning Research | www.nsca.com

VOLUME 27 | NUMBER 6 | JUNE 2013 | 1607

1608 Journal of Strength and Conditioning Research

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