The effects of maximal and submaximal arm crank ergometry and cycle ergometry on postural sway


Hill, M.W.; Goss-Sampson, M.; Duncan, M.J.; Price, M.J.

European Journal of Sport Science 14(8): 782-790

2015


Abstract This study aimed to determine whether arm crank ergometry (ACE) disturbed postural sway to the same extent as cycle ergometry (CE). Nine healthy, none specifically trained adults undertook posturographic tests before and after five separate exercise trials consisting of: two incremental exercise tests to exhaustion for ACE and CE to examine postural sway responses to maximal exercise and to determine peak power output (W max); two subsequent tests of 30 min duration for ACE and CE at a relative workload corresponding to 50% of the ergometer-specific W max (ACErel; 53 ± 8 W and CErel; 109 ± 16 W). A final CE trial was performed at the same absolute power output (CEabs) as the submaximal ACE trial to match absolute exercise intensity (i.e., 53 ± 8 W). The centre of pressure (COP) displacement was recorded using a force platform before, immediately after exercise and during a 30-min recovery period. ACE had no effects on postural sway (P > 0.05). An increase in mediolateral COP displacement was observed following maximal CE only (P = 0.001), while anteroposterior COP displacement and COP path length increased following maximal and submaximal CE (P < 0.05). These differences in postural sway according to exercise mode likely stem from the activity of postural muscles when considering that CE recruits lower limb muscles involved in balance. This study provides evidence of an exercise mode which does not elicit post-exercise balance impairments, therefore possesses applications to those at an increased risk of falling.

European
Journal
of
Sport
Science,
2014
Vol.
14,
No.
8,
782-790,
http://dx.doi.org/10.1080/17461391.2014.905985
1)
Routledge
.
1
11
Taylor
&Francis
Group
ORIGINAL
ARTICLE
The
effects
of
maximal
and
submaximal
arm
crank
ergometry
and
cycle
ergometry
on
postural
sway
MATHEW
W.
HILL',
MARK
GOSS-SAMPSON
2
,
MICHAEL
J.
DUNCAN
3
,
&
MICHAEL
J.
PRICE
3
'Sport,
Exercise
and
Life
Sciences,
School
of
Health,
University
of
Northampton, Northampton,
UK,
2
Centre
for
Sport
and
Exercise
Sciences,
The
University
of
Greenwich
at
Medway,
Kent,
UK,
3
Department
of
Biomolecular
and
Sport
Sciences,
Faculty
of
Health
and
Life
Sciences,
Coventry
University,
Coventry,
UK
Abstract
This
study
aimed
to
determine
whether
arm
crank
ergometry
(ACE)
disturbed
postural
sway
to
the
same
extent
as
cycle
ergometry
(CE).
Nine
healthy,
none
specifically
trained
adults
undertook
posturographic
tests
before
and
after
five
separate
exercise
trials
consisting
of:
two
incremental
exercise
tests
to
exhaustion
for
ACE
and
CE
to
examine
postural
sway
responses
to
maximal
exercise
and
to
determine
peak
power
output
(W
max
);
two
subsequent
tests
of
30
min
duration
for
ACE
and
CE
at
a
relative
workload
corresponding
to
50%
of
the
ergometer-specific
W
max
(ACE
re
i;
53
±
8
W
and
CE
re
i;
109
±
16
W).
A
final
CE
trial
was
performed
at
the
same
absolute
power
output
(CE
a
b
s
)
as
the
submaximal
ACE
trial
to
match
absolute
exercise
intensity
(i.e.,
53
±
8
W).
The
centre
of
pressure
(COP)
displacement
was
recorded
using
a
force
platform
before,
immediately
after
exercise
and
during
a
30-min
recovery
period.
ACE
had
no
effects
on
postural
sway
(P
>
0.05).
An
increase
in
mediolateral
COP
displacement
was
observed
following
maximal
CE
only
(P
=
0.001),
while
anteroposterior
COP
displacement
and
COP
path
length
increased
following
maximal
and
submaximal
CE
(P
<
0.05).
These
differences
in
postural
sway
according
to
exercise
mode
likely
stem
from
the
activity
of
postural
muscles
when
considering
that
CE
recruits
lower
limb
muscles
involved
in
balance.
This
study
provides
evidence
of
an
exercise
mode
which
does
not
elicit
post-
exercise
balance
impairments,
therefore
possesses
applications
to
those
at
an
increased
risk
of
falling.
Keywords:
Muscle
fatigue,
upper
body,
posture,
elderly,
balance
control,
exercise
Introduction
The
ability
to
maintain
and
control
bipedal
stance
is
an
essential
prerequisite
for
many
physical
and
daily
activities,
such
as
gait
initiation
and
reaching
tasks
(Lepers,
Bigard,
Diard,
Gouteyron,
&
Guezennec,
1997).
Maintaining
postural
control
during
quiet
standing
has
long
been
known
to
be
a
complex
process
of
positional
adjustments
of
the
muscles
acting
over
joints
of
the
lower
extremity
and
is
controlled
by
the
integration
of
afferent
information
from
visual,
vestibular
and
proprioceptive
informa-
tion
within
the
central
nervous
system
(Enoka,
2008).
There
are
also
indications
that
afferent
input
from
the
upper
extremity
plays
an
important
role
in
the
control
of
upright
stance
as
evidenced
by
an
increase
in
postural
sway
following
localised
muscle
fatigue
of
the
neck
(Schieppati,
Mardone,
&
Schmid,
2003),
deltoids
(Nussbaum,
2003)
and
the
trunk
extensors
(Vuillerme,
Anziani,
&
Rougier,
2007).
Postural
control
may
not
only
be
important
for
daily
activities,
but
also
for
sporting
activities
(Adler-
ton,
Moritz,
&
Moe-Nilssen,
2003).
Several
studies
have
reported
that
exhaustive
exercise,
such
as
a
maximal
oxygen
uptake
test
on
a
cycle
ergometer
(CE),
impairs
the
ability
to
minimise
postural
sway
during
quiet
bipedal
stance
(Gauchard,
Gangloff,
Vouriot,
Mallie,
&
Perrin,
2002;
Mello,
de
Oliveira,
&
Nadal,
2010).
However,
at
submaximal
intensities
the
effects
of
exercise
are
less
clear.
For
example,
no
Correspondence:
M.
W.
Hill,
Sport,
Exercise
and
Life
Sciences,
School
of
Health,
University
of
Northampton,
Boughton
Green
Road,
Northampton
NN2
7AL,
UK.
E-mail:
Mathew.hill@northampton.ac.uk
2014
European
College
of
Sport
Science
Arm
crank
ergometry
and
cycle
ergometry
on
postural
sway
783
changes
in
post-exercise
postural
sway
are
observed
when
CE
corresponds
to
60%
of
maximal
heart
rate
(HR;
Nardone,
Tarantola,
Giordano,
&
Schieppati,
1997)
or
70%
of
ventilator
threshold
(Mello,
de
Oliveira,
&
Nadal,
2010).
However,
disturbances
are
observed
when
CE
is
performed
at
50%
of
maximal
aerobic
power
(Demura
&
Uchiyama,
2009)
or
at
200
W
(Vuillerme
&
Hintzy,
2007).
Fatiguing
exer-
cise,
which
utilises
the
lower
body
musculature,
deteriorates
the
quality
of
sensory
proprioceptive
information
and/or
integration
(Paillard,
2012)
and
also
decreases
muscular
system
efficiency
(Nardone
et
al.,
1997),
thus
disturbing
postural
sway
post-
exercise.
Furthermore,
while
treadmill
and
CE
exercise
have
been
examined,
little
information
exists
for
arm
exercise.
Arm
crank
ergometry
(ACE)
training
elicits
improved
walking
distance
in
patients
with
reduced
lower
body
exercise
capacity
(Tew,
Nawaz,
Zwierska,
&
Saxton,
2009;
Zwierska
et
al.,
2006)
and
as
such
this
mode
of
exercise
may
have
other
important
applications.
For
example,
ACE
and
CE
have
been
shown
to
elicit
a
similar
improvement
in
both
specific
(trained
muscles)
and
cross
transfer
(untrained
muscles)
effects
following
training
in
both
young
(Loftin,
Boileau,
Massey,
&
Lohman,
1988)
and
older
adults
(Pogliaghi,
Terziotti,
Cevese,
Bales-
treri,
&
Schena,
2006).
On
a
practical
standpoint,
this
work
has
demonstrated
that
ACE
could
poten-
tially
be
an
effective
alternative
form
of
exercise
for
healthy
adults.
Upper
body
exercise
may
subse-
quently
provide
an
effective
training
stimulus
with-
out
fatiguing
the
lower
limbs
and
increasing
the
risk
of
falls
immediately
following
exercise
which
would
have
applications
for
elderly
and
clinical
groups.
Research
concerning
the
effects
of
ACE
on
pos-
tural
sway
has
provided
less
clear
findings
than
those
reported
for
CE.
For
example,
Douris
et
al.
(2011)
observed
a
greater
increase
in
single
limb
postural
sway
following
maximal
aerobic
ACE
compared
to
CE,
while
the
opposite
findings
were
observed
following
short
duration
high
intensity
anaerobic
exercise.
Both
exercise
protocols
were
explicitly
maximal
in
nature.
To
our
knowledge,
the
immedi-
ate
effects
of
a
submaximal
upper
body
exercise
protocol
on
postural
sway
are
yet
to
be
established,
and
have
therefore
have
not
been
compared
with
lower
body
exercise.
Therefore,
comparing
the
effects
of
submaximal
upper
and
lower
body
exercise
on
postural
sway
would
allow
applications
to
be
made
to
other
clinical
and
older
cohorts
which
are
comparable
to
the
level
of
exertion
experienced
during
training
in
these
populations.
In
addition,
previous
investigations
of
postural
sway
responses
to
CE
have
adopted
a
bipedal
stance
(Demura
&
Uchiyama,
2009;
Gauchard
et
al.,
2002;
Mello
et
al.,
2010;
Vuillerme
&
Hintzy,
2007).
It
is
well
known
that
during
quiet
bipedal
stance,
sway
is
controlled
by
ankle
plantar
and
dorsi
flexors
(Win-
ter,
1995).
However,
during
single
limb
stance
postural
adjustments
are
made
at
the
hip
(Tropp
&
Odenrick,
1988).
Therefore,
it
is
reasonable
to
assume
that
ACE
might
not
have
the
same
effect
on
postural
sway
when
standing
in
a
bipedal
com-
pared
to
a
single
limb
stance.
This
is
supported
by
findings
in
healthy
older
adults
which
showed
that
ACE
does
not
disturb
postural
sway
when
standing
in
a
bipedal
position
(Smith,
Chang,
Seale,
Walsh,
&
Hodges,
2010).
The
present
study
was
carried
out
to
more
thoroughly
investigate
the
effects
of
ACE
on
postural
sway
by
determining
whether
upper
limb
exercise
perturbed
postural
sway
to
the
same
extent
as
lower
limb
exercise
at
both
maximal
and
sub-
maximal
exercise
intensities.
This
work
will
build
on
prior
studies
(Douris
et
al.,
2011;
Smith
et
al.,
2010)
in
that
it
will
allow
more
comprehensive
compar-
isons
of
upper
body
exercise
to
be
made
with
previous
literature,
in
the
context
of
bipedal
stance.
It
was
hypothesised
that
ACE
would
be
an
alternat-
ive
mode
of
exercise
for
maintaining
health,
remov-
ing
the
effects
of
lower
limb
muscle
fatigue
on
postural
sway
and
subsequent
balance
impairment.
This
remains
a
novel
area
which
will
allow
applica-
tions
to
be
made
to
populations
at
an
increased
risk
of
falling,
such
as
the
elderly.
Methods
Participants
Nine
healthy
male
participants
(mean
±
SD
age,
24.1
±
4.8
years;
height,
1.77
±
0.05
m;
mass,
75.6
±
13.9
kg)
volunteered
to
take
part
in
the
study,
which
had
received
ethical
approval
by
Coventry
University
Ethics
Committee.
All
participants
reported
to
being
physically
active
at
least
3
hours
each
week
at
moderate
to
vigorous
intensities
(50-85%
VO2max)
as
recommended
by
American
College
of
Sports
Medicine's
guidelines
(Franklin,
Whaley,
&
Howley,
2000).
None
were
specifically
trained
in
either
upper
or
lower
body
exercise.
None
of
the
participants
reported
cardiovascular
or
pulmonary
diseases,
neurological
and
vestibular
disorders,
orthopaedic
pathology
or
musculoskeletal
problems.
All
partici-
pants
provided
written
informed
consent.
Exercise
tests
To
determine
each
individual's
ergometer-specific
peak
oxygen
uptake
(VO2peak)
and
peak
power
(W
m
..),
participants
performed
incremental
exercise
tests
on
both
an
arm
crank
ergometer
(ACE)
and
a
cycle
ergometer
(CE).
Maximal
tests
were
also
used
to
determine
the
effects
of
exhaustive
exercise
on
784
M.
W.
Hill
et
al.
postural
sway.
Tests
were
undertaken
at
the
same
time
of
the
day,
but
on
different
days
separated
by
at
least
72
hours
in
a
counterbalanced
order.
Each
trial
consisted
of
an
incremental
step
test
on
a
mechan-
ically
braked
ergometer
(Monark,
824E,
Ergomedic,
Sweden).
For
the
ACE
trial
the
ergometer
was
clamped
onto
a
sturdy
table
with
foot
pedals
replaced
with
hand
grips.
The
CE
protocol
started
at
an
initial
power
output
of
70
W
with
increments
of
35
W
every
4
min
for
the
first
4
stages,
followed
by
3-min
increments
until
volitional
exhaustion.
The
ACE
protocol
involved
an
initial
power
output
of
35
W,
with
increments
of
20
W
every
4
min
for
the
first
4
stages,
followed
by
2-min
increments
thereafter
until
volitional
exhaustion.
Arm
ergometry
trials
were
performed
in
a
seated
position
and
the
torso
was
not
restrained.
A
cadence
of
70
rev•min
-1
was
employed
throughout
both
trials
(Smith
&
Price,
2006).
Expired
gas
was
analysed
using
a
breath-by-breath
online
gas
system
(MetaMax,
Cortex
Biophsik,
Borsdorf,
Germany)
for
oxygen
uptake
(V0
2
)
and
minute
ventilation
(V
E
).
HR
was
continually
mon-
itored
(Polar
Electro,
Oy,
Finland)
and
recorded
in
the
final
10
s
of
each
incremental
stage
and
imme-
diately
upon
reaching
volitional
exhaustion.
A
rating
of
perceived
exertion
for
both
local
(working
mus-
cles;
RPE
L
)
and
central
(cardiorespiratory;
RPE
c
)
using
the
6-20
point
Borg
scale
(Borg,
1982)
was
obtained
at
the
same
time
as
HR
and
immediately
upon
reaching
volitional
exhaustion.
Earlobe
arter-
ialised
capillary
blood
samples
were
obtained
at
rest,
volitional
exhaustion
and
after
5
min
of
passive
recovery
following
standard
operating
procedures.
Blood
was
collected
and
mixed
in
20-p.L
capillary
tubes
and
analysed
for
blood
lactate
using
an
automatic
lactate
analyser
(Biosen
C_Line,
EKF
Diagnostic,
Germany).
Throughout
each
incremen-
tal
test
participants
were
verbally
encouraged
to
exercise
for
as
long
as
possible
until
volitional
exhaustion
or
until
the
prescribed
cadence
of
70
rev•min
-1
could
not
be
maintained
for
longer
than
10
s.
At
least
72
hours
after
the
ii02peak
trials
partici-
pants
visited
the
laboratory
on
a
three
further
occasions
to
perform
30-min
submaximal
erg-
ometer-specific
exercise
tests.
Two
submaximal
trials
involved
participants
exercising
at
50%
of
their
ergometer-specific
W
ma
.
(ACE
rei
;
53
±
8
W
and
CE
rei
;
109
±
16
W,
respectively).
Due
to
lower
W
ma
.
achieved
during
maximal
upper
body
exercise,
a
third
trial
was
performed
on
the
cycle
ergometer
at
the
same
absolute
power
output
as
the
ACE
re
i
trial
(CE
abs
;
53
±
8
W).
Prior
to
all
trials,
participants
were
required
to
perform
a
3-min
warm
up
on
the
unloaded
ergometer
at
a
cadence
of
70
rev•min
-1
.
Expired
gas,
HR,
blood
lactate
and
ratings
of
perceived
exertion
were
obtained
at
5,
15
and
30
min
of
exercise.
Posturography
Participants
were
instructed
to
minimise
postural
sway
by
standing
as
still
as
possible
for
30
s
on
a
force
platform
mounted
in
the
ground
(Kistler
Force
Plate
9281B,
Kistler
Instruments,
Switzerland).
After
signals
were
amplified
and
converted
from
analogue
to
digital
at
1000
Hz,
the
excursion
of
the
centre
of
pressure
(COP)
was
acquired
(Vicon
Peak
Workstation®,
Oxford
Metrics,
UK),
and
subse-
quently
calculated
(LabView
6.0).
Total
range
of
the
COP
displacement
in
the
mediolateral
and
anteroposterior
directions
(distance
between
max
and
min
position)
and
the
COP
path
length
were
calculated.
These
parameters
of
postural
sway
were
used
for
comparative
proposes
with
previous
inves-
tigations
(e.g.,
Gauchard
et
al.,
2002).
Following
calibration
of
the
force
plate
and
familiarisation
to
the
procedures,
participants
stood
barefoot
on
the
rectangular
force
platform
in
an
upright
bipedal
position
with
feet
3
cm
apart
as
measured
from
the
medial
extremity
of
the
posterior
side
of
the
calcaneus.
Participants
were
asked
to
avoid
any
extraneous
movements
and
instructed
to
stand
as
still
as
possible
looking
straight
ahead
with
their
arms
by
their
sides.
Before
exercise,
ten
30-s
trials
were
performed
alternating
between
eyes
open
(EO)
and
eyes
closed
(EC)
conditions
(Pinsault
&
Vuillerme,
2009).
Continuity
of
foot
placement
between
trials
was
ensured
by
drawing
a
stencil
around
the
feet
while
standing
on
the
force
platform.
Following
each
exercise
trial,
posturographic
tests
were
performed
immediately
after
exercise
and
at
3,
5,
10,
15
and
30
min
of
passive
recovery
for
EO
trials
and
at
2,
4,
6,
11,
16
and
31
min
for
the
EC
condition.
The
EO
trials
were
always
performed
first.
Visual
information
was
manipulated
in
order
to
compare
data
with
previous
studies
(Gauchard
et
al.,
2002;
Mello
et
al.,
2010).
Pre-exercise
rest
periods
of
60
s
were
provided
between
each
trial
during
which
time
participants
were
instructed
to
sit
down.
With
the
exception
of
the
first
three
EO
and
EC
trials
post-exercise
(1-5
min),
participants
were
allowed
to
sit
down
during
the
recovery.
A
10-cm
diameter
black
circle
was
placed
at
eye
level
2
m
away
for
participants
to
fixate
upon
during
EO
conditions.
Statistical
analysis
The
mean
and
standard
deviation
for
pre-exercise
COP
displacement
variables
were
obtained
by
aver-
aging
the
five
resting
trials
under
each
visual
condi-
tion.
The
first
and
fmal
3
s
of
each
trial
were
Arm
crank
ergometry
and
cycle
ergometry
on
postural
sway
785
removed
to
avoid
potential
transients
upon
com-
mencing
and
ending
the
trial
(Le
Clair
&
Riach,
1996).
A
two-way
analysis
of
variance
(ANOVA)
with
repeated
measures
on
both
factors
(time
x
mode)
was
conducted
to
examine
changes
induced
by
exercise
on
outcome
measures
obtained
from
the
COP
data
(e.g.,
modes:
ACE
reb
CE
rei
and
CE
abs
;
time:
pre
(0),
1,
3,
5,
10,
15
and
30
min).
The
visual
conditions
of
EO
and
EC
were
analysed
separately.
Two-way
ANOVA
was
also
conducted
to
examine
differences
in
physiological
responses
between
upper
and
lower
body
exercise.
Paired
t
tests
were
carried
out
to
examine
differences
in
peak
physiological
values
for
the
incremental
exercise
tests.
Data
were
analysed
using
Predictive
Analytics
Software
version
17.0
(SPSS
Inc.,
Chicago,
IL).
Statistical
signific-
ance
was
set
at
P
<
0.05
level.
Where
the
result
of
the
ANOVA
was
statistically
significant,
Tukey's
Honestly
Significant
Difference
(HSD)
post
hoc
analysis
was
conducted.
Results
Physiological
responses
Significant
differences
were
observed
between
maximal
ACE
and
CE
for
kOzpeak
(P
=
0.009),
Wmax
(P
=
0.001),
V
E
(P
=
0.032),
HRmax
(P
=
0.031)
and
RPE
c
(P
=
0.001).
With
the
exception
of
peak
RPE
L
and
peak
blood
lactate
(P
>
0.05)
where
no
differences
were
observed
(Table
I),
all
variables
were
significantly
greater
for
CE
compared
to
ACE.
Following
30
min
of
exercise
V0
2
(P
=
0.011),
V
E
(P
=
0.013),
HR
(P
=
0.001)
and
RPE
L
(P
=
0.03)
were
significantly
greater
for
CE
re
i
compared
to
ACE
rei
.
For
CE
re
b
V02
(P
=
0.019),
V
E
(P
=
0.001),
HR
(P
=
0.012),
BLa
(P
=
0.001)
and
both
RPE
L
(P
=
0.001)
and
RPEc
(P
=
0.008)
were
significantly
greater
than
those
reported
for
CEabs.
Similarly,
V0
2
(P
=
0.017),
HR
(P
=
0.018),
BLa
(P
=
0.001),
V
E
(P
=
0.001),
RPEc
(P
=
0.008)
and
RPE
L
(P
=
0.001)
were
greater
during
ACE
rei
Table
I.
Peak
physiological
responses
to
maximal
ACE
and
CE
tests
ACE
CE
kO2
pea
k
(I-zmin
-1
)
2.62
±
0.34*
3.23
±
0.52
VO2peak
(ml/min/kg)
34.7
±
6.7*
44.6
±
8.2
Peak
power
output
(Wmax)
106
±
16*
217
±
32
Time
to
exhaustion
(min)
16.29
±
3.18
18.54
±
3.17
kEpeak
(L'Inin
-1
)
77.6
±
13.3*
95.0
±
17.9
HR
max
(beats•min
-1
)
173
±
9*
182
±
8
Bla
peak
(mmol•L
-1
)
9.4
±
1.4
9.3
±
1.7
RPE
L
20
±
0.0
20
±
0.0
RPE
c
17
±
1.0*
20
±
1.0
*Significant
difference
between
protocols
(P
<
0.05).
Table
II.
Physiological
responses
to
submaximal
ACE
and
CE
tests
A
C
Ere
i
CE
rei
CEabe
Power
output
(W)
53
±
8a
109
±
16
b
53
±
8
k0
2
(Lmin
-1
)
1.28
±
0.19
a
1.61
±
0.33
b
1.19
±
0.17
c
VE
(Izmin
-1
)
31.8
±
3.30
a
37.2
±
7.00
b
27.5
±
5.5`
HR
(beats•min
-1
)
122
±
15a
135
±
12
b
106
±
9`
Bla
(mmol•L
-1
)
3.43
±
1.22
2.97
±
1.17
b
1.75
±
0.35`
RPE
L
14
±
2
13
+
2"
10
±
l
c
RPEc
10
±
2
11
±
2"
9
±
l
c
a
Significantly
different
between
ACE
ee
i
and
CE
re
i
(P
<
0.05).
b
Significantly
different
between
CE
ed
and
CE
a
b
a
(P
<
0.05).
`Significantly
different
between
ACE
ed
and
CEabs
(P
<
0.05).
compared
to
CE
abs
.
In
general,
the
greatest
responses
were
observed
during
CE
re
i
and
the
lowest
responses
were
observed
during
CE
abs
(Table
II).
Postural
sway
responses
to
maximal
exercise
Mode
x
time
interactions
were
observed
between
the
maximal
exercise
trials
for
COP
path
length
with
EO
(F6,48
=
3.33
1
,
P
=
0.008)
and
EC
(F
6
,
48
=
8.580,
P
=
0.001),
anteroposterior
COP
displacement
with
EO
(F
6
,
48
=
12.654,
P
=
0.001)
and
EC
(F
6
,
48
=
10.509,
P
=
0.001)
and
mediolateral
COP
displace-
ment
with
EO
(F
6
,
48
=
11.535,
P
=
0.001)
and
EC
(F6,48
=
10.241,
P
=
0.001).
Post
hoc
analysis
revealed
that
CE
elicited
an
increase
in
postural
sway
(P
<
0.05),
while
no
changes
were
observed
for
COP
measures
following
ACE
(P
>
0.05;
Figure
1).
Immediately
following
maximal
CE,
there
was
a
mean
increase
in
the
COP
path
length
of
16
±
9
and
15
±
7
cm
for
EO
and
EC
conditions
respect-
ively,
an
increase
in
anteroposterior
COP
displace-
ment
of
1.45
±
0.80
and
0.90
±
0.39
cm
for
EO
and
EC
conditions,
respectively,
and
an
increase
in
mediolateral
COP
displacement
of
0.21
±
0.15
and
0.25
±
0.18
cm
for
EO
and
EC
conditions,
respect-
ively,
when
compared
to
pre-exercise
values.
Sway
path
length
and
anteroposterior
COP
displacement
were
significantly
greater
than
pre-exercise
values
under
both
EO
and
EC
conditions
up
to
15-min
post-exercise
and
5-min
post-exercise
for
mediolat-
eral
COP
displacement
following
maximal
CE.
Postural
sway
responses
to
submaximal
exercise
Mode
x
time
interactions
were
observed
for
COP
path
length
during
EO
(F
12
,
96
=
1.877,
P
=
0.047)
and
EC
(F
12
,
96
=
2.778,
P
=
0.003)
conditions
and
anteroposterior
COP
displacement
for
EO
(F12,96
=
2.591,
P
=
0.005)
and
EC
conditions
(F
12
,
96
=
3.795,
P
=
0.001).
The
data
presented
in
Figure
2
show
that
CE
impaired
bipedal
postural
sway,
while
0
0.8
0.7
0.6
0.5
5
10
15
20
Time
(min)
25
30
0.4
1
0.3
0.2
0.1
0.0
0
5
10
15
20
25
30
Time
(min)
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
0
5
10
15
20
25
30
Time
(min)
(C)
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
(D)
0
5
10
15
20
25
30
Time
(min)
(E)
E
.c
0`
.c
a
a.
O
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
COP
p
a
t
h
leng
t
h
(cm)
3
786
M.
W.
Hill
et
al.
(A)
4.50
-e-CE
eyes
open
(B)
4.50
-m-CE
eyes
closed
o.
0
c
0
.6
4.00
3.50
-o-ACE
eyes
open
a.
o
4.00
3.50
*
-o-ACE
eyes
closed
o
E
3.00
8
3.00
43
0
0
E
T
o
0
2.50
2.00
1;
T
o
E
o
8
o.
2.50
2.00
2
0
.
1.50
2
m.
0
1.50
1.00
1.00
0.50
0.50
0.00
0.00
0
5
10 15
20
25
30
0
5
10
15
20
25
30
Time
(min)
Time
(min)
Figure
1.
Effects
of
incremental
upper
and
lower
body
exercise
to
exhaustion
on
COP
measures
of
postural
sway.
The
plots
show
the
time
course
effects
of
exercise
on
the
COP
measures
of
postural
sway
during
EO
(left)
and
EC
(right)
conditions
Asterisk
(*)
indicates
significantly
different
from
ACE
(P
<
0.05).
Dashed
lines
represent
transition
from
pre-
to
post-exercise.
no
changes
were
detected
following
ACE.
Immedi-
ately
following
CE,.
eb
there
was
a
mean
increase
in
the
COP
path
length
of
11.26
±
4.62
and
9.15
±
6.62
cm
for
EO
and
EC
conditions
respectively,
and
an
increase
following
CE
a
b
s
of
4.84
±
2.77
and
6.86
±
2.44
cm
for
EO
and
EC
conditions,
respect-
ively.
In
addition,
immediately
after
CE
re
antero-
posterior
COP
displacement
increased
by
1.23
±
0.60
and
1.14
±
0.65
cm
during
EO
and
EC
conditions,
respectively.
There
were
no
significant
main
effects
for
time
or
mode
for
mediolateral
COP
displacement
following
submaximal
exer-
cise.
COP
path
length
and
anteroposterior
COP
displacement
were
significant
with
respect
to
pre-exercise
conditions
up
until
5-min
post-exer-
cise
(P
<
0.05;
Figure
2).
Discussion
The
present
study
investigated
the
time
course
effects
of
upper
and
lower
body
exercise
on
COP
measures
of
postural
sway
during
bipedal
stance.
Upper
body
exercise
did
not
elicit
any
increases
in
COP
measures
of
postural
sway
when
compared
to
pre-exercise
conditions,
suggesting
that
ACE
does
not
disturb
bipedal
postural
sway
following
short-
term
maximal
exercise
and
longer
duration
submax-
imal
exercise.
On
the
contrary,
CE
resulted
in
an
(A)
E
.c
.c
a
a.
0
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
(B)
E
.c
.c
a
a.
0
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
Arm
crank
ergometry
and
cycle
ergometry
on
postural
sway
787
-e-
CE
rei
-
-o-
-
ACE
rei
0
CE
ab
,
0
10
15
20
25
30
Time
(min)
-m-
CE
rei
-
HD.
-
ACE
rei
C
Eabs
0
10
15
20
25
30
Time
(min)
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
(D)
a.
t
8
E
o
a
2
c
o
4.00
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
5
10
15
20
25
30
0
5
10
15
20
25
30
Time
(min)
Time
(min)
Figure
2.
Effects
of
submaximal
exercise
on
COP
measures
of
postural
sway.
Plots
of
left
show
time
course
effects
of
exercise
with
EO,
while
the
plots
on
the
right
show
time
course
effects
of
exercise
with
EC.
Asterisk
(*)
indicates
significant
effects
for
COP
path
length
and
anteroposterior
COP
displacement.
increase
in
COP
measures
of
postural
sway
post-
exercise
when
performed
maximally
and
at
the
same
relative
and
absolute
intensity
as
ACE.
Therefore,
changes
in
the
control
of
postural
sway
post-exercise
appear
to
be
specific
to
the
recruited
muscle
mass
engaging
the
lower
body
musculature
involved
in
balance
control.
This
study
provides
novel
findings
in
the
context
that
we
have
identified
a
mode
of
exercise
which
does
not
induce
any
post-exercise
balance
impairment.
Physiological
responses
As
expected,
peak
cardiorespiratory
responses
were
greater
during
maximal
CE
than
ACE
(Pimental,
Sawka,
Billings,
&
Trad,
1984).
The
lower
peak
values
observed
during
maximal
ACE
is
a
result
of
peripheral
factors
limiting
exercise
such
as
the
utilisation
of
a
relatively
small
muscle
mass
and
restrictions
to
muscle
perfusion
during
ACE
com-
pared
to
CE
(Sawka,
1986).
While
peak
cardiore-
spiratory
responses
were
different
between
the
protocols,
both
exercise
modes
elicited
maximal
effort
based
upon
similar
blood
lactate
concentra-
tions
(>8
mmol•L
-1
),
the
attainment
of
a
near
maximal
HR
and
maximal
local
rating
of
perceived
exertion
(RPE
L
;
Table
I).
In
the
present
study,
k02,
HR
and
V
E
were
greater
during
30
min
of
CE
rei
compared
to
ACE
rab
which
were
also
greater
when
compared
to
30
min
of
CE
abs
at
the
same
absolute
power
output
as
ACE,..
The
greater
oxygen
uptake
elicited
during
ACE
compared
to
CE
at
the
same
absolute
power
output
likely
reflects
an
increased
requirement
for
muscular
stabilisation
of
the
torso
(Toner,
Sawka,
Levine,
&
Pandolf,
1983),
a
greater
isometric
component
(Astrand,
Ekblom,
Messin,
Saltin,
&
Stenberg,
1964)
and
differences
in
skeletal
muscle
recruitment
.
patterns
(Sawka,
1986).
V
However,
the
difference
in
O
2
between
ACE,.
ai
and
CE
a
b
s
was
small
(-0.1
L•min
-1
).
Postural
sway
responses
to
lower
body
exercise
Our
results
confirm
previous
studies
reporting
increased
disturbance
of
the
COP
displacement
fol-
lowing
CE
(Derave,
DeClercq,
Bouckaert,
&
Pan-
nier,
1998;
Gauchard
et
al.,
2002;
Lepers
et
al.,
1997;
Mello
et
al.,
2010;
Nardone
et
al.,
1997;
Vuillerme
&
Hintzy,
2007).
However,
the
present
data
provide
further
information
with
regard
to
the
variables
affected
by
CE.
The
above-mentioned
studies
have
observed
an
increase
in
anteroposterior
COP
dis-
placement
following
CE,
while
no
significant
change
was
observed
following
mediolateral
COP
displace-
ment.
In
the
current
study,
following
maximal
CE
an
increase
in
mediolateral
COP
displacement
of
117%
(EO)
and
92%
(EC)
was
observed,
whereas
there
were
no
changes
in
mediolateral
COP
displacement
788
M.
W.
Hill
et
al.
following
submaximal
CE.
These
results
suggest
that
mediolateral
control
of
balance
is
not
affected
by
moderate
intensity
cycling
exercise
up
to
50%
W
max
.
An
increase
in
mediolateral
COP
displacement
fol-
lowing
maximal
CE
in
the
present
study
indicates
a
potentially
unique
adaptation
in
balance
strategy
post-exercise.
Such
an
increase
could
represent
a
safety
strategy
adopted
by
participants
to
reduce
fall
risk
following
such
exhaustive
exercise
(Burdet
&
Rougier,
2004).
For
example,
following
maximal
exercise
to
exhaustion
individuals
might
purposefully
search
for
larger
mediolateral
displacement
of
the
centre
of
gravity
for
the
purpose
of
taking
a
step
should
a
fall
ensue
(Burdet
&
Rougier,
2004).
While
the
authors
do
not
advocate
that
participants
were
at
an
increased
risk
of
falling
post-exercise,
previous
research
has
suggested
that
mediolateral
sway
mea-
sures
are
strong
predictors
of
imbalance
and
future
fall
risk
in
older
adults
(Piirtola
&
Era,
2006).
Therefore,
an
increase
in
postural
sway
in
this
direction
may
be
important
in
older
adults
where
the
ability
to
minimise
postural
sway
is
already
limited.
When
considering
that
anteroposterior
COP
dis-
placement
is
controlled
by
sagittal
plan
movers
(i.e.,
flexors
and
extensors
of
the
knee
and
dorsi
and
plantar
flexors
of
the
ankle)
and
these
same
muscles
are
engaged
during
CE,
an
increase
in
the
COP
displacement
along
this
axis
is
not
surprising
(Vuil-
lerme
&
Hintzy,
2007).
These
findings
support
the
evidence
of
directional
sensitivity
of
postural
muscles
(Winter,
Prince,
Franck,
Powel,
&
Zabjek,
1996).
The
increases
in
mediolateral
COP
displacement
in
the
present
study,
however,
challenge
this.
Increases
in
mediolateral
COP
displacement
may
be
a
result
of
the
engaged
musculature
during
cycling
contributing
to
mediolateral
balance
control.
It
should
be
noted
that
while
significant,
the
increase
in
mediolateral
COP
displacement
following
CE
was
small
(-0.25
cm)
and
therefore
these
findings
are
probably
not
clinically
relevant.
Moreover,
we
provide
novel
data
in
the
context
of
the
time
course
effects
of
CE
on
postural
sway.
Previous
research
has
showed
that
the
negative
consequences
of
treadmill
exercise
last
no
more
than
20-min
post-exercise
(Bove
et
al.,
2007;
Fox,
Mihalik,
Blackburn,
Battaglini,
&
Guskiewicz,
2008).
While
our
findings
are
difficult
to
compare
due
to
differences
in
exercise
protocols,
we
show
that
the
negatives
effects
of
CE
might
be
less
than
treadmill
exercise
and
diminish
within
15
and
5
min
for
maximal
and
submaximal
CE,
respectively.
Postural
sway
responses
to
upper
body
exercise
More
recent
investigations
have
considered
the
effects
of
exercise
using
the
upper
body
musculature
on
balance
control,
but
have
demonstrated
equivocal
findings
(Douris
et
al.,
2011;
Smith
et
al.,
2010).
In
the
present
study,
maximal
and
submaximal
ACE
had
no
effects
of
COP
measures
of
postural
sway
(Figures
1
and
2)
and
are
in
accordance
with
those
reported
for
healthy
older
adults
(Smith
et
al.,
2010).
Cycle
ergometry
(CE)
performed
at
the
same
relative
(50%
W
max
)
and
absolute
(W)
intensity
as
ACE
elicited
an
increase
in
postural
sway
post-exercise.
These
findings
suggest
that
the
effects
of
exercise
on
postural
sway
are
influenced
by
the
use
of
lower
extremity
muscles
which
are
involved
in
balance
control
rather
than
the
physiological
exertion
experi-
enced.
The
absence
of
changes
in
postural
sway
post-ACE
in
the
present
study
may
be
explained
by
the
relative
ease
of
standing
on
two
legs,
since
this
task
does
not
provide
a
major
challenge
to
the
balance
control
system
(Clifford
&
Holder-Powell,
2010).
Postural
sway
may
therefore
only
be
dis-
turbed
following
ACE
when
the
balance
task
is
more
difficult,
such
as
standing
on
a
single
limb.
In
line
with
the
present
study,
Smith
et
al.
(2010)
showed
that
in
healthy
older
adults,
postural
sway
was
not
disturbed
following
a
bout
of
ACE.
However,
Douris
et
al.
(2011)
reported
that
maximal
aerobic
ACE
disturbed
postural
sway
to
a
greater
extent
than
CE
when
standing
on
a
single
limb.
It
is
possible
that
the
discrepancies
in
findings
are
a
result
of
adopted
stance.
During
bipedal
stance,
postural
sway
is
predominantly
controlled
by
the
triceps
surae
mus-
cles
(Loram
&
Lakie,
2002).
However,
when
stance
is
more
challenging,
such
as
standing
on
a
single
limb,
postural
adjustments
are
made
at
the
hip
(Tropp
&
Odenrick,
1988).
Douris
et
al.
(2011)
suggested
that
the
trunk
muscles
were
more
fatigued
following
ACE
compared
to
CE,
and
therefore
these
muscles
were
less
able
to
assist
in
postural
adjust-
ments.
As
a
result,
it
appears
that
ACE
may
only
perturb
balance
when
standing
on
a
single
limb.
Previous
research
has
shown
that
the
destabilising
effects
of
lower
limb
muscle
fatigue
can
be
compen-
sated
for
in
bipedal
stance
(Caron,
2003)
but
not
in
single
limb
stance
(Bizid
et
al.,
2009)
and
the
effects
of
lower
limb
muscle
fatigue
on
postural
sway
is
greater
in
bipedal
compared
to
single
limb
stance
(Bisson,
McEwen,
Lajoie,
&
Bilodeau,
2010).
Therefore,
our
finding
suggests
that
while
the
upper
body
may
play
an
important
motor
and
sensory
role
in
single
limb
stance,
the
negative
effects
of
fatigue
induced
by
ACE
may
be
compensated
in
bipedal
stance.
Conclusion
In
summary,
this
study
contributes
to
the
existing
knowledge
on
post-exercise
postural
sway
by
dem-
onstrating
novel
findings
that
arm
crank
exercise
does
not
elicit
post-exercise
balance
impairment,
which
has
applications
to
those
at
risk
of
falling,
Arm
crank
ergometry
and
cycle
ergometry
on
postural
sway
789
such
as
the
elderly.
Furthermore,
CE
at
both
maximal
and
submaximal
intensities
resulted
in
a
disturbance
to
postural
sway,
suggesting
that
exer-
cise
effects
were
specific
to
lower
extremity
muscles
involved
in
balance
control
during
quiet
bipedal
standing.
The
impact
of
this
work
is
important
as
it
indicates
that
ACE
might
be
a
useful
mode
of
exercise
prescription
in
older
and
clinical
popula-
tions
which
does
not
appear
to
increase
the
risk
of
falling
post-exercise.
It
is
acknowledged
that
the
generalisability
of
these
results
to
an
at-risk
population
is
limited
due
to
the
young
healthy
cohort
used
in
present
study.
Whether
the
present
effects
would
be
observed
in
individuals
with
impaired
postural
control
(i.e.,
older
adults)
where
the
negat-
ive
consequences
of
exercise
may
be
more
exacer-
bated
remains
to
be
investigated.
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