Exposure to Visual Stimulus yields slight improvement

in Isokinetic Torque Production

Exercise Physiology 326

Fall 2016

Todd Astorino

December 12, 2016

Bustamante, Daniel., Diaz, Brenda., Greenberg, Adam.,

Malfavon, Ricardo., Ramirez, Daisy., Santiago, Gregoria.

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Abstract

Background: Muscle function is important for optimal performance in sports, exercise

and daily activities. Using an isokinetic device can be a great tool to assess muscle strength

which is an important factor in improving maximal force. Research shows that auditory

feedback, such as music, has an effect on the performance and motor skills of individuals (Cole

& Maeda, 2015). It has also been shown that visual feedback plays an effective role in muscle

production (Kim & Kramer, 1997). The present study will analyze different stimuli that can

influence torque production in knee extension and flexion.

Aim: To examine the effect of visual feedback and auditory feedback on peak torque of

men and women.

Method: Thirteen young and active men and women (m=7 and f=6) between the ages of

20-25 (age: 22 1.55 yr, weight: 75.2 13.25 kg, height: 166.95 4.4 cm) with moderate

to intense level of physical activity volunteered to take part in the study. A total of 12 subjects

completed three sets isokinetic bilateral dynamometer tests using auditory, visual and no

feedback for a total of four non consecutive days to measure peak torque production. Subjects

underwent a familiarization trial prior to receiving any form of feedback. Subjects were required

to warm up on a cycle ergometer for five minutes, the proceeded to perform 3 sets of 5

repetitions of knee extension and flexion on each leg with a 30 sec recovery period between each

set. These sets were repeated under conditions of visual, auditory, and no feedback. Data was

analyzed using an ANOVA test of significance between factors.

Results: Exposure to either visual and auditory stimulus yielded higher KE and KF

torque production, both peak and average. Peak KEvis torque was significantly higher (p=0.044)
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than control, 142.95 43.912 N m-1 and 126.91 39.989 N m-1 respectively. Peak

KF, average peak KE, and average peak KF were not significantly higher than control across

both stimuli.

Keywords: Visual Feedback, Auditory Feedback, Isokinetic Dynamometer, Torque, Muscle Force.

Introduction

Lack of motivation for many individuals is the primary reason for not leading an active

lifestyle. Furthermore, those who lead an active lifestyle may continually seek to improve levels

of fitness and increase performance. Many allied health professionals seek strategies to

maximize human performance in physical function through biofeedback techniques such as

verbal encouragement and visual feedback (Campenella et al., 2000). Visual feedback and verbal

encouragement have been studied previously to see if they produce a significant increase in

performance.

Knowledge of performance via visual feedback has been shown to enhance performance

during isokinetic test (Kim, 1996). Similarly, verbal encouragement has been shown to also

increase torque production, but results are quite variable (Campenella et al., 2000). Increased

torque in the presence of visual feedback has been shown regardless of gender, highlighting its

real-world applicability (Campenella et al., 2000). When looking at producing maximal torque,

the ability to fully excite and engage the nervous system is the center of focus for biofeedback

strategies. It is important to note that muscle lengths that are at or below the optimum length

result in less amount of force production once the muscle is stimulated (Powers and Howley,

2015). When the nervous system is fully engaged and excited, it is capable of rapidly increasing

neural activity to produce force during maximal contractions (Seynnes et al., 2007). It is this

engagement that the treatments in previous studies as well as the present study aim to enhance.
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Acknowledging that verbal encouragement can increased torque production leads to a

question of whether other auditory stimuli also yields similar results. Further research is needed

to determine whether visual or auditory stimulus produce better results than one another. It is

important to recognize strategies that maximize force production because it allows individuals

seeking to better their performance a way to track and enhance progress in training down the

long run. It may also serve as an effective way to motivate individuals to effectively train and

lead a more active and healthy lifestyle. On the other hand Thorstensson et al., 1976, explains

that fatigue can also affect peak torque by decreasing in power when contraction speed or

velocities increase (Thorstensson et al., 1976).

While previous studies have studied the effect of verbal encouragement in facilitating

maximal force production, it is unclear whether music will serve as a biofeedback for force

production as well. This study aims to assess the effect of alternative auditory feedback, such as

music, as well as validate visual feedback in the form of graphed production charts as effective

biofeedbacks on peak torque in the extensors and flexors of the knee. We hypothesize that

auditory feedback in the form of music will elicit significantly higher peak torque than visual

feedback in the extensors and flexors of the knee, regardless of gender. We hypothesize that

auditory feedback will provide significantly greater force because it is most applicable to a real

world setting and widely used as a means of motivation.

Methods

Subjects: Thirteen recreationally active men and women (male=7 and female= 6)

between the ages of 20-25 (age: 22 1.55 yr, weight: 75.2 13.25 kg, height: 166.95
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4.4 cm) with moderate-intense level of physical activity volunteered to take part in the study,

while a total of twelve subjects completed all trials within the study. Table 1 shows that the BMI

for male subjects was evidently higher (BMI=28.2 4.3) than for female subjects (BMI=28.2

4.3) . Subjects were recruited with no previous knee injury, filled out a health history

questionnaire, and provided written informed consent before participating in the study. Subjects

refrained from lower body exercise for 24 h before each trial. Subjects did not consume caffeine

12 h before each trial and fasted 3 h before each trial. Subjects were asked to maintain normal

food intake the morning before the trial all of which were held between the hours of 9:30am and

12:30pm on nonconsecutive days.

Table 1: Demographic data from all subjects

Parameter Male (n= 7) Female (n=6)

Age (years) 21.7 1.2 22.3 1.9

Height (cm) 178.1 4.1 155.8 4.7

Mass (kg) 90.2 12 60.2 14.5

BMI 28.2 4.3 24.39 5.1

Level of Moderate physical activity Moderate to intense physical

Fitness activity

Design: Muscle force of knee extension and flexion was assessed using an Isokinetic

dynamometer (Biodex System 3, Shirley, NY). Prior to beginning the exercise trials, subjects

warmed up on the cycle ergometer (Monark 824E, Monark Exercise, Varberg, Sweden) for five

minutes at a low intensity output. On day 1 all subjects completed baseline testing, consisting of

body weight (kg), height (cm), gender, and age measurements. The range of motion on the

Biodex machine, chair position, and leg length were measured for each trial. On days 2-4 of
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testing, subjects were asked to perform 3 randomized feedback trials while performing knee

extension and knee flexion of both right and left legs at maximal effort. Feedback consisted of

an auditory stimulus trial, a visual stimulus trial and a control trial. Peak torque production (full

flexion and extension), of both legs, was assessed using isokinetic dynamometer at 60

degrees/second, data was analyzed only for subject's dominant leg. Peak torque and average peak

torque were recorded over three sets of 5 repetitions on each leg throughout 3 days separated by

at least 48 hours. A 30 sec recovery period was allotted in between each set. Rate of perceived

exertion (RPE) and level of pain charts were presented in between resting periods as well as pre

and post trials. Peak torque and average peak torque data was recorded by the Isokinetic

dynamometer Biodex machine.

Control Trial: In order to compare any significant changes between auditory and visual

feedback, the control trial consisted of no feedback which created a baseline for the level of peak

performance without feedback. Based on the data from the control trial, differences can be

analyzed between usage of auditory and visual feedback or if any feedback improved

performance. The control trial was administered at random for every subject to reduce influence

of the level of familiarity. The subject was required to warm up for five minutes on the cycle

ergometer and was given instruction about the procedure for that trial and was given the

opportunity to ask any questions regarding their tasks.

Visual Feedback: After a familiarization trial all subjects were asked to focus their

attention during the exercise to a computer screen connected to the Biodex to view their real-

time force production on a line graph. As subjects warmed up on the cycle ergometer, clear

instructions were provided for this trial.

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Auditory Feedback: Subjects were instructed to pre-select a series of songs lasting at

least 15 minutes to listen to during the this trial with headphones prior to the day of testing.

During the five minute warm up, subjects were given clear instructions about signaling they had

to observe for initiating knee extension, flexion and stopping. Hand gestures were created in

order to compensate for the lack of auditory instruction, due to music. Time was tracked between

the last 2 minutes of the warm up until the last set was completed (time: 13.92 mins). Time

differences were due to technical difficulties with the Biodex set up, however whenever

applicable subjects were asked to remove their headphones.

Data Analysis: Data were expressed as mean SD. Differences between auditory,

visual, and control feedback were tested using SPSS software Version 20.0 (SPSS, IL) and

Microsoft Excel 2016. Repeated measures ANOVA was used to track the differences among the

different forms of feedback. Tukeys post hoc test was used when appropriate. A level of

significance less than =0.05 was deemed significant.

Results

One male participant did not complete protocol, his data was removed from analysis.
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Peak Torque
Bouts where subjects were exposed to visual stimulus yielded the highest KE peak torque
on average, 142.95 43.912 N m-1 (Table 2). Exposure to visual stimulus yielded +16.04
N m-1 improvement over control. Auditory stimulus only showed a slight increase in peak
KE torque production compared to control, +8.15 N m-1 improvement. Treatment showed a
significantly higher peak KE torque (p=0.044) than control. Tukeys post hoc test for bout one
showed a difference across treatment. Con vs Aud =-0.57068, Con vs Vis =-2.19344, Vis vs Aud
=-1.55288. Tukeys post hoc test revealed that peak KE torque was significantly higher only for
exposure to visual stimulus.
Analysis shows higher peak flexion torque when subjects were exposed to either visual or
auditory stimulus, +5.65N m-1 and +1.47N m-1 respectively. Although KF torque
increased when exposed to visual or auditory stimulus the difference is not significant (p=0.124)

Average Peak Torque

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Both treatments yielded higher average peak torque production than control (Table 2).
For bout one, auditory shows +4.54 N m-1 improvement over control, and visual yields +0.57
N m-1 improvement over control. There is no statistically significant difference recorded for
average peak torque (flexion) across treatments (p=.167). Tukeys post hoc test shows no
difference between treatments; Con vs Aud =-2.40254, Con vs Vis =-0.91419, Vis vs Aud =-
1.46057.
For bout one, exposure to visual stimulus yielded highest average peak torque production
(10.41 ft*lbs over control), and auditory stimulus resulted in 8.98 N m-1 improvement.
Neither treatment was significantly different than control (p=0.092). Tukeys post hoc test Con
vs Aud =-2.58503, Con vs Vis =-2.88736, Vis vs Aud =-0.39663.

Figure 1: Effects of different feedback modalities in muscle force production

*significant interaction (p<0.05) in response to visual feedback.

Muscle Force Production

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Peak and average extension/flexion torque showed a difference in muscle force

production across treatments but was not significant. Compared with control, visual and auditory
feedback did have an effect but was only significant during knee extension peak torque(Figure1).

Discussion

Our aim for this study was to examine the effect of visual feedback and auditory feedback

on peak torque of men and women. We found that visual feedback provided more peak torque

production than auditory and control. Although visual stimuli provided the highest peak torque

production, auditory feedback showed more improvement than the control test. This data

demonstrates that there could be improvement in fitness level if using visual feedback. Trainers,

and allied professionals that want to improve their clients fitness progress or individuals that

want to improve their strength can try an exercise where they can be visually stimulated to work

their neuromuscular system harder. This suggests that using visual feedback can add more stress

on the neuromuscular system, and individuals are more prone to adapt quicker long-term.

We found that when subjects are exposed to visual and auditory stimuli, the brain is

sending messages to the rest of the body which stimulates the CNS. Recent studies demonstrate

that well-selected music along with visual feedback can enhance performance and reduce

exhaustion during exercise (Hutchinson, 2014). This also shows that when the brain is being

stimulated by auditory or visual feedback, the brain is able to recruit motor units more efficiently.

It is known that the number of motor units that recruit each muscle does not increase between

birth and adulthood (De C. Hamilton, 2004). What can change is the individual's ability to

recruit motor units, resulting in more or less force production even if the muscle mass is

identical. External stimuli can have an effect on the bodys ability to recruit motor units by

adding noise to the system. Adding some noise to the system can result in higher force
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production (De C. Hamilton, 2004). The exposure to either visual or auditory stimulus in the

current study is an example of the addition of noise to the system, and the increased force

production was consistent with the results of De C. Hamilton et. al. What can not be said for

certain is whether the increased force was a result of motor unit innervation, increased

motivation, or another factor.

These findings were consistent with previous literature that held visual feedback as a

significantly more effective biofeedback in force production. Our findings rejected our

hypothesis that auditory feedback would elicit a significantly higher production in muscle force,

as measured by torque. However, our findings show our hypothesis to only be rejected in regards

to peak torque of knee extension. In peak torque of knee flexion and average torque of both

flexion and extension, we found no significant differences between visual, auditory, and no

feedback. Further study is necessary to explore these areas.

A similar study by Baltzopoulos et al. (1991) found that among male subjects, producing

maximum torque, both with no visual feedback and with visual feedback, subjects improved

torque output at slow speed (60 /sec) with visual feedback in comparison to fast speed (180

/sec) with visual feedback and no visual feedback. These findings support the results of the

present study where visual stimulus yielded the greatest peak torque, when compared to control

and auditory. Similarities between the present study and study by Baltzopoulos et al. is that

subjects also worked against a resistance with visual feedback and the control which rendered

no feedback, however there were no variations in speed. In the study at hand, there was no

improvement made by visual feedback or therefore in any of the two conditions from bout to

bout.
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Another study by Hald and Bottjen (1987), found that visual feedback yielded a greater

peak torque (59.8 N m-1) than no feedback (56.4 N m-1) at 60/sec. These findings are also

consistent with the present study were knee extensors with visual feedback yield produced a

greater peak torque (142.95 N m-1) than control (126.91 N m-1). Both studies use equal

amounts of male to female ratio, however Hald and Bottjen had their subjects tested twice in a

single day. They completed 7 sets, which could account for the smaller differences between peak

torque compared to the present study, which suggests that fatigue could have been a factor.

Some of the limitations we encountered were that we were not punctual in some of the

testing times for some subjects which could have made an impact in the subjects energy level.

We also did not standardize the sitting position for each subject which caused different

measurements in leg length and seat length on the biodex machine. Placement of the computer

monitor varied from subject to subject, and eye level adjustments were negligible due to the

expensiveness of equipment, also some subjects had to be reminded to look only at the monitor.

Even though subjects were asked to not participate in any physical activity prior to testing, we

did not specify to the subjects to be well rested a night before testing (staying up late, partying

etc.).

Another limitation was that some subjects did not bring in their own music and had to

borrow a music playlist for their auditory feedback test which could have impaired their

performance. Within the study there were differences in headphones and the song selections were

not all pre-selected by each subject. According to a previous study, listening to preferred music

vs. non-preferred had a larger effect on women than men in endurance training (Cole, 2015).

Since we did not explore whether preferred music had a better effect in peak torque production
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vs. non-preferred, we cannot determine if borrowing a playlist from someone else impaired their

performance. Further investigation is needed in this area.

Lastly, our list of subjects was incomplete due to uncontrollable circumstances from a

subject.

Conclusion

This study presents that visual feedback provided the most peak torque production than

auditory and control in one session. Visual feedback could provide the most motivation for those

who may lack the motivation to stay active. Further investigation is needed for other types of

exercises and for individuals with various activity levels.

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