Muscle Activation and Core Stability based on Body Fat

ranges in Four-point Kneeling Exercises after Dynamic

Stretching

Bin Lina, Sengfat Wonga

a. Department of Electromechanical Engineering, Faculty of Science and

Technology, University of Macau, Macau, China

Abstract
Muscle activation is essential to improve individual strength of the postural muscle
during balance. However, the core stability influence of subjects’ body fat differences
and muscle activation after dynamic stretching have not yet to be studied. We
investigated the core stability performance, correlation between the anthropometric
data and core stability, and muscle activation during four-point kneeling exercise after
dynamic stretching in thirty healthy subjects. All subjects were integrated into Underfat
(<8%), Healthy (8% -19%), Overfat (20%-25%), and Obese (>25%) groups. Each
subject participated in normalization and stabilization exercises. Time in the balance
and electromyographic activity of eight muscles were evaluated. The root mean square
of each interval amplitude during the stabilization exercise was calculated and
normalized as a percentage of the maximal voluntary contraction (MVIC%). During
the exercise, the healthy group (8%~19%) kept their balance longer than any other
groups (4.39±0.24s), and much more reliably (5.47%). The Latissimus Dorsi muscle
was the most active muscle for the healthy (26.39%), overfat (16.08%), and obese
(28.95%) groups, while for the Underfat group this was the Internal Oblique muscle
(51.48%). However, each group displayed the same lowest muscle activity for the RF
muscle. Comparing the activation of muscles for four different groups, the Internal
Oblique muscle was significantly different (P=0.036 <0.05). But, no significance was
observed between anthropometric data and core stability. Our findings suggest that a
multi-component exercise program can be developed based on body fat ranges for
enhancing balance and perhaps provide a benefit by reducing the risk of falls.

KEYWORDS: core stability; body fat ranges; four-point kneeling; dynamic stretching.
1.Introduction

Core stability is defined as the restoration or augmentation of the ability of the

neuromuscular system to control and protect the spine from injury or reinjury(Hodges,
2003). The model of core stability has been proposed, including passive, active muscle,
and the neutral subsystem. In recent years, core stability exercises have shown
themselves to be important both for the rehabilitation of patients with lower back pain,
and for healthy individuals in fit and athletic conditions (Kibler et al., 2006; Anderson
et al., 2005; Sukalinggam et al., 2012). Athletes specifically benefit directly from sports
stabilization condition training programs with a high level of force production in upper
or lower extremities. Core stability exercises also prevent injury (Peate et al., 2007).
Throughout the literature, four-point kneeling performances are widely recommended,
with hands and knees touching the ground for lower back pain rehabilitation programs
and core stability exercises. A study examined the activation of trunk and hip muscles
in a four-point kneeling exercise. The result showed they worked together to maintain
stability (Stevens, et al., 2007). Furthermore, two types of four-point kneeling training
were used on health subjects. Compared with before and after four-point kneeling
training, trunk muscle recruitment patterns can be changed. The study indicated that
this type of training can be a prevention strategy(Stevens, et al.,2007; Cugliari et al.,
2017). The Lumbar multifidus muscle activation was compared between prone trunk
extension and four-point kneeling. Due to the higher lumbar multifidus ratio, the four-
point kneeling exercise was recommended for training the lumbar multifidus muscle
(Kim et al., 2017). The trunk and lumbar muscle activation in different stages of the
four-point kneeling position were investigated. The muscle activation was changed in
a different position to balance the stability. One of the quantity measurements for core
stability in four-point kneeling was used in a stability platform. The result of this study
demonstrated the learning effect of using a stability platform and suggest the enough
trials (Liemohn et al., 2010).

Core stability exercises are associated with muscle group. The classification of muscle
group is divided into a local and global muscle system. The local muscle group controls
intersegmental motion. Conversely, the global muscle group is responsible for spine
motion and transferring force. Based on previous research, eight core muscles were
analyzed, including Rectus Abdominis upper (RA), External Oblique (EO), Internal
Oblique (IO), Multifidus (MF), Longissimus (L), Gluteus Maximus (GM), Latissimus
Dorsi (LD), and Rectus Femoris (RF) muscles. Muscle activation and balance were
influenced by static and dynamic stretching techniques(Lima et al., 2014; Han et al.,
2014). Dynamic stretching was reported to have a positive effect on postural control,
jump performance, balance, sprint and power (Fletcher et al., 2004; Behm et al., 2011).
The static and dynamic stretching protocols were compared for balance test
performance. The result demonstrated that dynamic stretching was more effective than
static stretching (Chatzopoulos et al., 2014). However, there is relatively little research
investigating different muscle activation on core stability performance after dynamic
stretching.

Therefore, the primary purpose of this study is to examine the core stability
performance based on body fat ranges and evaluate the Rectus Abdominis, External
Oblique, Internal Oblique, Multifidus, Longissimus, Gluteus Maximus, Latissimus
Dorsi, and Rectus Femoris muscle activation patterns on different core stability
performances. The study also investigated the relationship between anthropometric
data and core stability performance. We hypothesized that different groups based on
body fat ranges would have different muscle activation and core stability performances,
and the significant effect muscles could be found.

2.Methods

2.1 Participants

Thirty healthy young male adults participated in this study. The characteristics of four
different group shows in (age: 23.77±3.20 years; weight: 71.59±13.29 kg; height:
173.80±5.07 cm; body fate percentage: 18.92±7.56 %; arm length: 44.80±2.77 cm;
shoulder breadth: 81.77±3.69 cm; waist circumference: 84.60±11.45 cm; and hip
circumference: 99.53±7.56 cm). Participants were excluded if they had any form of
joint or bone disease, neuromuscular disorders or lower back pain. All subjects signed
an informed consent before the experimental test protocols. The experimental
procedures met the list of requirements in the 1975 Declaration of Helsinki.

2.2Experiment set-up
Eight core muscles were recorded to acquire the surface EMG signal during the exercise.
Before placing the electrode on the skin, the excess hair was shaved and the area
cleaned using alcoholic wipes to reduce impedance. The placement of surface
electrodes on eight core muscles was based on previous research. Surface EMG was
collected using wireless Trigon IM sensor (Delsys, Inc). The data was saved by Delsys
EMGworks Acquisition and Analysis software for further processing.

The Model 16030 Stability Platform (Lafayette Instrument Co.) was used to measure
balancing ability. The tilt range of the platform was set at ±15 degree. The balance limit
of the platform was set at 0 degree for both right and left zones. 30s was set as a trial in
each of the 15 repeat cycles. The balance time for the right, left and center zones was
recorded during the trial.

2.3 Experimental procedure

Each subject participated in three exercises, including a stretching exercise, a

normalization exercise and a stability exercise. The exercise was introduced in detail
by the trained instructor to reduce any learning effect before the experiment. All
experiment procedures took place in the gymnasium and activity room during 10:00 –
18:00 hours. After familiarization with the procedures, subjects followed trained
instructor for stretching exercise, practiced each normalization exercise and stability
exercise.

Several studies have reported the effect of stretch exercises on balance, reaction time,
and movement time (Behm et al., 2004). A study has investigated the different
stretching protocols. It suggested that dynamic stretching is more appropriate than
others (Chatzopoulos et al., 2014). Before the stretching exercise, all subjects were
required to do 3 minutes jogging at a self-selected moderate intensity. The ability to
assess the moderate intensity of jogging is by being able to have a comfortable
conversation with subjects during exercise. After 3 mins jogging, the subject has 2 mins
rest. The dynamic stretching protocol includes eight types of movements, which are
side/front arm crossover, walking lunge with rotation, triceps and side-bend stretch,
lateral shuffle, Frankenstein walks, heel-ups, inch worms, and modified shuttle run
(Chatzopoulos et al., 2014). Each type of exercise was performed for 1 minute and had
a 30-second interval rest.

Table 1. Dynamic stretching protocols: (1) side/front arm crossover, (2) walking
lunge with rotation, (3) triceps and side-bend stretch, (4) lateral shuffle, (5)
Frankenstein walks, (6) heel-ups, (7) inch worms, and (8) modified shuttle run

Exercise Description Diagram

(1)Side/Front Subjects swung both arms out to

arm crossover. their sides and then crossed them
in front of their chest, while
moving forward.

(2)Walking Subjects took a big step forward

lunge with and at the same time rotated their
rotation arms horizontally

(3)Triceps and Subjects brought the right arm

side-bend overhead with elbow ben and bent
stretch slightly toward the left side.

(4)Lateral Subjects moved laterally without

shuffle crossing feet.

(5)Frankenstei Subjects walked with both hands

n walks extended in front of the body,
palms down. They kicked with the
extended leg toward hands.
 (6)Heel-ups. Subjects kicked heels towards
buttocks which moving forward.

(7)Inch worms Starting position push-ups.

Keeping legs extended they
walked towards hands and then
they walked hands forward while
keeping limbs extended (6
repetitions)
(8)Modified Subjects ran to the opposite line at
shuttle run. a moderate pace (50% maximum
speed), bent to touch the line, and
returned back gradually
accelerating (75%) and touching
the starting line. After touching the
starting line, they ran to the
opposite line accelerating to near
maximum speed (90%), touched
the line and returned back to the
starting line at a walking pace.

A basis EMG signal amplitude normalization was provided by maximum voluntary

isometric contraction (MVIC). MVIC is a standard assessment for quantification of
muscle strength. Previous studies have reported various factors influencing the MVIC
measurement, including subject motivation, the condition of the neighboring join, the
contraction of synergic muscles, and the location of the joint (Ball et al., 2010; Jaskólski
et al., 2000). Therefore, the optimal maximal voluntary isometric exercise is
important in order to acquire quality data. Five MVIC exercises were performed to
target eight different muscles, shown in Fig. 1. In detail, these were the following
exercises: (1) Resisted sit-up for RA muscle (Lie on floor with knees bent to 90 degrees
and with back in neural position, place weight on chest and hold with arms folded across
chest). (2) Resisted hand for LD (Hang from a wall bar arms straight, facing wall,
securing feet. Subject attempts to pull body upwards using shoulders and arms). (3)
Resisted back extension for GM, L, MF muscles (Using a horizontal extension bench,
lie with hips over edge of bench and feet fixed under bar. The weight should be
sufficiently heavy to prevent substantial upper body movement). (4) Resisted Trunk
rotation for EO and IO muscles (Subject chooses sufficient weight to prevent upper
body rotation). (5) Resisted hip flexion (Subject chooses enough weight to attempt
lower body movement). All subjects attempted to do each MVIC exercise three times.
The duration of each MVIC exercise was 10 seconds, with 60 seconds’ rest between
each repetition. Verbal encouragement was given to ensure all subjects achieved
maximum effort during the exercise.

(1) (2) (3)

(4) (5)

Fig. 1. The MVIC exercise: (1) Resisted sit up (2) Resisted hand (3) Resisted back
extension (4) Resisted Trunk rotation (5) Resisted hip flexion

The Stabilization Exercise is considered as an important method for rehabilitation and

in sports competitions. And it aligned with optimal trunk position, transfer of loads and
neutral spinal (Huxel et al., 2013). By the literature, the four-point kneeling exercise
was recommended to improve trunk stability, protect the spine, rehabilitate lower back
pain (Borreani et al., 2015; Cholewicki et al., 2002; Gill et al., 1998). This study used
quadruped arm-raise four-point kneeling test to quality the core stability activity. The
location of surface electrodes was the same place as the MVIC measurement. Arms are
lengthened and knees beneath the hips. The three points of contact align spinal,
including the sacrum, the thoracic spin and the back of the head. All subjects began
with right arm raised, when the level vial is in the middle of the stability platform.
Before the trial, the subject was instructed to keep their balance in a horizontal position.
The metronome was set at 40 beats/minute during the experiment. The subject
attempted a total of 15 trials. The out of balance time for each trial was set at 30 seconds.
After 5 trials, the subject was given 2 mins rest.

Fig. 2. Four-point kneeling exercise

2.4 Data Processing

According to body fat ranges, 30 subjects were divided into 4 groups which were
underfat (<8%), healthy (8% -19%), overfat (20%-25%), and obese (>25%) (Gallagher
et al., 2000). The characteristics of the four different groups are illustrated in Table 2.

All surface EMG signals for both MVIC and stabilization exercises were collected by
EMGWorks Acquisition software (Delsys, Inc). The MATLAB software (Mathwork
Inc.) and EMGWorks Analysis software (Delsys, Inc.) were used to analyze the raw
surface EMG signals. The sample rate of sEMG signals was collected at 1111Hz. All
signals were bandpass filtered at 10-500 Hz. The root mean square of each interval
during stabilization exercises was calculated and normalized as a percentage of the
maximum root mean square EMG during the MVIC exercise. Due to the learning effect
of the stability platform, the last five trials were used for analysis (Chiviacowsky et al.,
2010). The mean value of five trials in each group was obtained.

The reliability of Time in Balance was measured by coefficient of variation which

standardizes the standard deviation to the mean. The relationship between waist
circumference, arm length, hip circumference, shoulder breadth, age, height, weight
and 3 different groups were measured by Pearson’s correlation coefficient (r values).
The means of the last five trials were analyzed in a 4 (groups: underfat, healthy, overfat,
obese) × 5 (Trails) repeated-measures ANOVA. The significant effects of muscles and
groups were examined (Using SPSS version 21, SPSS Inc.).

Table 2. The characteristics of four different groups. Abbreviations: BFP: Body

Fat Percentage, WC: Waist Circumference, SB: Shoulder Breadth, AL: Arm Length,
HP: Hip Circumference

Age Height Weight BFP WC SB AL HC

Underfat 29.00 175.00 55.30 6.40 68.00 42.50 79.50 88.50

(n=2)
Healthy 22.43 173.57 62.70± 14.1 78.14 46.07± 82.71±3. 95.14
(n=14) ±3.30 ±5.64 4.33 5±3. ±5.53 10.15 63 ±3.11
84
Overfat 23.86 172.86 75.30± 22.3 87.71 46.00± 80.29±3. 101.4
(n=7) ±1.35 ±6.41 5.29 3±1. ±3.82 2.83 82 3±4.4
54 7
Obese 24.86 174.86 90.33± 28.6 99.14 47.43± 82.00±3. 109.5
(n=7) ±2.54 ±3.29 9.20 3±3. ±9.84 2.57 96 7±5.1
58 9

3.Results

The average of last five balance trials time for the underfat, healthy, overfat, and obese
groups were presented in Fig. 3. In general, the healthy group could keep their balance
longer than any others. The longest mean balance time for the last five trials was kept
by the healthy group (4.39±0.24s). In addition, comparing the coefficient of variation,
the healthy group’s balancing performance is much more reliable (5.47%), compared
to the underfat (48.41%), obese (14.68%) and overfat (8.84%) groups as shown in Fig.

4. The main effect of the groups was significant, F(3,16)=3.806，p <.031, η² = 2.966.

However, the main effect of the trail was not significant, F(4,15)=0.358, p <.835, η²
=.465. And no significant correlations were found between anthropometric variables
within-group and core stability in Table 3.

Table 3. Summary of correlations between anthropometric variables within-group

and core stability

Healthy Overfat Obese

r p r p r p

Waist -.304 .291 .118 .801 .017 .971

Circumference
Arm Length -.155 .596 -.692 .085 .349 .443
Hip -.430 .125 .080 .865 -.146 .755
Circumference
Shoulder Breadth .251 .387 -.610 .146 .314 .493
Age -.010 .972 -.458 .301 -.050 .915
Height -.031 .915 -.519 .233 -.062 .894
Weight .197 .500 -.505 .248 -.127 .785
Fig. 3. Time in Balance for underfat, healthy, overfat and obese subjects during
the last five trials.

Fig. 4. Within-subject CV of Time in Balance derived from underfat, healthy,

overfat, and obese groups in last five trails
 Fig. 5. Normalized Root Mean Square Values (% MVIC) of four-point kneeing
exercise in underweight, healthy, overweight, and obese groups.

Abbreviations: RA, Rectus Abdominis upper; GM, Gluteus Maximus; L, Longissimus;

MF, Multifidus; EO, External Oblique; IO, Internal Oblique; LD, Latissimus Dorsi; RF,
Rectus Femoris.

Mean and standard error of normalized root mean square values for each muscle in four
different groups were obtained in Fig. 5. LD is the most active muscle for the healthy
(26.39%), overfat (16.08%), and obese (28.95%) groups, while IO is the most active
muscle for the underfat group (51.48%). However, the same lowest muscle activity
occurred for the RF muscle in each group. Comparing activation of muscles and four
different groups, IO muscle was significantly different (P=0.036 <0.05). The
correlations between normalized root mean square values EMG for each muscle and
core stability in the healthy, overfat and obese groups were demonstrated in Table 4.
No significance between normalized root mean square values EMG and core stability
were observed for any of dependent muscle variables.
Table 4. Summary of correlations between Normalized Root Mean Square
Values (% MVIC) and Core Stability in the healthy, overfat, and obese groups.

Healthy Overfat Obese

r p r P r p
RA .004 .991 .914* .030 .372 .467
GM .079 .808 .738 .155 -.661 .153
L -.046 .888 -.449 .448 -.027 .959
MF -.108 .737 .281 .647 .646 .165
EO -.079 .808 .549 .337 .505 .307
IO -.207 .519 .501 .390 .231 .660
LD -.149 .645 -.454 .442 .109 .837
RF -.278 .381 .506 .384 .143 .787

Abbreviations: RA, Rectus Abdominis upper; GM, Gluteus Maximus; L, Longissimus;

MF, Multifidus; EO, External Oblique; IO, Internal Oblique; LD, Latissimus Dorsi; RF,
Rectus Femoris.

4.Discussion

It is important to understand muscle activation and core stability performance in

addition to having core musculature training. This present study assessed the core
stability in four different groups based on body fat ranges, relationships between
anthropometric data with core stability, and muscle activation during the dynamic
balance test.

As we hypothesized, the best core stability performance from the four different groups
came from the healthy group, whose body fat range is 20% to 25%. The result showed
evidence to support our initial hypotheses. Comparing the average of the last five trails
balance times, the obese group managed 1.87s less than the healthy group, which had
the shortest balance time. The result was in accordance with a previous study showing
that postural instability is associated with obesity. The other study found that because
of its effects on the control of balance, obese individuals might be more at risk of
injuries (Berrigan et al., 2006). Comparing the coefficient of variance, it was surprising
that the Underfat group did not have a reliable score on the balance test.

Based on the body fat ranges, balance time exhibited significance between group
differences. It indicated that the present studies are able to predict stability based on
body fat ranges. The relationship between Waist Circumference, Arm Length, Hip
Circumference, Shoulder Breadth, Age, Height Weight and core stability were
investigated. The previous study also suggested that the anthropometric data may be
correlated with core stability (Liemohn et al., 2010). However, none of the core stability
in the present study was found to correlate or be significant. This may possibly be the
result of the availability of only young adult participants for this study.

Stability alters body awareness, such as muscle activation. It comes from internal
processes, and the result influences the external forces on body position. The RA
muscle plays a major role in the flexing of the torso, but a minor role in the stability of
spine (Cholewicki et al., 1996). Comparing RF muscle activity, the overfat group
reached highest at 10.06%. In addition, RF muscle activation in overfat group is
correlated with core stability (r=0.914). The GM muscle maintains a level pelvis and
prevents hip adduction and internal rotation. And the GM muscle activation
continuously increases based on body fat ranges, reaching the highest activation with
the obesity group at 10.29%. However, the L-muscle activation gradually decreases,
reaching its lowest at 12.7%. The action of the L muscle is to extend and bend the trunk.
It might indicate that the L muscle plays a minor role for the obesity group during the
four-point kneeing exercise. The MF muscle contributes significant support to the spine.
Particularly in subjects with chronic lower back pain, MF muscle activation was
significantly lower than in healthy subjects (Danneels et al., 2002). In the present study,
the group with the most MF muscle activation is the obese group (14.46%) which is
3.72% higher than the lowest – overfat – group. And none of the groups on balance
time of four-point kneeling exercise is corelated with MF muscle activation. The
function of EO and IO muscles is to flex the trunk and compress its contents. The EO
muscle activation for the obese group ranks the second activity within-group (18.03%).
For the healthy and overfat groups, IO muscle activation ranks second within-group.
This result indicates that EO and IO muscles are major active muscles during the four-
point kneeling exercise. The LD muscle is the most active for the healthy, overfat and
obese groups. This result is possibly due to arm-raising during the experiment. The
smallest activation is of the RF muscle for each group. This seems to be the result of a
muscle function that extends the knee and flexes the hip.

The limitations of this study were that we did not evaluate the posture of different
dynamic stretching and the effect of dynamic stretching via EMG. Also, different
gender subjects are needed in future studies.

5.Conclusion

Based on the present study, the healthy group had a better core stability performance
than others. Comparing coefficient of variance, the most reliable group is the healthy
one. And there was no correlation between anthropometric data and core stability. From
the RMS EMG muscle activation, the IO muscle is significantly different for each group.
And the IO muscle shows the most muscle activation for the underfat group while
for the healthy, overfat, obese group this is the LD muscle. However, the RF muscle
showed the same lowest muscle activation in each group. The study provided great
insight into the activation of different muscles for different groups in addition to
showing a benefit of balance training. And the finding suggests that a multi-component
exercise program can be developed for enhancing balance and perhaps benefit by
reducing the risk of falls based on body fat range groups.

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