Journal of Medical and Biological Engineering, 32(6): 437-442 437

Effects of Fatigue on Stability of Upper Extremity During

Bench-press Exercise
Pei-Hsi Chou1,2,3 Yen-Po Huang4 Shu-Zon Lou5 Wei-Zue Tseng4

Rong-Tyai Wang4 You-Li Chou6,*

1
Faculty of Sport Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 840, Taiwan, ROC
2
Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 840, Taiwan, ROC
3
Department of Orthopedic Surgery, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 840, Taiwan, ROC
4
Department of Engineering Science, National Cheng Kung University, Tainan 701, Taiwan, ROC
5
School of Occupational Therapy, Chung Shan Medical University, Taichung 404, Taiwan, ROC
6
Institute of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan, ROC

Received 12 Jul 2011; Accepted 23 Sep 2011; doi: 10.5405/jmbe.973

Abstract
This study explores the effect of exercise-induced fatigue on upper extremity stability. The kinematic changes of
the upper extremity during bench-press exercise are quantified by measuring the flexion angle and range of motion of
the elbow joint, the amplitude of the pitch angle, the amplitude of the yaw angle, and the perturbation frequencies of the
pitch and yaw angles, respectively. Fifteen healthy males performed bench presses until fatigue set in. The joint
kinematics in the initial stage and the fatigue stage of the bench-press exercise are calculated and analyzed using a
laboratory-developed three-dimensional motion analysis system. The flexion angle and range of motion of the elbow
joint are significantly higher in the initial stage of the bench-press exercise than in the fatigue stage. The amplitude of
the pitch angle in the fatigue stage (mean 11.98°, standard deviation (SD) 3.52°) is significantly higher than that in the
initial stage (mean 2.85°, SD 1.13°). The amplitude of the yaw angle in the fatigue stage (mean 8.87°, SD 2.05°) is
significantly higher than that in the initial stage (mean 3.27°, SD 1.70°). Finally, the perturbation frequencies of the
pitch and yaw angles, respectively, are both significantly higher in the fatigue stage than in the initial stage. The results
provide useful insight into the relationship between fatigue-induced perturbation frequency and the instability of the
upper extremity during bench-press exercise. An unstable upper extremity posture may increase the risk of injury during
the fatigue stage of repetitive exercise.

Keywords: Upper extremity, Bench press, Fatigue, Perturbation frequency, stability

performance of the whole upper extremity in throwing tasks

1. Introduction
Fatigue has a critical effect on an individual’s physical
performance and can result in various forms of musculoskeletal
injury. Many researchers have investigated the effects of
fatigue on the kinematics of the lower extremity during various
physical exercises [1-4]. In general, the results have shown that
fatigue leads to reduced knee proprioception, increased joint
laxity, a diminished capacity for rapid shock absorption, and
delayed muscular activation. In contrast, the effects of
exercise-induced fatigue on the upper extremity have attracted
relatively little attention. However, several researchers have
reported that functional fatigue affects the acuity of the
* Corresponding author: You-Li Chou
Tel: +886-6-2352645; Fax: +886-6-2750621
E-mail: ylchou@mail.ncku.edu.tw
[5-7]. In addition, it has been shown that the kinematic and
positional sense changes of the upper extremity joints
following functional fatigue protocols, indicating a decrease in
proprioceptive sense with muscle fatigue, may play a role in
decreasing athletic performance and in fatigue-related shoulder
dysfunction [8].
Sparto et al. [9] reported that the significant reduction in
postural stability caused by repetitive lifting tasks leads to a
higher risk of injury in the presence of unexpected
perturbations. Bench-press exercise notably improves the
muscular strength and stamina of the upper extremity.
However, during prolonged bench-press exercise, fatigue
causes the movement time to increase and the exercise speed to
decrease [10,11]. Thus, to maximize the effectiveness of bench-
press protocols while simultaneously minimizing the risk of
physical injury, it is essential to clarify the relationship between
fatigue and the stability of the upper extremity.
438 J. Med. Biol. Eng., Vol. 32 No. 6 2012

Various biomechanical models of the upper extremity assumptions for the trunk (cervical vertebra 7, thoracic vertebra
have been proposed for investigating kinematic parameters 4, and acromion processes), upper arm (acromion process and
under simulated fall conditions or in upper-extremity training medial and lateral epicondyles of the elbow), forearm (medial
exercises [12-16]. These models have proven useful in and lateral epicondyles of the elbow and ulnar styloid
investigating potential injury mechanisms in the event of a fall processes), and hand (radial and ulnar styloid processes and
onto an outstretched hand. However, they have not been third metacarpal bone) (Fig. 2). In addition, three markers were
applied to specifically examine the effects of fatigue on the attached to a triangular frame and placed on the upper arm in
joint variables during upper-extremity exercises. Recent studies order to minimize errors caused by movement of skin over
have utilized one-repetition maximum (1RM) tests to measure epicondyle during the bench-press repetitions. The center of the
the upper-extremity muscular strength in basic lift exercises shoulder joint was defined as the point located at 90% of the
such as bench presses by evaluating the maximum weight way along an imaginary line drawn from the elbow joint center
which can be lifted successfully through the full range of (as calculated from the medial and lateral markers) to the
motion [17-20]. Knoll et al. presented several predictive acromion marker.
equations based on the number of repetition cycles required for
fatigue to set in for evaluating upper-extremity muscular
strength [21]. In general, a strong correlation exists between the
1RM value and the number of repetitions for 10 or fewer
repetitions. However, the exact 1RM value depends on both the
gender and the training history of the participant [22].
The present study examines the effects of fatigue on the
stability of the upper extremity during bench-press exercise.
The kinematic changes of the upper extremity during bench- (a) (b)
press exercise are quantified by measuring the flexion angle Figure 1. Photographs showing (a) “up” state and (b) “down” state in
and range of motion of the elbow joint, the amplitude of the bench-press cycle.
pitch angle (APA), the amplitude of the yaw angle (AYA), and
the perturbation frequencies of the pitch and yaw angles,
respectively.

2. Materials and methods

2.1 Instruments

The motion trajectories of the upper extremity were

recorded with a sampling frequency of 60 Hz using a three-
dimensional (3D) optical motion capture system (Eagle Digital
System, Motion Analysis Corporation, Santa Rosa, CA, USA).
The system comprised eight Eagle Digital Cameras, an Eagle
Hub, and EVaRT software to acquire and post-process the
experimental data. Figure 2. Diagram of reflective markers on bony anatomical landmarks.

2.2 Participants and experimental procedures
Fifteen healthy weight-lifting males (mean age:
19.6 ± 0.8 years old; mean weight: 69.6 ± 8.6 kg; mean height:
168.7 ± 5.5 cm) volunteered to take part in the study. A 19-kg
weight was used to ensure identical loading conditions during
the bench-press exercise. None of the subjects had any previous
history of upper extremity injuries or disorders.
The participants were asked to begin the bench-press
exercise in the “up” state. A bench-press cycle involved
lowering the barbell to the “down” state and then returning it to
the “up” state (Fig. 1). The subjects were asked to repeat the
cycle continuously until they were physically unable to perform
any more repetitions.
For each participant, reflective markers were placed on
selected bony anatomical landmarks. The trajectories of these
landmarkers were recorded using the motion analysis system.
The landmarks were chosen in accordance with rigid body
The experimental test procedure was approved by both the
Institutional Review Board of Kaohsiung Medical University
and the National Science Council of Taiwan. Moreover, each
subject signed a consent-release agreement before commencing
the bench-press exercise. In addition, all of the experiments
were supervised in person by either the author or one of the
coauthors (all with a sports medicine background) in order to
minimize the risk of physical injury.
2.3 Data processing and analysis
The aim of the experiments was to analyze the stability of
the upper extremity in the initial stage (IS) and the fatigue stage
(FS) of the bench-press exercise. For convenience, the IS and
FS were defined as the first and last three cycles of a test run,
respectively. For each stage, the three sets of kinematic
measurements obtained in the “up-to-down” and “down-to-up”
phases of the bench-press cycle were averaged to obtain a mean
 Bench-press on Upper Extremity Stability 439

measurement value for further analysis.

The kinematic changes of the upper extremity over the
course of the bench-press exercise were quantified by
measuring the flexion angle and range of motion of the elbow
joint, the amplitude of pitch angle (APA), the amplitude of yaw
angle (AYA), and the perturbation frequencies of the pitch and
yaw angles, respectively. As shown in Fig. 3, the APA is
defined as the change in the angle of rotation of the barbell
about the I axis, where the I-J horizontal plane is defined as
zero-degree rotation. Similarly, the AYA is defined as the
change in the angle of rotation of the barbell about the K axis,
where the vertical J-K plane is defined as zero-degree rotation.
The APA and AYA data were plotted in the form of time-based
curves, and the perturbation frequency was then calculated as
the number of peaks per cycle in the portion of the curve.
3. Results
This section presents the major results obtained for the
kinematic parameters of the upper extremity during the IS and
FS of the bench-press exercise.
As shown in Table 1, in the “down” state of the bench-
press cycle, the mean flexion/extension angle of the elbow was
significantly smaller in the FS (mean 99.10°, standard deviation
(SD) 10.33°) than in the IS (mean 105.01°, SD 10.9°). In the
“up” state, no significant difference exists between the mean
flexion/extension angles in the IS and FS, respectively.
However, a significant difference exists in the range of motion
of the elbow joint between the FS (mean 79.29°, SD 9.07°) and
the IS (mean 85.4°, SD 10.60°). Overall, the results show that
fatigue has a significant effect on the kinematic response of the
elbow joint.

Table 1. Elbow joint angle and elbow range of motion during initial
stage and fatigue stage of continuous bench-press exercise.
Elbow Initial Stage (IS) Fatigue Stage (FS)
Flexion( + )/ Mean (SD) Mean (SD) P*
(a) Extension( - ) (degrees) (degrees)
Up 19.62 (11.57) 18.27 (7.74) 0.43
Down 105.01 (10.9) 99.10 (10.33) 0.01* IS > FS
Range of motion 85.40 (10.6) 79.29 (9.07) 0.01* IS > FS
*
P value is significant (p < 0.05) between initial and fatigue stages as obtained
using the paired t-test.

As shown in Table 2, the APA in the FS (mean 11.98°, SD

(b) 3.52°) was significantly higher than that in the IS (mean 2.85°,
SD 1.13°). The pitching perturbation frequency (PPF) in the
“up-to-down” portion of the cycle was significantly higher in
the FS (mean 8.8, SD 0.7) than in the IS (mean 5.4, SD 0.6).
Similarly, the PPF in the “down-to-up” portion of the cycle was
significantly higher in the FS (mean 9.5, SD 0.9) than in the IS
(mean 6.1, SD 0.5).

(c) Table 2. Amplitude of pitch angle (APA) and pitching perturbation

frequency (PPF) during initial stage and fatigue stage of
Figure 3. (a) Definition of APA; (b) definition of AYA; and (c) continuous bench-press exercise.
coordinate system used to describe motion trajectories during
bench-press exercise. I, J, and K denote three orthogonal unit Initial Stage Fatigue Stage
Pitching motion (IS) (FS) P*
vectors. L, R, and C markers on the barbell denote the left-
Mean (SD) Mean (SD)
hand side, the right-hand side, and the center of the barbell,
APA (degrees) 2.85 (1.13) 11.98 (3.52) 0.01* FS > IS
respectively.
PPF (number of
The joint kinematics of the upper extremity were peaks per cycle)
calculated using proprietary kinematic and MATLAB programs. Descending 5.4 (0.6) 8.8 (0.7) 0.01* FS > IS
(per cycle)
Each segment of the upper-extremity was assumed to be a rigid
Ascending 6.1 (0.5) 9.5 (0.9) 0.01* FS > IS
body. In addition, the 3D orientations of the joint movements (per cycle)
were calculated using Euler’s method with a y-x’-z” rotational *
P value is significant (p < 0.05) between initial and fatigue stages as obtained
using the paired t-test.
sequence via the marker-based coordinate system.

2.4 Statistical analysis
The experimental data were analyzed using commercial
SPSS statistical analysis software (SPSS Inc., Chicago, IL,
USA). In addition, a paired t-test with a 95% confidence
interval was performed to compare the values of the kinematic
parameters obtained in the IS of the exercise with those
obtained in the FS.
As shown in Table 3, the AYA in the FS (mean 8.87°, SD
2.05°) was significantly higher than that in the IS (mean 3.27°,
SD 1.70°). The yawing perturbation frequency (YPF) in the
“up-to-down” portion of the cycle was significantly higher in
the FS (mean 49.4, SD 8.6) than in the IS (mean 25.5, SD 8.2).
Similarly, the YPF in the “down-to-up” portion of the cycle
was significantly higher in the FS (mean 54.5, SD 5.2) than in
the IS (mean 31.3, SD 5.50).
440 J. Med. Biol. Eng., Vol. 32 No. 6 2012
Table 3. Amplitude of yaw angle (AYA) and yawing perturbation
frequency (YPF) during initial stage and fatigue stage of
continuous bench-press exercise.
Initial Stage Fatigue Stage
Yawing motion (IS) (FS) P*
Mean (SD) Mean (SD)
AYA (degrees) 3.27 (1.70) 8.87 (2.05) 0.01*
YPF (number of
peaks per cycle)
Descending 25.5 (8.2) 49.4 (8.6) 0.01*
(per cycle)
Ascending 31.3 (5.5) 54.5 (5.2) 0.01*
(per cycle)
* occurrence of sudden unexpected perturbations of kinematic
P value is significant (p < 0.05) between initial and fatigue stages as obtained
using the paired t-test
The average number of cycles required for fatigue to set in
was 20.5 (SD 4.55).
4. Discussion
The results presented in Tables 1-3 suggest that a loss in
stability of the upper extremity occurs during the FS of bench-
press exercise. This loss in stability may be due to fatigue
inducing unexpected perturbations in the joint kinematics of the
upper extremity [9].
In 3D Euclidean space, the reference orientations of a rigid
body are usually described using three independent Euler angles
[23]. The barbell used in the present experiments can be
regarded as a slender body [24-26]. Hence, the three-axis
conventions and notations used to describe the movement of
traditional slender bodies such as aircraft, missiles, and
sea-going vessels can be used to describe the motion of the
barbell during each cycle of the bench-press exercise.
Conventionally, the axes used to describe the motion of an
aircraft, missile, or ship are referred to as the vertical, lateral,
and longitudinal axes. The rotations of the slender body around
these axes are defined as yaw, pitch, and roll, respectively [26].
A dynamic system is said to be stable if it tends to return to and
remain in an equilibrium state when slightly disturbed from this
state via an external force or displacement [24]. In this study, the
state of equilibrium is described using roll, pitch, and yaw. Thus,
the stability of the barbell was evaluated using the parameters
APA, AYA, PPF, and YPF, with the assumption that the stability
of the barbell was representative of the stability of the upper
extremity.
In general, the experimental results obtained in this study
show that fatigue has a critical effect on both the elbow joint
angle and the stability of the upper extremity during bench-
press exercise. In the bench-press experiments, the subjects were
asked to perform repetitions until they were physically unable to
perform any more. This condition is very similar to that applied
in 1RM tests, which measure muscular strength in terms of the
maximum weight which the subject can successfully lift through
the full range of motion. The significant difference observed in
the elbow joint angles in the IS and FS of the bench-press
exercise confirms that fatigue has a major effect on the
multi-joint kinematics of the upper extremity. For both the IS
and the FS, the values of the elbow joint angles in the “down”
state of the bench-press cycle are consistent with a previous
study by the current group, which found that the peak flexion
angle of the elbow during bench- press exercise is around
90~100 [27]. The upper extremity can be regarded as a simple
three-linkage system, comprising the hand, forearm, and upper
arm. At the start of the bench-press cycle, the upper extremity
FS > IS forms a vertical pillar which supports the barbell in the “up”
position. As the barbell moves to the “down” position, the
flexion of the upper extremity induces medial and posterior
FS > IS
stress. Fatigue affects not only the elbow angle, but also the
stability of the upper extremity, as quantified by the APA, AYA,
FS > IS PPF, and YPF parameters. Sparto et al. [9] suggested that the
trajectories during repetitive exercises may lead to an increased
risk of physical injury. Thus, in designing bench-press exercise
protocols, reliable means of quantifying the perturbations in the
motion trajectories of the upper body are required in order to
minimize the risk of injury.
This study provides the first reported analysis of upper-
extremity stability during bench-press exercise using yaw and
pitch perturbation frequencies, and the first direct comparison of
the APA, AYA, PPF, and YPF parameters in the initial and
fatigue stages of the bench-press exercise. The results confirm
that fatigue leads to a significant reduction in the elbow angle
and a significant increase in the APA, AYA, and associated
perturbation frequency parameters. Overall, the results suggest
that fatigue causes a loss in upper-extremity stability during
prolonged bench-press exercise.
The present results extend the findings of previous studies
regarding repetition-related differences in the ability of different
subjects to sustain a high level of performance when engaged in
exercises involving the upper extremity. For example, some
studies have shown a post-fatigue performance reduction, while
others have found that some individuals maintain the ability to
accurately hit a target even when fatigued [28,29]. The apparent
discrepancy in the two sets of findings may be explained by the
redundancy of the human body, which enables very similar tasks
to be performed using different muscle combinations.
The barbell weight determines the onset of muscle fatigue.
In order to minimize the risk of exercise-related injury, a 19-kg
barbell, which provides a loading that is similar to that during a
push up, was used in this study. Sparto et al. [9] developed
several biomechanical models to investigate the kinematic
effects of fatigue during repetitive lifting exercises. The present
study examined the effects of fatigue on the upper-extremity
kinematics from an instability perspective. The experimental
results show that fatigue has a significant effect on the multi-
joint kinematics of the upper extremity during bench- press
exercise. The perturbation frequency results presented in
Tables 2 and 3 indicate that fatigue reduces the ability of the
subject to control the motion trajectories of the upper
extremities, leading to instability. As discussed in [9], the
occurrence of unexpected perturbations in the joint kinematics
during the performance of repetition-based exercises increases
the risk of physical injury due to the corresponding unexpected
perturbation of the joint forces. Specifically, the joint forces
increase with increasing perturbation frequency. The present
results show that the perturbation frequency increases
 Bench-press on Upper Extremity Stability
significantly as the subject approaches the point of fatigue. In
other words, the risk of physical injury increases as the subject
tires. Thus, in designing any bench-press-related exercise
protocol, the number of repetitions should be carefully
controlled in accordance with training history of the participant.
This study had several limitations. The perturbation
frequency was examined in only two directions (pitch and yaw).
However, in practice, the stability of the upper extremity is
governed by a complex combination of muscles and joints.
Another limitation is the lack of information regarding muscle
power. Thus, while the present results provide useful insight into
the effects of fatigue on unexpected perturbation frequency and
upper extremity stability, a future study should develop a more
sophisticated model to describe the effects of exercise- induced
fatigue on the stability of the upper extremity.
5. Conclusion
This study investigated the effects of fatigue on the stability
of the upper extremity during bench-press exercise. The results
show that the amplitude of the pitch angle in the fatigue stage is
significantly higher than that in the initial stage. Similarly, the
amplitude of the yaw angle in the FS is significantly higher than
that in the IS. Finally, the perturbation frequencies of the APA
and AYA responses, respectively, are significantly higher in the
FS than in the IS. Previous studies have suggested that the risk
of physical injury increases with increasing frequency of
unexpected perturbations in the motion trajectories of the upper
extremities. Thus, the present results suggest that bench-press
repetitions should be terminated before the stage of complete
fatigue.
Acknowledgement
This study was financially supported by the National
Science Council of Taiwan under grant NSC 96-2221-E-
037-MY3.
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