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. 2018 Aug 8;8(8):e020946. doi: 10.1136/bmjopen-2017-020946

Table 2.

Test activities: exercise descriptor and reliability

Test # Title Justification for inclusion Instructions to participants Successful completion Test reliability
1 EIL: Extension in lying, held for 3 s Maximal lumbar extension simulates the physical properties of normal spinal movements36 79 because limited extension80 is related to low back pain (LBP),81 clinically impaired spinal control82 and may inhibit symptom centralisation.83 84 Lying face down, hands beneath shoulders, forehead on the floor. Keep your pelvis on the floor, breathe in, press with your arms, raise your chest off the ground, breathing out and increasing the movement until your arms are straight. Hold for 3 s. Hips/pelvis remains in contact with floor, arms fully extended. ICC=0.95–0.98.85
2 SITUP: sit-up from supine, performed 10 times Through range, active concentric and eccentric trunk flexion control enables the lumbar spine to dissipate and distribute load and provides a stable area for performing limb and trunk activities.14 36 86 87 Lying face-up on the floor, knees bent, feet flat, arms straight and hands on thighs. Breathe in, slowly sit up while breathing out, move the elbows to touch your knees, rolling forward and up from the floor in a continuous movement, until everything above the buttocks is not touching the ground and your elbows reach your knees. Lower down in a continuous movement without falling or dropping while breathing out. Repeat 10 times. No sudden/rapid inertial motion, trunk not held rigid, feet remain on floor, elbows reach/pass the knees, body does not drop down. ICC=0.995.88
3 LEGEXT: supine bilateral leg extension performed 10 times Abdominal muscles are used predominantly isometrically to stabilise the body during this exercise53 89 and relevant to performing many household, occupational and sports activities.54 The exercise provides coactivation significantly greater than in sit-ups/curl,90 enabling testing of rectus abdominis muscle and the internal and external oblique muscle activation53 reducing LBP risk when part of a motor control exercise programme.91 Lying on back on floor breathing in, head in contact or elevated, knees bent and above the umbilicus, lower back contacts the floor, hands by side or under buttocks. Both legs are straightened, knees straightening until heels touch floor while breathing out. Small amounts of knee flexion are permitted. Return legs to the start position. Repeat 10 times. Back and buttocks contact the floor, heels touch the ground, hands remain in start position. (double) leg lower (ICC=0.81–1.00)54 ICC=0.9892; active single leg raise ICC3.3=0.95–0.9793; abdominal muscle % ‘time active’ is 54%–86%.53
4 SQUAT: ‘toilet squat’ barefoot, hands touch feet, held for 3 s Squatting is frequently used and associated with many activities of daily living. It requires optimal lumbar flexion control to ensure normal spinal movements are maintained,36 79 and shear forces/lateral movement are minimalised.94 Squatting is a complex multisegmental functional movement requiring coordinated biomechanical and neuromuscular components involving the leg and pelvic joints and muscles, respiratory system, with prime-mover muscle activation not significantly affected by common variations in kinetic chain continuity.95 A semirigid spine eliminates planar motion but retains anteroposterior spinal integrity, as spinal flexion generally increases with hip flexion and the associated synergistic lumbar-pelvic action,94 96 which reduces the risk of LBP.97 Standing comfortably, feet shoulder-width apart, arms loosely at your side. Breathe in, slowly squat, as though using a squat-toilet, allow the arms to move forward and hands touch the feet. Hold for 3 s. Pelvis is lowered, heels/feet flat, fingers touch the feet. Intrarater kappa=0.81–1.00 when tested alone98; ICC >0.60 within a multiexercise screen99 and ICC=0.81.100
5 RISEUP: full squat and stand-up, performed five times Repeated squatting is functional and readily transfers to multiple ADLs. It requires coordinated prime-mover muscle activation and endurance95 being the technique of choice for manual handling as net moments, muscle forces and internal spinal loads related to compression and shear force are reduced.101 Reduces LBP risk and is critical for normal spinal movement.36 79 Complete the squat position described, then rise to full standing with the head rising at the slightly before or at the same time as the buttocks. Repeat five times; a short rest is permitted. Full squat action as above; on rise trunk rises before buttocks/pelvis, that is, knee extension before hip. ICC=0.61–0.80, SE of measurement
<3%.102