Professional Documents
Culture Documents
Fall 2016
Todd Astorino
Abstract
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
Aim: To examine the effect of visual feedback and auditory feedback on peak torque of
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
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
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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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
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
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
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
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
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
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
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
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)
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.
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
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
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
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
References
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Cole, Z., & Maeda, H. (2015). Effects of listening to preferential music on sex differences in
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Hald, R. D., & Bottjen, E. J. (1987). Effect of visual feedback on maximal and submaximal
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Thorstensson, A., Grimby, G., & Karlsson, J. (1976). Force-velocity relations and fiber
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