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Tuesday, June 6, 2023

Effects of Integrated vs Isolated Training on Performance and Neuromuscular Control

Brent Brookbush

Brent Brookbush


Research Review: Effects of Integrated vs Isolated Training on Performance and Neuromuscular Control

By Stefanie DiCarrado DPT, NASM CPT & CES

Edited by Brent Brookbush DPT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation: DiStefano, L., DiStefano, M., Frank, B., Clark, M., and Padua, D. (2013). Comparison of integrated and isolated training on performance measures and neuromuscular control. Journal of Strength and Conditioning Research/National Strength & Conditioning Association. 27(4), 1083-1090. ABSTRACT

Why is this relevant?: This study provides evidence that a larger increase in performance may be attained using an integrated training (INT) approach when compared to traditional strength training (ISO). Integrated training combines multi-planar resistance training, plyometrics (power), balance, stabilization, and agility exercises, focused on whole body, functional movement patterns. Isolated strength training typically targets one muscle or muscle group, with progressively increasing resistance to improve strength, generally, within a single plane of motion. Activities of daily living (ADL), as well as recreation and sport, involve a combination of attributes including strength, speed, balance, and coordination through multiple planes. This review suggests that the human movement professionals should consider all variables when designing a program; as greater benefit may be seen from addressing all attributes of performance in an integrated program.

Dr. Brookbush instructs model, Melissa Ruiz, on proper form during a Kneeling Chop
Caption: Dr. Brookbush instructs model, Melissa Ruiz, on proper form during a Kneeling Chop

Kneeling Chop

Study Summary

Study Design Randomized Controlled Trial (RCT)
Level of Evidence IIb - 1 RCT with a small sample size
Subject Demographics
  • Age: 19 + 2 yrs (INT); 19 + 1 yrs (ISO)
  • Gender: 5 females, 25 males
  • Characteristics:
    • Height: 176 + 9 cm (INT); 178 + 8 cm (ISO)
    • Mass: 77 +  20 kg (INT); 77+ 21 kg (ISO)
    • Members of an introductory strength training course; young, healthy, free from injury or illness that would impede participation

  • No significant differences in height, weight, age, or other baseline measure between groups
Outcome MeasuresSubjects were randomly assigned to the INT (n=15) or ISO (n=15) group and instructed to complete two 45 minute training sessions per week over the course of 8 weeks.  Pre & post training assessments included 3 trials of the following:
  • Landing Error Scoring System (LESS) for a jump landing task to assess neuromuscular control and movement quality.  This test consisted of 3 trials videotaped by 2 digital cameras capturing sagittal and frontal plane movement.  Subjects jumped forward (a distance of 1/2 their height) off a 30cm box and upon landing had to jump as high as possible.  The lower the LESS score, the better the performance.
  • Vertical jump height to assess power production:  subjects jumped from a static stance position in an attempt to reach an overhead object.
  • T-test time to assess agility: subjects were timed as they sprinted forward, then side-shuffled left, right, then left again, and returned to the starting line by running backwards.
  • Push-up & Sit-up performance to assess strength and endurance:  researchers recorded the number of push-ups/sit-ups performed in 1 minute (separately).
  • Sit & Reach test to assess flexibility: subjects sat with their backs against a wall and legs out in front of them; they were instructed to reach forward toward their toes without bouncing.
ResultsAll subjects completed a minimum of 15 training sessions. Both groups demonstrated improvement in push-up performance, vertical jump height, and sit & reach flexibility.  The INT group improved by a greater degree on all outcome measures except for vertical jump and sit & reach than the ISO group at post-test assessment.
ConclusionsThese results indicate a training protocol that includes various forms of exercise (flexibility, strength, power, agility) and multi-planar movements within a young, healthy population will yield greater performance enhancement than isolated strengthening.  Not only does an integrated approach challenge the musculoskeletal system, but it also places demand on one's cardiovascular system and, possibly most importantly, the neurological system.  The neurological system adapts to the imposed demands and learns when to fire the appropriate muscles and with the appropriate amount of force.  Such neuromuscular education may not exist to the same extent when training for strength and power alone. Although we can assume these results would occur in other populations, it remains an assumption until further research is published.
Conclusions of the ResearchersIntegrated training is superior to isolated strength training in performance enhancement.  Since our bodies specifically adapt to imposed demands (SAIDs principle), the tasks performed will be the tasks that improve to the greatest degree.  The INT group performed exercises that targeted components of each outcome measure.  The ISO group performed only flexibility, strength, and power exercises and, therefore, improved only in those outcome measures. Additionally, the higher quality of movement (as measured by the LESS) demonstrated after integrated training could potentially decrease lower extremity injury which typically occurs with excessive and uncontrolled frontal and transverse plane movement.

Ice Skaters
Caption: Ice Skaters

Review & Commentary: Despite the relatively small sample size (30), the use of a randomized control trial provides strong evidence to support the use of an integrated training program. The authors took special care to minimize interference between the two groups by blinding the individual responsible for pre/post test assessments. Additionally, the supervisors of each group, and the group members themselves, were blinded to other the group's specific intervention protocol.

The authors describe the methodology in detail, offering the ability to reproduce the study within a different population or with a greater sample size. Researchers standardized the testing and training protocols by implementing the following procedures:

  • All testing, as applicable, occurred on the subject's dominant limb which was determined by which leg could kick a ball the farthest distance
  • All pre/post test results were averaged among 3 trials
  • Participants were able to practice the assessment tasks as needed to avoid poor performance due to novelty
  • The LESS score was determined using two digital cameras to allow for greater detailed examination
  • Both intervention groups were provided identical standard warm up and cool down exercises
  • All individuals were monitored by a certified strength and conditioning coach or athletic trainer

This article is not without limitations. The authors provide validation of the LESS via one citatation, and offer no citations for validation of the other assessments. Although commonly used, it would be interesting to see the available research validating the use of sit-up & push-up tests, and the author's commentary on the selection of these assessments. The homogeneous sample included young, healthy, active, individuals free of injury, so transference of results to other populations may be assumed but is not evident at this time. As mentioned above, this study would also benefit from a larger sample size. Overall, this article is a great first step in demonstrating the need to treat the whole person with an integrated approach rather than treating each muscle as though it is a separate organ.

Why is this study important?

This study provides high level evidence to support that integrated training improves measures of performance and neuromuscular control. Interestingly, the integrated training group performed better on the strength endurance assessments than did the isolated strengthening group, indicating there is more to developing strength than simply lifting heavy weights. This may have to do with proximal stability and neuromuscular control leading to more efficient force production by the larger muscles that move our limbs against an external load. In essence, without neurmuscular control, compensation leads to inefficiency and a reduction in force output. Integrated training is intended to increase both intra-muscular control (activation of a single muscle) and inter-muscular control (coordination between different muscles) whereas isolated strength training is typically limited to intra-muscular control. Further, it is important to consider all of the variables that contribute to performance, including balance, stability, coordination and endurance, rather than being so focused on maximal strength and power that it consumes the entirety of our training programs.

How does it affect practice?

Rehabilitation and performance enhancement professionals must provide a regimen to be performed both in and outside of the gym/clinic that integrates all the requirements of proper movement. To focus on only strength, flexibility, and power with an individual looking to increase their sport performance or regain function lost due to injury, will neglect the essential components of stability, balance, and agility. Exercises must be further tailored to the individuals' needs and abilities in an effort to target any plane specific weakness, movement impairment, compensation and/or risk of injury.

T-test for Agility Testing http://www.professionalsoccercoaching.com/online-courses/online-courses/images/drills/ttest.jpg

How does it relate to Brookbush Institute Content?

The Brookbush Institute promotes an integrated approach as a means of correcting movement dysfunction . This is evident in the integrated warm-up and rehabilitation templates that include: Release, Stretch , Mobilize (when appropriate), Isolated activation , Core activation , Stability Integration, Reactive Integration, Subsystem Integration , Functional Tasks (may be integrated into stability/reactive/subsystem integration exercises) followed by reinforcement of the program through a home exercise program, patient education, and external devices such as taping. The Brookbush models of Lower Leg dysfunction , Lumbo Pelvic Hip Complex dysfunction , Sacroiliac dysfunction , and Upper Body dysfunction  provide a means to assess movement impairment with the intent of providing an integrated training approach which can be expanded by the human movement professional to fit the needs of their clients. Further, the concept of inter-muscular coordination and stability playing a role in performance enhancement is illustrated in the exercise progressions listed in Resistance Training , Core Strength Training and Core Subsystem Articles.

Related Videos:

Self-Administered Ankle Joint Mobilization:

Gluteus Medius Reactive Activation

Trapezius Reactive Activation

Power Pushups (UE Power)

Box Jumps (LE Power)

© 2014 Brent Brookbush

Questions, comments, and criticisms are welcomed and encouraged -