Exercises and Sequences

A total number of 72 exercises were provided, grouped into 8 different sequences of increasing difficulty, from the simplest to the most complex, with each sequence having a training target directed to a specific body part and requiring an ever-increasing physical and motor effort as the participant levels up. Of the 8 total sequences, 3 involved the lower limbs, 2 the core stability, 1 the trunk and 2 the upper limbs. Based on an unpublished preliminary study of ours, the sequences were classified as entry-level, medium-level and high-level according to their overall degree of difficulty. The method used did not require special equipment, but only inexpensive and easily available materials: 1 gymnastics mat, 1 rubber ball and 1 elastic band. The therapists involved in the project had undergone a period of training on the method and application criteria and alternated in following the study participants. The therapists, who were all physiotherapists and/or motor scientists, were responsible for planning and applying the HT method.

All subjects started training with entry-level sequences (sequences 1, 2 and 3). Descriptions of sequences 1, 2 and 3 are provided in Figure 1, Figure 2 and Figure 3.Figure 1, Sequence 1: (1) squat from a chair, hands on table; (2) chair squat; (3) isometric wall squat; (4) wall squat with ball between lower back and wall; (5) squat; (6) squat with shoulder abduction; (7) candelabrum squat; (8) squat alternating arm moves; (9) y squat.Figure 2, Sequence 2: (1) chair “spinal wave”; (2) wall “spinal wave”, lower back against the wall; (3) isometric back extension (sitting on a chair, trunk–hip angle at 45°, hands on hips); (4) from previous position 3 to “spinal wave”; (5) back extension (sitting on a chair, hands on hips, from trunk–hip angle at 45° to 90°); (6) alternating shoulder back elevation (stand up position, hip–trunk angle at 45°); (7) double back shoulder extension (stand up position, hip–trunk angle at 45°); (8) shoulder back elevation (stand up position, hip–trunk angle at 45°); (9) dynamic movement from exercise position 7 to 8 and return.Figure 3, Sequence 3: (1) isometric chair low rowing with elastic band (sitting position); (2) chair dynamic full R.O.M. low row with elastic band (sitting position); (3) chair single alternating low row with elastic band (sitting position); (4) isometric low row (with elastic band in standing position); (5) low rowing (with elastic band in standing position); (6) single arm alternating low row (with elastic band in standing position); (7) “w” low row (with elastic band in standing position); (8) low rowing and calf raise at the end of row (with elastic band in standing position); (9) single arm alternating low rowing and calf raise at the end of row (with elastic band in standing position).According to the initial assessment and response to treatment, medium-level sequences (sequences 4, 5 and 6, shown in Figure 4, Figure 5 and Figure 6) could be introduced.Figure 4, Sequence 4: (1) side squat from a chair, hands on table; (2) chair side squat; (3) isometric single leg wall squat; (4) side squat, hands on table; (5) side squat; (6) walking side squat; (7) candelabrum side squat; (8) side squat with single front arm elastic band rowing; (9) side squat alternating arm elastic band rowing.Figure 5, Sequence 5: (1) isometric wall push-up (hands against the wall); (2) dynamic wall push-up; (3) isometric chair push-up (hands on chair seat); (4) chair push-up (dynamic movement, hands on chair seat); (5) easy push-up (knee on the floor); (6) easy double-time push-up (knee on the floor, isometric contraction between concentric and eccentric arm movement); (7) isometric push-up; (8) push-up; (9) push-up with single hip extension.Figure 6, Sequence 6: (1) table plank, (isometric, hands on table); (2) easy plank plus alternating arm row; (3) chair plank (isometric, hands on chair seat); (4) chair plank alternating single arm row; (5) plank; (6) reverse plank; (7) side plank; (8) dynamic movement from chair plank to chair “v position” (hip flexed at 90°); (9) plank with single hip extension.After completing the lower-level sequences, high-level sequences (sequences 7 and 8; see Figure 7 and Figure 8) could be administered, if applicable.Figure 7, Sequence 7: (1) lunge with front leg movement, hands on wall; (2) lunge plus other hip extension movement; (3) half R.O.M. lunge; (4) isometric full R.O.M. lunge; (5) dynamic full R.O.M. lunge; (6) lunge plus double arm rowing; (7) lunge with shoulder abduction; (8) lunge with twist; (9) from dynamic full R.O.M. lunge to calf raise and return.Figure 8, Sequence 8: (1) table side plank (isometric, hand on table); (2) easy side plank with rotational reach; (3) chair side plank (isometric, hand on chair seat); (4) chair side plank with rotational reach; (5) easy side plank (side plank dynamic movement, one lower limb extended with foot on the floor, the other lower limb positioned forward, with knee flexed at 90° and movement of the foot on the floor, which pushes and facilitates movement; (6) side plank; (7) side plank with single shoulder elevation; (8) side plank with single frontal shoulder abduction; (9) weighted side plank with single frontal shoulder abduction (extra load, 1.5 L water bottle in the free hand).

Participants underwent two sessions per week for 12 weeks. The sequence exercises were the main part of the training session unit. Before this phase, a standardized warm-up of 8 min, consisting of exercises of joint mobility, marching in place and muscle stretching, was carried out. At the end of the session, a standardized cool-down, including exercises of joint mobility and muscle stretching, was administered. FITT parameters: frequency was twice a week; intensity was moderate (3.4 ± 1.0 in the CR10 Borg scale); time (duration) of each session was around 1 h; type was strength training with body weight and resistance band exercises.