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ORIGINAL
ARTICLE
Exercise
intensity
and
energy
expenditure
during
a
mini-trampoline
rebounding
exercise
session
in
overweight
women
Quantification
de
l’intensité
de
l’exercice
et
de
la
dépense
énergétique
pendant
une
session
de
minitrampoline
chez
des
femmes
en
surpoids
L.
Cugusi
a,b,∗,
A.
Manca
c,
G.
Romita
b,
M.
Bergamin
d,
A.
Di
Blasio
e,
G.
Mercuro
a,b,
in
collaboration
with
the
Working
Group
of
Gender
Cardiovascular
Disease
of
the
Italian
Society
of
Cardiology
aDepartmentofMedicalSciencesandPublicHealth,UniversityofCagliari,StradaStatale554perSestu,
09042Monserrato,Italy
bAdaptedPhysicalActivityMasterDegreeCourse,UniversityofCagliari,09042Monserrato,Italy cDepartmentofBiomedicalSciences,UniversityofSassari,07100Sassari,Italy
dSportandExerciseMedicineDivision,DepartmentofMedicine,UniversityofPadova,35128Padova,Italy eEndocrineSection,DepartmentofMedicineandAgingSciences,‘G.d’Annunzio’Universityof
Chieti—Pescara,66013Chieti,Italy
Received15February2016;accepted21June2016 Availableonline27October2016
KEYWORDS Mini-trampoline; Reboundingexercise; Exerciseintensity; Energyexpenditure; Overweightwomen; Cardiovascular health;
Bodyweightcontrol
Summary
Objectives.—Thepurposeofthisstudywastoestimatetheexerciseintensityandenergy expen-ditureduringamini-trampolinereboundingtrainingsessioninagroupofoverweightwomento assesswhethersuchfitnessactivitymeetstheguidelinesforexerciseprescriptioninadultsof theAmericanCollegeofSportsMedicine(ACSM)andwhetheritcanberecommendedforan overweightfemalepopulation.
Equipmentandmethods.— To achieve the aims of our study, eighteen overweight women (36.7±10.6years, BMI: 26.8±1.6kg/m2), were enrolled. Allthe participants underwent a
maximalcardiopulmonary exercisetestandthemainphysiologicalvariableswere recorded. Afterwards, the subjects performed a mini-trampoline rebounding exercise session where
∗Correspondingauthor.DepartmentofMedicalSciencesandPublicHealth,UniversityofCagliari,StradaStatale554perSestu,09042
Monserrato,Italy.
E-mailaddress:[email protected](L.Cugusi).
http://dx.doi.org/10.1016/j.scispo.2016.06.006
exerciseintensityandenergy expenditureweremeasured withaheart ratemonitor,a rat-ingperceivedexertionscaleandaportable armbanddevice,respectively.Successively,the physiologicalresponsesobtainedfromthesetwoactivitieswerecompared.
Results.—The average heart rate throughout the mini-trampoline exercise session, lasting 46.1±5.0min,was132.3±7.7bpm,correspondingto72.2±3.3%ofthatobtainedinthe pre-liminarymaximaltest.Theestimatedenergyexpenditureofparticipantstomini-trampoline reboundingexercisesessionwas6.9±0.8kcal/min,correspondingtoatotalof317.3±45.7kcal forthedurationoftheentiresession.
Conclusions.—Ourresultsshowedthatmini-trampolinereboundingexerciseisavigorous phys-icalactivity,whichcanbeidentifiedasaneffectivewaytoachieveanoptimalleveloftraining, asindicatedbytheACSMguidelines.
©2016ElsevierMassonSAS.Allrightsreserved.
MOTSCLÉS Minitrampoline; Intensitéd’exercice; Dépense énergétique; Femmesensurpoids; Système cardiovasculaire Résumé
Objectifs.—Cetteétudeviseàévaluerl’intensitédel’exerciceetladépenseénergétique pen-dantunesessiond’entraînementsurminitrampolinechezungroupedefemmesensurpoids,et àdéterminersicetteactivitéphysiqueestconformeaveclesguidelinesforexercise prescrip-tioninadultsdel’AmericanCollegeofSportsMedicine(ACSM),etpeutainsiêtrerecommandée pourunepopulationdefemmesensurpoids.
Sujetsetméthodes.— Dix-huitfemmesensurpoids(36,7±10,6ans,BMI:26,8±1,6kg/m2)ont
étéinclusesdanscetteétude.Touteslesparticipantesontpréalablementréaliséuntestd’effort maximaldonttouteslesprincipalesvariablesphysiologiquesontétéenregistrées.Lessujetsont ensuiteréaliséuneséancedeminitrampolinedontl’intensitéetladépensed’énergieontété contrôléesavecunactimètre,uneéchelled’intensitédel’effortperc¸uetunbrassardportable. Lesdonnéesphysiologiquesobtenueslorsdupremieretdeuxièmeexerciceontétécomparées.
Résultats.—Lafréquencecardiaquemoyennependantlasessiondeminitrampoline,quidurait 46,1±5,0min,aétéde132,3±7,7battementsparminute,cequicorrespondau72,2±3,3% delafréquenceobtenuelorsdutestd’effortmaximaleinitial.Ladépenseénergétiquedes par-ticipantesàlasessiondeminitrampolineaétéestiméeà6,9±0,8kcal/min,cequicorrespond antotalde317,3±45,7kcalpourladuréetotaledelaséance.
Conclusions.—Nos résultats montrent que l’exercice sur minitrampoline est une activ-ité physique vigoureuse qui peut constituer un moyen efficace pour atteindre un niveau d’entraînementoptimalconformeauxpréconisationsdel’ACSM.
©2016ElsevierMassonSAS.Tousdroitsr´eserv´es.
1.
Introduction
Mini-trampoline rebounding exercise (MRE) is a long time
knownandverypopularfitnessworkout.Thefirstresearch
in this field began in the 1980s with preliminary
stud-iesby Carter [1] andWhite [2]. In the firstinstance, the
authors attempted to outline the characteristics of the rebound while describing the effects onthe human body. Subsequently,otherstudiesonreboundcarriedoutby Bhat-tacharya et al. confirmed the beneficial effects of this particulartrainingonthehumanbody,especiallyinpeople exposedtoabsenceofgravity[3].
Exercise on the mini-trampoline consists of a multi-componentapproachwhich involves strength andbalance training, physical fitness, body stability, coordination of muscleresponsesandspatialorientation[4—10].
Duetothemultipleeffectsofreboundingonmotion pat-terns,severalrecent studieswereundertakenfocusingon theusageofmini-trampoline.Someoftheseweretailored toevaluateitseffectonimproving athletes’performance
[11,12]while others investigatedtherole ofMRE training in improving balance ability and movement coordination
[13—15]. Besides, studies on the use of MRE protocols in specialpopulationsareincreasing,withtheaimtohighlight its usefulness in medical rehabilitation treatment and its positivepsychologicaleffects[14—18].
DespitethespreadandinterestinMREasafitness work-out, only a few studies dating back to 1990s examined the exerciseintensity (ExI)duringan MREsession [2,4,8]. Indeed,littleis knownabout theenergyexpenditure (EE) inthecontextofMRE,especiallyifmeasuredinoverweight andobesesubjects,whoseattendanceofgymfitnessclasses has been continuously increasing in the last decade [19]. Conversely,theassessmentofEEandExIwouldbe particu-larlyusefultoclarifywhetherMREcanimprovetheoverall healthstatusofpeoplewhoperformthisspecificexercise. In addition,such approachcould revealwhetherthe MRE isan effectiveactivity forthoseindividuals,suchas over-weightwomen,whohaveaparticularneedtofollowspecific exercise prescription guidelines as recommended by the AmericanCollegeofSportMedicine(ACSM)[20,21].
Starting a program of physical training is particularly encouragedinindividualswithahighercardiovascularrisk profile,wheretheexerciseisacknowledged asakeypoint
ofprimaryprevention.Thisisthecase ofperi-menopausal women,inwhomtherapiddepletionofovarianestrogensis linkedtotheonsetofcardiovascularriskfactorsortotheir greater expression, if already present [22]. Among these risk factors,weight gainand redistribution of bodyfat in anandroidshapebecomeprevalent[22].
Based onthesepremises,thepresent study wasaimed atassessingtheExIthroughtheanalysisofheartrate(HR), theEE,inkcalandmetabolicequivalent(MET),andthe rat-ingsofperceivedexertion(RPE)duringasessionofMREina groupofoverweightwomenfreeofcardiovasculardiseases.
2.
Materials
and
Methods
2.1. Participants
Eighteen overweight women (36.7±10.6 years, BMI: 26.8±1.6kg/m2),whohadceasedanypracticeofphysical activityfor morethanoneyearpriortothepresentstudy wererecruitedfromthedatabase ofagymlocatedin the hinterlandareaofCagliari,Sardinia.
Inclusioncriteriawere:agebetween25and55years,BMI between25and29.9kg/m2 andsedentarylifestyle. Exclu-sioncriteriawere:thepresenceofotherriskfactors,except overweight,cardiovasculardiseasesandmajorsystemic ill-nessesthatcouldseriouslyreducetheirabilitytoparticipate in the study.The study wasapproved by ourinstitutional review board and conducted under the strict supervision of ourCardiovascularDiseaseUnit. Writteninformed con-sentwasobtainedfromallparticipantsbeforeenrollment, in accordancewiththe Declarationof Helsinki for Human Researchof1964(lastamendedin2000).Subjects’ charac-teristicsarereportedinTable1.
2.2. Anthropometricprofileandcardiopulmonary exercisetest
Bodyweight(kg)andheight(cm)weremeasuredby stan-dardized anthropometric procedures [23]. The bodymass index(BMI)wasalso calculated(kg/m2).Waist circumfer-ence(WC),hipcircumference(HC)andthewaist-hipratio (WHR)wereassessedbylinearmeter (tothenearest cen-timeter).
After admissionto thestudy,all women underwentan integratedmaximalcardiopulmonaryexercisetest(CPExT) on an electrically braked stationary cycle ergometer (Medical Graphics Corporation, Minneapolis; USA-Breeze Software, integrated with the XScribe 5, Mortara Instru-ment EuropeSrl)[20,24,25]. Heartrate andrhythm were continuouslymonitoredwitha12-leadECG,recordedevery 30seconds, both during exercise and for a post-exercise recoveryperiodof 10minutes.Arterialbloodpressurewas ascertained by the standard technique with a sphygmo-manometercuffplacedontheparticipant’sleftarm.Aramp protocol withan exerciseregimen of a 4min warm-up at 10W atapedal speedof60—65rpmwasapplied,inorder torecordthemainphysiologicalvariables.Breath-by-breath VO2,carbondioxideproduction(VCO2),minuteventilation (VE)andmaximum effort(watt)weremeasured.VO2max andtheconsumptionofoxygenattheanaerobicthreshold were expressed asabsolute values, standardized by body
Table1 Anthropometricprofileandcardiopulmonary exer-cisetestdata.
Variables(n=18) M±SD Anthropometricprofile Age(years) 36.7±10.6 Height(cm) 162±0.0 Weight(kg) 68.5±6.4 BMI(kg/m2) 26.8±1.6 WC(cm) 78.9±5.2 HC(cm) 105.5±3.8 WHR 0.7±0.0
Cardiopulmonaryexercisetest
RHRatrest(bpm) 75.3±6.2 SBPatrest(mmHg) 128±7.7 DBPatrest(mmHg) 71±4.5 HRmax(bpm) 183.3±10.6 SBPmax(mmHg) 147.5±2.6 DBPmax(mmHg) 78±6.9 VO2max(l/min) 1.0±0.2 VO2max(ml/kg/min) 15.4±2.6 VO2maxpredicted(l/min) 1.8±2 VO2max(%ofpredicted) 57.6±13.3
AT(l/min) 6.6±1.6
AT(%) 44.1±7.3
Work(watt) 104±21.1 Note:dataareexpressedasthemean±SD.BMI:bodymass index; WC: waist circumference; HC: hip circumference; WHR: waist-hipratio; RHR:restingheartrate;SBP:systolic blood pressure; DBP: diastolic blood pressure; VO2 max: maximumoxygen uptakeexpressedinabsoluteand indexed forbodyweight;VO2maxpredicted:maximumoxygenuptake predictedbyWasserman’sequation;AT:anaerobicthreshold; AT%:anaerobicthresholdinpercentagecomparedtotheVO2 max;Work:maximumwork.
weightandasa percentagecomparedto theabove
men-tionedvalues,accordingtotheWasserman’sformula[25].
Anaerobic threshold was calculated by two independent skilledoperatorsusingtheV-Slopemethod[25].
2.3. Mini-trampolinereboundingexercisesession monitoring
Thesession consisted ofapproximately50minutesof MRE (46.1±5.0min),precededbya5-minutewarm-upand fol-lowedbya5-minutecool-down.Allwomenwerebeginners tothe MRE,soit was decidedto performthe monitoring sessionafteroneweekoffamiliarizationsessions.
Thetrainingwascarriedoutwiththeuseofeighteen indi-vidualmini-trampolineswiththefollowingcharacteristics: diameter 115cm, height 27cm, weight 13kg, dimensions of thespring 105/3.2mm, number of feet 8. Participants weretrainedandsupervisedbyaprofessionaltrainer spe-cializedinbothexerciseprescriptionforspecialpopulations (AdaptedPhysicalActivityMasterDegreeCourse)andMRE (RebgymBasicTrainer).Theroomtemperaturewasbetween 19◦and23◦C,ata<60%relativehumidity.Eachparticipant worearadio-telemetric heart ratemonitor (Polar Team2 Pro,Polar Electro Oy, Kempele,Finland) which registered
theheartratepattern continuouslyduringtheentire MRE session[26].DataresultingfromtheCPExTwereincluded inthecalculationofthePolarTeam2softwareandusedto obtaintheExI.
TheEEwasestimatedduringtheMREbytheSenseWear Pro3Armband(SWA;BodyMedia,Pittsburgh,PA).TheSWAis amultisensoryactivitymonitor.Thedeviceprovides estima-tionofEEduringphysicalandfreelivingactivitiesthrough abiaxialaccelerometer,thegalvanicskinresponseandthe bodyheat loss.The SWAwasworn bythe participants on theupperrightarmduringthewholeMREsession,without causinganydiscomfort.TheEEwasestimatedusingaproper algorithm that incorporates the subject’s height, weight, ageandsex,whichwereintroducedpriortotheanalysisof data.Theminute-by-minutevalueswerereportedineither kilocalories(kcal)orMET.
The SWAis a validated device, already usedto assess EE,bothatrestandduringlow-moderateandhigh-intensity physical activity in healthy people,obese individuals and patientswithchronicdiseases[27—31].
RPEduringtheMREsessionwasquantifiedbytheBorg’s method,a15-pointRPEscalerangingfrom6to20(20—100% effort) [32], previously shown to strongly correlate with HR[33]:one RPEpointis considered approximatelyas10 beats/minute(bpm).TheBorg’sscalewasexplainedtoeach participantbeforetheexercisesession(Fig.1).
2.4. StatisticalAnalysis
Descriptivestatisticsarereportedasthemean±SDor per-centagefrequencyforalltheeighteenwomen.Differences inmeansofthevariablesofrestingheartrateassessedprior totheCPExTandbeforecarryingouttheMREsessionwere tested by the analysis of variance (ANOVA). The analyses werecarriedoutusingInStat(GraphPadSoftware,Inc.)with statisticalsignificancesetforPvalue<05.
3.
Results
All the examined women exhibited an anthropomet-ric profile of overweight (weight: 68.5±6.4kg; BMI: 26.8±1.6kg/m2; WC: 78.9±5.2cm; HC: 105.5±3.8cm; WHR: 0.7±0.0) (Table 1). None of the participants was underpharmacologictreatmentduringthewholestudy.
Table 1 shows the modifications of cardiovascular and metabolicparameters duringmaximal CPExT. HRand sys-tolic(SBP) anddiastolic(DBP) bloodpressurewere within normallimitsinrestingconditionsatbaselineandnormally increased during exercise [25]. At the end of the CPExT effort,maximalHRwas183.3±10.6bpm,withSBPandDBP valuesbeing147.5±2.6mmHgand78±6.9mmHg, respec-tively.
The enrolled subjects showed a low aerobic capacity (VO2max:15.4±2.6ml/kg/min)butexecutedan appropri-ateworkrate(104±21.1watt)[25].
PriortothestartoftheMREsession,HRvaluesandblood pressurelevelsatrestwerere-measuredandnosignificant differencebetweenthetworegistrationswasfound(P=n. s). Then, all women completed the MRE session without reportinganyclinicalproblem(Table1).
Figure 1 Example of mini-trampoline rebounding exercise session.
The HR,recorded by radio-telemetry technique during theMREsessionwhichlasted46.1±5.0min,was132.3±7.7 bpm (range: 75—177 bpm), corresponding to 72.2±3.3% (range:41—96%)oftheHRmaxobtainedinthepreliminary CPExT.
TheestimatedEE,evaluatedduringeveryminuteMREby SWAregistration,was6.9±0.8kcal/min,correspondingtoa totalof317.3±45.7kcalfortheentiredurationoftheMRE session(46.1±5.0min).On theother hand,theEE during MREwas5.2±1.1MET/min.
Finally,meanRPE, accordingtotheBorg’sratingscale, was 13.2±1.3 (range: 12—15). The average physiologic responsestotheMREsessionarereportedinTable2.
4.
Discussion
The present studyprovidesoriginal informationabout the exerciseintensityandenergyrequiredbytheMREaddressed tothespecifictargetpopulationofoverweightwomen.Our resultsindicatethattheMRE:(i)isaformofvigorous physi-calactivity(72.2±3.3%)and(ii)requiresthecardiovascular systemtoworkatlevelswhichimposeamoderate-to-high EE andis considered to beadequate tothe physiological requirements(5.2±1.1METs/min)[20,21].
Table2 AveragephysiologicresponsestotheMREsession. Variables(n=18) M±SD(range)
Exerciseintensity(ExI)
WorkoutTime(min) 46.1±5.0 AverageHRduring MREsession(bpm) 132.3±7.7(75—177) %ofHRmaxin CPExT 72.2±3.3%(41—96%)
Energyexpenditure(EE)
MET/minduring MREsession 5.2±1.1 kcal/min 6.9±0.8 kcal (46.1±5.0min) 317.3±45.7 RPEattheendof
MREsession
13.2±1.3(12—15) Note:dataare expressedas themean±SD, percentage (%) and range. HR: heart rate; VO2: oxygen uptake expressed in absolute and indexed for body weight; AT: anaerobic threshold; MET: metabolic equivalent (1 MET is defined as theenergytolie/sitquietly,itisequivalenttoametabolic rateofconsuming 3.5mlO2/kg/minute); RPE: Borg’srating ofperceivedexertionscale.
Indeed,accordingtotheguidelinesforexercisetesting
and prescription of the ACSM, individuals should perform
exercisebetween64—94%ofHRmaxorat40—85%of VO2
maxtoimprovecardiovascularfitness[20,21].Accordingly,
overweightwomenenrolledinthisstudyachievedanenergy
costthat,in line withtheaboveguidelines,appears
ade-quatetoincreasetheaerobiccapacityandinducetraining
effects.Ontheotherhand,inagreementwithprevious
stud-iesinvestigatingitsbeneficialeffectsonbalanceabilityand
movementcoordination[13—15],theMREislikelytoprove
asanexcellentworkoutactivityforthoseoverweight peo-ple,who, morethan others, areat high risk of joint and muscleinjuriesduringphysicalactivities[34—36].
Ourdataconfirmandextendthosefrompreviousstudies that evaluated the exercise intensity of MRE [4]. Tomas-sonietal.showedan ExIbetween75—80%of theHRmax in10young women(18—28years)[6];likewise,Gerberich etal.foundthata12-weekMREprogramin10adultwomen (18—40 years) resulted in an ExI between 70—85% of the HRmax[8].Inaddition,ourstudyintegratesthese evalua-tionswiththeuseofaRPEscale,resultinginaself-reported 13.2±1.3score,whichisconsideredan appropriatevalue foraworkoutactivity[33].
Tothebestofourknowledgeandtodate,nostudywas aimedsofaratmeasuringEEduringaMREsession.The rea-sonforthislackofinformationmayberelatedtothefact thatpreviousresearchesontheMREwereconductedwhen portableandappropriatedevicesfortheassessmentofthe EEduringphysicalactivitieswerenotavailableyet.
BytheuseoftheSWA,apractical,comfortableand easy-to-wear device, we were able toassess and measure the adequatelevelofEEguaranteedbyMREactivities(5.2±1.1 MET/minwithatotalof317.3±45.7kcal)[20,21].
Duringthe MREsession,participants werecontinuously monitoredinHRandEE.Thehighvariabilityoftherecorded
valuessuggests thatexercising at mini-trampoline canbe consideredasaphysicalactivityinvolvingbothaerobicand anaerobicmetabolismoftheenrolledwomen.This finding is also confirmed by the low level of VO2 max measured duringtheCPExT,ifcomparedtoVO2maxvaluespredicted bytheWasserman’sformula[25].Indeed,subjectsshoweda lowleveloffitness,probablyduetotheirsedentarylifestyle andoverweight.
In thelight of these findings, while in healthy popula-tionsand/or insubjectswithlowcardiovascularrisk(asin ourstudy) this typeof exercise is appropriate and easily prescribable,inmiddle-agedpatients withhigh cardiovas-cularrisk,theMREshouldbeadministeredwithcautionand acardiovascularcheck-upisdefinitelyrecommendedbefore startingaprogram.
Finally, the results of our study show that the degree ofengagementachievedduringMREis consistentwiththe guidelines provided by the ACSM which recommend that individualsconsumeatleast300kcal/workoutandatarget volumeof500—1000 METs/min/week,inordertopromote weightlossormaintainahealthybodyweight[21].
5.
Limitations,
future
aims
and
conclusions
Alimitationofthisstudyistherestrictedpopulation evalu-ated.Therefore,agoaloftheimmediatefuturewillbeto increasethenumberofparticipants.
Afurtherinterest inthesame researchareawill beto expandtheanalysisofEEamongothertypesoffitness activ-itiesandtoevaluatetheappropriatenessandeffectsofthe MREprotocolsonotherspecialpopulations.
Inconclusion,ourfindingsshowthattheMREprovedas atypeoftrainingsuitabletopotentiallyensurebeneficial effectsonhealthinordertomaintainorimprovetheoverall fitness.
Therefore,theMREappears toberecommendableand prescribableinadultoverweightwomen,whoneedtoexert effectivecontrolofbodyweight.
Disclosure
of
interest
Theauthorsdeclarethattheyhavenocompetinginterest.
Acknowledgements
The study was supported by Grant 2015 from the Ital-ian Society of Cardiology and MSD Italia-MERCK SHARP & DOHME CORPORATION for the implementation of the project: ‘‘Physical exercise and therapy: an integrated approachforthereductionofcardiovascularriskandhealth promotion’’atSt.George’sUniversity,UniversityofLondon.
References
[1]CarterAE.TheMiraclesofreboundexercise.TheNational insti-tuteofReboundologyandHealth.Washington:Inc.Edmonds; 1979.
[2]WhiteJR.Changesfollowingtenweeksofexerciseusinga mini-trampolinein overweightwomen (Abstract).MedSci Sports Exerc1980;12:103.
[3]BhattacharyaEP,McCutcheonES,GreenleafJE.Body acceler-ationdistributionandO2uptakeinhumansduringrunningand jumping.JApplPhysiol1980;49:881—4.
[4]SmithJF,BishopPA.Reboundingexercise,arethetraining suf-ficientforcardiorespiratoryfitness?SportsMed1988;5:6—10.
[5]EvansBW,ClaiborneJM,ThomasS.Changesinaerobiccapacity and bodycompositionsubsequenttoaneightweekrebound trainingprogram.MedSciSportsExerc1984;16:104.
[6]TomassoniTL,BlanchardMS,GoldfarbAH.Effectsofarebound exercisetrainingprogramonaerobiccapacityandbody compo-sition.PhysSportsMed1985;13:110—5.
[7]AtterbomHA,MacleanTA.Aerobicbenefitsofreboundjogging. AnnSportsMed1983;1:113—4.
[8]GerberichSG,LeonAS,McNallyC,SerfassR,EdinBJ.Analysis oftheacutephysiologiceffectsofmini-trampolinerebounding exercise.JCardiopulmRehabil1990;10:395—400.
[9]EdinBJ,GerberichSG,LeonAS,McNallyC,SerfassR, Shaw G, et al.Analysis ofthetrainingeffects ofmini-trampoline rebounding onphysical fitness,bodycomposition and blood lipids.JCardiopulmRehabil1990;10:401—8.
[10]SmithJF,BishopPA,EllisL,ConerlyMD,MansfieldER. Exer-cise intensityincreased byaddition of handheldweights to reboundingexercise.JCardiopulmRehabil1995;15(1):34—8.
[11]KidgellDJ,HorvathDM,JacksonBM,SeymourPJ.Effectofsix weeksofdura discand mini-trampolinebalancetrainingon posturalswayinathleteswithfunctionalankleinstability. J StrengthCondRes2007;21(2):466—9.
[12]Karakollukc¸uM,AslanCS,PaoliA,BiancoA,SahinFN.Effects of mini-trampoline exercise on male gymnasts’ physiologi-cal parameters: a pilot study. J Sports Med Phys Fitness 2015;55(7—8):730—4.
[13]HeitkampHC, HorstmannT,MayerF,WellerJ,DickhuthHH. Gaininstrengthandmuscularbalanceafterbalancetraining. IntJSportsMed2001;22(4):285—90.
[14]Aragao FA, Karamanidis K, Vaz MA, Arampatzis A. Mini-trampolineexerciserelatedtomechanismsofdynamicstability improves the ability to regain balance in elderly. J Elec-tromyogrKinesiol2011;21:512—8.
[15]de Oliveira MR,da SilvaRA, Dascal JB,Teixeira DC. Effect ofdifferenttypesofexercise onposturalbalanceinelderly women:arandomizedcontrolledtrial.ArchGerontolGeriatr 2014;59:506—14.
[16]StanghelleJK,HjeltnesN,BangstadHJ,MichalsenH.Effectof dailyshortboutsoftrampolineexerciseduring8weeksonthe pulmonaryfunctionandthemaximaloxygenuptakeofchildren withcysticfibrosis.IntJSportsMed1988;9(1):32—6.
[17]MiklitschC,KrewerC,FreivogeS,SteubeD.Effectsofa prede-finedmini-trampolinetrainingprogrammeonbalance,mobility andactivitiesofdailylivingafterstroke:a randomized con-trolledpilotstudy.ClinRehabil2013;27(10):939—47.
[18]Crowther RG, Spinks WL, Leicht AS, Spinks CD. Kinematic responsestoplyometricexercisesconductedoncompliantand noncompliantsurfaces.JStrengthCondRes2007;21(2):460—5.
[19]Cugusi L, WilsonB, Serpe R, MeddaA, DeiddaM, GabbaS, etal.Cardiovasculareffects,bodycomposition,qualityoflife
andpainafterazumba®fitnessprograminItalianoverweight
women.JSportsMedPhysFitness2016;56(3):328—35.
[20]AmericanCollegeofSportsMedicine.Guidelinesforexercise testing and prescription. Baltimore: Lippincott, Williams & Wilkins;2010.
[21]GarberCE,Blissmer B,DeschenesMR,FranklinBA,Lamonte MJ,LeeIM,etal.Quantityandqualityofexercisefor devel-opingandmaintainingcardiorespiratory,musculoskeletal,and neuromotorfitness,inapparentlyhealthyadults:guidancefor prescribingexercise.MedSciSportsExerc2011:1334—59.
[22]MercuroG,ZoncuS, CherchiA, RosanoGM.Canmenopause beconsidered anindependent riskfactor for cardiovascular disease?ItalHeartJ2001;2:719—27.
[23]Lohman TG, Roche AF, Martorell R. Manuale di riferimento perlastandardizzazioneantropometrica.Milano,Italy:EDRA; 1997.
[24]LockwoodPA, YoderJE, Deuster PA.Comparison and cross-validationofcycleergometryestimatesofVO2max.MedSci SportsExerc1997;29(11):1513—20.
[25]WassermannK,HansenJE,SueDY,WhippBJ.Normalvalues. Principlesofexercisetestingandinterpretation.Philadelphia: Lea,Febiger;1987.p.72—85.
[26]SchonfelderM,HinterseherG,PeterP,SpitzenpfeilP.Scientific comparisonofdifferentonlineheartratemonitoringsystems. IntJTelemedAppl2011;2011:6.
[27]MassiddaM,CugusiL,IbbaM,TradoriI,CalòCM.Energy expen-ditureduringcompetitiveLatinAmericandancingsimulation. MedProblPerformArt2011;26(4):206—10.
[28]VanRemoortelH,GiavedoniS,RasteY,BurtinC,LouvarisZ, Gimeno-SantosE,etal.Validityofactivitymonitorsinhealth andchronicdisease:asystematicreview.IntJBehavNutrPhys Act2012;9(9):84.
[29]HermannA,Ried-LarsenM,JensenAK,HolstR,AndersenLB, OvergaardS,etal.LowvalidityoftheSensewearPro3 activ-itymonitorcomparedtoindirectcalorimetryduringsimulated freelivinginpatientswithosteoarthritisofthehip.BMC Mus-culoskeletDisord2014;15:43.
[30]van Hoye K, Mortelmans P, Lefevre J. Validation of the SenseWearPro3Armbandusinganincrementalexercisetest.J StrengthCondRes2014;28(10):2806—14.
[31]CalabróMA,LeeJM,Saint-MauricePF,YooH,WelkGJ. Valid-ityofphysicalactivitymonitorsfor assessinglowerintensity activityinadults.IntJBehavNutrPhysAct2014;11:119.
[32]Borg GA. Perceived exertion. Exerc Sport Sci Rev 1974;2:131—53.
[33]ScherrJ, WolfarthB, ChristleJW, PresslerA, Wagenpfeil S, HalleM.AssociationsbetweenBorg’sratingofperceived exer-tionandphysiologicalmeasuresofexerciseintensity.EurJAppl Physiol2013;113:147—55.
[34]GaidaJE,CookJL,BassSL.Adiposityandtendinopathy.Disabil Rehabil2008;30(20—22):1555—62.
[35]SabharwalS,RootMZ. Impactofobesityon orthopaedics.J BoneJointSurgAm2012;94(11):1045—52.
[36]SheehanKJ,GormleyJ.Theinfluenceofexcessbodymasson adultgait.ClinBiomech2013;28(3):337—43.
