Verbal Cueing vs. Constraint-Led Approach for Teaching the Kettlebell Swing.

Study Overview
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Brief Summary
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The purpose of this study is to determine which method is most effective for teaching the kettlebell swing: verbal cueing, physical constraints, or a combination of the two.

Detailed Description
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There is a method of teaching and learning movement and exercise skills known as the constraint-led approach. This method of movement learning has the learner exploring and experimenting different variations of an exercise by self-organizing around a set of given constraints of the individual, environment and task (Newell 1986, Moy & Renshaw 2020, chow et al. 2011). Individual constraints are qualities about the person performing the task such as their arm length and height. Environmental constraints regard the environment where the task is being performed and include factors such as lighting and temperature. Finally, the task constraints are qualities about the movement and exercises being performed such as asking someone to do a half squat onto a box instead of a full bodyweight squat in the air. This constraints way of teaching movement has the movement educator as a guide or architect that shapes the qualities of the task the learner must navigate. The kettlebell swing was chosen as the primary exercise for this study due to its efficacy and practicality as a functional movement pattern. Current literature suggests that kettlebell swings may elicit an increase in strength measured in the form of a deadlift exercise, which may have carry over to activities of daily living, such as bending over to lift a box with proper form (Maulit et al, 2017). In a 2016 study, Edinborough et al. examined the proposed implications that repeated kettlebell swings could be used as a practical tool to increase endurance capacity of the lumbar extensor complex. The investigators of this study found that after a 60 second bout of continuous kettlebell swings, participants demonstrated a reduction in isometric strength, demonstrating fatigue of this musculature. The implications of this study suggest that kettlebell swings may increase the fatigue threshold of the lumbar extensor musculature, which may provide protective measures regarding the development of musculoskeletal conditions such as low back pain, as a decrease in activation of these associated muscles may be apparent during periods of fatigue.

Official Title
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Comparing Verbal Cueing and the Constraint-Led Approach for Teaching the Kettlebell Swing.

Conditions
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Movement Disorders, Muscle Tenderness

Intervention / Treatment
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* Behavioral: Verbal coaching vs. Constraint based coaching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects between the ages of 18 and 55 years. Subjective rating of 3/5 or less on confidence with kettlebell swings. Exclusion Criteria: Inability to read and write in English. Previous injury to the lower extremity that prevents normal squatting motion. Physical Activity Readiness Questionnaire suggesting inability to safely participate in exercise.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: verbal and physical constraint group<br>○ Warm-up → pre-intervention measurement of joint angles with kettlebell swing → 30 seconds to 1 minute rest interval → 15 repetitions of kettlebell swings using verbal cues and physical constraints to teach the first part of the movement → 30 seconds to 1 minute rest interval→ 15 repetitions of kettlebell swings using verbal cues and physical constraints to teach the second part of the movement → 30 seconds to 1 minute rest interval→ 15 repetitions of kettlebell swings using verbal cues and physical constraints to combine both parts of the movement → 30 seconds to 1 minute rest interval → Post-intervention measurement of joint angles with kettlebell swing | Behavioral: Verbal coaching vs. Constraint based coaching<br>* Providing verbal cues only to demonstrated proper form during a kettlebell swing exercise vs. the constraint of specific movements to enhance the kettle bell swing exercise.<br>|
| Active Comparator: verbal constraint group<br>○ Warm-up → pre-intervention measurement of joint angles with kettlebell swing → 30 seconds to 1 minute rest interval → 15 repetitions of kettlebell swings using verbal cues to teach the first part of the movement → 30 seconds to 1 minute rest interval→ 15 repetitions of kettlebell swings using verbal cues to teach the second part of the movement → 30 seconds to 1 minute rest interval→ 15 repetitions of kettlebell swings using verbal cues to combine both parts of the movement → 30 seconds to 1 minute rest interval → Post-intervention measurement of joint angles with kettlebell swing | Behavioral: Verbal coaching vs. Constraint based coaching<br>* Providing verbal cues only to demonstrated proper form during a kettlebell swing exercise vs. the constraint of specific movements to enhance the kettle bell swing exercise.<br>|
| Experimental: physical constraint group<br>○ Warm-up → pre-intervention measurement of joint angles with kettlebell swing → 30 seconds to 1 minute rest interval→ 15 repetitions of kettlebell swings using physical constraints to teach the first part of the movement → 30 seconds to 1 minute rest interval→ 15 repetitions of kettlebell swings using physical constraints to teach the second part of the movement → 30 seconds to 1 minute rest interval→ 15 repetitions of kettlebell swings using physical constraints to combine both parts of the movement → 30 seconds to 1 minute rest interval → Post-intervention measurement of joint angles with kettlebell swing | Behavioral: Verbal coaching vs. Constraint based coaching<br>* Providing verbal cues only to demonstrated proper form during a kettlebell swing exercise vs. the constraint of specific movements to enhance the kettle bell swing exercise.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hip range of motion | Joint angles of the subject's dominant side of the hip will be measured from a horizontal view using the OnForm app on the ipad. Subjects will have yellow, circular stickers placed on bony landmarks such as the greater trochanter, lateral femoral epicondyle, lateral malleolus, and the tuberosity of the 5th metatarsal. The participant will be performing the kettlebell swings without shoes for standardization purposes. These measurements will be compared both pre- and post-test to measure any changes. | Base line and immediately after intervention | 
| Knee range of motion | Joint angles of the subject's dominant side of the knee will be measured from a horizontal view using the OnForm app on the ipad (as shown below). Subjects will have yellow, circular stickers placed on bony landmarks such as the greater trochanter, lateral femoral epicondyle, lateral malleolus, and the tuberosity of the 5th metatarsal. The participant will be performing the kettlebell swings without shoes for standardization purposes. These measurements will be compared both pre- and post-test to measure any changes. | Base line and immediately after intervention | 
| Ankle range of motion | Joint angles of the subject's dominant side of the ankle will be measured from a horizontal view using the OnForm app on the ipad (as shown below). Subjects will have yellow, circular stickers placed on bony landmarks such as the greater trochanter, lateral femoral epicondyle, lateral malleolus, and the tuberosity of the 5th metatarsal. The participant will be performing the kettlebell swings without shoes for standardization purposes. These measurements will be compared both pre- and post-test to measure any changes. | Base line and immediately after intervention |