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DÖRT FARKLI İZOMETRİK KASILMA YOĞUNLUĞUNDA MUTLAK VE NORMALLEŞTİRİLMİŞ KUVVETTE CİNSİYET FARKI

Year 2024, Volume: 35 Issue: 1, 29 - 36, 20.04.2024
https://doi.org/10.21653/tjpr.1226407

Abstract

Amaç: İzometrik kasılmaları ölçerken gerçek zamanlı görsel geribildirim sağlamak genel klinik ortamdaki uygulamalardan farklıdır. Bununla birlikte, erkek ve kadınların belirgin fiziksel ve fizyolojik farklılıkları olmasına rağmen mevcut çalışmaların çoğunda mutlak kas kontraksiyonları cinsiyet ayrımı yapılmadan analiz edilmiştir. Bu çalışmanın amacı, erkekler ve kadınlar arasında görsel geribildirim olmaksızın ölçülen mutlak ve normalize edilmiş kalça ekstansiyon kuvvetlerinde farklılık olup olmadığını araştırmaktır.
Yöntem: Çalışmaya 28 sağlıklı yetişkin katıldı (13 erkek ve 15 kadın; yaş=22,00±11,44 yıl; boy=165,86±18,30 cm; ve vücut ağırlığı=61,91±12,34 kg). Kalça ekstansiyonunun maksimum (MVC) ve submaksimal istemli kasılma kuvvetleri (MVC'nin %75, %50 ve %25'i, rastgele sırayla) kablosuz bir gerinim ölçer kullanılarak ve görsel geri bildirim olmaksızın ölçüldü.
Sonuçlar: Erkeklerde dört hedef yoğunlukta ölçülen mutlak kasılma kuvvetleri önemli ölçüde daha yüksekti (p<0,001). Tekrarlı ölçüm tutarlılığı üç deneme boyunca hem erkeklerde hem de kadınlarda çok yüksekti. MVC'nin %75'inde (p=0,024), %50'sinde (p=0,033) ve %25'inde (p=0,004) cinsiyetler arasında anlamlı fark vardı.
Tartışma: Hedef yoğunluğa yakın normalleştirilmiş kuvvet erkeklerde yüksek yoğunlukta, kadınlarda düşük yoğunlukta ölçüldü. Submaksimal yoğunluklarda, hedef yoğunluk azaldıkça, erkeklerde orantılı olarak daha küçük olmak üzere hem erkeklerde hem de kadınlarda belirlenmiş olan hedef yoğunluktan daha küçük bir normalleştirilmiş kuvvet azalması gözlendi.

References

  • Saranya S, Poonguzhali S, Karunakaran S. Gaussian mixture model-based clustering of manual muscle testing grades using surface electromyogram signals. Phys Eng Sci Med. 2020;43(3):837–47.
  • Lim W. Perceived exertion responses to exercise differ for progressively increasing and decreasing order of intensity: a crossover design study. Ann Appl Sport Sci. 2023;11(1):1–8.
  • Lim W. Comparison of contraction intensity and perceived intensity between dominant and non-dominant leg in sedentary adults. Physiotherapy Quarterly. 2023;31(1):13–8.
  • Lim W. Effects of hip rotation on the electromyographic activity of the medial and lateral hamstrings and muscle force. J Back Musculoskelet Rehabil. 2021;34(6):1023–9.
  • Lim W, Park H. No significant correlation between the intensity of static stretching and subject’s perception of pain. J Phys Ther Sci. 2017;29(10):1856–9.
  • Kearney E, Shellikeri S, Martino R, Yunusova Y. Augmented visual feedback-aided interventions for motor rehabilitation in Parkinson’s disease: a systematic review. Disabil Rehabil. 2019;41(9):995–1011.
  • Lim W. Easy Method for Measuring stretching intensities in real clinical settings and effects of different stretching intensities on flexibility. J Back Musculoskelet Rehabil. 2019;32(4):579–85.
  • Sheard PW, Smith PM, Paine TJ. Athlete compliance to therapist requested contraction intensity during proprioceptive neuromuscular facilitation. Man Ther. 2009;14(5):539–43.
  • . Hill EC, Housh TJ, Smith CM, Schmidt RJ, Johnson GO. Gender- and muscle-specific responses during fatiguing exercise. J Strength Cond Res 2018;32(5):1471–8.
  • Obrębska P, Skubich J, Piszczatowski S. Gender differences in the knee joint loadings during gait. Gait Posture. 2020;79:195–202.
  • Lipovšek T, Kacin A, Puh U. Reliability and validity of hand-held dynamometry for assessing lower limb muscle strength. Isokinet Exerc Sci. 2022;30(3):231–40.
  • Todd G, Gorman RB, Gandevia SC. Measurement and reproducibility of strength and voluntary activation of lower-limb muscles. Muscle Nerve. 2004;29(6):834–42.
  • Park S, Lim W. Comparison of muscle activity of hamstrings as knee flexors and hip extensors and effect of tibial and hip rotation on the contribution of hamstrings. J Bodyw Mov Ther. 2023;34:1–5.
  • Oh D, Lim W. Influence of Submaximal isometric contractions of the hamstrings on electromyography activity and force while functioning as hip extensors. Isokinet Exerc Sci. 2021;29(3):291– 8.
  • Navarro-Flores E, Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Lopez-Lopez D, Vilar-Fernandez JM, Palomo-Lopez P, et al. Transcultural adaptation and validation of the Spanish Bristol Foot Score (BFS-S). Aging Dis. 2018;9(5):861–8.
  • Lee N, Ahn J, Lim W. Concurrent and angle-trajectory validity and intra-trial reliability of a novel multi-view image-based motion analysis system. J Hum Kinet. 2023;86(1):31–40.
  • Haynes EMK, Neubauer NA, Cornett KMD, O’Connor BP, Jones GR, Jakobi JM. Age and sex-related decline of muscle strength across the adult lifespan: a scoping review of aggregated data. Appl Physiol Nutr Metab. 2020;45(11):1185–96.
  • De Ste Croix M, ElNagar YO, Iga J, Ayala F, James D. The impact of joint angle and movement velocity on sex differences in the functional hamstring/quadriceps ratio. Knee. 2017;24(4):745– 50.
  • Esbjörnsson ME, Dahlström MS, Gierup JW, Jansson ECh. Muscle fiber size in healthy children and adults in relation to sex and fiber types. Muscle Nerve. 2021;63(4):586–92.
  • Guilherme JPLF, Semenova EA, Borisov OV, Larin AK, Moreland E, Generozov EV, et al. Genomic predictors of testosterone levels are associated with muscle fiber size and strength. Eur J Appl Physiol. 2022;122(2):415–23.
  • Trumble BC, Pontzer H, Stieglitz J, Cummings DK, Wood B, Emery Thompson M, et al. Energetic costs of testosterone in two subsistence populations. Am J Hum Biol. 2023;e23949.
  • Côté JN. A critical review on physical factors and functional characteristics that may explain a sex/gender difference in work-related neck/shoulder disorders. Ergonomics. 2012;55(2):173–82.
  • Marshall PWM, Siegler JC. Lower hamstring extensibility in men compared to women is explained by differences in stretch tolerance. BMC Musculoskelet Disord. 2014;15:223.
  • Nagai T, Sell TC, Abt JP, Lephart SM. Reliability, precision, and gender differences in knee internal/external rotation proprioception measurements. Phys Ther Sport. 2012;13(4):233–7.
  • Lee SJ, Ren Y, Kang SH, Geiger F, Zhang L-Q. Pivoting neuromuscular control and proprioception in females and males. Eur J Appl Physiol. 2015;115(4):775–84.
  • Steinberg N, Tenenbaum S, Zeev A, Pantanowitz M, Waddington G, Dar G, et al. Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers. BMC Musculoskelet Disord. 2021;22(1):161.
  • Lim W. Sex Differences in repeatability of measurement for hamstring strength during maximal voluntary contractions. J Korean Phys Ther Sci.. 2020;27(1):9–17.
  • Rodrigues LG, Vianna KB, de Oliveira NT, Chaves A de C, Severo-Silveira L, Ribeiro-Alvares JB, et al. Sex-related differences in muscular factors previously identified in the literature as potentially associated with hamstring strain injury in professional football players. Sport Sci Health. 2022;
  • Williams DSB, Welch LM. Male and female runners demonstrate different sagittal plane mechanics as a function of static hamstring flexibility. Braz J Phys Ther. 2015;19(5):421–8.
  • Pincivero DM, Dixon PT, Coelho AJ. Knee extensor torque, work, and EMG during subjectively graded dynamic contractions. Muscle Nerve. 2003;28(1):54–61.
  • Godinho P, Nicoliche E, Cossich V, de Sousa EB, Velasques B, Salles JI. Proprioceptive deficit in patients with complete tearing of the anterior cruciate ligament. Rev Bras Ortop. 2014;49(6):613–8.
  • Yu S, Lowe T, Griffin L, Dong XN. Single bout of vibration-induced hamstrings fatigue reduces quadriceps inhibition and coactivation of knee muscles after anterior cruciate ligament (ACL) reconstruction. J Electromyogr Kinesiol. 2020;55:102464.
  • Stefanik JJ, Frey-Law L, Segal NA, Niu J, Lewis CE, Nevitt MC, et al. The relation of peripheral and central sensitization to muscle co-contraction: the MOST study. Osteoarthritis Cartilage. 2020;28(9):1214–9.
  • Buhmann R, Trajano GS, Kerr G, Shield A. Voluntary activation and reflex responses after hamstring strain injury. Med Sci Sports Exerc. 2020;52(9):1862.
  • Kim K, Choi B, Lim W. The efficacy of virtual reality assisted versus traditional rehabilitation intervention on individuals with functional ankle instability: a pilot randomized controlled trial. Disabil Rehabil Assist Technol. 2019;14(3):276–80.
  • Del Vecchio A, Casolo A, Negro F, Scorcelletti M, Bazzucchi I, Enoka R, et al. The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding. J Physiol. 2019;597(7):1873–87.
  • Enoka RM, Duchateau J. Rate coding and the control of muscle force. Cold Spring Harb Perspect Med. 2017;7(10):a029702.
  • Oliveira AS, Negro F. Neural control of matched motor units during muscle shortening and lengthening at increasing velocities. J Appl Physiol. 2021;130(6):1798–813.
  • Mannion AF, Dolan P. Relationship between myoelectric and mechanical manifestations of fatigue in the quadriceps femoris muscle group. Eur J Appl Physiol Occup Physiol. 1996;74(5):411–9.
  • Kimpara H, Mbanisi KC, Li Z, Troy KL, Prokhorov D, Gennert MA. Force anticipation and its potential implications on feedforward and feedback human motor control. Hum Factors. 2021;63(4):647–62.
  • Piscitelli D, Falaki A, Solnik S, Latash ML. Anticipatory postural adjustments and anticipatory synergy adjustments: preparing to a postural perturbation with predictable and unpredictable direction. Exp Brain Res. 2017;235(3):713–30.
  • Proske U, Allen T. The neural basis of the senses of effort, force and heaviness. Exp Brain Res. 2019;237(3):589–99.
  • Matsutani Y, Tahara K, Kino H. Set-point control of a musculoskeletal system under gravity by a combination of feed-forward and feedback manners considering output limitation of muscular forces. J Robot Mechatron. 2019;31(4):612–20.

SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES

Year 2024, Volume: 35 Issue: 1, 29 - 36, 20.04.2024
https://doi.org/10.21653/tjpr.1226407

Abstract

Purpose: When measuring isometric contractions, providing real-time visual feedback differs from the practices in general clinical environment. In addition, even though men and women have clear physical and physiological differences, most of the existing studies analyzed absolute muscle contractions with no distinction between men and women. The aim of this study was to investigate whether there are differences in absolute and normalized hip extension forces measured without visual feedback between men and women.
Methods: Twenty-eight healthy adults participated (13 men and 15 women; age=- 22.00±11.44 years; height=165.86±18.30 cm; and weight=61.91±12.34 kg) in the study. Maximum (MVC) and submaximal voluntary contraction forces (75%, 50%, and 25% of MVC, in a random order) of hip extension were measured using a wireless strain gauge and with no visual feedback.
Results: Absolute contraction forces measured at four target intensities were significantly greater in men (p<0.001). Intra-trial reliability of contraction forces across 3 trials was very high in both men and women. There was a significant difference in normalized forces at 75% (p=0.024), 50% (p=0.033), and 25% (p=0.004) of MVC between the sexes.
Conclusion: Normalized force close to the target intensity was measured at high-intensity for men and low-intensity for women. In submaximal intensities, a decrease in normalized force smaller than the assigned target intensity occurred in both men and women as the target intensity decreased, with men showing a smaller decrease proportionally.

References

  • Saranya S, Poonguzhali S, Karunakaran S. Gaussian mixture model-based clustering of manual muscle testing grades using surface electromyogram signals. Phys Eng Sci Med. 2020;43(3):837–47.
  • Lim W. Perceived exertion responses to exercise differ for progressively increasing and decreasing order of intensity: a crossover design study. Ann Appl Sport Sci. 2023;11(1):1–8.
  • Lim W. Comparison of contraction intensity and perceived intensity between dominant and non-dominant leg in sedentary adults. Physiotherapy Quarterly. 2023;31(1):13–8.
  • Lim W. Effects of hip rotation on the electromyographic activity of the medial and lateral hamstrings and muscle force. J Back Musculoskelet Rehabil. 2021;34(6):1023–9.
  • Lim W, Park H. No significant correlation between the intensity of static stretching and subject’s perception of pain. J Phys Ther Sci. 2017;29(10):1856–9.
  • Kearney E, Shellikeri S, Martino R, Yunusova Y. Augmented visual feedback-aided interventions for motor rehabilitation in Parkinson’s disease: a systematic review. Disabil Rehabil. 2019;41(9):995–1011.
  • Lim W. Easy Method for Measuring stretching intensities in real clinical settings and effects of different stretching intensities on flexibility. J Back Musculoskelet Rehabil. 2019;32(4):579–85.
  • Sheard PW, Smith PM, Paine TJ. Athlete compliance to therapist requested contraction intensity during proprioceptive neuromuscular facilitation. Man Ther. 2009;14(5):539–43.
  • . Hill EC, Housh TJ, Smith CM, Schmidt RJ, Johnson GO. Gender- and muscle-specific responses during fatiguing exercise. J Strength Cond Res 2018;32(5):1471–8.
  • Obrębska P, Skubich J, Piszczatowski S. Gender differences in the knee joint loadings during gait. Gait Posture. 2020;79:195–202.
  • Lipovšek T, Kacin A, Puh U. Reliability and validity of hand-held dynamometry for assessing lower limb muscle strength. Isokinet Exerc Sci. 2022;30(3):231–40.
  • Todd G, Gorman RB, Gandevia SC. Measurement and reproducibility of strength and voluntary activation of lower-limb muscles. Muscle Nerve. 2004;29(6):834–42.
  • Park S, Lim W. Comparison of muscle activity of hamstrings as knee flexors and hip extensors and effect of tibial and hip rotation on the contribution of hamstrings. J Bodyw Mov Ther. 2023;34:1–5.
  • Oh D, Lim W. Influence of Submaximal isometric contractions of the hamstrings on electromyography activity and force while functioning as hip extensors. Isokinet Exerc Sci. 2021;29(3):291– 8.
  • Navarro-Flores E, Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Lopez-Lopez D, Vilar-Fernandez JM, Palomo-Lopez P, et al. Transcultural adaptation and validation of the Spanish Bristol Foot Score (BFS-S). Aging Dis. 2018;9(5):861–8.
  • Lee N, Ahn J, Lim W. Concurrent and angle-trajectory validity and intra-trial reliability of a novel multi-view image-based motion analysis system. J Hum Kinet. 2023;86(1):31–40.
  • Haynes EMK, Neubauer NA, Cornett KMD, O’Connor BP, Jones GR, Jakobi JM. Age and sex-related decline of muscle strength across the adult lifespan: a scoping review of aggregated data. Appl Physiol Nutr Metab. 2020;45(11):1185–96.
  • De Ste Croix M, ElNagar YO, Iga J, Ayala F, James D. The impact of joint angle and movement velocity on sex differences in the functional hamstring/quadriceps ratio. Knee. 2017;24(4):745– 50.
  • Esbjörnsson ME, Dahlström MS, Gierup JW, Jansson ECh. Muscle fiber size in healthy children and adults in relation to sex and fiber types. Muscle Nerve. 2021;63(4):586–92.
  • Guilherme JPLF, Semenova EA, Borisov OV, Larin AK, Moreland E, Generozov EV, et al. Genomic predictors of testosterone levels are associated with muscle fiber size and strength. Eur J Appl Physiol. 2022;122(2):415–23.
  • Trumble BC, Pontzer H, Stieglitz J, Cummings DK, Wood B, Emery Thompson M, et al. Energetic costs of testosterone in two subsistence populations. Am J Hum Biol. 2023;e23949.
  • Côté JN. A critical review on physical factors and functional characteristics that may explain a sex/gender difference in work-related neck/shoulder disorders. Ergonomics. 2012;55(2):173–82.
  • Marshall PWM, Siegler JC. Lower hamstring extensibility in men compared to women is explained by differences in stretch tolerance. BMC Musculoskelet Disord. 2014;15:223.
  • Nagai T, Sell TC, Abt JP, Lephart SM. Reliability, precision, and gender differences in knee internal/external rotation proprioception measurements. Phys Ther Sport. 2012;13(4):233–7.
  • Lee SJ, Ren Y, Kang SH, Geiger F, Zhang L-Q. Pivoting neuromuscular control and proprioception in females and males. Eur J Appl Physiol. 2015;115(4):775–84.
  • Steinberg N, Tenenbaum S, Zeev A, Pantanowitz M, Waddington G, Dar G, et al. Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers. BMC Musculoskelet Disord. 2021;22(1):161.
  • Lim W. Sex Differences in repeatability of measurement for hamstring strength during maximal voluntary contractions. J Korean Phys Ther Sci.. 2020;27(1):9–17.
  • Rodrigues LG, Vianna KB, de Oliveira NT, Chaves A de C, Severo-Silveira L, Ribeiro-Alvares JB, et al. Sex-related differences in muscular factors previously identified in the literature as potentially associated with hamstring strain injury in professional football players. Sport Sci Health. 2022;
  • Williams DSB, Welch LM. Male and female runners demonstrate different sagittal plane mechanics as a function of static hamstring flexibility. Braz J Phys Ther. 2015;19(5):421–8.
  • Pincivero DM, Dixon PT, Coelho AJ. Knee extensor torque, work, and EMG during subjectively graded dynamic contractions. Muscle Nerve. 2003;28(1):54–61.
  • Godinho P, Nicoliche E, Cossich V, de Sousa EB, Velasques B, Salles JI. Proprioceptive deficit in patients with complete tearing of the anterior cruciate ligament. Rev Bras Ortop. 2014;49(6):613–8.
  • Yu S, Lowe T, Griffin L, Dong XN. Single bout of vibration-induced hamstrings fatigue reduces quadriceps inhibition and coactivation of knee muscles after anterior cruciate ligament (ACL) reconstruction. J Electromyogr Kinesiol. 2020;55:102464.
  • Stefanik JJ, Frey-Law L, Segal NA, Niu J, Lewis CE, Nevitt MC, et al. The relation of peripheral and central sensitization to muscle co-contraction: the MOST study. Osteoarthritis Cartilage. 2020;28(9):1214–9.
  • Buhmann R, Trajano GS, Kerr G, Shield A. Voluntary activation and reflex responses after hamstring strain injury. Med Sci Sports Exerc. 2020;52(9):1862.
  • Kim K, Choi B, Lim W. The efficacy of virtual reality assisted versus traditional rehabilitation intervention on individuals with functional ankle instability: a pilot randomized controlled trial. Disabil Rehabil Assist Technol. 2019;14(3):276–80.
  • Del Vecchio A, Casolo A, Negro F, Scorcelletti M, Bazzucchi I, Enoka R, et al. The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding. J Physiol. 2019;597(7):1873–87.
  • Enoka RM, Duchateau J. Rate coding and the control of muscle force. Cold Spring Harb Perspect Med. 2017;7(10):a029702.
  • Oliveira AS, Negro F. Neural control of matched motor units during muscle shortening and lengthening at increasing velocities. J Appl Physiol. 2021;130(6):1798–813.
  • Mannion AF, Dolan P. Relationship between myoelectric and mechanical manifestations of fatigue in the quadriceps femoris muscle group. Eur J Appl Physiol Occup Physiol. 1996;74(5):411–9.
  • Kimpara H, Mbanisi KC, Li Z, Troy KL, Prokhorov D, Gennert MA. Force anticipation and its potential implications on feedforward and feedback human motor control. Hum Factors. 2021;63(4):647–62.
  • Piscitelli D, Falaki A, Solnik S, Latash ML. Anticipatory postural adjustments and anticipatory synergy adjustments: preparing to a postural perturbation with predictable and unpredictable direction. Exp Brain Res. 2017;235(3):713–30.
  • Proske U, Allen T. The neural basis of the senses of effort, force and heaviness. Exp Brain Res. 2019;237(3):589–99.
  • Matsutani Y, Tahara K, Kino H. Set-point control of a musculoskeletal system under gravity by a combination of feed-forward and feedback manners considering output limitation of muscular forces. J Robot Mechatron. 2019;31(4):612–20.
There are 43 citations in total.

Details

Primary Language English
Subjects Rehabilitation
Journal Section Araştırma Makaleleri
Authors

Wootaek Lım 0000-0002-5523-6294

Publication Date April 20, 2024
Published in Issue Year 2024 Volume: 35 Issue: 1

Cite

APA Lım, W. (2024). SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, 35(1), 29-36. https://doi.org/10.21653/tjpr.1226407
AMA Lım W. SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES. Turk J Physiother Rehabil. April 2024;35(1):29-36. doi:10.21653/tjpr.1226407
Chicago Lım, Wootaek. “SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi 35, no. 1 (April 2024): 29-36. https://doi.org/10.21653/tjpr.1226407.
EndNote Lım W (April 1, 2024) SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES. Türk Fizyoterapi ve Rehabilitasyon Dergisi 35 1 29–36.
IEEE W. Lım, “SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES”, Turk J Physiother Rehabil, vol. 35, no. 1, pp. 29–36, 2024, doi: 10.21653/tjpr.1226407.
ISNAD Lım, Wootaek. “SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES”. Türk Fizyoterapi ve Rehabilitasyon Dergisi 35/1 (April 2024), 29-36. https://doi.org/10.21653/tjpr.1226407.
JAMA Lım W. SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES. Turk J Physiother Rehabil. 2024;35:29–36.
MLA Lım, Wootaek. “SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, vol. 35, no. 1, 2024, pp. 29-36, doi:10.21653/tjpr.1226407.
Vancouver Lım W. SEX DIFFERENCE IN ABSOLUTE AND NORMALIZED FORCE AT FOUR DIFFERENT ISOMETRIC CONTRACTION INTENSITIES. Turk J Physiother Rehabil. 2024;35(1):29-36.