Despite the claims of nefarious infomercials, large numbers of crunches and planks will not magically result in selective fat loss from the abdominal region because the claims of spot reduction simply are not supported by research (10). Any type of exercise can contribute to creating a negative energy balance needed to ultimately reduce body fat, but body part–specific exercise does not create preferential fat loss in one region of the body over another (10).
A recent systematic review and meta-analysis quantified the associations between measures of trunk muscle strength, physical fitness, and athletic performance (12). Not surprisingly, training the core had a large effect on measures of trunk muscle strength. However, core training had only small effects on measures of physical fitness and athletic performance (12). One possible explanation provided by the study authors hypothesizes that the role of specificity of training often is not captured in classic core assessments, in which tests performed in an isometric or prone position do not adequately mimic upright explosive muscle actions observed in sport (12).
Low back pain is the leading cause of activity limitation and work absence throughout much of the world (3) and its prevalence has led some to refer to it as the common cold of the musculoskeletal system (8). Especially among clinicians, motor control exercise (MCE) is a popular intervention that aims to restore coordinated and efficient use of the muscles that control and support the spine, such as the transversus abdominus and multifidus muscles (14). MCE is based on the theory that stability and control of the core is altered in individuals with low back pain (14). Therefore, MCE interventions focus on the activation of the deep trunk muscles in a specific and sequential manner, and may include the use of ultrasound imaging, biofeedback, and palpitation (14). Patients are guided initially by a therapist to selectively recruit and practice normal use of these muscles during simple tasks, and as the patient’s skill increases, the exercises are progressed to more complex and functional tasks involving additional muscles of the trunk and limbs (14). However, MCE has not been shown to be superior to other forms of core training exercises that address either muscle endurance or strength (3). Aerobic exercise, particularly walking, actually has the best evidence of efficacy for low back pain among all exercise regimens (2). Therefore, the choice of exercise for chronic low back pain should be determined by patient and therapist preferences, costs, and safety (14). Despite the frustration that can accompany low back pain, it is not a life sentence (8). In fact, there is clear evidence that individuals who seek therapy early on, and adhere to the exercise therapy, will feel better faster (5)! Whereas the prescription of exercise can play an integral role in helping a client manage acute or chronic low back pain, the health/fitness/exercise professional needs to understand clearly that his or her scope of practice does not ever include a medical evaluation or the diagnosis of low back pain because this rests solely within the scope of practice of a licensed health care professional (1).
The popularity and widespread use of core training exercises throughout the health and fitness landscape present a myriad of opportunities for the health and fitness professional to educate his or her clients as to the facts and fictions associated with core training. Given the plethora of information that exists — both good and bad — the health and fitness professional is encouraged to incorporate an evidence-based approach to provide clients the best exercise prescription for their specific goals and needs.
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