Effect of upper body plyometric training on physical performance in healthy individuals: A systematic review

Accepted Manuscript Effect of upper body plyometric training on physical performance in healthy individuals: A systematic review Deepika Singla, M. Ejaz Hussain, Jamal Ali Moiz PII:

S1466-853X(17)30139-6

DOI:

10.1016/j.ptsp.2017.11.005

Reference:

YPTSP 851

To appear in:

Physical Therapy in Sport

Received Date: 5 April 2017 Revised Date:

6 September 2017

Accepted Date: 10 November 2017

Please cite this article as: Singla, D., Hussain, M.E., Moiz, J.A., Effect of upper body plyometric training on physical performance in healthy individuals: A systematic review, Physical Therapy in Sports (2017), doi: 10.1016/j.ptsp.2017.11.005. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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TITLE PAGE Fill in information in each box below

ARTICLE INFORMATION

Effect of upper body plyometric training on physical performance in healthy individuals: a systematic review

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199

Funding sources State funding sources (grants, funding sources, equipment, and supplies). Include name and number of grant if available. Clearly state if study received direct NIH or national funding. All sources of funding should be acknowledged in the manuscript.

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CORRESPONDING AUTHOR CONTACT INFORMATION

Deepika Singla, Ph.D pursuing, MPT Sports(Master of Physiotherapy), BPT(Bachelor of Physiotherapy) [email protected] Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Jamia Nagar, Okhla, Delhi-110025, India. +918802201116,+91 8586976427

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Email address – this is where your proofs will be sent Postal mailing address – this is where your complimentary copy will be shipped Phone number Fax number

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For the corresponding author (responsible for correspondence, proofreading, and reprints) First name, middle initial, last name and degrees

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Article Title

First author First name, middle initial, last name of author. Include highest academic degree(s). Title, academic or professional position (eg, Professor, University of Illinois) Name of department(s) and institution(s) to which work should be attributed for this author (eg, Kinesiology Department)

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Second author First name, middle initial, last name of author. Include highest academic degree(s). Title, academic or professional position (eg, Professor, University of Illinois) Name of department(s) and institution(s) to which work should be attributed for this author (eg, Kinesiology Department)

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Third author First name, middle initial, last name of author. Include highest academic degree(s). Title, academic or professional position (eg, Professor, University of Illinois) Name of department(s) and institution(s) to which work should be attributed for this author (eg, Kinesiology Department)

Deepika Singla, Ph.D pursuing, MPT Sports(Master of Physiotherapy) Research Scholar, Jamia Millia Islamia Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Jamia Nagar, Okhla, Delhi-110025, India.

M. Ejaz Hussain, Ph.D Director and Professor, Jamia Millia Islamia Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Jamia Nagar, Okhla, Delhi-110025, India.

Jamal Ali Moiz, Ph.D pursuing Assistant Professor, Jamia Millia Islamia Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Jamia Nagar, Okhla, Delhi-110025, India.

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TITLE PAGE

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Title: Effect of upper body plyometric training on physical performance in healthy individuals: a systematic review

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ABSTRACT

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Objective: To determine the impact of upper body plyometric training (UBPT) on physical performance parameters such as strength, ball

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throwing speed, ball throw distance and power in healthy individuals.

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Methods: PubMed, Scopus, ResearchGate and ERIC databases were searched up to August 2017. Selection of articles was done if they

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described the outcomes of an upper body plyometric exercise intervention; included measures of strength, ball throwing speed, ball throw

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distance, or power; included healthy individuals; used a randomized control trial; and had full text available in English language. The

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exclusion criteria were unpublished research work and clubbing of UBPT with some other type(s) of training apart from routine sports

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training. PEDro scale was used to rate the quality of studies eligible for this review.

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Results: Initially 264 records were identified and out of them only 11 articles met the eligibility criteria and were selected (PEDro score =

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4 to 6). Though large to very small effects observed in improving ball throwing velocity, ball throwing distance, power and strength of

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upper limb muscles after UBPT, the results should be implemented with caution.

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Conclusion: Inconclusive results obtained preclude any strong conclusion regarding the efficacy of UBPT on physical performance in

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healthy individuals.

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Upper limb plyometric, upper body plyometric, upper extremity plyometric

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KEY WORDS

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INTRODUCTION

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Many sports and occupational activities require explosive movements of the upper extremities14. Improvement in parameters of strength

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and power has been observed if plyometric exercises are performed regularly7. Previously known by different names such as the shock

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method and jump training, plyometric training aims to improve power production by combining strength and speed26. The term

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“plyometric” is a combination of two greek words, “plio” which means “more” and “metric” which means “to measure”34. Plyometric

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exercises involve stretch shortening cycles (SSCs) to powerfully contract the muscles after rapidly stretching the same muscles24. The

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muscle group is first eccentrically loaded to store elastic energy in the muscles and then contracted concentrically to produce increased

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force in one SSC1. The two phases eccentric and concentric are separated by a brief rest period known as the amortization phase27.

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Significance of amortisation phase lies in the fact that lesser the duration of this phase, greater is the utilization of elastic energy stored in

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the muscles leading to increased work output11.

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While there is abundance of researches based on lower body plyometric training2,3,17,19,21 that majorly includes jumping13,32 and

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hopping6,25, training adaptations incurred due to upper body plyometric training (UBPT) have been studied by very few researchers in the

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past4,11,14,23,26,27,32. Upper limb plyometric exercises include open kinetic chain medicine ball exercises such as chest passes and ball

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throws, and closed kinetic chain exercises such as plyometric push-ups12, clap push ups and medicine ball push ups14. It has been proposed

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that both upper body and lower body plyometric training programs would produce similar results4,26. Presently, there is dearth of studies

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those have examined the impact of purely upper body plyometric exercise on upper body performance. It is clear that more and more

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researches are needed to determine the effect of such type of training on physical performance parameters. The purpose of this review was

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to determine the impact of UBPT on physical performance parameters such as strength, ball throwing speed, ball throw distance and power

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in healthy individuals.

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MATERIALS AND METHODS

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Inclusion Criteria

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To be a part of this systematic review research articles had to meet the following inclusion criteria (a) describe the outcomes of an upper

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body plyometric exercise intervention; (b) include measures of strength, ball throwing speed, ball throw distance, or power; (c) include

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healthy individuals; (d) use a randomized control trial; and (e) have full text available in English language.

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Exclusion Criteria

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(a) Unpublished research studies, conference papers, dissertations or theses (since these are not peer reviewed by the experts and hence

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their authenticity is questionable, also, these are generally not shown up in the search engines, thus, making replication of similar

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systematic review impossible for other researchers) and (b) clubbing of UBPT with some other type(s) of training (eg. weight training,

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resistance training, lower body plyometric training, etc. since the authors were interested to determine solely the effect of UBPT) apart

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from routine sports training.

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Articles that met the inclusion and exclusion criteria were chosen for the final review.

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Experimental Approach to the Problem

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The Google search engine was used in August 2017 to search the following databases for relevant literature: PubMed, Scopus,

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ResearchGate and ERIC using the search terms ‘‘upper body plyometric,’’ ‘‘upper limb plyometric,’’ and ‘‘upper extremity plyometric.’’

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Quality of the selected studies

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The Physiotherapy Evidence Database (PEDro) Scale5,8,18 was used to assess the methodological quality of all the included studies. The

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scale contains the items of Jadad scale as well as items of Delphi list18,30. This scale has 11 items (refer TABLE 1), the answer for which

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are either yes or no. A score of ‘1’ is awarded to the item in case it is present otherwise ‘0’ is awarded. In the end, all items are summed up

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to provide a score out of 10 (eligibility criteria satisfied item not included in total score). Studies were classified to be having poor, fair,

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good or excellent quality if the PEDro scores were <4, 4-5, 6-8 or 9-10 respectively20.

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Search, selection, reading, analysis and quality assessment of the articles was done by two independent reviewers. The two reviewers were

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in total agreement with each other.

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Calculation of effect sizes and their confidence intervals

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Standardized mean difference and its upper and lower limits were calculated using mean values and pooled standard deviation values of

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the outcome variables in order to assess the effect of intervention . Effect sizes were classified to be small, medium or large based on value

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of Cohen’s d (0.2= small effect size, 0.5=medium effect size, 0.8= large effect size)16,20,21,28. Also, heterogeneity between the studies (Q

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value) was determined using MedCalc software. Since Q statistic possesses low differential power, studies were considered to be

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heterogenous at P < 0.1. Also, standardized mean differences and their confidence intervals were represented in the form of forest plots.

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RESULTS

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Study selection

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The process of study selection in accordance with PRISMA is depicted in FIGURE 1. Initially 264 records were found having 149

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duplicates. Upon reading the abstracts, 84 articles did not meet the eligibility criteria and were rejected. While screening the records, 7

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conference papers, 2 dissertations/theses, 3 unpublished research studies and 2 studies that had chosen diseased individuals as their study

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population were excluded. Also, 27 studies did not describe outcomes of UBPT, 29 studies were not found to have randomised control

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study design, 2 studies had described the outcomes of a plyometric training involving both lower body and upper body plyometrics and 12

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studies had clubbed UBPT with some other type of training such as strength training, resistance training, etc.; all of these were excluded.

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In case of any doubt 31 full texts were read to decide whether to accept the articles or not. A total of 11 studies were found to be eligible

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for this review.

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TABLE 1 presents the results of the methodological quality rating of all the selected studies based on PEDro scale. Two out of eleven

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studies had a PEDro score of 4 out of 10, four out of eleven studies had a PEDro score of 5 out of 10 and five out of eleven studies had a

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PEDro score of 6 out of 10.

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TABLE 1: PEDro scores of the eleven eligible studies

et al, et 20129

Schulte-

Heidersceit

al, Edelmann

20074

et

et

al, 199611

200526

Eligibility criteria Yes

Yes

Yes

Yes

1

1

1

randomly allocated groups crossover subjects

to (in

a

study,

et

Newton

al, and

200032

201531

Yes

1

EP

were 1

Vossen

Sen,

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Subjects

al, and

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11

Konto

McEvoy

Hayath

Ulrich

Wilcox et al,

u et al, and

and

200633

201715

Spargol

Parsto

i, 201610

rfer,

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Carter

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Gelen

, 199423

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Criterion

201629

Yes

Yes

Yes

Yes

No

Yes

1

1

1

1

1

1

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of 10) 147

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Total points (out 6

Impact of upper body plyometric training on physical performance

149

Eleven studies included in this systematic review4,9,10,11,15,23,26,29,31,32,33 are presented in a tabular manner describing detailed breakdown of

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objectives, study populations, upper extremity plyometric protocols, outcome variables and outcomes (TABLE 2). The total sample size of

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this study was 311 subjects (152 females11,15,26,32, 109 males10,15,23,26,29,31,33, 50 unreporte,4,9). Schulte-Edelmann et al26 and Kontou et al15

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had recruited both the genders for participation in their study, while Gelen et al9 and Carter et al4 did not mention about the sex of the

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participants. The mean age of the participants could not be calculated due to lack of reporting of mean age by Schulte-Edelmann et al26 and

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Vishen and Sen31. Regarding the type of study population Gelen et al9, Carter et al4, Vishen and Sen31, Newton and McEvoy23 and Kontou

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et al15, Hayath and Spargoli10, Ulrich and Parstorfer29 and Wilcox et al33 all studied sports players while Schulte-Edelmann et al26,

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Heidersceit et al11, and Vossen et al32 included persons not involved in any sort of sports.

158

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148

159

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TABLE 2: Summary of studies found eligible for this systematic review and Objective

Sample(S)

year

and Protocol

Outcome

Research

SC

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al, To compare the S: 26 elite tennis TRPLYO: ballistic Tennis

serve Significant

Both

acute effects of players (mean age= six exercises using speed

differences

extremity

static stretching, 15.1+4.2

between

plyometric

participated in four 3kg medicine balls,

exercises

upper

volume group

1Control ballistic

extremity 3Experimental

plyometric

groups

six

(TRAD), exercises, 1 X 20,

EP

high

and groups:

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dynamic

years) theraband, 1kg and

60

seconds

rest

namely between

TRPLYO

and exercises

and TRPLYO

and ball serve speed TRDE

sretching repetitions.

and TRSS, TRDE

serve

(TRSS),

dynamic TRDE: 2 X 15, 30

and TRAD.

exercises

(TRDE), seconds

18

rest

and

TRSS, significantly

activity on tennis static

performance

upper

TRDE, TRPLYO dynamic exercises

TRAD,

AC C

20129

et

Main finding(s)

variable(s)

design(RD) Gelen

Result(s)

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Author(s)

↑

plyometric

between each set,

exercises

60

seconds

rest

(TRPLYO), gender between repetitions.

SC

not specified

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RD: within subject TRSS: 10 seconds randomized

X

3

times,

30

repeated- measures

seconds

rest

between

each

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move, 10 seconds rest in between

Carter 20074

et

al, To

study

the S:

24

baseball PG: ballistic six Throwing

effects of 8 week players high

warm up only

AC C

EP

TRAD: traditional

volume age=19.7+1.3

(mean exercises

+ velocity

routine off season

19

Significant

Upper

difference

plyometric

between

groups training

extremity

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plyometric

plyometric

limb

group strength

and

on (PG), 11 in control conditioning

isokinetic strength

in upper

and not specified

for

throwing improves

velocity.

group (CG), gender exercises, 3 X 10-

throwing velocity

(pre and post test) significantly

SC

training

13

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extremity years),

20, 30 seconds rest

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upper

Significant ↑ in in

baseball

throwing velocity players

RD: pretest-posttest between each set,

in

randomized groups 2/wk X 8 wks

(p<0.05).

design

throwing velocity

PG

only

CG: rotator cuff

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strengthening exercises + routine

AC C

EP

off season upper

Schulte-

limb strength and conditioning exercises

To examine the S: 30 (mean age not EG:

retro Isokinetic

20

Significant ↑ in Retro plyometric

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training posterior shoulder elbow

experimental group with 1 kg plyoball, of on (EG), 15 in control 3

and genders

convenience

1800/s, 3000/s

plyometric training isokinetic

sedentary PG: one handed Isokinetic

EP

effect

TE D

speeds: 600/s, elbow

78

of collegiate (aged 18- overhead

between significantly

groups

the

stratified by gender, training

the S:

(mean

X

seconds

21

at improves of

throw power

power

power posterior

10,

90 distance rest

and

of elbow muscles

extensors

in EG.

Between

the Shoulder

tests, groups statistical plyometric

23 years), 27 in using 3lb/4lb ball, soft ball throw comparison

and control group (CG) 3-4

with

extensors at 3 Significant ↑ in shoulder

trial, CG: no plyometric different

AC C

al, 199611

study

of training

3000/s.

between sets, 2/wk elbow

sampling et To

and the

rest rotators

randomised X 6 wks

RD:

rotators

10-20, external

group (CG), both adequate

controlled

Heidersceit

X

power

shoulder shoulder external plyoball

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plyometric

SC

200526

power the

of mentioned), 15 in plyometric training tests:

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Edelmann et al, effects

not training

done.

significantly

Significant

improves

non-

ball

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rotators isokinetic

group weight ↑d after 4

age=18.7+0.8

IG: 3-4 sets X 10

years), 27 in PG repetitions

at

in throwing distance

concentric

and

eccentric shoulder internal

(mean weeks

SC

and on softball (IG)

rotators

power in IG. Non-significant ↑

(mean

varying isokinetic

in

age=19.0+1.5

speeds (eccentric:

distance

in

years), only females

1800,

three

groups

RD:

900/second,

randomised concentric:

EP

controlled trial

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distance

in 2/wk X 8 wks, ball

27

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internal

shoulder years),

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of

increase

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between each set,

training on power age=19.2+1.5

1200/second),

seconds

2400, 90 rest

between each set, 2/wk X 8 wks, speed ↓d after 4

22

ball

throw all

(greatest in PG).

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weeks

of cricket

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effect

of S: 36 professional 3 X 10-12 for first Medicine ball Non players four weeks, 4 X put age

(to differences

not 10-11 for last two test ball throw between

the improves equally

2

training on upper dynamic

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up training and mentioned) divided weeks, 3/wk X 6 distance), one groups for both with dynamic push-up into

body

performance

SC

plyometric push- (mean

test

significant Upper

both

groups: wks

arm hop test tests.

plyometric push-

push-up

(to test upper Significant

up training and

group

and

body power)

performance

plyometric push-up

and post training training

group, only males

within the groups

RD:

randomised

for one arm hop test.

TE D

body

EP

Sen, 201531

and Comparison

controlled trial

AC C

Vishen

differences

pre dynamic push-up

Significant improvement for medicine ball put

23

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test

within

the

200032

of dynamic

effect

41,

plyometric push- (DPU)

18

in 3 X 10-12 for first Medicine ball Significantly

push-up four weeks, 4 X put

training 10-11 for last two test ball throw than

up training and program

(mean weeks, 3/wk X 6 distance),

dynamic push-up age=17.4+2.1

wks

training on power years) and 17 in

1RM

chest

strength)

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upper

training (mean

EP

program age=17.3+2.1

medicine ball put

chest test.

significantly and non-significantly

body greater ↑ in PPU than

up training

DPU

chest press.

for

improves upper body power and strength respectively as

dynamic push-up

years), only females RD:

for

Plyometric push-

compared to

AC C

shoulder muscles

DPU

press (to test Non-significantly

and strength of plyometric push-up and (PPU)

(to greater ↑ in PPU

test

SC

of S:

M AN U

Vossen et al, Comparison

RI PT

groups.

training

randomised

controlled trial

24

ACCEPTED MANUSCRIPT

the S:24 of players

McEvoy,

effects

199423

plyometric

(mean chest

age=18.6+1.9

pass

overhead

and years), 8 in control using

and throwing

Non

significant Medicine

differences

throw velocity, 6RM between 3

kg bench

press groups

SC

training conventional weight

baseball MB: two handed Baseball

RI PT

study

group (CG), 8 in medicine ball, 3 X (to test upper significant

M AN U

and To

training the effective

ball less than

and weight training in ↑ in improving upper

training medicine ball (MB) 8 for first four body strength) WT for throwing body

strength.

on upper body group, 8 in weight weeks, 3 X 10 for

velocity.

Medicine

strength

Significant

training does not

difference

improve throwing

and training

RD:

minutes

TE D

group, only males

rest

randomised between sets, 2/wk

controlled trial

EP

throwing velocity

(WT) last four weeks, 3

AC C

Newton

X 8 wks WT:

between WT and velocity. other two groups,

barbell

significant

↑ in

exercises, 8-10RM

MB and WT for

X 3 sets each for

6RM bench press.

first four weeks, 6-

25

ball

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for last four weeks, 3

minutes

rest

SC

between sets, 2/wk

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8RM X 3 sets each

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X 8 wks CG:

routine

baseball

training,

2/wk X 8 wks

impact of various (mean extremity 19.9+1.7

years) ups for males & 4 (to

and

lower participated

extremity

in

groups: plyometric CMJ:

exercises

on push-ups

acute

put countermovement

shot

4 reps for females

throwing 3 distance)

(PLYO), consecutive countermovement

26

↑ plyometric push-

put Significant

push- performance

EP

upper

age: plyometric

AC C

201715

TE D

Kontou et al, To determine the S: total 17 throwers PLYO: 6 reps of Shot

with-in

groups ups

acutely

test after PLYO, ISO improve shot-put and CMJ. Non-significant ↑ after SKIP. Non-significant

performance

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jumps

(CMJ), jumps

isometric push-ups ISO: (ISO),

difference 6

seconds

skipping isometric push-ups both SKIP: 10 reps of

SC

(SKIP),

RD:

plyometric exercises (ballistic

TE D

upper

limb age=25.6+3.2 years)

dynamic speed

stretches, dynamic

EP

201610

of fast bowlers (mean 2X15,

participated shoulder

AC C

acute effect

in 3 groups: no movements 2X15

six BSP, 30% BSP and 30% BSP: 3X3 for

protocol; BSP) of 50%

after PLYO, ISO and CMJ.

randomised leg)

and To determine the S: Total 7 cricket No BSP: push-ups Bowling

Spargoli,

↑s

ground touches per

cross-over design Hayath

percentage

M AN U

genders (8 males, 9 static skipping (5 females)

between

RI PT

performance

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only all 6 exercises, 30

27

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30%

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BSP warm-up protocol

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50% BSP.

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ACCEPTED MANUSCRIPT

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sets-

external

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90/90

external

SC

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50% BSP more

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rotation, overhead soccer

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baseball throw 50% BSP: 3X5 for all

exercises

of

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same

28

rest

effective

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rest

TE D

bowling speed

on RD:

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EP

intensities

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AC C

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than

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ACCEPTED MANUSCRIPT

interval

of resistance

acute effect

201629

plyometric bouts sports

trained plyometric

upper performance

peak Non-significant

performed prior to

(80%

groups: ECC:

3

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of

(CON)

1X3

(PLY), eccentric

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and 1RM)

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only

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throw

participated 1RM)

years) on in

exercises

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press

and age=23.1+3.2

TE D

contractions

press CON and PLY.

CON: 1X3 bench power output

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eccentric

push- bench

students ups

with concentric- (mean eccentric

Significant ↑s in Plyometric

1X10 Ballistic

SC

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16 PLY:

Total

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and To compare the S:

EP

Ulrich

randomised

cross-over design

29

of

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when

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in

terms of power output

ACCEPTED MANUSCRIPT

acute

(mean

enhancement bench

age (5

in =22.3+2.5

press participated

mins.

of press strength

years) stationary cycling in

3 and

upper

body

explosive (NP),

upper movements

body push-up

after (p=.004)

↑s Low

and body movements

MBCP (p=.025).

should

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(PPU), push-ups + warm-

order to enhance

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M AN U

performance after trials: no plyometric static stretches) doing

bench Significant

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200633

determine S: Total 12 athletes NP: only warm-up 1RM

SC

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AC C

cross-over design

mins.=minutes, 3 X 10-20 means 3 sets and 10-20 repetitions, 2/wk X 8 wks means 2 sessions per week for 8 weeks, ↑ = increase, reps= repetitions, 1RM = 1 Repetition-maximum

30

performance

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Of the eleven studies selected4,9,10,11,15,23,26,29,31,32,33 for inclusion, ten demonstrated statistically significant results4,9,10,15,23,26,29,31,32,33 to

161

improve physical performance. Between the groups’ significant improvements were reported by Gelen et al9, Carter et al4, Schulte-

162

Edelmann et al26, Vossen et al32, Kontou et al15, Hayath and Spargoli10, Ulrich and Parstorfer29 and Wilcox et al33 and and within the

163

groups improvements were reported by Carter et al4, Schulte-Edelmann et al26, Vishen and Sen31 and, Newton and McEvoy23. Effect sizes

164

and their confidence intervals for main outcomes have been depicted in TABLE 3. Ball throwing velocity was measured by four studies

165

4,9,10,23

166

Table 3-6). Of the four studies that reported ball throwing distance

167

significant improvement with large effect size of magnitude 1 and very small effect size of magnitude 0.1, respectively. Power outcome

168

was measured by four studies

169

Their study produced a small effect size of magnitude 0.3. Strength outcome was measured by three studies23,32,33 and only Wilcox et al33

170

reported significant difference between the groups with an effect size of only 0.1 magnitude.

171

Our statistical analysis revealed slight heterogeneity amongst the studies that assessed ball throwing velocity (TABLE 3). The tests for

172

heterogeneity were found to be non-significant for all other parameters (Table 4-6). Of note is the fact that study belonging to Vishen and

173

Sen31 did not report standard deviation values for the outcome variables (ball throwing distance and power), hence, their effect sizes could

174

not be calculated.

SC

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160

11,15,31,32

only Vossen et al32 and Kontou et al15 reported statistically

and only Schulte-Edelmann et al26 and Ulrich and Parstorfer29 demonstrated significant results.

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11,26,29,31

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and three of these reported significant improvements2,4,30 with moderate and large effect sizes of magnitudes 0.7, 1.4 and 1 (refer

31

ACCEPTED MANUSCRIPT

Study

^N1

^^N2

Total

*

SMD

#

95% CI

SMD and 95% CI forest plot

26

26

52

0.696

0.121 to 1.271

Carter et al., 20074

13

11

24

1.371

0.410 to 2.332

8

8

16

-0.390

7

7

14

1.031

-0.237 to 2.299

54

52

106

0.692

0.284 to 1.099

54

52

0.682

0.00628 to 1.358

Hayath and

Total (fixed

Total (random effects)

AC C

effects)

EP

Spargoli, 201610

106

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McEvoy, 199423

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Gelen et al., 20129

Newton and

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TABLE 3: Effect of UBPT on ball throwing velocity in healthy individuals

32

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Heterogeneity: Q=7.1, P=0.07

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^N1 = number of participants in experimental group, ^^N2 = number of participants in control group, *SMD = standardized mean difference, #95% CI = confidence interval

SC

175

M AN U

176 177 178

182 183 184 185

EP

181

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180

TE D

179

33

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^^N2

Total

*

SMD

#

95% CI

27

27

54

0.260

-0.289 to 0.809

17

18

35

0.977

17

17

34

0.103

61

62

123

61

62

123

199611 Vossen et al.

Total (fixed

Total (random effects)

0.402

0.0377 to 0.766

-0.0727 to 0.916

0.422

AC C

effects)

-0.596 to 0.802

EP

201715

0.244 to 1.710

TE D

200032 Kontou et al.

SMD and 95% CI forest plot

SC

Heidersceit et al.

^N1

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Study

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TABLE 4: Effect of UBPT on ball throwing distance in healthy individuals

Heterogeneity: Q=3.6, P=0.17

^N1 = number of participants in experimental group, ^^N2 = number of participants in control group, *SMD = standardized mean

34

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difference, #95% CI = confidence interval

186

SC

187 188

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189 190 191

195 196 197 198

EP

194

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193

TE D

192

35

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^^N2

Total

*

SMD

#

95% CI

15

30

-0.264

-1.016 to 0.487

27

27

54

-0.201

16

16

32

0.303

58

58

116 -0.0791

-0.449 to 0.290

58

58

116 -0.0791

-0.449 to 0.290

SC

15

et al. 200526 Heidersceit et

Parstorfer. 201629 Total (fixed

Total (random effects)

-0.424 to 1.030

AC C

effects)

-0.749 to 0.346

TE D

al.199611 Ulrich and

SMD and 95% CI forest plot

M AN U

Schulte-Edelmann

^N1

EP

Study

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TABLE 5: Effect of UBPT on power in healthy individuals

Heterogeneity: Q=1.6, P=0.45

^N1 = number of participants in experimental group, ^^N2 = number of participants in control group, *SMD = standardized mean

36

ACCEPTED MANUSCRIPT

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difference, #95% CI = confidence interval

199

SC

200 201

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202 203 204

208 209 210 211

EP

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TE D

205

37

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^^N2

Total

*

SMD

#

95% CI

17

18

35

0.650

-0.0581 to 1.358

8

8

16

-0.559

12

12

24

0.127

37

38

75

0.222

-0.248 to 0.691

37

38

-0.517 to 0.822

Wilcox et al. 200633 Total (fixed

Total (random effects)

-0.721 to 0.974

75

0.152

AC C

effects)

-1.659 to 0.541

TE D

McEvoy. 199423

M AN U

200032 Newton and

SMD and 95% CI forest plot

SC

Vossen et al.

^N1

EP

Study

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TABLE 6: Effect of UBPT on strength in healthy individuals

Heterogeneity: Q=3.9, P=0.14

^N1 = number of participants in experimental group, ^^N2 = number of participants in control group, *SMD = standardized mean

38

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difference, #95% CI = confidence interval

212

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DISCUSSION

227

This is the first systematic review conducted to determine the impact of UBPT on physical performance parameters such as strength, ball

228

throwing speed, ball throw distance and power in healthy individuals. Eleven randomised controlled trials that were included in this review

229

were rated as having fair to good methodological quality20. The results suggest that UBPT has a large effect on improving ball throwing

230

velocity and moderate effect on improving ball throwing distance but only a small effect on improving power of upper limb muscles and

231

negligible effect on improving strength of upper limb muscles.

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The mean PEDro score of the eleven eligible studies came out to be 5.3 thus reflecting a fair overall quality of the eleven studies

234

attributable to non-concealment of allocation and lack of blinding of subjects, therapists and assessors. Only five studies turned up to have

235

good quality on the PEDro scale with rest of the six studies possessing fair quality (TABLE 1).

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We came across a variety of equipments, protocols and dosimetry while compiling the findings of research studies eligible for this review,

238

thus, making it difficult for us to compare the effects amongst different studies (TABLE 2). Some researchers had employed plyometric

239

push-ups as their mode of training, some utilized medicine balls with weight of medicine balls varying across studies, while some utilized

240

a combination of medicine balls and theraband exercises. Different protocols were followed across studies with ballistic six protocol

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consisting of latex tubing external rotation and 90-90 external rotation, overhead soccer throw, 90-90 external rotation side-throw,

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deceleration baseball throw and baseball throw exercises being followed by Gelen et al9, Carter et al4 and Hayath and Spargoli10;

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Heidersceit et al11 used only one handed overhead throw while Newton and McEvoy23 employed two handed overhead throw and chest

244

pass, Schulte-Edelmann et al26 incorporated retro exercises and Vossen et al32, Vishen and Sen31, Kontou et al15, Ulrich and Parstorfer29

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and Wilcox et al33 did not use medicine balls rather they trained the subjects by plyometric push-ups. Exercise dosage too varied from 2 to

246

3 sessions per week (with Gelen et al9, Kontou et al15, Hayath and Spargoli10, Ulrich and Parstorfer29 and Wilcox et al33 observing only the

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acute effects after only 1 session of upper limb plyometric training) for 6 to 8 weeks with number of sets and repetitions varying from 3 to

248

4 and 10 to 20 respectively with varying amounts of rest between sets and repetitions. Development of standardised exercise protocol is,

249

here forth, in order so as to compare the effects of plyometric training in different studies.

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Not only this, there were differences in the research populations chosen by different researchers in terms of gender, age, level of physical

252

activity and type of sports (TABLE 2). Male10,15,23,26,29,31,33 and female11,15,26,32 participants were chosen as study population in seven and

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four studies, respectively, while, two researchers did not reveal the gender of their participants4,9. Schulte-Edelmann et al26 and Vishen and

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Sen31 did not specify the age of their subjects; subjects belonging to the researches of Carter et al4, Heidersceit et al11, Newton and

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McEvoy23, Kontou et al15, Hayath and Spargoli10, Ulrich and Parstorfer29 and Wilcox et al33 had mean ages of greater than eighteen years,

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while those who participated in the studies of Gelen et al9 and Vossen et al32 had mean ages of less than eighteen years. Subjects were

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sports players in eight studies4,9,10,15,23,29,31,33, they were sedentary in one study11 and their level of physical activity could not be known in

258

remaining of the two studies26,32. Sports players too belonged to different sports such as tennis1, baseball4,23,33, shot-put15, discus throw15,

259

javelin throw15, football33 and cricket10,31. Thus, we also recommend future dose response studies in different genders, different age groups

260

and different populations for an effective comparison across research studies.

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Three out of four studies that measured ball throwing velocity produced moderate to large effect size (TABLE 3). Research by Gelen et al9

263

resulted in 3.33% increase in tennis serve speed with just one session of upper extremity plyometric exercises attributable to the

264

phenomenon of post-activation potentiation that temporarily improves the muscular contraction ability. Similarly, Carter et al4 and Hayath

265

and Spargoli10 revealed large improvements in throwing velocity owing to the ballistic nature of plyometric exercises thus utilising the

266

stretch-shortening cycle. Newton and McEvoy23 could not demonstrate improvement in throwing velocity owing to the fact of bigger size

267

of the medicine balls and movement patterns other than the baseball throwing pattern used for training i.e. chest pass and overhead throw.

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Newton and McEvoy23 who conducted their research way back in 1994 had used only two exercises using 3kg medicine ball as a part of

269

training while Gelen et al9 and Carter et al4 had utilized the ballistic six protocol that uses 2 pounds and 6 pounds medicine balls along

270

with latex tubing.

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A large effect size was observed for effect on ball throwing distance in the research conducted by Vossen et al32 as a result of greater

273

resistance being overcome during plyometric push-ups due to gain in momentum attained by the fall of trunk when compared to non-

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plyometric push-ups referred to as dynamic push-ups by the authors of the study. Kontou et al15 though reported significant improvement

275

in ball throwing distance in plyometric group that performed plyometric push-ups just before testing the outcome variable, the effect size

276

was found to be negligible since throwers with greater training experience benefitted more after doing plyometric push-ups than throwers

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having low experience and possessing lesser muscular strength. Also, in players with fewer years of training experience sub-maximal

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exercise are said to be more effective due to less fatigue induced as compared to maximal exercises such as plyometric push-ups. Vishen

279

and Sen31 however were unable to demonstrate any significant difference between the plyometric and control groups for throwing distance

280

due to inappropriate training stimulus being provided to trained athletic population for improvement of upper body performance.

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272

Only a small effect size was depicted in the study conducted by Schulte-Edelmann et al26 on improving upper body power consequent to

283

upper body plyometric training since the load was kept constant throughout the training period, had the weight of the ball being increased,

284

its circumference would have increased making the subjects unable to grip the ball. Similarly, Ulrich and Parstorfer29 too demonstrated a

285

small effect size. Though loads of 60-84% of 1RM are required to improve muscle power maximally, exercises of such moderate to heavy

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levels require cumbersome equipment thus, compelling the authors to test the results of low load upper body plyometric exercises which

287

seem to be more practical in competition settings. Two studies that belonged to Carter et al4 and Vishen and Sen31 demonstrated non-

288

significant effects of upper body plyometric training on power. The former reasoned that presence of an in-built acceleration limiter in

289

their isokinetic dynamometer might have affected the results while the latter attributed it to the inappropriateness of the training load.

290

Upper body power too was found to be tested using different tools and recorded in either Watts, by Schulte-Edelmann et al26 and

291

Heidersceit et al11 using isokinetic dynamometer or in seconds by Vishen and Sen31 using one arm hop test and by Carter et al4

292

isokinetically.

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Upper body strength improved in only one of the three studies that intended to improve it (TABLE 6). Study by Wilcox et al33

295

demonstrated significant improvement in strength measured shortly after doing upper body plyometrics as a result of post activation

296

potentiation, it produced a very small effect size of magnitude 0.1 only. It could be attributed to the extremely low volume of plyometric

297

exercises (2 repetitions only) performed by the participants since the authors were concerned about fatigue that might have resulted if they

298

had used greater volume or load. Also, authors speculate that strength might have improved due to the learning effect. Vossen et al32

299

reasoned that although non-significant difference between the groups was observed but both groups demonstrated improvements in chest

300

press strength with plyometric group demonstrating greater improvements than the non-plyometric group. Newton and McEvoy23 said that

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the load was constant throughout eight weeks of training with only number of repetitions being increased after four weeks with principle of

302

progressive overload not being followed leading to insignificant increase in strength with plyometric training. Additionally, the strength

303

parameter has been assessed differently by different researchers thus yielding the values in different units like Newton32 and Kilograms23,33

304

which made it difficult for the authors to establish a concrete result regarding the effect of upper body plyometric training on strength of

305

upper limb muscles. Carter et al had measured torque and strength ratios using isokinetic testing, Vossen et al32 and Wilcox et al33

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recorded weight moved during 1RM chest press and 1RM bench press, respectively and Newton & McEvoy23 recorded maximum weight

307

lifted during 6RM bench press.

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Limitations of the study

310

Limited availability of search engines for this review might have yielded lesser number of results. Furthermore, none of the studies found

311

to be eligible for this review belonged to the excellent category of the PEDro scale. Thus, further well designed future randomized control

312

studies are needed to address the research question.

313

Established gold standard tools could not be found to measure the effects of upper body plyometric training on upper body physical

314

performance; different studies have used different measuring tools which further made the review more difficult to establish a concrete

315

result owing to different criteria.

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Additionally, we acknowledge the limitation of not including studies with diseased population as their subjects in our review, with such

317

studies being excluded during the study selection process, thus, making us to recommend future reviews to be based on diseased

318

population too.

319

Finally, this review was limited to studies published in only English language, English being the commonest language in the field of

320

research, important research studies relevant to this systematic review might exist in languages other than English thus encouraging future

321

researchers to cover other languages’ studies too.

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CONCLUSION

332

With extensive search only eleven studies turned up to be eligible for the review and out of eleven, eight studies showed effectiveness on

333

improving ball throwing velocity, ball throwing distance and power of upper limb muscles, two studies demonstrated ineffectiveness of

334

upper body plyometric training and one study did not report between the group analysis. Our review highlights the fact that future good

335

quality randomised control trials are required to confirm our findings and to obtain useful information on the effect of upper body

336

plyometric training on physical performance parameters. Due to methodological limitations in the review and paucity of relevant articles

337

the data presented do not allow the study to present clear conclusion on the impact of UBPT on physical performance in healthy

338

individuals.

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and selected muscle performance characteristics. J Shoulder Elbow Surg. 2002 Dec 31;11(6):579-86. 28. Thompson B. What future quantitative social science research could look like: Confidence intervals for effect sizes. Educational Researcher. 2002 Apr;31(3):25-32.

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29. Ulrich G, Parstorfer M. Effects of Plyometric vs. Concentric and Eccentric Conditioning Contractions on Upper Body

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Postactivation Potentiation. International journal of sports physiology and performance. 2017 Jul;12(6):736-741. DOI:

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10.1123/ijspp.2016-0278. [Epub ahead of print].

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30. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG. The Delphi list: a criteria list for quality

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assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of clinical

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epidemiology. 1998 Dec 31;51(12):1235-41.

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32. Vossen JF, Kramer JE, Burke DG, Vossen DP. Comparison of Dynamic Push-Up Training and Plyometric Push-Up Training on

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cricket Player. International Journal of Physical Education, Sports and Health. 2015; 2(1): 199-203.

Upper-Body Power and Strength. J Strength Cond Res. 2000 Aug 1;14(3):248-53. 33. Wilcox J, Larson R, Brochu KM, Faigenbaum AD. Acute explosive-force movements enhance bench-press performance in athletic

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31. Vishen PK, Sen S. Comparision of dynamic push-up training and plyometric push-up training on upper body performance test in

men. International journal of sports physiology and performance. 2006 Sep;1(3):261-9.

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34. Wilk KE, Voight ML, Keirns MA, Gambetta V, Andrews JR, Dillman CJ. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993 May;17(5):225-39.

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Records screened (n = 115)

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Records after duplicates (n = 149) removed (n = 115)

Pubmed = 84 Scopus = 91 ResearchGate = 85 ERIC = 4

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Records identified through database searching (n = 264)

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Identification

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Records excluded (n = 84)

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Eligibility

Full-text articles excluded due to:

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(n = 20)

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Included

Full-text articles assessed for eligibility (n = 31)

Not being randomized control trial (n=2), Non inclusion of upper body plyometric exercises (n=4), upper body plyometric training clubbed with lower body plyometric training (n=11) or clubbed with some other type of training (n=3)

Studies included in qualitative synthesis (n = 11)

FIGURE 1: PRISMA flowchart of study selection

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HIGHLIGHTS UBPT improves ball throwing velocity, distance and power (effect size 0.3-1.5).

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Improvement of muscle strength with UBPT is questionable (effect size 0.1).

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Exercise the results with caution due to only few studies involved.

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Ethical statement

Human subjects were not involved in this research

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If human subject or animals were used, state the name of IRB, Research Ethics Committee or equivalent in the Methods and here.

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Conflicts of interest

None declared

Ethical statement

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List all potential conflicts of interest for all authors. Include those listed in the ICMJE form. These include financial, institutional and/or other relationships that might lead to bias or a conflict of interest. If there is no conflict of interest state none declared.

Human subjects were not involved in this research

Funding sources

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If human subject or animals were used, state the name of IRB, Research Ethics Committee or equivalent in the Methods and here.

None

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State funding sources (grants, funding sources, equipment, and supplies). Include name and number of grant if available. Clearly state if study received direct NIH or national funding. All sources of funding should be acknowledged in the manuscript.

Acknowledgement

None

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List the names of people who you are acknowledging and specifically how they contributed to the study. A signed letter of permission from each person and/or entity stating they give permission to the JMPT to print their name must be uploaded to the website at the initial time of submission. List permissions here.