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One-repetition maximum (strength test).
Only one maximum strength test was performed in each direction to minimize the potential for reduced force output with increased cervical pain due to repeated testing.
We did not use a maximum strength test for the back extensor muscles because of the potential risk of further vertebral fracture.
The target repetition rate was derived from the maximal repetition rate (MRR) in a maximum strength test for all eight muscle groups: Patients were asked to perform as many repetitions as possible in 1 min.
Objective physical functioning will be assessed using standard measures: resting heart rate, blood pressure, limb girth circumferences, 6 minute walk, sit to stand (30 seconds), 1 repetition maximum strength test, and Apley's shoulder test [ 43].
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The patients were also familiarised with the one-repetition maximum strength tests (1-RM).
The intensity was set on the basis of 10 repetition maximum strength tested at baseline [ 29].
Maximum strength tests (1 repetition maximum or 1RM) were performed fortnightly and a new 80% load was prescribed; in between strength tests participants were prescribed 3% increments in load per session as tolerated.
Since we observed a faster increase in the patients' strength, in modification of the training programme according to figure 1, maximum strength tests for new baseline parameters and the corresponding training adaption were initiated after 3, 5, 7 and 9 months.
A significant increase (p<0.05) in repetitions in the maximum strengths tests was only achieved towards the end of the study after 12 months and only for some of the muscle groups, namely for the leg extensor, adductor, abdomen and abductor (see table 2).
Altogether, for overall pain 473 patients were analyzed, for pain during maximum handgrip strength test 136 patients and for maximum handgrip strength 193 patients.
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