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Effects of modified hybrid resistance training on concentric quadriceps femoris peak torque and eccentric hamstring peak torque in untrained healthy subjects

  • Wirawan Indra Priyantono ,
  • Damayanti Tinduh ,
  • Yudith Dian Prawitri ,
  • I Putu Alit Pawana ,
  • Soenarnatalina Melaniani ,


Background: Leg muscular strength may decline as a result of decreased mechanical stress on the muscles brought on by the COVID-19 pandemic's physical inactivity. The hybrid training method uses the force generated by an electrically stimulated antagonist muscle to resist a voluntarily contracting agonist muscle. Due to the lack of external resistance or stability equipment, this exercise may be a good option for strengthening workouts during a pandemic. Modifications were made using conventional stimulation tools because the hybrid training system was difficult to replicate. The study's objective was to analyze the effect of modified hybrid resistance training on concentric quadriceps femoris peak torque (QCON) and eccentric hamstring peak torque (HECC).

Methods: The study was conducted at the Medical Rehabilitation Installation of Dr. Soetomo General Academic Hospital Surabaya. The subjects were 30 untrained healthy men aged 18-40 years divided into the treatment group, which received modified hybrid resistance training and the control group, which received Russian protocol neuromuscular electrical stimulation 3 times per week for 4 weeks. Due to COVID-19 infection, four participants couldn’t continue in intervention. Statistical tests were carried out on subjects that were able to complete the study (treatment: 13, control:13).

Results: There were increases in 60o/sec QCON (p-value 0.005) and 120o/sec QCON (p-value 0.001) in the non-dominant leg in the treatment group. There were increases in 60o/sec QCON (p-value 0.043), 120o/sec QCON (p-value 0.014), and 120o/sec HECC (p-value 0.043) in the non-dominant leg in the control group. There is a significant difference in non-dominant 120o/sec ΔQCON between the two groups (p-value 0.036).

Conclusion: There was a more significant increase in QCON in the modified hybrid training exercises group compared to the Russian stimulation group in untrained healthy subjects.


  1. Roschel H, Artioli GG, Gualano B. Risk of Increased Physical Inactivity During COVID-19 Outbreak in Older People: A Call for Actions. J Am Geriatr Soc. 2020;68(6):1126-1128. doi:10.1111/jgs.16550.
  2. Ghozy S, Abdelaal A, Shah J, Parker KE, Islam SMS. COVID-19 and physical inactivity: Teetering on the edge of a deadlier pandemic? J Glob Health. 2021;11:03031. Published 2021 Feb 11. doi:10.7189/jogh.11.03031.
  3. Tison GH, Avram R, Kuhar P, et al. Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study. Ann Intern Med. 2020;173(9):767-770. doi:10.7326/M20-2665.
  4. Breen L, Stokes KA, Churchward-Venne TA, Moore DR, Baker SK, Smith K, and Atherton PJ, et al. Two weeks of reduced activity decreases leg lean mass and induces anabolic resistance of myofibrillar protein synthesis in healthy elderly. The Journal of Clinical Endocrinology & Metabolism. 2013;98(6). p2604-2612. DOI:10.1210/jc.2013-1502.
  5. Reidy PT, McKenzie AI, Mahmassani Z, et al. Skeletal muscle ceramides and relationship with insulin sensitivity after 2 weeks of simulated sedentary behaviour and recovery in healthy older adults. J Physiol. 2018;596(21):5217-5236. doi:10.1113/JP276798.
  6. Kang SR, Kim GW, Ko MH, Han KS, Kwon TK. The effect of exercise load deviations in whole body vibration on improving muscle strength imbalance in the lower limb. Technol Health Care. 2020;28(S1):103-114. doi:10.3233/THC-20900.
  7. Pringga GA, Andriana M, dan Pawana IPA. Comparison of increases in hamstrings and quadriceps femoris muscle strength in high intensity muscle strengthening exercises agonist-antagonist paired set method with traditional set method in untrained healthy subjects. 2021. Universitas Airlangga Library. Available at:
  8. Hughes G and Watkins J. A risk-factor model for anterior cruciate ligament injury. Sports Medicine. 2006;36(5). p411-428.
  9. Pescatello LS, Arena R, Riebe D, and Thompson PD. Health-related Physical Fitness Testing and Interpretation. ACSM’s Guidelines for Exercise Testing and Prescription 9th ed. Philadelphia: Lippincott Williams & Wilkins. 2014. p181-185.
  10. Paillard T. Combined application of neuromuscular electrical stimulation and voluntary muscular contractions. Sports medicine. 2008;38(2). p161-177. DOI:10.2165/00007256-200838020-00005.
  11. Adams V. Electromyostimulation to fight atrophy and to build muscle: facts and numbers. J Cachexia Sarcopenia Muscle. 2018;9(4):631-634. doi:10.1002/jcsm.12332.
  12. Cameron, Michelle H, Shapiro S, and Ocelnik M. Electrical Currents for Muscle Contraction. In: Physical Agents in Rehabilitation: An Evidence-Based Approach to Practice, Fifth Edition. Elsevier, Inc. 2018. p1-504.
  13. Yanagi T, Shiba N, Maeda T, et al. Agonist contractions against electrically stimulated antagonists. Arch Phys Med Rehabil. 2003;84(6):843-848. doi:10.1016/s0003-9993(02)04948-1.
  14. Iwasaki T, Shiba N, Matsuse H, et al. Improvement in knee extension strength through training by means of combined electrical stimulation and voluntary muscle contraction. Tohoku J Exp Med. 2006;209(1):33-40. doi:10.1620/tjem.209.33.
  15. Ito T, Tagawa Y, Shiba N, et al. Development of practical and effective hybrid exercise for use in weightless environment. Conf Proc IEEE Eng Med Biol Soc. 2004;2004:4252-4255. doi:10.1109/IEMBS.2004.1404185.
  16. Pringga GA, Andriana RM, Wardhani IL, and Arfianti L. Original Research Comparison of Hamstrings and Quadriceps Femoris Muscle Thickness Increment between Agonist-Antagonist Paired Set and Traditional Set Resistance Training in Untrained Healthy Subjects. SPMRJ. 2021;3(2). p60-70.
  17. World Health Organization. Obesity: preventing and managing the global epidemic. World Health Organization. Technical Report Series 894, Geneva. 2000.
  18. Bogdanis GC. Effects of physical activity and inactivity on muscle fatigue. Front Physiol. 2012;3:142. Published 2012 May 18. doi:10.3389/fphys.2012.00142.
  19. Del Vecchio A, Casolo A, Negro F, 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):1873-1887. doi:10.1113/JP277250.
  20. Rosenbaum DA. Chapter 3: Physiological Foundations. In Human Motor Control (Second Edition). Academic Press. 2010. p43-91.
  21. Hunter SK, Senefeld JW, and Neumann DA. Muscle: The Primary Stabilizer and Mover of the Skeletal System. In: Kinesiology of the musculoskeletal system: Foundations for rehabilitation, Third edition. Mosby & Elsevier. 2017. p1-708.
  22. Park SH, Hwangbo G. Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis. J Phys Ther Sci. 2015;27(3):729-731. doi:10.1589/jpts.27.729.
  23. Hortobágyi T and Maffiuletti NA. Neural adaptations to electrical stimulation strength training. European journal of applied physiology. 2011;111(10). p2439-2449.
  24. Vandeweerd J. Comparing individual muscle size and strength responses in younger and older adults after prolonged resistance training. Master’s Thesis Science of Sport Coaching and Fitness Testing, Faculty of Sport and Health Sciences, University of Jyväskylä. 2021. Available at:

How to Cite

Priyantono, W. I., Tinduh, D., Prawitri, Y. D., Pawana, I. P. A., & Melaniani, S. . (2023). Effects of modified hybrid resistance training on concentric quadriceps femoris peak torque and eccentric hamstring peak torque in untrained healthy subjects. Bali Medical Journal, 12(1), 959–965.




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Wirawan Indra Priyantono
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Damayanti Tinduh
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Yudith Dian Prawitri
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I Putu Alit Pawana
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Soenarnatalina Melaniani
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