Medicine and Health Sciences Commons^™

Blood Flow Restriction Therapy: A Review Of Physiology, Clinical Application, And Guidelines For Implementation, Nathan Schuliger

Senior Honors Theses

Blood flow restriction (BFR) therapy is an emerging clinical modality utilizing the metabolic stress of a hypoxic state to induce hypertrophic and strength adaptations in a manner allowing for reduced external loading. BFR has a variety of applications in rehabilitation settings, showing great potential for patients seeking the benefits of high intensity training without the associated degrees of mechanical stress. This literature review details the proposed mechanisms of BFR, along with various clinical applications of BFR including active and aerobic BFR. Concerns and contraindications for BFR usage are discussed regarding certain clinical populations, with risk stratification recommendations provided. Current BFR …

Frailty Assessment In Prospective Lvad Candidates: An International Survey, Malachy Clancy, Phd, Otr/L, Bcpr, Sarah Schroeder, Phd, Acpn-Bc, Msn, Rn, Aacc, Yu Wu, Dnp, Agacnp

Department of Occupational Therapy Posters and Presentations

Introduction

• The concept of frailty, initially developed in geriatrics, has recently been applied to individuals with heart failure (HF) and is recognized as an essential measure for prognostication of health status and predicting health outcomes
• Frailty remains highly prevalent, ranging between 56-79% in those undergoing left ventricular assist device (LVAD) evaluation¹ and is associated with poor postoperative outcomes.²
• Since little is known about frailty assessment and instruments used, this study aimed to evaluate institutional assessment processes of frailty during evaluation and the implications of frailty in LVAD eligibility.

Playful Progress: A Parent's Guide To Growth And Development, Gabriella N. Lawrey

Honors Theses

This thesis presents a creative project aimed at empowering parents to recognize developmental achievements, as well as address potential developmental delays in their children. Grounded in the principles of child development, this project focuses on creating age-appropriate activities that facilitate the identification of developmental milestones. By utilizing foundational resources in the field of child development, this toolkit of engaging activities has been curated to support parental understanding and observation. The primary objective of this applied knowledge project is to better equip parents with the vocabulary and tools to facilitate their child’s development. Throughout these activities, parents are encouraged to engage …

Comprehensive Quality Assessment For Aphasia Rehabilitation After Stroke: Protocol For A Multicentre, Mixed-Methods Study, Sam Harvey, Marissa Stone, Sally Zingelman, David A. Copland, Monique F. Kilkenny, Erin Godecke, Dominique A. Cadilhac, Joosup Kim, Muideen T. Olaiya, Miranda L. Rose, Caterina Breitenstein, Kirstine Shrubsole, Robyn O'Halloran, Annie J. Hill, Deborah Hersh, Kathryn Mainstone, Penelope Mainstone, Carolyn A. Unsworth, Emily Brogan, Kylie J. Short, Clare L. Burns, Caroline Baker, Sarah J. Wallace

Research outputs 2022 to 2026

INTRODUCTION: People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS: This research …

Pembrolizumab Versus Placebo As Adjuvant Therapy In Resected Stage Iib Or Iic Melanoma: Outcomes In Histopathologic Subgroups From The Randomized, Double-Blind, Phase 3 Keynote-716 Trial, Dirk Schadendorf, Jason J. Luke, Paolo A. Ascierto, Georgina V. Long, Piotr Rutkowski, Adnan Khattak, Michele Del Vecchio, Luis De La Cruz-Merino, Jacek Mackiewicz, Vanna C. Sileni, John M. Kirkwood, Caroline Robert, Jean-Jacques Grob, Reinhard Dummer, Matteo S. Carlino, Yujie Zhao, Mizuho Kalabis, Clemens Krepler, Alexander Eggermont, Richard A. Scolyer

Research outputs 2022 to 2026

Background Adjuvant pembrolizumab significantly improved recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) versus placebo in the phase 3 KEYNOTE-716 study of resected stage IIB or IIC melanoma. At the prespecified third interim analysis (data cut-off, January 4, 2022), the HR for RFS in the overall population was 0.64 (95% CI, 0.50 to 0.84) and the HR for DMFS was 0.64 (95% CI, 0.47 to 0.88). We present a post hoc analysis of efficacy by subtypes defined by histopathologic characteristics. Methods Patients aged ≥ 12 years with newly diagnosed, resected stage IIB or IIC melanoma were randomly assigned (1:1) to …

Interventions To Optimize Spinal Cord Perfusion In Patients With Acute Traumatic Spinal Cord Injury: An Updated Systematic Review, Nathan Evaniew, Benjamin Davies, Farzin Farahbakhsh, Michael G. Fehlings, Mario Ganau, Daniel E. Graves, James D. Guest, Radha Korupolu, Allan R. Martin, Stephen L. Mckenna, Lindsay A. Tetreault, Aditya Vedantam, Erika D. Brodt, Andrea C. Skelly, Brian K. Kwon

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Systematic review update.

OBJECTIVES: Interventions that aim to optimize spinal cord perfusion are thought to play an important role in minimizing secondary ischemic damage and improving outcomes in patients with acute traumatic spinal cord injuries (SCIs). However, exactly how to optimize spinal cord perfusion and enhance neurologic recovery remains controversial. We performed an update of a recent systematic review (Evaniew et al, J. Neurotrauma 2020) to evaluate the effects of Mean Arterial Pressure (MAP) support or Spinal Cord Perfusion Pressure (SCPP) support on neurological recovery and rates of adverse events among patients with acute traumatic SCI.

METHODS: We …

An Umbrella Review Of Self-Management Interventions For Health Conditions With Symptom Overlap With Traumatic Brain Injury, Angelle Sander, Monique Pappadis, Tamara Bushnik, Nancy Chiaravalloti, Simon Driver, Robin Hanks, Kirk Lercher, Dawn Neumann, Amanda Rabinowitz, Ronald T Seel, Erica Weber, Rick Ralston, John Corrigan, Kurt Kroenke, Flora Hammond

Department of Rehabilitation Medicine Faculty Papers

OBJECTIVE: To synthesize evidence for the effectiveness of self-management interventions for chronic health conditions that have symptom overlap with traumatic brain injury (TBI) in order to extract recommendations for self-management intervention in persons with TBI.

DESIGN: An umbrella review of existing systematic reviews and/or meta-analyses of randomized controlled trials or nonrandomized studies targeting self-management of chronic conditions and specific outcomes relevant to persons with TBI.

METHOD: A comprehensive literature search of 5 databases was conducted using PRISMA guidelines. Two independent reviewers conducted screening and data extraction using the Covidence web-based review platform. Quality assessment was conducted using criteria adapted from …

Diondre Also Has Bad Days: Cannabis Use And The Criminalization Of Black Youth, Rommel Johnson

School of Rehabilitation Services & Counseling Faculty Publications and Presentations

Black, school-aged youth may experience socioeconomic, psychological, and emotional difficulties that affect their mental health, leading to maladaptive ways of coping, such as cannabis use. Instead of getting treatment and support to help them manage their stressors in positive ways, Black youth often receive punitive school practices, including referrals to the juvenile justice system. Counselors who work with school-aged youth are likely to encounter many Black youth and can thus either be instrumental to their psychological development or inadvertently impede their well-being with over-pathologization and criminalization of their cannabis use. In this article, the author reflects on a particular experience …

Timing Of Decompressive Surgery In Patients With Acute Spinal Cord Injury: Systematic Review Update, Michael Fehlings, Laureen Hachem, Lindsay Tetreault, Andrea Skelly, Joseph Dettori, Erika Brodt, Shay Stabler-Morris, Britt Redick, Nathan Evaniew, Allan Martin, Benjamin Davies, Farzin Farahbakhsh, James Guest, Daniel Graves, Radha Korupolu, Stephen Mckenna, Brian Kwon

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Systematic review and meta-analysis.

OBJECTIVE: Surgical decompression is a cornerstone in the management of patients with traumatic spinal cord injury (SCI); however, the influence of the timing of surgery on neurological recovery after acute SCI remains controversial. This systematic review aims to summarize current evidence on the effectiveness, safety, and cost-effectiveness of early (≤24 hours) or late (>24 hours) surgery in patients with acute traumatic SCI for all levels of the spine. Furthermore, this systematic review aims to evaluate the evidence with respect to the impact of ultra-early surgery (earlier than 24 hours from injury) on these …

Designing Effective E-Learning Modules: Exploring Best Practices In Module Navigation, Stacie Mae Larreau Christensen, Lukas Pohlmann, Elizabeth Lyden, Elizabeth L. Beam, Stephanie Langel

Posters and Presentations: Physical Therapy

No abstract provided.

Female Enrollment In Rehabilitation Trials: A Systematic Review Of Reporting Sex And Female Participation In Randomized Controlled Trials Of Poststroke Upper Extremity Rehabilitation Over 50 Years, Sarvenaz Mehrabi, Amber Harnett, Marcus Saikaley, Jamie L Fleet, Janice J Eng, Mark Bayley, Robert Teasell

Physical Medicine and Rehabilitation Publications

OBJECTIVE: To systematically assess the reporting of sex and the percentage of female participants in randomized controlled trials (RCTs) examining interventions for the post-stroke rehabilitation of upper extremity (UE) motor disorders.

DATA SOURCES: CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to April 1, 2021. Additional articles were identified using the Evidence-Based Review of Stroke Rehabilitation.

STUDY SELECTION: Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English, (2) ≥50% of participants were diagnosed and affected by stroke, (3) included adults ≥18 years old, and (4) applied an intervention to the …

Correlation Enhanced Distribution Adaptation For Prediction Of Fall Risk, Ziqi Guo, Teresa Wu, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon

Physical Therapy Faculty Articles and Research

With technological advancements in diagnostic imaging, smart sensing, and wearables, a multitude of heterogeneous sources or modalities are available to proactively monitor the health of the elderly. Due to the increasing risks of falls among older adults, an early diagnosis tool is crucial to prevent future falls. However, during the early stage of diagnosis, there is often limited or no labeled data (expert-confirmed diagnostic information) available in the target domain (new cohort) to determine the proper treatment for older adults. Instead, there are multiple related but non-identical domain data with labels from the existing cohort or different institutions. Integrating different …

Occupational Therapy Using Hippotherapy For Children With Developmental Disabilities, Ainsley Ellen Dillon

Doctoral Dissertations and Projects

The purpose of this quantitative study was to explore the impact of incorporating equine movement (hippotherapy) as a treatment tool in occupational therapy (OT) sessions for children with developmental disabilities. This study posed research questions relating to the impact of this treatment tool in OT practice on mobility and daily activity skills within the population of interest. A non-randomized controlled trial with pretest-posttest design was utilized to explore the research questions. Sixteen subjects enrolled in this study by convenience sampling and participated in six weeks of 45-minute OT sessions incorporating equine movement (intervention group, n = 8) or six weeks …

Running Biomechanics Differ During And After Pregnancy Compared To Females Who Have Never Been Pregnant, Jennifer J. Bagwell, Elizabeth Avila, Nicholas Reynolds, Jo Armour Smith, Kevin Valenzuela, Dimitrios Katsavelis

Physical Therapy Faculty Articles and Research

Background

Perinatal running participation has increased recently; however, pregnancy related symptoms can limit activity. Perinatal running biomechanics could inform interventions to help perinatal individuals maintain an active lifestyle.

Research question

Are perinatal running biomaechanics and muscle activation different compared to nulligravida females?

Methods

Sixteen pregnant participants completed self-selected velocity running during second trimester (2 T), third trimester (3 T), and postpartum (PP) and 16 matched controls completed these procedures once in this case control study. Kinematic, kinetic, and electromyography (EMG) data were collected using a motion capture system, force plates, and EMG electrodes. Peak trunk, pelvis, hip, knee, and ankle …

Age-Related Changes In The Neural Gating Of Respiratory Sensations In Humans, Wen-Pin Chang, Kai-Jie Liang, Chia-Hsiung Cheng, Chia-Yih Liu, Andreas Von Leupoldt, Pei-Ying S. Chan

Occupational Therapy Faculty Publications and Presentations

Background: Neural gating of respiratory sensations (NGRS) characterises the brain's ability to filter out repetitive respiratory sensory stimuli. This mechanism plays a crucial role in the neural processing of respiratory stimuli. However, whether ageing affects NGRS in healthy adults is still unclear. Therefore, we aimed to measure the effect of age on NGRS as well as the corresponding S1 and S2 components of the respiratory-related evoked potentials (RREPs).

Methods: Three age groups of healthy adults participated in this study: a young group (YG; age 20-39 years), a middle-aged group (MG; age 40-59 years) and an old group (OG; age ≥60 …

Dropout From Exercise Trials Among Cancer Survivors—An Individual Patient Data Meta-Analysis From The Polaris Study, Benedikte Western, Andreas Ivarsson, Ingvild Vistad, Ingrid Demmelmaier, Neil K. Aaronson, Gillian Radcliffe, Marc Van Beurden, Martin Bohus, Kerry S. Courneya, Amanda J. Daley, Daniel A. Galvão, Rachel Garrod, Martine M. Goedendorp, Kathleen A. Griffith, Wim H. Van Harten, Sandi C. Hayes, Fernando Herrero-Roman, Anouk E. Hiensch, Melinda L. Irwin, Erica James, Marlou-Floor Kenkhuis, Marie J. Kersten, Hans Knoop, Alejandro Lucia, Anne M. May, Alex Mcconnachie, Willem Van Mechelen, Nanette Mutrie, Robert U. Newton, Frans Nollet, Hester S. Oldenburg, Ron Plotnikoff, Martina E. Schmidt, Katie H. Schmitz, Karl-Heinz Schulz, Camille E. Short, Gabe S. Sonke, Karen Steindorf, Martijn M. Stuiver, Dennis R. Taaffe, Lene Thorsen, Miranda J. Velthuis, Jennifer Wenzel, Kerri M. Winters-Stone, Joachim Wiskemann, Sveinung Berntsen, Laurien M. Buffart

Research outputs 2022 to 2026

Introduction: The number of randomized controlled trials (RCTs) investigating the effects of exercise among cancer survivors has increased in recent years; however, participants dropping out of the trials are rarely described. The objective of the present study was to assess which combinations of participant and exercise program characteristics were associated with dropout from the exercise arms of RCTs among cancer survivors. Methods: This study used data collected in the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) study, an international database of RCTs investigating the effects of exercise among cancer survivors. Thirty-four exercise trials, with a total of 2467 patients …

Participatory Research With Persons Who Experience Mental Illness In Occupational Therapy: A Scoping Review., Elham Javadizadeh, Abram Oudshoorn, Lori Letts, Skye Barbic, Chelsea Shanoff, Carrie Anne Marshall

Occupational Therapy Publications

Background. Persons who experience mental illness also face stigma and discrimination that frequently lead to a loss of ability to exercise autonomy and agency in their lives. Purpose. The range and breadth of literature exploring participatory research with persons living with mental illness are unknown in occupational therapy and occupation science. We initiated this study to fill this gap in the existing occupational therapy and occupational science literature. Method. Using the method of Arksey and O’Malley, we have conducted a scoping review to identify the range and breadth of literature. A qualitative content analysis was per- formed. Findings. A total …

Effectiveness Of Emotionally Focused Therapy (Eft) With Chinese Couple Clients: From The Chinese Eft Therapists' Cultural Lens, Yifan Wang

Doctoral Dissertations and Projects

The purpose of this phenomenological study is to understand the Chinese EFT (Emotionally Focused Therapy) therapists’ experiences of working with Chinese couples in EFT sessions, as well as to discover how the cultural factors play a role in the effectiveness of EFT use with Chinese couples. This study was conducted by finding out 10 EFT-oriented therapists and analyzing via online interviews their experiences of working with Chinese couples. The theories guiding this study are based on Emotionally Focused Therapy (EFT). One of the founding therapists of this approach is Dr. Sue Johnson. EFT is heavily influenced by attachment theory, which …

Emotion Regulation From A Virtue Perspective, Jeong Han Kim, Jina Chun, Jaeyoung Kim, Hyun-Ju Ju, Byung Jin Kim, Jeongwoon Jeong, Dong Hun Lee

School of Rehabilitation Services & Counseling Faculty Publications and Presentations

Background

The ability to regulate one’s emotional state is an important predictor of several behaviors such as reframing a challenging situation to reduce anger or anxiety, concealing visible signs of sadness or fear, or focusing on reasons to feel happy or calm. This capacity is referred to as emotion regulation. Deficits in this ability can adversely affect one’s adaptive coping, thus are associated with a variety of other psychopathological symptoms, including but not limited to depression, borderline personality disorder, substance use disorders, eating disorders, and somatoform disorders.

Methods

The present study examined emotion regulation in relation to the virtue-based psychosocial …

Covid-19 Pandemic’S Effect On Occupational Therapy Students’ Time-Use And Occupational Engagement On Returning To In-Person Learning, Jhannell Hannah D. Ocampo, Susan Macdermott, Karen Mccarthy

Occupational Therapy | Faculty Scholarship

The COVID-19 pandemic emotionally and physically impacted students in occupational therapy and occupational therapy assistant programs. College students lost autonomy and access to meaningful occupations and environments. As students returned to campus, they struggled to navigate and adapt to in-person occupations and how they use their time. This study uses a mixed method descriptive research design to understand how the pandemic affected occupational therapy students' time-use and occupational engagement during the transition to in-person learning. Seventy-three students completed an online survey, while 12 of those students additionally participated in a follow-up time-use diary and interview. Eighty-three percent of the participants …

In Vivo Behavior Of The Soleus Muscle During Various Activities In Persons Post-Stroke, Madison Swaney, Molly Carter, Mitchell Mckinley, Joshua Nelson, Robin Dorociak, Tyler Cuddeford

Student-Faculty Research - College of Physical Therapy

Current protocols for post stroke populations consists of inconsistent and outdated interventions that target less functional strength training through heavier and slower movements. Current research displays a 90/10 principle displaying the tendon as the primary power absorber and generator during ballistic and cyclic movements, supported by a primarily isometric muscle activation. Power generation is key for walking. High angular velocity needed during the gait cycle to be able to produce and absorb power rapidly. Ballistic training requires the perfect tradeoff between speed and force to generate and train populations targeting power absorption and output with greater tendon activity. Therefore, current …

Is Sway-Referenced Haptic Assistance Sensitive To Perceptual Context, Andrew Meszaros, Robin Dorociack, Peter Jang, Tanner Lehr, Bayli Mohl

Student-Faculty Research - College of Physical Therapy

Falls account for >$50 billion of medical spending in 2015 (CDC). Real-time haptic feedback shows promise at reducing static standing COM sway (Meszaros, 2019). Pilot data variability suggests that some haptic-wearers ‘over-correct’ (unnecessarily reducing available degrees of freedom), when haptic correction is perceived as ‘a mistake. Does over-correction reduce multi-segment control and impair sway stability (Hsu, Scholz, et al. 2007)?

Implementing Pt In Pediatric Primary Care, Juliann Fronius, Scout Cai, Courtney Hoffman, Carlee Martin, Joel Wiley, Chris Yuen, Ryan Jacobson

Student-Faculty Research - College of Physical Therapy

Patients are referred to PT everyday, but referrals can delay care. Early care is preferred, but getting to the right healthcare provider at the right time is ideal. Upstream PT improves patient care and clinician experience. Purpose: Implement PT within pediatric primary care.

Imu And Markerless Technology In Gait Analysis: Clinical Lessons, Jessa Barendse, Trevor Nannini, Joanna Zuckerman, Tess Swake, Robin Dorociak, Peter Jang, Andrew Meszaros

Student-Faculty Research - College of Physical Therapy

- Haptic feedback refers to the external vibratory cue that is activated by data picked up by the haptic device, Inertial Measurement Unit (IMU) (Figure 1), which senses joint position.

- Position-driven haptic touch input can modify movement in real-time (Meszaros, 2019)

- Original goal: to reduce knee hyperextension during gait using a popliteal fossa tactor driven by an IMU-based angle sensor (Sagemotion)

-Concerns arose on the validity of IMU/tactor and markerless motion analysis ❏ Are these algorithm-based data technologies clinic-ready?

- Does Sagemotion IMU fire the tactor at the actual knee angle selected in its software?

- Can markerless …

Hamstring Tendons Don’T Lie #Eccentricsdontexist, Alec Espinoza, Chris Garcia, Enoch Ho, Ian Rousseau, Joel Centeno, Robin Dorociak, Tyler Cuddeford

Student-Faculty Research - College of Physical Therapy

Research done on the plantarflexor MTU have shown the degree of achilles tendon and muscle fascicle shortening/stretching is specific to demands of the activity. To expand on this principle, we wanted to explore if a similar relationship exists with the Biceps Femoris MTU. We predict that the biceps femoris (long head) muscle tendon unit (MTU) will behave similarly to the Achilles tendon complex exhibiting the 80/20 principle during dynamic activities (jogging, walking) and the muscle fascicle will lengthen more than the MTU during stationary exercise (Nordic hamstring curls, Romanian deadlifts).

Fatigue Changes Biomechanical Variables In Drop Vertical Jump Performance In Competitive Basketball Players, Isabella Bruno, Caroline Linardos, Michala Rennels, Kristina Williams, Robin Dorociak, Jaydee Romick, Jason Brumitt

Student-Faculty Research - College of Physical Therapy

The drop vertical jump (DVJ) has been used as a tool to identify athletes at risk for injury. Initial studies have suggested an association between biomechanical variables and injury (1); however, subsequent research has demonstrated no relationship (2-4). Evaluating variables in fatigued athletes may help clinicians identify athletes at risk. Advances in motion capture technology now allow for assessment of variables after a fatigue protocol.

Factors Affecting Peak Effort In Max Effort Tests, Amanda Pardue, Michael Forster, Taylor Kopecky, Zoralei Dayley, Jeff Houck, Rebecca Dobler

Student-Faculty Research - College of Physical Therapy

Challenging older adults to execute peak effort functional tests is not common. A peak effort test pushes patients to the point of not sustaining the task. The Wingate test is a peak effort test that measures the amount of revolutions per second a participant can perform over 30s. Older adults with knee osteoarthritis (OA) may regulate their effort during the Wingate. Alternatively, high exertion during the Wingate test may yield high value in influencing attitudes related to pain and aging. The purpose of this study was to develop themes of what influences peak effort during the Wingate test in participants …

Effect Of Perturbation-Based Balance Training On Fall Risk And Fear Of Falls In Community-Dwelling Older Adults – A Pilot Study, Lindsey Kelly, Casey Kostecki, Garrett Markham, Conner Morris, Trevor Strem, Lyndsay Strutzenberger, Gabe Haberly

Student-Faculty Research - College of Physical Therapy

Falls are a major health concern among adults ≥65 years as it is the leading cause of injury and injury related death in the United States. Perturbation-based training (PBT) has been shown to reduce rate of falls by 50% and 24 slips has been shown to be optimal. It is unknown whether falls reduction would be greater with one session or spread out over multiple sessions. The purpose of this study was to determine the effects of PBT dosage (12 slips over 2 sessions vs. 24 slips in one session) on falls incidence, fear of falling, and reactive stepping in …

Does The Size-Weight Illusion Exist During Deadlift?, Dakota Kerbow, Luke Mallory, Robin Dorociak, Peter Jang, Andrew Meszaros

Student-Faculty Research - College of Physical Therapy

Purpose:

to assess whether the SWI exists during deadlift (whole body loading), and identify the mechanical factors that explain or overcome the illusion

Changes In Quadriceps Strength In Recreationally Active Individuals Using Single-Limb Or Double-Limb Blood Flow Restriction, Brogan Boen, Logan Cockrell, Olivia Aho, Taylor Bryant, Bethany Nguyen, Jason Brumitt

Student-Faculty Research - College of Physical Therapy

Blood flow restriction training utilizes a tourniquet system to occlude arterial and venous flow while one performs exercises. This training strategy allows one to exercise using loads at a lower percentage of 1RM while experiencing physiological change similar to those achieved when training at a higher percentage of 1RM.