HEALTH & FITNESS A TO Z

Core Training
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Separating Fact From Fiction

by Charles Fountaine, Ph.D. and Todd Perry, M.S.
INTRODUCTION and core strength often differ between practitioners in rehabili-
What’s the first thing that comes to mind when you hear the term tation versus those of fitness professionals (7). Nonetheless, core
core training? Late-night infomercials featuring incredibly lean fit- stability is generally agreed to be the ability to control the posi-
ness models promising the secret to six-pack abs? Endless amounts tion and motion of the trunk, whereas core strength is the ability
of crunches, side bends, and back extensions? Planking and bridg- of the core musculature to exert or withstand force (4,7). The
ing exercises held until seismic earth-shaking exhaustion? It is safe concept of core stiffness may provide the best of both worlds, in
to say that core training has an ubiquitous presence across multiple which proximal stiffness of the core enhances distal segment
health and fitness disciplines, ranging from rehab protocols for limb speed. In lay terms, this means core stability in the trunk
low back pain to protocols for individuals who are pursuing aes- musculature allows for an efficient transfer of forces (speed,
thetic or physique-based goals to specific exercises designed to strength, and/or power) in the shoulders and hips (9,13).
promote physical fitness and enhance athletic performance. Ac-
cording to ACSM’s annual worldwide survey of health and fitness
CORE TRAINING 101
trends, core training has occupied a spot in the top 20 fitness The four primary movements of the trunk that comprise core
trends for the past 10 years (15), firmly cementing core training into training are flexion, extension, lateral flexion, and rotation (6).
the lexicon of the health and fitness professional. Despite the omni- Thus, when considering specific exercises to address the muscu-
present nature of core training, much misinformation continues lature of the core, the health and fitness professional may select
to exist (9,16), therefore the purpose of this column is to separate exercises that 1) isolate the core through a dynamic range of
the fact from fiction when it comes to the world of core training. motion, 2) isolate the core by preventing motion, often referred to
as antiexercises, or 3) integrate the core via exercises that require
WHAT EXACTLY IS THE CORE? stability of the core while moving from the hips or shoulders (see
Table 2 for sample exercises via movement pattern). In addition,
One of the major challenges of defining core training is the in-
the core demands of many classic resistance training exer-
consistent and imprecise definition of what actually constitutes
cises can be manipulated by performing exercises bilaterally or
the core in both lay and scientific publications (7,16). For many
unilaterally (barbell row vs. one-arm dumbbell row; barbell
in the lay public, the core is synonymous with the rectus abdo-
minus, the much revered “six-pack,” with the mistaken belief that
the core and subsequent core training only encompasses clas-
sic bodybuilding isolation exercises such as sit-ups or weighted
crunches (9,16). However, a much more nuanced definition of
the core addresses the entire trunk region, with the skeleton
and connective tissues providing a structural framework, while
the muscles of the trunk cause, control, or prevent movement
(16). Therefore, for the purposes of this article, the core is oper-
ationally defined as the area of the torso between the ball and
socket joints of the shoulders and hips (13). Table 1 provides
an overview of the kinesiology of the core.

CORE CONCEPTS
The terms core strength and core stability often are used inter-
changeably when describing various core training exercises (7,11).
Leading to further confusion is that definitions of core stability Flexion and extension
4 ACSM’s Health & Fitness Journal ® March/April 2017

Copyright © 2017 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
TABLE 1: Kinesiology of the Core (Adapted from (6))
Movement Muscles

Flexion Rectus abdominus, external oblique, internal oblique

Extension Erector spinae, deep spinal muscles
Lateral flexion Rectus abdominus, external oblique, internal oblique,
erector spinae, deep spinal muscles, quadratus
lumborum, psoas major

Rotation External oblique, internal oblique, erector spinae, deep

spinal muscles

bench press vs. alternating dumbbell bench press). It should be-

come quite evident that nearly every exercise imaginable is
fundamentally a core exercise! Therefore, based on the specific
goals and needs of the client, program design for the core may
address endurance, hypertrophy, strength, power, or specific
sport actions, particularly when following ACSM FITT-VP
guidelines for exercise prescription: F — Frequency (how often
core exercises are performed), I — Intensity (magnitude of
loading/difficulty of core exercises), T — Time (duration of core
training), T — Type (mode of core exercise selection), V —
Volume (total amount of core exercises), and P — Progression
(rate of advancement) (2).
CORE TRAINING MYTHS AND MISPERCEPTIONS
Spot Reduction
Despite the claims of nefarious infomercials, large numbers of
crunches and planks will not magically result in selective fat loss
from the abdominal region because the claims of spot reduction
simply are not supported by research (10). Any type of exercise
can contribute to creating a negative energy balance needed
to ultimately reduce body fat, but body part–specific exercise
does not create preferential fat loss in one region of the body
over another (10).
Rotation
Trunk Muscle Strength Is the Key to Athletic Performance
A recent systematic review and meta-analysis quantified the as-
sociations between measures of trunk muscle strength, physical
fitness, and athletic performance (12). Not surprisingly, training
the core had a large effect on measures of trunk muscle strength.
However, core training had only small effects on measures of
physical fitness and athletic performance (12). One possible
explanation provided by the study authors hypothesizes that
the role of specificity of training often is not captured in classic
core assessments, in which tests performed in an isometric or
prone position do not adequately mimic upright explosive
muscle actions observed in sport (12).
Motor Control Exercise and Low Back Pain
Low back pain is the leading cause of activity limitation and
work absence throughout much of the world (3) and its prev-
alence has led some to refer to it as the common cold of
the musculoskeletal system (8). Especially among clinicians,
TABLE 2: Sample Core Exercises
Movement Pattern Sample Exercises
Flexion Stability ball crunch
Antiflexion McGill modified curl-up
Integrated Dead bug
Extension Back extension

Antiextension Forearm plank

Integrated Ab wheel rollout
Lateral Flexion Dumbbell side bend
Antilateral flexion Side bridge
Integrated Farmers walk
Rotation Russian twist

Antirotation Palloff isometric press

Lateral flexion Integrated Standing medicine ball chop/slam

Volume 21 | Number 2 www.acsm-healthfitness.org 5

Copyright © 2017 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
HEALTH & FITNESS A TO Z
motor control exercise (MCE) is a popular intervention that
aims to restore coordinated and efficient use of the muscles
that control and support the spine, such as the transversus
abdominus and multifidus muscles (14). MCE is based on the
theory that stability and control of the core is altered in individ-
uals with low back pain (14). Therefore, MCE interventions fo-
cus on the activation of the deep trunk muscles in a specific and
sequential manner, and may include the use of ultrasound imag-
ing, biofeedback, and palpitation (14). Patients are guided ini-
tially by a therapist to selectively recruit and practice normal
use of these muscles during simple tasks, and as the patient’s
skill increases, the exercises are progressed to more complex
and functional tasks involving additional muscles of the trunk
and limbs (14). However, MCE has not been shown to be supe-
rior to other forms of core training exercises that address either
muscle endurance or strength (3). Aerobic exercise, particularly
walking, actually has the best evidence of efficacy for low back
pain among all exercise regimens (2). Therefore, the choice of
exercise for chronic low back pain should be determined by
patient and therapist preferences, costs, and safety (14). Despite
the frustration that can accompany low back pain, it is not a life
sentence (8). In fact, there is clear evidence that individuals who
seek therapy early on, and adhere to the exercise therapy, will
feel better faster (5)! Whereas the prescription of exercise can
play an integral role in helping a client manage acute or chronic
low back pain, the health/fitness/exercise professional needs to
understand clearly that his or her scope of practice does not ever
include a medical evaluation or the diagnosis of low back pain
because this rests solely within the scope of practice of a licensed
health care professional (1).
Sidebar:
For videos of core exercises, see below:
DB Side Bend (http://links.lww.com/FIT/A43)
Deadbug (http://links.lww.com/FIT/A44)
Farmers Walk (http://links.lww.com/FIT/A45)
Forearm Plank (http://links.lww.com/FIT/A46)
McGill Modified Curl-up (http://links.lww.com/FIT/A47)
Medicine Ball Chop (http://links.lww.com/FIT/A48)
Palloff Press (http://links.lww.com/FIT/A49)
Russian Twist (http://links.lww.com/FIT/A50)
SideBridge (http://links.lww.com/FIT/A51)
Stability Ball Crunch (http://links.lww.com/FIT/A52)
CONCLUSIONS
The popularity and widespread use of core training exercises
throughout the health and fitness landscape present a myriad
of opportunities for the health and fitness professional to educate
his or her clients as to the facts and fictions associated with core
training. Given the plethora of information that exists — both
good and bad — the health and fitness professional is encouraged
6 ACSM’s Health & Fitness Journal ®
Copyright © 2017 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
to incorporate an evidence-based approach to provide clients
the best exercise prescription for their specific goals and needs.
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Disclosure: The authors declare no conflict of interest and do not have any
financial disclosures.
Charles Fountaine, Ph.D., is an associate profes-
sor of Exercise Science at the University of Minnesota
Duluth. Dr. Fountaine teaches courses in research
methods and the science of resistance training, and
served as president of the Northland Chapter of the
American College of Sports Medicine from 2014
to 2016.
Todd Perry, M.S., is a licensed physical therapist
employed by Essentia Health in Duluth, MN. He
is a board-certified specialist in orthopedic physical
therapy and is a certified manual therapist through
the University of St. Augustine.
March/April 2017