Home Effects of a single session of motor imagery and action observation plus physical exercise on lumbo-pelvic sensorimotor function in healthy women: a randomized controlled pilot trial
Article Open Access

Effects of a single session of motor imagery and action observation plus physical exercise on lumbo-pelvic sensorimotor function in healthy women: a randomized controlled pilot trial

  • Alba Nieves-Gómez , Natalia Millán-Isasi , Amelia Lara-Bolinches , Lucía Marcos-Hernández , Laura Fuentes-Aparicio ORCID logo , Ferran Cuenca-Martínez ORCID logo EMAIL logo and Núria Sempere-Rubio ORCID logo
Published/Copyright: August 13, 2024
Download Article (PDF)
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Journal of Imagery Research in Sport and Physical Activity
From the journal Journal of Imagery Research in Sport and Physical Activity Volume 19 Issue 1

Abstract

Objectives

The main aim of this study was to assess the effects of a single session motor imagery (MI) and action observation (AO) plus physical exercise (PE) on lumbo-pelvic sensorimotor function.

Methods

Thirty-six healthy women were randomized into three groups: MI (n=12), AO (n=12), or sham observation (SO) group (n=12). All the groups performed PE consisting of a combination of aerobic and strengthening exercises. The outcome measures included lumbo-pelvic motor control, pressure pain threshold (PPT) in lumbar and tibialis anterior region, and pelvic floor muscle (PFM) strength. A pre- and post-intervention evaluation was conducted.

Results

Regarding the lumbo-pelvic motor control, only the AO group showed significant within-group differences with a moderate effect size (mean difference (MD)=−3.55 mmHg (−6.6 to −0.5), p=0.023, d=−0.56). With respect to the PPT in the lumbar region, only the MI group showed significant within-group differences with a small effect size (MD=0.775 kg/cm2 (0.35–1.2), p=0.001, d=0.44). No statistically significant PFM strength gain was found (p>0.05). Finally, no between-group differences were found (p>0.05).

Conclusions

MI and AO training plus PE had a slight impact on lumbo-pelvic sensorimotor function such as motor control or local pain sensitivity when applied in a single session.

Keywords: women’s health; motor imagery; action observation; physical exercise

Introduction

Motor imagery (MI) is defined as a cognitive ability that involves the representation of an action, internally, without its actual motor execution [1]. MI training elicits an activation of brain areas related to the planning and execution of voluntary movement in a similar way as when the action is actually performed [2]. In fact, Lebon et al [3] argued that the coincidence in cortical activation of such areas between actual motor execution and motor imagery is a reliable means to assess the quality of mental representation. Motor programs stored in procedural memory systems allow the generation of MI without the need for an external stimulus although it has been shown that bringing visual information prior to the MI task facilitates the imagery task and elicits greater neurophysiological activity than if performed in isolation [4], [5], [6]. The MI allows the practice of movements without the need to physically perform them, and that is why it has been widely used in the training of technical ability in both athletes, as well as in neurorehabilitation [7, 8].

On the other hand, action observation (AO) training is also a widely used movement representation technique in the field of rehabilitation and physical performance [9, 10]. AO training is considered as an internal representation of the set of real movements evoked by that visualized by the spectator [11]. In the same way as MI, the AO training is able to elicit neurophysiological activation of premotor, supplementary motor, primary somatosensory and posterior parietal cortex areas in a qualitatively equal but quantitatively lesser manner than when the action is actually performed [2, 12]. Both movement representation techniques have been shown to result in greater strength gains [13], greater improvements in motor control [14], and greater decreases in pain intensity [15] when added to physical exercise intervention as compared to when physical exercise is performed in isolation, without mental practice. However, research using movement representation techniques such as MI or AO performs several sessions on different days of intervention. We do not know whether movement representation techniques would have a clinical impact in a single session. Moreover, the study of movement representation techniques in women’s health is currently starting [16, 17] and we do not know almost everything at the moment. This is a first pilot study where we want to combine mentally and physically a set of global exercises to see the generalization effects on the functioning of the lumbo-pelvic sensorimotor system as well as the maximal strength of the pelvic floor musculature (PFM) in healthy women. Women with musculoskeletal disorders commonly present with loss of maximal PFM strength [18], as well as lumbo-pelvic pain and motor control aberrations [19]. If we assume that therapeutic exercise has a significant impact on these variables in women with musculoskeletal disorders [20, 21], it is likely that adding mental practice will result in greater improvements when combined with therapeutic exercise than just exercise alone. Even in specific problems, such as vestibulodynia or in the immediate postpartum period, movement representation techniques alone could be applied to improve some clinical variables of interest, although for the moment, we want to see what happens in healthy women at the physiological level.

Thereby the main aim of this study was to assess the effects of a single session motor imagery and action observation plus physical exercise on lumbo-pelvic sensorimotor function in healthy women.

Methods

Study design

This study was a randomized, single-blind, placebo controlled pilot trial, planned, and conducted in accordance with Consolidated Standards of Reporting Trials (CONSORT) requirements, and was approved by The Ethics Committee of Research in Humans of the Ethics Commission in Experimental Research of University of Valencia (2699494). This study was registered in the United States Randomized Trials Registry on clinicaltrial.gov (trial registry number: NCT06073210).

Participants

Between October and December 2023, healthy women were recruited. Advertisements, social networks, and emails were used for this purpose. Prior to final inclusion, all signed the informed consent. All women participants received a detailed explanation of the study procedures, which were planned according to the ethical standards of the Helsinki Declaration. The criteria for inclusion were: (1) being an asymptomatic woman, and (2) be aged between 18 and 30 y/o. The exclusion criteria were: (1) suffering from any pathology that presents pain, (2) suffering pathologies of a pelvic floor origin, (3) having any musculoskeletal disorders in the upper/lower limbs and (4) having a metabolic disease, all assessed by personal interview.

Randomization

Randomization was performed using a computer-generated random sequence table with a balanced three-block design (GraphPad Software, Inc., CA, USA). An independent researcher generated the randomization list, and a member of the research team who was not involved in the assessment of the participants or the intervention was in charge of the randomization and maintained the list. The patients included were randomly assigned to one of the three groups using the random sequence list, ensuring concealed allocation.

Blinding

The assessments and interventions were performed by two different physiotherapists. The evaluator was blinded to the participants’ group assignment. All the intervention procedures were performed by the same physiotherapist who had experience in the women’s health field and was blinded to the purpose of the study. All participants were blinded to their group allocation.

Interventions

All women conducted a single intervention session of mental practice (MI, AO, or sham observation (SO) training) plus PE, lasting about 1 h.

Physical exercise

All women underwent a PE program that combined aerobic exercise with strengthening exercises. Firstly, aerobic exercise was performed for 20 min at an intensity between 12 and 14/20 on the perceived fatigue scale (“somewhat hard”) [22]. The strengthening program consisted of a combo of three exercises: non-weighted free squats (4 sets of 45 s), followed by abdominal isometric exercise (4 sets of 30 s) and specific exercise of the PFM (4 sets of eight maximum voluntary pelvic floor contractions). Between sets there was a 30 s rest, and between exercises there was a 1 min rest. In total, the exercise program lasted approximately 45 min.

Motor imagery

The MI group performed 10 min of mental training prior to aerobic exercise. The participants were taken to the training track to see the place where they would later train to facilitate the imagining task. MI was dosed as follows: 10 sets of 50 s (followed by a 10 s rest) were performed imagining in first person (or egocentric) and kinesthetically (5 sets) and in third person (or allocentric) and visually (5 sets). Some verbal cues were provided in order to facilitate the imagination: “keep imagining”, “imagine running faster”, “imagine how you overtake the person in front of you”, “try to feel how your feet step on the ground”, “feel how your heart speeds up”, “feel how you breathe faster and faster”. Subsequently, 4 sets of 30 s each of the strengthening exercises were performed in third person and visually with the exception of the maximum voluntary contraction of the PFM, which was performed only kinesthetically to try to feel the contraction they had just performed in a real way. The MI sets were performed during the rest between sets of the actual exercises. Therefore, MI’s total intervention lasted 16 min.

Action observation

The AO group made a 10 min observation of a woman running on the same training track where they would later train. The video had two 5 min parts, one where the perspective was in first person, and the other, where the perspective was in third person. Subsequently, the participants watched for 4 sets of 30 s each of the strengthening exercises in third person perspective. The AO sets were visualized during the rest between sets of the actual exercises. The AO training performed on PFM contraction was through an illustrative video. The AO’s total intervention lasted 16 min.

Sham action observation

Women in this group underwent a SO protocol. This group performed the same visualization training as the AO group, but the video showed images of interstellar space (without visualizing any motor gesture). This kind of SO protocol has been used in previous research [23, 24]. The duration of this placebo mental training lasted exactly the same as the two groups of effective mental practice (16 min).

Outcome measures

Baseline outcomes

Baseline measurements included physical activity levels and motor imagery ability and were performed to ensure that all women had the same conditions of physical activity levels and ability to imagine at the beginning of the study.

Physical activity levels

The level of physical activity was evaluated using the international physical activity questionnaire (IPAQ) [25]. This questionnaire has shown an acceptable validity to measure total physical activity. The level of METs expended in the previous week is estimated by applying a formula. The reliability of this questionnaire was approximately 0.65 (r=0.76; 95 % CI 0.73–0.77) [26].

Motor imagery ability

The motor imagery ability was measured with the revised version of the movement imagery questionnaire (MIQ-R). The MIQ-R is an 8-item self-report inventory that assesses visual and kinaesthetic motor imagery ability. Four different movements are included in MIQ-R, which is comprised of four visual and four kinaesthetic items. Participants are required to read a description of each movement, physically performed the movement, and then we were instructed to return to the starting position before engaging in the mental task, imaging the movement visually or kinaesthetically. Each participant then rates the ease or difficulty of generating that image on a 7-point scale in which 7 indicates “very easy to see/feel” and 1 “very difficult to see/feel”. The internal consistencies of the MIQ-R have been consistently adequate, with Cronbach’s α coefficients above 0.84 for the total scale, 0.80 for the visual subscale and 0.84 for the kinaesthetic subscale [27].

Primary outcome

Lumbo-pelvic motor control

Motor control of the lumbar region was evaluated through a stabilizer pressure biofeedback unit (Chattanooga Group Inc., Chattanooga, TN). We employed a modification of the neutral position test (developed by Azevedo et al. [28]) based on the stabilizer instructions; the measurement was based on a protocol validated in a previous study and presents an intraclass correlation coefficient of 0.94 (95 % confidence interval [CI] 0.87–0.97) [28]. The women were positioned in supine decubitus with the stabilizer in the lumbar region with an initial pressure of 40 mmHg and a knee flexion of 90°. The women were then instructed to perform a 90° hip and knee flexion with one limb and then the same action with the opposite limb. According to the stabilizer’s treatment protocol, the pressure will increase between 8 and 10 mmHg during the exercise. The evaluator performed three measurements and calculated the total mean pressure of both lower limbs.

Secondary outcomes

Pain sensitivity

Pain sensitivity was examined through the pressure pain threshold (PPT). PPT is defined as the minimum amount of pressure needed to elicit pain. Measurements of PPT were made using a digital algometer (Model FDX 10®, Wagner Instruments, Greenwich, CT, USA). This instrument measures the pressure in kg/cm2. The PPTs were measured on two locations on the body: (a) the medial plane of the lumbar zone, just below the fifth lumbar vertebra (local region), and (b) on the dominant leg, 4 cm distal of the tuberositas tibiae (distal region). The evaluation points of the PPTs were chosen following the research work carried out by Grundström et al. [29]. The average of three measurements was recorded, with an interval of 30 s between each measurement to avoid a temporal summation effect. PPT has shown good reliability and internal consistency [30].

Pelvic floor muscle strength

The PFM strength was objectively measured with a commercially plastic intravaginal dynamometry speculum (Pelvimeter Phenix, Montpellier, France) in g. Three maximum effort PFM contractions was performed and the mean value of the three trials was retained for analysis as reported by Navarro Brazález et al. [31]. The test was connected to a Phenix USB2 biofeedback system (Vivaltis, Montpellier, France), interfaced with an IBM compatible computer, and protected by latex or polyethylene covers.

Procedures

After consenting to participate, all the women were received an initial evaluation prior to the intervention process. Once the pre-intervention assessment was completed, the intervention was performed, which consisted of 45 min of aerobic and strength training, together with 16 min of mental practice (depending on the assignment group) in a single session. Finally, the outcome measures were assessed at the end of the intervention again.

Data analysis

The statistical data analysis was performed using statistical SPSS software version 25.0 (SPSS Inc., Chicago, IL, USA). The normality of the variables was evaluated by the Shapiro–Wilk test. Descriptive statistics were used to summarize the data for continuous variables and are presented as mean±standard deviation, 95 % confidence interval. For the inferential analysis of continuous variables, a mixed two-factor analysis of variance (ANOVA) was conducted with a between-subject factor “intervention group” having three categories (MI, AO, and SO) and a within-subject factor “time measurements” having two categories (pre- and post-intervention). A post hoc analysis with Bonferroni correction was performed in the case of significant findings for multiple comparisons between variables. Effect sizes (d) were calculated according to Cohen’s method, in which the magnitude of the effect was classified as small (0.20–0.49), moderate (0.50–0.79) or large (0.8) [32]. The α level was set at 0.05 for all tests.

Results

A total of 36 women were included in the study, were randomly allocated into three groups (n=12 per group) (Figure 1). There were no adverse events reported in either group. All the variables presented a normal distribution. No statistically significant between-group differences were found at baseline for any demographic data or self-report variables (Table 1).

Figure 1: Flowchart according to CONSORT statement for the report of randomized trials. MI, Motor imagery; AO, Action observation; SO, Sham observation.
Figure 1:

Flowchart according to CONSORT statement for the report of randomized trials. MI, Motor imagery; AO, Action observation; SO, Sham observation.

Table 1:

Descriptive statistics of baseline outcomes.

Measures MI (n=12) AO (n=12) SO (n=12) p-Value
Age, y/o 21.8±2.2 23.0±2.1 22.5±1.9 0.24
BMI, kg/m2 22.3±2.7 22.5±3.5 22.1±1.6 0.71
IPAQ 4,409.4±1,607 3,566.1±1,568 4,428.5±2033 0.06
MIQ-R
MIQR-K 23.4±4.0 23.5±2.4 19.8±5.1 0.75
MIQR-V 23.7±3.9 24.7±2.2 24.1±3.3 0.17
MIQ-R (total) 47.1±6.8 48.3±4.2 43.9±5.7 0.39

  1. Values are presented as mean±standard deviation; y/o, Years old; MI, Motor imagery; AO, Action observation; SO, Sham observation; MIQ-R, the Revised Movement Imagery Questionnaire; MIQR-K, Kinaesthetic subscale; MIQR-V, Visual subscale; IPAQ, International Physical Activity Questionnaire.

Lumbo-pelvic motor control

The ANOVA revealed significant changes in the lumbo-pelvic motor control during time (F=4.102, p=0.048, ƞp 2=0.11) but not, during group*time interaction (F=1.47, p=0.24, ƞp 2=0.08). The post hoc analysis revealed significant within-group differences only in the AO group with a moderate effect size (mean difference (MD)=−3.55 mmHg (−6.6 to −0.5), p=0.023, d=−0.56). No other within-group differences were found (p>0.05) (Figure 2). No between-group differences were observed (p>0.05) (Table 2). These results show that the AO group performed the lumbo-pelvic motor control test statistically significantly more accurately at the end of the session than at the beginning, although this result was not enough to be statistically different from that found in the rest of the groups at the end of the intervention.

Figure 2: Results of lumbo-pelvic motor control variable. *p<0.05. mmHg, millimeters of mercury; MI, Motor imagery; AO, Action observation; SO, Sham observation.
Figure 2:

Results of lumbo-pelvic motor control variable. *p<0.05. mmHg, millimeters of mercury; MI, Motor imagery; AO, Action observation; SO, Sham observation.

Table 2:

Comparative analysis of motor control and pain sensitivity variables.

Measure Group Mean difference (95 % CI); effect size (d)
Pre Post Pre vs. post
L-P motor control MI 49.8±8.9 48.2±5.8 −1.6 (−1.4 to 4.6); d=−0.21
AO 49.0±8.0 45.4±4.2 −3.5a (−6.6 to −0.5); d=−0.56
SO 44.6±9.4 44.7±9.9 0.1 (−3.1 to 2.6); d=0.09
Mean difference (95 % CI); effect size (d) MI vs. AO −0.8 (−9.9 to 8.2); d=0.14 −2.7 (−10.1 to 4.6); d=−0.45
MI vs. SO −5.2 (−14.3 to 3.8); d=−0.51 −3.5 (−10.9 to 3.8); d=−0.50
AO vs. SO −4.3 (−13.4 to 4.6); d=−0.49 −0.8 (−8.1 to 6.6); d=−0.22
Lumbar pain sensitivity MI 4.9±1.7 5.7±1.7 0.7b (0.3–1.2); d=0.44
AO 5.6±1.9 5.7±1.8 0.1 (−0.3 to 0.5); d=0.10
SO 5.7±1.9 6.0±2.0 0.3 (−0.7 to 0.1); d=0.17
Mean difference (95 % CI); effect size (d) MI vs. AO 0.7 (−2.6 to 1.2); d=0.12 0.1 (−1.9 to 1.8); d=0.0
MI vs. SO 0.8 (−2.7 to 1.1); d=0.13 0.3 (−2.2 to 2.0); d=0.15
AO vs. SO 0.1 (−1.9 to 1.9); d=0.0 0.4 (−2.3 to 1.9); d=0.18

  1. ap<0.05; bp<0.01; CI, Confidence interval; MI, Motor imagery; AO, Action observation; SO, Sham observation; L-P, Lumbo-pelvic.

Pain sensitivity

Local pain sensitivity (lumbar region)

The ANOVA revealed significant changes in the lumbar PPT during time (F=7.086, p=0.012, ƞp 2=0.16) but not, during group*time interaction (F=2.02, p=0.11, ƞp 2=0.09). The post hoc analysis revealed significant within-group differences only in the MI group with a small effect size (MD=0.775 kg/cm2 (0.35–1.2), p=0.001, d=0.44). No other within-group differences were found (p>0.05) (Figure 3). No between-group differences were observed (p>0.05) (Table 2). These results show that the MI group increased PPTs significantly at the end of the session with respect to the PPTs reported at baseline, although this result was not enough to be statistically different from that found in the rest of the groups at the end of the intervention.

Figure 3: Results of pain sensitivity variable in lumbar region. *p<0.05; **p<0.01; kg, kilogram; cm, centimeter; MI, Motor imagery; AO, Action observation; SO, Sham observation.
Figure 3:

Results of pain sensitivity variable in lumbar region. *p<0.05; **p<0.01; kg, kilogram; cm, centimeter; MI, Motor imagery; AO, Action observation; SO, Sham observation.

Distal pain sensitivity (tibialis anterior region)

The ANOVA revealed no significant differences in the tibialis anterior PPT during time (F=0.26, p=0.61, ƞp 2=0.01), nor in during group*time interaction (F=0.04, p=0.96, ƞp 2=0.001).

Pelvic floor muscle strength

The ANOVA revealed no significant differences in the PFM strength during time (F=0.78, p=0.38, ƞp 2=0.02), nor in during group*time interaction (F=0.05, p=0.95, ƞp 2=0.002).

Sample size calculation

The sample size was estimated with the program G*Power 3.1.7 for Windows (G*Power© from University of Dusseldorf, Germany) [33]. The sample size calculation was considered as a power calculation to detect statistically significant between-group differences in the primary outcome measure. We considered three groups (MI, AO, and SO) and two measurements (pre- and post-intervention) to obtain 80 % statistical power (1-β error probability) with an α error level probability of 0.05 using ANOVA, repeated measures, between factors, and an obtained effect size f=0.344 from our results. This generated a sample size of total of 66 participants (22 per group).

Discussion

The main aim of this study was to analyze the effects of a single session MI and AO plus PE on lumbo-pelvic sensorimotor function in healthy women. The results obtained in the present study showed that AO training added to PE resulted in significant improvements in lumbo-pelvic motor control. In addition, we also found that adding MI to PE resulted in improvements in pain sensitivity in the local area (specifically lumbar area) and we found no changes in maximal PFM strength.

If we consider the first result, it seems that AO training facilitates the process of acquisition of fine motor skills, i.e., it facilitates the motor learning process. This intra-session change was not found either in the PE group or in the group of adding MI to PE. AO training is able to improve sensorimotor control probably because, at the neurophysiological level, the premotor cortex has a direct functional connection pathway with the striate cortex. Visual information is integrated into a brain area that is responsible for planning voluntary movement, so it seems that motor transfer is greater when the information provided is visual prior to exercise. Pascual-Leone et al. [34] found the importance of the premotor and prefrontal cortex in acquiring motor gestures, and its role in the working memory, the latter of which requires activation of temporal regions. Visual information, therefore, appears to play an important role in the functioning of working memory and, consequently, in motor learning [35]. The obtained result in motor control variable is consistent with that found in other similar investigations. For example, Cuenca-Martínez et al. [36] found that AO training resulted in improvements in lumbar motor control significantly faster when added to an exercise program than exercise alone. In addition to this, Cuenca-Martínez et al. also found that AO training resulted in greater improvements in motor learning, as well as, in the acquisition of fine motor ability through cervical joint position sense in patients with persistent neck pain [36, 37]. All of these findings are consistent with those found in this study.

Regarding the pain sensitivity variable, only the group that combined MI to an exercise program showed statistically significant differences between before and after the intervention. This result is consistent with others found in the scientific literature. For example, La Touche et al. [38] found that mental practice in combination with physical practice applied in the orofacial region obtained hypoalgesia faster than the group that only performed physical exercise in isolation. So far, we do not know the exact mechanisms by which hypoalgesia is generated by the application of movement representation techniques such as MI. It is possible that the excitatory sympathetic system participates in this generation of hypoalgesia as mentioned by Suso-Martí et al. [39]. However, another mechanism by which hypoalgesia could be explained would be distraction. This argument has already been used by other researchers such as Hayashi et al. [40] or Peerdeman et al. [41]. MI involves a conscious process and therefore requires concentration and high cognitive demand on the part of the individual, which may involve greater attentional focus than motor execution [42, 43], especially in complex movements [44]. All this could explain the results obtained.

Finally, we found no improvement in the variable PFM strength. This result is not surprising as a recent meta-analysis concluded that several training sessions are necessary to improve strength through MI with or without combined with real exercise [45]. However, we wanted to check whether this also occurred in the PFM, as the Paravlic et al. study does not include any trials in this body region. It is indeed more than proven that MI improves strength parameters [8, 13, 46, 47], however, it seems that a single session is not enough to improve PFM strength. Therefore, more training sessions would be necessary in order to observe significant changes within, and between groups. Finally, this is an exploratory and pilot study in a field yet to be discovered and investigated in depth in the coming years. This study leads us to think that a single session is insufficient, and that we should add more intervention sessions if we want to expect more robust results. In addition, MI and AO training should be implemented on what you intend to improve (e.g., imagining and observing motor control exercises if you want to improve motor control) as there seems to be no generalization effect of the results. This initial and pilot work would make more sense in a population that had difficulty performing the global exercises (aerobic and strengthening), since through mental practice, one could help them to perform them, and thus, secondarily, have a greater clinical impact on the variables of interest. However, before going to patients, we wanted to evaluate what happens in healthy people.

Study limitations

The present study has a number of limitations that should be considered. First, the present study is a pilot study, so the sample size is very small. This is an important limitation as the results should be interpreted with considerable caution. In addition, this is a preliminary study and should be considered as such, to see a first general idea of the behavior of the data in this field of study. Finally, this research was conducted in healthy women. It is not possible to extrapolate the results to patients who have pain or sensorimotor disorders.

Conclusions

In conclusion, our results showed that MI and AO training plus PE had a slight impact on lumbo-pelvic sensorimotor function such as motor control or lumbar pain sensitivity when applied in a single session. Future studies are needed to evaluate the impact of applying movement representation techniques together with therapeutic exercise-based rehabilitation programs on strength or somatosensory variables in women with pelvic floor musculoskeletal disorders and related structures.

Corresponding author: Professor Ferran Cuenca-Martínez, Department of Physiotherapy, University of Valencia, Gascó Oliag 5, Valencia 46010, Spain, E-mail:
ANG and NMI contributed equally to this work.

Acknowledgments

We would like to thank Marta Aznar Marín for the help provided during the interventions in this research.

  1. Research ethics: This study was approved by The Ethics Committee of Research in Humans of the Ethics Commission in Experimental Research of University of Valencia (2699494).

  2. Informed consent: Prior to final inclusion, all signed the informed consent.

  3. Author contributions: FCM and NRS: Conceptualization; Methodology; Formal analysis; Investigation; Data curation; Writing – original draft; Writing – review and editing; Visualization and Supervision. LFA: Methodology; Investigation; Writing – original draft; Writing – review and editing and Visualization. All authors: Investigation and Writing – original draft.

  4. Competing interests: None declared.

  5. Research funding: None declared.

  6. Data availability: Contact with the corresponding author.

References

1. Decety, J. The neurophysiological basis of motor imagery. Behav Brain Res 1996;77:45–52. https://doi.org/10.1016/0166-4328(95)00225-1.Search in Google Scholar PubMed

2. Hardwick, RM, Caspers, S, Eickhoff, SB, Swinnen, SP. Neural correlates of action: comparing meta-analyses of imagery, observation, and execution. Neurosci Biobehav Rev 2018;94:31–44. https://doi.org/10.1016/j.neubiorev.2018.08.003.Search in Google Scholar PubMed

3. Lebon, F, Byblow, WD, Collet, C, Guillot, A, Stinear, CM. The modulation of motor cortex excitability during motor imagery depends on imagery quality. Eur J Neurosci 2012;35:323–31. https://doi.org/10.1111/j.1460-9568.2011.07938.x.Search in Google Scholar PubMed

4. Sakamoto, M, Muraoka, T, Mizuguchi, N, Kanosue, K. Combining observation and imagery of an action enhances human corticospinal excitability. Neurosci Res 2009;65:23–7. https://doi.org/10.1016/j.neures.2009.05.003.Search in Google Scholar PubMed

5. Taube, W, Mouthon, M, Leukel, C, Hoogewoud, H-M, Annoni, J-M, Keller, M. Brain activity during observation and motor imagery of different balance tasks: an fMRI study. Cortex 2015;64:102–14. https://doi.org/10.1016/j.cortex.2014.09.022.Search in Google Scholar PubMed

6. Vogt, S, Rienzo, FD, Collet, C, Collins, A, Guillot, A. Multiple roles of motor imagery during action observation. Front Hum Neurosci 2013;7:807. https://doi.org/10.3389/fnhum.2013.00807.Search in Google Scholar PubMed PubMed Central

7. Grabherr, L, Jola, C, Berra, G, Theiler, R, Mast, FW. Motor imagery training improves precision of an upper limb movement in patients with hemiparesis. NeuroRehabilitation 2015;36:157–66. https://doi.org/10.3233/NRE-151203.Search in Google Scholar PubMed

8. Scott, M, Taylor, S, Chesterton, P, Vogt, S, Eaves, DL. Motor imagery during action observation increases eccentric hamstring force: an acute non-physical intervention. Disabil Rehabil 2017;40:1443–51. https://doi.org/10.1080/09638288.2017.1300333.Search in Google Scholar PubMed

9. Mattar, AAG, Gribble, PL. Motor learning by observing. Neuron 2005;46:153–60. https://doi.org/10.1016/j.neuron.2005.02.009.Search in Google Scholar PubMed

10. Villafañe, JH, Pirali, C, Isgrò, M, Vanti, C, Buraschi, R, Negrini, S. Effects of action observation therapy in patients recovering from total hip arthroplasty arthroplasty: a prospective clinical trial. J Chiropr Med 2016;15:229–34. https://doi.org/10.1016/j.jcm.2016.08.011.Search in Google Scholar PubMed PubMed Central

11. Buccino, G. Action observation treatment: a novel tool in neurorehabilitation. Phil Trans Biol Sci 2014;369:20130185. https://doi.org/10.1098/rstb.2013.0185.Search in Google Scholar PubMed PubMed Central

12. Munzert, J, Zentgraf, K, Stark, R, Vaitl, D. Neural activation in cognitive motor processes: comparing motor imagery and observation of gymnastic movements. Exp Brain Res 2008;188:437–44. https://doi.org/10.1007/s00221-008-1376-y.Search in Google Scholar PubMed

13. Losana-Ferrer, A, Manzanas-López, S, Cuenca-Martínez, F, Paris-Alemany, A, La Touche, R. Effects of motor imagery and action observation on hand grip strength, electromyographic activity and intramuscular oxygenation in the hand gripping gesture: a randomized controlled trial. Hum Mov Sci 2018;58:119–31. https://doi.org/10.1016/j.humov.2018.01.011.Search in Google Scholar PubMed

14. Cuenca-Martínez, F, León-Hernández, J. V., Suso-Martí, L, Sánchez-Martín, D, Soria-Soria, C, Serrano-Santos, J, Paris-Alemany, A. Effects of motor imagery and action observation on lumbo-pelvic motor control, trunk muscles strength and level of perceived fatigue: a randomized controlled trial. Res Q Exerc Sport 2020;91:34–46. https://doi.org/10.1080/02701367.2019.1645941.Search in Google Scholar PubMed

15. Cuenca-Martínez, F, Reina-Varona, Á, Castillo-García, J, La Touche, R, Angulo-Díaz-Parreño, S, Suso-Martí, L. Pain relief by movement representation strategies: an umbrella and mapping review with meta-meta-analysis of motor imagery, action observation and mirror therapy. Eur J Pain 2022;26:284–309. https://doi.org/10.1002/EJP.1870.Search in Google Scholar PubMed

16. Díaz-Mohedo, E, González-Roldán, G, Muñoz-Gámez, I, Padilla-Romero, V, Castro-Martín, E, Cabrera-Martos, I, et al.. Implicit motor imagery for chronic pelvic pain: a cross-sectional case-control study. J Clin Med 2023;12:4738. https://doi.org/10.3390/JCM12144738.Search in Google Scholar PubMed PubMed Central

17. Jager, L, Schulte-Frei, B. Motor imagery in the context of pelvic floor disorders. J Dis Global Health 2017;9:138–47.Search in Google Scholar

18. Loving, S, Thomsen, T, Jaszczak, P, Nordling, J. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain: a cross-sectional population-based study. Eur J Pain 2014;18:1259–70. https://doi.org/10.1002/J.1532-2149.2014.485.X.Search in Google Scholar

19. Beales, DJ, Ther, MM, O’Sullivan, PB, Briffa, NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine 2009;34:861–70. https://doi.org/10.1097/BRS.0B013E318198D212.Search in Google Scholar PubMed

20. Fuentes-Aparicio, L, Cuenca-Martínez, F, Muñoz-Gómez, E, Mollà-Casanova, S, Aguilar-Rodríguez, M, Sempere-Rubio, N. Effects of therapeutic exercise in primary dysmenorrhea: an umbrella and mapping review. Pain Med 2023;24:1386–95. https://doi.org/10.1093/PM/PNAD104.Search in Google Scholar PubMed

21. Klotz, SGR, Schön, M, Ketels, G, Löwe, B, Brünahl, CA. Physiotherapy management of patients with chronic pelvic pain (CPP): a systematic review. Physiother Theory Pract 2019;35:516–32. https://doi.org/10.1080/09593985.2018.1455251.Search in Google Scholar PubMed

22. Borg, GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982;14:377–81. https://doi.org/10.1249/00005768-198205000-00012.Search in Google Scholar

23. Bang, D-H, Shin, W-S, Kim, S-Y, Choi, J-D. The effects of action observational training on walking ability in chronic stroke patients: a double-blind randomized controlled trial. Clin Rehabil 2013;27:1118–25. https://doi.org/10.1177/0269215513501528.Search in Google Scholar PubMed

24. Buccino, G, Arisi, D, Gough, P, Aprile, D, Ferri, C, Serotti, L, et al.. Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy. Dev Med Child Neurol 2012;54:822–8. https://doi.org/10.1111/j.1469-8749.2012.04334.x.Search in Google Scholar PubMed

25. Roman-Viñas, B, Serra-Majem, L, Hagströmer, M, Ribas-Barba, L, Sjöström, M, Segura-Cardona, R. International physical activity questionnaire: reliability and validity in a Spanish population. Eur J Sport Sci 2010;10:297–304. https://doi.org/10.1080/17461390903426667.Search in Google Scholar

26. Mantilla Toloza, SC, Gómez-Conesa, A. El Cuestionario Internacional de Actividad Física. Un instrumento adecuado en el seguimiento de la actividad física poblacional. Rev Iberoam Fisioter Kinesiol 2007;10:48–52. https://doi.org/10.1016/S1138-6045(07)73665-1.Search in Google Scholar

27. Campos, A, González, MÁ. Spanish version of the revised movement image questionnaire (MIQ-R): psychometric properties and validation. Rev Psic Dep 2010;19:265–75.Search in Google Scholar

28. Azevedo, DC, Lauria, AC, Pereira, ARS, Andrade, GT, Ferreira, ML, Ferreira, PH, et al.. Intraexaminer and interexaminer reliability of pressure biofeedback unit for assessing lumbopelvic stability during 6 lower limb movement tests. J Manipulative Physiol Therapeut 2013;36:33–43. https://doi.org/10.1016/j.jmpt.2012.12.008.Search in Google Scholar PubMed

29. Grundström, H, Gerdle, B, Alehagen, S, Berterö, C, Arendt-Nielsen, L, Kjølhede, P. Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis. Acta Obstet Gynecol Scand 2019;98:327–36. https://doi.org/10.1111/AOGS.13508.Search in Google Scholar PubMed

30. Lacourt, TE, Houtveen, JH, van Doornen, LJP. Experimental pressure-pain assessments: test-retest reliability, convergence and dimensionality. Scand J Pain 2012;3:31–7. https://doi.org/10.1016/J.SJPAIN.2011.10.003/MACHINEREADABLECITATION/RIS.Search in Google Scholar

31. Navarro Brazález, B, Torres Lacomba, M, de la Villa, P, Sánchez Sánchez, B, Prieto Gómez, V, Asúnsolo del Barco, Á, et al.. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: a reliability and correlation study. Neurourol Urodyn 2018;37:269–77. https://doi.org/10.1002/NAU.23287.Search in Google Scholar

32. Cohen, J. Statistical power analysis for the behavioral sciences. In: Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates; 1988, 2:567 p.Search in Google Scholar

33. Faul, F, Erdfelder, E, Lang, A-G, Buchner, A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175–91.10.3758/BF03193146Search in Google Scholar PubMed

34. Pascual-Leone, A, Wassermann, E, Grafman, J, Hallett, M. The role of the dorsolateral prefrontal cortex in implicit procedural learning. Exp Brain Res 1996;107:479–85. https://doi.org/10.1007/BF00230427.Search in Google Scholar PubMed

35. Salmon, E, Van der Linden, M, Collette, F, Delfiore, G, Maquet, P, Degueldre, C, et al.. Regional brain activity during working memory tasks. Brain 1996;119:1617–25. https://doi.org/10.1093/brain/119.5.1617.Search in Google Scholar PubMed

36. Cuenca-Martínez, F, La Touche, R, León-Hernández, JV, Suso-Martí, L. Mental practice in isolation improves cervical joint position sense in patients with chronic neck pain: a randomized single-blind placebo trial. PeerJ 2019;7:e7681. https://doi.org/10.7717/peerj.7681.Search in Google Scholar PubMed PubMed Central

37. Cuenca-Martínez, F, Suso-Martí, L, León-Hernández, JV, La Touche, R. Effects of movement representation techniques on motor learning of thumb-opposition tasks. Sci Rep 2020;10:12267. https://doi.org/10.1038/s41598-020-67905-7.Search in Google Scholar PubMed PubMed Central

38. La Touche, R, Herranz-Gómez, A, Destenay, L, Gey-Seedorf, I, Cuenca-Martínez, F, Paris-Alemany, A, et al.. Effect of brain training through visual mirror feedback, action observation and motor imagery on orofacial sensorimotor variables: a single-blind randomized controlled trial. J Oral Rehabil 2020;47:620–35. https://doi.org/10.1111/joor.12942.Search in Google Scholar PubMed

39. Suso-Martí, L, León-Hernández, JV, La Touche, R, Paris-Alemany, A, Cuenca-Martínez, F. Motor imagery and action observation of specific neck therapeutic exercises induced hypoalgesia in patients with chronic neck pain: a randomized single-blind placebo trial. J Clin Med 2019;8:1019. https://doi.org/10.3390/jcm8071019.Search in Google Scholar PubMed PubMed Central

40. Hayashi, K, Aono, S, Shiro, Y, Ushida, T. Effects of virtual reality-based exercise imagery on pain in healthy individuals. BioMed Res Int 2019;2019:1–9. https://doi.org/10.1155/2019/5021914.Search in Google Scholar PubMed PubMed Central

41. Peerdeman, KJ, van Laarhoven, AIM, Bartels, DJP, Peters, ML, Evers, AWM. Placebo-like analgesia via response imagery. Eur J Pain 2017;21:1366–77. https://doi.org/10.1002/ejp.1035.Search in Google Scholar PubMed PubMed Central

42. Cuenca-Martínez, F, Suso-Martí, L, León-Hernández, JV, Touche, RL. The role of movement representation techniques in the motor learning process: a neurophysiological hypothesis and a narrative review. Brain Sci 2020;10:27–48. https://doi.org/10.3390/brainsci10010027.Search in Google Scholar PubMed PubMed Central

43. Dahm, S, Rieger, M. Errors in imagined and executed typing. Vision 2019;3:66. https://doi.org/10.3390/VISION3040066.Search in Google Scholar PubMed PubMed Central

44. O’shea, H, Moran, A. Are fast complex movements unimaginable? Pupillometric studies of motor imagery in Expert Piano playing. J Mot Behav 2019;51:371–84. https://doi.org/10.1080/00222895.2018.1485010.Search in Google Scholar PubMed

45. Paravlic, AH, Slimani, M, Tod, D, Marusic, U, Milanovic, Z, Pisot, R. Effects and dose–response relationships of motor imagery practice on strength development in healthy adult populations: a systematic review and meta-analysis. Sports Med 2018;48:1165–87. https://doi.org/10.1007/S40279-018-0874-8.Search in Google Scholar PubMed

46. Cuenca-Martínez, F, Angulo-Díaz-Parreño, S, Feijóo-Rubio, X, Fernández-Solís, M, León-Hernández, JV, La Touche, R, et al.. Motor effects of movement representation techniques and cross-education: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2021;58:94–107. https://doi.org/10.23736/S1973-9087.21.06893-3.Search in Google Scholar PubMed PubMed Central

47. Ferrer-Peña, R, Cuenca-Martínez, F, Romero-Palau, M, Flores-Román, LM, Arce-Vázquez, P, Varangot-Reille, C, et al.. Effects of motor imagery on strength, range of motion, physical function, and pain intensity in patients with total knee arthroplasty: a systematic review and meta-analysis. Braz J Phys Ther 2021;25:698–708. https://doi.org/10.1016/J.BJPT.2021.11.001.Search in Google Scholar
Received: 2024-02-22
Accepted: 2024-07-11
Published Online: 2024-08-13

© 2024 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Research Articles
  2. Effects of a single session of motor imagery and action observation plus physical exercise on lumbo-pelvic sensorimotor function in healthy women: a randomized controlled pilot trial
  3. Memorizing soccer tactics through immersive and non-immersive visualizations: the moderating effect of visuospatial abilities
  4. Pain characteristics and imagery ability in patients with familial Mediterranean fever
  5. Cardiorespiratory response patterns during multifunctional imagery-assisted biofeedback training – a case study
  6. The effects of PETTLEP imagery and action observation on strength performance of a leg extension and flexion task
  7. Imagery use gender differences across competition and training contexts in Australian elite level athletes
  8. Cross-cultural adaptation, reliability and validity of the Greek version of the Movement Imagery Questionnaire-3 (MIQ-3)
https://doi.org/10.1515/jirspa-2024-0018
Keywords for this article
women’s health; motor imagery; action observation; physical exercise
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Effects of a single session of motor imagery and action observation plus physical exercise on lumbo-pelvic sensorimotor function in healthy women: a randomized controlled pilot trial
  3. Memorizing soccer tactics through immersive and non-immersive visualizations: the moderating effect of visuospatial abilities
  4. Pain characteristics and imagery ability in patients with familial Mediterranean fever
  5. Cardiorespiratory response patterns during multifunctional imagery-assisted biofeedback training – a case study
  6. The effects of PETTLEP imagery and action observation on strength performance of a leg extension and flexion task
  7. Imagery use gender differences across competition and training contexts in Australian elite level athletes
  8. Cross-cultural adaptation, reliability and validity of the Greek version of the Movement Imagery Questionnaire-3 (MIQ-3)
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 5.11.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jirspa-2024-0018/html
Scroll to top button