Original Article

https://doi.org/10.12965/jer.2346536.268 Journal of Exercise Rehabilitation 2023;19(6):332-338

Effects of plank exercise on respiratory capacity, physical

fitness, and immunocytes in older adults
Sihwa Park1, Byung-Hwa Choi², Yong-Seok Jee¹,²,*
Research Institute of Sports and Industry Science, Hanseo University, Seosan, Korea
1

Department of Physical Education, Graduate School of Hanseo University, Seosan, Korea

2

Plank is a readily accessible form of exercise that can benefit individu- and sit-ups increased by about 12%, 18%, and 42% in the PXG. Notably,
als of various fitness levels. However, its effectiveness in older individu- innate immunocytes, such as NK cells, increased by approximately 30%
als has not been conclusively established. Specifically, its impact on re- in the PXG. For adaptive immunocytes, including CD3+ T cells, CD4+ T
spiratory function, physical fitness, and immunocytes in them has not cells, and CD8+ T cells, there were notable increases of around 18%,
been thoroughly verified. The study encompassed participants with an 19%, and 28%, respectively, in the PXG. These findings underline signifi-
average age of 64.33± 1.98 years. All participants were randomly as- cant differences (P< 0.001) between the two groups. This study pro-
signed to either the control group (COG) or the plank exercise group vides confirmation that engaging in plank exercise can enhance the
(PXG). The plank exercise was conducted 3 days a week for 12 weeks. function of immunocytes, while also improving respiratory capacity and
While the values in the COG deteriorated, the PXG showed significant physical fitness in older adults.
improvements in several parameters. Forced expiratory volume in one
second and peak expiratory flow increased by approximately 27% and
16%, respectively, in the PXG, demonstrating significant differences Keywords: Plank exercise, Respiratory capacity, Immunocyte, Older
(P< 0.001) between the two groups. Additionally, VO2max, grip strength, people, Physical fitness

INTRODUCTION strength and endurance (Akuthota et al., 2008; Behm et al., 2010),
reducing lower back pain (Kline et al., 2013), and preventing falls
In recent times, the world has experienced a significant number (Granacher et al., 2013a). Previous studies have also demonstrated
of casualties as a result of the coronavirus, which can lead to respi- the effectiveness of plank exercises in activating core muscles, but
ratory system infections in both humans and animals (Zhang et their effects on the body’s immune cells are still not well known.
al., 2020). While hygiene and vaccines play a crucial role in pre- In addition to the benefits mentioned earlier, plank exercise is a
venting this virus, it’s also widely recognized that building a ro- popular choice for many individuals due to its ability to enhance
bust immune defense system through regular exercise is of great the core muscles in the abdominal and lower back regions, as demon-
importance (Walsh, 2018). strated by Byrne et al. (2014). Furthermore, it demands minimal
The plank exercise, originating from pilates, yoga, and stretch- time, space, and expense, making it an attractive option for fitness
ing, can be done with minimal space requirements and is accessi- enthusiasts. The plank exercise involves maintaining a position
ble to virtually anyone. This exercise, which engages the entire where the body is supported by the forearms and both feet in a
body, has the potential to burn a significant amount of calories straight line, as described by Calatayud et al. (2017). This exercise
and build muscle in a relatively short time (Park and Park, 2019). is particularly effective in enhancing overall body stability and
Research indicates that plank exercises are effective for improving mobility by focusing on strengthening the abdominal muscles

*Corresponding author: Yong-Seok Jee https://orcid.org/0000-0001-6797-0843 This is an Open Access article distributed under the terms of the Creative Commons At-
Research Institute of Sports and Industry Science, Hanseo University, Hanseo 1-ro, tribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/)
Haemi-myeon, Seosan 31962, Korea which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Email: [email protected]
Received: October 11, 2023 / Accepted: November 15, 2023

Copyright © 2023 Korean Society of Exercise Rehabilitation 332 https://www.e-jer.org pISSN 2288-176X
eISSN 2288-1778
Park S, et al. • Effects of plank exercise

within the core muscle groups. Table 1. Physical characteristics of the participants
Up to this point, the plank exercise has been recognized as a Variable COG (n= 30) PXG (n= 30) Z P-value η²
convenient at-home workout that targets core muscles. However, Age (yr) 64.40± 2.08 64.27± 1.91 -0.352 0.725 0.001
its impact on respiratory function and its potential positive effects Gender 1.40± 0.50 1.40± 0.50 0.000 1.000 0.000
on immune cells related to respiratory infections, such as those Height (cm) 167.25± 9.55 169.70± 6.50 -0.621 0.535 0.023
caused by the coronavirus, have not been well understood. Addi- Weight (kg) 65.96± 9.91 66.66± 10.18 -0.399 0.690 0.001
tionally, it remains unclear whether plank exercises are suitable for Muscle mass (kg) 25.41± 4.75 25.60± 4.48 -0.096 0.923 0.000
Fat mass (kg) 16.20± 3.35 16.33± 3.82 -0.163 0.871 0.000
older individuals or if they bring about changes in respiratory func-
Percent fat (%) 25.03± 6.10 24.65± 5.12 -0.340 0.734 0.001
tion and immune cell activity. Hence, the primary objective of
Valeus are presented mean± standard deviaiton.
this study was to examine alterations in respiratory capacity, phys- COG, control group; PXG, plank exercise group.
ical fitness, and immune cell function in older adults.
to either the control group (COG) or the plank exercise group
MATERIALS AND METHODS (PXG), each consisting of 30 participants as shown in Table 1.
More precisely, there were no dropouts among the participants
Participants from the initial enrollment to the analysis phase.
The study involved male and female older adults with ages rang-
ing from 60 to 69, and the mean age was 64.33 ± 1.98 years. In Experimental design
this study, participants were recruited from elderly individuals re- This was a prospective cross-sectional study conducted to inves-
siding in a Seoul Seniors Tower in Korea. These individuals were tigate the impact of plank exercises on respiratory capacity, physi-
not engaged in regular exercise, and this was verified by assessing cal fitness, and immunocytes in older adults. All data for this study
their daily activities and calorie intake. Participants were exclu- were collected between March 13, 2023 and June 16, 2023. After
sively recruited from older individuals who demonstrated the abil- obtaining approval from the Institutional Review Board under
ity to independently carry out daily activities and were in good the reference HS22-05-03, which was granted by the Health Sci-
physical health for engaging in physical activities. Their selection ence Human Studies Committee of Hanseo University, the exper-
criteria also included having no prior experience with plank exer- iment was carried out. Detailed explanations of all study proce-
cises. Additionally, all participants were non-smokers, free from dures were provided to the participants, and efforts were made to
back pain, and did not consume alcohol. Individuals who had un- minimize external influences by recording and evaluating the di-
dergone specific medical treatments or were taking medications etary intake (Korean Nutrition Society, 2023) and physical activity
that could affect their physical or psychological conditions, or had (Cheng, 2016) of all participants in both groups on a daily basis.
undergone significant surgery within the year prior to the study, The plank exercise program for the PXG was conducted 3 days a
were excluded from participation. The sample size for the study week (on Mondays, Wednesdays, and Fridays) for a duration of
was determined using the GPower software (version 3.1.9.7, Hein- 12 weeks.
rich-Heine-Universität, Düsseldorf, Germany). The calculations
considered various parameters, including an effect size of f ² (V)= Respiratory capacity measures
0.25, an alpha error probability of 0.05, a power of 0.95, the exis- Respiratory function assessment involved the use of a spirome-
tence of two groups, and a numerator difference of two (pre- and ter manufactured by Switzerland. The following parameters were
postvalues). According to GPower’s calculations, the ideal sample measured: Forced expiratory volume in 1 sec (FEV1) and peak ex-
size for the experimental design was found to be 54 participants. piratory flow (PEF). To conduct the tests, participants blocked
To account for potential dropouts, the study selected 60 partici- their noses with a stopper and inserted a disposable mouthpiece
pants. They were assigned unique identification numbers and then into their mouths. They then exhaled their maximum breath to
randomly allocated to one of two groups using random number measure the above variables after taking a deep inhalation. Before
tables. To ensure a genuinely random allocation, the Research Ran- the actual testing, participants underwent practice sessions to be-
domizer program (Urbaniak and Plous, 2023) was used. Each par- come familiar with the spirometry measurement technique. Each
ticipant drew a numbered ticket from a container, and these indi- subject underwent the spirometry test 3 times, and the highest
vidual sets were input into the program to assign them randomly recorded value among the three attempts was used for statistical

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Park S, et al. • Effects of plank exercise

analysis, following the approach detailed in Sutbeyaz et al. (2010). treated with anti-human antibodies (anti-CD3, anti-CD4, anti-
Additionally, this research assessed the resting respiratory rate CD8, and anti-CD56) obtained from BD Biosciences (Franklin
(rRR) of each participant for a duration of 60 sec. Participants Lakes, NJ, USA). After a 15-min incubation in the dark at room
were instructed to close their eyes and breathe comfortably. One temperature, red blood cells were broken down by adding 450 μL
researcher determined respiratory rate by observing the partici- of Fluorescence-Activated Cell Sorting (FACS) lysing solution to
pants’ natural chest movements and counting their breathing each test tube, followed by another 15-min incubation in the dark
while they were relaxed. at room temperature. Subsequently, these samples were analyzed
using the FACS Canto II system from BD Bioscience, and the re-
Physical fitness measures sults, presented as percentages, were processed with Flowjo soft-
This study assessed various aspects of health-related physical ware (Treestar, Ashland, OR, USA).
fitness, including body composition, strength, muscle endurance,
and cardiopulmonary endurance using a graded exercise test (GXT). Plank exercise program
Body composition was measured using a bioelectrical impedance Before and after the plank exercises, participants engaged in
analysis method with a body composition analyzer (Inbody 770, 5-min sessions of lying stretches. Throughout the workout phase,
Biospace, Seoul, Korea) to obtain participants’ demographic char- participants were required to maintain a straight and stable align-
acteristics. Strength was assessed through a grip strength test, per- ment from their head to their toes, ensuring that their hips did
formed with a Smedley dynamometer (Takei Inc., Tokyo, Japan). not sag, while keeping their shoulders and elbows flexed at a 90°
The participants held the dynamometer without touching any angle. The plank exercise involves determining the maximal RPE
other part of their body. After measuring both hands alternately and, based on this RPE, performing the exercise at different in-
twice, the maximum value was recorded, and the mean value from tensities: 60% intensity during the first 1 to 4 weeks, 70% inten-
both hands was used. Muscle endurance was measured using a sit- sity from weeks 5 to 8, and 80% intensity from weeks 9 to 12.
up test lasting for 1 min. The total number of completed sit-ups While plank exercise is effective for strengthening various muscle
was recorded. Participants lay down with their backs on the floor, groups, including the abdominals, back, shoulders, arms, and
bent their knees at right angles, secured their feet on the sit-up lower body (Tong et al., 2014), it’s important to avoid excessive or
board, and interlocked their fingers behind their head. This study improper execution as it can lead to joint problems. In particular,
evaluated the maximal oxygen uptake (VO2max) as an indicator of it may strain the wrists, elbows, shoulders, and spinal joints. There-
cardiopulmonary endurance by conducting a GXT. Various devices fore, participants were instructed to discontinue the plank exercise
were utilized for this assessment, including an electrocardiogram if they experienced any discomfort or pain in these areas during
(Q-4500, SunTech Medical Inc., Morrisville, NA, USA), an auto- the process of determining their maximal RPE using the Borg
matic sphygmomanometer (M-412, SunTech Medical Inc.), a gas category ratio-10 scale, which rates intensity on a scale from 1 to
tester (QMC4200, SunTech Medical Inc.), and a treadmill (Q65 10 (Guo et al., 2017). This scale typically ranges from 0 (repre-
Series 90, Quinton Instrument Co., Seattle, WA, USA). The test senting complete rest) to 10 (representing the most strenuous ef-
followed the modified Bruce protocol, which required participants fort). During the initial 1 to 4 weeks, the objective of the plank
to walk or run until they reached their maximal rating of perceived exercise was to achieve a duration of 20 min, with each individual
exertion (RPE), signifying an all-out effort level. This approach performing sets at 60% of their maximal RPE. To meet this tar-
helped determine their VO2max and provided insights into their get, participants completed approximately 15–16 sets of plank
cardiopulmonary endurance. exercises during this period. In the subsequent 5 to 8 weeks, the
goal was to extend the duration to 25 min, and in the final 9 to
Immunocyte measures 12 weeks, the aim was to reach 30 min as shown in Table 2. After
Blood samples were collected in the morning from participants completing each set of plank exercises, participants were instruct-
who had fasted for approximately 10 hr. This research aimed to ed to take a 1-min break.
examine changes in complete blood counts as well as lymphocyte
and granulocyte subsets. The analysis involved determining the Statistical analysis
percentage and absolute cell counts of peripheral blood cell sub- Statistical analysis for this study was conducted using IBM SPSS
sets using the following procedure: A 50-μL blood sample was Statistics version 25.0 (IBM Corp., Armonk, NY, USA). The nor-

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Park S, et al. • Effects of plank exercise

Table 2. Plank exercise program for older adults Table 3. Changes and differences of respiratory capacity
Items Measures/performances Time/set Variable COG PXG Z P-value η²
max RPE Time to reach max RPE (sec) 136.30± 24.70 FEV1 (L)
Weeks 1–4 Time equivalent to 60% of max RPE (sec) 82.40± 14.35 Pre 1.93± 0.44 1.94± 0.44 -0.178 0.859 0.000
Set that reached the goal of 20 min 15.33± 2.35 Post 1.59± 0.35 2.41± 0.59 -5.575 0.000 0.424
Time to reach set (sec) 1,231.60± 22.10 ∆% -15.45± 16.85 27.07± 29.99 -5.869 0.000 0.442
Weeks 5–8 Time equivalent to 70% of max RPE (sec) 95.41± 17.29 PEF (L/sec)
Set that reached the goal of 25 min 15.53± 2.54 Pre 3.51± 0.64 3.50± 0.67 -0.022 0.982 0.000
Time to reach set (sec) 1,440.72± 25.53 Post 2.82± 0.60 3.99± 0.71 -5.236 0.000 0.449
Weeks 9–12 Time equivalent to 80% of max RPE (sec) 109.04± 19.76 ∆% -17.74± 18.83 15.82± 18.61 -5.464 0.000 0.454
Set that reached the goal of 30 min 15.53± 2.54 rRR (reps)
Time to reach set (sec) 1,646.53± 29.18 Pre 18.23± 2.64 18.47± 2.75 -0.757 0.449 0.002
Valeus are presented mean± standard deviaiton. Post 19.30± 2.22 15.43± 3.76 -3.726 0.000 0.289
max RPE, maximal ratings of perceived exertion. ∆% 7.05± 13.81 -14.63± 24.26 -3.808 0.000 0.238
Valeus are presented mean± standard deviaiton.
mality of all measured variables was assessed with the Shapiro– COG, control group; PXG, plank exercise group; FEV1, forced expiratory volume in
1 sec; PEF, peak expiratory flow; rRR, resting respiratory rate.
Wilk normality test. To compare continuous outcomes between
groups, the non-parametric Mann–Whitney U-test was employed. were documented as 1,509.47 ± 373.14 MET ·min/wk for the
In this study, delta % was calculated for each period to enable de- COG and 1,532.10 ± 477.48 MET·min/wk for the PXG. This
tailed data analysis, and the significance of this value was also test- data also showed no significant difference between the two groups
ed using the Mann–Whitney U-test. The effect size (η²) was cal- (Z=-0.096, P=0.923, η²=0.001).
culated based on Cohen d, which is derived from the mean differ-
ence of the groups divided by the pooled standard deviation, fol- Changes and differences of respiratory capacity
lowing the framework outlined by Cohen (1992). Cohen d effect As indicated in Table 3, there were no notable differences in
sizes are typically classified as small (0.2–0.3), medium (~0.5), or FEV1, PEF, and rRR prior to the commencement of the experi-
large (≥0.8). For all analyses, the significance level was set at ment between the two groups. However, following the 12-week
P≤0.05. study, FEV1 decreased by approximately 15% in the COG and in-
creased by about 27% in the PXG. This observed contrast between
RESULTS the groups was statistically significant. Following the 12-week
experiment, PEF exhibited a decrease of approximately 18% in
Demographic and physical characteristics before the the COG, whereas it increased by about 16% in the PXG, demon-
experiment strating a significant distinction between the groups. Furthermore,
In the COG, there were 12 females, constituting 40.0% of the in the case of rRR, it increased by about 7% in the COG, while it
group, and 18 males. PXG also consisted of 12 women and 18 men, decreased by about 15% in the PXG, again showing a significant
which matched the gender distribution of the COG. As shown in difference between the two groups. It’s noteworthy that these chang-
Table 1, there were no significant differences in terms of age, gen- es in FEV1 (η²=0.442), PEF (η²=0.454), and rRR (η²=0.238)
der distribution, height, or body weight between the two groups. were associated with large effect sizes (≥0.14).
Furthermore, various other body composition factors, such as muscle
mass, fat mass, and percentage of body fat, also did not display any Changes and differences of physical fitness
statistically significant variations between the groups prior to the As depicted in Table 4, there were no significant disparities
commencement of the study. Although not presented in the table, in VO2max, grip strength, and sit-ups before the initiation of the
the mean daily dietary intake over the course of 12 weeks was de- experiment across the two groups. However, at the end of the
termined to be 1,371.67 ± 202.98 kcal for the COG and 1,323.13 ± 12-week study, VO2max displayed a reduction of approximately 9%
208.16 kcal for the PXG. The comparison between the two groups in the COG, while it increased by about 12% in the PXG, indi-
demonstrated no statistically significant difference (Z=-0.814, cating a noteworthy distinction between the groups. Furthermore,
P=0.415, η²=0.014). Likewise, the daily physical activity levels grip strength decreased by roughly 12% in the COG, but it in-

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Park S, et al. • Effects of plank exercise

Table 4. Changes and differences of physical fitness factors Table 5. Changes and differences of innate and adaptive immunocytes
Variable COG PXG Z P-value η² Variable COG PXG Z P-value η²
VO2max (mL/kg/min) WBC (× 10³/μL)
Pre 30.13± 5.58 29.46± 7.24 -0.481 0.631 0.003 Pre 5.81± 0.70 5.77± 0.71 -0.081 0.935 0.001
Post 26.66± 4.81 32.20± 5.81 -3.579 0.000 0.218 Post 5.67± 0.99 5.96± 0.62 -1.554 0.120 0.032
∆% -9.25± 19.72 11.88± 15.26 -3.888 0.000 0.271 ∆% -1.86± 16.55 4.56± 15.73 -1.353 0.176 0.039
Grip strength (kg) NK cells (%)
Pre 32.30± 7.51 31.48± 6.54 -0.688 0.492 0.003 Pre 8.81± 2.73 8.87± 2.65 -0.104 0.918 0.000
Post 27.53± 5.38 36.71± 7.91 -4.407 0.000 0.323 Post 7.43± 1.76 11.12± 3.37 -4.724 0.000 0.327
∆% -12.14± 19.25 17.68± 17.54 -5.160 0.000 0.404 ∆% -10.78± 24.00 29.78± 35.56 -4.436 0.000 0.316
Sit-ups (reps) CD3+ T cells (%)
Pre 15.03± 4.21 16.30± 4.84 -0.890 0.373 0.020 Pre 59.07± 9.09 58.63± 10.05 -0.229 0.819 0.001
Post 12.57± 3.47 21.90± 4.52 -5.892 0.000 0.581 Post 49.52± 9.51 68.11± 11.39 -5.308 0.000 0.448
∆% -13.58± 19.95 41.86± 37.42 -5.508 0.000 0.469 ∆% -15.18± 16.80 18.45± 22.47 -5.277 0.000 0.426
Valeus are presented mean± standard deviaiton. CD4+ T cells (%)
COG, control group; PXG, plank exercise group; VO2max, maximal oxygen consump- Pre 37.99± 10.90 37.97± 8.07 -0.274 0.784 0.000
tion. Post 30.49± 6.30 43.30± 6.81 -5.445 0.000 0.497
∆% -14.59± 23.39 18.84± 32.22 -4.109 0.000 0.267
creased by about 18% in the PXG, revealing a significant differ- CD8+ T cells (%)
ence between the groups. In the case of sit-ups, a measure of mus- Pre 18.56± 5.30 18.85± 2.93 -0.267 0.790 0.001
cular endurance, it decreased by about 14% in the COG, while Post 15.68± 3.18 23.62± 5.40 -5.399 0.000 0.453
it surged by about 42% in the PXG, demonstrating a significant ∆% -10.80± 23.31 28.01± 34.29 -4.399 0.000 0.312
contrast between the two groups. It is important to note that these Valeus are presented mean± standard deviaiton.
changes in VO2max (η²=0.271), grip strength (η²=0.404), and COG, control group; PXG, plank exercise group; WBC, white blood cell; NK, natural
killer.
sit-ups (η²=0.469) were characterized by substantial effect sizes
(≥0.14).
DISCUSSION
Changes and differences of immunocytes
As indicated in Table 5, prior to the commencement of the ex- This study observed multiple alterations in respiratory capacity,
periment, natural killer (NK) cells, CD3+ T cells, CD4+ T cells, physical fitness, and immunocyte function in older adults after
and CD8+ T cells exhibited no significant distinctions between 12 weeks of plank exercise. Regarding respiratory variables, the
the two groups. However, at the end of the 12-week study, there study noted that FEV1 and PEF increased by approximately 27%
were noteworthy changes. NK cells decreased by approximately and 16%, respectively, in the PXG. In the case of rRR, it increased
11% in the COG, while they increased by about 30% in the PXG, by about 7% in the COG but decreased by roughly 15% in the
indicating a significant difference between the groups. CD3+ T PXG. Furthermore, this study demonstrated that plank exercise
cells decreased by around 15% in the COG, but they increased by leads to an increase in maximum oxygen intake, as well as im-
about 18% in the PXG, displaying a significant distinction be- provements in strength and muscular endurance. These improve-
tween the groups. In the case of CD4+ T cells, they decreased by ments were associated with positive changes in immune cells.
roughly 15% in the COG, but increased by about 19% in the Training the strength and endurance of the muscles in the trunk
PXG, again revealing a significant difference between the groups. region is a crucial aspect of resistance training, and it has garnered
CD8+ T cells also exhibited a reduction of about 11% in the increased attention in scientific literature and rehabilitation fields
COG, while they increased by about 28% in the PXG, highlight- (Byrne et al., 2014). While the effectiveness of trunk muscle train-
ing a significant difference between the two groups. It’s important ing as a tool for enhancing athletic performance may lack robust
to emphasize that these changes in NK cells (η²=0.316), CD3+ research support, positive outcomes have been documented in
T cells (η²=0.426), CD4+ T cells (η²=0.267), and CD8+ T cells various areas. These include promoting low back health, reducing
(η²=0.312) were characterized by substantial effect sizes. the risk of injuries, enhancing the ability to transfer power to the
extremities, and preventing falls among senior individuals (Gra-

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Park S, et al. • Effects of plank exercise

nacher et al., 2013a; Granacher et al., 2013b). Granacher et al. ence between the two groups. Notably, for adaptive immune cells,
(2013b) conducted research to show that core strength instability including CD3+ T cells, CD4+ T cells, and CD8+ T cells, there
training, which is akin to plank exercises, is a viable form of exer- were declines of approximately 15%, 15%, and 11% in COG,
cise for older adults. They found that this type of training improved while they increased by about 18%, 19%, and 28% in PXG, un-
spinal mobility, dynamic balance, functional mobility, and trunk derscoring significant distinctions between the two groups. These
strength. Consequently, they proposed that this training program results can be interpreted as the plank exercise having a positive
could serve as a supplementary or alternative approach to tradi- impact on the immune cell function of the elderly participants.
tional balance and resistance training. In this study, the aim of the Specifically, the enhanced function of innate and/or adaptive im-
plank exercise for the initial 1 to 4 weeks was for each individual munocytes suggests that plank exercise may provide protection
to reach a duration of 20 min while performing sets at an intensi- against external substances (i.e., virus or bacteria). In light of the
ty level of 60% of their maximum RPE. The subsequent goal was lasting effects of the recent coronavirus disease 2019 (COVID-19)
to increase the duration to 25 min during weeks 5 to 8 and fur- pandemic, many elderly individuals have faced disruptions in their
ther extend it to 30 min in weeks 9 to 12. To attain this objective, lives and health, experiencing significant changes in their respira-
older adults needed to complete approximately 15 to 16 sets of tory and immune function. To counteract these challenges, the
plank exercises. In summary, plank exercise is a viable option even continuous practice of plank exercise is recommended to the older
for older individuals, and this form of exercise can lead to improve- people. T cells, including both CD4+ and CD8+ T cells, play a
ments not only in the development of physical strength, includ- crucial role in the body’s defense against viruses by facilitating the
ing core muscles but also in respiratory function and immune cell production of pathogen-specific antibodies, stimulating T-depen-
function, as observed in this study. dent B cells, and eliminating virus-infected cells (Maloir et al.,
In particular, when examining the results of this study and com- 2018). The significance of CD4+ T cells in controlling the repli-
paring them to the pre-experimental values, it becomes evident cation of the severe acute respiratory syndrome coronavirus and
that in the COG, FEV1 and PEF experienced reductions of approx- mitigating disease severity has been underscored through studies
imately 15% and 18%, respectively, while in the PXG, they in- involving T cell-deficient mice, highlighting the pivotal role of
creased by about 27% and 16%. Conversely, rRR increased by CD4+ T cells in primary severe acute respiratory syndrome coro-
around 7% in COG but decreased by about 15% in PXG, indi- navirus infection (Maloir et al., 2018). Virus-specific CD4+ T cells
cating an improvement in respiratory function. Concerning phys- are essential for complete virus clearance, while memory CD8+ T
ical fitness components, VO2max and grip strength declined by cells also contribute significantly through the production of vari-
roughly 9% and 12%, respectively, in COG, whereas they increased ous cytokines and cytolytic molecules like granzyme B (Chen et
by about 12% and 18% in PXG. To be more specific, sit-ups, al., 2010). In the context of the COVID-19 pandemic, as we have
which assess the endurance of trunk muscles, decreased by around all witnessed, there was a substantial reduction in the total num-
14% in COG but surged by about 42% in PXG, underscoring ber of T cells, encompassing both CD4+ and CD8+ T cells (Diao
the substantial impact of plank exercise on core muscles. These re- et al., 2020; Hosseini et al., 2020). Paradoxically, these findings
sults indicate that the duration of plank exercise per set for the suggest that the plank exercise observed in this study may have
older participants in this study was appropriate, aligning with helped alleviate or prevent some of the adverse effects caused by
previous research (Byrne et al., 2014; Granacher et al., 2013a; the coronavirus.
Granacher et al., 2013b). In essence, this implies that enhancing This study has verified that plank exercises, performed at vary-
core muscles through plank exercises may play a role in enhancing ing levels of intensity from light to high, enhanced immunocyte
respiratory function. function and various physical fitness components, including respi-
Furthermore, this study verified that, in addition to the changes ratory capacity, in older adults. Nevertheless, it is important to ac-
in respiratory function and physical strength factors, immune cell knowledge the limitations of our study. Firstly, the sample size
function improved after engaging in the aforementioned plank was relatively small. Secondly, while there are numerous types of
exercise. In particular, NK cells, a type of innate immune cell ob- immunocytes, this study focused on a specific subset of immune
served in this study, decreased by around 11% in the COG, which cells. Given these limitations, further research that explores the
did not engage in plank exercise. In contrast, they increased by effectiveness of plank exercises on a larger and more diverse partic-
approximately 30% in the PXG, indicating a significant differ- ipant pool, encompassing a broader range of immunocyte assess-

https://doi.org/10.12965/jer.2346536.268 https://www.e-jer.org 337

Park S, et al. • Effects of plank exercise

ments, is encouraged. Granacher U, Gollhofer A, Hortobágyi T, Kressig RW, Muehlbauer T. The

importance of trunk muscle strength for balance, functional perfor-
CONFLICT OF INTEREST mance, and fall prevention in seniors: a systematic review. Sports
Med 2013a;43:627-641.
No potential conflict of interest relevant to this article was re- Granacher U, Lacroix A, Muehlbauer T, Roettger K, Gollhofer A. Effects
ported. of core instability strength training on trunk muscle strength, spinal
mobility, dynamic balance and functional mobility in older adults.
ACKNOWLEDGMENTS Gerontology 2013b;59:105-113.
Guo F, Sun YJ, Zhang RH. Perceived exertion during muscle fatigue as
This research was supported by the 2023 Hanseo University reflected in movement-related cortical potentials: an event-related po-
Research Grant. tential study. Neuroreport 2017;28:115-122.
Hosseini A, Hashemi V, Shomali N, Asghari F, Gharibi T, Akbari M,
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