The prevention and treatment of exercise-induced muscle damage

Dietary strategies to recover from exercise-induced muscle damage

Exhaustive or unaccustomed intense exercise can cause exercise-induced muscle damage (EIMD) and its undesirable consequences may decrease the ability to exercise and to adhere to a training programme. This review briefly summarises the muscle damage process, focusing predominantly on oxidative stress and inflammation as contributing factors, and describes how nutrition may be positively used to recover from EIMD. The combined intake of carbohydrates and proteins and the use of antioxidants and/or anti-inflammatory nutrients within physiological ranges are interventions that may assist the recovery process. Although the works studying food instead of nutritional supplements are very scarce, their results seem to indicate that food might be a favourable option as a recovery strategy. To date, the only tested foods were milk, cherries, blueberries and pomegranate with promising results. Other potential solutions are foods rich in protein, carbohydrates, antioxidants and/or anti-inflammatory nutrients.

Human inflammatory and resolving lipid mediator responses to resistance exercise and ibuprofen treatment

Classical proinflammatory eicosanoids, and more recently discovered lipid mediators with anti-inflammatory and proresolving bioactivity, exert a complex role in the initiation, control, and resolution of inflammation. Using a targeted lipidomics approach, we investigated circulating lipid mediator responses to resistance exercise and treatment with the NSAID ibuprofen. Human subjects undertook a single bout of unaccustomed resistance exercise (80% of one repetition maximum) following oral ingestion of ibuprofen (400 mg) or placebo control. Venous blood was collected during early recovery (0-3 h and 24 h postexercise), and serum lipid mediator composition was analyzed by LC-MS-based targeted lipidomics. Postexercise recovery was characterized by elevated levels of cyclooxygenase (COX)-1 and 2-derived prostanoids (TXB2, PGE2, PGD2, PGF2α, and PGI2), lipooxygenase (5-LOX, 12-LOX, and 15-LOX)-derived hydroxyeicosatetraenoic acids (HETEs), and leukotrienes (e.g., LTB4), and epoxygenase (CYP)-derived epoxy/dihydroxy eicosatrienoic acids (EpETrEs/DiHETrEs). Additionally, we detected elevated levels of bioactive lipid mediators with anti-inflammatory and proresolving properties, including arachidonic acid-derived lipoxins (LXA4 and LXB4), and the EPA (E-series) and DHA (D-series)-derived resolvins (RvD1 and RvE1), and protectins (PD1 isomer 10S, 17S-diHDoHE). Ibuprofen treatment blocked exercise-induced increases in COX-1 and COX-2-derived prostanoids but also resulted in off-target reductions in leukotriene biosynthesis, and a diminished proresolving lipid mediator response. CYP pathway product metabolism was also altered by ibuprofen treatment, as indicated by elevated postexercise serum 5,6-DiHETrE and 8,9-DiHETrE only in those receiving ibuprofen. These findings characterize the blood inflammatory lipid mediator response to unaccustomed resistance exercise in humans and show that acute proinflammatory signals are mechanistically linked to the induction of a biological active inflammatory resolution program, regulated by proresolving lipid mediators during postexercise recovery.

The effect of eccentric exercise-induced delayed-onset muscle soreness on positioning sense and shooting percentage in wheelchair basketball players

BACKGROUND

Eccentric exercise is defined as a type of exercise in which the muscle produces power by extending. In contrast to isometric and concentric exercises, eccentric muscle activity is much more effective mechanically; however, it may expose the muscle to soreness. Delayed-Onset Muscle Soreness (DOMS) emerges a couple of hours after an eccentric activity, especially in individuals who are not used to this kind of exercise, and causes a temporary decrease in muscle performance, joint movement angle and muscle power, and also a temporary increase in the blood creatine kinase (CK) activity.

AIMS

This study investigates the effect of DOMS on the upper extremities motor performance by conducting an eccentric exercise load on the elbow flexor muscles.

STUDY DESIGN

Cross sectional study.

METHODS

The study included 10 wheelchair basketball players. First, the participants underwent blood CK activity, positioning sense, muscle pain, shooting performance measurements tests at the base, and after 30 minutes and 24 and 48 hours. Then, one week later, the one-repetition-maximums of biceps curls were determined in order to define the intensity of the eccentric exercise. An eccentric exercise protocol which would cause DOMS was applied to all players. All tests were replaced with acute exhaustive eccentric exercise; the same tests were repeated in the same order after the exercise. Blood CK activity was measured by taking an earlobe capillary blood sample. The muscle pain level was measured by using a Visual Analogue Scale (VAS). Positioning sense loss was assessed via goniometer at 30º, 60° and 90° degrees horizontally.

RESULTS

The study found a statistically significant increase in blood CK activity and positioning sense loss, and a decrease in the pressure-pain threshold, as well as the shooting percentages in the exercise group when compared with the control.

CONCLUSION

These findings suggest that DOMS negatively affects the upper extremities motor performance of wheelchair basketball players at least 48 hours after eccentric exercise.

Ingestion of carbohydrate during recovery in exercising people

PURPOSE OF REVIEW

The primary focus of this brief review is to describe the effect of carbohydrate (CHO) supplementation alone or in combination with protein on two responses during postexercise recovery that are not specifically related to the usual emphasis on glycogen resynthesis; that is, rapid postexercise rehydration, and recovery from exercise-induced muscle damage.

RECENT FINDINGS

Evidence from postexercise rapid rehydration studies suggests that the addition of CHO to a rehydration solution may increase the rate of fluid restoration compared with water placebo. Adding protein to a CHO solution may further accentuate the beneficial effects. An additional postexercise concern for active individuals is the development of postexercise muscle soreness, a response that is pronounced with novel, eccentric exercise. Ingestion of CHO supplements, especially those combined with protein may help to minimize the exercise-induced muscle damage that is accompanied by muscle soreness, and reduced muscle function.

SUMMARY

The practical implications of these findings are that CHO supplementation, especially in combination with protein, can enhance the rate of recovery relative to fluid balance and muscle damage; thus, these nutritional interventions should be considered for purposes in addition to the usual focus on glycogen resynthesis.

Recovery in soccer : part ii-recovery strategies

In the formerly published part I of this two-part review, we examined fatigue after soccer matchplay and recovery kinetics of physical performance, and cognitive, subjective and biological markers. To reduce the magnitude of fatigue and to accelerate the time to fully recover after completion, several recovery strategies are now used in professional soccer teams. During congested fixture schedules, recovery strategies are highly required to alleviate post-match fatigue, and then to regain performance faster and reduce the risk of injury. Fatigue following competition is multifactorial and mainly related to dehydration, glycogen depletion, muscle damage and mental fatigue. Recovery strategies should consequently be targeted against the major causes of fatigue. Strategies reviewed in part II of this article were nutritional intake, cold water immersion, sleeping, active recovery, stretching, compression garments, massage and electrical stimulation. Some strategies such as hydration, diet and sleep are effective in their ability to counteract the fatigue mechanisms. Providing milk drinks to players at the end of competition and a meal containing high-glycaemic index carbohydrate and protein within the hour following the match are effective in replenishing substrate stores and optimizing muscle-damage repair. Sleep is an essential part of recovery management. Sleep disturbance after a match is common and can negatively impact on the recovery process. Cold water immersion is effective during acute periods of match congestion in order to regain performance levels faster and repress the acute inflammatory process. Scientific evidence for other strategies reviewed in their ability to accelerate the return to the initial level of performance is still lacking. These include active recovery, stretching, compression garments, massage and electrical stimulation. While this does not mean that these strategies do not aid the recovery process, the protocols implemented up until now do not significantly accelerate the return to initial levels of performance in comparison with a control condition. In conclusion, scientific evidence to support the use of strategies commonly used during recovery is lacking. Additional research is required in this area in order to help practitioners establish an efficient recovery protocol immediately after matchplay, but also for the following days. Future studies could focus on the chronic effects of recovery strategies, on combinations of recovery protocols and on the effects of recovery strategies inducing an anti-inflammatory or a pro-inflammatory response.

Resistance training decreases serum inflammatory markers in diabetic rats

Inflammation plays an important role in the genesis and progression of diabetes. The purpose of this study was to investigate the effect of resistance training on serum levels of some inflammatory markers associated with diabetes mellitus. Twenty-four male Wistar rats (290 ± 19 g) were randomly divided into three groups: non-diabetic control (non-DC), diabetic control (DC), and diabetic trained (DT). Animals in DT group were subjected to a resistance training program with the use of a ladder (3 days/week, for 4 weeks). Body weight, serum high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, fasting glucose, and insulin were measured. Four weeks of resistance training decreased serum levels of TNF-α, hs-CRP, and IL-6 in diabetic rats when compared with DC animals. We conclude that resistance training with appropriate intensity, duration, and recovery between exercise bouts has marked anti-inflammatory effects on diabetic rats. This may be an efficient strategy to protect against some diabetic complications.

The role of cherries in exercise and health

Recently, cherries and cherry products have received growing attention within the literature with regard to their application in both exercise and clinical paradigms. Reported to be high in anti-inflammatory and anti-oxidative capacity, cherries and their constituents are proposed to provide a similar but natural alternative akin to over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics. Within exercise paradigms, concern has been raised with regard to the use of products, which inhibit such inflammatory or oxidative actions, because of the possibility of the blunting of physiological training adaptations. Despite this, numerous scenarios exist both within exercise and clinical populations where a goal of optimal recovery time is more important than physiological adaptation. This review critically evaluates and discusses the use of cherries as a supplementation strategy to enhance recovery of muscle function, inhibit exercise-induced inflammation, oxidative stress, and pain primarily; furthermore, the potential application of cherries to clinical populations is discussed.

Marine oil dietary supplementation reduces delayed onset muscle soreness after a 30 km run

Objective

Runners are prone to delayed onset muscle soreness (DOMS) during long distance training. This especially holds for unaccustomed training volumes at moderate to high intensities. We investigated the effects of a marine oil complex, PCSO-524®, derived from the New Zealand green-lipped mussel (formulated as Lyprinol® and Omega XL®) on DOMS after a 30 km training run.

Methods

Initially, peak oxygen uptake of 32 distance runners (4 female, 28 male; median age 45 years, range 28–53) was measured on a treadmill with a 1.5 km hour⁻¹ increase every 4 minutes starting from 8.5 km hour⁻¹. At least 1-week after this initial test, they participated in a 30 km road run at a speed corresponding to about 70% of their individual peak oxygen uptake on a flat terrain. Before and after (0, 24, and 48 hours) the run, blood concentration of creatine kinase (CK) were measured and pain sensation was determined (pain scale from 0 = no pain to 10 = extremely painful). Runners were then matched in pairs based on maximal CK and peak oxygen uptake, and allocated randomly into two different groups. One group was supplemented with 400 mg per day of PCSO-524® for 11 weeks, the other group with an olive oil placebo. After that period, CK and pain sensations were remeasured following a second 30 km run at the same speed and on the same terrain.

Results

The general pattern of soreness in the PCSO-524® supplemented group was reduced by 1.1 units (standard error 0.41) compared to the placebo (P < 0.05), the effects being greater in lesser trained runners (P < 0.05). CK levels were positively associated with pain sensation (P < 0.05), but trends toward lower CK in the PCSO-524® group, which were also more pronounced in the lesser trained runners, were not statistically significant.

Conclusion

Pain sensations experienced by distance runners following a 30 km run were reduced by supplementation with the marine oil complex PCSO-524®, an effect which was greater in lesser trained runners.

Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis

The aim of this systematic review was to examine the effect of Contrast Water Therapy (CWT) on recovery following exercise induced muscle damage. Controlled trials were identified from computerized literature searching and citation tracking performed up to February 2013. Eighteen trials met the inclusion criteria; all had a high risk of bias. Pooled data from 13 studies showed that CWT resulted in significantly greater improvements in muscle soreness at the five follow-up time points (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Pooled data also showed that CWT significantly reduced muscle strength loss at each follow-up time (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Despite comparing CWT to a large number of other recovery interventions, including cold water immersion, warm water immersion, compression, active recovery and stretching, there was little evidence for a superior treatment intervention. The current evidence base shows that CWT is superior to using passive recovery or rest after exercise; the magnitudes of these effects may be most relevant to an elite sporting population. There seems to be little difference in recovery outcome between CWT and other popular recovery interventions.

Oral consumption of electrokinetically modified water attenuates muscle damage and improves postexercise recovery

The purpose of this study was to assess the effects of consuming electrokinetically modified water (EMW) on attenuating muscle damage and improving functional recovery following a single bout of isokinetic resistance exercise. Subjects were randomly assigned to an EMW (n = 20) or a placebo control (n = 20) group. Subjects consumed EMW or placebo water daily for 23 days. On day 19 subjects completed an exercise protocol for the biceps brachii to induce muscle damage. The protocol consisted of three sets of 20 repetitions using concentric and eccentric contractions of the elbow flexors. Blood draw and clinical measurements were performed preexercise as well as 24, 48, and 96 h postexercise. Clinical measures included maximal isometric strength, muscle soreness, pain with elbow extension, relaxed elbow angle (RANG), and self-report arm disability. Plasma samples were analyzed to determine concentrations of creatine kinase (CK) and high-sensitivity C-reactive protein (hsCRP). Pain with elbow extension and self-report arm disability were significantly higher in the placebo group compared with the EMW group at 48 h (P < 0.01) and 96 h (P < 0.01) after exercise, while RANG was significantly higher in the EMW group compared with placebo at 48 h (P < 0.01) and 96 h (P < 0.01) after exercise. Similarly, plasma concentrations for hsCRP and CK were significantly lower in the EMW group compared with placebo at 48 h (P < 0.05) and 96 h (P < 0.01) after exercise. Oral consumption of EMW significantly reduced exercise-induced muscle damage and inflammation and improved functional recovery.

Recovery in soccer: part I - post-match fatigue and time course of recovery

In elite soccer, players are frequently required to play consecutive matches interspersed by 3 days and complete physical performance recovery may not be achieved. Incomplete recovery might result in underperformance and injury. During congested schedules, recovery strategies are therefore required to alleviate post-match fatigue, regain performance faster and reduce the risk of injury. This article is Part I of a subsequent companion review and deals with post-match fatigue mechanisms and recovery kinetics of physical performance (sprints, jumps, maximal strength and technical skills), cognitive, subjective and biochemical markers. The companion review will analyse recovery strategies used in contemporary professional soccer. Soccer involves many physically demanding activities including sprinting, changes in running speed, changes of direction, jumps and tackles, as well as technical actions such as dribbling, shooting and passing. These activities lead to a post-match fatigue that is linked to a combination of dehydration, glycogen depletion, muscle damage and mental fatigue. The magnitude of soccer match-induced fatigue, extrinsic factors (i.e. match result, quality of the opponent, match location, playing surface) and/or intrinsic factors (i.e. training status, age, gender, muscle fibre typology), potentially influence the time course of recovery. Recovery in soccer is a complex issue, reinforcing the need for future research to estimate the quantitative importance of fatigue mechanisms and identify influencing factors. Efficient and individualized recovery strategies may consequently be proposed.

Exercise acts as a drug; the pharmacological benefits of exercise

The beneficial effects of regular exercise for the promotion of health and cure of diseases have been clearly shown. In this review, we would like to postulate the idea that exercise can be considered as a drug. Exercise causes a myriad of beneficial effects for health, including the promotion of health and lifespan, and these are reviewed in the first section of this paper. Then we deal with the dosing of exercise. As with many drugs, dosing is extremely important to get the beneficial effects of exercise. To this end, the organism adapts to exercise. We review the molecular signalling pathways involved in these adaptations because understanding them is of great importance to be able to prescribe exercise in an appropriate manner. Special attention must be paid to the psychological effects of exercise. These are so powerful that we would like to propose that exercise may be considered as a psychoactive drug. In moderate doses, it causes very pronounced relaxing effects on the majority of the population, but some persons may even become addicted to exercise. Finally, there may be some contraindications to exercise that arise when people are severely ill, and these are described in the final section of the review. Our general conclusion is that exercise is so effective that it should be considered as a drug, but that more attention should be paid to the dosing and to individual variations between patients.

Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder

OBJECTIVE

To compare 2 different treatment approaches, physical therapy modalities, and joint mobilization versus whole-body cryotherapy (WBC) combined with physical therapy modalities and joint mobilization, for symptoms of adhesive capsulitis (AC) of the shoulder.

DESIGN

A randomized trial.

SETTING

Hospital.

PARTICIPANTS

Patients with AC of the shoulder (N=30).

INTERVENTION

Patients were randomly assigned to 2 groups. The WBC group received physical therapy modalities, passive joint mobilization of the shoulder, and WBC, whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder.

MAIN OUTCOME MEASURES

Visual analog scale (VAS), active range of motion (ROM) of flexion, abduction, internal and external rotation of the shoulder, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were measured before and after the intervention.

RESULTS

A statistically significant difference between groups was found for the VAS, active ROM of flexion, abduction, internal rotation, and external rotation, and the ASES with greater improvements in the WBC group (Ps<.01). Overall, both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P<.01.

CONCLUSIONS

There is significant improvement with the addition of WBC to treatment interventions in this sample of patients.

Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study

BACKGROUND

It is well documented that exercise-induced muscle damage (EIMD) decreases muscle function and causes soreness and discomfort. Branched-chain amino acid (BCAA) supplementation has been shown to increase protein synthesis and decrease muscle protein breakdown, however, the effects of BCAAs on recovery from damaging resistance training are unclear. Therefore, the aim of this study was to examine the effects of a BCAA supplementation on markers of muscle damage elicited via a sport specific bout of damaging exercise in trained volunteers.

METHODS

Twelve males (mean ± SD age, 23 ± 2 y; stature, 178.3 ± 3.6 cm and body mass, 79.6 ± 8.4 kg) were randomly assigned to a supplement (n = 6) or placebo (n = 6) group. The damaging exercise consisted of 100 consecutive drop-jumps. Creatine kinase (CK), maximal voluntary contraction (MVC), muscle soreness (DOMS), vertical jump (VJ), thigh circumference (TC) and calf circumference (CC) were measured as markers of muscle damage. All variables were measured immediately before the damaging exercise and at 24, 48, 72 and 96 h post-exercise.

RESULTS

A significant time effect was seen for all variables. There were significant group effects showing a reduction in CK efflux and muscle soreness in the BCAA group compared to the placebo (P<0.05). Furthermore, the recovery of MVC was greater in the BCAA group (P<0.05). The VJ, TC and CC were not different between groups.

CONCLUSION

The present study has shown that BCAA administered before and following damaging resistance exercise reduces indices of muscle damage and accelerates recovery in resistance-trained males. It seems likely that BCAA provided greater bioavailablity of substrate to improve protein synthesis and thereby the extent of secondary muscle damage associated with strenuous resistance exercise.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01529281.

Mechanical strain applied to human fibroblasts differentially regulates skeletal myoblast differentiation

Cyclic short-duration stretches (CSDS) such as those resulting from repetitive motion strain increase the risk of musculoskeletal injury. Myofascial release is a common technique used by clinicians that applies an acyclic long-duration stretch (ALDS) to muscle fascia to repair injury. When subjected to mechanical strain, fibroblasts within muscle fascia secrete IL-6, which has been shown to induce myoblast differentiation, essential for muscle repair. We hypothesize that fibroblasts subjected to ALDS following CSDS induce myoblast differentiation through IL-6. Fibroblast conditioned media and fibroblast-myoblast cocultures were used to test fibroblasts' ability to induce myoblast differentiation. The coculture system applies strain to fibroblasts only but still allows for diffusion of potential differentiation mediators to unstrained myoblasts on coverslips. To determine the role of IL-6, we utilized myoblast unicultures ± IL-6 (0-100 ng/ml) and cocultures ± α-IL-6 (0-200 μg/ml). Untreated uniculture myoblasts served as a negative control. After 96 h, coverslips (n = 6-21) were microscopically analyzed and quantified by blinded observer for differentiation endpoints: myotubes per square millimeter (>3 nuclei/cell), nuclei/myotube, and fusion efficiency (%nuclei within myotubes). The presence of fibroblasts and fibroblast conditioned media significantly enhanced myotube number (P < 0.05). However, in coculture, CSDS applied to fibroblasts did not reproduce this effect. ALDS following CSDS increased myotube number by 78% and fusion efficiency by 96% vs. CSDS alone (P < 0.05). Fibroblasts in coculture increase IL-6 secretion; however, IL-6 secretion did not correlate with enhanced differentiation among strain groups. Exogenous IL-6 in myoblast uniculture failed to induce differentiation. However, α-IL-6 attenuated differentiation in all coculture groups (P < 0.05). Fibroblasts secrete soluble mediators that have profound effects on several measures of myoblast differentiation. Specific biophysical strain patterns modify these outcomes, and suggest that myofascial release after repetitive strain increases myoblast differentiation and thus may improve muscle repair in vivo. Neutralization of IL-6 in coculture significantly reduced differentiation, suggesting fibroblast-IL-6 is necessary but not sufficient in this process.

Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis

INTRODUCTION

Exhaustive and/or unaccustomed exercise, mainly involving eccentric muscle actions, induces temporary muscle damage, evidenced by delayed onset muscle soreness (DOMS) and decreased muscle function. Different strategies to recover from its signs and symptoms have been studied and, as a result, a significant number of articles on this issue have been published.

OBJECTIVE

To assess whether some modalities currently used in physiotherapy such as massage, cryotherapy, stretching and low-intensity exercise are effective for treating the signs and symptoms of exercise-induced muscle damage.

METHODS

Randomized controlled trials (RCTs), written in English or Portuguese, that included physiotherapeutic interventions [i.e., massage, cryotherapy, stretching and low-intensity exercise, on adult human subjects (18-60 years old) of both gender] were searched on electronic databases including MEDLINE, CINHAL, EMBASE, PEDro and SPORTDiscus.

MAIN OUTCOME MEASURES

"Muscle soreness" and "muscle strength" were the outcome measures included in the meta-analysis.

RESULTS

Thirty-five studies were included; nine analysed the effects of massage, 10 examined the effects of cryotherapy, nine investigated the effects of stretching and seven focused on low-intensity exercise intervention. Massage was the only intervention with positive effects, reducing soreness at 24 h, on average, 0.33 on 10 cm visual analog scale (95 percent CI: -0.59, -0.07) and increasing muscle recovery by 1.87 percent (95 percent CI: 0.30, 3.44). Additionally, there is inconclusive evidence to support the use of cryotherapy, while there is little evidence to prove the efficacy of stretching and low-intensity exercise.

CONCLUSION

Massage proved slightly effective in the relief of symptoms and signs of exercise-induced muscle damage. Therefore, its mean effect was too small to be of clinical relevance. There is a lack of evidence to support the use of cryotherapy, stretching and low-intensity exercise.

The use of thermal infrared imaging to assess the efficacy of a therapeutic exercise program in individuals with diabetes

BACKGROUND

Exercise is of great value for individuals with diabetes in helping to control their hemoglobin A1c levels and in increasing their insulin sensitivity. Delayed-onset muscle soreness (DOMS) is a common problem in healthy individuals and in people who have diabetes. People with diabetes are also faced with metabolic and endothelial impairments, which could make DOMS even worse. But because they usually have neuropathies, they may not feel this soreness appropriately, leading to premature return to exercise and causing further injuries.

RESEARCH DESIGN

One hundred eighteen subjects participated in this study and were divided into four groups. Two groups (healthy and diabetes) performed a series of abdominal exercises, and the other two groups (healthy and diabetes) performed a series of arm exercises to induce DOMS. Skin temperature above the muscle was assessed using a thermal infrared camera, and perceived soreness of the exercised muscle was assessed using a 100-mm visual analog scale. Serum myoglobin concentrations were also measured.

RESULTS

There was a significant increase in skin temperature 24 h post-exercise for all four exercise groups (P<0.05), where the combined average increase in skin temperature for all four groups was approximately 0.65°C from baseline. Also, 24 h post-exercise, all four groups were significantly sorer than they were at baseline (P<0.05). Serum myoglobin levels were also significantly higher on day 3 compared with day 1 (P<0.05).

CONCLUSION

Infrared thermal imaging may be a valuable technique of seeing which muscles are sore hours or even days after the exercise is over. Thus, thermal imaging would be an efficient and painless way of looking at DOMS in both healthy individuals and individuals who have diabetes, even if they are facing neurological problems.

The use of thermal infra-red imaging to detect delayed onset muscle soreness

Delayed onset muscle soreness (DOMS), also known as exercise induced muscle damage (EIMD), is commonly experienced in individuals who have been physically inactive for prolonged periods of time, and begin with an unexpected bout of exercise, but can also occur in athletes who exercise beyond their normal limits of training. The symptoms associated with this painful phenomenon can range from slight muscle tenderness, to severe debilitating pain. The intensity of these symptoms and the related discomfort increases within the first 24 hours following the termination of the exercise, and peaks between 24 to 72 hours post exercise. For this reason, DOMS is one of the most common recurrent forms of sports injury that can affect an individual's performance, and become intimidating for many. For the last 3 decades, the DOMS phenomenon has gained a considerable amount of interest amongst researchers and specialists in exercise physiology, sports, and rehabilitation fields. There has been a variety of published studies investigating this painful occurrence in regards to its underlying mechanisms, treatment interventions, and preventive strategies. However, it is evident from the literature that DOMS is not an easy pathology to quantify, as there is a wide amount of variability between the measurement tools and methods used to quantify this condition. It is obvious that no agreement has been made on one best evaluation measure for DOMS, which makes it difficult to verify whether a specific intervention really helps in decreasing the symptoms associated with this type of soreness or not. Thus, DOMS can be seen as somewhat ambiguous, because many studies depend on measuring soreness using a visual analog scale (VAS), which is a subjective rather than an objective measure. Even though needle biopsies of the muscle, and blood levels of myofibre proteins might be considered a gold standard to some, large variations in some of these blood proteins have been documented, in addition to the high risks sometimes associated with invasive techniques. Therefore, in the current investigation, we tested a thermal infra-red (IR) imaging technique of the skin above the exercised muscle to detect the associated muscle soreness. Infra-red thermography has been used, and found to be successful in detecting different types of diseases and infections since the 1950's. But surprisingly, near to nothing has been done on DOMS and changes in skin temperature. The main purpose of this investigation was to examine changes in DOMS using this safe and non-invasive technique.

Potential therapeutic effects of branched-chain amino acids supplementation on resistance exercise-based muscle damage in humans

Branched-chain amino acids (BCAA) supplementation has been considered an interesting nutritional strategy to improve skeletal muscle protein turnover in several conditions. In this context, there is evidence that resistance exercise (RE)-derived biochemical markers of muscle soreness (creatine kinase (CK), aldolase, myoglobin), soreness, and functional strength may be modulated by BCAA supplementation in order to favor of muscle adaptation. However, few studies have investigated such effects in well-controlled conditions in humans. Therefore, the aim of this short report is to describe the potential therapeutic effects of BCAA supplementation on RE-based muscle damage in humans. The main point is that BCAA supplementation may decrease some biochemical markers related with muscle soreness but this does not necessarily reflect on muscle functionality.

Effects of whole-body cryotherapy vs. far-infrared vs. passive modalities on recovery from exercise-induced muscle damage in highly-trained runners

Enhanced recovery following physical activity and exercise-induced muscle damage (EIMD) has become a priority for athletes. Consequently, a number of post-exercise recovery strategies are used, often without scientific evidence of their benefits. Within this framework, the purpose of this study was to test the efficacy of whole body cryotherapy (WBC), far infrared (FIR) or passive (PAS) modalities in hastening muscular recovery within the 48 hours after a simulated trail running race. In 3 non-adjoining weeks, 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized treadmill, designed to induce muscle damage. Immediately (post), post 24 h, and post 48 h after exercise, all participants tested three different recovery modalities (WBC, FIR, PAS) in a random order over the three separate weeks. Markers of muscle damage (maximal isometric muscle strength, plasma creatine kinase [CK] activity and perceived sensations [i.e. pain, tiredness, well-being]) were recorded before, immediately after (post), post 1 h, post 24 h, and post 48 h after exercise. In all testing sessions, the simulated 48 min trail run induced a similar, significant amount of muscle damage. Maximal muscle strength and perceived sensations were recovered after the first WBC session (post 1 h), while recovery took 24 h with FIR, and was not attained through the PAS recovery modality. No differences in plasma CK activity were recorded between conditions. Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from EIMD to a greater extent than FIR or PAS modalities.

Trekking poles reduce exercise-induced muscle injury during mountain walking

Temporary muscle damage precipitated by downhill walking affects muscle function and potentially exposes muscle to further musculoskeletal injury.

PURPOSE

We hypothesized that the use of trekking poles would help maintain muscle function and reduce indices of muscle damage after a day's mountain trekking.

METHODS

Thirty-seven physically active males (n = 26) and females (n = 11) volunteered to participate and were divided into either a trekking pole (TP) or no pole (NP) group. Participants carried a day sack (5.6 ± 1.5 kg) and made the ascent and descent of the highest peak in England and Wales (Mount Snowdon). HR and RPE were recorded during the ascent and descent. Indices of muscle damage, namely, maximal voluntary contraction, muscle soreness, creatine kinase (CK), and vertical jump performance, were measured before, immediately after (except CK), and 24, 48, and 72 h after trek.

RESULTS

HR was not different between groups, although RPE was significantly lower in TP during the ascent. The TP group showed attenuation of reductions in maximal voluntary contraction immediately after and 24 and 48 h after the trek; muscle soreness was significantly lower at 24 and 48 h after the trek, and CK was also lower at 24 h after the trek in the TP group. No differences in vertical jump were found.

CONCLUSIONS

Trekking poles reduce RPE on mountain ascents, reduce indices of muscle damage, assist in maintaining muscle function in the days after a mountain trek, and reduce the potential for subsequent injury.

Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise

The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race. Endurance trained males (n = 11) completed two experimental trials separated by 1 month in a randomized crossover design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise (repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-α), protein C-reactive (CRP) and white blood cells count were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p<0.05). Indeed, IL-1β (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared to PAS. In WBC condition (p<0.05), TNF-α, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines anti-inflammatory.

Mechanical, biochemical, and electromyographic responses to short-term eccentric-concentric knee extensor training in humans

This study examined the effects of short-term eccentric-concentric knee extensor training on mechanical and biochemical variables, myoelectric activity, and muscle soreness. Seventeen men were assigned to either experimental (E, n = 10) or control group (C, n = 7). Group E performed 90 maximal isokinetic eccentric-concentric knee extensor contractions on each of 3 consecutive days (Tr1-Tr3) followed by 1-day rest, and then on 4 more consecutive days (Tr4-Tr7). Peak eccentric torque of each contraction during the training was recorded and averaged for each session (MTr). Maximal isometric torque (M0), eccentric torque (M(ecc)), integrated electromyography (iEMG), plasma creatine kinase (CK), and lactate dehydrogenase (LDH) activities were measured before, immediately, 24, 48, and 72 hours after Tr1, at 1 and 3 days after Tr7. Group C did not train but performed all exercise tests; CK and LDH were measured at 3 time points only. Acutely, M0 and M(ecc) decreased and CK, LDH, and soreness increased more in E than in C 24 hours after Tr1. Chronically, MTr and M0 increased more in E than C by Tr7 and CK, LDH, and muscle soreness gradually decreased by Tr7 whereas iEMG increased more in E than in C after Tr3 through Tr7. High-intensity short-term eccentric-concentric knee extensor exercise training produced immediate reductions in maximal voluntary force. Most likely neural adaptations contributed to rapid recovery and strength adaptations because maximal voluntary force increased by the end of the training protocol in previously trained healthy adults.

Effects of flexibility training on eccentric exercise-induced muscle damage

PURPOSE

This study investigated whether flexibility training would attenuate muscle damage induced by maximal eccentric exercise.

METHODS

Thirty untrained young men were allocated to static stretching (SS), proprioceptive neuromuscular facilitation (PNF), or control group (n = 10 per group). The SS consisted of 30 sets of a 30-s standard SS with a 30-s rest between sets, and the PNF included 5 sets of the 30-s standard SS followed by 3 sets of three "contract-relax-agonist-contract" procedures. These were performed three times a week for 8 wk, and all subjects performed six sets of 10 maximal isokinetic (30°·s) lengthening contractions of the knee flexors after the 8-wk training or 8 wk after the baseline measures (control). Changes in indirect markers of muscle damage before and for 5 d after the eccentric exercise were compared among the groups.

RESULTS

The range of motion (ROM) of the hip joint increased by 25°, and the optimum angle of the knee flexors shifted (P < 0.05) to a longer muscle length by 10° after training, without significant differences between SS and PNF. No significant changes in these variables were evident for the control group. Compared with the control group, the SS and PNF groups showed significantly (P < 0.05) smaller decreases and faster recovery of knee flexor muscle strength and smaller changes in optimum angle, ROM, muscle soreness, and plasma creatine kinase activity and myoglobin concentration without significant differences between the groups. The preeccentric exercise ROM or optimum angle was significantly (P < 0.05) correlated with the changes in the muscle damage markers.

CONCLUSIONS

These results suggest that both SS and PNF training are effective in attenuating eccentric exercise-induced muscle damage and that flexible muscles are less susceptible to the damage.

Efficacy and consequences of very-high-protein diets for athletes and exercisers

Athletes and exercisers have utilised high-protein diets for centuries. The objective of this review is to examine the evidence for the efficacy and potential dangers of high-protein diets. One important factor to consider is the definition of a ‘high-protein diet’. There are several ways to consider protein content of a diet. The composition of the diet can be determined as the absolute amount of the protein (or other nutrient of interest), the % of total energy (calories) as protein and the amount of protein ingested per kg of body weight. Many athletes consume very high amounts of protein. High-protein diets most often are associated with muscle hypertrophy and strength, but now also are advocated for weight loss and recovery from intense exercise or injuries. Prolonged intake of a large amount of protein has been associated with potential dangers, such as bone mineral loss and kidney damage. In otherwise healthy individuals, there is little evidence that high protein intake is dangerous. However, kidney damage may be an issue for individuals with already existing kidney dysfunction. Increased protein intake necessarily means that overall energy intake must increase or consumption of either carbohydrate or fat must decrease. In conclusion, high protein intake may be appropriate for some athletes, but there are potential negative consequences that must be carefully considered before adopting such a diet. In particular, care must be taken to ensure that there is sufficient intake of other nutrients to support the training load.

Study of muscle cell dedifferentiation after skeletal muscle injury of mice with a Cre-Lox system

Background

Dedifferentiation of muscle cells in the tissue of mammals has yet to be observed. One of the challenges facing the study of skeletal muscle cell dedifferentiation is the availability of a reliable model that can confidentially distinguish differentiated cell populations of myotubes and non-fused mononuclear cells, including stem cells that can coexist within the population of cells being studied.

Methodology/Principal Findings

In the current study, we created a Cre/Lox-β-galactosidase system, which can specifically tag differentiated multinuclear myotubes and myotube-generated mononuclear cells based on the activation of the marker gene, β-galactosidase. By using this system in an adult mouse model, we found that β-galactosidase positive mononuclear cells were generated from β-galactosidase positive multinuclear myofibers upon muscle injury. We also demonstrated that these mononuclear cells can develop into a variety of different muscle cell lineages, i.e., myoblasts, satellite cells, and muscle derived stem cells.

Conclusions/Significance

These novel findings demonstrated, for the first time, that cellular dedifferentiation of skeletal muscle cells actually occurs in mammalian skeletal muscle following traumatic injury in vivo.

Oxidative stress, inflammation and recovery of muscle function after damaging exercise: effect of 6-week mixed antioxidant supplementation

There is no consensus regarding the effects of mixed antioxidant vitamin C and/or vitamin E supplementation on oxidative stress responses to exercise and restoration of muscle function. Thirty-eight men were randomly assigned to receive either placebo group (n = 18) or mixed antioxidant (primarily vitamin C & E) supplements (n = 20) in a double-blind manner. After 6 weeks, participants performed 90 min of intermittent shuttle-running. Peak isometric torque of the knee flexors/extensors and range of motion at this joint were determined before and after exercise, with recovery of these variables tracked for up to 168 h post-exercise. Antioxidant supplementation elevated pre-exercise plasma vitamin C (93 ± 8 μmol l(-1)) and vitamin E (11 ± 3 μmol l(-1)) concentrations relative to baseline (P < 0.001) and the placebo group (P ≤ 0.02). Exercise reduced peak isometric torque (i.e. 9-19% relative to baseline; P ≤ 0.001), which persisted for the first 48 h of recovery with no difference between treatment groups. In contrast, changes in the urine concentration of F(2)-isoprostanes responded differently to each treatment (P = 0.04), with a tendency for higher concentrations after 48 h of recovery in the supplemented group (6.2 ± 6.1 vs. 3.7 ± 3.4 ng ml(-1)). Vitamin C & E supplementation also affected serum cortisol concentrations, with an attenuated increase from baseline to the peak values reached after 1 h of recovery compared with the placebo group (P = 0.02) and serum interleukin-6 concentrations were higher after 1 h of recovery in the antioxidant group (11.3 ± 3.4 pg ml(-1)) than the placebo group (6.2 ± 3.8 pg ml(-1); P = 0.05). Combined vitamin C & E supplementation neither reduced markers of oxidative stress or inflammation nor did it facilitate recovery of muscle function after exercise-induced muscle damage.

Effects of resistance training on the inflammatory response

Resistance training (RT) is associated with reduced risk of low grade inflammation related diseases, such as cardiovascular disease and type 2 diabetes. The majority of the data studying cytokines and exercise comes from endurance exercise. In contrast, evidence establishing a relationship between RT and inflammation is more limited. This review focuses on the cytokine responses both following an acute bout, and after chronic RT. In addition, the effect of RT on low grade systemic inflammation such as individuals at risk for type 2 diabetes is reviewed. Cytokines are secreted proteins that influence the survival, proliferation, and differentiation of immune cells and other organ systems. Cytokines function as intracellular signals and almost all cells in the body either secrete them or have cytokine receptors. Thus, understanding cytokine role in a specific physiological situation such as a bout of RT can be exceedingly complex. The overall effect of long term RT appears to ameliorate inflammation, but the specific effects on the inflammatory cytokine, tumor necrosis factor alpha are not clear, requiring further research. Furthermore, it is critical to differentiate between chronically and acute Interleukin-6 levels and its sources. The intensity of the RT and the characteristics of the training protocol may exert singular cytokine responses and as a result different adaptations to exercise. More research is needed in the area of RT in healthy populations, specifically sorting out gender and age RT acute responses. More importantly, studies are needed in obese individuals who are at high risk of developing low grade systemic inflammatory related diseases. Assuring adherence to the RT program is essential to get the benefits after overcoming the first acute RT responses. Hence RT could be an effective way to prevent, and delay low grade systemic inflammatory related diseases.