Neural Adaptations to Resistive Exercise

Effective therapeutic exercise prescription: the right exercise at the right dose

The prescription of an effective therapeutic exercise program requires the right dosage of the right exercise, at the right time for that patient. The therapist must understand and apply training principles effectively in the presence of pathology, injury, or otherwise unhealthy tissue. The intervention goal is to close the gap between current performance and the desired goal or capacity. Although there may be a preferred linear path from current performance to optimal outcome, complexities of the human body, internal factors, and external variables may create barriers to this direct path. Successful programs include key program design considerations such as ensuring a stable baseline before progression, treating the right impairments and activity limitations, understanding contextual factors, considering the principles of specificity and optimal loading, and applying dosing principles. Program progression can be achieved through increases in total exercise volume and/or through manipulation of exercise challenges at the same exercise volume. Effective application of these principles will guide patients toward their goals as quickly and efficiently as possible.

Atrophy/hypertrophy cell signaling in muscles of young athletes trained with vibrational-proprioceptive stimulation

OBJECTIVE

To compare the effects of isokinetic (ISO-K) and vibrational-proprioceptive (VIB) trainings on muscle mass and strength.

METHODS

In 29 ISO-K- or VIB-trained young athletes we evaluated: force, muscle fiber morphometry, and gene expression of muscle atrophy/hypertrophy cell signaling.

RESULTS

VIB training increased the maximal isometric unilateral leg extension force by 48·1%. ISO-K training improved the force by 24·8%. Both improvements were statistically significant (P⩿0·01). The more functional effectiveness of the VIB training in comparison with the ISO-K training was shown by the statistical significance changes only in VIB group in: rate of force development in time segment 0-50 ms (P<0·001), squat jump (P<0·05) and 30-m acceleration running test (P<0·05). VIB training induced a highly significant increase of mean diameter of fast fiber (+9%, P<0·001), but not of slow muscle fibers (-3%, not significant). No neural cell adhesion molecule-positive (N-CAM(+)) and embryonic myosin heavy chain-positive (MHC-emb(+)) myofibers were detected. VIB induced a significant twofold increase (P<0·05) of the skeletal muscle isoform insulin-like growth factor-1 (IGF-1) Ec mRNA. Atrogin-1 and muscle ring finger-1 (MuRF-1) did not change, but myostatin was strongly downregulated after VIB training (P<0·001). Peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) expression increased in post-training groups, but only in VIB reached statistical significance (+228%, P<0·05).

DISCUSSION

We demonstrated that both trainings are effective and do not induce muscle damage. Only VIB-trained group showed statistical significance increase of hypertrophy cell signaling pathways (IGF-1Ec and PGC-1α upregulation, and myostatin downregulation) leading to hypertrophy of fast twitch muscle fibers.

Lack of muscle contractile property changes at the time of perceived physical exhaustion suggests central mechanisms contributing to early motor task failure in patients with cancer-related fatigue

CONTEXT

Fatigue is one of the most common symptoms reported by cancer survivors, and fatigue worsens when patients are engaged in muscle exertion, which results in early motor task failure. Central fatigue plays a significant role, more than muscle (peripheral) fatigue, in contributing to early task failure in cancer-related fatigue (CRF).

OBJECTIVES

The purpose of this study was to determine if muscle contractile property alterations (reflecting muscle fatigue) occurred at the end of a low-intensity muscle contraction to exhaustion and if these properties differed between those with CRF and healthy controls.

METHODS

Ten patients (aged 59.9±10.6 years, seven women) with advanced solid cancer and CRF and 12 age- and gender-matched healthy controls (aged 46.6±12.8 years, nine women) performed a sustained contraction of the right arm elbow flexion at 30% maximal level until exhaustion. Peak twitch force, time to peak twitch force, rate of peak twitch force development, and half relaxation time derived from electrical stimulation-evoked twitches were analyzed pre- and post-sustained contraction.

RESULTS

CRF patients reported significantly greater fatigue as measured by the Brief Fatigue Inventory and failed the motor task earlier, 340±140 vs. 503±155 seconds in controls. All contractile property parameters did not change significantly in CRF but did change significantly in controls.

CONCLUSION

CRF patients perceive physical exhaustion sooner during a motor fatigue task with minimal muscular fatigue. The observation supports that central fatigue is a more significant factor than peripheral fatigue in causing fatigue feelings and limits motor function in cancer survivors with fatigue symptoms.

Impact of vitamin D supplementation during a resistance training intervention on body composition, muscle function, and glucose tolerance in overweight and obese adults

BACKGROUND & AIMS

The impact of vitamin D supplementation in overweight and obese adults during resistance training on body composition, muscle function, and glucose tolerance was investigated.

METHODS

Twenty-three overweight and obese (age: 26.1±4.7 y; BMI: 31.3±3.2 kg/m(2); 25-hydroxyvitamin D: 19.3±7.2 ng/mL) adults were recruited for participation in a double-blind, placebo-controlled trial. Participants were randomly divided into vitamin D (VitD, 4000 IU/d; 5 females, 5 males) and placebo (PL; 7 females, 6 males) groups. Both groups completed 12 weeks of resistance training. 25-hydroxyvitamin D, parathyroid hormone, body composition, and glucose tolerance were assessed at baseline and 12 weeks. Muscle function (strength and power) was assessed at baseline, 4, 8, and 12 weeks.

RESULTS

During the intervention, 25-hydroxyvitamin D increased and parathyroid hormone decreased in the VitD group (P<0.05). Peak power was significantly increased at 4 weeks in the VitD group only (P<0.05). Regression analysis revealed an inverse association between the change in 25-hydroxyvitamin D with the change in waist-to-hip ratio (R(2)=0.205, P=0.02). No other improvements were observed with supplementation.

CONCLUSIONS

Vitamin D supplementation in overweight and obese adults during resistance training induced an early improvement in peak power, and elevated vitamin D status was associated with reduced waist-to-hip ratio.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01199926.

Transcranial magnetic stimulation in sport science: a commentary

The aim of this commentary is to provide a brief overview of transcranial magnetic stimulation (TMS) and highlight how this technique can be used to investigate the acute and chronic responses of the central nervous system to exercise. We characterise the neuromuscular responses to TMS and discuss how these measures can be used to investigate the mechanisms of fatigue in response to locomotor exercise. We also discuss how TMS might be used to study the corticospinal adaptations to resistance exercise training, with particular emphasis on the responses to shortening/lengthening contractions and contralateral training. The limited data to date suggest that TMS is a valuable technique for exploring the mechanisms of central fatigue and neural adaptation.

Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: a randomized controlled trial

BACKGROUND

Quadriceps femoris muscle (QFM) weakness is a feature of knee osteoarthritis (OA) and exercise programs that strengthen this muscle group can improve function, disability and pain. Traditional supervised resistance exercise is however resource intensive and dependent on good adherence which can be challenging to achieve in patients with significant knee OA. Because of the limitations of traditional exercise programs, interest has been shown in the use of neuromuscular electrical stimulation (NMES) to strengthen the QFM. We conducted a single-blind, prospective randomized controlled study to compare the effects of home-based resistance training (RT) and NMES on patients with moderate to severe knee OA.

METHODS

41 patients aged 55 to 75 years were randomised to 6 week programs of RT, NMES or a control group receiving standard care. The primary outcome was functional capacity measured using a walk test, stair climb test and chair rise test. Additional outcomes were self-reported disability, quadriceps strength and cross-sectional area. Outcomes were assessed pre- and post-intervention and at 6 weeks post-intervention (weeks 1, 8 and 14 respectively).

RESULTS

There were similar, significant improvements in functional capacity for the RT and NMES groups at week 8 compared to week 1 (p ≤ 0.001) and compared to the control group (p < 0.005), and the improvements were maintained at week 14 (p ≤ 0.001). Cross sectional area of the QFM increased in both training groups (NMES: +5.4%; RT: +4.3%; p = 0.404). Adherence was 91% and 83% in the NMES and RT groups respectively (p = 0.324).

CONCLUSIONS

Home-based NMES is an acceptable alternative to exercise therapy in the management of knee OA, producing similar improvements in functional capacity.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN85231954.

Long-term effects of pelvic floor muscle training with vaginal cone in post-menopausal women with urinary incontinence: a randomized controlled trial

AIMS

The findings are limited about the long-term effects of treatment with vaginal cones in women with stress urinary incontinence (SUI). The aim of this study was to investigate the long-term effects of vaginal cones and pelvic floor muscle training in post-menopausal women with SUI.

METHODS

This randomized controlled trial included 45 post-menopausal women with SUI. They were randomly allocated in three groups: vaginal cones (VC, n = 15), pelvic floor muscle training (PFMT, n = 15), and control group (CG, n = 15). Women in VC and PFMT groups were treated for 6 weeks with twice weekly sessions. Women in VC group carried out the pelvic floor muscle strengthening with vaginal cones. The CG did not receive any treatment during the corresponding time. Women were evaluated before treatment, at the end, 3 and 12 months after treatment completion for primary outcome (urinary leakage) and secondary outcomes (pelvic floor muscle strength, quality of life, satisfaction with treatment, and continuity of training).

RESULTS

There was a significant decrease of urinary leakage in the VC and PFMT group comparing values at the end of treatment, 3 and 12 months to baseline values. There were no differences between VC and PFMT group in primary outcome in any evaluations.

CONCLUSIONS

Treatments with and without vaginal cones can promote positive long-term effects on urinary leakage, pelvic floor muscle strength and quality of life in post-menopausal women with SUI in 6 weeks.

Specificity of training in the lingual musculature

PURPOSE

Training specificity for a number of exercise parameters has been demonstrated for the limb musculature. The current study is a Phase I exploration of training specificity in the lingual musculature.

METHOD

Twenty-five healthy participants were assigned to 1 of 5 training conditions. Four groups completed 4 weeks of lingual exercise targeting strength, endurance, power, or speed; a control group did not exercise. Performance measures of strength, endurance, power, and speed were obtained before and after training.

RESULTS

Although statistically significant group effects were not detected, specificity was observed with respect to effect size for the performance variables of strength, endurance, and power. Further evidence of specificity was provided by the finding that training isotonic endurance did not increase performance on an isometric endurance task. Speed training did not improve performance on any of the outcome measures, nor did speed increase following training with any of the exercises.

CONCLUSIONS

The findings provide initial evidence that training specificity may be observed in the lingual musculature. The reported effect sizes can inform future studies examining the benefit of training muscle functions underlying speech and swallowing.

Training mode-dependent changes in motor performance in neck pain

OBJECTIVE

To determine whether changes in motor performance after a course of exercise in patients with mechanical neck pain (MNP) were dependent on the primary behavioral demand of the exercise performed.

DESIGN

Randomized controlled trial.

SETTING

University laboratory.

PARTICIPANTS

Volunteers (N=60; 35 women, 25 men; mean age, 37.9y) with chronic MNP participated in the study.

INTERVENTION

Exercise targeted to improve cervical motor performance including endurance training (ETr; n=20), coordination training (CTr; n=20), and active mobility training (n=20).

MAIN OUTCOME MEASURES

Changes in the cervical motor performance domains of strength, endurance, coordination, and active mobility were evaluated immediately after the 10-week training program, and at a 26-week follow-up.

RESULTS

Between-group comparisons revealed significantly greater gains in endurance (P<.02) by the ETr group, and significantly greater gains in coordination (P<.01) by the CTr group. All 3 groups had improvement in pain (P<.01) and disability (P<.01).

CONCLUSIONS

Changes in motor performance in individuals with MNP in response to an exercise program were dependent on the specific mode of exercise performed, with minimal improvement in other domains of motor performance.

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: a randomized controlled trial

OBJECTIVE

Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals.

METHODS

Twenty-seven healthy untrained volunteers participated in a randomized controlled trial of quadriceps strengthening (3 times per week for 8 weeks). Participants were randomized to perform resistance training either during pain induced by injections of painful hypertonic saline (pain group, n = 13) or during a nonpainful control condition with injection of isotonic saline (control group, n = 14) into the infrapatellar fat pad. The primary outcome measure was change in maximal isokinetic muscle strength in knee extension/flexion (60, 120, and 180 degrees/second).

RESULTS

The group who exercised with pain had a significantly larger improvement in isokinetic muscle strength at all angular velocities of knee extension compared to the control group. In knee flexion there were improvements in isokinetic muscle strength in both groups with no between-group differences.

CONCLUSION

Experimental knee joint pain improved the training-induced gain in muscle strength following 8 weeks of quadriceps training. It remains to be studied whether knee joint pain has a positive effect on strength gain in patients with knee pathology.

Physical function predicts improvement in quality of life in elderly Icelanders after 12 weeks of resistance exercise

BACKGROUND

Little is known about the effects of resistance training on health related quality of life (HRQL) in the elderly.

AIM

The main purpose of the study was to investigate the effects of resistance training on strength, body composition, functional capacity and HRQL in independent living elderly people. We hypothesised that resistance training would improve lean mass, muscle strength, physical function and HRQL.

METHODS

Subjects (N = 237, 73.7±5.7 yrs, 58.2% female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) designed to increase strength and muscle mass of major muscle groups. Body composition, quadriceps- and grip strength, timed up and go test (TUG), six minute walk for distance (6MW) and HRQL were measured at baseline and endpoint.

RESULTS

Two hundred-and-four participants completed the study. Although the increase in lean mass was small (+0.8 kg, P<0.01), quadriceps strength (+53.5 N), grip strength (+3.0 lb), TUG (-0.6 sec), 6MW (+33.6 m) and HRQL (+1.2 t-score) improved significantly (all P<0.01). Changes in 6MW predicted improvement in HRQL after 12 weeks.

CONCLUSIONS

Our study shows that a 12-week resistance exercise program significantly improves lean mass, muscle strength, physical function and HRQL in elderly individuals, and that improvements in physical function predict improvements in HRQL. Our study indicates that resistance training should be promoted for the elderly as it has the potential to improve physical performance, thereby prolonging healthy, independent aging.

Repeated-sprint ability - part II: recommendations for training

Short-duration sprints, interspersed with brief recoveries, are common during most team sports. The ability to produce the best possible average sprint performance over a series of sprints (≤10 seconds), separated by short (≤60 seconds) recovery periods has been termed repeated-sprint ability (RSA). RSA is therefore an important fitness requirement of team-sport athletes, and it is important to better understand training strategies that can improve this fitness component. Surprisingly, however, there has been little research about the best training methods to improve RSA. In the absence of strong scientific evidence, two principal training theories have emerged. One is based on the concept of training specificity and maintains that the best way to train RSA is to perform repeated sprints. The second proposes that training interventions that target the main factors limiting RSA may be a more effective approach. The aim of this review (Part II) is to critically analyse training strategies to improve both RSA and the underlying factors responsible for fatigue during repeated sprints (see Part I of the preceding companion article). This review has highlighted that there is not one type of training that can be recommended to best improve RSA and all of the factors believed to be responsible for performance decrements during repeated-sprint tasks. This is not surprising, as RSA is a complex fitness component that depends on both metabolic (e.g. oxidative capacity, phosphocreatine recovery and H+ buffering) and neural factors (e.g. muscle activation and recruitment strategies) among others. While different training strategies can be used in order to improve each of these potential limiting factors, and in turn RSA, two key recommendations emerge from this review; it is important to include (i) some training to improve single-sprint performance (e.g. 'traditional' sprint training and strength/power training); and (ii) some high-intensity (80-90% maximal oxygen consumption) interval training to best improve the ability to recover between sprints. Further research is required to establish whether it is best to develop these qualities separately, or whether they can be developed concurrently (without interference effects). While research has identified a correlation between RSA and total sprint distance during soccer, future studies need to address whether training-induced changes in RSA also produce changes in match physical performance.

Short-term isokinetic training versus isotonic training: effects on asymmetry in strength of thigh muscles

The aim of this study was to investigate the effects of two training protocols on the isokinetic performance of athletes. The study was conducted in 38 athletes, (age 23.3 ± 3.6 years) participating in national level leagues of different sports, whose initial concentric hamstrings-to-quadriceps (conH/Q) torque ratio was lower than 0.5. During seasonal testing, an isokinetic measurement of knee extensors and flexors was performed at 60°/s. The athletes were divided into two groups. Nineteen athletes performed the isokinetic training protocol (IT) while the second group of 19 athletes followed the isotonic training protocol (RT). Both protocols lasted 4 weeks. After completing the training protocols, both groups underwent a final isokinetic testing. The isokinetic data revealed significant increases after training in measures of peak torque in both extensor and flexor muscle groups, in both the IT and RT study groups (p < 0.05). There were significant increases (p< 0.05) in conH/Q ratio in both groups after the implemented protocols, but greater in IT group. Consequently, applied IT protocol induced changes in working muscles, thereby restoring detected asymmetry to an acceptable balance more efficiently compared to RT protocol.

Progressive resistance exercise and Parkinson's disease: a review of potential mechanisms

This paper reviews the therapeutically beneficial effects of progressive resistance exercise (PRE) on Parkinson's disease (PD). First, this paper discusses the rationale for PRE in PD. Within the first section, the review discusses the central mechanisms that underlie bradykinesia and muscle weakness, highlights findings related to the central changes that accompany PRE in healthy individuals, and extends these findings to individuals with PD. It then illustrates the hypothesized positive effects of PRE on nigro-striatal-thalamo-cortical activation and connectivity. Second, it reviews recent findings of the use of PRE in individuals with PD. Finally, knowledge gaps of using PRE on individuals with PD are discussed along with suggestions for future research.

Effects of training on the estimation of muscular moment in submaximal exercise

The purpose of this study was to observe the effects of a submaximal isometric training program on estimation capacity at 25, 50, and 75% of maximal contraction in isometric action and at two angular velocities. The second purpose was to study the variability of isometric action. To achieve these purposes, participants carried out an isokinetic extension movement of the dominant lower limb during six test sessions and nine training sessions. Following the training program, estimation capacity in the different actions did not improve. However an improvement in performance was observed with a reduction in the variability of submaximal isometric actions. The proprioceptors activated in isometric action seemed to adapt to the training program itself which would promote better adaptation by a greater solicitation of internal feedback.

Effect of head and neck position on outcome of quantitative neuromuscular diagnostic techniques in Warmblood riding horses directly following moderate exercise

REASONS FOR PERFORMING STUDY

There has been growing interest in training techniques with respect to the head and neck position (HNP) of the equine athlete. Little is known about the influence of HNP on neuromuscular transmission in neck muscles.

OBJECTIVE

To test the hypothesis that different HNPs have effect on single fibre (SF), quantitative electromyographic (QEMG) examination and muscle enzyme activity directly after moderate exercise.

METHODS

Seven Warmblood horses were studied using a standard exercise protocol in 5 HNPs: HNP1: unrestrained; HNP2: neck raised; bridge of nose around the vertical; HNP4: neck lowered and considerably flexed, bridge of nose pointing towards the chest; HNP5: neck raised and considerably extended; bridge of nose in front of the vertical; HNP7: neck lowered and flexed; bridge of nose pointing towards the carpus. Mean consecutive difference (MCD) of single muscle fibre potentials and motor unit action potential (MUP) variables (amplitude, duration, area, turns and phases) were recorded in each fixed position directly after exercise at rest using commercial EMG equipment. Muscle enzyme activity was measured before and 4, 6 and 24 h after exercise.

RESULTS

Mean consecutive difference in all HNPs was higher than in HNP1 (22 µs, P < 0.001) of which HNP4 was highest with 39 µs compared to 30 µs in HNP2 (P = 0.04); MCD in HNP 5,7 was with 25 µs lower than in HNP 2 and 4 (P < 0.001). Odds ratio for MCD suggestive for conduction delay or block was 13.6 in HNP4 compared to HNP1 (P < 0.001). Motion unit action potential variables followed the same pattern as MCD. Lactate dehydrogenase (LDH) activity increased in HNP4 at 4 h (P = 0.014), 6 h (P = 0.017) and 24 h (P = 0.038) post exercise and in HNP5 and HNP7 at 4 h (P = 0.037; 0.029).

CONCLUSIONS AND CLINICAL RELEVANCE

HNP4 in particular leads to a higher rise in LDH activity, MCD and MUP variables, indicating that HNPs have effect on variables characterising neuromuscular functionality.

Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial

BACKGROUND

Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aimed at increasing the muscle mass are lacking. Objective, participants and intervention: This randomized controlled trial was performed to evaluate the effect of a high-intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments, and living in residential care facilities.

DESIGN

Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink. A bioelectrical impedance spectrometer (BIS) was used in the evaluation. The amount of muscle mass and body weight (BW) were followed-up at three and six months and analyzed in a 2 x 2 factorial ANCOVA, using the intention to treat principle, and controlling for baseline values.

RESULTS

At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group. No interaction effects were seen between the exercise and nutritional intervention. Long-term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up.

CONCLUSION

A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass. There were negative long-term effects on muscle mass and BW, indicating that it is probably necessary to compensate for an increased energy demand when offering a high-intensity exercise program.

Early neural responses to strength training

The neural adaptations that accompany strength training have yet to be fully determined. Here we sought to address this topic by testing the idea that strength training might share similar mechanisms with some forms of motor learning. Since ballistic motor learning is accompanied by a shift in muscle twitches induced by transcranial magnetic stimulation (TMS) toward the training direction, we sought to investigate if these changes also occur after single isometric strength training sessions with various contraction duration and rate of force development characteristics (i.e., brief or sustained ballistic contractions or slow, sustained contractions). Twitch force resultant vectors and motor-evoked potentials (MEPs) induced by TMS were measured before and after single sessions of strength training involving the forearm muscles. Participants ( n = 12) each performed three training protocols (each consisting of 4 sets of 10 repetitions) and served as their own control in a counterbalanced order. All three training protocols caused a significant ( P < 0.05) shift in TMS-induced twitch force resultant vectors toward the training direction, followed by a gradual shift back toward the pretraining direction. The strongest effect was found when training involved both ballistic and sustained force components. There were no large or consistent changes in the direction of twitches evoked by motor nerve stimulation for any of the three training protocols. We suggest that these early neural responses to strength training, which share similar corticospinal changes to motor learning, might reflect an important process that precedes more long-term neural adaptation that ultimately enhance strength.

Activation of selected shoulder muscles during unilateral wall and bench press tasks under submaximal isometric effort

STUDY DESIGN

Controlled laboratory study.

OBJECTIVE

To assess the activation of 7 shoulder muscles under 2 closed kinetic chain (CKC) tasks for the upper extremity using submaximal isometric effort, thus providing relative quantification of muscular isometric effort for these muscles across the CKC exercises, which may be applied to rehabilitation protocols for individuals with shoulder weakness.

BACKGROUND

CKC exercises favor joint congruence, reduce shear load, and promote joint dynamic stability. Additionally, knowledge about glenohumeral and periscapular muscle activity elicited during CKC exercises may help clinicians to design protocols for shoulder rehabilitation.

METHODS

Using surface electromyography, activation level was measured across 7 shoulder muscles in 20 healthy males, during the performance of a submaximal isometric wall press and bench press. Signals were normalized to the maximal voluntary isometric contraction, and, using paired t tests, data were analyzed between the exercises for each muscle.

RESULTS

Compared to the wall press, the bench press elicited higher activity for most muscles, except for the upper trapezius. Levels of activity were usually low but were above 20% maximal voluntary isometric contraction for the serratus anterior on both tasks, and for the long head triceps brachii on the bench press.

CONCLUSIONS

Both the bench press and wall press, as performed in this study, led to relatively low EMG activation levels for the muscles measured and may be considered for use in the early phases of rehabilitation.

Neural adaptations to electrical stimulation strength training

This review provides evidence for the hypothesis that electrostimulation strength training (EST) increases the force of a maximal voluntary contraction (MVC) through neural adaptations in healthy skeletal muscle. Although electrical stimulation and voluntary effort activate muscle differently, there is substantial evidence to suggest that EST modifies the excitability of specific neural paths and such adaptations contribute to the increases in MVC force. Similar to strength training with voluntary contractions, EST increases MVC force after only a few sessions with some changes in muscle biochemistry but without overt muscle hypertrophy. There is some mixed evidence for spinal neural adaptations in the form of an increase in the amplitude of the interpolated twitch and in the amplitude of the volitional wave, with less evidence for changes in spinal excitability. Cross-sectional and exercise studies also suggest that the barrage of sensory and nociceptive inputs acts at the cortical level and can modify the motor cortical output and interhemispheric paths. The data suggest that neural adaptations mediate initial increases in MVC force after short-term EST.

Non-invasive physiological monitoring of exercise and fitness

OBJECTIVE

To review the current research of new emerging diagnostic technology for non-invasive physiological monitoring of exercise and fitness. As a personal trainer, I believe that exercise can improve the conditions of several diseases and/or events such as stroke, post-traumatic head injury, spinal cord injury, and a multitude of other diseases. This compilation of information will allow health care providers tools of a non-invasive manner to promote healing and health that go beyond the initial event. Allowing patients continued managed care beyond what is believed to be their plateau.

MATERIAL AND METHOD

Review science-based research involving non-invasive technology, including cardiovascular evaluations: heart rate monitors, near-infrared spectroscopy, blood pressure, and electrocardiography; motor capabilities: surface electromyography and manual testers, i.e. dynamometer, and digital and video photography; radiological monitoring: magnetic resonance imaging, three-dimensional computer tomography, and laser Doppler.

RESULTS

This investigation has found that a new approach should be implemented for non-invasive physiological monitoring of exercise and fitness through development and utilization across a wide variety of equipment, and monitoring technology. This non-invasive methodology will not only motivate but encourage individuals to begin and remain compliant with an exercise program allowing a variety of health care providers to assist in patient care.

DISCUSSION

We need to shift the paradigm from taking care of the sick to maintaining the health of our patients. This can be accomplished with non-invasive evaluation, tracking, and monitoring tools. Many of the suggestions for monitoring are used in a clinical setting rather than a general fitness environment. These monitoring tests need to be economical as well as available for continual re-evaluation.

The effects of exercise for the prevention of overuse anterior knee pain: a randomized controlled trial

BACKGROUND

Anterior knee pain (AKP) is the most common activity-related injury of the knee. The authors investigated the effect of an exercise intervention on the incidence of AKP in UK army recruits undergoing a 14-week physically arduous training program.

HYPOTHESIS

Modifying military training to include targeted preventative exercises may reduce the incidence of AKP in a young recruit population.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

A single-blind cluster randomized controlled trial was performed in 39 male and 11 female training groups (median age: 19.7 years; interquartile range, 17-25) undergoing phase 1 of army recruit training. Each group was randomly assigned to either an intervention (n = 759) or control (n = 743) protocol. The intervention consisted of 4 strengthening and 4 stretching exercises completed during supervised physical training lessons (7 per week). The control group followed the existing training syllabus warm-up exercises. The primary outcome was a diagnosis of AKP during the 14-week training program.

RESULTS

Forty-six participants (3.1%; 95% confidence interval [CI], 2.3-4.1) were diagnosed with AKP. There were 36 (4.8%; 95%CI, 3.5-6.7) new cases of AKP in the control group and 10 (1.3%; 0.7-2.4) in the intervention group. There was a 75% reduction in AKP risk in the intervention group (unadjusted hazard ratio = 0.25; 95% CI, 0.13-0.52; P < .001). Three participants (0.4%) from the intervention group were discharged from the military for medical reasons compared to 25 (3.4%) in the control group.

CONCLUSION

A simple set of lower limb stretching and strengthening exercises resulted in a substantial and safe reduction in the incidence of AKP in a young military population undertaking a physical conditioning program. Such exercises could also be beneficial for preventing this common injury among nonmilitary participants in recreational physical activity.

The potential neural mechanisms of acute indirect vibration

There is strong evidence to suggest that acute indirect vibration acts on muscle to enhance force, power, flexibility, balance and proprioception suggesting neural enhancement. Nevertheless, the neural mechanism(s) of vibration and its potentiating effect have received little attention. One proposal suggests that spinal reflexes enhance muscle contraction through a reflex activity known as tonic vibration stretch reflex (TVR), which increases muscle activation. However, TVR is based on direct, brief, and high frequency vibration (>100 Hz) which differs to indirect vibration, which is applied to the whole body or body parts at lower vibration frequency (5-45 Hz). Likewise, muscle tuning and neuromuscular aspects are other candidate mechanisms used to explain the vibration phenomenon. But there is much debate in terms of identifying which neural mechanism(s) are responsible for acute vibration; due to a number of studies using various vibration testing protocols. These protocols include: different methods of application, vibration variables, training duration, exercise types and a range of population groups. Therefore, the neural mechanism of acute vibration remain equivocal, but spinal reflexes, muscle tuning and neuromuscular aspects are all viable factors that may contribute in different ways to increasing muscular performance. Additional research is encouraged to determine which neural mechanism(s) and their contributions are responsible for acute vibration. Testing variables and vibration applications need to be standardised before reaching a consensus on which neural mechanism(s) occur during and post-vibration. Key pointsThere is strong evidence to suggest that acute indirect vibration acts on muscle to enhance force, power, flexibility, balance and proprioception, but little attention has been given to the neural mechanism(s) of acute indirect vibration.Current findings suggest that acute vibration exposure may cause a neural response, but there is little consensus on identifying which neural mechanism(s) are specifically responsible. This is due to a number of studies using various vibration testing protocols (i.e.varying frequencies, amplitudes, durations, and methods of application).Spinal reflexes, muscle tuning and neuromuscular aspects and central motor command are all viable neuromechanical factors that may contribute at different stages to transiently increasing muscular performance.Additional research is encouraged to determine when (pre, during and post) the different neural mechanism(s) respond to direct and indirect vibration stimuli.

Neuromuscular Responses to Platform Perturbations in Power-Versus Endurance-Trained Athletes

The purpose was to assess differences in postural response characteristics between two groups of elite athletes having power or endurance training. Participants were all men and included power- ( M age = 21 yr., SD = 3, n = 12) and endurance-trained ( M age = 22, SD = 3, n = 12) athletes. Muscle response characteristics and center of pressure measures were recorded during recovery from Fast (10 cm at 80 cm/sec.) and Slow (10 cm at 20 cm/sec.) horizontal platform perturbations. In response to Fast perturbations, power-trained athletes responded with significantly shorter times to stabilize the center of pressure, shorter muscle-contraction onset times, and larger muscle response amplitudes than endurance-trained athletes. This suggests power-trained athletes are more effective than endurance-trained athletes in responding to balance threats such as slips and trips in daily life and that power training should be studied to improve balance control of balance-impaired populations.

Bilateral neuromuscular plasticity from unilateral training of the ankle dorsiflexors

Training a muscle group in one limb yields strength gains bilaterally-the so-called cross-education effect. However, to date there has been little study of the targeted application of this phenomenon in a manner relevant to clinical rehabilitation. For example, it may be applicable post-stroke, where hemiparesis leads to ankle flexor weakness. The purpose of this study was to examine the effects of high-intensity unilateral dorsiflexion resistance training on agonist (tibialis anterior, TA) and antagonist (plantarflexor soleus, SOL) muscular strength and H-reflex excitability in the trained and untrained limbs. Ankle flexor and extensor torque, as well as SOL and TA H-reflexes evoked during low-level contraction, were measured before and after 5 weeks of dorsiflexion training (n = 19). As a result of the intervention, dorsiflexor maximal voluntary isometric contraction force (MVIC) significantly increased (P < 0.05) in both the trained and untrained limbs by 14.7 and 8.4%, respectively. No changes in plantarflexor MVIC force were observed in either limb. Significant changes in H-reflex excitability threshold were also detected: H(@thresh) significantly increased in the trained TA and SOL; and H(@max) decreased in both SOL muscles. These findings reveal that muscular crossed effects can be obtained in the ankle dorsiflexor muscles and provide novel information on agonist and antagonist spinal adaptations that accompany unilateral training. It is possible that the ability to strengthen the ankle dorsiflexors bilaterally could be applied in post-stroke rehabilitation, where ankle flexor weakness could be counteracted via dorsiflexor training in the less-affected limb.

Motor unit behavior during submaximal contractions following six weeks of either endurance or strength training

The study investigated changes in motor output and motor unit behavior following 6 wk of either strength or endurance training programs commonly used in conditioning and rehabilitation. Twenty-seven sedentary healthy men (age, 26.1 ± 3.9 yr; mean ± SD) were randomly assigned to strength training (ST; n = 9), endurance training (ET; n = 10), or a control group (CT; n = 8). Maximum voluntary contraction (MVC), time to task failure (isometric contraction at 30% MVC), and rate of force development (RFD) of the quadriceps were measured before ( week 0), during ( week 3), and after a training program of 6 wk. In each experimental session, surface and intramuscular EMG signals were recorded from the vastus medialis obliquus and vastus lateralis muscles during isometric knee extension at 10 and 30% MVC. After 6 wk of training, MVC and RFD increased in the ST group (17.5 ± 7.5 and 33.3 ± 15.9%, respectively; P < 0.05), whereas time to task failure was prolonged in the ET group (29.7 ± 13.4%; P < 0.05). The surface EMG amplitude at 30% MVC force increased with training in both groups, but the training-induced changes in motor unit discharge rates differed between groups. After endurance training, the motor unit discharge rate at 30% MVC decreased from 11.3 ± 1.3 to 10.1 ± 1.1 pulses per second (pps; P < 0.05) in the vasti muscles, whereas after strength training it increased from 11.4 ± 1.2 to 12.7 ± 1.3 pps ( P < 0.05). Finally, motor unit conduction velocity during the contractions at 30% MVC increased for both the ST and ET groups, but only after 6 wk of training ( P < 0.05). In conclusion, these strength and endurance training programs elicit opposite adjustments in motor unit discharge rates but similar changes in muscle fiber conduction velocity.

Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial

Objective: To determine whether sensory transcutaneous electrical nerve stimulation (TENS) augmented with therapeutic exercise and worn for daily activities for four weeks would alter peak gait kinetics and kinematics, compared with placebo electrical stimulation and exercise, and exercise only.

Design: Randomized controlled trial.

Setting: Motion analysis laboratory.

Subjects: Thirty-six participants with radiographically assessed knee osteoarthritis and volitional quadriceps activation below 90% were randomly assigned to electrical stimulation, placebo and comparison (exercise-only) groups.

Interventions: Participants in all three groups completed a four-week quadriceps strengthening programme directed by an experienced rehabilitation clinician. Active electrical stimulation units and placebo units were worn in the electrical stimulation and placebo groups throughout the rehabilitation sessions as well as during all activities of daily living.

Main measures: Peak external knee flexion moment and angle during stance phase were analysed at a comfortable walking speed before and after the intervention.

Findings: Comfortable walking speed increased for all groups over time (TENS 1.16 ± 0.15 versus 1.32 ± 0.16 m/s; placebo 1.21 ± 0.34 versus 1.3 ± 0.24 m/s; comparison 1.27 ± 0.18 versus 1.5 ± 0.14 m/s), yet no group differences in speed were found. No differences were found for peak flexion moment or angle between groups overtime.

Conclusions: TENS in conjunction with therapeutic exercise does not seem to affect peak flexion moment and angle during stance over a four-week period in participants with tibiofemoral osteoarthritis.

Improvements in dynamic plantar flexor strength after resistance training are associated with increased voluntary activation and V-to-M ratio

The aim of this study was to investigate if, and via what mechanisms, resistance training of the plantar flexor muscles affects voluntary activation during maximal voluntary eccentric and concentric muscle actions. Twenty healthy subjects were randomized into a resistance training group ( n = 9) or a passive control group ( n = 11). Training consisted of 15 sessions of unilateral mainly eccentric plantar flexor exercise over a 5-wk period. During pre- and posttraining testing, dynamic plantar flexor strength was measured and voluntary activation was calculated using the twitch interpolation technique. The soleus Hoffman reflex (H-reflex) was used to assess motoneurone excitability and presynaptic inhibition of Ia afferents, whereas the soleus V-wave was used to test for changes in both presynaptic inhibition of Ia afferents and supraspinal inputs to the motoneurone pool. H-reflexes, V-waves, supramaximal M-waves, and twitches were evoked as the foot was moved at 5°/s through an angle of 90° during passive ankle rotations (passive H-relexes and M-waves) and during maximal voluntary concentric and eccentric plantar flexions [maximal voluntary contraction (MVC) H-reflexes, M-waves, and V-waves]. Training induced significant improvements in plantar flexor strength and voluntary activation during both concentric and eccentric maximal voluntary actions. Soleus passive and MVC H-to-M ratios remained unchanged after training, whereas the soleus V-to-M ratio was increased during both concentric and eccentric contractions after training. No changes were found in the control group for any of the parameters. The enhanced voluntary strength could be attributed partly to an increase in voluntary activation induced by eccentric training. Since the passive and MVC H-to-M ratios remained unchanged, the increase in activation is probably not due to decreased presynaptic inhibition. The increased V-to-M ratio for both action types indicates that increased voluntary drive from supraspinal centers and/or modulation in afferents other than Ia afferents may have contributed to such an increase in voluntary activation.

A mathematical model of neuromuscular adaptation to resistance training and its application in a computer simulation of accommodating loads

A large corpus of data obtained by means of empirical study of neuromuscular adaptation is currently of limited use to athletes and their coaches. One of the reasons lies in the unclear direct practical utility of many individual trials. This paper introduces a mathematical model of adaptation to resistance training, which derives its elements from physiological fundamentals on the one side, and empirical findings on the other. The key element of the proposed model is what is here termed the athlete's capability profile. This is a generalization of length and velocity dependent force production characteristics of individual muscles, to an exercise with arbitrary biomechanics. The capability profile, a two-dimensional function over the capability plane, plays the central role in the proposed model of the training-adaptation feedback loop. Together with a dynamic model of resistance the capability profile is used in the model's predictive stage when exercise performance is simulated using a numerical approximation of differential equations of motion. Simulation results are used to infer the adaptational stimulus, which manifests itself through a fed back modification of the capability profile. It is shown how empirical evidence of exercise specificity can be formulated mathematically and integrated in this framework. A detailed description of the proposed model is followed by examples of its application-new insights into the effects of accommodating loading for powerlifting are demonstrated. This is followed by a discussion of the limitations of the proposed model and an overview of avenues for future work.

Resistive vibration exercise attenuates bone and muscle atrophy in 56 days of bed rest: biochemical markers of bone metabolism

During and after prolonged bed rest, changes in bone metabolic markers occur within 3 days. Resistive vibration exercise during bed rest impedes bone loss and restricts increases in bone resorption markers whilst increasing bone formation.

INTRODUCTION

To investigate the effectiveness of a resistive vibration exercise (RVE) countermeasure during prolonged bed rest using serum markers of bone metabolism and whole-body dual X-ray absorptiometry (DXA) as endpoints.

METHODS

Twenty healthy male subjects underwent 8 weeks of bed rest with 12 months follow-up. Ten subjects performed RVE. Blood drawings and DXA measures were conducted regularly during and after bed rest.

RESULTS

Bone resorption increased in the CTRL group with a less severe increase in the RVE group (p = 0.0004). Bone formation markers increased in the RVE group but decreased marginally in the CTRL group (p < 0.0001). At the end of bed rest, the CTRL group showed significant loss in leg bone mass (-1.8(0.9)%, p = 0.042) whereas the RVE group did not (-0.7(0.8)%, p = 0.405) although the difference between the groups was not significant (p = 0.12).

CONCLUSIONS

The results suggest the countermeasure restricts increases in bone resorption, increased bone formation, and reduced bone loss during bed rest.

Resistance training induces supraspinal adaptations: evidence from movement-related cortical potentials

Early effects of a resistance training program include neural adaptations at multiple levels of the neuraxis, but direct evidence of central changes is lacking. Plasticity exhibited by multiple supraspinal centers following training may alter slow negative electroencephalographic activity, referred to as movement-related cortical potentials (MRCP). The purpose of this study was to determine whether MRCPs are altered in response to resistance training. Eleven healthy participants (24.6 +/- 3.5 years) performed 3 weeks of explosive unilateral leg extensor resistance training. MRCP were assessed during 60 self-paced leg extensions against a constant nominal load before and after training. Resistance training was effective (P < 0.001) in increasing leg extensor peak force (+22%), rate of force production (+32%) as well as muscle activity (iEMG; +47%, P < 0.05). These changes were accompanied by several MRCP effects. Following training, MRCP amplitude was attenuated at several scalp sites overlying motor-related cortical areas (P < 0.05), and the onset of MRCP at the vertex was 28% (561 ms) earlier. In conclusion, the 3-week training protocol in the present study elicited significant strength gains which were accompanied by neural adaptations at the level of the cortex. We interpret our findings of attenuated cortical demand for submaximal voluntary movement as evidence for enhanced neural economy as a result of resistance training.

Sarcopenia--mechanisms and treatments

BACKGROUND

Sarcopenia is a consequence of aging. This atrophic event is responsible for decrease in strength and associated functional deficits seen in the aging adult.

PURPOSE

This paper reviews: (1) the mechanisms contributing to sarcopenia, (2) the impact of age-related changes in muscle composition on 3 processes integral to muscle function, (3) the efficacy of pharmaceuticals and over-the-counter nutritional supplements in the management of sarcopenia, (4) experimental use of pharmaceutical regulation of myostatin to increase muscle mass and strength in animal models, and (5) efficacy of resistance training as a means of maintaining or recovering muscle mass and strength.

METHODS

PubMed was searched for relevant research articles using the following descriptors: sarcopenia, aging, muscle mass, muscle performance, muscle strength, myostatin, testosterone, growth hormone, dehydroepiandrosterone, hormone replacement, nutrition, resistance training, and endurance training.

RESULTS

Sarcopenia is mediated by multiple mechanisms, including alpha-motor neuron death, altered hormone concentrations, increased inflammation, and altered nutritional status. Age-related changes within muscle likely affect processes integral to muscle function. These changes negatively influence muscle performance directly or by contributing to sarcopenia. Pharmaceutical or supplement interventions to treat sarcopenia have not proved encouraging to date, either lacking or providing limited efficacy, along with the potential for negative health consequences. In contrast, resistance training has proven safe and highly effective for increasing muscle mass and strength in aging adults.

CONCLUSION

Sarcopenia is a multifactorial consequence of aging that will affect many adults. Resistance training is the most effective and safe intervention to attenuate or recover some of the loss of muscle mass and strength that accompanies aging.

Comparison between linear and daily undulating periodized resistance training to increase strength

To determine the most effective periodization model for strength and hypertrophy is an important step for strength and conditioning professionals. The aim of this study was to compare the effects of linear (LP) and daily undulating periodized (DUP) resistance training on body composition and maximal strength levels. Forty men aged 21.5 +/- 8.3 and with a minimum 1-year strength training experience were assigned to an LP (n = 20) or DUP group (n = 20). Subjects were tested for maximal strength in bench press, leg press 45 degrees, and arm curl (1 repetition maximum [RM]) at baseline (T1), after 8 weeks (T2), and after 12 weeks of training (T3). Increases of 18.2 and 25.08% in bench press 1 RM were observed for LP and DUP groups in T3 compared with T1, respectively (p < or = 0.05). In leg press 45 degrees , LP group exhibited an increase of 24.71% and DUP of 40.61% at T3 compared with T1. Additionally, DUP showed an increase of 12.23% at T2 compared with T1 and 25.48% at T3 compared with T2. For the arm curl exercise, LP group increased 14.15% and DUP 23.53% at T3 when compared with T1. An increase of 20% was also found at T2 when compared with T1, for DUP. Although the DUP group increased strength the most in all exercises, no statistical differences were found between groups. In conclusion, undulating periodized strength training induced higher increases in maximal strength than the linear model in strength-trained men. For maximizing strength increases, daily intensity and volume variations were more effective than weekly variations.

Seventy-year-old habitual volleyball players have larger tibial cross-sectional area and may be differentiated from their age-matched peers by the osteogenic index in dynamic performance

The osteogenicity of a given exercise may be estimated by calculating an osteogenic index (OI) consisting of magnitude and rate of strain. Volleyball involves repetitive jumping and requires high power output and thus may be expected to be beneficial to bone and performance. The purpose of the present study was to examine if habitual volleyball playing is reflected in OI. Ten elderly habitual volleyball players [age 69.9 (SD 4.4) years] and ten matched controls volunteered [age 69.7 (4.2) years] as subjects. Distal tibia (d), tibial mid-shaft (50) and femoral neck (FN) bone characteristics were measured using pQCT and DXA. To estimate skeletal rigidity, cross-sectional area (ToA(50)), and compressive (BSI(d)) and bending strength indices (SSImax(50)) were calculated. Maximal performance was assessed with eccentric ankle plantar flexion, isometric leg press and countermovement jump (CMJ). A fast Fourier transform (FFT) was calculated from the acceleration of the center of mass during the CMJ. Maximal acceleration (MAG) and mean magnitude frequency (MMF) were selected to represent the constituents of OI. OI was calculated as the sum of the products of magnitudes and corresponding frequencies. Volleyball players had 7% larger ToA(50) and 37% higher power in CMJ, 15% higher MAG and 36% higher OI (P <or= 0.047) than the matched controls. No difference was observed in leg press, plantar flexion or the MMF (P >or= 0.646). In conclusion, habitual volleyball players may be differentiated from their matched peers by their dynamic jumping performance, and the differences are reflected in the magnitude but not rate of loading.

The effect of strength training and short-term detraining on maximum force and the rate of force development of older men

This study examined the effect of strength training (ST) and short-term detraining on maximum force and rate of force development (RFD) in previously sedentary, healthy older men. Twenty-four older men (70-80 years) were randomly assigned to a ST group (n = 12) and C group (control, n = 12). Training consisted of three sets of six to ten repetitions on an incline squat at 70-90% of one repetition maximum three times per week for 16 weeks followed by 4 weeks of detraining. Regional muscle mass was assessed before and after training by dual-energy X-ray absorptiometry. Training increased RFD, maximum bilateral isometric force, and force in 500 ms, upper leg muscle mass and strength above pre-training values (14, 25, 22, 7, 90%, respectively; P < 0.05). After 4 weeks detraining all neuromuscular variables were significantly (P < 0.05) lower than after 16 weeks training but remained significantly (P < 0.05) higher than pre-training levels except for RFD which had returned to pre-training levels. These findings demonstrate that high-intensity ST can improve maximum force and RFD of older men. However, older individuals may lose some neuromuscular performance after a period of short-term detraining and that resistance exercise should be performed on a regular basis to maintain training adaptations.