Molecular regulation of skeletal muscle mitochondrial biogenesis following blood flow-restricted aerobic exercise: a call to action

Mitochondrial and cardiovascular responses to aerobic exercise training in supine and upright positions in healthy young adults: a randomized parallel arm trial

Objectives

Aerobic exercise training can increase skeletal muscle mitochondrial content. Supine exercise training with legs above the heart potentially augments these increases. However, the impact of supine exercise training on mitochondrial biogenesis and cardiovascular adaptations remains unclear.

Methods

In this single-centred, randomized, parallel arm trial, 19 recreationally active individuals underwent seven sessions of either supine with legs up (SUP; n=9, 6 females) or upright with legs down (UP; n=10, 7 females) aerobic training on a recumbent bike at 71 ± 7 % and 71 ± 2 % of peak work rate (WRpeak), respectively. The study aimed to test the effects of training with decreased muscle oxygenation on indices of muscle mitochondrial remodelling. Secondary outcomes included exercise performance, muscle oxygenation, and cardiovascular responses.

Results

Secondary outcomes revealed significant interaction effects for time to fatigue (TTF) and WRpeak in the SUP group during supine testing, suggesting enhanced exercise tolerance and performance. No between group interaction effects were observed for upright testing. No clear effects on mitochondrial biogenesis were observed based on expression of mitochondrial protein subunits and transcriptional regulators. Acutely, HRpeak was lower during the SUP Test compared to the UP Test. No central cardiovascular adaptations were observed following training.

Conclusions

Our exploratory analyses showed that supine aerobic training more effectively improves supine exercise tolerance and performance compared with upright training, despite no differences in measured proteins related to mitochondrial biogenesis. Further research is needed to elucidate the mechanisms underlying these postural-specific training effects.

Registration

clinicaltrials.gov: NCT04151095.

Neurophysiology of ACL Injury

The neurophysiology of ACL injury extends beyond the mechanical rupture of the ligament to encompass profound alterations in the central and peripheral nervous systems, impacting sensorimotor integration and neuromuscular control. The ACL, densely populated with mechanoreceptors, plays a critical role in joint proprioception, dynamically regulating knee stability through complex neural circuits that connect to the spinal cord and brain. When disrupted by injury, these neural pathways contribute to delayed muscular activation, altered motor planning, and compromised joint stability. Such neuromechanical deficits increase the likelihood of reinjury and highlight the need for comprehensive neuroplastic rehabilitation. Neuroplastic therapy, employing tools like external focus strategies, stroboscopic glasses, smartboards, and virtual reality, aims to restore and enhance neural connectivity, sensory integration, and motor coordination. These advanced tools target distinct phases of motor learning, promoting automaticity and resilience in movement patterns. By integrating visual-cognitive, proprioceptive, and reflexive controls, this therapeutic approach not only accelerates recovery but also optimizes performance and reduces the risk of re-injury, representing a paradigm shift in ACL rehabilitation.

Sprint training in hypoxia and with blood flow restriction: Controversies and perspectives

This narrative review assesses the effects of repeated sprint training (RST) in hypoxia (RSH) and blood flow restriction (BFR) methods on skeletal muscle adaptations and performance. Current literature suggests that RSH promotes metabolic modifications in muscle cells, especially driven by reactive oxygen species production, HIF-1α stabilization, and changes in metabolism. Training with BFR promotes metabolite accumulation in working muscles due to limited blood flow, however, cellular mechanisms affected by BFR during RST are less explored. Data highlight that RSH improves repeated sprint ability (RSA) in several sport disciplines (e.g. rugby, tennis, soccer, cross-country skiing). However, recent studies showed that addition of hypoxia or BFR during RST did not promote supplementary benefits on aerobic performance, force-velocity power profile, and V ˙ O 2 max . Nonetheless, gains in V ˙ O 2 max were observed during sprint interval training protocols when BFR was applied during recovery between sets. Finally, recent studies highlighted that RSH can improve RSA in a short period. Thus, RSH and sprint training with BFR may be useful for sports disciplines requiring high glycolytic demand and can promote gains in RSA in a short window. Further studies must be encouraged to better understand the biological consequences of adding such stimuli to exercise, especially BFR, on long-term adaptation.

Risk of bias in exercise science: A systematic review of 340 studies

Risk of bias can contribute to irreproducible science and mislead decision making. Analyses of smaller subsections of the exercise science literature suggest many exercise science studies have unclear or high risk of bias. The current review (osf.io/jznv8) assesses whether this unclear or high risk of bias is more widespread in the exercise science literature and whether this bias has decreased since the publication of the 1996 Consolidated Standards of Reporting Trials (CONSORT) guidelines. We report significant reductions in selection, performance, detection, and reporting biases in 2020 compared with 1995 in the 340 of 5,451 studies assessed using the Cochrane Risk of Bias tool. Despite these improvements, most 2020 studies still had unclear or high risks of bias. These results underscore the need for methodological vigilance, adherence to reporting standards, and education on experimental bias. Factors contributing to these improvements, such advancements in education and journal requirements, remain uncertain.

Single-leg disuse decreases skeletal muscle strength, size, and power in uninjured adults: A systematic review and meta-analysis

We aimed to quantify declines from baseline in lower limb skeletal muscle size and strength of uninjured adults following single-leg disuse. We searched EMBASE, Medline, CINAHL, and CCRCT up to 30 January 2022. Studies were included in the systematic review if they (1) recruited uninjured participants; (2) were an original experimental study; (3) employed a single-leg disuse model; and (4) reported muscle strength, size, or power data following a period of single-leg disuse for at least one group without a countermeasure. Studies were excluded if they (1) did not meet all inclusion criteria; (2) were not in English; (3) reported previously published muscle strength, size, or power data; or (4) could not be sourced from two different libraries, repeated online searches, and the authors. We used the Cochrane Risk of Bias Assessment Tool to assess risk of bias. We then performed random-effects meta-analyses on studies reporting measures of leg extension strength and extensor size. Our search revealed 6548 studies, and 86 were included in our systematic review. Data from 35 and 20 studies were then included in the meta-analyses for measures of leg extensor strength and size, respectively (40 different studies). No meta-analysis for muscle power was performed due to insufficient homogenous data. Effect sizes (Hedges' g_av ) with 95% confidence intervals for leg extensor strength were all durations = -0.80 [-0.92, -0.68] (n = 429 participants; n = 68 aged 40 years or older; n ≥ 78 females); ≤7 days of disuse = -0.57 [-0.75, -0.40] (n = 151); >7 days and ≤14 days = -0.93 [-1.12, -0.74] (n = 206); and >14 days = -0.95 [-1.20, -0.70] (n = 72). Effect sizes for measures of leg extensor size were all durations = -0.41 [-0.51, -0.31] (n = 233; n = 32 aged 40 years or older; n ≥ 42 females); ≤7 days = -0.26 [-0.36, -0.16] (n = 84); >7 days and ≤14 days = -0.49 [-0.67, -0.30] (n = 102); and >14 days = -0.52 [-0.74, -0.30] (n = 47). Decreases in leg extensor strength (cast: -0.94 [-1.30, -0.59] (n = 73); brace: -0.90 [-1.18, -0.63] (n = 106)) and size (cast: -0.61[-0.87, -0.35] (n = 41); brace: (-0.48 [-1.04, 0.07] (n = 41)) following 14 days of disuse did not differ for cast and brace disuse models. Single-leg disuse in adults resulted in a decline in leg extensor strength and size that reached a nadir beyond 14 days. Bracing and casting led to similar declines in leg extensor strength and size following 14 days of disuse. Studies including females and males and adults over 40 years of age are lacking.

Estrogen signaling as a bridge between the nucleus and mitochondria in cardiovascular diseases

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide. Epidemiological studies indicate that pre-menopausal women are more protected against the development of CVDs compared to men of the same age. This effect is attributed to the action/effects of sex steroid hormones on the cardiovascular system. In this context, estrogen modulates cardiovascular function in physiological and pathological conditions, being one of the main physiological cardioprotective agents. Here we describe the common pathways and mechanisms by which estrogens modulate the retrograde and anterograde communication between the nucleus and mitochondria, highlighting the role of genomic and non-genomic pathways mediated by estrogen receptors. Additionally, we discuss the presumable role of bromodomain-containing protein 4 (BRD4) in enhancing mitochondrial biogenesis and function in different CVD models and how this protein could act as a master regulator of estrogen protective activity. Altogether, this review focuses on estrogenic control in gene expression and molecular pathways, how this activity governs nucleus-mitochondria communication, and its projection for a future generation of strategies in CVDs treatment.

Muscle Deoxygenation Rates and Reoxygenation Modeling During a Sprint Interval Training Exercise Performed Under Different Hypoxic Conditions

This study compared the kinetics of muscle deoxygenation and reoxygenation during a sprint interval protocol performed under four modalities: blood flow restriction at 60% of the resting femoral artery occlusive pressure (BFR), gravity-induced BFR (G-BFR), simulated hypoxia (FiO2≈13%, HYP) and normoxia (NOR). Thirteen healthy men performed each session composed of five all-out 30-s efforts interspaced with 4 min of passive recovery. Total work during the exercises was 17 ± 3.4, 15.8 ± 2.9, 16.7 ± 3.4, and 18.0 ± 3.0 kJ for BFR, G-BFR, HYP and NOR, respectively. Muscle oxygenation was continuously measured with near-infrared spectroscopy. Tissue saturation index (TSI) was modelled with a linear function at the beginning of the sprint and reoxygenation during recovery with an exponential function. Results showed that both models were adjusted to the TSI (R2 = 0.98 and 0.95, respectively). Greater deoxygenation rates were observed in NOR compared to BFR (p = 0.028). No difference was found between the conditions for the deoxygenation rates relative to sprint total work (p > 0.05). Concerning reoxygenation, the amplitude of the exponential was not different among conditions (p > 0.05). The time delay of reoxygenation was longer in BFR compared to the other conditions (p < 0.05). A longer time constant was found for G-BFR compared to the other conditions (p < 0.05), and mean response time was longer for BFR and G-BFR. Finally, sprint performance was correlated with faster reoxygenation. Hence, deoxygenation rates were not different between the conditions when expressed relatively to total sprint work. Furthermore, BFR conditions impair reoxygenation: BFR delays and G-BFR slows down reoxygenation.

Mechanical, Cardiorespiratory, and Muscular Oxygenation Responses to Sprint Interval Exercises Under Different Hypoxic Conditions in Healthy Moderately Trained Men

Objective: The aim of this study was to determine the effects of sprint interval exercises (SIT) conducted under different conditions (hypoxia and blood flow restriction [BFR]) on mechanical, cardiorespiratory, and muscular O₂ extraction responses.

Methods: For this purpose, 13 healthy moderately trained men completed five bouts of 30 s all-out exercises interspaced by 4 min resting periods with lower limb bilateral BFR at 60% of the femoral artery occlusive pressure (BFR₆₀) during the first 2 min of recovery, with gravity-induced BFR (pedaling in supine position; G-BFR), in a hypoxic chamber (FiO₂≈13%; HYP) or without additional stress (NOR). Peak and average power, time to achieve peak power, rating of perceived exertion (RPE), and a fatigue index (FI) were analyzed. Gas exchanges and muscular oxygenation were measured by metabolic cart and NIRS, respectively. Heart rate (HR) and peripheral oxygen saturation (SpO₂) were continuously recorded.

Results: Regarding mechanical responses, peak and average power decreased after each sprint (p < 0.001) excepting between sprints four and five. Time to reach peak power increased between the three first sprints and sprint number five (p < 0.001). RPE increased throughout the exercises (p < 0.001). Of note, peak and average power, time to achieve peak power and RPE were lower in G-BFR (p < 0.001). Results also showed that SpO₂ decreased in the last sprints for all the conditions and was lower for HYP (p < 0.001). In addition, Δ[O₂Hb] increased in the last two sprints (p < 0.001). Concerning cardiorespiratory parameters, BFR₆₀ application induced a decrease in gas exchange rates, which increased after its release compared to the other conditions (p < 0.001). Moreover, muscle blood concentration was higher for BFR₆₀ (p < 0.001). Importantly, average and peak oxygen consumption and muscular oxyhemoglobin availability during sprints decreased for HYP (p < 0.001). Finally, the tissue saturation index was lower in G-BFR.

Conclusions: Thus, SIT associated with G-BFR displayed lower mechanical, cardiorespiratory responses, and skeletal muscle oxygenation than the other conditions. Exercise with BFR₆₀ promotes higher blood accumulation within working muscles, suggesting that BFR₆₀ may additionally affect cellular stress. In addition, HYP and G-BFR induced local hypoxia with higher levels for G-BFR when considering both exercise bouts and recovery periods.

Effects of Blood Flow Restriction on O2 Muscle Extraction and O2 Pulmonary Uptake Kinetics During Heavy Exercise

This study aimed to determine the effects of three levels of blood flow restriction (BFR) onV ˙ O 2 and O 2 extraction kinetics during heavy cycling exercise transitions. Twelve healthy trained males completed two bouts of 10 min heavy intensity exercise without BFR (CON), with 40% or 50% BFR (BFR40 and BFR50, respectively).V ˙ O 2 and tissue saturation index (TSI) were continuously measured and modelled using multiexponential functions. The time constant of theV ˙ O 2 primary phase was significantly slowed in BFR40 (26.4 ± 2.0s; p < 0.001) and BFR50 (27.1 ± 2.1s; p = 0.001) compared to CON (19.0 ± 1.1s). The amplitude of theV ˙ O 2 slow component was significantly increased (p < 0.001) with BFR in a pressure-dependent manner 3.6 ± 0.7, 6.7 ± 0.9 and 9.7 ± 1.0 ml·min-1·kg-1 for CON, BFR40, and BFR50, respectively. While no acceleration of the primary component of the TSI kinetics was observed, there was an increase (p < 0.001) of the phase 3 amplitude with BFR (CON -0.8 ± 0.3% VS BFR40 -2.9 ± 0.9%, CON VS BFR50 -2.8 ± 0.8%). It may be speculated that BFR applied during cycling exercise in the heavy intensity domain shifted the working muscles to an O 2 dependent situation. The acceleration of the extraction kinetics could have reached a plateau, hence not permitting compensation for the slowdown of the blood flow kinetics, and slowingV ˙ O 2 kinetics.

Perceived Barriers to Blood Flow Restriction Training

Blood flow restriction (BFR) training is increasing in popularity in the fitness and rehabilitation settings due to its role in optimizing muscle mass and strength as well as cardiovascular capacity, function, and a host of other benefits. However, despite the interest in this area of research, there are likely some perceived barriers that practitioners must overcome to effectively implement this modality into practice. These barriers include determining BFR training pressures, access to appropriate BFR training technologies for relevant demographics based on the current evidence, a comprehensive and systematic approach to medical screening for safe practice and strategies to mitigate excessive perceptual demands of BFR training to foster long-term compliance. This manuscript attempts to discuss each of these barriers and provides evidence-based strategies and direction to guide clinical practice and future research.