Acute Effects of Training Loads on Muscle Damage Markers and Performance in Semi-elite and Elite Athletes: A Systematic Review and Meta-analysis

Superset Versus Traditional Resistance Training Prescriptions: A Systematic Review and Meta-analysis Exploring Acute and Chronic Effects on Mechanical, Metabolic, and Perceptual Variables

BACKGROUND

Supersets are a time-efficient resistance training (RT) method that involve the sequencing of two exercises with little or no rest between them. However, despite their common implementation during RT, a comprehensive and quantitative review is still lacking.

OBJECTIVES

The primary aim of this systematic review and meta-analysis was to compare the acute and chronic effects of superset and traditional set prescriptions on mechanical, metabolic, and perceptual variables. We also aimed to conduct subgroup analyses to determine the effect of different types of supersets (agonist-antagonist, similar biomechanical, and alternate peripheral supersets).

METHODS

A systematic literature search was conducted in PubMed, Web of Science, Embase, and EBSCO databases from inception to 10 February 2024. Studies written in English and meeting our inclusion criteria were included. Pooled meta-analysis and subgroup meta-analysis were performed using a random-effects model.

RESULTS

Nineteen studies involving 313 participants were included. Although there was considerable variance in certain outcomes, our estimated effects suggested that, compared with traditional set prescription, supersets allow for (1) a similar total number of repetitions [standardized mean differences (SMD) =  - 0.03; p = 0.92] and volume load (SMD = 0.05; p = 0.86) with a shorter session duration and increased training efficiency (SMD = 1.74; p = 0.01); (2) higher blood lactate concentration during (SMD = 0.94; p = 0.03) and after (SMD = 1.13; p < 0.01) RT; (3) higher energy cost during RT (SMD = 1.93; p = 0.04); (4) similar creatine kinase concentration after RT (SMD = 0.22; p = 0.36), surface electromyography (SMD = 0.01; p = 0.98), acute muscle swelling (SMD = - 0.28; p = 0.36) and blood pressure (systolic blood pressure [SMD = 0.08; p = 0.71], diastolic blood pressure [SMD = - 0.05; p = 0.85], and mean arterial pressure [SMD = - 0.03; p = 0.88]); (5) higher rating of perceived exertion (SMD = 0.77; p = 0.02) and similar perceived recovery (SMD = 0.32; p = 0.33); and (6) similar chronic adaptations in maximal strength (SMD = 0.10; p = 0.36), strength endurance (SMD = 0.07; p = 0.81), and muscle hypertrophy (SMD =  - 0.05; p = 0.87). The subgroup analysis revealed that utilizing agonist-antagonist supersets leads to a significant increase in the number of repetitions that are able to be completed compared with traditional sets (SMD = 0.68; p = 0.01). Similar biomechanical supersets led to less volume load (SMD =  - 1.08; p < 0.01) compared with traditional sets.

CONCLUSIONS

Supersets provide a time-efficient alternative to traditional RT, reducing session duration without compromising training volume, muscle activation, perceived recovery, or chronic adaptations in maximal strength, strength endurance, and muscle hypertrophy. Thus, supersets can be effectively implemented by athletes with busy schedules and RT enthusiasts whose main barrier to exercise is time. However, it should be noted that supersets generally induce higher internal loads, more severe muscle damage, and increased perceived exertion, potentially necessitating extended recovery times between sessions. Additionally, superset RT may have a similar potential to traditional RT in eliciting post-exercise hypotension. Regarding different types of supersets, agonist-antagonist supersets are more suitable for maintaining training volume, while similar biomechanical supersets concentrate stimulation on the same muscle group, compromising volume load.

PROTOCOL REGISTRATION

The original protocol for this review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) in December 2023 (CRD42023491533).

The effect of eccentric arm cycling on muscle damage and injury-related biomarkers

PURPOSE

There is a scarcity of information regarding the effect of upper-body eccentric exercise on biomarkers of muscle damage. This study sought to investigate the effect of eccentric arm cycling on muscle damage [exercise-induced muscle damage (EIMD)].

METHOD

Ten subjects performed a 15 min eccentric arm cycling protocol (cadence 49 ± 7 rpm, power absorbed 248 ± 34 W). Maximal voluntary contraction (MVC) of the elbow flexors was evaluated at rest and at 5 min, 24 h, and 48 h post-exercise. In addition, blood samples were drawn at rest and thereafter at 30 min, 24 h, and 48 h intervals after exercise for quantification of creatine kinase (CK), myoglobin, lactate dehydrogenase (LDH) and endothelin (ET-1) concentrations. Delayed onset muscle soreness (DOMS) was assessed using a category ratio scale (0-10).

RESULTS

Myoglobin was increased from baseline at 30 min post-exercise (+114%, 46.08 ± 22.17 µg/L, p = 0.018). Individual peak values were higher than baseline values for CK (+72.8%, 204 ± 138 U/L, p = 0.046) and LDH (+17%, 3.3 ± 0.88 nmole/min/mL, p = 0.017), but not for ET-1 (+9%, 1.4 ± 0.48 pg/mL, p = 0.45). DOMS was reported at 24 h (median 4) and 48 h (median 4) post-exercise and MVC of the elbow flexors were reduced from baseline (216 ± 44 N) at 5 min (-34%, 147 ± 61 N, p < 0.001), 24 h (-17%, 181 ± 56 N, p = 0.005) and 48 h (-9%, 191 ± 54 N, p = 0.003).

CONCLUSION

Eccentric arm cycling incites EIMD with reduced MVC and elevation of myoglobin, CK and LDH.

Inflammation and cognitive performance in elite athletes: A cross-sectional study

Functional cognition is relevant for athletic success and interdependent with physical exercise, yet despite repeatedly demonstrated inflammatory responses to physical training, there are no studies addressing the relationship between cognition and inflammation in athletes. The aim of this study was to investigate the relationship between cognitive performance and selected inflammatory, and further physiological biomarkers in elite athletes. Data from 350 elite athletes regarding cognitive performance (processing speed, selective attention, working memory, cognitive flexibility), systemic inflammatory markers, metabolic hormones, growth factors, tissue damage markers, and micronutrients (e.g., ferritin, 25-OH-vitamin D), as well as physiological, subjective ratings of recovery and stress were analysed by correlative and multiple regression analyses. Results show that across all athletes variance in processing speed, selective attention, and working memory, could be best explained through a combination of metabolic hormones with physiological and psychological indicators of stress, and in cognitive flexibility through vitamin D levels. Only for the subgroup of athletes from closed-skill sports, the ratio TNF-α:IL-10 significantly contributed to explanation of variance in working memory and cognitive flexibility. In general, found correlations point to the importance of inflammatory balance and sufficient long-term nutrient supply for unaffected cognitive performance.

Does the Repeated-Bout Effect Influence Post-Activation Performance Enhancement in Recreational Runners?

Purpose: This study examined how a low dose of an eccentric-oriented lunge exercise could induce the repeated-bout effect (RBE) and affect the subsequent post-activation performance enhancement (PAPE) in recreational runners. Methods: Twenty male recreational runners (32.1 ± 2.8 years; 173.4 ± 6.1 cm; 73.3 ± 11.5 kg; 57.8 ± 7.2 mL·kg-1·min-1) were divided into control (N = 10) and experimental (N = 10) groups. In the first and fourth weeks, the groups were assessed for jump capacity, dynamic balance, and submaximal running kinematics before and after an incremental shuttle-run test until exhaustion. The experimental group was also submitted to two sessions of the eccentric-oriented lunge exercise (3 sets of 10 repetitions with 2 min of passive recovery) in the second and third weeks. Results: We observed that the first session promoted muscle damage, which was significantly (p < .05) reduced after the second training session, thus indicating an RBE. Meanwhile, there was no effect of the RBE on dynamic balance and submaximal running kinematics in the post-intervention. However, there was a significant increase in countermovement jump height (p = .008) for the experimental group when compared to the control group, although no PAPE was observed. Conclusions: The current results demonstrate that a simple, low-dose eccentric-oriented exercise may induce an RBE, leading to reduced muscle damage and a possibly improved lower limbs' muscle power in recreational runners. However, the absence of PAPE effects suggests that the RBE may not directly influence the potentiation/fatigue balance after fatiguing running exercises.

Acute Response to Training after Returning from the Off-Season in Elite Rugby League Athletes

The purposes of this study were to quantify the physiological response to the initial two-week preseason period in elite male rugby league (RL) athletes, and to determine if a repeated bout effect (RBE) occurs. Eighteen RL players were monitored for the initial two-week preseason period. Blood samples were collected on days (D)1, D2, D4, D5, D8, D9, D11 and D12 to measure creatine kinase (CK). Neuromuscular power was assessed on D1, D5, D8 and D12. During field-based sessions, the external training load was quantified using global positioning system technology, whilst the internal load was quantified using the training impulse and the session rating of perceived exertion. Resistance-based gym session volume was quantified by total repetitions x weight lifted. Perceived measures of fatigue and muscle soreness were assessed on all training days. Two-way (day x week) repeated measures analysis of variance and Bonferroni's corrected post-hoc tests identified significant changes. There were no significant changes in CK activity (649.2 ± 255.0 vs. 673.8 ± 299.1 µL; p = 0.63) or internal training load measures from week 1 to week 2. External training load measures including total distance (4138.1 ± 198.4 vs. 4525.0 ± 169.2 m; p < 0.001) and repeated high-intensity efforts (12.6 ± 1.8 vs. 17.5 ± 1.8 au; p < 0.001) significantly increased in week 2 compared to week 1. Internal training loads and CK activity did not change in response to an increase in external training loads during the initial preseason. The current results provide support for a 'real world' perspective of the RBE phenomenon that may be more applicable for team sport practitioners.

Association between Gray-Scale Ultrasound Imaging and Serological Creatine Kinase for Quantifying Exercise-Induced Muscle Damage: An Observational Study

Limited evidence has verified if ultrasound imaging (US) can detect post-exercise muscle damage based on size, shape, and brightness metrics. This study aimed to analyze the correlation between creatine kinase (CK) concentration and (as a biomarker of muscle damage) changes in US gray-scale metrics after an exercise-induced muscle damage protocol. An observational study was conducted at a private university lab located in Madrid. Twenty-five untrained and asymptomatic volunteers were enrolled in this study. Baseline demographic data and body composition metrics were collected. In addition, the rectus femoris US data and CK concentration were assessed at baseline and after inducing muscle damage (24 and 48 h later). After calculating time differences for all the outcomes, the correlation between the changes observed with US and biomarkers was assessed. Significant CK concentration increases were found 24 h (p = 0.003) and 48 h (p < 0.001) after exercise. However, no significant changes in muscle size, shape, or brightness were found in any location (p > 0.05 for all). In addition, no significant associations were found between CK changes and US changes (p > 0.05 for all). Gray-scale US is not a sensitive tool for detecting muscle damage, as a protocol of exercise-induced muscle damage confirmed with CK produced no significant gray-scale US changes after 24 or 48 h. In addition, US and CK changes after 24 and 48 h were not associated with each other.

The Repeated Bout Effect of Multiarticular Exercises on Muscle Damage Markers and Physical Performances: A Systematic Review and Meta-Analyses

ABSTRACT

Doma, K, Matoso, B, Protzen, G, Singh, U, and Boullosa, D. The repeated bout effect of multiarticular exercises on muscle damage markers and physical performances: a systematic review and meta-analyses. J Strength Cond Res 37(12): 2504-2515, 2023-This systematic review and meta-analysis compared muscle damage markers and physical performance measures between 2 bouts of multiarticular exercises and determined whether intensity and volume of muscle-damaging exercises affected the outcomes. The eligibility criteria consisted of (a) healthy male and female adults; (b) multiarticular exercises to cause muscle damage across 2 bouts; (c) outcome measures were compared at 24-48 hours after the first and second bouts of muscle-damaging exercise; (d) at least one of the following outcome measures: creatine kinase (CK), delayed onset of muscle soreness (DOMS), muscle strength, and running economy. Study appraisal was conducted using the Kmet tool, whereas forest plots were derived to calculate standardized mean differences (SMDs) and statistical significance and alpha set a 0.05. After screening, 20 studies were included. The levels of DOMS and CK were significantly greater during the first bout when compared with the second bout at T24 and T48 (p < 0.001; SMD = 0.51-1.23). Muscular strength and vertical jump performance were significantly lower during the first bout compared with the second bout at T24 and T48 (p ≤ 0.05; SMD = -0.27 to -0.40), whereas oxygen consumption and rating of perceived exertion were significantly greater during the first bout at T24 and T48 (p < 0.05; SMD = 0.28-0.65) during running economy protocols. The meta-analyses were unaffected by changes in intensity and volume of muscle-damaging exercises between bouts. Multiarticular exercises exhibited a repeated bout effect, suggesting that a single bout of commonly performed exercises involving eccentric contractions may provide protection against exercise-induced muscle damage for subsequent bouts.

Intravenous Injection of Sodium Hyaluronate Diminishes Basal Inflammatory Gene Expression in Equine Skeletal Muscle

Following strenuous exercise, skeletal muscle experiences an acute inflammatory state that initiates the repair process. Systemic hyaluronic acid (HA) is injected to horses routinely as a joint anti-inflammatory. To gain insight into the effects of HA on skeletal muscle, adult Thoroughbred geldings (n = 6) were injected with a commercial HA product weekly for 3 weeks prior to performing a submaximal exercise test. Gluteal muscle (GM) biopsies were obtained before and 1 h after exercise for gene expression analysis and HA localization. The results from RNA sequencing demonstrate differences in gene expression between non-injected controls (CON; n = 6) and HA horses. Prior to exercise, HA horses contained fewer (p < 0.05) transcripts associated with leukocyte activity and cytokine production than CON. The performance of exercise resulted in the upregulation (p < 0.05) of several cytokine genes and their signaling intermediates, indicating that HA does not suppress the normal inflammatory response to exercise. The transcript abundance for marker genes of neutrophils (NCF2) and macrophages (CD163) was greater (p < 0.05) post-exercise and was unaffected by HA injection. The anti-inflammatory effects of HA on muscle are indirect as no differences (p > 0.05) in the relative amount of the macromolecule was observed between the CON and HA fiber extracellular matrix (ECM). However, exercise tended (p = 0.10) to cause an increase in ECM size suggestive of muscle damage and remodeling. The finding was supported by the increased (p < 0.05) expression of CTGF, TGFβ1, MMP9, TIMP4 and Col4A1. Collectively, the results validate HA as an anti-inflammatory aid that does not disrupt the normal post-exercise muscle repair process.

The Effects of Pre-conditioning on Exercise-Induced Muscle Damage: A Systematic Review and Meta-analysis

BACKGROUND

Several studies have utilised isometric, eccentric and downhill walking pre-conditioning as a strategy for alleviating the signs and symptoms of exercise-induced muscle damage (EIMD) following a bout of damaging physical activity.

OBJECTIVES

This systematic review and meta-analysis examined the effects of pre-conditioning strategies on indices of muscle damage and physical performance measures following a second bout of strenuous physical activity.

DATA SOURCES

PubMed, CINAHL and Scopus.

ELIGIBILITY CRITERIA

Studies meeting the PICO (population, intervention/exposure, comparison, and outcome) criteria were included in this review: (1) general population or "untrained" participants with no contraindications affecting physical performance; (2) studies with a parallel design to examine the prevention and severity of muscle-damaging contractions; (3) outcome measures were compared using baseline and post-intervention measures; and (4) outcome measures included any markers of indirect muscle damage and muscular contractility measures.

PARTICIPANTS

Individuals with no resistance training experiences in the previous 6 or more months.

INTERVENTIONS

A single bout of pre-conditioning exercises consisting of eccentric or isometric contractions performed a minimum of 24 h prior to a bout of damaging physical activity were compared to control interventions that did not perform pre-conditioning prior to damaging physical activity.

STUDY APPRAISAL

Kmet appraisal system.

SYNTHESIS METHODS

Quantitative analysis was conducted using forest plots to examine standardised mean differences (SMD, i.e. effect size), test statistics for statistical significance (i.e. Z-values) and between-study heterogeneity by inspecting I2.

RESULTS

Following abstract and full-text screening, 23 articles were included in this paper. Based on the meta-analysis, the pre-conditioning group exhibited lower levels of creatine kinase at 24 h (SMD =  - 1.64; Z = 8.39; p = 0.00001), 48 h (SMD =  - 2.65; Z = 7.78; p = 0.00001), 72 h (SMD =  - 2.39; Z = 5.71; p = 0.00001) and 96 h post-exercise (SMD =  - 3.52; Z = 7.39; p = 0.00001) than the control group. Delayed-onset muscle soreness was also lower for the pre-conditioning group at 24 h (SMD =  - 1.89; Z = 6.17; p = 0.00001), 48 h (SMD =  - 2.50; Z = 7.99; p = 0.00001), 72 h (SMD =  - 2.73; Z = 7.86; p = 0.00001) and 96 h post-exercise (SMD =  - 3.30; Z = 8.47; p = 0.00001). Maximal voluntary contraction force was maintained and returned to normal sooner in the pre-conditioning group than in the control group, 24 h (SMD = 1.46; Z = 5.49; p = 0.00001), 48 h (SMD = 1.59; Z = 6.04; p = 0.00001), 72 h (SMD = 2.02; Z = 6.09; p = 0.00001) and 96 h post-exercise (SMD = 2.16; Z = 5.69; p = 0.00001). Range of motion was better maintained by the pre-conditioning group compared with the control group at 24 h (SMD = 1.48; Z = 4.30; p = 0.00001), 48 h (SMD = 2.20; Z = 5.64; p = 0.00001), 72 h (SMD = 2.66; Z = 5.42; p = 0.00001) and 96 h post-exercise (SMD = 2.5; Z = 5.46; p = 0.00001). Based on qualitative analyses, pre-conditioning activities were more effective when performed at 2-4 days before the muscle-damaging protocol compared with immediately prior to the muscle-damaging protocol, or 1-3 weeks prior to the muscle-damaging protocol. Furthermore, pre-conditioning activities performed using eccentric contractions over isometric contractions, with higher volumes, greater intensity and more lengthened muscle contractions provided greater protection from EIMD.

LIMITATIONS

Several outcome measures showed high inter-study heterogeneity. The inability to account for differences in durations between pre-conditioning and the second bout of damaging physical activity was also limiting.

CONCLUSIONS

Pre-conditioning significantly reduced the severity of creatine kinase release, delayed-onset muscle soreness, loss of maximal voluntary contraction force and the range of motion decrease. Pre-conditioning may prevent severe EIMD and accelerate recovery of muscle force generation capacity.

A Carnitine-Containing Product Improves Aspects of Post-Exercise Recovery in Adult Horses

Strenuous exercise can cause tissue damage, leading to an extended recovery period. To counteract delayed post-exercise recovery, a commercial product containing L-carnitine (AID) was tested in adult horses performing consecutive exercise tests to exhaustion. Fit Thoroughbreds were administered an oral bolus of placebo (CON) or AID prior to performing an exercise test to exhaustion (D1). The heart rate (HR) and fetlock kinematics were captured throughout the exercise test. Blood was collected before, 10 min and 1, 4 and 6 h relative to exercise for the quantification of cytokine (IL1β, IL8, IL10, TNFa) gene expression and lactate concentration. Horses performed a second exercise test 48 h later (D2), with all biochemical and physiological measures repeated. The results demonstrate that the horses receiving AID retained a greater (p < 0.05) amount of flexion in the front fetlock on D2 than the horses given CON. The horses presented a reduced (p < 0.05) rate of HR decline on D2 compared to that on D1. The expression of IL1β, IL8 and IL10 increased at 1 h post-exercise on D1 and returned to baseline by 6 h; the cytokine expression pattern was not duplicated on D2. These results provide evidence of disrupted cytokine expression, HR recovery and joint mobility in response to consecutive bouts of exhaustive exercise. Importantly, AID may accelerate recovery through an undetermined mechanism.

Exercise-Induced Muscle Damage and Protein Intake: A Bibliometric and Visual Analysis

Numerous studies have covered exercise-induced muscle damage (EIMD) topics, ranging from nutritional strategies to recovery methods, but few attempts have adequately explored and analyzed large volumes of scientific output. The purpose of this study was to assess the scientific output and research activity regarding EIMD and protein intake by conducting a bibliometric and visual analysis. Relevant publications from 1975-2022 were retrieved from the Web of Science Core Collection database. Quantitative and qualitative variables were collected, including the number of publications and citations, H-indexes, journals of citation reports, co-authorship, co-citation, and the co-occurrence of keywords. There were 351 total publications, with the number of annual publications steadily increasing. The United States has the highest total number of publications (26.21% of total publications, centrality 0.44). Institutional cooperation is mostly geographically limited, with few transnational cooperation links. EIMD and protein intake research is concentrated in high-quality journals in the disciplines of Sport Science, Physiology, Nutrition, and Biochemistry & Molecular Biology. The top ten journals in the number of publications are mostly high-quality printed journals, and the top ten journals in centrality have an average impact factor of 13.845. The findings of the co-citation clusters and major keyword co-occurrence reveal that the most discussed research topics are "exercise mode", "nutritional strategies", "beneficial outcomes", and "proposed mechanisms". Finally, we identified the following research frontiers and research directions: developing a comprehensive understanding of new exercise or training models, nutritional strategies, and recovery techniques to alleviate EIMD symptoms and accelerate recovery; applying the concept of hormesis in EIMD to induce muscle hypertrophy; and investigating the underlying mechanisms of muscle fiber and membrane damage.