Neuromuscular and balance responses to flywheel inertial versus weight training in older persons

Interactive boxing-cycling on frailty and activity limitations in frail and prefrail older adults: A randomized controlled trial

BACKGROUND

Frailty is common among older adults, often associated with activity limitations during physical and walking tasks. The interactive boxing-cycling combination has the potential to be an innovative and efficient training method, and our hypothesis was that interactive boxing-cycling would be superior to stationary cycling in improving frailty and activity limitations in frail and prefrail older adults.

OBJECTIVE

To examine the impact of interactive boxing-cycling on frailty and activity limitations in frail and prefrail older adults compared to stationary cycling.

MATERIALS AND METHODS

A single-blinded randomized controlled trial. Forty-five participants who met at least one frailty phenotype criteria were randomly assigned to receive either interactive boxing-cycling (n = 23) or stationary-cycling (n = 22) for 36 sessions over 12 weeks. The interactive boxing-cycling was performed on a cycle boxer bike with an interactive boxing panel fixed in front of the bike. The primary outcomes were frailty status, including score and phenotypes. Secondary outcomes included activity limitations during physical and walking tasks. The pre- and post-intervention data of both groups were analyzed using a repeated measures two-way ANOVA.

RESULTS

Both types of cycling significantly improved frailty scores (p<0.001). Interactive boxing-cycling was more effective than stationary cycling in reversing the frailty phenotype of muscle weakness (p = 0.03, odds ratio 9.19) and demonstrated greater improvements than stationary cycling in arm curl (p = 0.002, η2=0.20), functional reach (p = 0.001, η2=0.22), and grip strength (p = 0.02, η2=0.12) tests. Additionally, interactive boxing-cycling exhibited a greater effect on gait speed (p = 0.02, η2=0.13) and gait variability (p = 0.01, η2=0.14) during dual-task walking.

CONCLUSION

In frail and prefrail older adults, interactive boxing-cycling effectively improves frailty but is not superior to stationary cycling. However, it is more effective at improving certain activity limitations.

REGISTRATION NUMBER

TCTR20220328001.

The effect of flywheel complex training with eccentric-overload on muscular adaptation in elite female volleyball players

This study aimed to compare the effects of 8 weeks (24 sessions) between flywheel complex training with eccentric overload and traditional complex training of well-trained volleyball players on muscle adaptation, including hypertrophy, strength, and power variables. Fourteen athletes were recruited and randomly divided into the flywheel complex training with an eccentric-overload group (FCTEO, n = 7) and the control group (the traditional complex training group, TCT, n = 7). Participants performed half-squats using a flywheel device or Smith machine and drop jumps, with three sets of eight repetitions and three sets of 12 repetitions, respectively. The variables assessed included the muscle thickness at the proximal, mid, and distal sections of the quadriceps femoris, maximal half-squats strength (1RM-SS), squat jump (SJ), countermovement jump (CMJ), and three-step approach jump (AJ). In addition, a two-way repeated ANOVA analysis was used to find differences between the two groups and between the two testing times (pre-test vs. post-test). The indicators of the FCTEO group showed a significantly better improvement (p < 0.05) in CMJ (height: ES = 0.648, peak power: ES = 0.750), AJ (height: ES = 0.537, peak power: ES = 0.441), 1RM-SS (ES = 0.671) compared to the TCT group and the muscle thicknes at the mid of the quadriceps femoris (ES = 0.504) after FCTEO training. Since volleyball requires lower limb strength and explosive effort during repeated jumps and spiking, these results suggest that FCTEO affects muscular adaptation in a way that improves performance in well-trained female volleyball players.

Benefits of Eccentric Training with Emphasis on Demands of Daily Living Activities and Feasibility in Older Adults: A Literature Review

Aging is associated with a decline in physical capabilities and several other health-related conditions. One of the most common age-related processes is sarcopenia. Sarcopenia is usually accompanied with a decline in skeletal muscle mass and physical functioning. A decrease in these markers usually impacts basic daily living activities (DLAs), which become somewhat harder to accomplish for older individuals. Several research studies have examined the demands of DLA in older individuals with results indicating that activities such as walking, sitting, standing, stair climbing, stair descending, and running generate high demands on older adults. The forces that act on individuals are in most cases equal or multiple times higher relative to their body mass. For instance, it was reported that the GRF (ground reaction force) during stair descent ranged from 1.43 to 1.50 of BW (body weight) in an older population. Even higher demands were recorded during other related activities. These demands of DLA raise the question of appropriate rehabilitative or training management procedures. During the past decades, an eccentric form of resistance training gained popularity due to its effectiveness and lower metabolic demands, which seems to be an appropriate method to develop and maintain a basic level of strength capabilities in higher age. Multiple factors of eccentric training have been examined including modality of exercise, intensity, frequency, and safety of the elderly. Several modalities of eccentric exercise have been shown to be effective including traditional methods, as well as machine-based ones, with or without using some equipment. The studies included in this review varied in intensity from low to high; however, the most frequently used intensity was ≥50% of the maximal eccentric strength during two or three eccentric sessions per week. Importantly, the prevalence of injury of older adults appears to have been low to none, highlighting the safety of this approach. In summary, eccentric training prescriptions for older adults should consider the demands of DLA and the characteristics of the elderly for appropriate management of training recommendations.

Effects of a Physical Activity Program that Incorporates Exercises Targeting Balance, Strength, and Proprioception on Cognitive Functions and Physical Performance in Old Adults with Mild Cognitive Impairment

BACKGROUND

Aging often leads to cognitive function decline, sensory structure deterioration, and musculoskeletal system weakening. This impacts postural control during static and dynamic activities like walking, increasing the fall risk among the elderly. Older adults with mild cognitive impairment (MCI) face an elevated fall risk and cognitive decline, magnifying the public health concern.

OBJECTIVE

This study aimed to explore solutions by investigating the effects of a multi-component physical activity program on cognitive and motor functions in MCI patients.

METHODS

Twenty-three participants were enrolled in the study and assigned into two groups: an intervention group (n = 13; age = 85.7±5.5 years) and a control group (n = 9; age = 85±6.7 years). The study spanned two months, with participants engaging in three 60-minute weekly physical exercise sessions. The intervention focused on improving proprioception, muscle strength, and balance.

RESULTS

Results demonstrated significant enhancements in physical performance, fall risk reduction, and balance (p < 0.05). Various tests, including the timed up and go test, Unipedal Stance test, Tinetti test, Short Physical Performance Battery, and 6-minute walking test, indicated these improvements. Cognitive function was evaluated with the Mini-Mental State Examination, revealing non-significant progress (p > 0.05). Predictive models for outcomes were developed using linear regression analysis during the follow-up stage.

CONCLUSIONS

This study underscores the effectiveness of a multi-component physical activity program encompassing balance, proprioception, and muscle-strengthening exercises as a non-pharmaceutical approach in improving balance skills and playing a key role in mitigating the risk of falls among old adults with MCI.

Mechanical, Material and Morphological Adaptations of Healthy Lower Limb Tendons to Mechanical Loading: A Systematic Review and Meta-Analysis

BACKGROUND

Exposure to increased mechanical loading during physical training can lead to increased tendon stiffness. However, the loading regimen that maximises tendon adaptation and the extent to which adaptation is driven by changes in tendon material properties or tendon geometry is not fully understood.

OBJECTIVE

To determine (1) the effect of mechanical loading on tendon stiffness, modulus and cross-sectional area (CSA); (2) whether adaptations in stiffness are driven primarily by changes in CSA or modulus; (3) the effect of training type and associated loading parameters (relative intensity; localised strain, load duration, load volume and contraction mode) on stiffness, modulus or CSA; and (4) whether the magnitude of adaptation in tendon properties differs between age groups.

METHODS

Five databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE) were searched for studies detailing load-induced adaptations in tendon morphological, material or mechanical properties. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated and data were pooled using a random effects model to estimate variance. Meta regression was used to examine the moderating effects of changes in tendon CSA and modulus on tendon stiffness.

RESULTS

Sixty-one articles met the inclusion criteria. The total number of participants in the included studies was 763. The Achilles tendon (33 studies) and the patella tendon (24 studies) were the most commonly studied regions. Resistance training was the main type of intervention (49 studies). Mechanical loading produced moderate increases in stiffness (standardised mean difference (SMD) 0.74; 95% confidence interval (CI) 0.62-0.86), large increases in modulus (SMD 0.82; 95% CI 0.58-1.07), and small increases in CSA (SMD 0.22; 95% CI 0.12-0.33). Meta-regression revealed that the main moderator of increased stiffness was modulus. Resistance training interventions induced greater increases in modulus than other training types (SMD 0.90; 95% CI 0.65-1.15) and higher strain resistance training protocols induced greater increases in modulus (SMD 0.82; 95% CI 0.44-1.20; p = 0.009) and stiffness (SMD 1.04; 95% CI 0.65-1.43; p = 0.007) than low-strain protocols. The magnitude of stiffness and modulus differences were greater in adult participants.

CONCLUSIONS

Mechanical loading leads to positive adaptation in lower limb tendon stiffness, modulus and CSA. Studies to date indicate that the main mechanism of increased tendon stiffness due to physical training is increased tendon modulus, and that resistance training performed at high compared to low localised tendon strains is associated with the greatest positive tendon adaptation. PROSPERO registration no.: CRD42019141299.

The Effect of Eccentric vs. Traditional Resistance Exercise on Muscle Strength, Body Composition, and Functional Performance in Older Adults: A Systematic Review With Meta-Analysis

The effects of eccentric exercise (ECC) in older adults have received limited scientific attention, considering the ample evidence for its effectiveness in general and athletic populations. The purpose of this paper is to review the effects of ECC exercise modalities vs. traditional or concentric (CON) exercise on muscle strength, body composition and functional performance in older adults. Inclusion criteria regarding the age was >55 years. Three major scientific literature databases (PubMed, Scopus and Web of Science) were screened for trials comparing the effect of ECC and CON exercise programs, and 19 papers were included in the meta-analysis. ECC and CON training programs were typically matched by the duration of each session. The difference between ECC and CON was expressed as standardized mean difference (SMD). Regarding isometric knee strength, the pooled effect favored ECC (SMD = 0.50), but was not statistically significant (p = 0.160). ECC exercise elicited greater improvements in timed up and go test (SMD = −0.68; p = 0.004), 2-min sit-stand test (SMD = 0.53; p = 0.030) and 30-s sit-stand test (SMD = 0.81; p = 0.002), but not in 6-min walking test (SMD = 0.01; p = 0.960). The effects on body composition and muscle architecture were unclear (SMD = −1.44 to 1.95; p = 0.060–0.689). In conclusion, our literature review indicates that ECC exercise is superior to, or at least as good as CON exercise for preserving health and overall function in older adults.

Flywheel Training in Older Adults—A Systematic Review

The process of healthy aging might be reconsidered, based on the nonfatal outcomes of falls in older adults. Flywheel training is a relatively new training method used by different age groups, which enables the muscles to contract at maximum force in minimum time. The study aim was to summarize the relevant literature about the effects of flywheel training in older adults and to determine its efficiency and feasibility. PRISMA guidelines were followed for both the search and analysis. Electronic databases (Google Scholar, PubMed, Science Direct, Scopus, Web of Science and SPORTDiscuss) yielded 9915 studies, but we have included studies published in English between 2005 and 2021, cross-sectional and pre-post treatments, with older adults (≥60 years) as the sample, where flywheel training was conducted. A total of nine studies have met the pre-defined criteria and entered the systematic review, with a total of 216 participants, both male and female. After analyzing the obtained results, it can be concluded that flywheel training showed physical, neuromuscular, and functional improvements in older adults. However, the review did not reveal an optimal duration, frequency, intensity, or volume. Furthermore, it can be stated that this training method can be considered as an appropriate form of activity in older adults, as a tool for improving overall health.

Impact of Inertial Training on Muscle Strength and Quality of Life in Breast Cancer Survivors

The aim of the study was to evaluate the impact of inertial training on the muscle strength, on breast-cancer-related lymphedema, and on quality of life in breast cancer survivors. After a mastectomy, 24 women (age, 66.2 ± 10.6 years) were randomized to a training (n = 12) or control group (n = 12). The training group performed inertial training twice per week for 6 weeks with a training load of about 70% of the maximal force. Before and after training, we tested the maximum force of shoulder flexors, extensors, abductors, and adductors; body composition; breast-cancer-related lymphedema; and disabilities of the arm, shoulder, and hand. Inertial training significantly improved the strength in all tested muscles (from 32 to 68%; effect size (ES) from 0.89 to 1.85 in the impaired limb and from 31 to 64%; ES from 0.86 to 1.57 in the unimpaired limb). However, changes in the control group were not significant. Quality of life improved following treatment; the disabilities of the arm, shoulder, and hand score decreased significantly by 24.5% (ES from—0.29 to 1.38), p ≤ 0.05 in the training group and by 3.99% (ES from −0.49 to 1.14) in the control group p > 0.05. Breast-cancer-related lymphedema and body composition did not change significantly after the intervention in either group. We recommend inertial training for increasing muscle strength and improving quality of life in breast cancer survivors.

Importance of core stability for coordinated movement of the human body in stroke rehabilitation

OBJECTIVES

To examine the effect of core stability on parameters of coordinated movement of the trunk and lower extremities in post-stroke rehabilitation.

METHODS

A total of 55 subjects (mean age, 58 years) were included in the study: 33 patients after stroke (17 with ischemic cerebral stroke and 16 with cerebellar) and 22 neurologically healthy subjects with lower back pain. Participation was voluntary. All subjects were asked to complete two exercises: a dynamic movement in the seated position (leaning forward and back) and a march-in-place exercise with a high elevation of the knees. The two exercises were performed with and without contraction of the abdominal muscles. The frontal and sagittal inclination of the trunk during movement, gait speed, elevation of the feet, and muscle tension was recorded. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04886466.

RESULTS

Core stability (abdominal contraction) was associated with more precise trunk movement in the frontal and sagittal plane, as well as higher elevation of the feet and a faster gait. This occurred in both post-stroke patients and neurologically healthy subjects with lower back pain.

DISCUSSION

Muscle tensions were generally lower in post-stroke patients compared to those with lower back pain syndrome but active abdominal tension muscles caused the increase of core stability and alter the trunk movement path, and improves gait and range of movement. Core stability training during stroke rehabilitation may help patients to achieve a higher level of coordinated movement.

Improved Muscle Strength, Muscle Power, and Physical Function After Flywheel Resistance Training in Healthy Older Adults: A Randomized Controlled Trial

ABSTRACT

Sañudo, B, de Hoyo, M, and McVeigh, JG. Improved muscle strength, muscle power, and physical function after flywheel resistance training in healthy older adults: A randomized controlled trial. J Strength Cond Res 36(1): 252-258, 2022-This study aimed to examine whether flywheel resistance exercise training improved muscle strength, muscle power, and physical function in older adults. Thirty-six older adults (64 ± 5 years) were randomly allocated to either a flywheel resistance exercise training group (ETG; n = 18) or a control (CON) group (n = 18). Subjects in the ETG underwent 6 weeks of resistance training on a flywheel squat device (4 sets of 9 maximal repetitions). Isokinetic concentric (60 and 240°·s-1) and eccentric (120°·s-1) knee extension and flexion peak torques and mean power were measured. Physical function was assessed by the 30-second Chair Sit-Stand Test (CST) and walking speed. After the intervention, within-group analyses showed significantly greater flexion torques and mean power with the dominant leg (concentric at 60°·s-1 and 240°·s-1 and eccentric at 120°·s-1; all d > 0.7, p < 0.05) and improvements in CST (d > 0.8) in the ETG, while no substantial differences were found in the CON group. Significant between-group differences in knee flexion torque both concentric (at 60°·s-1: η2 = 0.168 and 240°·s-1: η2 = 0.112) and eccentric (at 120°·s-1: η2 = 0.103) with the dominant leg were also found in favor of the ETG. There was also significantly better performance in the CST for the ETG (η2 = 0.207). There was a significant association between changes in strength and changes in mean power in the ETG. Changes in physical function outcomes were also observed. In conclusion, flywheel resistance exercise training is an appropriate form of activity for improving strength and functional capacity of older adults.

Eccentric Exercise: Adaptations and Applications for Health and Performance

The goals of this narrative review are to provide a brief overview of the muscle and tendon adaptations to eccentric resistance exercise and address the applications of this form of training to aid rehabilitative interventions and enhance sports performance. This work is centered on the author contributions to the Special Issue entitled "Eccentric Exercise: Adaptations and Applications for Health and Performance". The major themes from the contributing authors include the need to place greater attention on eccentric exercise mode selection based on training goals and individual fitness level, optimal approaches to implementing eccentric resistance exercise for therapeutic purposes, factors that affect the use of eccentric exercise across the lifespan, and general recommendations to integrate eccentric exercise in athletic training regimens. The authors propose that movement velocity and the absorption or recovery of kinetic energy are critical components of eccentric exercise programming. Regarding the therapeutic use of eccentric resistance training, patient-level factors regarding condition severity, fitness level, and stage of rehabilitation should govern the plan of care. In athletic populations, use of eccentric exercise may improve movement competency and promote improved safety and performance of sport-specific tasks. Eccentric resistance training is a viable option for youth, young adults, and older adults when the exercise prescription appropriately addresses program goals, exercise tolerability, and compliance. Despite the benefits of eccentric exercise, several key questions remain unanswered regarding its application underscoring the need for further investigation.

Effects of gravitational and iso-inertial resistance trainings using rating of perceived exertion on lower limbs muscle force and power abilities and metabolic cost of walking in healthy older adults

BACKGROUND

The purpose was to compare the effects of 8-weeks resistance training programs (Flywheel Iso-inertial, FW vs Traditional Gravity-Dependent Resistance Training, GD) performed twice a week at the same rate of perceived exertion (RPE), on muscle force and power capacities and physical performance in healthy older participants.

METHODS

Twenty-four participants were randomly assigned to either FW (male/female: 7/5, age: 67.1±3.8 yr) or GD (male/female: 6/6, age 68.3±3.0 yr) group. Knee extension maximal isometric voluntary contractions (MVC), lower limb maximal explosive power (MEP), six-minute walking distance (6MWT), timed "Up & Go" scores (TUG), metabolic cost of walking (CW) and agonist-antagonist co-contraction time (CCT) during walking were evaluated before and after training.

RESULTS

absolute MEP and MEP normalized for body mass increased only in FW than GD group (+10.8% vs +0.31%, p: 0.056, respectively; +14.8% vs +13.9%, p<0.001, respectively). Both training modalities improved MVC to a similar extent (+11.1% in FW vs +13.4% in GD, p<0.001). Analogously, 6MWT distance increased in FW and GD (+5.2 and +5.5%, p<0.041, respectively). No effects of time and training modality were observed on the other parameters.

CONCLUSIONS

The study suggests that when FW and GD are administered at the same RPE with FW performed at higher movement speed in the concentric phase, both the trainings generate similar improvements in muscle strength but only the former can promote greater muscle power enhancements than GD in healthy older adults.

Effects of flywheel training on strength-related variables in female populations. A systematic review

This study aimed to evaluate the effect of flywheel training on female populations, report practical recommendations for practitioners based on the currently available evidence, underline the limitations of current literature, and establish future research directions. Studies were searched through the electronic databases (PubMed, SPORTDiscus, and Web of Science) following the preferred reporting items for systematic reviews and meta-analysis statement guidelines. The methodological quality of the seven studies included in this review ranged from 10 to 19 points (good to excellent), with an average score of 14-points (good). These studies were carried out between 2004 and 2019 and comprised a total of 100 female participants. The training duration ranged from 5 weeks to 24 weeks, with volume ranging from 1 to 4 sets and 7 to 12 repetitions, and frequency ranged from 1 to 3 times a week. The contemporary literature suggests that flywheel training is a safe and time-effective strategy to enhance physical outcomes with young and elderly females. With this information, practitioners may be inclined to prescribe flywheel training as an effective countermeasure for injuries or falls and as potent stimulus for physical enhancement.

Preliminary Study of the Effects of Eccentric-Overload Resistance Exercise on Physical Function and Torque Capacity in Chronic Kidney Disease

The purpose of this preliminary study was to describe changes in physical function and torque capacity in adults with chronic kidney disease (CKD) in response to a novel progressive eccentric-overload resistance exercise (ERE) regime. Participants included men (n = 4) diagnosed with CKD according to estimated glomerular filtration rate (eGFR) between 59 and 15 mL/kg/1.73 m2 and not requiring dialysis. Physical function was determined by the Short Physical Performance Battery (SPPB), five repetitions of a sit-to-stand (STS) task, and timed-up and go (TUG). Knee extensor strength was assessed using both isometric and isokinetic contractions and performance fatigability indexes were calculated during a 30-s maximal isometric test and a 30-contraction isokinetic test at 180°/second. None of the patients exhibited significant worsening in their health status after training. Participants demonstrated improvements in several measures of physical function and torque capacity following 24 sessions of ERE. Following training, performance fatigability remained relatively stable despite the increases in torque capacity, indicating the potential for greater fatigue resistance. These findings provide initial evidence for ERE as a potential treatment option to combat declines in physical function and neuromuscular impairments in people with CKD. Future research is required to determine optimal progression strategies for maximizing specific neuromuscular and functional outcomes when using ERE in this patient population.

Intra-session reliability of electromyographic measurements in flywheel squats

Although the popularity of flywheel (FW) devices in sports research is increasing, to date, no study has been designed to test the reliability of electromyographic (EMG) variables during FW squats as a basic lower-body FW resistance exercise. At the primary level, our study was conducted to determine the minimum number of the consecutive flywheel (FW) squat repetitions that need to be averaged in a single set to obtain excellent reliability of peak, mean and three position-specific EMG variables. At the secondary level, comprehensive analysis for peak and mean EMG variables was done. Intra-set reliability was investigated using the minimum number of repetitions determined from the primary level of the study. Twenty-six participants performed five sets of seven squats with three FW loads (0.05, 0.125, 0.225 kg∙m²). EMG signals were collected from eight leg muscles. By averaging twelve consecutive repetitions, we obtained ICC_2.k > 0.95 for mean and peak EMG_RMS regardless of the muscle, load or phase of the squat (concentric vs. eccentric). Due to the heterogeneity of the results at the primary level, position-specific variables were excluded from the inter-set reliability analysis at the secondary level. Trustworthy mean and peak EMG variables from the primary level showed good to excellent inter-set reliability. We suggest averaging twelve consecutive squat repetitions to achieve good to excellent intra-session reliability of EMG variables. By following the proposed protocol, activation of leg muscles can be confidently studied in intra-session repeated-measures study designs.

Minimizing sedentary behavior (without increasing medium-to-vigorous exercise) associated functional improvement in older women is somewhat dependent on a measurable increase in muscle size

The optimal pattern of sedentarism displacement and mechanisms underlying its health effects are poorly understood. Therefore, the aim of this study was to quantify muscle-tendon adaptation in response to two different sedentarism displacement interventions and relate any adaptations to functional outcomes. Thirty-four older women (73±5yrs) underwent skeletal muscle-tendon size and functional assessments. Participants were randomly allocated to: Sedentary behavior fragmentation (SBF), Light intensity physical activity (LIPA), or Control groups. Measures were taken at weeks 0 and 8. Gait speed significantly increased (p=0.003), in both experimental groups (SBF: 0.06 ± 0.08m/s, 6±10%, LIPA: 0.06 ± 0.07m/s, 6±6%), but not control (-0.02 ± 0.12m/s, -2±9%). Accordingly, the relative change in Vastus Lateralis muscle volume, accounted for 30% (p=0.027), and 45% (p=0.0006) of the explained variance in the relative change in gait speed, for SBF and LIPA respectively. Gastrocnemius Medialis fascicle length changes were positively associated with gait speed changes, following LIPA exclusively (R²= 0.50, p=0.009). This is the first study to show SBF and LIPA are adequate loading in older women, with related muscle adaptation and clinically relevant gait speed improvements. Such adaptations appear similar irrespective of whether sedentarism displacement is prescribed in a single bout (LIPA) or in frequent micro-bouts (SBF).

Hamstring strength and architectural adaptations following inertial flywheel resistance training

OBJECTIVES

To investigate the architectural and strength adaptations of the hamstrings following 6-weeks of inertial flywheel resistance training.

DESIGN

Randomised, stratified training intervention METHODS: Twenty healthy males undertook 6-weeks of a conventional (n=10) or eccentrically biased (n=10) flywheel leg-curl training intervention as well as a subsequent 4-week detraining period. Biceps femoris long head (BFlh) architecture was assessed weekly, whilst assessments of eccentric and isometric knee flexor strength and rate of force development (RFD) were conducted prior to and following the intervention and detraining periods.

RESULTS

The participants who undertook the eccentrically biased flywheel intervention showed a significant 14±5% (p<0.001, d=1.98) increase in BFlh fascicle length after 6-weeks of training. These improvements in fascicle length subsequently declined by 13±4% (p<0.001. d=-2.04) following the 4-week detraining period. The conventional flywheel leg-curl training group saw no changes in BFlh fascicle length after the intervention (-0.5%±0.8%, p=0.939, d=-0.04) or detraining (-1.1%±1%, p=0.984, d=-0.03) periods. Both groups saw no changes in any of the strength or RFD variables after the intervention or the detraining period.

CONCLUSIONS

Flywheel leg-curl training performed with an eccentric bias led to significant lengthening of BFlh fascicles without a change in RFD, eccentric or isometric strength. These increases in fascicle length were lost following a 4-week detraining period. Conventional flywheel leg-curl training resulted in no changes in fascicle length, strength and RFD. These findings suggest that additional eccentric bias is required during inertial flywheel resistance training to promote fascicle lengthening in the BFlh, however this may still be insufficient to cause alterations to strength and RFD.

Speed-power based training in the elderly and its potential for daily movement function enhancement

Resistance exercise is widely recommended strategy to improve functional ability and quality of life of the elderly. Novel resistance exercises approaches, such as flywheel exercise have recently emerged as superior alternatives to traditional methods. Eccentric exercise methods are well documented to elicit different and often the more pronounced effect on physical ability and function of the elderly. By reviewing the relevant scientific literature, we found that only limited studies have investigated the effects of flywheel exercise in the elderly, however, the results are very promising. Thus, more research is desired to explore the effect of flywheel exercise type in elderly individuals.

Inertial Training Improves Strength, Balance, and Gait Speed in Elderly Nursing Home Residents

Purpose

The aim of the study was to evaluate the impact of inertial training on upper and lower extremity strength in the elderly. The study also assessed the influence of inertial training on their independence, balance, and speed and quality of gait.

Methods

Twenty physically inactive older residents of a nursing home (6 women and 14 men; age, 76.7 ± 8.77 years) were randomized to a training (T; n = 10) or control group (C; n = 10). The T group performed inertial training twice a week for 6 weeks using a Cyklotren inertial device. Each training session included 12 exercise sets involving the elbow and knee flexor and extensor muscles (3 sets per single muscle group). The training loads were 10 and 20 kg for the upper and lower extremities, respectively. Before and after training, the maximum force of trained muscles was evaluated under training conditions. Functional tests were also completed.

Results

Participants from the T group had significantly increased (37.1–69.1%) elbow and knee flexor and extensor muscle strength. Improvement in upper and lower limb strength in non-specific conditions was also noted; 23.3% and 40.6%, respectively. Functional abilities improved significantly in the T group (Tinetti balance test: 29%, Tinetti gait tests: 18.6%, and gait speed (8-Foot Up-and-Go): 12.8%), while remaining unchanged in C.

Conclusion

We strongly recommend a daily routine of inertial training for older adults. Benefits from inertial training can reduce the risk of falls and increase the safety and independence of the elderly.

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/Za2qKcJ0UjU

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Utility and Advantages of the Eccentric Training through the Isoinertial System

We are glad to introduce the first Journal Club of volume five, the first issue. This edition is focused on relevant studies published in the last years in the field of eccentric training, chosen by our editorial board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport, seen also from a scientific point of view. The editorial board members wish you an inspiring lecture.

[Effects of mild intensity physical activity on the physical condition of older adults: A systematic review]

Physical activity can improve function in people over 65. The aim of the study was to evaluate the efficacy of mild intensity exercise interventions on the functional health and quality of life of this population. A systematic review was conducted using WOS (n=20), Scopus (n=235), PubMed (n=15), and PEDro (n=20) databases. Eight studies met the inclusion criteria. Six hundred and nineteen subjects with an age range of 60-103 years were evaluated. Interventions included endurance, aerobic, and vibration exercises. Those who used pedometers, telephone calls and follow-up controls showed positive effects in increasing physical activity. Five studies evaluated strength and showed that increasing strength also improved balance and walking speed. The results indicate that applying mild intensity physical activity interventions is a way of ensuring improved functional health and quality of life in older people.

Effects of High-Intensity Interval Training and Isoinertial Training on Leg Extensors Muscle Function, Structure, and Intermuscular Adipose Tissue in Older Adults

We compared the effects of aerobic high-intensity training (HIT) and isoinertial resistance training (IRT) on the strength, mass, architecture, intermuscular adipose tissue (IMAT) quality, and neuromuscular activation of the quadriceps in elderly subjects. Twelve healthy men (69.3 ± 4.2 years; 77.8 ± 10.4 kg; 1.72 ± 0.05 m) were exposed to 8 weeks of HIT (7 × 2-min cycling repetitions at 90% of V.O_2peak, 3 times/week) and, after 4 months (detraining), to IRT (4 × 7 maximal concentric–eccentric knee extensions, 3 times/week). Before and after trainings, we measured knee extension isometric (T_MVC) and dynamic (T_C) maximal concentric torque, anatomical cross-sectional area (ACSA) at 25, 50, and 75% of femur length, quadriceps volume (Vol), IMAT, pennation angle (θ_p) of the fibers from the vastus lateralis, and voluntary activation (%Act). T_MVC and T_C were significantly larger only after IRT (P = 0.008); IRT was able to elicit a greater increase of ACSA than HIT; Vol increases similarly and significantly after HIT and IRT (P = 0.003–0.001); IMAT at 50% of femur length decreased after both HIT and IRT (P = 0.001–0.003); physiological cross-sectional area (PCSA) was larger after IRT than before (P = 0.025); specific torque did not change throughout the study (45.5 N cm^–2 ± 12.0); %Act of the quadriceps was significantly affected only by IRT (P = 0.011). Both HIT and IRT are able to elicit beneficial modifications of muscular mass, architecture, and quality (reducing IMAT) in elderly subjects in connection with an amelioration of strength. HIT and IRT caused a homogeneous increase of ACSA and of Vol of the quadriceps. PCSA increases, but specific strength per unit of PCSA did not change. The increases of functional torque seemed to be attributed to a parallel increase of %Act and muscle hypertrophy only after IRT. Data suggest that IMAT may be a prominent indicator to track metabolic-dependent activity and skeletal muscle quality.

Eccentric Overload Flywheel Training in Older Adults

Age-related reductions in muscle strength and muscle power can have significant adverse effects on functional performance in older adults. Exercise training has been shown to be a potent stimulus for improvements in strength and power. However, investigation into how to best optimize training-related adaptations, as well as the accessibility of training methods, is needed. Traditional (TR) methods using gravity-dependent free-weights or weight machines can improve and maintain strength and power but are limited in their ability to provide constant muscle tension and high levels of muscle activation throughout the lowering (eccentric) phase of lifting. Eccentric overload (EO) training may overcome these limitations and has been shown to result in potent adaptations in both young and older adults. Methods of producing EO are significantly limited from a practical perspective. The addition of whole-body flywheel training equipment provides a practical method of producing EO and may be appropriate for older adults wanting to optimize training outcomes. Our review provides limited evidence of the use of eccentric overload flywheel training as a novel training method in seniors. Through the review of literature, EO training overcame some of the limitations set forth by traditional resistance training and demonstrated to have key benefits when combating age-related changes affecting muscle strength and muscle power. It can be concluded that EO training is an important addition to the training arsenal for older adults. Flywheel training provides a practical method of achieving EO, increasing strength and power, combating age-related adaptations, and overall improving quality of life in older adults.

Stand Trainer With Applied Forces at the Pelvis and Trunk: Response to Perturbations and Assist-As-Needed Support

Functional rehabilitation of patients with spinal cord injury remains a current challenge. Training these patients to successfully stand is the first step towards restoring advanced skills such as walking. To address this need, we have developed a novel robotic stand trainer that can apply controlled forces on the trunk and the pelvis of a user, while controlling the knee angle. The stand trainer utilizes cables to apply assistive, resistive, or perturbation forces at the trunk, pelvis, and the knees, simultaneously. We have conducted a human study to validate the system. In this study, we applied multi-direction perturbation forces either at the pelvis or the trunk while assist-as-needed forces were applied to the other segment to keep balance. This study characterizes the human kinematics and measures of balance under the perturbations and assistive forces on the human body. Results shows that the level of force-field assistance (trunk or pelvis) directly affects the motion of the trunk, pelvis, and center of pressure. This provides a quantitative framework to restore balance in patients while providing assistance only when needed. This stand trainer can potentially free up therapists to attend to higher level rehabilitation goals and objectively assist patients to engage in interventions that challenge both their musculoskeletal and sensorimotor impairments.

Implementing Eccentric Resistance Training-Part 2: Practical Recommendations

The purpose of this review is to provide strength and conditioning practitioners with recommendations on how best to implement tempo eccentric training (TEMPO), flywheel inertial training (FIT), accentuated eccentric loading (AEL), and plyometric training (PT) into resistance training programs that seek to improve an athlete's hypertrophy, strength, and power output. Based on the existing literature, TEMPO may be best implemented with weaker athletes to benefit positional strength and hypertrophy due to the time under tension. FIT may provide an effective hypertrophy, strength, and power stimulus for untrained and weaker individuals; however, stronger individuals may not receive the same eccentric (ECC) overload stimulus. Although AEL may be implemented throughout the training year to benefit hypertrophy, strength, and power output, this strategy is better suited for stronger individuals. When weaker and stronger individuals are exposed to PT, they are exposed to an ECC overload stimulus as a result of increases in the ECC force and ECC rate of force development. In conclusion, when choosing to utilize ECC training methods, the practitioner must integrate these methods into a holistic training program that is designed to improve the athlete's performance capacity.

Long-Term Effects of Balance Training on Habitual Physical Activity in Older Adults with Parkinson's Disease

The HiBalance program is a progressive and highly challenging balance training intervention incorporating Parkinson's disease (PD) specific balance components. The program improves balance and gait and increases the amount of ambulation in short-term, in older adults with PD. Yet, potential short- and long-term effects on habitual physical activity and sedentary behavior are currently unidentified. The aim of this study was to conduct preplanned secondary analyses of short- and long-term effects of the HiBalance program on objectively measured amount and bouts of brisk walking, sedentary behavior, and total physical activity in older adults with PD. Further, our aim was to investigate demographic, intervention-related, disease-related, and function-related factors potentially related to a difference in activity after intervention. A total of 100 older adults with mild-moderate PD were recruited. The intervention group participated in the HiBalance program, and the control received care as usual and was offered the HiBalance program after study termination. Physical activity data were collected using accelerometers at baseline, after intervention and after 6 and 12 months. A multilevel model was utilized to investigate the postintervention and long-term (6 and 12 months) effects on total physical activity, amount and bouts of brisk walking (i.e., moderate intensity physical activity), and sedentary behavior. Between-group difference for the main outcome brisk walking was at postintervention: Δ -10, CI -23.78 to 3.69 min/day (p < 0.05); 6 months: Δ -10, CI -23.89 to 3.89 min/day (p < 0.05); and 12 months: Δ -4, CI -16.81 to 8.81 min/day (p=0.43). Being part of the intervention group as well as finishing training during spring/summer showed an independent association to increased brisk walking after the intervention period. In conclusion, the HiBalance program increases the physical activity on moderate intensity after intervention and at 6 months but not at 12 months, independently of improved balance. Season seems to influence the effect on the physical activity.

Isokinetic eccentric training is more effective than constant load eccentric training for quadriceps rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial

OBJECTIVE

To compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functional performance in recreational athletes following anterior cruciate ligament (ACL) reconstruction.

METHODS

Thirty recreational male athletes (25 years old) undergoing ACL reconstruction received a standard rehabilitation program. Volunteers were randomized to conventional group (CG; n = 15) or isokinetic group (IG; n = 15) to be engaged in a 6-week (2 sessions/week) quadriceps eccentric training program at the extensor chair or at the isokinetic dynamometer, respectively. Assessments of quadriceps muscle mass (through magnetic resonance imaging), strength (through isokinetic dynamometry) and self-aware functionality (through questionnaire) were performed before and after the training programs. Single leg hop test performance was assessed only at post-training evaluation.

RESULTS

IG had significantly higher improvements than CG (p < 0.05) for all muscle mass outcomes (+17-23% vs. +5-9%), as well as for isometric (+34% vs. +20%) and eccentric (+85% vs. +23%) peak torques. There was no between-group difference (p > 0.05) for concentric peak torque, Lysholm score, and single leg hop test.

CONCLUSION

Isokinetic eccentric training promotes greater responses than conventional eccentric training on quadriceps muscle mass and strength of recreational athletes following ACL reconstruction.

Effects of Flywheel Training on Strength-Related Variables: a Meta-analysis

BACKGROUND

Strength and power development are abilities important for athletic performance in many sports. Generally, resistance training based on gravity is used to improve these qualities. Flywheel training instead utilizes kinetic energy transferred to a flywheel. This allows for eccentric overload and variable resistance throughout the movement. The aim of this review was to identify the effects of flywheel training on multiple strength-related variables affecting athletic performance. The meta-analysis investigates the effects on (1) muscle growth (cross-sectional area (CSA) and volume/mass), (2) maximum dynamic strength, (3) development of power, (4) development of horizontal movement, and (5) development of vertical movement.

METHODS

The meta-analysis includes 20 experimental studies that met the inclusion criteria. The quality of included studies was ranked according to the PEDro scale. Possible bias was identified in Funnel plot analyses. To enable the compilation of all results analyses, the random effect model was carried out using the software Review Manager Version 5.3 and presented with Forest plots.

RESULTS

Flywheel training for a period of 4-24 weeks shows statistically significant increases in all strength aspects. Effect sizes were for hypertrophy, CSA 0.59; volume/mass 0.59; maximum strength 1.33; power 1.19; horizontal 1.01 and vertical movement 0.85. The evidence is particularly strong for beneficial effects from flywheel training in the development of maximal strength and power in trained younger individuals, and utilization of this training modality in shorter more intensive blocks.

CONCLUSIONS

Flywheel training is an effective method for improving several aspects of strength and power with importance for sports performance.

Age-Related Changes in Achilles Tendon Stiffness and Impact on Functional Activities: A Systematic Review and Meta-Analysis

Achilles tendon stiffness determines calf muscle functioning during functional activities. However, contrasting evidence was found in studies comparing Achilles tendon stiffness in older and younger adults. Therefore, this systematic review compares Achilles tendon stiffness and elastic modulus in older and younger adults and reviews functional implications. Studies revealed by systematic bibliographic searches were included if healthy older adults were investigated, and if Achilles tendon stiffness was measured using ultrasound and dynamometry. Meta-analyses were performed to compare Achilles tendon stiffness and elastic modulus in older and younger adults. Achilles tendon stiffness (weighted standardized mean difference = 1.40, 95% confidence intervals [0.42-2.38]) and elastic modulus (weighted standardized mean difference = 1.74, 95% confidence intervals [0.99-2.49]) were decreased in older compared with younger adults. Decreased Achilles tendon stiffness was related to walking performance and balance. Possibly, decreased Achilles tendon stiffness is caused by altered elastic modulus in older adults. Training interventions increasing Achilles tendon stiffness could improve functional capacity.

Morphological and Mechanical Properties of the Human Patella Tendon in Adult Males With Achondroplasia

Achondroplasia is a genetic mutation of fibroblast growth factor receptor resulting in impaired growth plate development in long bones due to lower collagen turnover. Despite the characteristic shorter stature and lower strength in Achondroplasic groups, little is known of the tendon mechanical properties under loading. The aim of this study was therefore to conduct a between measure design of patella tendon (PT) mechanical properties (stress, strain, stiffness and Young's Modulus) in 10 men with Achondroplasia (22 ± 3 years) and 17 male controls (22 ± 2 years). PT mechanical properties were measured during isometric maximal voluntary contraction (iMVC) of the knee extensors using ultrasonography. The Achondroplasic group produced 54% less stress at iMVC than controls (29.4 ± 8.0 v 64.5 ± 14.0 MPa, P < 0.001, d = 3.12). Maximal excursion of the Achondroplasic PT was 22% less than controls at iMVC (7.4 ± 2.1 v 5.5 ± 1.7 mm, P < 0.001, d = 0.99), but there was no difference in strain between groups (13 ± 4 v 13 ± 3%, P > 0.05). Achondroplasic PT were 47% less stiff (748 ± 93 v 1418 ± 101 N·mm⁻¹, P < 0.001, d = 6.89) and had a 51% lower Young's modulus (0.39 ± 0.09 v 0.77 ± 0.14 GPa, P < 0.001, d = 3.46) than controls at iMVC. Achondroplasic PT are indeed more compliant than controls which may contribute to lower relative force production. The causes of higher Achondroplasic PT compliance are unclear but are likely due to the collagen related genetic mutation which causes Achondroplasia.

Effects of 14 days of bed rest and following physical training on metabolic cost, mechanical work, and efficiency during walking in older and young healthy males

In this study, we investigated: i) the effects of bed rest and a subsequent physical training program on metabolic cost (Cw), mechanical work and efficiency during walking in older and young men; ii) the mechanisms underlying the higher Cw observed in older than young men.Twenty-three healthy male subjects (N = 16 older adults, age 59.6±3.4 years; N = 7 young, age: 23.1±2.9 years) participated in this study. The subjects underwent 14 days of bed rest followed by two weeks of physical training (6 sessions). Cw, mechanical work, efficiency, and co-contraction time of proximal muscles (vastus lateralis and biceps femoris) and distal muscles (gastrocnemius medialis and tibialis anterior) were measured during walking at 0.83, 1.11, 1.39, 1.67 m·s-1 before bed rest (pre-BR), after bed rest (post-BR) and after physical training (post-PT).No effects of bed rest and physical training were observed on the analysed parameters in either group. Older men showed higher Cw and lower efficiency at each speed (average +25.1 and -20.5%, P<0.001, respectively) compared to young. Co-contraction time of proximal and distal muscles were higher in older than in young men across the different walking speeds (average +30.0 and +110.3%, P<0.05, respectively).The lack of bed rest and physical training effects on the parameters analyzed in this study may be explained by the healthy status of both young and older men, which could have mitigated the effects of these interventions on walking motor function. On the other hand, the fact that older adults showed greater Cw, overall higher co-contraction time of antagonist lower limb muscles, and lower efficiency compared to the young cohort throughout a wide range of walking speed may suggest that older adults sacrificed economy of walking to improve stability.

Loss of maximal explosive power of lower limbs after 2 weeks of disuse and incomplete recovery after retraining in older adults

KEY POINTS

Disuse in older adults can critically decrease lower limb muscle power, leading to compromised mobility and overall quality of life. We studied how muscle power and its determinants (muscle mass, single muscle fibre properties and motor control) adapted to 2 weeks of disuse and subsequent 2 weeks of physical training in young and older people. Disuse decreased lower limb muscle power in both groups; however, different adaptations in single muscle fibre properties and co-contraction of leg muscles were observed between young and older individuals. Six physical training sessions performed after disuse promoted the recovery of muscle mass and power. However, they were not sufficient to restore muscle power to pre-disuse values in older individuals, suggesting that further countermeasures are required to counteract the disuse-induced loss of muscle power in older adults.

ABSTRACT

Disuse-induced loss of muscle power can be detrimental in older individuals, seriously impairing functional capacity. In this study, we examined the changes in maximal explosive power (MEP) of lower limbs induced by a 14-day disuse (bed-rest, BR) and a subsequent 14-day retraining, to assess whether the impact of disuse was greater in older than in young men, and to analyse the causes of such adaptations. Sixteen older adults (Old: 55-65 years) and seven Young (18-30 years) individuals participated in this study. In a subgroup of eight Old subjects, countermeasures based on cognitive training and protein supplementation were applied. MEP was measured with an explosive ergometer, muscle mass was determined by magnetic resonance, motor control was studied by EMG, and single muscle fibres were analysed in vastus lateralis biopsy samples. MEP was ∼33% lower in Old than in Young individuals, and remained significantly lower (-19%) when normalized by muscle volume. BR significantly affected MEP in Old (-15%) but not in Young. Retraining tended to increase MEP; however, this intervention was not sufficient to restore pre-BR values in Old. Ankle co-contraction increased after BR in Old only, and remained elevated after retraining (+30%). Significant atrophy occurred in slow fibres in Old, and in fast fibres in Young. After retraining, the recovery of muscle fibre thickness was partial. The proposed countermeasures were not sufficient to affect muscle mass and power. The greater impact of disuse and smaller retraining-induced recovery observed in Old highlight the importance of designing suitable rehabilitation protocols for older individuals.

Is inertial flywheel resistance training superior to gravity-dependent resistance training in improving muscle strength? A systematic review with meta-analyses

OBJECTIVE

The primary aim of this systematic review was to determine if inertial flywheel resistance training is superior to gravity-dependent resistance training in improving muscle strength. The secondary aim was to determine whether inertial flywheel resistance training is superior to gravity-dependent resistance training in improving other muscular adaptations.

DESIGN

A systematic review with meta-analyses of randomised and non-randomised controlled trials.

METHODS

We searched MEDLINE, Scopus, SPORTDiscus, Web of Science and Cochrane Central Register of Controlled Trials with no publication date restrictions until November 2016. We performed meta-analyses on randomised and non-randomised controlled trials to determine the standardized mean difference between the effects of inertial flywheel and gravity-dependent resistance training on muscle strength. A total of 76 and 71 participants were included in the primary and secondary analyses, respectively.

RESULTS

After systematic review, we included three randomised and four non-randomised controlled trials. In the primary analysis for the primary outcome muscle strength, the pooled results from randomised controlled trials showed no difference (SMD=-0.05; 95%CI -0.51 to 0.40; p=0.82; I²=0%). In the secondary analyses of the primary outcome, the pooled results from non-randomised controlled trials showed no difference (SMD=0.02; 95%CI -0.45 to 0.49; p=0.93; I²=0%; and SMD=0.03; 95%CI -0.43 to 0.50; p=0.88; I²=0%). Meta-analysis on secondary outcomes could not be performed.

CONCLUSION

Based on the available data, inertial flywheel resistance training was not superior to gravity-dependent resistance training in enhancing muscle strength. Data for other strength variables and other muscular adaptations was insufficient to draw firm conclusions from.

Muscle strength and stiffness in resistance exercise: Force transmission in tissues

Physical therapists and osteopaths want to know the quantitative force transmitted in the tissues during resistance exercise and also the relationship between tissue strength and the specific type of resistance exercise of the skeletal muscles. This paper uses the strain energy function for large deformations associated with the active and passive response of transversely isotropic skeletal muscle tissue to evaluate muscle strength and force transmitted in tissues during resistance exercises for the quadriceps muscle at the knee during isometric training exercise at different knee angles in vivo. It is found that after an exercise program, the muscle stiffness is halved when the bending angle of the knee increases from 50° to 100°. The muscle strength generated is marginally greater at 100° than at 50°. The stress transmitted in the lateral direction for 100° bending is double that for 50°.

Changes in tendon spatial frequency parameters with loading

To examine and compare the loading related changes in micro-morphology of the patellar tendon. Fifteen healthy young males (age 19±3yrs, body mass 83±5kg) were utilised in a within subjects matched pairs design. B mode ultrasound images were taken in the sagittal plane of the patellar tendon at rest with the knee at 90° flexion. Repeat images were taken whilst the subjects were carrying out maximal voluntary isometric contractions. Spatial frequency parameters related to the tendon morphology were determined within regions of interest (ROI) from the B mode images at rest and during isometric contractions. A number of spatial parameters were observed to be significantly different between resting and contracted images (Peak spatial frequency radius (PSFR), axis ratio, spatial Q-factor, PSFR amplitude ratio, and the sum). These spatial frequency parameters were indicative of acute alterations in the tendon micro-morphology with loading. Acute loading modifies the micro-morphology of the tendon, as observed via spatial frequency analysis. Further research is warranted to explore its utility with regard to different loading induced micro-morphological alterations, as these could give valuable insight not only to aid strengthening of this tissue but also optimization of recovery from injury and treatment of conditions such as tendinopathies.

Clinical Applications of Iso-Inertial, Eccentric-Overload (YoYo™) Resistance Exercise

In the quest for a viable non-gravity dependent method to "lift weights" in space, our laboratory introduced iso-inertial resistance (YoYo™) exercise using spinning flywheel(s), more than 25 years ago. After being thoroughly tested in individuals subjected to various established spaceflight analogs, a multi-mode YoYo™ exercise apparatus was eventually installed on the International Space Station in 2009. The method, applicable to any muscle group, provides accommodated resistance and optimal muscle loading through the full range of motion of concentric actions, and brief episodes of eccentric overload. This exercise intervention has found terrestrial applications and shown success in enhancing sports performance and preventing injury and aiding neurological or orthopedic rehabilitation. Research has proven that this technique offers unique physiological responses not possible with other exercise hardware solutions. This paper provides a brief overview of research that has made use, and explored the efficacy, of this method in healthy sedentary or physically active individuals and populations suffering from muscle wasting, disease or injury. While the collective evidence to date suggests YoYo™ offers a potent stimulus to optimize the benefits of resistance exercise, systematic research to support clinical use of this method has only begun to emerge. Thus, we also offer perspectives on unresolved issues, unexplored applications for clinical conditions, and how this particular exercise paradigm could be implemented in future clinical research and eventually being prescribed. Fields of particular interest are those aimed at promoting muscle health by preventing injury or combating muscle wasting and neurological or metabolic dysfunction due to aging or illness, or those serving in rehabilitation following trauma and/or surgery.

Skeletal muscle functional and structural adaptations after eccentric overload flywheel resistance training: a systematic review and meta-analysis

OBJECTIVES

The purpose of this meta-analysis was to examine the effect of flywheel (FW) resistance training with Eccentric Overload (FW-EOT) on muscle size and functional capacities (i.e. strength and power) in athletes and healthy subjects, and to compare FW-induced adaptations with those triggered by traditional resistance exercise interventions.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

METHODS

A search of electronic databases [PubMed, MEDLINE (SportDiscus), Web of Science, Scopus and PEDro] was conducted to identify all publications employing FW-EOT up to April 30, 2016. Outcomes were analyzed as continuous outcomes using a random effects model to calculate a standardized mean difference (SMD) and 95% CI. A total of 9 studies with 276 subjects and 92 effect sizes met the inclusion criteria and were included in the statistical analyses.

RESULTS

The overall pooled estimate from the main effects analysis was 0.63 (95% CI 0.49-0.76) with a significant (p<0.001) Z overall effect of 9.17. No significant heterogeneity (p value=0.78) was found. The meta-analysis showed significant differences between FW-EOT vs. conventional resistance training in concentric and eccentric strength, muscle power, muscle hypertrophy, vertical jump height and running speed, favoring FW-EOT.

CONCLUSIONS

This meta-analysis provides evidence supporting the superiority of FW-EOT, compared with traditional weight-stack exercise, to promote skeletal muscle adaptations in terms of strength, power and size in healthy subjects and athletes.

Effects of adding a weekly eccentric-overload training session on strength and athletic performance in team-handball players

To investigate the influence of adding a weekly eccentric-overload training (EOT) session in several athletic performance's tests, 18 team-handball players were assigned either to an EOT (n = 11) or a Control (n = 7) group. Both groups continued to perform the same habitual strength training, but the EOT group added one session/week during a 7-week training programme consisting of four sets of eight repetitions for the bilateral half-squat and unilateral lunge exercises. The test battery included handball throwing velocity, maximum dynamic strength (1RM), countermovement jump (CMJ), 20 m sprint, triple hop for distance, and eccentric/concentric power in both the half-squat and lunge exercises. Data were analysed using magnitude-based inferences. Both groups improved their 1RM in the half squat, 20 m sprint time, and CMJ performance to a similar extent, but the EOT group showed a beneficial effect for both right [(42/58/0), possibly positive] and left [(99/1/0), very likely positive] triple hop for distance performance. In addition, the EOT group showed greater power output improvements in both eccentric and concentric phases of the half-squat (difference in percent of change ranging from 6.5% to 22.0%) and lunge exercises (difference in per cent of change ranging from 13.1% to 24.9%). Nevertheless, no group showed changes in handball throwing velocity. Selected variables related to team-handball performance (i.e. functional jumping performance, power output) can be improved by adding a single EOT session per week, highlighting the usefulness of this low-volume/high-intensity training when aiming at optimizing dynamic athletic performance.

Influence of short-term inertial training on swimming performance in young swimmers

The aim of this study was to evaluate the influence of dry-land inertial training (IT) on muscle force, muscle power, and swimming performance. Fourteen young, national-level, competitive swimmers were randomly divided into IT and control (C) groups. The experiment lasted four weeks, during which time both groups underwent their regular swimming training. In addition, the IT group underwent IT using the Inertial Training Measurement System (ITMS) three times per week. The muscle groups involved during the upsweep phase of the arm stroke in front crawl and butterfly stroke were trained. Before and after training, muscle force and power were measured under IT conditions. Simultaneously with the biomechanical measurements on the ITMS, the electrical activity of the triceps brachii was registered. After four weeks of training, a 12.8% increase in the muscle force and 14.2% increase in the muscle power (p < .05) were noted in the IT group. Moreover, electromyography amplitude of triceps brachii recorded during strength measurements increased by 22.7% in the IT group. Moreover, swimming velocity in the 100 m butterfly and 50 m freestyle improved significantly following the four weeks of dry-land IT (-1.86% and -0.76%, respectively). Changes in the C group were trivial. Moreover, values of force and power registered during the ITMS test correlated negatively with the 100 m butterfly and 50 m freestyle swimming times (r value ranged from -.80 to -.91). These results suggest that IT can be useful in swimming practice.

Force Outputs during Squats Performed Using a Rotational Inertia Device under Stable versus Unstable Conditions with Different Loads

The purpose of the study was to compare the force outputs achieved during a squat exercise using a rotational inertia device in stable versus unstable conditions with different loads and in concentric and eccentric phases. Thirteen male athletes (mean ± SD: age 23.7 ± 3.0 years, height 1.80 ± 0.08 m, body mass 77.4 ± 7.9 kg) were assessed while squatting, performing one set of three repetitions with four different loads under stable and unstable conditions at maximum concentric effort. Overall, there were no significant differences between the stable and unstable conditions at each of the loads for any of the dependent variables. Mean force showed significant differences between some of the loads in stable and unstable conditions (P < 0.010) and peak force output differed between all loads for each condition (P < 0.045). Mean force outputs were greater in the concentric than in the eccentric phase under both conditions and with all loads (P < 0.001). There were no significant differences in peak force between concentric and eccentric phases at any load in either stable or unstable conditions. In conclusion, squatting with a rotational inertia device allowed the generation of similar force outputs under stable and unstable conditions at each of the four loads. The study also provides empirical evidence of the different force outputs achieved by adjusting load conditions on the rotational inertia device when performing squats, especially in the case of peak force. Concentric force outputs were significantly higher than eccentric outputs, except for peak force under both conditions. These findings support the use of the rotational inertia device to train the squatting exercise under unstable conditions for strength and conditioning trainers. The device could also be included in injury prevention programs for muscle lesions and ankle and knee joint injuries.

Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial

BACKGROUND

Resistance exercise (RE) improves neuromuscular function and physical performance after stroke. Yet, the effects of RE emphasizing eccentric (ECC; lengthening) actions on muscle hypertrophy and cognitive function in stroke patients are currently unknown. Thus, this study explored the effects of ECC-overload RE training on skeletal muscle size and function, and cognitive performance in individuals with stroke.

METHODS

Thirty-two individuals with chronic stroke (≥6 months post-stroke) were randomly assigned into a training group (TG; n = 16) performing ECC-overload flywheel RE of the more-affected lower limb (12 weeks, 2 times/week; 4 sets of 7 maximal closed-chain knee extensions; <2 min of contractile activity per session) or a control group (CG; n = 16), maintaining daily routines. Before and after the intervention, quadriceps femoris volume, maximal force and power for each leg were assessed, and functional and dual task performance, and cognitive functions were measured.

RESULTS

Quadriceps femoris volume of the more-affected leg increased by 9.4 % in TG. Muscle power of the more-affected, trained (48.2 %), and the less-affected, untrained limb (28.1 %) increased after training. TG showed enhanced balance (8.9 %), gait performance (10.6 %), dual-task performance, executive functions (working memory, verbal fluency tasks), attention, and speed of information processing. CG showed no changes.

CONCLUSION

ECC-overload flywheel resistance exercise comprising 4 min of contractile activity per week offers a powerful aid to regain muscle mass and function, and functional performance in individuals with stroke. While the current intervention improved cognitive functions, the cause-effect relationship, if any, with the concomitant neuromuscular adaptations remains to be explored.

TRIAL REGISTRATION

Clinical Trials NCT02120846.

Effects of eccentric-focused and conventional resistance training on strength and functional capacity of older adults

The aim of the study was to assess the effect of eccentric training using a constant load with longer exposure time at the eccentric phase on knee extensor muscle strength and functional capacity of elderly subjects in comparison with a conventional resistance training program. Twenty-six healthy elderly women (age = 67 ± 6 years) were randomly assigned to an eccentric-focused training group (ETG; n = 13) or a conventional training group (CTG; n = 13). Subjects underwent 12 weeks of resistance training twice a week. For the ETG, concentric and eccentric phases were performed using 1.5 and 4.5 s, respectively, while for CTG, each phase lasted 1.5 s. Maximum dynamic strength was assessed by the one-repetition maximum (1RM) test in the leg press and knee extension exercises, and for functional capacity, subjects performed specific tests (6-m walk test, timed up-and-go test, stair-climbing test, and chair-rising test). Both groups improved knee extension 1RM (24-26 %; p = 0.021), timed up-and-go test (11-16 %; p < 0.001), 6-m walk test (9-12 %; p = 0.004), stair-climbing test (8-13 %; p = 0.007), and chair-rising test (15-16 %; p < 0.001), but there was no significant difference between groups. In conclusion, the strategy of increasing the exposure time at the eccentric phase of movement using the same training volume and intensity does not promote different adaptations in strength or functional capacity compared to conventional resistance training in elderly woman.

Training effectiveness of the inertial training and measurement system

The purpose of this study was to evaluate the efficacy of inertial training with different external loads using a new original device - the Inertial Training and Measurement System (ITMS). Forty-six physical education male students were tested. The participants were randomly divided into three training groups and a control group (C group). The training groups performed inertial training with three different loads three times weekly for four weeks. The T0 group used only the mass of the ITMS flywheel (19.4 kg), the T5 and T10 groups had an additional 5 and 10 kg on the flywheel, respectively. Each training session included three exercise sets involving the shoulder joint adductors. Before and after training, the maximal torque and power were measured on an isokinetic dynamometer during adduction of the shoulder joint. Simultaneously, the electromyography activity of the pectoralis major muscle was recorded. Results of the study indicate that ITMS training induced a significant increase in maximal muscle torque in the T0, T5, T10 groups (15.5%, 13.0%, and 14.0%, respectively). Moreover, ITMS training caused a significant increase in power in the T0, T5, T10 groups (16.6%, 19.5%, and 14.5%, respectively). The percentage changes in torque and power did not significantly differ between training groups. Electromyography activity of the pectoralis major muscle increased only in the T0 group after four weeks of training. Using the ITMS device in specific workouts allowed for an increase of shoulder joint adductors torque and power in physical education students.

Influence of exercise intensity on training-induced tendon mechanical properties changes in older individuals

This study compared the effects of low vs. high intensity training on tendon properties in an elderly population. Participants were pair-matched (gender, habitual physical activity, anthropometrics, and baseline knee extension strength) and then randomly assigned to low (LowR, i.e., ~40 % 1RM) or high (High R, i.e., ~80 % 1RM) intensity resistance training programmes for 12 weeks, 3× per week (LowR, n = 9, age 74 ± 5 years; HighR, n = 8, age 68 ± 6 years). Patellar tendon properties (stiffness [K], Young's modulus [YM], cross-sectional area [T CSA], and tendon length [T L]) were measured pre and post training using a combination of magnetic resonance imaging (MRI), B-mode ultrasonography, dynamometry, electromyography and ramped isometric knee extensions. With training K showed no significant change in the LowR group while it incremented by 57.7 % in the HighR group (p < 0.05). The 51.1 % group difference was significant (p < 0.05). These differences were still apparent when the data was normalized for T CSA and T L, i.e., significant increase in YM post-intervention in HighR (p < 0.05), but no change in LowR. These findings suggest that when prescribing exercise for a mixed genders elderly population, exercise intensities of ≤40 % 1RM may not be sufficient to affect tendon properties.