Review of exercise-induced muscle injury: relevance for athletic populations

Occupational Health-Related Problems among Portuguese Fitness Instructors

BACKGROUND

The fitness sector has experienced significant expansion, with fitness instructors (FIs) playing a pivotal role. Given the demands of their profession, understanding their health profile is crucial. This study's purpose is to explore the prevalence of fitness instructors' occupational health-related problems.

METHODS

A questionnaire covering sociodemographic, occupational, and health-related items was administered. Statistical analyses, including Mann-Whitney U and chi-square tests, Spearman's rho correlations, and logistic regressions, were conducted.

RESULTS

Fifty-nine FIs reported occupational health-related problems, with the majority occurring during instruction (66.1%), being muscular (32.2%), and knee (15.3%), the most common type and localization. Significant statistical differences were observed between injured and non-injured FIs, including sex (p = 0.012), years as an FI (p = 0.001), weekly days worked (p = 0.039), and daily hours worked (p = 0.013). Weak negative (-0.284 - -0.362) statistically significant correlations were found between health problems; weight; height; main activity; and FIs in the workplace. Logistic regressions identified significant models showing that having a sport/physical exercise background and practicing it regularly were less likely to report bursitis (OR 0.018; p = 0.020) and hip injuries (OR 0.026; p = 0.037).

CONCLUSIONS

Approximately one-third of FIs reported occupational-related health problems, predominantly musculoskeletal injuries. Sociodemographic, personal, and occupational factors appear to influence the prevalence of these health problems.

Exercise induced muscle damage and repeated bout effect: an update for last 10 years and future perspectives

Exercise-induced muscle damage (EIMD) and repeated bout effect (RBE) are widely researched across various populations. EIMD is the muscle damage occurring after one bout of unaccustomed exercise while RBE is the attenuation of the same muscle damage in subsequent second bout. RBE seems to have significant implications for exercise prescription. Despite existence of vast literature, there is lack of clarity on the effects of EIMD and RBE in a healthy population. The purpose of this study is to review the literature on EIMD and RBE in healthy participants published during the last 10 years. The search of major databases (including Scopus, Google Scholar and PubMed) was conducted using specific keywords ‘Exercise induced muscle damage’, ‘Repeated bout effect’, ‘Healthy participants’ ‘Pre-conditioning’, ‘Eccentric exercise’. Studies published from 2011 onwards which included EIMD and RBE assessment in healthy participants were included in this review. Database searching revealed a total of 38 studies on EIMD and RBE in healthy participants. Three major themes of papers were identified that focused on EIMD and RBE along with (1) age related differences, (2) sex-based differences, and (3) response in athletes. Findings of this comprehensive review suggests that both EIMD and RBE are age, and sex specific. Delayed onset muscle soreness played a major role in both EIMD and RBE in all the population types. Female participants are less susceptible to EIMD as compared to age-matched male counterparts. Moreover, both EIMD and RBE are more elicited in middle aged and younger adults as compared to children and older adults while the magnitude of RBE turns out to be minimal in trained individuals due to persisting adaptations.

Foam rolling is an effective recovery tool in trained distance runners

Purpose

Many endurance athletes use foam rolling (FR) to decrease muscle soreness, but it is unclear whether FR effectively treats soreness in this population. Moreover, the effects of FR in highly trained runners are unknown. The aim of this study was to use downhill running (DHR) to induce muscle soreness in runners and to determine the influence of FR on soreness and running performance when compared to sham compression tights.

Methods

Participants performed a running economy (RE) test at 75% of 5-km race speed and a 3-km time trial (TT). In a crossover design, subjects then completed DHR followed by either a FR protocol or wearing sham compression tights. Two days post-DHR, subjects repeated the RE and TT tests. Crossover visits occurred 2-4 weeks later. During RE tests, VO2 and rating of perceived exertion (RPE) were recorded. Passive and active soreness were measured on a scale of 0 (no soreness) to 10 (extreme soreness).

Results

Eight runners (aged 31 ± 7 years; four females; VO2peak 57 ± 7 ml kg-1 min-1) completed the study. Both treatment conditions experienced passive (p = 0.026) and active soreness (p = 0.012) induced by DHR. Active soreness 2 days postDHR was significantly lower after FR than after sham compression tights (p = 0.025). With tights, there was a trend for an increased RPE compared to pre-DHR (p = 0.056).

Conclusions

Foam rolling decreases leg soreness in well-trained runners and attenuates soreness-related increases in perceived exertion during sub-maximal running.

Insights into the molecular etiology of exercise-induced inflammation: opportunities for optimizing performance

The study of exercise-induced muscle damage (EIMD) is of paramount importance not only because it affects athletic performance but also because it is an excellent model to study the mechanisms governing muscle cachexia under various clinical conditions. Although, a large number of studies have investigated EIMD and its associated inflammatory response, several aspects of skeletal muscles responses remain unclear. In the first section of this article, the mechanisms of EIMD are reviewed in an attempt to follow the events that result in functional and structural alterations of skeletal muscle. In the second section, the inflammatory response associated with EIMD is presented with emphasis in leukocyte accumulation through mechanisms that are largely coordinated by pro- and anti-inflammatory cytokines released either by injured muscle itself or other cells. The practical applications of EIMD and the subsequent inflammatory response are discussed with respect to athletic performance. Specifically, the mechanisms leading to performance deterioration and development of muscle soreness are discussed. Emphasis is given to the factors affecting individual responses to EIMD and the resulting interindividual variability to this phenomenon.

Effect of ultra-endurance exercise on left ventricular performance and plasma cytokines in healthy trained men

The purpose of this study was to investigate the effect of ultra-endurance exercise on left ventricular (LV) performance and plasma concentration of interleukin (IL)-6, IL-10, IL-18 and tumour necrosis factor alpha (TNF-α) as well as to examine the relationships between exercise-induced changes in plasma cytokines and those in echocardiographic indices of LV function in ultra-marathon runners. Nine healthy trained men (mean age 30±1.0 years) participated in a 100-km ultra-marathon. Heart rate, blood pressure, ejection fraction (EF), fractional shortening (FS), ratio of early (E) to late (A) mitral inflow peak velocities (E/A), ratio of early (E’) to late (A’) diastolic mitral annulus peak velocities (E’/A’) and E-wave deceleration time (DT) were obtained by echocardiography before, immediately after and in the 90th minute of the recovery period. Blood samples were taken before each echocardiographic evaluation. The ultra-endurance exercise caused significant increases in plasma IL-6, IL-10, IL-18 and TNF-α. Echocardiography revealed significant decreases in both E and the E/A ratio immediately after exercise, without any significant changes in EF, FS, DT or the E/E’ ratio. At the 90th minute of the recovery period, plasma TNF-α and the E/A ratio did not differ significantly from the pre-exercise values, whereas FS was significantly lower than before and immediately after exercise. The increases in plasma TNF-α correlated with changes in FS (r=0.73) and DT (r=-0.73). It is concluded that ultra-endurance exercise causes alterations in LV diastolic function. The present data suggest that TNF-α might be involved in this effect.

Changes in stress hormone levels with the application of vibrations before resistance exercises at different intensities

[Purpose] The purpose of the present study was to determine whether vibrations should be applied before resistance exercises by examining changes in stress hormone levels with vibrations applied before different exercise intensities. [Subjects] Eighteen male subjects in their 20s were included, and were randomly divided into one-repetition maximum (1RM) 50% group (50% RMG, n = 6), 1RM 70% group (70%RMG, n = 6), and 1RM 90% group (90% RMG, n = 6). [Methods] Three sets of Smith squats were performed at 1RM 50%, 70%, and 90% according to resistance intensities, and vibrations were applied for 1 min at a fixed frequency of 30 Hz before each set. Epinephrine, norepinephrine, and dopamine stress hormone levels were analyzed. [Results] Epinephrine levels were significantly higher immediately after exercise than at rest in the 50%RMG; however, no significant changes were noted in the 70%RMG and 90%RMG. Norepinephrine levels were significantly higher immediately after exercise than at rest in all three groups. However, no significant changes in dopamine levels were noted in the three groups. [Conclusion] The application of vibrations at a frequency of 30 Hz before 70%RM and 90%RM resistance exercises suppressed increases in the stress hormone epinephrine levels immediately after exercise.

Reduced susceptibility to eccentric exercise-induced muscle damage in resistance-trained men is not linked to resistance training-related neural adaptations

The purpose of this study was to examine the acute effects of maximal concentric vs. eccentric exercise on the isometric strength of the elbow flexor, as well as the biceps brachii muscle electromyographic (EMG) responses in resistance-trained (RT) vs. untrained (UT) men. Thirteen RT men (age: 24 ± 4 years; height: 180.2 ± 7.7 cm; body weight: 92.2 ± 16.9 kg) and twelve UT men (age: 23 ± 4 years; height: 179.2 ± 5.0 cm; body weight: 81.5 ± 8.6 kg) performed six sets of ten maximal concentric isokinetic (CON) or eccentric isokinetic (ECC) elbow flexion exercise in two separate visits. Before and after the exercise interventions, maximal voluntary contractions (MVCs) were performed for testing isometric strength. In addition, bipolar surface EMG signals were detected from the biceps brachii muscle during the strength testing. Both CON and ECC caused isometric strength to decrease, regardless of the training status. However, ECC caused greater isometric strength decline than CON did for the UT group (p = 0.006), but not for the RT group. Both EMG amplitude and mean frequency significantly decreased and increased, respectively, regardless of the training status and exercise intervention. Resistance-trained men are less susceptible to eccentric exercise-induced muscle damage, but this advantage is not likely linked to the chronic resistance training-induced neural adaptations.

Single nucleotide polymorphisms associated with non-contact soft tissue injuries in elite professional soccer players: influence on degree of injury and recovery time

BACKGROUND

The biological mechanisms involved in non-contact musculoskeletal soft tissue injuries (NCMSTI) are poorly understood. Genetic risk factors may be associated with susceptibility to injuries, and may exert marked influence on recovery times.

METHODS

Data on type and degree of injury and recovery time were collected in 73 male professional soccer players (43 White, 11 Black Africans and 19 Hispanics) who suffered total of 242 injuries (203 muscle, 24 ligament, and 15 tendon injuries). One single nucleotide polymorphism (SNPs) in the following genes were analyzed: Elastin (ELN); Titin (TTN); SRY-related HMG-box (SOX15); Insulin-like growth factor 2 (IGF2); Chemokine, CC motif, ligand 2 (CCL2); Collagen type 1 alpha 1(COL1A1); Collagen type 5 alpha 1 (COL5A1), and Tenascin C (TNC).

RESULTS

There was evidence of a statistically significant association between the degree of injury and the IGF2 genotype (P = 0.034). In addition, there was evidence of a statistically significant association between the degree of muscle injury and CCL2 (P = 0.026) Finally, there was evidence of a statistically significant association between ELN and degree of injury (p = 0.009) and recovery time (P = 0.043). There was no evidence of a statistically significant association between any of the genes studied and degree of injury or recovery time for tendon injuries.

CONCLUSION

SNPs in the IGF2, CCL2, and ELN genes may be associated to the degree and recovery time of NCMSTI.

Effects of taurine supplementation following eccentric exercise in young adults

The purpose of the present study was to investigate the effects of taurine supplementation on muscle performance, oxidative stress, and inflammation response after eccentric exercise (EE) in males. Twenty-one participants (mean age, 21 ± 6 years; weight, 78.2 ± 5 kg; height, 176 ± 7 cm) were selected and randomly divided into two groups: placebo (n = 10) and taurine (n = 11). Fourteen days after starting supplementation, subjects performed EE (3 sets until exhaustion, with EE of the elbow flexors on the Scott bench, 80% 1 repetition maximum (RM)). Blood samples were collected and muscle performance was measured on days 1, 14, 16, 18, and 21 after starting the supplements. Then, performance, muscle damage, oxidative stress, and inflammatory markers were analyzed. The taurine supplementation resulted in increased strength levels and thiol total content and decreased muscle soreness, lactate dehydrogenase level, creatine kinase activity, and oxidative damage (xylenol and protein carbonyl). Antioxidant enzymes (superoxide dismutase, catalase, and gluthatione peroxidase) and inflammatory markers (tumor necrosis factor, interleukin-1β (IL-1β), and interleukin-10 (IL-10)) were not altered during the recovery period compared with the placebo group. The results suggest that taurine supplementation represents an important factor in improving performance and decreasing muscle damage and oxidative stress but does not decrease the inflammatory response after EE.

The effects of a downhill running bout on running economy

This study investigated whether downhill (DH) running (10-min @ 214.4 m·min(-1) and -10% grade) would elicit acute and delayed effects on running economy (RE) upon completion of DH running (RE2) and daily over 72 h (RE3, RE4, RE5). Fifteen runners (8 female, 7 male) completed the protocol. RE was measured during level running performed at 70% VO2peak. A baseline RE test (RE1) was used for comparison. Muscle soreness was significantly elevated at RE3 and RE4 vs. RE1. Oxygen uptake was significantly elevated at RE2 relative to RE3, RE4 and RE5 but was not different from RE1. Heart rate was similarly elevated at RE2. Measures of ankle, knee and hip joint angles at heel strike and toe off were not affected at any time-point in a subset of subjects (N = 6). A short DH running bout did not elicit significant delayed adverse effects on oxygen uptake or gait parameters relative to baseline.

Repeated bout effect is absent in resistance trained men: an electromyographic analysis

A prior bout of exercise is well known to confer protection from subsequent eccentric bouts (i.e. repeated bout effect; RBE), which may be fostered through neural adaptations, specifically a shift in the frequency content of the surface electromyogram (EMG). It is currently not clear whether chronically resistance trained men are capable of a RBE driven by neural adaptations. Eleven resistance trained men (23.5+/-3.4 yrs) performed 100 eccentric actions of the barbell bench press exercise, followed by an equivalent bout 14 days later. Indirect markers of muscle damage (i.e. force production, soreness) along with surface EMG were measured before and through 48 h of recovery. Median frequency and maximal isometric force demonstrated time main effects (p>0.05), but no RBE. A prior bout of eccentric exercise does not confer a RBE for indirect markers of muscle injury or elicit changes in the frequency content of the EMG signal in resistance trained men.

Delayed-onset muscle injury and its modification by wheat gluten hydrolysate

OBJECTIVE

We investigated the pattern of delayed-onset muscle injury in well-trained athletes after a competitive half-marathon and the effects of post-race intake of wheat gluten hydrolysate (WGH).

METHODS

Thirty well-trained college runners with a best time of 14-15 min over 5000 m raced in a half-marathon. Thereafter, they were divided into three groups based on finish times and given 0 (control), 10, or 20 g of WGH. Blood biochemical parameters were monitored at -1 d, +1 h, +1 d, and +2 d after the race. Data selected according to finish times and biochemical parameters were then analyzed.

RESULTS

Plasma creatine kinase activity peaked at 1 d after the race in the control group and correlated with post-race white blood cell counts. The post-race elevation of creatine kinase activity was dose-dependently suppressed by WGH.

CONCLUSION

Delayed-onset muscle injury peaked in well-trained distance runners at 1 d after a half-marathon and was dose-dependently suppressed by a post-race intake of WGH.

Effect of exercise on oxidative stress biomarkers

Acute bouts of aerobic and anaerobic exercise can induce a state of oxidative stress, as indicated by an increase in oxidized molecules in a variety of tissues and body fluids. The extent of oxidation is dependent on the exercise mode, intensity, and duration, and is specifically related to the degree of oxidant production. Findings of increased oxidative stress have been reported for both healthy and diseased subjects following single bouts of exercise. While acute exercise has the ability to induce an oxidative stress, this same exercise stimulus appears necessary to allow for an upregulation in endogenous antioxidant defenses. This chapter presents a summary of exercise-induced oxidative stress.

Comparison of responses to strenuous eccentric exercise of the elbow flexors between resistance-trained and untrained men

This study compared resistance-trained and untrained men for changes in commonly used indirect markers of muscle damage after maximal voluntary eccentric exercise of the elbow flexors. Fifteen trained men (28.2 +/- 1.9 years, 175.0 +/- 1.6 cm, and 77.6 +/- 1.9 kg) who had resistance trained for at least 3 sessions per week incorporating exercises involving the elbow flexor musculature for an average of 7.7 +/- 1.4 years, and 15 untrained men (30.0 +/- 1.5 years, 169.8 +/- 7.4 cm, and 79.9 +/- 4.4 kg) who had not performed any resistance training for at least 1 year, were recruited for this study. All subjects performed 10 sets of 6 maximal voluntary eccentric actions of the elbow flexors of one arm against the lever arm of an isokinetic dynamometer moving at a constant velocity of 90 degrees .s. Changes in maximal voluntary isometric and isokinetic torque, range of motion, upper arm circumference, plasma creatine kinase activity, and muscle soreness before, immediately after, and for 5 days after exercise were compared between groups. The trained group showed significantly (P < 0.05) smaller changes in all of the measures except for muscle soreness and faster recovery of muscle function compared with the untrained group. For example, muscle strength of the trained group recovered to the baseline by 3 days after exercise, where the untrained group showed approximately 40% lower strength than baseline. These results suggest that resistance-trained men are less susceptible to muscle damage induced by maximal eccentric exercise than untrained subjects.