Greater cross education following training with muscle lengthening than shortening

Age, Sex, and Training Specific Effects on Cross-Education Training

An extensive number of publications have examined cross-education effects with adults, primarily investigating contralateral homologous (same) muscles. There are far fewer investigations on cross-education effects on contralateral heterologous (different) muscles and age (youth vs adult) and no studies investigating sex differences. Hence, the objective was to compare cross-education in female and male youth and young adults to contralateral homologous (chest press [CP], elbow flexors and extensors, handgrip isometric strength, and shot put) and heterologous (leg press, knee extension isometric strength, and countermovement jump) muscles. Twenty-eight female adults, 28 female youth, 28 male adults, and 28 male youth (total: 112) were examined before and after an 8-week (3 sessions/wk) unilateral, dominant arm, CP training program. Unilateral testing assessed dominant and nondominant leg press and CP 1-repetition maximum, knee extensors, elbow extensors, elbow flexors, and handgrip maximum voluntary isometric contraction (MVIC) strength, as well as shot put distance and countermovement jump height. Unilateral CP training induced training specific (CP 1-repetition maximum) and nonspecific (elbow extensors, elbow flexors, handgrip MVIC force, and shot put distance) improvements (P < .04, η2: .45-.85) but no significant lower body improvements. There was evidence for testing limb specificity as the dominant arm provided significantly (P < .021, η2: .17-.75) greater training gains than the nondominant arm. Youth's training adaptations exceeded with unilateral CP 1-repetition maximum, elbow extensors MVIC force, and shot put distance (P < .049, η2: .14-.49). No sex main effect differences were apparent. In conclusion, cross-education was training specific (greatest gains with upper body and dominant limbs) with greater benefits for youth and generally no sex differences with the exception of elbow extensors MVIC.

Cross-education of lower limb muscle strength following resistance exercise training in males and females: A systematic review and meta-analysis

Cross-education describes the training of one limb that leads to performance enhancements in the contralateral untrained limb, driven by neural changes rather than muscle adaptation. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of cross-education (vs. a control group) via resistance exercise training (RET) for improving muscle strength in the untrained lower limb of healthy males and females. A literature search from inception to September 2023 was conducted using MEDLINE (via PubMed), the Cochrane Library (CENTRAL), Web of Science (Core Database), Scopus, EBSCO-host, and Ovid-EMBASE. Independent screening, data extraction and quality assessment were conducted. The measured outcomes were change in one-repetition maximum (1-RM) load, maximum voluntary contraction (MVC), and concentric, eccentric and isometric peak torque. Change in muscle structure (pennation angle and muscle thickness) was also analysed. A total of 29 studies were included. The pooled effect size from the random-effects model shows that cross-education significantly increased 1-RM compared to the control group (standardised mean difference (SMD): 0.59, 95% CI: 0.22-0.97; P = 0.002). Cross-education also significantly improved MVC (SMD: 0.55, 95% CI: 0.16-0.94; P = 0.006), concentric (SMD: 0.61, 95% CI: 0.39-0.84; P < 0.00001), eccentric (SMD: 0.39, 95% CI: 0.13-0.64; P = 0.003) and isometric (SMD: 0.45, 95% CI: 0.26-0.64; P < 0.00001) peak torque, each compared to the control group. When RET was categorised as eccentric or concentric, subgroup analysis showed that only eccentric training was associated with significantly increased isometric peak torque via cross-education (SMD: 0.37, 95% CI: 0.13-0.61; P = 0.003) (concentric, SMD: 0.33, 95% CI: -0.09 to 0.74; P = 0.12). This systematic review and meta-analysis emphasise the potency of cross-education for improving lower limb muscle strength. These findings have potential implications for clinical situations of impaired unilateral limb function (e.g., limb-casting or stroke). Future work exploring the mechanisms facilitating these enhancements will help to develop optimised rehabilitation protocols.

Cross-Education Effects of Isokinetic Eccentric Plantarflexor Training on Flexibility, Strength, and Muscle-Tendon Mechanics

INTRODUCTION

Large increases in joint range of motion (ROM) have been reported after eccentric resistance training; however, limited data exist describing the associated mechanisms or potential cross-education effects in the contralateral limb. Therefore, the effects of a 6-wk isokinetic eccentric plantarflexor training program were examined in 26 participants.

METHODS

Before and after the training program, dorsiflexion ROM, plantarflexor strength, and muscle-tendon unit (MTU) morphology and mechanics were measured in control ( n = 13) and experimental ( n = 13) young adult groups. Training consisted of 5 sets of 12 maximal isokinetic eccentric plantarflexor contractions twice weekly on the right limb.

RESULTS

Significant ( P < 0.05) increases in dorsiflexion ROM (4.0-9.5°), stretch tolerance (40.3-95.9%), passive elastic energy storage (47.5-161.3%), and isometric (38.1-40.6%) and eccentric (46.7-67.0%) peak plantarflexor torques were detected in both trained and contralateral limbs in the experimental group. Significant increases in gastrocnemius medialis and soleus thickness (5.4-6.1%), gastrocnemius medialis fascicle length (7.6 ± 8.5%), passive plantarflexor MTU stiffness (30.1 ± 35.5%), and Achilles tendon stiffness (5.3 ± 4.9%) were observed in the trained limb only. Significant correlations were detected between the changes in trained and contralateral limbs for dorsiflexion ROM ( r = 0.59) and both isometric ( r = 0.79) and eccentric ( r = 0.73) peak torques. No significant changes in any metric were detected in the control group.

CONCLUSIONS

Large ROM increases in the trained limb were associated with neurological, mechanical, and structural adaptations, with evidence of a cross-education effect in the contralateral limb being primarily driven by neurological adaptation (stretch tolerance). The large improvements in ROM, muscle size, and strength confirm that isokinetic eccentric training is a highly effective training tool, with potential for use in athletic and clinical populations where MTU function is impaired and current therapies are ineffective.

Relative Cross-Education Training Effects of Male Youth Exceed Male Adults

ABSTRACT

Ben Othman, A, Anvar, SH, Aragão-Santos, JC, Behm, DG, and Chaouachi, A. Relative cross-education training effects of male youth exceed male adults. J Strength Cond Res 38(5): 881-890, 2024-Cross-education has been studied extensively with adults, examining the training effects on contralateral homologous muscles. There is less information on the cross-education effects on contralateral heterologous muscles and scant information comparing these responses between adults and youth. The objective was to compare cross-education training effects in male youth and adults to contralateral homologous and heterologous muscles. Forty-two male children (10-13-years) and 42 adults (18-21-years) were tested before and following an 8-week unilateral, dominant or nondominant arm, chest press (CP) training program or control group (14 subjects each). Unilateral testing assessed dominant and nondominant limb strength with leg press and CP 1 repetition maximum (1RM), knee extensors, elbow extensors (EE), elbow flexors, and handgrip maximum voluntary isometric contraction (MVIC) strength and shot put distance and countermovement jump height. Upper-body tests demonstrated large magnitude increases, with children overall exceeding adults ( p = 0.05- p < 0.0001, η2 : 0.51, 10.4 ± 11.1%). The dominant trained limb showed significantly higher training adaptations than the nondominant limb for the adults with CP 1RM ( p = 0.03, η2 : 0.26, 6.7 ± 11.5%) and EE ( p = 0.008, η2 : 0.27, 8.8 ± 10.3%) MVIC force. Unilateral CP training induced significantly greater training adaptations with the ipsilateral vs. contralateral limb ( p = 0.008, η2 : 0.93, 27.8 ± 12.7%). In conclusion, children demonstrated greater training adaptations than adults, upper-body strength increased with no significant lower-body improvements, and ipsilateral training effects were greater than contralateral training in adults.

Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial

HYPOTHESIS

This study aimed to investigate the effects of cross education (CE) on rotator cuff (RC) muscle strength recovery and shoulder function in patients who underwent arthroscopic anterior shoulder stabilization surgery.

METHODS

Twenty-eight patients who underwent shoulder stabilization surgery were included in the study (age, 25 ± 6 years; body mass index, 24.8 ± 3.6 kg/m2). The patients were randomly divided into either the CE group (n = 14) or the control group (n = 14). All patients received a standardized rehabilitation program until the end of the 12th postoperative week. The CE group also received isokinetic training of the nonoperative shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and at 3 and 6 months postoperatively using an isokinetic dynamometer at 60°/s and 180°/s angular velocities. Shoulder function was assessed with the Closed Kinetic Chain Upper Extremity Stability Test and Y-Balance Test-Upper Quarter. Analyses of covariance were used for the statistical analyses.

RESULTS

At 6 months postoperatively, at 60°/s angular velocity, there was higher internal rotator strength in the CE group (P = .02) and similar external rotator strength (P = .62) between the groups. At 180°/s angular velocity, both internal rotator strength (P = .04) and external rotator strength (P = .02) were higher in the CE group. The Closed Kinetic Chain Upper Extremity Stability Test (P = .47), Y-Balance Test-Upper Quarter (P = .95), and Western Ontario Shoulder Instability Index (P = .12) scores were similar between the groups at 6 months after surgery.

CONCLUSIONS

CE in the early period of postoperative rehabilitation following stabilization surgery improves RC strength recovery. However, it has no effect on functional outcomes. Integrating a CE program into the postoperative rehabilitation protocol may help to improve dynamic shoulder stability but not functional capacity.

Contralateral versus ipsilateral protective effect against muscle damage of the elbow flexors and knee extensors induced by maximal eccentric exercise

The present study compared the ipsilateral repeated bout effect (IL-RBE) and contralateral repeated bout effect (CL-RBE) of the elbow flexors (EF) and knee flexors (KF) for the same interval between bouts to shed light on their mechanisms. Fifty-two healthy sedentary young (20-28 years) men were randomly assigned to the IL-EF, IL-KF, CL-EF, and CL-KF groups (n = 13/group). Thirty maximal eccentric contractions of the EF were performed in IL-EF and CL-EF, and 60 maximal eccentric contractions of the KF were performed in IL-KF and CL-KF, with a 2-week interval between bouts. Changes in muscle damage markers such as maximal voluntary contraction (MVC) torque, muscle soreness, and plasma creatine kinase activity, and proprioception measures before to 5 days post-exercise were compared between groups. Changes in all variables were greater (p < 0.05) after the first than second bout for all groups, and the changes were greater (p < 0.05) for the EF than KF. The changes in all variables after the second bout were greater (p < 0.05) for the CL than IL condition for both EF and KF. The magnitude of the average protective effect was similar between CL-EF (33%) and CL-KF (32%), but slightly greater (p < 0.05) for IL-EF (67%) than IL-KF (61%). These demonstrate that the magnitude of CL-RBE relative to IL-RBE was similar between the EF and KF (approximately 50%), regardless of the greater muscle damage for the EF than KF. It appears that the CL-RBE is more associated with neural adaptations at cerebrum, cerebellum, interhemispheric inhibition, and coricospinal tract, but the IL-RBE is induced by additional adaptations at muscles.

Eccentric Cycling Is an Alternative to Nordic Hamstring Exercise to Increase the Neuromuscular Function of Knee Flexors in Untrained Men

ABSTRACT

Valdes, O, Inzulza, S, Collao, N, Garcia-Vicencio, S, Tufano, JJ, Earp, J, Venegas, M, and Peñailillo, L. Eccentric cycling is an alternative to Nordic hamstring exercise to increase the neuromuscular function of knee flexors in untrained men. J Strength Cond Res 37(11): 2158-2166, 2023-Nordic hamstring exercise (NHE) has been proposed to reduce knee flexor (KF) injuries. However, submaximal alternatives to NHE are necessary for the clinical or weaker population. The aim of this study was to compare the effects of Nordic hamstring training (NHT) and eccentric cycling (ECC) training on the neuromuscular function of the KF. Twenty healthy men (27.7 ± 3.5 years) were randomly assigned into 2 groups that performed 10 training sessions (2-3 sessions·week-1) of either NHT (n = 10) or ECC (n = 10). Maximal voluntary isometric contraction of the KF and knee extensor (KE) muscles (MVICKF and MVICKE) was measured, and the hamstring/quadriceps strength (H/Q) ratio was calculated. Furthermore, changes in NHE maximum reaction force (NHE-MRFKF), NHE break-point angle (NHE-BPA), and muscle activity of the semitendinosus (STEMG) and biceps femoris (BFEMG) during the NHE after the interventions were compared. Although no group × time effects were observed (p = 0.09-0.70), but time effects were found for all variables. Pairwise comparisons revealed that MVICKF (+16.9%; p = 0.02), H/Q ratio (+11.8%; p = 0.01), NHE-MRFKF (+19.8%; p = 0.005), and NHE-BPA (+30.8%; p = 0.001) increased after ECC, whereas NHE-MRFKF (+9.7%; p = 0.003), NHE-BPA (+35.5%; p = 0.0002), and STEMG (+33.7%; p = 0.02) increased after NHT. A group × time effect was observed (p = 0.003) in BFEMG, revealing an increase only after ECC (+41.1%; p < 0.0001). Similar neuromuscular adaptations were found after both training modalities. Therefore, ECC provides similar adaptations as NHT and may serve as an alternative form of KF training for those unable to perform NHE.

Exercise prescription and strategies to promote the cross-education of strength: a scoping review

The cross-education of strength is moderated by exercise design and prescription in clinical and non-clinical populations. This review synthesizes the available evidence regarding exercise design strategies for unilateral resistance training and provides evidence-based recommendations for the prescription of unilateral training to maximize the cross-education of strength. Greater insights regarding the timing and effectiveness of cross-education interventions in clinical scenarios will strengthen the use of unilateral resistance training for individuals who may benefit from its use.

Effects of Unilateral Eccentric versus Concentric Training of Nonimmobilized Arm during Immobilization

INTRODUCTION

The present study tested the hypothesis that eccentric training (ET) of nonimmobilized arm would attenuate negative effects of immobilization and provide greater protective effects against muscle damage induced by eccentric exercise after immobilization, when compared with concentric training (CT).

METHODS

Sedentary young men were placed to ET, CT, or control group ( n = 12 per group), and their nondominant arms were immobilized for 3 wk. During the immobilization period, the ET and CT groups performed five sets of six dumbbell curl eccentric-only and concentric-only contractions, respectively, at 20%-80% of maximal voluntary isometric contraction (MVCiso) strength over six sessions. MVCiso torque, root-mean square (RMS) of electromyographic activity during MVCiso, and bicep brachii muscle cross-sectional area (CSA) were measured before and after immobilization for both arms. All participants performed 30 eccentric contractions of the elbow flexors (30EC) by the immobilized arm after the cast was removed. Several indirect muscle damage markers were measured before, immediately after, and for 5 d after 30EC.

RESULTS

ET increased MVCiso (17% ± 7%), RMS (24% ± 8%), and CSA (9% ± 2%) greater ( P < 0.05) than CT (6% ± 4%, 9% ± 4%, 3% ± 2%) for the trained arm. The control group showed decreases in MVCiso (-17% ± 2%), RMS (-26% ± 6%), and CSA (-12% ± 3%) for the immobilized arm, but these changes were attenuated greater ( P < 0.05) by ET (3% ± 3%, -0.1% ± 2%, 0.1% ± 0.3%) than CT (-4% ± 2%, -4% ± 2%, -1.3% ± 0.4%). Changes in all muscle damage markers after 30EC were smaller ( P < 0.05) for the ET and CT than the control group, and ET than the CT group (e.g., peak plasma creatine kinase activity: ET, 860 ± 688 IU·L -1 ; CT, 2390 ± 1104 IU·L -1 ; control, 7819 ± 4011 IU·L -1 ).

CONCLUSIONS

These results showed that ET of the nonimmobilized arm was effective for eliminating the negative effects of immobilization and attenuating eccentric exercise-induced muscle damage after immobilization.

Effects of Eccentric-Oriented Strength Training on Return to Sport Criteria in Late-Stage Anterior Cruciate Ligament (ACL)-Reconstructed Professional Team Sport Players

Background and Objectives: An effective post-injury training program is essential to regain performance and fulfill criteria for return to sport for team sport athletes following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare the effects of 6 weeks of eccentric-oriented strength training vs. traditional strength training during the late-stage ACL-rehab phase on leg strength and vertical and horizontal jumping performance in professional team sport athletes. Materials and Methods: Twenty-two subjects (14 males, 8 females, age 19.9 ± 4.4 years, mass 77.4 ± 15.6 kg, height 182.4 ± 11.7 cm) (mean ± SD) with a unilateral reconstructed ACL (BTB graft) were included in the study. All participants enrolled in the same rehabilitation protocol prior to the training study. Players were randomly assigned to an experimental (ECC: n = 11, age 21.8 ± 4.6 years, mass 82.7 ± 16.6 kg, height 185.4 ± 12.2 cm), and a control group (CON: n = 11, age 19.1 ± 2.1 years, mass 76.6 ± 16.5 kg, height 182.5 ± 10.2 cm). Both groups underwent an equivolumed rehabilitation program, with the only difference being in strength training, which consisted of flywheel training vs. traditional strength training for the experimental and control groups, respectively. Testing was organized before and after the 6-week training programs and included isometric semi-squat tests (ISOSI-injured and ISOSU-uninjured legs), vertical jump tests (CMJ), single-leg vertical jump tests (SLJI-injured and SLJU-uninjured legs), single-leg hop tests (SLHI-injured and SLHU-uninjured legs), and triple hop tests (TLHI-injured and TLHU-uninjured legs). In addition, limb symmetry indexes were calculated for the isometric semi-squat (ISOSLSI) test, the single-leg vertical jump (SLJLSI), and the hop (SLHLSI) tests, as well as the triple-leg hop (THLLSI) test. Results: Main effects of time across training were observed for all dependent variables (posttest > pretest, p < 0.05). Significant group-by-time interactions were found for ISOSU (p < 0.05, ES = 2.51, very large), ISOSI (p < 0.05, ES = 1.78, large), CMJ (p < 0.05, ES = 2.23, very large), SLJI (p < 0.05, ES = 1.48, large), SLHI (p < 0.05, ES = 1.83, large), and TLHI (p < 0.05, ES = 1.83, large). Conclusions: This study suggests that eccentric-oriented strength training in late-stage ACL recovery, undertaken twice or three times weekly for 6 weeks, results in better outcomes than traditional strength training in leg strength, vertical jump ability, and single and triple hop tests with injured legs in professional team sport athletes. It seems that flywheel strength training can be recommended in late-stage ACL recovery for professional team sport athletes in order to regain recommended performance outcome levels faster.

Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears?

PURPOSE

Neuromuscular control is important for joint stabilization. Supraspinatus muscle plays an essential role in the perception of proprioceptive sense. The aim of this study is to investigate active joint position sense (AJPS) both in patients with partial and full-thickness supraspinatus tears and in healthy participants.

METHODS

Twenty patients with partial supraspinatus tears, 20 patients with full-thickness supraspinatus tears, and 20 healthy participants, aged 40-65 years, were included in the study. Proprioceptive sense was assessed with AJPS measurement. Absolute error was calculated to evaluate joint position sense.

RESULTS

Active joint position sense was decreased in partial and full-thickness tears on both in affected and contralateral shoulders compared to control group (p < 0.05). There was no difference between groups with partial and full-thickness tears on the affected and contralateral shoulders at 40° and 100° elevation (p > 0.05).

CONCLUSION

AJPS was affected after supraspinatus injury. It was seen as proprioceptive deficit in patients with partial and full-thickness tears in both affected and contralateral shoulders.

To assess the effects of cross-education on strength and motor function in post stroke rehabilitation: a systematic literature review and meta-analysis

BACKGROUND

Cross-education refers to the increase in motor output of the untrained limb following unilateral training of the opposite limb. Cross education has been shown to be beneficial in clinical settings.

OBJECTIVES

This systematic literature and meta-analysis aims to assess the effects of cross-education on strength and motor function in post stroke rehabilitation.

DATA SOURCES

MEDLINE, CINAHL, Cochrane Library, PubMed, PEDro, Web of Science, ClinicalTrails.gov and Cochrane Central registers were searched up to 1st October 2022.

STUDY SELECTION

Controlled trials using unilateral training of the less affected limb in individuals diagnosed with stroke and English language.

DATA SYNTHESIS

Methodological quality was assessed using Cochrane Risk-of-Bias tools. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. Meta-analyses were performed using RevMan 5.4.1.

RESULTS

Five studies capturing 131 participants were included in the review and three studies capturing 95 participants were included in the meta-analysis. Cross education was shown to have a statistically and clinically significant effect on upper limb strength (p < 0.003; SMD 0.58; 95% CI 0.20-0.97; n = 117) and upper limb function (p = 0.04; SMD 0.40; 95% CI 0.02-0.77; n = 119).

LIMITATIONS

Small number of studies, with all studies identified as having some risk of bias. Quality of evidence graded 'low' due to limitations and imprecision.

CONCLUSION

Cross education may be beneficial in improving strength and motor function in the more affected upper limb post stroke. Further studies are needed as the research into the benefits of cross education in stroke rehabilitation is still limited. Systematic Review Registration Number: PROSPERO (CRD42020219058).

Training in the Initial Range of Motion Promotes Greater Muscle Adaptations Than at Final in the Arm Curl

OBJECTIVE

The effects of ROM manipulation on muscle strength and hypertrophy response remain understudied in long-term interventions. Thus, we compared the changes in strength and regional muscle hypertrophy after training in protocols with different ranges of motion (ROM) in the seated dumbbell preacher curl exercise using a within-participant experimental design.

DESIGN AND METHODS

Nineteen young women had one arm randomly assigned to train in the initial ROM (INITIALROM: 0°-68°; 0° = extended elbow) while the contralateral arm trained in the final ROM (FINALROM: 68°-135°), three times per week over an eight-week study period. Pre- and post-training assessments included one repetition maximum (1RM) testing in the full ROM (0°-135°), and measurement of biceps brachii cross-sectional area (CSA) at 50% and 70% of humerus length. Paired t-tests were used to compare regional CSA changes between groups, the sum of CSA changes at 50% and 70% (CSAsummed), and the strength response between the training protocols.

RESULTS

The INITIALROM protocol displayed a greater CSA increase than FINALROM protocol at 70% of biceps length (p = 0.001). Alternatively, we observed similar increases between the protocols for CSA at 50% (p = 0.311) and for CSAsummed (p = 0.111). Moreover, the INITIALROM protocol displayed a greater 1RM increase than FINALROM (p < 0.001).

CONCLUSIONS

We conclude that training in the initial angles of elbow flexion exercise promotes greater distal hypertrophy of the biceps brachii muscle in untrained young women. Moreover, the INITIALROM condition promotes a greater dynamic strength increase when tested at a full ROM compared to the FINALROM.

Bilateral Improvements Following Unilateral Home-Based Training in Plantar Flexors: A Potential for Cross-Education in Rehabilitation

CONTEXT

Cross-education (CE) refers to neuromuscular gains in the untrained limb upon contralateral limb training. To date, only laboratory-based exercise programs have demonstrated CE. Home-based exercise prescription eliciting CE could have greater clinical applicability.

OBJECTIVE

To determine the effect of an 8-week, home-based unilateral strength training intervention on isokinetic muscle strength, muscular excitation, and power in trained and untrained plantar flexors.

DESIGN

Randomized controlled trial.

METHODS

Thirty-four healthy participants were randomized to intervention (n = 20) or control (n = 14). The intervention group completed 3 sets of 12 repetitions of progressively loaded unilateral calf raises 3 days per week. Concentric and eccentric peak torque were measured using isokinetic dynamometry at 30°/s and 120°/s. Maximal electromyogram amplitude was simultaneously measured. Power was measured using a jump mat. All variables were measured at preintervention, midintervention, and postintervention.

RESULTS

Strength significantly increased bilaterally pre-post at both velocities concentrically and eccentrically in intervention group participants. Maximal electromyogram amplitude significantly increased pre-post bilaterally at both velocities in the medial gastrocnemii of the intervention group. Power significantly increased bilaterally pre-post in the intervention group, with a dose-response effect demonstrated in the untrained plantar flexors. The CE effects of strength, power, and electromyogram activation were 23.4%, 14.6%, and 25.3%, respectively. All control group values were unchanged pre-post.

CONCLUSION

This study shows that a simple at-home unilateral plantar flexor exercise protocol induces significant increases in contralateral strength, muscular excitation, and power. These results suggest the applicability of CE in home rehabilitation programs aiming to restore or maintain neuromuscular function in inactive individuals or immobilized ankles.

The Eccentric Phase in Unilateral Resistance Training Enhances and Preserves the Contralateral Knee Extensors Strength Gains After Detraining in Women: A Randomized Controlled Trial

The current randomized controlled study investigated whether or not the inclusion of the eccentric phase in resistance training favors the contralateral strength gains after different unilateral protocols, and whether such gains are retained after detraining. Sixty healthy women were randomly assigned to a unilateral concentric-only (CONC), eccentric-only (ECC), concentric–eccentric (TRAD) volume-equated knee extension training or control group (CON). The participants trained 2 days/week for 8 weeks and then did not train for further 8 weeks. Knee extensors isokinetic concentric, eccentric, and isometric peak torque and vastus lateralis muscle thickness were assessed in the contralateral limb at baseline, post-training, and post-detraining. At post-training, concentric peak torque increased in CONC [+9.2%, 95%CI (+6.2/+12.3), p < 0.001, ES: 0.70, 95%CI (0.01/1.39)], ECC [+11.0% (+7.7/+14.2), p < 0.001: ES: 0.66(0.09/1.23)] and TRAD [+8.5%(+5.7/+11.6), p < 0.001, ES: 0.50(0.02/0.98)]. Eccentric peak torque increased in ECC in ECC [+15.0%(+11.4/+20.7), p < 0.001, ES: 0.91(0.14/1.63)] and TRAD [+5.5%(+0.3/10.7), p = 0.013, ES: 0.50(0.05/0.95)]. Isometric peak torque increased in ECC [+11.3(+5.8/16.8), p < 0.001, ES: 0.52(0.10/0.94)] and TRAD [+8.6%(+3.4/+13.7), p < 0.001, ES: 0.55(0.14/0.96)]. No change in eccentric and isometric peak torque occurred in CONC (p > 0.05). Muscle thickness did not change in any group (p > 0.05). At post-detraining, all groups preserved the contralateral strength gains observed at post-training (p < 0.05). The findings showed that ECC and TRAD increased contralateral knee extensors strength in concentric, eccentric, and isometric modality, while CONC only increased concentric strength. The eccentric phase appears to amplify the cross-education effect, permitting a transfer in strength gaining toward multiple testing modalities. Both eccentric-based and traditional eccentric–concentric resistance protocols are recommended to increase the contralateral retention in strength gains after a detraining period.

Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation

CONTEXT

Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice.

OBJECTIVES

To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions.

EVIDENCE ACQUISITION

PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI.

EVIDENCE SYNTHESIS

122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect.

CONCLUSION

AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.

Cross-education effects of unilateral accentuated eccentric isoinertial resistance training on lean mass and function

PURPOSE

We investigated the effects of three different unilateral isoinertial resistance training protocols with eccentric overload on changes in lean mass and muscle function of trained (TL) and contralateral non-trained (NTL) legs.

METHODS

Physically active university students were randomly assigned to one of three training groups or a control group (n = 10/group). Participants in the training groups performed dominant leg isoinertial squat training twice a week for 6 weeks (4 sets of 7 repetitions) using either an electric-motor device with an eccentric phase velocity of 100% (EM100) or 150% (EM150) of concentric phase velocity or a conventional flywheel device (FW) with the same relative inertial load. Changes in thigh lean mass, unilateral leg-press one-repetition maximum (1-RM), muscle power at 40-80% 1-RM, and unilateral vertical jump height before and after training were compared between the groups and between TL and NTL.

RESULTS

No changes in any variable were found for the control group. In TL, all training groups showed similar increases (p < 0.05) in 1-RM strength (22.4-30.2%), lean tissue mass (2.5-5.8%), muscle power (8.8-21.7%), and vertical jump height (9.1-32.9%). In NTL, 1-RM strength increased 22.0-27.8% without significant differences between groups; however, increases in lean mass (p < 0.001) were observed for EM150 (3.5%) and FW (3.8%) only. Unilateral vertical jump height (6.0-32.9%) and muscle power (6.8-17.5%) also increased in NTL without significant differences between training groups.

CONCLUSION

The three eccentric-overload resistance training modalities produced similar neuromuscular changes in both the trained and non-trained legs, suggesting that strong cross-education effects were induced by the eccentric-overload training.

Finishing stationary cycling too early after anterior cruciate ligament reconstruction is likely to lead to higher failure

Background

Anterior cruciate ligament injury arises when the knee anterior ligament fibers are stretched, partially torn, or completely torn. Operated patients either end up re-injuring their reconstructed anterior cruciate ligament or majority develop early osteoarthritis regardless of the remarkable improvements of surgical techniques and the widely available rehabilitation best practices. New mechanism theories of non-contact anterior cruciate ligament injury and delayed onset muscle soreness could provide a novel perspective how to respond to this clinical challenge.

Main body

A tri-phasic injury model is proposed for these non-contact injuries. Mechano-energetic microdamage of the proprioceptive sensory nerve terminals is suggested to be the first-phase injury that is followed by a harsher tissue damage in the second phase. The longitudinal dimension is the third phase and that is the equivalent of the repeated bout effect of delayed onset muscle soreness. Current paper puts this longitudinal injury phase into perspective as the phase when the long-term memory consolidation and reconsolidation of this learning related neuronal injury evolves and the phase when the extent of the neuronal regeneration is determined. Reinstating the mitochondrial energy supply and ‘breathing capacity’ of the injured proprioceptive sensory neurons during this period is emphasized, as avoiding fatigue, overuse, overload and re-injury.

Conclusions

Extended use, minimum up to a year or even longer, of a current rehabilitation technique, namely moderate intensity low resistance stationary cycling, is recommended preferably at the end of the day. This exercise therapeutic strategy should be a supplementation to the currently used rehabilitation best practices as a knee anti-aging maintenance effort.

Neural mechanisms mediating cross education: With additional considerations for the ageing brain

CALVERT, G.H.M., and CARSON, R.G. Neural mechanisms mediating cross education: With additional considerations for the ageing brain. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2021. - Cross education (CE) is the process whereby a regimen of unilateral limb training engenders bilateral improvements in motor function. The contralateral gains thus derived may impart therapeutic benefits for patients with unilateral deficits arising from orthopaedic injury or stroke. Despite this prospective therapeutic utility, there is little consensus concerning its mechanistic basis. The precise means through which the neuroanatomical structures and cellular processes that mediate CE may be influenced by age-related neurodegeneration are also almost entirely unknown. Notwithstanding the increased incidence of unilateral impairment in later life, age-related variations in the expression of CE have been examined only infrequently. In this narrative review, we consider several mechanisms which may mediate the expression of CE with specific reference to the ageing CNS. We focus on the adaptive potential of cellular processes that are subserved by a specific set of neuroanatomical pathways including: the corticospinal tract, corticoreticulospinal projections, transcallosal fibres, and thalamocortical radiations. This analysis may inform the development of interventions that exploit the therapeutic utility of CE training in older persons.

Elbow Joint Angles in Elbow Flexor Unilateral Resistance Exercise Training Determine Its Effects on Muscle Strength and Thickness of Trained and Non-trained Arms

The present study compared two unilateral arm curl resistance exercise protocols with a different starting and finishing elbow joint angle in the same ROM for changes in elbow flexors strength and muscle thickness of the trained and non-trained arms. Thirty-two non-resistance trained young adults were randomly assigned to one of the three groups: extended joint training (0°–50°; EXT, n = 12); flexed joint training (80°–130°; FLE, n = 12); and non-training control (n = 8). The exercise training was performed by the dominant arms twice a week for 5 weeks with gradual increases in the training volume over 10 training sessions, and the non-dominant (non-trained) arms were investigated for the cross-education effect. Maximal voluntary contraction torque of isometric (MVC-ISO), concentric (MVC-CON), and eccentric contractions (MVC-ECC), and thickness (MT) of biceps brachii and brachialis of the trained and non-trained arms were assessed at baseline and 4–8 days after the last training session. The control group did not show significant changes in any variables. Significant (P < 0.05) increases in MVC-ISO torque (16.2 ± 12.6%), MVC-CON torque (21.1 ± 24.4%), and MVC-ECC torque (19.6 ± 17.5%) of the trained arm were observed for the EXT group only. The magnitude of the increase in MT of the trained arm was greater (P < 0.05) for EXT (8.9 ± 3.9%) than FLE (3.4 ± 2.7%). The cross-education effect was evident for MVC-ISO (15.9 ± 14.8%) and MVC-CON (16.7 ± 20.0%) torque of the EXT group only. These results suggest that resistance training at the extended elbow joint induces greater muscle adaptations and cross-education effects than that at flexed elbow joint.

Cross-education and detraining effects of eccentric vs. concentric resistance training of the elbow flexors

Background

Unilateral resistance training increases the strength of the contralateral non-trained homologous muscles known as the cross-education effect. We tested the hypothesis that unilateral eccentric resistance training (ET) would induce greater and longer-lasting cross-education effect when compared with concentric resistance training (CT).

Methods

Young (20–23 y) participants were allocated to ET (5 males, 4 females) or CT (5 males, 4 females) group that performed unilateral progressive ET or CT of the elbow flexors, twice a week for 5 weeks (10 sessions) followed by a 5-week detraining, and control group (7 males, 6 females) that did not perform any training. Maximum voluntary isometric contraction torque of the elbow flexors (MVIC), one-repetition maximum of concentric dumbbell curl (1-RM), and biceps brachii and brachialis muscle thickness (MT) were measured from the trained and non-trained arms before, several days after the last training session, and 5 weeks later. A ratio between the trained and non-trained arms for the change in MVIC or 1-RM from pre- to post-training (cross-body transfer ratio) was compared between ET and CT groups.

Results

The control group did not show significant changes in any variables. Both ET and CT increased (P < 0.05) MVIC (22.5 ± 12.3 % vs. 26.0 ± 11.9 %) and 1-RM (28.8 ± 6.6 % vs. 35.4 ± 12.9 %) of the trained arm without a significant difference between groups. MVIC was maintained after detraining for ET but returned to the baseline for CT, and 1-RM was maintained after detraining for both ET and CT. For the non-trained arm, MVIC (22.7 ± 17.9 % vs. 12.2 ± 10.2 %) and 1-RM (19.9 ± 14.6 % vs. 24.0 ± 10.6 %) increased similarly (P > 0.05) after ET and CT, and MVIC returned to the baseline after detraining, but 1-RM was maintained for both groups. An increase (P < 0.05) in MT was found only after ET for the trained arm (7.1 ± 6.1 %). The cross-body transfer ratio for MVIC was greater (P < 0.05) for ET (90.9 ± 46.7 %) than CT (49.0 ± 30.0 %).

Conclusions

These results did not support the hypothesis and showed similar changes in the most of the variables between ET and CT for the trained and non-trained arms, and strong cross-education effects on MVIC and 1-RM, but less detraining effect after ET than CT on MVIC of the trained arm.

Trial registration

University Hospital Medical Information Network Clinical Trials Registry (UMIN000044477; Jun 09, 2021).

Set Configuration in Strength Training Programs Modulates the Cross Education Phenomenon

ABSTRACT

Fariñas, J, Mayo, X, Giraldez-García, MA, Carballeira, E, Fernandez-Del-Olmo, M, Rial-Vazquez, J, Kingsley, JD, and Iglesias-Soler, E. Set configuration in strength training programs modulates the cross education phenomenon. J Strength Cond Res 35(9): 2414-2420, 2021-This study aimed to compare the strength gains in the nontrained arm after 2 independent unilateral training programs differing in the set configuration. Thirty-five subjects were randomly assigned to 3 groups: traditional training (TT; n = 12), cluster training (CT; n = 11), or control (CON; n = 12). The experimental groups performed a 5-week training program of a unilateral biceps curl exercise with the dominant limb using the 10 repetition maximum (10RM) load. Traditional training performed 5 sets of 6 repetitions and 135 seconds of rest between sets. Cluster training completed 30 repetitions with 18.5 seconds of rest between each repetition. Anthropometry (ANT), muscle thickness (MT), 1RM, the number of repetitions with 10RM (n10RM), and isometric maximal voluntary contraction (MVC) were measured before and after the intervention. Regarding the nontrained arm, TT improved 1RM (7.3%, p < 0.001). No changes were observed in CT. Regarding the trained arm, TT improved 1RM (9.1%, p < 0.001), n10RM (p = 0.005), and MVC (p = 0.011), whereas CT only showed a trend for improvement of 1RM (3.4%, p = 0.052). These results suggest that when total volume and repetition-to-rest ratio are equated, a more fatiguing set configuration causes a higher effect on the non-trained limb.

Effects of Cross-Education After 6 Weeks of Eccentric Single-Leg Decline Squats Performed With Different Execution Times: A Randomized Controlled Trial

BACKGROUND

Cross-education of strength refers to the strength gain that is transferred to the contralateral limb after a unilateral training program.

HYPOTHESIS

Unilateral eccentric training using different muscle contraction times would improve the structural and functional properties of the untrained contralateral limb.

STUDY DESIGN

Randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

Thirty-six participants were randomized into a control group, experimental group 1 (EG6s; eccentric contraction runtime = 6 seconds) and experimental group 2 (EG3s; eccentric contraction runtime = 3 seconds). The thickness and elastographic index of the patellar tendon (PT), lean mass and fat percentage of the thigh, contractile properties of the vastus lateralis (VL), as well as isometric, concentric, and eccentric knee extensor peak torques, and eccentric single-leg decline squat (SLDS_e) 1 repetition maximum (1-RM) were measured after 6 weeks of SLDS_e training (3 times per week, 80% of 1-RM) and after 6 weeks of detraining in the untrained contralateral limb.

RESULTS

After training, there was an increase in lean thigh mass of the untrained limb in both groups: EG6s (0.17 ± 0.29 kg;P = 0.03; effect size [ES] = 0.15) and EG3s (0.15 ± 0.23 kg; P = 0.04; ES = 0.19). Likewise, both EG6s (62.30 ± 19.09 kg; P < 0.001; ES = 4.23) and EG3s (68.09 ± 27.49 kg; P < 0.001; ES = 3.40) increased their 1-RM, isometric (EG6s: 48.64 ± 44.82 N·m, P < 0.001, ES = 0.63; EG3s: 34.81 ± 47.30 N·m, P = 0.004, ES = 0.38), concentric at 60 deg/s and 180 deg/s and eccentric at 60 deg/s and 180 deg/s knee extensor peak torques (P < 0.05) in the untrained limb. However, no differences were found in the contractile properties of the VL or in the thickness of the PT after eccentric training in either of the 2 experimental groups.

CONCLUSION

Regardless of the runtime of the contraction, 6 weeks of SLSD_e was effective for inducing structural and strength adaptations in the contralateral untrained limb. However, most of these adaptations were lost after 6 weeks of detraining.

CLINICAL RELEVANCE

Our study suggests that cross-education training can be of great importance for clinical application and musculoskeletal and neuromuscular rehabilitative processes after unilateral injury.

Effects of Augmented Eccentric Load Bench Press Training on One Repetition Maximum Performance and Electromyographic Activity in Trained Powerlifters

ABSTRACT

Montalvo, S, Gruber, LD, Gonzalez, MP, Dietze-Hermosa, MS, and Dorgo, S. Effects of augmented eccentric load bench press training on one repetition maximum performance and electromyographic activity in trained powerlifters. J Strength Cond Res 35(6): 1512-1519, 2021-Augmented eccentric load (AEL) training has been shown to elicit greater lower-body muscular strength increases and faster performance improvements compared with traditional strength training. However, it is unknown whether AEL training could provide similar improvements in upper-body muscular strength. Therefore, this study investigated the effects of a 4-week AEL training program on bench press one repetition maximum (1RM) strength, bar kinetics and kinematics, and surface electromyography (EMG) activity. Eight competitive powerlifters completed 5 training sessions consisting of 7 sets of a single repetition with up to 5 minutes rest between sets. Each session was completed at a predetermined AEL percentage consisting of 90% 1RM for concentric and supramaximal loads ranging from 105 to 125% 1RM during the eccentric phase with the use of eccentric hooks. After 4 weeks of AEL training, 1RM performance significantly increased from pretest to posttest (116.62 ± 27.48-124.28 ± 26.96 kg, p = 0.001). In addition, EMG amplitude of the pectoralis major decreased during the 125% AEL session to 59.86 ± 15.36% of pretest 1RM EMG values (p = 0.049, effect sizes [ESs] = 0.69). Furthermore, peak power of 1RM increased by 36.67% from pretest to posttest (p = 0.036, ES = 0.58). These study findings suggest that incorporating AEL bench press training into a 4-week training cycle may be a novel strategy to improve 1RM performance in competitive powerlifters in a short period.

Contralateral training effects of low-intensity blood-flow restricted and high-intensity unilateral resistance training

PURPOSE

Determine whether unilateral low-intensity blood-flow restricted (LIBFR) exercise is as effective as high-intensity (HI) resistance training for improving contralateral muscle strength.

METHODS

Thirty healthy adults (20-30 years) were randomly allocated to the following dynamic plantar-flexion training interventions: HI [75% of one-repetition maximum (1RM), 4 sets, 10 reps] and LIBFR [20% of 1RM, 4 sets, 30 + 15 + 15 + 15 reps]. Evoked V-wave and H-reflex recruitment curves, as well as maximal voluntary contraction (MVC) and panoramic ultrasound assessments of the trained and untrained soleus muscles were obtained pre-training, post-4 weeks of training and post-4 weeks of detraining.

RESULTS

Both interventions failed to increase contralateral MVC and muscle cross-sectional area (CSA). Yet, contralateral rate of torque development (RTD) was enhanced by both regimens (12-26%) and this was accompanied by heightened soleus EMG within the first milliseconds of the rising torque-time curve (14-22%; p < 0.05). These improvements were dissipated after detraining. Contralateral adaptations were not accompanied by changes in V-wave or H-reflex excitability. Conversely, LIBFR and HI elicited a similar magnitude of ipsilateral increase in MVC, RTD and CSA post-training (10-18%). Improvements in V-wave amplitude and soleus EMG were limited to the trained leg assigned to LIBFR training (p < 0.05). While gains in strength and CSA remained preserved post-4 weeks of detraining, this did not occur with RTD.

CONCLUSION

Since gains in RTD were similar between interventions, our findings indicate that both training regimens can be used interchangeably for improving contralateral rapid torque production. Ultimately, this may be beneficial in circumstances of limb immobilization after injury or surgery.

Resistance training with different repetition duration to failure: effect on hypertrophy, strength and muscle activation

Background

This study investigated the effects of two 14-week resistance training protocols with different repetition duration (RD) performed to muscle failure (MF) on gains in strength and muscle hypertrophy as well as on normalized electromyographic (EMG) amplitude and force-angle relationships.

Methods

The left and right legs of ten untrained males were assigned to either one of the two protocols (2-s or 6-s RD) incorporating unilateral knee extension exercise. Both protocols were performed with 3–4 sets, 50–60% of the one-repetition maximum (1RM), and 3 min rest. Rectus femoris and vastus lateralis cross-sectional areas (CSA), maximal voluntary isometric contraction (MVIC) at 30^o and 90^o of knee flexion and 1RM performance were assessed before and after the training period. In addition, normalized EMG amplitude-angle and force-angle relationships were assessed in the 6^th and 39^th experimental sessions.

Results

The 6-s RD protocol induced larger gains in MVIC at 30^o of knee angle measurement than the 2-s RD protocol. Increases in MVIC at 90^o of knee angle, 1RM, rectus femoris and vastus lateralis CSA were not significant between the 2-s and 6-s RD protocols. Moreover, different normalized EMG amplitude-angle and force-angle values were detected between protocols over most of the angles analyzed.

Conclusion

Performing longer RD could be a more appropriate strategy to provide greater gains in isometric maximal muscle strength at shortened knee positions. However, similar maximum dynamic strength and muscle hypertrophy gains would be provided by protocols with different RD.

Locomotor activities as a way of inducing neuroplasticity: insights from conventional approaches and perspectives on eccentric exercises

Corticospinal excitability, and particularly the balance between cortical inhibitory and excitatory processes (assessed in a muscle using single and paired-pulse transcranial magnetic stimulation), are affected by neurodegenerative pathologies or following a stroke. This review describes how locomotor exercises may counterbalance these neuroplastic alterations, either when performed under its conventional form (e.g., walking or cycling) or when comprising eccentric (i.e., active lengthening) muscle contractions. Non-fatiguing conventional locomotor exercise decreases intracortical inhibition and/or increases intracortical facilitation. These modifications notably seem to be a consequence of neurotrophic factors (e.g., brain-derived neurotrophic factor) resulting from the hemodynamic solicitation. Furthermore, it can be inferred from non-invasive brain and peripheral stimulation studies that repeated activation of neural networks can endogenously shape neuroplasticity. Such mechanisms could also occur following eccentric exercises (lengthening of the muscle), during which motor-related cortical potential (electroencephalography) is of greater magnitude and lasts longer than during concentric exercises (i.e., muscle shortening). As single-joint eccentric exercise decreased short- and long-interval intracortical inhibition and increased intracortical facilitation, locomotor eccentric exercise (e.g., downhill walking or eccentric cycling) may be even more potent by adding hemodynamic-related neuroplastic processes to endogenous processes. Besides, eccentric exercise is especially useful to develop relatively high force levels at low cardiorespiratory and perceived intensities, which can be a training goal alongside the induction of neuroplastic changes. Even though indirect evidence let us think that locomotor eccentric exercise could shape neuroplasticity in ways relevant to neurorehabilitation, its efficacy remains speculative. We provide future research directions on the neuroplastic effects and underlying mechanisms of locomotor exercise.

RESIDENTS CASE REPORT: MUSCULOCUTANEOUS NERVE INJURY IN A COLLEGIATE BASEBALL PITCHER

Background

Literature regarding musculocutaneous nerve injuries among the athletic population is scarce, with only several reported clinical cases among baseball and softball pitchers.

Purpose

To present a unique case of a musculocutaneous nerve injury to aid in clinician awareness and propose innovative rehabilitation practices that may facilitate improved patient outcomes during recovery.

Case Description

A 23-year-old Division 1 NCAA collegiate baseball pitcher presented with vague anterior arm pain following a pre-season game. The athlete described the pain as an "intense stretch" of his right arm that occurred during his last pitch. The initial evaluation identified tenderness over the right distal bicep. All shoulder and elbow orthopedic tests to assess shoulder impingement, labral pathologies, and glenohumeral instability were unremarkable. Increased neural tension was also noted with upper limb neurodynamic testing of the median and ulnar nerves on the right arm compared bilaterally. Electromyography (EMG) testing confirmed a right upper and mid-brachial plexus stretch injury with the primary involvement of the musculocutaneous nerve. Rehabilitation focused on restoring strength deficits and diminishing neural tension. Blood flow restriction (BFR) was introduced on the uninvolved limb to reduce deficits in bicep musculature strength. Once the athlete regained bicep strength and forearm sensation, he was progressed from flat-ground throwing activities to throwing off the mound.

Outcomes

A reduction in neural tension during neurodynamic testing of the right arm, improvement of bicep brachii deficits seen between the right and left limbs, and restoration of sensation in the right lateral forearm enabled a progressive return to sport.

Discussion

Due to vague reports and inconclusive findings, the initial presentation of musculocutaneous nerve injuries may be mistaken for other conditions such as a biceps brachii strain. Further -documentation of this injury and rehabilitation procedures are needed to enhance patient outcomes.

Training load but not fatigue affects cross-education of maximal voluntary force

The purpose of this study was to determine the effects of training load (25% vs. 75% of one repetition maximum [1RM]) and fatigue (failure vs. non-failure) during four weeks of unilateral knee extension resistance training (RT) on maximal voluntary force in the trained and the untrained knee extensors. Healthy young adults (n = 42) were randomly assigned to control (CON, n = 9, 24 ± 4.3 years), low-load RT to failure (LLF, n = 11, 21 ± 1.3 years, three sets to failure at 25% of 1RM), high-load RT to failure (HLF, n = 11, 21 ± 1.4 years, three sets to failure at 75% of 1RM), and high-load RT without failure (HLNF, n = 11, 22 ± 1.5 years, six sets of five repetitions at 75% of 1RM) groups. Before and after the four weeks of training, 1RM, maximal voluntary isometric force, and corticospinal excitability (CSE) were measured. 1RM in the trained (20%, d = 0.70, 15%, d = 0.61) and the untrained knee extensors (5%, d = 0.27, 6%, d = 0.26) increased only in the HLF and HLNF groups, respectively. MVIC force increased only in the trained leg of the HLF (5%, d = 0.35) and HLNF groups (12%, d = 0.67). CSE decreased in the VL of both legs in the HLNF group (-19%, d = 0.44) and no changes occurred in the RF. In conclusion, high- but not low-load RT improves maximal voluntary force in the trained and the untrained knee extensors and fatigue did not further enhance these adaptations. Voluntary force improvements were unrelated to CSE changes in both legs.

Contralateral effects of eccentric resistance training on immobilized arm

This study compared the effects of contralateral eccentric-only (ECC) and concentric-/eccentric-coupled resistance training (CON-ECC) of the elbow flexors on immobilized arm. Thirty healthy participants (18-34 y) were randomly allocated to immobilization only (CTRL; n = 10), immobilization and ECC (n = 10), or immobilization and CON-ECC group (n = 10). The non-dominant arms of all participants were immobilized (8 h·day^-1 ) for 4 weeks, during which ECC and CON-ECC were performed by the dominant (non-immobilized) arm 3 times a week (3-6 sets of 10 repetitions per session) with an 80%-120% and 60%-90% of one concentric repetition maximum (1-RM) load, respectively, matching the total training volume. Arm circumference, 1-RM and maximal voluntary isometric contraction (MVIC) strength, biceps brachii surface electromyogram amplitude (sEMG_RMS ), rate of force development (RFD), and joint position sense (JPS) were measured for both arms before and after immobilization. CTRL showed decreases (P < .05) in MVIC (-21.7%), sEMG_RMS (-35.2%), RFD (-26.0%), 1-RM (-14.4%), JPS (-87.4%), and arm circumference (-5.1%) of the immobilized arm. These deficits were attenuated or eliminated by ECC and CON-ECC, with greater effect sizes for ECC than CON-ECC in MVIC (0.29: +12.1%, vs -0.18: -0.1%) and sEMG_RMS (0.31:17.5% vs -0.15: -5.9%). For the trained arm, ECC showed greater effect size for MVIC than CON-ECC (0.47 vs 0.29), and increased arm circumference (+2.9%), sEMG_RMS (+77.9%), and RDF (+31.8%) greater (P < .05) than CON-ECC (+0.6%, +15.1%, and + 15.8%, respectively). The eccentric-only resistance training of the contralateral arm was more effective to counteract the negative immobilization effects than the concentric-eccentric training.

Contralateral Effects by Unilateral Eccentric versus Concentric Resistance Training

PURPOSE

Unilateral resistance training increases muscle strength of the contralateral homologous muscle by the cross-education effect. Muscle damage induced by second eccentric exercise bout is attenuated, even when it is performed by the contralateral limb. The present study compared the effects of unilateral eccentric training (ET) and concentric training (CT) of the elbow flexors (EF) on maximal voluntary isometric contraction (MVC) strength and muscle damage of the contralateral untrained EF.

METHODS

Young men were placed into ET, CT, ipsilateral repeated bout (IL-RB), and contralateral repeated bout (CL-RB) groups (n = 12 per group). The ET and CT groups performed unilateral EF training consisting of five sets of six eccentric and concentric contractions, respectively, once a week for 5 wk by increasing the intensity from 10% to 100% of MVC, followed by 30 maximal eccentric contractions (30MaxEC) of the opposite EF 1 wk later. The IL-RB group performed two bouts of 30MaxEC separated by 2 wk using the nondominant arm, and CL-RB group performed two bouts of 30MaxEC with a different arm for each bout in 1-wk apart.

RESULTS

The MVC increased (P < 0.05) greater for the trained (19% ± 8%) and untrained (11% ± 5%) arms in ET when compared with those in CT (10% ± 6%, 5% ± 2%). The magnitude of changes in muscle damage markers was reduced by 71% ± 19% after the second than the first bout for IL-RB group, and by 48% ± 21% for CL-RB group. Eccentric training and CT attenuated the magnitude by 58% ± 25% and 13% ± 13%, respectively, and the protective effect of ET was greater (P < 0.05) than CL-RB, but smaller (P < 0.05) than IL-RB.

CONCLUSIONS

These results showed that cross-education effect was stronger for ET than CT, and progressive ET produced greater contralateral muscle damage protective effect than a single eccentric exercise bout.

Longitudinal hypertrophic and transcriptional responses to high-load eccentric-concentric vs concentric training in males

High-load eccentric training reputedly produces greater muscle hypertrophy than concentric training, possibly due to greater loading and/or inflammation. We quantified the temporal impact of combined maximal concentric-eccentric training vs maximal concentric training on muscle cross-sectional area (CSA), volume, and targeted mRNA expression (93 transcripts). Eight recreationally active males (24 ± 5 years, BMI 23.5 ± 2.5 kg/m² ) performed 3 x 30 maximal eccentric isokinetic knee extensions and 2 x 30 maximal concentric knee extensions in dominant limb (ECC + CON) and 5 x 30 maximal concentric contractions (CON) in the non-dominant limb for 12 weeks (all 90°/s, 3x/wk). Quadriceps muscle CSA and volume were measured at baseline, 28 days (d), and 84 d in both limbs (3T MRI). Resting vastus lateralis biopsies were obtained from both limbs at baseline, 24 hours (h), 7, 28, and 84 d for mRNA abundance measurements (RT-PCR microfluidic cards). Work output was greater throughout training in ECC + CON vs CON (20.8 ± 9.7%, P < .001). Muscle CSA increased from baseline in both limbs at 28 d (CON 4.3 ± 2.6%, ECC + CON 4.0 ± 1.9%, both P < .001) and 84d (CON 3.9 ± 2.3%, ECC + CON 4.0 ± 3.1%, both P < .001), and muscle volume and isometric strength at 84 d (CON 44.8 ± 40.0%, P < .001; ECC + CON 36.9 ± 40.0%, P < .01), but no between-limb differences existed in any parameter. Ingenuity Pathway Analysis identified several cellular functions associated with regulation of muscle mass and metabolism as altered by both modalities at 24 h and 7 d, but particularly with ECC + CON. However, mRNA responses waned thereafter, regardless of modality. Initial muscle mRNA responses to training did not reflect chronic training-induced hypertrophy. Moreover, ECC + CON did not produce greater hypertrophy than CON, despite greater loading throughout and a differential mRNA response during the initial training week.

Eccentric, but not concentric blood flow restriction resistance training increases muscle strength in the untrained limb

OBJECTIVES

Little is known regarding the variables or mechanisms mediating cross-education as a result of resistance training. Therefore, the purpose of the present study was to examine the effects of low-load eccentric-only blood flow restriction (Ecc-BFR) and low-load concentric-only BFR (Con-BFR) on indices of cross-education.

DESIGN

Thirty-six women were randomly assigned to 4-wks of unilateral resistance training with Ecc-BFR (n = 12), Con-BFR (n = 12) or control (no intervention, n = 12) group. Eccentric peak torque, concentric peak torque, maximal voluntary isometric contraction torque, muscle thickness, and muscle activation were assessed from the contralateral, untrained arm.

RESULTS

Muscle strength (collapsed across mode) increased from 0-wk to 2-wks (4.9%) and 4-wks (13.0%) for Ecc-BFR only. There were increases in muscle activation (collapsed across mode and group) regardless of training modality, but there were no changes in muscle size for any of the conditions.

CONCLUSIONS

The findings of the present study indicated that low-load Ecc-BFR increased muscle strength. The increases in muscle strength as a result of Ecc-BFR were not mode-specific. Thus, low-load Ecc-BFR provides a unique alternative to maintain muscle function in an untrained limb that may have application during limb immobilization and rehabilitation practices.

Unilateral Elbow Flexion and Leg Press Training Induce Cross-Education But Not Global Training Gains in Children

PURPOSE

Whereas cross-education has been extensively investigated with adults, there are far fewer youth investigations. Two studies suggested that children had greater global responses to unilateral knee extensor fatigue and training, respectively, than adults. The objective of this study was to compare global training responses and cross-education effects after unilateral elbow flexion (EFlex) and leg press (LP) training.

METHODS

Forty-three prepubertal youths (aged 10-13 y) were randomly allocated into dominant LP (n = 15), EFlex (n = 15) training groups, or a control (n = 13). Experimental groups trained 3 times per week for 8 weeks and were tested pretraining and posttraining for ipsilateral and contralateral 1-repetition maximum LP; knee extensor, knee flexors, elbow flexors; and handgrip maximum voluntary isometric contractions (MVIC), and countermovement jump.

RESULTS

In comparison to no significant changes with the control group, dominant elbow flexors training demonstrated significant ( P < .001) improvements only with ipsilateral and contralateral upper body testing (EFlex MVIC [15.9-21.5%], EFlex 1-repetition maximum [22.9-50.8%], handgrip MVIC [5.5-13.8%]). Dominant LP training similarly exhibited only significant ( P < .001) improvements for ipsilateral and contralateral lower body testing (LP 1-repetition maximum [59.6-81.8%], knee extensor MVIC [12.4-18.3%], knee flexor MVIC [7.9-22.3%], and countermovement jump [11.1-18.1%]).

CONCLUSIONS

The ipsilateral and contralateral training adaptations in youth were specific to upper or lower body training, respectively.

Cross-limb dynamics of postural tremor due to limb loading to fatigue: neural overflow but not coupling

Many experiments have shown independence of the index finger dynamics under bilateral postural tremor protocols. Here we investigated in young adults the dynamics of bilateral multidirectional postural tremor and forearm muscle activity under the progressively fatiguing conditions supporting an external weight to the point of induced postural failure. When no loads were applied, tremor in the vertical (VT) and mediolateral (ML) directions was similar with prominent peaks within 2- to 4-Hz and 8- to 12-Hz bandwidths. Contrastingly tremor in the anterior-posterior (AP) direction was characterized by a single peak between 0 and 2 Hz. Although no tremor coupling occurred cross limbs, strong within-limb coupling was found between ML and VT directions when no loads were applied (coherence range: 0.77–0.85), implying that these oscillations are related and likely derived from mechanical sources. Applying an external load to the index finger(s) led to significant increases in the amplitude of VT tremor and EMG activity within that limb but also caused increases in tremor directions not aligned with the gravitational vector (AP and ML). Significant increases in VT and ML tremor and EMG activity in the contralateral (unloaded) limb were also found when a single index finger was loaded; however, this bilateral increase did not align with increases in interlimb coupling (coherence <0.21). The effects of fatigue caused by prolonged loading were widespread, affecting tremor and muscle activity in both limbs through a combination of neural and mechanical mechanisms. The single- and dual-limb loading to fatigue increased neural overflow but not tremor coupling between the index fingers.

NEW & NOTEWORTHY This study investigated bilateral multidirectional tremor under unloaded and loaded conditions. We found that tremor in the mediolateral and vertical directions within a limb were strongly coupled, a result not reported previously. Furthermore, when holding a weight to failure, tremor in all directions increased. Tremor also increased in the contralateral (unloaded) limb despite no interlimb coupling. This contralateral increase in tremor following loading a limb until fatigue is hypothesized to stem from motor-overflow effects.

Determining the Corticospinal Responses to Single Bouts of Skill and Strength Training

Mason, J, Frazer, AK, Jaberzadeh, S, Ahtiainen, JP, Avela, J, Rantalainen, T, Leung, M, and Kidgell, DJ. Determining the corticospinal responses to single bouts of skill and strength training. J Strength Cond Res 33(9): 2299-2307, 2019-Neuroplastic changes in the primary motor cortex accompany performance improvements following motor practice. Recent evidence suggests that the corticospinal responses to strength and skill training are similar, following both a single session and repeated bouts of training, promoting discussion that strength training is a form of motor learning. However, these findings are limited by the lack of a light-load strength training group. Therefore, the aim of the current study was to determine whether a single session of heavy-load strength training, light-load strength training or skill training differentially modulates the corticospinal pathway. Transcranial magnetic stimulation was used to assess the excitatory and inhibitory circuitry of the motor cortex following a single session of skill training, and following a single session of light-load and heavy-load strength training. Following a single session of training, participants in all groups experienced comparable increases in corticospinal excitability (ranging from 38 to 46%, all p < 0.05); however, disparity was observed in the inhibitory responses. Corticospinal inhibition was reduced in all 3 single-sessions, although to a greater magnitude in the heavy-load and skill-training sessions (22 and 18% respectively, compared with 11% following light-load training, all p < 0.05). Short-interval intracortical inhibition was reduced immediately following single sessions of heavy-load strength training (40% p < 0.05) and skill training (47% p < 0.05), but remained unchanged the following light-load strength training session. It appears that the corticospinal responses to single sessions of different types of strength and skill training are task-dependent. These findings reinforce the notion that strength training, at least when heavily-loaded, can be considered a form of motor learning, potentially because of the sensory feedback involved.

Force irradiation effect of kinesiotaping on contralateral muscle activation

We aimed to determine the force irradiation effect of kinesiotaping (KT) on contralateral muscle activity during unilateral muscle contraction. Forty healthy (26 females, 14 males) subjects were divided into two groups: KT and control groups. KT was applied on the biceps brachii at the contralateral limb (non-dominant limb) in the KT group, whereas no taping was applied to the control group. All participants performed unilateral isometric, concentric, and eccentric contractions with their dominant upper limbs (exercised limb) by means of an isokinetic dynamometer, while the contralateral limb was in the resting condition, neutral position, and motionless during the testing procedure. During the exercise, contralateral biceps brachii muscle activity was recorded by surface electromyography (EMG). To quantify the muscle activation, EMG signals were expressed as a percentage of the maximal isometric voluntary contraction, which is referred to as %EMG_max. The KT group showed significantly higher %EMG_max in the biceps brachii compared to the control group at the contralateral limb during the isometric, concentric, and eccentric contractions (p = 0.035, p = 0.046, and p = 0.002, respectively) The median values of the contralateral muscle activity were 2.74 %EMG_max and 6.62 %EMG_max during the isometric contraction for the control and KT groups, respectively (p = 0.035). During the concentric contraction, the median values of the contralateral muscle activity were 1.61 %EMG_max and 9.39 %EMG_max for the control and KT groups, respectively (p = 0.046). The median values of the contralateral muscle activity were 4.49 %EMG_max and 22.89 %EMG_max for the eccentric contraction for the control and KT groups, respectively (p = 0.002). In conclusion, KT application on the contralateral limb increased the contralateral muscle activation in the biceps brachii during the unilateral isometric, concentric, and eccentric contractions.

Eccentric Muscle Contractions: Risks and Benefits

Eccentric contractions, characterized by the lengthening of the muscle-tendon complex, present several unique features compared with other types of contractions, which may lead to unique adaptations. Due to its specific physiological and mechanical properties, there is an increasing interest in employing eccentric muscle work for rehabilitation and clinical purposes. However, unaccustomed eccentric exercise is known to cause muscle damage and delayed pain, commonly defined as “Delayed-Onset Muscular Soreness” (DOMS). To date, the most useful preventive strategy to avoid these adverse effects consists of repeating sessions involving submaximal eccentric contractions whose intensity is progressively increased over the training. Despite an increased number of investigations focusing on the eccentric contraction, a significant gap still remains in our understanding of the cellular and molecular mechanisms underlying the initial damage response and subsequent adaptations to eccentric exercise. Yet, unraveling the molecular basis of exercise-related muscle damage and soreness might help uncover the mechanistic basis of pathological conditions as myalgia or neuromuscular diseases. In addition, a better insight into the mechanisms governing eccentric training adaptations should provide invaluable information for designing therapeutic interventions and identifying potential therapeutic targets.

Neuromuscular Adaptations to Work-matched Maximal Eccentric versus Concentric Training

It is unclear whether the superiority of eccentric over concentric training on neuromuscular improvements is due to higher torque (mechanical loading) achievable during eccentric contractions or due to resulting greater total work.

Cross-education does not improve early and late-phase rehabilitation outcomes after ACL reconstruction: a randomized controlled clinical trial

PURPOSE

Limited evidence suggests that cross-education affords clinical benefits in the initial 8 weeks after anterior cruciate ligament (ACL) reconstruction, but it is unknown if such cross-education effects are reproducible and still present in later phases of rehabilitation. We examined whether cross-education, as an adjuvant to standard therapy, would accelerate the rehabilitation up to 26 weeks after ACL reconstruction by attenuating quadriceps weakness.

METHODS

ACL-reconstructed patients were randomized into experimental (n = 22) and control groups (n = 21). Both groups received standard care after ACL reconstruction. In addition, the experimental group strength trained the quadriceps of the non-operated leg during weeks 1-12 after surgery (i.e., cross-education). Self-reported knee function was assessed with the Hughston Clinic Knee score as the primary outcome. Secondary outcomes were maximal quadriceps and hamstring strength and single leg hop distance. All outcomes were measured 29 ± 23 days prior to surgery, as a reference, and at 5-week, 12-week, and 26-week post-surgery.

RESULTS

Both groups scored 12% worse on self-reported knee function 5-week post-surgery (95% CI 7-17) and showed 15% improvement 26-week post-surgery (95% CI - 20 to - 10). No cross-education effect was found. Interestingly, males scored 8-10% worse than females at each time point post-surgery. None of 33 secondary outcomes showed a cross-education effect. At 26-week post-surgery, both legs improved maximal quadriceps (5-14%) and hamstring strength (7-18%), and the non-injured leg improved 2% in hop distance. The ACL recovery was not affected by limb dominance and age.

CONCLUSION

26 weeks of standard care improved self-reported knee function and maximal leg strength relative to pre-surgery and adding cross-education did not further accelerate ACL recovery.

LEVEL OF EVIDENCE

I.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION

This randomized controlled clinical trial is registered at the Dutch trial register ( http://www.trialregister.nl ) under NTR4395.

Dominant and nondominant leg press training induce similar contralateral and ipsilateral limb training adaptations with children

Cross-education has been extensively investigated with adults. Adult studies report asymmetrical cross-education adaptations predominately after dominant limb training. The objective of the study was to examine unilateral leg press (LP) training of the dominant or nondominant leg on contralateral and ipsilateral strength and balance measures. Forty-two youth (10-13 years) were placed (random allocation) into a dominant (n = 15) or nondominant (n = 14) leg press training group or nontraining control (n = 13). Experimental groups trained 3 times per week for 8 weeks and were tested pre-/post-training for ipsilateral and contralateral 1-repetition maximum (RM) horizontal LP, maximum voluntary isometric contraction (MVIC) of knee extensors (KE) and flexors (KF), countermovement jump (CMJ), triple hop test (THT), MVIC strength of elbow flexors (EF) and handgrip, as well as the stork and Y balance tests. Both dominant and nondominant LP training significantly (p < 0.05) increased both ipsilateral and contralateral lower body strength (LP 1RM (dominant: 59.6%-81.8%; nondominant: 59.5%-96.3%), KE MVIC (dominant: 12.4%-18.3%; nondominant: 8.6%-18.6%), KF MVIC (dominant: 7.9%-22.3%; nondominant: nonsignificant-3.8%), and power (CMJ: dominant: 11.1%-18.1%; nondominant: 7.7%-16.6%)). The exception was that nondominant LP training demonstrated a nonsignificant change with the contralateral KF MVIC. Other significant improvements were with nondominant LP training on ipsilateral EF 1RM (6.2%) and THT (9.6%). There were no significant changes with EF and handgrip MVIC. The contralateral leg stork balance test was impaired following dominant LP training. KF MVIC exhibited the only significant relative post-training to pretraining (post-test/pre-test) ratio differences between dominant versus nondominant LP cross-education training effects. In conclusion, children exhibit symmetrical cross-education or global training adaptations with unilateral training of dominant or nondominant upper leg.

Cross-education improves quadriceps strength recovery after ACL reconstruction: a randomized controlled trial

PURPOSE

The aim of this study was to investigate the effects of concentric and eccentric cross-education (CE) on quadriceps strength and knee function recoveries after anterior cruciate ligament (ACL) reconstruction.

METHODS

Forty-eight patients (age: 29.5 ± 6.8 years, body mass index: 26.1 ± 3.2 kg/m²) who had undergone ACL reconstruction with hamstring tendon autograft were included in the study. The patients were randomly divided into three groups when they reached four weeks post surgery: (1) concentric CE (n = 16); (2) eccentric CE (n = 16); and (3) control (n = 16). All groups followed the same post-surgical rehabilitation program for their reconstructed limb. Additionally, the two experimental groups followed eight weeks of isokinetic training for the uninjured knee at 60°/s for 3 days per week. Quadriceps maximum voluntary isometric strength (MVIC) was measured during the 4th week (pre-training), 12th week (post training), and 24th week post surgery. The single-leg hop distance and International Knee Documentary Committee (IKDC) scores were also evaluated during the 24th week post surgery. Analysis of variance was used for statistical analysis.

RESULTS

Group-by-time interaction was significant for quadriceps MVICs for reconstructed and healthy limbs (p = 0.02). Quadriceps strength of both knees was greater in concentric and eccentric CE groups compared to control group during the 12th- and 24th weeks post surgery (p < 0.05). Strength gain was 28% and 31% in concentric and eccentric CE groups, respectively, when compared with the control group. Concentric and eccentric CE had similar effects on quadriceps strength recovery (n.s.). IKDC score, and single-leg hop distances were not significantly different among groups (n.s.).

CONCLUSIONS

Concentric and eccentric quadricep strengthening of healthy limbs in early phases of ACL rehabilitation improved post-surgical quadriceps strength recovery of the reconstructed limb. CE should be integrated into ACL reconstruction rehabilitation, especially in the early rehabilitative phases to restore quadriceps strength.

LEVEL OF EVIDENCE

Randomized controlled trial, Level I.

Contralateral Repeated Bout Effect of the Knee Flexors

PURPOSE

Eccentric exercise of the elbow flexors (EF) confers protective effect against muscle damage of the same exercise performed by the opposite arm at 1, 7, or 28 d later. This is known as the contralateral repeated bout effect (CL-RBE), but it is not known whether CL-RBE is evident for the knee flexors (KF). The present study tested the hypothesis that KF CL-RBE would be observed at 1, 7, and 28 d after the initial bout.

METHODS

Young untrained men were assigned to a control or one of three experimental groups (n = 13 per group). The experimental groups performed 60 maximal KF eccentric contractions (60MaxEC) using one leg followed by the same exercise using the opposite leg at 1, 7, or 28 d later. The control group used the nondominant leg to repeat 60MaxEC separated by 14 d. Changes in several indirect muscle damage markers after 60MaxEC were compared between bouts and among the groups by using a mixed-design, two-way ANOVA.

RESULTS

Changes in maximal voluntary isokinetic concentric contraction torque, range of motion, muscle soreness, and plasma creatine kinase activity after the first 60MaxEC were similar among the groups. These changes were smaller after the second than the first 60MaxEC for the control, 1-d, and 7-d groups, and the changes after the second 60MaxEC were smaller for the control than for both the 1- and 7-d groups (P < 0.05). When the KF CL-RBE was compared with the EF CL-RBE of the previous study, the magnitude was not significantly different.

CONCLUSIONS

These results showed that CL-RBE was evident for KF in a similar manner to that for EF, but did not last for 28 d, and the CL-RBE was smaller than the ipsilateral RBE.

Time course of interlimb strength transfer after unilateral handgrip training

"Cross-education" is the increase in strength or functional performance of an untrained limb after unilateral training. A major limitation for clinical translation from unilateral injury includes knowledge on the minimum time for the emergence of crossed effects. Therefore, the primary purpose was to characterize the time course of bilateral strength changes during both "traditional" ( n = 11) and "daily" ( n = 8) unilateral handgrip training in neurologically intact participants. Traditional training included five sets of five maximal voluntary handgrip contractions 3 times/wk for 6 wk whereas daily training included the same number of sessions and contractions but over 18 consecutive days. Three pre- and one posttest session evaluated strength, muscle activation, and reflex excitability bilaterally. Time course information was assessed by recording handgrip force for every contraction in the trained limb and from a single contraction on every third training session in the untrained limb. Six weeks of traditional training increased handgrip strength in the trained limb after the 9th session whereas the untrained limb was stronger after the 12th session. This was accompanied by increased peak muscle activation and bilateral alterations in Hoffmann reflex excitability. Daily training revealed a similar number of sessions (15) were required to induce significant strength gains in the untrained limb (7.8% compared with 12.5%) in approximately half the duration of traditional training. Therefore, minimizing rest days may improve the efficiency of unilateral training when the trained limb is not the focus. Establishing a "dose" for the time course of adaptation to strength training is paramount for effective translation to rehabilitative interventions. NEW & NOTEWORTHY Unilateral handgrip training using a "traditional" protocol (3 times/wk; 6 wk) increased strength bilaterally after 9 (trained arm) and 12 (untrained arm) sessions. "Daily" training (18 consecutive days) increased strength in the untrained limb in a similar number of training sessions, which was accomplished in approximately half the time. Within clinical populations when the focus is on the untrained limb, reducing rest days may optimize the recovery of strength.