Training‐, muscle‐ and task‐specific up‐ and downregulation of cortical inhibitory processes

Re: JP-TR-2024-286891 'The ageing brain: Cortical overactivation - How does it evolve?'

There is overwhelming evidence for an age-related change in brain activity when performing motor and motor-cognitive tasks (i.e. dual-tasking). In general this research shows increased cortical activity, i.e. cortical overactivation, and, less evident, subcortical deactivation in the healthy brains of older compared to young adults. Furthermore brain network activity becomes less distinct and less segregated. Interestingly from a behavioural point of view some of these adaptations seem helpful, leading to better motor performances than in age-matched seniors, but others are related to inferior performance. Current theories try to explain these findings, therefore, either in favour of compensatory strategies or in terms of non-selective, inefficient (dedifferentiated) brain activation. However the limitation of current theories is that they are 'static', considering only one point in time instead of age-related progression of brain activity over time. In contrast this review article proposes a developmental process, from compensation to negative overcompensation to chronic maladaptive overcompensation, which leads to dedifferentiation and desegregation. In addition this article highlights that elderly subjects utilize motor control strategies, such as increased cortical activity, down-regulation of inhibitory processes and less-segregated and lateralized brain activation patterns, that are also commonly found in healthy young adults when task challenges increase. Thus many findings about differences in brain activation may result from the fact that although 'absolute task difficulty' remains the same, 'relative task difficulty' increases for the older subjects, forcing them to apply the above-mentioned neural activation strategies. This initially compensatory strategy can, however, turn into non-efficient brain activation over time.

Changes in the cortical GABAergic inhibitory system with ageing and ageing-related neurodegenerative diseases

The human cortical inhibitory system is known to play a vital role for normal brain development, function, and plasticity. GABA is the most prominent inhibitory neurotransmitter in the CNS and is a key regulator not only for motor control and motor learning, but also for cognitive processes. With ageing and many neurodegenerative pathologies, a decline in GABAergic function in several cortical regions together with a reduced ability to task-specifically modulate and increase inhibition in the primary motor cortex has been observed. This decline in intracortical inhibition is associated with impaired motor control but also with diminished motor-cognitive (i.e. dual-tasking) and cognitive performance (e.g. executive functions). Furthermore, more general well-being such as sleep quality, stress resistance or non-specific pain perception are also associated with reduced GABA functioning. The current review highlights the interplay between changes in GABAergic function and changes in motor control, motor-cognitive and cognitive performance associated with healthy ageing, as well as in seniors with neurodegenerative diseases such as mild cognitive impairment. Furthermore, recent evidence highlighting the ability to up- or downregulate cortical inhibition by means of physical exercise programs is presented and discussed.

Rebalance the Inhibitory System in the Elderly Brain: Influence of Balance Learning on GABAergic Inhibition and Functional Connectivity

Aging involves complex processes that impact the structure, function, and metabolism of the human brain. Declines in both structural and functional integrity along with reduced local inhibitory tone in the motor areas, as indicated by reduced γ-aminobutyric acid (GABA) levels, are often associated with compromised motor performance in elderly adults. Using multimodal neuroimaging techniques including magnetic resonance spectroscopy (MRS), diffusion magnetic resonance imaging (MRI), functional MRI as well as transcranial magnetic stimulation to assess short-interval intracortical inhibition (SICI), this study explores whether these age-related changes can be mitigated by motor learning. The investigation focused on the effects of long-term balance learning (3 months) on intracortical inhibition, metabolism, structural, and functional connectivity in the cortical sensorimotor network among an elderly cohort. We found that after 3 months of balance learning, subjects significantly improved balance performance, upregulated sensorimotor cortical GABA levels and ventral sensorimotor network functional connectivity (VSN-FC) compared to a passive control group. Furthermore, correlation analysis suggested a positive association between baseline VSN-FC and balance performance, between baseline VSN-FC and SICI, and between improvements in balance performance and upregulation in SICI in the training group, though these correlations did not survive the false discovery rate correction. These findings demonstrate that balance learning has the potential to counteract aging-related decline in functional connectivity and cortical inhibition on the "tonic" (MRS) and "functional" (SICI) level and shed new light on the close interplay between the GABAergic system, functional connectivity, and behavior.

Age-related decline in GABAergic intracortical inhibition can be counteracted by long-term learning of balance skills

Ageing induces a decline in GABAergic intracortical inhibition, which seems to be associated not only with decremental changes in well-being, sleep quality, cognition and pain management but also with impaired motor control. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. Therefore, the present study investigated whether age-related cortical dis-inhibition could be reversed after 6 months of balance learning and whether improvements in postural control correlated with the extent of reversed dis-inhibition. The results demonstrated that intracortical inhibition can be upregulated in elderly subjects after long-term balance learning and revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition and may therefore be seminal for many pathologies in which the equilibrium between inhibitory and excitatory neurotransmitters is disturbed. KEY POINTS: Ageing induces a decline in GABAergic intracortical inhibition. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. After 6 months of balance learning, intracortical inhibition can be upregulated in elderly subjects. The results of this study also revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition.

Differential modulation of corticomotor excitability in older compared to young adults following a single bout of strength -exercise

Evidence shows corticomotor plasticity diminishes with age. Nevertheless, whether strength-training, a proven intervention that induces corticomotor plasticity in younger adults, also takes effect in older adults, remains untested. This study examined the effect of a single-session of strength-exercise on corticomotor plasticity in older and younger adults. Thirteen older adults (72.3 ± 6.5 years) and eleven younger adults (29.9 ± 6.9 years), novice to strength-exercise, participated. Strength-exercise involved four sets of 6-8 repetitions of a dumbbell biceps curl at 70-75% of their one-repetition maximum (1-RM). Muscle strength, cortical, corticomotor and spinal excitability, before and up to 60-minutes after the strength-exercise session were assessed. We observed significant changes over time (p < 0.05) and an interaction between time and age group (p < 0.05) indicating a decrease in corticomotor excitability (18% p < 0.05) for older adults at 30- and 60-minutes post strength-exercise and an increase (26% and 40%, all p < 0.05) in younger adults at the same time points. Voluntary activation (VA) declined in older adults immediately post and 60-minutes post strength-exercise (36% and 25%, all p < 0.05). Exercise had no effect on the cortical silent period (cSP) in older adults however, in young adults cSP durations were shorter at both 30- and 60- minute time points (17% 30-minute post and 9% 60-minute post, p < 0.05). There were no differences in short-interval cortical inhibition (SICI) or intracortical facilitation (ICF) between groups. Although the corticomotor responses to strength-exercise were different within groups, overall, the neural responses seem to be independent of age.

Influence of the Menstrual Cycle and Training on the Performance of a Perturbed Single-Leg Squatting Task in Female Collegiate Athletes

Background

Anterior cruciate ligament (ACL) injuries often occur when an athlete experiences an unexpected disruption, or perturbation, during sports. ACL injury rates may also be influenced by the menstrual cycle.

Purpose

To determine whether training adaptations to knee control and muscle activity during a perturbed single-leg squatting (SLS) task depend on menstrual cycle phase in female athletes.

Study Design

Controlled laboratory study.

Methods

A total of 21 healthy female collegiate athletes (current or former [<3 years]) who competed in 9 different sports performed an SLS task in which they attempted to match their knee position (user signal) to a target signal. The protocol consisted of a 9-condition pretest, 5 sets of 3 training trials, and a 9-condition posttest. One perturbation was delivered in each condition by altering the resistance of the device. Sagittal knee control (absolute error between the target signal and user signal) was assessed using a potentiometer. Muscle activity during perturbed squat cycles was normalized to maximal activation and to corresponding muscle activity during unperturbed squat cycles (%unperturbed) within the same test condition. Athletes performed the protocol during a distinct menstrual cycle phase (early follicular [EF], late follicular [LF], midluteal [ML]). Two-way mixed analysis of variance was used to determine the effects of the menstrual cycle and training on knee control and muscle activity during task performance. Venous blood was collected for hormonal analysis, and a series of health questionnaires and anthropometric measures were also assessed to determine differences among the menstrual cycle groups.

Results

After training, athletes demonstrated better knee control during the perturbed squat cycles (lower absolute error, P < .001) and greater soleus feedback responses to the perturbation (%unperturbed, P = .035). Better knee control was demonstrated in the ML phase versus the EF phase during unperturbed and perturbed squat cycles (P < .039 for both). Quadriceps activation was greater in the ML phase compared with the EF and LF phases, both immediately before and after the perturbation (P < .001 for all).

Conclusion

Athletes learned to improve knee control during the perturbed performance regardless of menstrual cycle phase. The best knee control and greatest quadriceps activation during the perturbed squatting task was found in the ML phase.

Clinical Relevance

These findings may correspond to a lower incidence of ACL injury in the luteal phase and alterations in exercise performance across the menstrual cycle.

Balance Training Under Fatigue: A Randomized Controlled Trial on the Effect of Fatigue on Adaptations to Balance Training

ABSTRACT

Keller, M, Lichtenstein, E, Roth, R, and Faude, O. Balance training under fatigue: a randomized controlled trial on the effect of fatigue on adaptations to balance training. J Strength Cond Res 38(2): 297-305, 2024-Balance training is an effective means for injury prevention in sports. However, one can question the existing practice of putting the balance programs at the start of a training session (i.e., train in an unfatigued state) because the occurrence of injuries has been associated with fatigue. Therefore, the aim of this study was to assess the influence of balance training in a fatigued or an unfatigued state on motor performance tested in fatigued and unfatigued conditions. Fifty-two, healthy, active volunteers (28.0 years; 19 women) were randomly allocated to 1 of 3 different training groups. The BALANCE group completed 6 weeks of balance training. The other 2 groups completed the identical balance tasks either before (BALANCE-high-intensity interval training [HIIT]) or after (HIIT-BALANCE) a HIIT session. Thus, these groups trained the balance tasks either in a fatigued or in an unfatigued state. In PRE and POST tests, balance (solid ground, soft mat, wobble board) and jump performance was obtained in fatigued and unfatigued states. Balance training resulted in reduced sway paths in all groups. However, the linear models revealed larger adaptations in BALANCE-HIIT and BALANCE when compared with HIIT-BALANCE ( d = 0.22-0.71). These small to moderate effects were-despite some uncertainties-consistent for the "unfatigued" and "fatigued" test conditions. The results of this study revealed for the first time that balance training under fatigue results in diminished adaptations, even when tested in a fatigued state. Therefore, the data indicate that balance training should be implemented at the start of a training session or in an unfatigued state.

Neural Correlates of Balance Skill Learning in Young and Older Individuals: A Systematic Review and Meta-analysis

BACKGROUND

Despite the increasing number of research studies examining the effects of age on the control of posture, the number of annual fall-related injuries and deaths continues to increase. A better understanding of how old age affects the neural mechanisms of postural control and how countermeasures such as balance training could improve the neural control of posture to reduce falls in older individuals is therefore necessary. The aim of this review is to determine the effects of age on the neural correlates of balance skill learning measured during static (standing) and dynamic (walking) balance tasks in healthy individuals.

METHODS

We determined the effects of acute (1-3 sessions) and chronic (> 3 sessions) balance skill training on balance in the trained and in untrained, transfer balance tasks through a systematic review and quantified these effects by robust variance estimation meta-analysis in combination with meta-regression. We systematically searched PubMed, Web of Science, and Cochrane databases. Balance performance and neural plasticity outcomes were extracted and included in the systematic synthesis and meta-analysis.

RESULTS

Forty-two studies (n = 622 young, n = 699 older individuals) were included in the systematic synthesis. Seventeen studies with 508 in-analysis participants were eligible for a meta-analysis. The overall analysis revealed that acute and chronic balance training had a large effect on the neural correlates of balance skill learning in the two age groups combined (g = 0.79, p < 0.01). Both age groups similarly improved balance skill performance in 1-3 training sessions and showed little further improvements with additional sessions. Improvements in balance performance mainly occurred in the trained and less so in the non-trained (i.e., transfer) balance tasks. The systematic synthesis and meta-analysis suggested little correspondence between improved balance skills and changes in spinal, cortical, and corticospinal excitability measures in the two age groups and between the time courses of changes in balance skills and neural correlates.

CONCLUSIONS

Balance skill learning and the accompanying neural adaptations occur rapidly and independently of age with little to no training dose-dependence or correspondence between behavioral and neural adaptations. Of the five types of neural correlates examined, changes in only spinal excitability seemed to differ between age groups. However, age or training dose in terms of duration did not moderate the effects of balance training on the changes in any of the neural correlates. The behavioral and neural mechanisms of strong task-specificity and the time course of skill retention remain unclear and require further studies in young and older individuals.

REGISTRATION

PROSPERO registration number: CRD42022349573.

Sleep-push movement performance in elite field hockey champions with and without training specialization

Objective

To investigate kinematic and muscle activity differences during the sleep-push movement in elite field hockey players. We hypothesized that players with specialized sleep-push movement training (specialists) would possess a lower center of mass (CoM) and enhanced reproducibility of muscle activations during the movement, compared to players without explicit movement training (non-specialists).

Methods

Ten field hockey players of the Belgian national field hockey team performed the sleep-push movement (5 specialists and 5 non-specialists). Muscle activity and kinematic data were recorded using EMG to evaluate the reproducibility of muscle activations by cross-correlation analysis and power spectral features across the movement, while a motion capture system was used to assess kinematics.

Results

Compared to non-specialists, specialists had significantly (p < 0.05) increased stick velocity (9.17 ± 1.28 m/s versus 6.98 ± 0.97 m/s) and lower CoM height (141 ± 52 mm versus 296 ± 64 mm), during the second part of the shot. Specialists also showed a significant (p < 0.05) lower power spectrum in the activity of the upper limb muscles before the shot. Superimposition of the auto crosscorrelation results demonstrated a high degree of reproducibility in specialists' muscle activations.

Conclusion

Sleep-push movements realized by elite players who are specialists in the sleep-push movement presented significant kinematics and muscular activation differences when compared to the sleep-push movements realized by elite players who were not specialists in such movement. Characterization of the specific movement and the related high-level performer's muscular strategies offers the possibility of translating sport science findings into functional training with concrete applications for coaches, players, and other key stakeholders for the continued development of the field.

Identifying the changes in the cortical activity of various brain regions for different balance tasks: A review

BACKGROUND

Balance support is critical to a person's overall function and health. Previous neuroimaging studies have shown that cortical structures play an essential role in postural control.

OBJECTIVE

This review aims to identify differences in the pattern of neural activity induced by balance tasks with different balance control requirements.

METHODS

Seventy-four articles were selected from the field of balance training and were examined based on four brain function detection technologies.

RESULTS

In general, most studies focused on the activity changes of various cortical areas during training at different difficulty levels, but more and more attention has also begun to focus on the functional changes of other cortical and deep subcortical structures. Our analysis also revealed the neglect of certain task types.

CONCLUSION

Based on these results, we identify and discuss future research directions that may contribute to a clear understanding of neural functional plasticity under different tasks.

Short-term balance consolidation relies on the primary motor cortex: a rTMS study

Structural and functional adaptations occur in the primary motor cortex (M1) after only a few balance learning sessions. Nevertheless, the role of M1 in consolidating balance tasks remains to be discussed, as direct evidence is missing due to the fact that it is unclear whether adaptations in M1 are indeed the driving force for balance improvements or merely the consequence of improved balance. The aim of the present study was to investigate whether the primary motor cortex is involved in the learning and consolidation of balance tasks. Thirty participants were randomly allocated into a repetitive transcranial magnetic stimulation (rTMS) or sham-rTMS group. The experimental design included a single balance acquisition phase, followed by either 15 min of low-frequency rTMS (1 Hz at 115% of resting motor threshold to disrupt the involvement of M1) or sham-rTMS, and finally a retention test 24 h later. During the acquisition phase, no differences in balance improvements were observed between the two groups. However, significant differences between the rTMS and the sham-rTMS group were found from the end of the acquisition phase to the retention test. While the rTMS group had a performance loss, the sham-rTMS group displayed significant off-line gains (p = 0.001). For the first time, this finding may propose a causal relationship between the involvement of M1 and the acquisition and consolidation of a balance task.

Probing the link between cortical inhibitory and excitatory processes and muscle fascicle dynamics

During movements, neural signals are translated into muscle fibre shortening, lengthening or they remain isometric. This study investigated cortical excitatory and inhibitory processes in relation to muscle fascicle dynamics during fixed-end rapid contractions. Fourteen adults performed submaximal and maximal ankle dorsiflexions. Single and paired pulse transcranial magnetic stimulation over the cortical representation projecting to the tibialis anterior (TA) was applied during rest, the activation and deactivation phase of contractions to test for short- (SICI) and long-interval intracortical inhibition (LICI) and intracortical facilitation (ICF). Ultrasound images were taken to measure muscle fascicle dynamics of the superficial (TA_SF) and deep (TA_DP) TA compartments. The results show significantly greater maximal shortening velocities (p = 0.003, d = 0.26, CI [4.89, 18.52]) and greater maximal fascicle shortening (p = 0.003, d = 0.86, CI [0.29, 3.13]) in TA_SF than TA_DP during submaximal dorsiflexions. Significantly lower SICI levels during activation compared to deactivation (p = 0.019, d = 1.12, CI [19.82, 1.76]) and at rest (p < 0.0001) were observed. ICF was significantly greater during activation (p = 0.03) than during rest while LICI did not modulate significantly. Maximal TA_SF but not TA_DP shortening velocity correlated with SICI levels at activation (p = 0.06) and with the rate of torque development (p = 0.02). The results suggest that SICI might be related to muscle fascicle behavior and that intracortical inhibition and excitation are phase-dependently modulated.

A Comparison of the Effects of Stochastic Resonance Therapy, Whole-Body Vibration and Balance Training on Pain Perception and Sensorimotor Function in Patients with Chronic Non-Specific Neck Pain: Protocol for a Randomized Controlled Trial

Background

Neck pain is a prevalent pathological condition, and together with low back pain, it presents as the leading cause of years lived with disability worldwide in 2015 and continues to contribute substantially to the global burden of disease.

Objective

This study will investigate and compare the effects of stochastic resonance therapy (SRT), whole-body vibration (WBV), and balance training (BLT) in the management of chronic nonspecific neck pain.

Methods

In total, 45 participants with chronic neck pain will be randomly allocated into SRT, WBV, and BLT groups. Pain intensity, pressure pain threshold, neck disability, and cervical joint position sense will be measured before, immediately after, and 15 minutes after the first intervention session and after 4 weeks of intervention. A follow-up postintervention measurement would be taken after 4 weeks. The SRT group will train on an SRT device (SRT Zeptor Medical plus noise, Zeptoring). The WBV group will train on a Galileo vibration device (Novotec Medical), while the BLT group will perform balance exercises. All participants shall train 3 times a week for a period of 4 weeks. Mixed ANOVA will be used to determine the main and effects of interactions within (before intervention, post intervention 1, post intervention 2, post intervention 3, and follow-up) and between (SRT, WBV, and BLT) factors on the study outcome variables.

Results

Recruitment of participants started in May 2021, and as of May 2022, a total of 20 patients have been enrolled in the study. All participants are expected to have completed the trial by the end of 2022, and data analysis will commence thereafter.

Conclusions

The outcome of this study will shed closer light on the effects of SRT, WBV, and BLT on pain and function in patients with chronic neck pain.

Trial Registration

German Clinical Trials Register DRKS00023881; https://tinyurl.com/ycxuhj37

International Registered Report Identifier (IRRID)

DERR1-10.2196/34430

Increased short interval intracortical inhibition in participants with previous hamstring strain injury

PURPOSE

Cortical mechanisms may contribute to weakness in participants with previous hamstring strain injury. This study aims to examine intra-cortical inhibition (SICI) and corticospinal excitability in previously injured participants.

METHODS

In this cross-sectional study, TMS was used to examine SICI, silent period, silent period: MEP ratios and area under the stimulus response curve in the biceps femoris and medial hamstrings. Comparisons were made between participants with (n = 10) and without (n = 10) previous hamstring strain injury. Motor threshold and isometric knee flexor strength were also compared between participants and the relationship between strength and SICI in control and previously injured participants was examined.

RESULTS

Isometric knee flexor strength was lower in previously injured limbs compared with control limbs (mean difference = - 41 Nm (- 26%) [95% CI = - 80 to - 2 Nm], p = 0.04, Cohen's d = - 1.27) and contralateral uninjured limbs (mean difference = - 23 Nm (- 17%), [95% CI = - 40 to - 6 Nm], p = 0.01, Cohen's d = - 0.57). Previously injured limbs exhibited smaller responses to paired pulse stimulation (i.e. greater levels of SICI) in the biceps femoris compared with control limbs (mean difference = - 19%, [95% CI = - 34 to - 5%], p = 0.007, Cohen's d = - 1.33). Isometric knee flexor strength was associated with the level of SICI recorded in the biceps femoris in previously injured participants (coefficient = 23 Nm [95% CI = 7-40 Nm], adjusted R² = 0.31, p = 0.01). There were no differences in markers of corticospinal excitability between previously injured and control limbs (all p > 0.24, all Cohen's d < 0.40).

CONCLUSION

Athletes with previous injury in the biceps femoris exhibit increased SICI in this muscle compared with control participants. Increased SICI is related to lower levels of hamstring strength, and rehabilitation programs targeting the removal of intra-cortical inhibition should be considered.

Short-Term Effects of Balance Training with Stroboscopic Vision for Patients with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial

Chronic Ankle Instability (CAI) is one of the most common musculoskeletal dysfunctions. Stroboscopic vision (SV) training has been deemed to enhance somatosensorial pathways in this population group; nevertheless, until recently no studies have addressed the additional effects of this treatment option to the traditional therapeutic approach.

METHODS

To evaluate the effectiveness of a partial visual deprivation training protocol in patients with CAI, a randomized controlled trial was carried out. Patients with CAI (n = 73) were randomized into either a balance training, SV training, or a control (no training) group. For participants assigned into training groups, they received 18 training sessions over 6 weeks. The primary outcome was dynamic balance as measured by the Star Excursion Balance Test assessed at baseline and after 6 weeks of intervention. Secondary outcome measures included ankle dorsiflexion range of motion, self-reported instability feeling, and ankle functional status.

RESULTS

Better scores in stroboscopic training and balance training groups in all outcome measures were observed in comparison with the control group with moderate to large effect sizes. Stroboscopic training was more effective than neuromuscular training in self-reported instability feeling (cohen's d = 0.71; p = 0.042) and anterior reach distance of the star excursion balance test (cohen's d = 1.23; p = 0.001).

CONCLUSIONS

Preliminary findings from the effects of SV Stroboscopic training in patients with CAI, suggest that SV may be beneficial in CAI rehabilitation.

What to train first: Balance or explosive strength? Impact on performance and intracortical inhibition

Explosive strength and balance training are commonly applied to enhance explosive strength and balance performance. Even though both training methods are frequently implemented, ordering effects have largely been neglected. Therefore, the present study aimed to investigate ordering effects of balance and explosive strength training on explosive strength and balance performance as well as changes in short-interval intracortical inhibition (SICI). Two groups of subjects either participated in 4 weeks of balance training followed by 4 weeks of explosive strength training (BT-ET) or vice versa (ET-BT). Before, after 4 and 8 weeks, balance performance, as well as explosive strength, was tested. Additionally, SICI was tested during rest as well as during balance perturbations and explosive contractions. The results show a training specific increase in performance with an increase in balance control followed by an increase in explosive strength in the BT-ET, while the ET-BT increased its balance and explosive strength in the opposite order. There were no significant ordering effects. Both groups showed a significant decrease in SICI during the explosive contractions after the eight weeks of training. When SICI was tested during the balance perturbations, SICI initially increased after the first 4 weeks of training but returned to baseline until the end of the eight weeks. It is suggested that the decrease in SICI with prolonged training might show a disengagement of the motor cortex during the balance task. During the explosive contractions, the low SICI levels are beneficial to provide the necessary level of excitatory cortical drive.

Corticospinal and spinal adaptations to motor skill and resistance training: Potential mechanisms and implications for motor rehabilitation and athletic development

Optimal strategies for enhancing strength and improving motor skills are vital in athletic performance and clinical rehabilitation. Initial increases in strength and the acquisition of new motor skills have long been attributed to neurological adaptations. However, early increases in strength may be predominantly due to improvements in inter-muscular coordination rather than the force-generating capacity of the muscle. Despite the plethora of research investigating neurological adaptations from motor skill or resistance training in isolation, little effort has been made in consolidating this research to compare motor skill and resistance training adaptations. The findings of this review demonstrated that motor skill and resistance training adaptations show similar short-term mechanisms of adaptations, particularly at a cortical level. Increases in corticospinal excitability and a release in short-interval cortical inhibition occur as a result of the commencement of both resistance and motor skill training. Spinal changes show evidence of task-specific adaptations from the acquired motor skill, with an increase or decrease in spinal reflex excitability, dependant on the motor task. An increase in synaptic efficacy of the reticulospinal projections is likely to be a prominent mechanism for driving strength adaptations at the subcortical level, though more research is needed. Transcranial electric stimulation has been shown to increase corticospinal excitability and augment motor skill adaptations, but limited evidence exists for further enhancing strength adaptations from resistance training. Despite the logistical challenges, future work should compare the longitudinal adaptations between motor skill and resistance training to further optimise exercise programming.

Functional relevance of resistance training-induced neuroplasticity in health and disease

Repetitive, monotonic, and effortful voluntary muscle contractions performed for just a few weeks, i.e., resistance training, can substantially increase maximal voluntary force in the practiced task and can also increase gross motor performance. The increase in motor performance is often accompanied by neuroplastic adaptations in the central nervous system. While historical data assigned functional relevance to such adaptations induced by resistance training, this claim has not yet been systematically and critically examined in the context of motor performance across the lifespan in health and disease. A review of muscle activation, brain and peripheral nerve stimulation, and imaging data revealed that increases in motor performance and neuroplasticity tend to be uncoupled, making a mechanistic link between neuroplasticity and motor performance inconclusive. We recommend new approaches, including causal mediation analytical and hypothesis-driven models to substantiate the functional relevance of resistance training-induced neuroplasticity in the improvements of gross motor function across the lifespan in health and disease.

A Systematic Review and Meta-Analysis on Neural Adaptations Following Blood Flow Restriction Training: What We Know and What We Don't Know

Objective: To summarize the existing evidence on the long-term effects of low-load (LL) blood flow restricted (BFR) exercise on neural markers including both central and peripheral adaptations. Methods: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. The literature search was performed independently by two reviewers in the following electronic databases: PubMed, Web of Science, Scopus and CENTRAL. The systematic review included long-term trials investigating the effects of LL-BFR training in healthy subjects and compared theses effects to either LL or high-load (HL) training without blood flow restriction. Results: From a total of N = 4499 studies, N = 10 studies were included in the qualitative synthesis and N = 4 studies in a meta-analysis. The findings indicated that LL-BFR resulted in enhanced levels of muscle excitation compared to LL training with pooled effect sizes of 0.87 (95% CI: 0.38-1.36). Compared to HL training, muscle excitation following LL-BFR was reported as either similar or slightly lower. Differences between central activation between LL-BFR and LL or HL are less clear. Conclusion: The summarized effects in this systematic review and meta-analysis highlight that BFR training facilitates neural adaptations following LL training, although differences to conventional HL training are less evident. Future research is urgently needed to identify neural alterations following long-term blood flow restricted exercise.