Muscle injury after repeated bouts of voluntary and electrically stimulated exercise

Neuromuscular electrical stimulation producing low evoked force elicits the repeated bout effect on muscle damage markers of the elbow flexors

This study examined the repeated bout effect (RBE) on muscle damage markers following two bouts of neuromuscular electrical stimulation (NMES) in untrained individuals. Following familiarization, participants received 45 consecutive NMES to the biceps brachii at an intensity that produced low evoked force for the elbow flexors. Muscle damage markers (maximal voluntary isometric contraction [MVIC], elbow range of motion [ROM], muscle soreness via visual analogue scale [VAS] scores, pressure pain threshold [PPT], and muscle thickness) were measured before (PRE), after (POST), 1 day after (24 POST), and 2 days after (48 POST) NMES. Following 1 week of rest, procedures were replicated. Separate repeated measures two-way ANOVAs examined each measure. There were no interactions or bout main effects for MVIC or ROM. Time main effects indicated PRE MVIC was greater than POST (p ​= ​0.002) and 24-POST (p ​= ​0.024), and PRE ROM was greater than POST (p ​= ​0.036). There was no interaction for muscle thickness. Respective time and bout main effects indicated muscle thickness at PRE was less than POST (p ​= ​0.017), and second-bout muscle thickness (p ​= ​0.050) was less compared to the initial-bout. For PPT, there was an interaction (p ​= ​0.019). Initial-bout PRE PPT was less than POST (p ​= ​0.033). Initial-bout 48-POST PPT was less than second-bout 48-POST (p ​= ​0.037). There was a significant interaction for VAS (p ​= ​0.009). Initial-bout PRE VAS was less than POST (p ​= ​0.033) and 24-POST (p ​= ​0.015). Initial-bout POST and 24-POST VAS were greater than second-bout POST (p ​= ​0.023) and 24-POST (p ​= ​0.006), respectively. The results support RBE on muscle damage markers related to inflammation, but not MVIC and ROM.

In vivo intracellular Ca2+ profiles after eccentric rat muscle contractions: addressing the mechanistic bases for repeated bout protection

Eccentric contractions (ECC) are accompanied by the accumulation of intracellular calcium ions ([Ca2+]i) and induce skeletal muscle damage. Suppressed muscle damage in repeated bouts of ECC is well characterized; however, whether it is mediated by altered Ca2+ profiles remains unknown. We tested the hypothesis that repeated ECC suppresses Ca2+ accumulation via adaptations in Ca2+ regulation. Male Wistar rats were divided into two groups: ECC single bout (ECC-SB) and repeated bout (ECC-RB). Tibialis anterior (TA) muscles were subjected to ECC (40 times, 5 sets) once (ECC-SB) or twice 14 days apart (ECC-RB). Under anesthesia, the TA muscle was loaded with Ca2+ indicator Fura 2-AM, and the 340/380 nm ratio was evaluated as [Ca2+]i. Ca2+ handling proteins were measured by Western blots. ECC induced [Ca2+]i increase in both groups, but ECC-RB evinced a markedly suppressed [Ca2+]i (Time: P < 0.01, Group: P = 0.0357). Five hours post-ECC, in contrast to the localized [Ca2+]i accumulation in ECC-SB, ECC-RB exhibited lower and more uniform [Ca2+]i (P < 0.01). In ECC-RB, mitochondria Ca2+ uniporter complex (MCU) components MCU and MICU2 were significantly increased pre-second ECC bout (P < 0.01), and both SERCA1 and MICU1 were better preserved after contractions (P < 0.01). Fourteen days after novel ECC, skeletal muscle mitochondrial Ca2+ regulating proteins were elevated. Following subsequent ECC, [Ca2+]i accumulation and muscle damage were suppressed and SERCA1 and MICU1 preserved. These findings suggest that tolerance to a subsequent ECC bout is driven, at least in part, by enhanced mitochondrial and sarcoplasmic reticulum Ca2+ regulation.NEW & NOTEWORTHY We demonstrated a reduced [Ca2+]i profile with suppressed muscle damage after a repeated bout of ECC in vivo: the ECC-induced immediate [Ca2+]i increase was suppressed and the persistence of increased [Ca2+]i with localized accumulation was diminished after repeated ECC. This effect occurred consonant with the upregulation of the mitochondrial Ca2+ uniporter complex and better preservation of SERCA1 and MICU1. These findings suggest that the mechanistic bases for repeated bout protection involve adaptation of Ca2+ regulation.

Blood Flow Restricted Electrical Stimulations to Prevent or Attenuate Symptoms of Muscle Damage

The objective of this study was to determine if performing electrical stimulations (E-STIM) under blood flow restriction (BFR) would result in a greater protective effect against symptoms of muscle damage. 18 individuals (9 females) completed a damaging bout of exercise followed by a low frequency E-STIM treatment protocol on both arms, one of which was completed under BFR. The treatment protocol was then repeated 24-hours post-exercise. There were main effects of time for muscle thickness (pre: 3.5 cm; 48 h post: 3.8 cm; BF10 = 88.476), discomfort (pre: 0.0 au; 48 h post: 4.2 au; BF10 = 241.996), and isometric strength (pre: 278 N; 48 h post: 232 N; BF10 = 10,289.894) which all changed as a result of the damaging exercise protocol, but there were no differences between conditions [all Bayes Factors (BF10) < 0.28]. The effectiveness of low frequency E-STIM for preventing the onset of exercise-induced muscle damage would not appear to be enhanced if performed under BFR.

Acute effects of foam roller or stick massage on indirect markers from exercise-induced muscle damage in healthy individuals: A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis examined the effects of foam roller or stick massage performed after exercise-induced muscle damage protocols on indirect markers of muscle damage compared to a non-intervention control group in healthy individuals.

METHODS

PubMed, Biblioteca Virtual em Saúde, Scopus, Google Scholar, and Cochrane Library database were searched in August 2, 2020, with last update on February 21, 2021. Were included clinical trials involving healthy adult individuals who received foam roller/stick massage versus a non-intervention group and evaluated indirect markers of muscle damage. Risk of bias was assessed by the Cochrane Risk of Bias tools. Standardized mean differences with 95% confidence intervals were used to measure the foam roller/stick massage effect on muscle soreness.

RESULTS

The five included studies investigated 151 participants (136 men). Overall, the studies presented a moderate/high risk of bias. A between-groups meta-analysis showed no significant difference between massage and non-intervention control groups on muscle soreness immediately after (0.26 [95%CI: 0.14; 0.65], p = 0.20), 24 h (-0.64 [95%CI: 1.34; 0.07], p = 0.08), 48 h (-0.35 [95%CI: 0.85; 0.15], p = 0.17), 72 h (-0.40 [95%CI: 0.92; 0.12], p = 0.13), and 96 h (0.05 [95%CI: 0.40; 0.50], p = 0.82) after an exercise-induced muscle damage protocol. Moreover, the qualitative synthesis showed that foam roller or stick massage had no significant effect on range of motion, muscle swelling, and maximal voluntary isometric contraction recovery.

CONCLUSION

In conclusion, the current literature appears to not support the advantage of foam roller or stick massage to improve recovery of muscle damage indirect markers (muscle soreness, range of motion, muscle swelling, and maximal voluntary isometric contraction) compared to a non-intervention control group in healthy individuals. Furthermore, due to the heterogeneity of the methodological designs among the included studies, making it difficult to compare the results. In addition, there are not enough high-quality and well-designed studies on foam roller or stick massage to draw any definite conclusions.

REVIEW PROTOCOL NUMBER

The study was pre-registered in the International Prospective Register of Systematic Review (PROSPERO) on August 2, 2020, with last update on February 21, 2021. Protocol number: CRD2017058559.

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.

Damage and the repeated bout effect of arm, leg, and trunk muscles induced by eccentric resistance exercises

This study compared nine resistance eccentric exercises targeting arm, leg, and trunk muscles in one session for changes in maximal voluntary isometric contraction strength (MVC), delayed onset muscle soreness (DOMS), plasma creatine kinase (CK) activity, and myoglobin (Mb) concentration after the first and second bouts. Fifteen sedentary men (20-25 years) performed 5 sets of 10 eccentric contractions with 80% of MVC load for the elbow flexors (EF), elbow extensors (EE), pectoralis, knee extensors (KE), knee flexors (KF), plantar flexors (PF), latissimus, abdominis, and erector spinae (ES) in a randomized order and repeated the same exercises 2 weeks later. MVC decreased at 1 (16%-57%) to 4 (13%-49%) days, DOMS developed (peak: 43-70 mm), and CK activity (peak: 23 238-207 304 IU/L) and Mb concentration showed large increases after the first bout. The magnitude of decrease in MVC was greater (P < 0.05) for EF, EE, and PEC than others and for KF than KE, PF, and ES. DOMS was greater (P < 0.05) for EF, EE, and ES than others. Changes in all measures were smaller (P < 0.05) after the second than the first bout, and the magnitude of the repeated bout effect was similar among the muscles. Plasma CK activity and Mb concentration did not increase significantly after the second exercise bout. It was concluded that muscle damage was greater for arm than leg muscles, and muscle proteins in the blood increased to a critical level after unaccustomed whole-body resistance exercises, but the magnitude of damage was largely attenuated for all muscles similarly after the second bout.

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.

Minimal Evidence for a Secondary Loss of Strength After an Acute Muscle Injury: A Systematic Review and Meta-Analysis

BACKGROUND

An immediate loss of strength follows virtually all types of muscle injury but there is debate whether the initial strength loss is maximal or if a secondary loss of strength occurs during the first 3 days post-injury.

OBJECTIVE

The objective of this analysis was to conduct a systematic review and meta-analysis of the research literature to determine if a secondary loss of strength occurs after an injurious initiating event.

METHODS

Literature searches were performed using eight electronic databases (e.g., PubMed, Cochrane Library). Search terms included skeletal muscle AND (injur* OR damage*) AND (strength OR force OR torque). The extracted strength data were converted to a standard format by calculating the standardized mean difference, which is reported as the effect size (ES) along with its 95 % confidence interval (CI). The calculation of ES was designed so that a negative ES that was statistically less than zero would be interpreted as indicating a secondary loss of strength.

RESULTS

A total of 223 studies with over 4000 human and animal subjects yielded data on 262 independent groups and a total of 936 separate ESs. Our overall meta-analysis yielded a small-to-medium, positive overall ES that was statistically greater than zero (overall ES = +0.34, 95 % CI 0.27-0.40; P < 0.00000001). Considerable variation in ES was observed among studies (I ² = 86 %), which could be partially explained by the research group conducting the study, sex of the subject, day of post-injury strength assessment, whether fatigue was present immediately post-injury, and the muscle group injured. From the subgroup meta-analyses probing these variables, 36 subgroup ESs were calculated and none were statistically less than zero.

CONCLUSION

Overall, our findings do not support the presence of a secondary loss of strength following an acute muscle injury, and strongly suggest that strength, on average, recovers steadily over the first 3 days post-injury.

Time Course and Association of Functional and Biochemical Markers in Severe Semitendinosus Damage Following Intensive Eccentric Leg Curls: Differences between and within Subjects

Purpose: To investigate the extent and evolution of hamstring muscle damage caused by an intensive bout of eccentric leg curls (ELCs) by (1) assessing the time course and association of different indirect markers of muscle damage such as changes in the force-generating capacity (FGC), functional magnetic resonance (fMRI), and serum muscle enzyme levels and (2) analyzing differences in the degree of hamstring muscle damage between and within subjects (limb-to-limb comparison).

Methods: Thirteen male participants performed six sets of 10 repetitions of an ELC with each leg. Before and at regular intervals over 7 days after the exercise, FGC was measured with maximal isometric voluntary contraction (MVC). Serum enzyme levels, fMRI transverse relaxation time (T2) and perceived muscle soreness were also assessed and compared against the FGC.

Results: Two groups of subjects were identified according to the extent of hamstring muscle damage based on decreased FGC and increased serum enzyme levels: high responders (n = 10, severe muscle damage) and moderate responders (n = 3, moderate muscle damage). In the high responders, fMRI T2 analysis revealed that the semitendinosus (ST) muscle suffered severe damage in the three regions measured (proximal, middle, and distal). The biceps femoris short head (BFsh) muscle was also damaged and there were significant differences in the FGC within subjects in the high responders.

Conclusion: FGC and serum enzyme levels measured in 10 of the subjects from the sample were consistent with severe muscle damage. However, the results showed a wide range of peak MVC reductions, reflecting different degrees of damage between subjects (high and moderate responders). fMRI analysis confirmed that the ST was the hamstring muscle most damaged by ELCs, with uniform T2 changes across all the measured sections of this muscle. During intensive ELCs, the ST muscle could suffer an anomalous recruitment pattern due to fatigue and damage, placing an excessive load on the BFsh and causing it to perform a synergistic compensation that leads to structural damage. Finally, T2 and MVC values did not correlate for the leg with the smaller FGC decrease in the hamstring muscles, suggesting that long-lasting increases in T2 signals after FGC markers have returned to baseline values might indicate an adaptive process rather than damage.

Adaptations in antagonist co-activation: Role in the repeated-bout effect

Eccentric exercise results in an adaptation which attenuates muscle damage from subsequent exercise—termed the “repeated-bout effect (RBE).” Purpose: Study examined antagonist co-activation and motor-unit recruitment strategy, assessed via dEMG, concomitant to the RBE. Methods: Nine participants performed 5 sub-maximal isometric trapezoid (ramp-up, hold, ramp-down) contractions at force levels corresponding to 50% and 80% of maximal isometric strength (MVC). Surface EMG signals of the biceps brachii were decomposed into individual motor-unit action potential trains. The relationship between mean firing rate (MFR) of each motor-unit and its recruitment threshold (RT) was examined using linear regression. Eccentric exercise was then performed until biceps brachii MVC had decreased by ~40%. Surface EMG of the biceps and triceps were collected during eccentric exercise. MVC, range-of-motion (ROM), and delayed onset muscle soreness (DOMS) were measured 24-hours, 72-hours, and 1-week following eccentric exercise. Three weeks later all procedures were repeated. Results: Changes in MVC (-32±14% vs -25±10%; p = 0.034), ROM (-11% vs 6%; p = 0.01), and DOMS (31.0±19mm vs 19±12mm; p = 0.015) were attenuated following the second bout of exercise. Triceps EMG was reduced (16.8±9.5% vs. 12.6±7.2%; p = 0.03) during the second bout of eccentric exercise. The slope (-0.60±0.13 vs -0.70±0.18; p = 0.029) and y-intercept (46.5±8.3 vs 53.3±8.8; p = 0.020) of the MFR vs. RT relationship was altered during contractions at 80% of MVC prior to the second bout of eccentric exercise. No changes were observed at 50% of MVC. Conclusion: A reduction in antagonist co-activation during the second bout of eccentric exercise suggests less total force was required to move an identical external load. This finding is supported by the increased negative slope coefficient and an increased y-intercept of the linear relationship between RT and MFR.

Blunted Myoglobin and Quadriceps Soreness After Electrical Stimulation During the Luteal Phase or Oral Contraception

PURPOSE

Acute muscle damage after exercise triggers subsequent regeneration, leading to hypertrophy and increased strength after repeated exercise. It has been debated whether acute exercise-induced muscle damage is altered under various premenopausal estrogen conditions. Acute contraction-induced muscle damage was compared during exogenous (oral contraceptive, OC), endogenous (luteal phase, HI), or low (menses, LO) estrogen in healthy young women aged 21 to 30 years old.

METHODS

Women (OC, n = 9; HI, n = 9; LO, n = 8; total N = 26) performed 1 neuromuscular electrical stimulation (NMES) bout. Soreness, measured via visual analog scale and the Likert Scale of Muscle Soreness for Lower Limb (LSMSLL), quadriceps strength, and plasma myoglobin (Mb), interleukin (IL)-6, IL-8, and granulocyte-colony stimulating factor were measured before and after NMES.

RESULTS

NMES performance was similar across groups. Meaningful within-group increases in Mb (effect size [ES] = 1.12) and IL-8 (ES = 0.38) occurred in LO; ES for HI and OC were trivial. ES of the between-group difference in change was moderate for Mb (LO vs. HI = 1.15) and IL-8 (LO vs. HI = 0.86; LO vs. OC = 0.73). 17-β estradiol correlated moderately and negatively with Mb relative change (r = -.52, p < .05). LO had ~5% greater strength loss than OC and HI. The mean change score for the LSMSLL 2 days post-NMES was clinically greater in LO than OC or HI.

CONCLUSIONS

Acute NMES-induced indicators of muscle fiber damage and qualitative muscle soreness may be attenuated during the luteal phase or active OC pill consumption compared with the menstrual phase.

IL-6, Antioxidant Capacity and Muscle Damage Markers Following High-Intensity Interval Training Protocols

The aim of this study was to investigate changes of interleukin-6 (IL-6), total antioxidant capacity (TAC) and muscle damage markers (creatine kinase (CK), myoglobin and lactate dehydrogenase (LDH)) in response to three different high-intensity interval training (HIIT) protocols of identical external work. Twelve moderately-trained males participated in the three HIIT trials which consisted of a warm-up, followed by 12 min of 15 s, 30 s or 60 s HIIT sequences with the work/rest ratio 1. The biochemical markers of inflammation, oxidative stress and muscle damage were analysed POST, 3 h and 24 h after the exercise. All HIIT protocols caused an immediate increase in IL-6, TAC, CK, myoglobin and LDH. The most pronounced between-trials differences were found for the POST-exercise changes in IL-6 (Effect size ± 90% confidence interval: 1.51 ± 0.63, 0.84 ± 0.34 and 1.80 ± 0.60 for the 15s/15s, 30s/30s and 60s/60s protocol, respectively) and myoglobin (1.11 ± 0.29, 0.45 ± 0.48 and 1.09 ± 0.22 for the 15s/15s, 30s/30s and 60s/60s protocol, respectively). There were no substantial between-trial differences in other biochemical variables. In conclusion, the 15s/15s and 60s/60s protocols might be preferred to the 30s/30s protocols in order to maximize the training stimulus.

Chronic effects of superimposed electromyostimulation during cycling on aerobic and anaerobic capacity

PURPOSE

To examine if chronic endurance training by means of simultaneously applied, superimposed electromyostimulation (EMS) can be used to improve performance and physiological core parameters compared to the traditional cycling.

METHODS

Twenty-one male subjects (VO_2peak 55.2 ± 5.1 ml min^- 1 kg^- 1) were assigned to either a cycling (C) or cycling with superimposed EMS (C + E) group. Before and after the 4-week training period, including 14 sessions of moderate cycling [60 min at 60% peak power output (PPO)], participants performed a 20-min time-trial, a step test to exhaustion, a 30-s isokinetic sprint test, and maximum force- and power-tests. Markers of muscle damage and metabolic condition were assessed during the training period.

RESULTS

Step test results revealed increases in PPO, VO_2peak, lactate threshold 1, and the anaerobic threshold for both groups (p < 0.05). Mean power output (MPO) obtained from time-trial was improved in C and C + E (p < 0.05). Isokinetic sprint test revealed increased PPO in both groups, whereas MPO was only changed in C (p < 0.05). Strength parameters were unaffected. Although metabolic stimuli and markers of muscle damage were higher in C + E compared to C, improvements of endurance performance and capacity were not significantly different between C and C + E.

CONCLUSIONS

Despite a higher metabolic, respiratory, and muscular demand, chronic additional superimposed EMS during cycling does not result in superior improvements in endurance and strength performance compared to the traditional cycling.

Safety and feasibility of a neuromuscular electrical stimulation chronaxie-based protocol in critical ill patients: A prospective observational study

PURPOSE

The aim of this study was to evaluate the safety and feasibility of a neuromuscular electrical stimulation (NMES) protocol based on neuromuscular excitability and applied in numerous muscle groups of critical ill patients.

MATERIALS AND METHODS

We performed a prospective observational study using an NMES applied daily and bilaterally into 5 muscle groups in lower limbs for 3 consecutive days. The characteristics of NMES were 90 contractions per muscle, pulse width equal to chronaxie, and a pulse frequency of 100 Hz. We assessed safety with central venous oxygen saturation, serum lactate, and creatine phosphokinase measurements. To evaluate feasibility, we recorded the time spent for the entire NMES protocol and the number of NMES sessions completed.

RESULTS

Eleven male patients finished the study. There were no significant changes observed in creatine phosphokinase from baseline up to 96 hours: 470(±270) IU/L and 455(±240) IU/L (P>.99). Central venous oxygen saturation and serum lactate had the same pattern with no significant variations (P=.23 and P=.8, respectively). The time spent during the whole procedure and the number of complete NMES sessions performed were 107±24 minutes and 84 sessions (85%), respectively.

CONCLUSIONS

We demonstrated that NMES chronaxie-based protocol is safe and feasible.

Localization and quantification of intramuscular damage using statistical parametric mapping and skeletal muscle parcellation

In the present study, we proposed an original and robust methodology which combines the spatial normalization of skeletal muscle images, the statistical parametric mapping (SPM) analysis and the use of a specific parcellation in order to accurately localize and quantify the extent of skeletal muscle damage within the four heads of the quadriceps femoris. T₂ maps of thigh muscles were characterized before, two (D2) and four (D4) days after 40 maximal isometric electrically-evoked contractions in 25 healthy young males. On the basis of SPM analysis of coregistrated T₂ maps, the alterations were similarly detected at D2 and D4 in the superficial and distal regions of the vastus medialis (VM) whereas the proportion of altered muscle was higher in deep muscle regions of the vastus lateralis at D4 (deep: 35 ± 25%, superficial: 23 ± 15%) as compared to D2 (deep: 18 ± 13%, superficial: 17 ± 13%). The present methodology used for the first time on skeletal muscle would be of utmost interest to detect subtle intramuscular alterations not only for the diagnosis of muscular diseases but also for assessing the efficacy of potential therapeutic interventions and clinical treatment strategies.

Low-intensity eccentric contractions of the knee extensors and flexors protect against muscle damage

This study investigated the magnitude and duration of the protective effect of low-intensity eccentric contractions (LowEC) against damage induced by maximal eccentric contractions (MaxEC) of the knee flexors (KF) and extensors (KE). Young men were assigned to 8 experimental groups and 2 control groups (n = 13/group); the experimental groups performed LowEC of KF or KE 2 days (2d), 1 week (1wk), 2 weeks (2wk), or 3 weeks (3wk) before MaxEC, while the control groups performed MaxEC of KF or KE without LowEC. The 2d, 1wk, 2wk, and 3wk groups performed 30 LowEC of KF or 60 LowEC of KE with a load of 10% of maximal voluntary isometric contraction strength on a resistance-training machine, and all groups performed 30 MaxEC of KF or 60 MaxEC of KE on an isokinetic dynamometer. Several muscle damage markers were measured from before to 2 days after exercise (LowEC) or from before to 5 days after exercise (MaxEC). No significant changes in any variables were evident after LowEC. The changes in all variables after MaxEC were smaller (P < 0.05) for the 2d and 1wk groups (e.g., peak creatine kinase activity: 1002 ± 501 IU/L; peak muscle soreness: 13 ± 5 mm) than for the control group (peak creatine kinase activity: 3005 ± 983 IU/L; peak muscle soreness 28 ± 6 mm) for both KE and KF. There were no significant differences between the 2d and 1wk groups or among the 2wk, 3wk, and control groups. These results show that LowEC provided 30%–66% protection against damage induced by MaxEC of KF and KE, and the protective effect lasted 1 week.

Time-course of recovery of peak oxygen uptake after exercise-induced muscle damage

V̇O2 peak has been shown to be reduced 48 h following exercise-induced muscle damage (EIMD), but it is unclear how long this reduction may persist. In this study eight endurance trained participants (21.5 ± 1.1 years old) performed a maximal exercise tests over 10-days followings EIMD. Cardiorespiratory variables were collected via open-circuit spirometry and soreness, maximal strength (MVC), motor-unit recruitment, and contractile properties were assessed prior to each test. MVC was reduced for up to 4-days (p ≤ 0.05) and soreness was evident for 10-days in the quadriceps (p < 0.05). V̇O2peak was reduced 7.4% 2-days post EIMD (55.5 ± 6.0 vs. 51.3 ± 5.8; p = 0.006) and remained reduced in 6 of 8 participants at 10-days post (p = 0.005). No relationship was found between changes in MVC, soreness, motor-unit recruitment, and contractile properties and changes in V̇O2peak (p > 0.05). EIMD resulted in small, but prolonged reductions in V̇O2peak. Our findings suggest mechanisms aside from force loss and soreness are primarily responsible for the reductions in V̇O2peak after EIMD.

Torque decrease during submaximal evoked contractions of the quadriceps muscle is linked not only to muscle fatigue

The aim of this study was to analyze the neuromuscular mechanisms involved in the torque decrease induced by submaximal electromyostimulation (EMS) of the quadriceps muscle. It was hypothesized that torque decrease after EMS would reflect the fatigability of the activated motor units (MUs), but also a reduction in the number of MUs recruited as a result of changes in axonal excitability threshold. Two experiments were performed on 20 men to analyze 1) the supramaximal twitch superimposed and evoked at rest during EMS (Experiment 1, n = 9) and 2) the twitch response and torque-frequency relation of the MUs activated by EMS (Experiment 2, n = 11). Torque loss was assessed by 15 EMS-evoked contractions (50 Hz; 6 s on/6 s off), elicited at a constant intensity that evoked 20% of the maximal voluntary contraction (MVC) torque. The same stimulation intensity delivered over the muscles was used to induce the torque-frequency relation and the single electrical pulse evoked after each EMS contraction (Experiment 2). In Experiment 1, supramaximal twitch was induced by femoral nerve stimulation. Torque decreased by ~60% during EMS-evoked contractions and by only ~18% during MVCs. This was accompanied by a rightward shift of the torque-frequency relation of MUs activated and an increase of the ratio between the superimposed and posttetanic maximal twitch evoked during EMS contraction. These findings suggest that the torque decrease observed during submaximal EMS-evoked contractions involved muscular mechanisms but also a reduction in the number of MUs recruited due to changes in axonal excitability.

Acute effects of superimposed electromyostimulation during cycling on myokines and markers of muscle damage

OBJECTIVES

The purpose of the present study was to evaluate the effects of superimposed electromyostimulation (E) during cycling on myokines and markers of muscle damage, as E might be a useful tool to induce a high local stimulus to skeletal muscle during endurance training without performing high external workloads.

METHODS

13 subjects participated in three experimental trials each lasting 60 min in a randomized order. 1) Cycling (C), 2) Cycling with superimposed E (C+E) and 3) E. Interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF), creatine kinase (CK) and myoglobin were determined before (pre) and 0', 30', 60', 240' and 24h after each intervention.

RESULTS

Only C+E caused significant increases in levels of CK and myoglobin. BDNF and IL-6 significantly increased after C and C+E, however increases for IL-6 were significantly higher after C+E compared to C.

CONCLUSION

The present study showed that superimposed E during cycling might be a useful tool to induce a high local stimulus to skeletal muscle even when performing low to moderate external workloads. This effect might be due the activation of additional muscle fibers and mild eccentric work due to the concomitant activation of agonist and antagonist. However the higher load to skeletal muscle has to be taken into account.

Time course of central and peripheral alterations after isometric neuromuscular electrical stimulation-induced muscle damage

Isometric contractions induced by neuromuscular electrostimulation (NMES) have been shown to result in a prolonged force decrease but the time course of the potential central and peripheral factors have never been investigated. This study examined the specific time course of central and peripheral factors after isometric NMES-induced muscle damage. Twenty-five young healthy men were subjected to an NMES exercise consisting of 40 contractions for both legs. Changes in maximal voluntary contraction force of the knee extensors (MVC), peak evoked force during double stimulations at 10 Hz (Db₁₀) and 100 Hz (Db₁₀₀), its ratio (10∶100), voluntary activation, muscle soreness and plasma creatine kinase activity were assessed before, immediately after and throughout four days after NMES session. Changes in knee extensors volume and T₂ relaxation time were also assessed at two (D2) and four (D4) days post-exercise. MVC decreased by 29% immediately after NMES session and was still 19% lower than the baseline value at D4. The decrease in Db₁₀ was higher than in Db₁₀₀ immediately and one day post-exercise resulting in a decrease (−12%) in the 10∶100 ratio. On the contrary, voluntary activation significantly decreased at D2 (−5%) and was still depressed at D4 (−5%). Muscle soreness and plasma creatine kinase activity increased after NMES and peaked at D2 and D4, respectively. T₂ was also increased at D2 (6%) and D4 (9%). Additionally, changes in MVC and peripheral factors (e.g., Db₁₀₀) were correlated on the full recovery period, while a significant correlation was found between changes in MVC and VA only from D2 to D4. The decrease in MVC recorded immediately after the NMES session was mainly due to peripheral changes while both central and peripheral contributions were involved in the prolonged force reduction. Interestingly, the chronological events differ from what has been reported so far for voluntary exercise-induced muscle damage.

The increase in surface EMG could be a misleading measure of neural adaptation during the early gains in strength

PURPOSE

To test the validity of using the increase in surface EMG as a measure of neural adaptation during the early gains in strength.

METHODS

Simulation of EMG signals detected by surface bipolar electrode with 20-mm inter-pole distance at different radial distances from the muscle and longitudinal distances from the end-plate area. The increases in the root mean square (RMS) of the EMG signal due to possible alteration in the neural drive or elevation of the intracellular negative after-potentials, detected in fast fatigable muscle fibres during post-tetanic potentiation and assumed to accompany post-activation potentiation, were compared.

RESULTS

Lengthening of the intracellular action potential (IAP) profile due to elevation of the negative after-potentials could affect amplitude characteristics of surface EMG detected at any axial distance stronger than alteration in the neural drive. This was irrespective of the fact that the elevation of IAP negative after-potential was applied to fast fatigable motor units (MUs) only, while changes in frequency of activation (simulating neural drive changes) were applied to all MUs. In deeper muscles, where the fibre-electrode distance was larger, the peripheral effect was more pronounced. The normalization of EMG amplitude characteristics to an M-wave one could result only in partial elimination of peripheral factor influence

CONCLUSIONS

The increase in RMS of surface EMG during the early gains in strength should not be directly related to the changes in the neural drive. The relatively small but long-lasting elevated free resting calcium after high-resistance strength training could result in force potentiation and EMG increase.

Protection against muscle damage induced by electrical stimulation: efficiency of a preconditioning programme

PURPOSE

The aim of this study was to explore the efficiency of a preconditioning programme composed of neuromuscular electrical stimulation (NMES) in the protection against muscle damage induced by a subsequent bout of NMES.

METHODS

Sixteen male volunteers were split up into a control group (CG; n = 8) and a preconditioned group (PCG; n = 8). Both groups attended two NMES bouts (test 1 and test 2) spaced 5 weeks apart. Each one consisted in 100 quadriceps contractions and 100 hamstrings contractions. PCG attended five additional progressive NMES sessions between test 1 and test 2. The outcome measures were the changes in muscle soreness [0-10 pain score on visual analogue pain scale (VAS)], muscle flexibility and serum creatine kinase (CK) activity; they were assessed before (pre-T1) and after (post-T1) test 1 and before (pre-T2) and after (post-T2) test 2.

RESULTS

Damage markers increased similarly in both groups after test 1 (at post-T1, VAS scores = 4·18 ± 2 and 4·43 ± 1·56 cm in CG and PCG, respectively; CK activity = 2307 ± 3774 and 1671 ± 1790 IU l(-1) in CG and PCG, respectively). Compared with test 1, these damage markers were reduced after test 2 in CG (at post-T2, VAS score = 2·68 ± 1·27 cm and CK activity = 218 ± 72 IU l(-1) ). Muscle soreness was further reduced after test 2 in PCG (VAS score = 0·37 ± 0·74 cm).

CONCLUSIONS

A protective effect against muscle damage can be obtained after only one NMES bout, and an additional protective effect can be induced by a preconditioning programme.

Does blood flow restriction result in skeletal muscle damage? A critical review of available evidence

Blood flow restriction (BFR) alone or in combination with exercise has been shown to result in muscle hypertrophy and strength gain across a variety of populations. Although there are numerous studies in the literature showing beneficial muscular effects following the application of BFR, questions have been raised over whether BFR may lead to or even increase the incidence of muscle damage. The purpose of this review is to examine the proposed mechanisms behind muscle damage and critically review the available BFR literature. The available evidence does not support the hypothesis that BFR in combination with low-intensity exercise increases the incidence of muscle damage. Instead, the available literature suggests that minimal to no muscle damage is occurring with this type of exercise. This conclusion is drawn from the following observations: (a) no prolonged decrements in muscle function; (b) no prolonged muscle swelling; (c) muscle soreness ratings similar to a submaximal low load control; and (d) no elevation in blood biomarkers of muscle damage.

Prior eccentric exercise augments muscle pain and perception of effort during cycling exercise

OBJECTIVES

This study examined the effects of exercise-induced muscle damage (EIMD) on the physiological and perceptual responses to 30 minutes of submaximal cycling at 60% of oxygen consumption (VO2 peak).

METHODS

Ten participants completed two 30-minute bouts of cycling, one before and one 48 hours after performance of strenuous (24 contractions with 120% of concentric 1-repeition maximum) eccentric exercise.

RESULTS

Eccentric exercise resulted in a significant delayed-onset muscle pain (1.6±1.6 mm to 44.8±20 mm on a 100-mm visual analog scale; P<0.001) and a 15% (P<0.001) reduction in maximal strength 48 hours after exercise. Ratings of quadriceps muscle pain (1.99±0.42 vs. 3.30±0.56; P=0.003) and perceived exertion (RPE; 13.0±0.30 vs. 13.8±0.61; P=0.02) were elevated during cycling after EIMD at identical work rates. No changes were observed in VO2 (29.6±4.6 vs. 30.2±4.4 mL/kg/min; P=0.41), heart rate (154±15 vs. 155±9 beats/min; P=0.58), and ventilation (57.2±12.1 vs. 59.8±12.7 L/min; P=0.13) during exercise after EIMD. The mean change in RPE was significantly correlated (r=0.56; P<0.01) with the change in muscle pain during cycling and delayed-onset pain during resistance exercise (r=0.86; P<0.01), but did not correlate with changes in VO2, heart rate, ventilation, and maximal strength.

DISCUSSION

These findings indicate the elevations in RPE after EIMD are likely a consequence of the EIMD with the most likely explanation being an increase in localized pain before and during cycling exercise.

Attenuation of eccentric exercise-induced muscle damage by preconditioning exercises

PURPOSE

This study compared the effect of an initial exercise consisting of either low-intensity eccentric or maximal isometric contractions (ISOs) on protective effect against maximal eccentric contraction (MaxECC)-induced muscle damage.

METHODS

Untrained young men were placed into one of five groups (n = 13 per group): MaxECC, 10% ECC, 20% ECC, 90° ISO, and 20° ISO. The MaxECC, 10% ECC, and 20% ECC groups performed 30 ECCs of the elbow flexors using a dumbbell equivalent to 100%, 10%, and 20% of maximal voluntary isometric contraction strength, respectively. The 90° ISO and 20° ISO groups performed 30 ISOs at 90° and 20° of elbow flexion, respectively. Three weeks later, all subjects performed 30 MaxECCs with the arm used for the first bout. Changes in maximal voluntary isometric and concentric contraction strength, range of motion, upper arm circumference, plasma creatine kinase and myoglobin concentration, and muscle soreness before and for 5 d after the first and second exercise bouts were compared among groups by a two-way repeated-measure ANOVA.

RESULTS

Changes in all measures after the first bout were smaller (P < 0.05) for 10% ECC, 20% ECC, 90° ISO, and 20° ISO groups compared with MaxECC group, and the changes were smaller (P < 0.05) for 10% ECC and 90° ISO than 20° ISO and 20% ECC groups. When compared with the first bout of MaxECC group, changes in the measures after the second bout were smaller for 20% ECC and 20° ISO groups with greater protective effect evident for 20° ISO group, but the protective effect conferred by these was smaller (P < 0.05) compared with MaxECCs.

CONCLUSION

These results suggest that there is threshold intensity for ECCs to confer protective effect, and ISOs at a long muscle length provide preconditioning effect.

Two maximal isometric contractions attenuate the magnitude of eccentric exercise-induced muscle damage

This study investigated whether maximal voluntary isometric contractions (MVC-ISO) would attenuate the magnitude of eccentric exercise-induced muscle damage. Young untrained men were placed into one of the two experimental groups or one control group (n = 13 per group). Subjects in the experimental groups performed either two or 10 MVC-ISO of the elbow flexors at a long muscle length (20° flexion) 2 days prior to 30 maximal isokinetic eccentric contractions of the elbow flexors. Subjects in the control group performed the eccentric contractions without MVC-ISO. No significant changes in maximal voluntary concentric contraction peak torque, peak torque angle, range of motion, upper arm circumference, plasma creatine kinase (CK) activity and myoglobin concentration, muscle soreness, and ultrasound echo intensity were evident after MVC-ISO. Changes in the variables following eccentric contractions were smaller (P < 0.05) for the 2 MVC-ISO group (e.g., peak torque loss at 5 days after exercise, 23% ± 3%; peak CK activity, 1964 ± 452 IU·L–1; peak muscle soreness, 46 ± 4 mm) or the 10 MVC-ISO group (13% ± 3%, 877 ± 198 IU·L–1, 30 ± 4 mm) compared with the control (34% ± 4%, 6192 ± 1747 IU·L–1, 66 ± 5 mm). The 10 MVC-ISO group showed smaller (P < 0.05) changes in all variables following eccentric contractions compared with the 2 MVC-ISO group. Therefore, two MVC-ISO conferred potent protective effects against muscle damage, whereas greater protective effect was induced by 10 MVC-ISO, which can be used as a strategy to minimize muscle damage.

Endpoint measures in the mdx mouse relevant for muscular dystrophy pre-clinical studies

Loss of mobility influences the quality of life for patients with neuromuscular diseases. Common measures of mobility and chronic muscle damage are the six-minute walk test and serum creatine kinase. Despite extensive pre-clinical studies of therapeutic approaches, characterization of these measures is incomplete. To address this, a six-minute ambulation assay, serum creatine kinase, and myoglobinuria were investigated for the mdx mouse, a dystrophinopathy mouse model commonly used in pre-clinical studies. mdx mice ambulated shorter distances than normal controls, a disparity accentuated after mild exercise. An asymmetric pathophysiology in mdx mice was unmasked with exercise, and peak measurements of serum creatine kinase and myoglobinuria were identified. Our data highlights the necessity to consider asymmetric pathology and timing of biomarkers when testing potential therapies for muscular dystrophy.

The spectral changes in EMG during a second bout eccentric contraction could be due to adaptation in muscle fibres themselves: a simulation study

The mechanism of marked reduction in damage symptoms after repeated bout of similar eccentric contractions is still unknown. The neuronal adaptation leading to reduction of muscle fibre propagation velocity (MFPV) due to increased activation of slow-twitch motor units (MUs), decrease in activation of fast-twitch MUs, and/or increase in MU synchronization was suggested as a cause for lower EMG frequency characteristics. However, the repeated bout effect could occur also after electrically stimulated exercise. Prolonged elevation of cytoplasmic Ca(2+) due to the increased membrane permeability after eccentric contractions was reported. Elevated Ca(2+) induced peripheral changes that included alteration of intracellular action potential and MFPV reduction. We simulated and compared changes in EMG frequency characteristics related to effects of central nervous system (CNS) or to peripheral changes. The simulations were performed for different electrode arrangements and positions. The results showed that the peripheral effects could be similar or even stronger than the effects related to CNS. We hypothesised that the repeated bout effect was a consequence of the adaptation in muscle fibres necessary for avoiding Ca(2+)-induced protein and lipid degradation due to Ca(2+) overload resulting from the increased membrane permeability after eccentric contraction. The possibilities for noninvasive testing of this hypothesis were discussed.

Repeated bout effect is not correlated with intraindividual variability during muscle-damaging exercise

The aim of this study was to test the hypothesis that the repeated bout effect depends on intraindividual variability during a second bout of eccentric exercise. Eleven healthy men performed 2 resistance training bouts consisting of maximal eccentric exercise (EE1 and EE2) using the knee extensor muscles. The interval between the exercise bouts was 2 weeks and consisted of 10 sets of 12 repetitions at 160° · s(-1). Maximal isokinetic concentric torque at 30° · s(-1) was measured before the bouts and 2 minutes and 24 hours thereafter. Muscle soreness score and creatine kinase activity were determined before and after exercise. Intraindividual variability in torque during each eccentric repetition was measured during exercise. Repeated bout effect manifested after EE2: Muscle soreness was less, the shift in optimal knee joint angle to a longer muscle length was less, and the decrease in isokinetic concentric torque 2 minutes after exercise was less for EE2 compared with that for EE1. During concentric (isokinetic) contraction, length-dependent changes in isokinetic torque (IT) occurred after both EE1 and EE2: The shorter the muscle length, the greater the change in IT. There was a significant relationship between the decrease in maximal isokinetic knee extension torque 24 hours after EE1 and intraindividual variability of EE1 (R2 = 0.71, p < 0.05), but this relationship was not significant for EE2 (R2 = 0.18). It seems that intraindividual variability during eccentric exercise protects against muscle fatigue and damage during the first exercise bout but not during a repeat bout. These findings may be useful to coaches who wish to improve muscle function in resistance training with less depression in muscle function and discomfort of their athletes, specifically, when muscle is most sensitive to muscle-damaging exercise.

Comparison in eccentric exercise-induced muscle damage among four limb muscles

This study tested the hypothesis that changes in indirect markers of muscle damage following maximal eccentric exercise would be smaller for the knee extensors (KE) and flexors (KF) compared with the elbow flexors (EF) and extensors (EE). A total of 17 sedentary men performed five sets of six maximal isokinetic (90° s(-1)) eccentric contractions of EF (range of motion, ROM: 90°-0°, 0 = full extension), EE (55°-145°), KF (90°-0°), and KE (30°-120°) using a different limb with a 4-5-week interval in a counterbalanced order. Changes in maximal isometric and concentric isokinetic strength, optimum angle, limb circumference, ROM, plasma creatine kinase activity and myoglobin concentration, muscle soreness, and echo-intensity of B-mode ultrasound images before and for 5 days following exercise were compared amongst the four exercises using two-way repeated-measures ANOVA. All variables changed significantly following EF, EE, and KF exercises, but KE exercise did not change the optimum angle, limb circumference, and echo-intensity. Compared with KF and KE, EF and EE showed significantly greater changes in all variables, without significant differences between EF and EE. Changes in all variables were significantly greater for KF than KE. For the same subjects, the magnitude of change in the dependent variables following exercise varied among the exercises. These results suggest that the two arm muscles are equally more susceptible to muscle damage than leg muscles, but KF is more susceptible to muscle damage than KE. The difference in the susceptibility to muscle damage seems to be associated with the use of muscles in daily activities.

Junctophilin damage contributes to early strength deficits and EC coupling failure after eccentric contractions

Junctophilins (JP1 and JP2) are expressed in skeletal muscle and are the primary proteins involved in transverse (T)-tubule and sarcoplasmic reticulum (SR) membrane apposition. During the performance of eccentric contractions, the apposition of T-tubule and SR membranes may be disrupted, resulting in excitation-contraction (EC) coupling failure and thus reduced force-producing capacity. In this study, we made three primary observations: 1) through the first 3 days after the performance of 50 eccentric contractions in vivo by the left hindlimb anterior crural muscles of female mice, both JP1 and JP2 were significantly reduced by approximately 50% and 35%, respectively, while no reductions were observed after the performance of nonfatiguing concentric contractions; 2) following the performance of a repeated bout of 50 eccentric contractions in vivo, only JP1 was immediately reduced ( approximately 30%) but recovered by 3-day postinjury in tandem with the recovery of strength and EC coupling; and 3) following the performance of 10 eccentric contractions at either 15 degrees or 35 degrees C by isolated mouse extensor digitorum longus (EDL) muscle, isometric force, EC coupling, and JP1 and JP2 were only reduced after the eccentric contractions performed at 35 degrees C. Regression analysis of JP1 and JP2 content in tibialis anterior and EDL muscles from each set of experiments indicated that JP damage is significantly associated with early (0-3 days) strength deficits after performance of eccentric contractions (R = 0.49; P < 0.001). As a whole, the results of this study indicate that JP damage plays a role in early force deficits due to EC coupling failure following the performance of eccentric contractions.