Short-Term Unilateral Resistance Training Results in Cross Education of Strength Without Changes in Muscle Size, Activation, or Endocrine Response

Task Specificity of Dynamic Resistance Training and Its Transferability to Non-trained Isometric Muscle Strength: A Systematic Review with Meta-analysis

BACKGROUND

Resistance training (RT) specificity has been confirmed for movement patterns (e.g., multi-joint or single joint), movement velocities, ranges of motion, and contraction types (e.g., dynamic vs isometric). However, a systematic analysis of the effects of dynamic mass-loaded (e.g., isoinertial) RT on dynamic versus isometric strength tests is lacking.

OBJECTIVE

We aimed to examine the specific effects of dynamic RT on dynamic (isoinertial) versus isometric muscle strength, including possible moderating factors (e.g., training length, single joint and multi-joint, upper body and lower body, RT status) and mechanisms (e.g., hypertrophy, muscle activation).

METHODS

A systematic literature search was conducted in MEDLINE (EBSCO), Web of Science, and Scopus up to March 2024. The included interventions contained at least ten training sessions, both dynamic and isometric muscle strength assessments before and after the training period, and healthy participants aged 16-60 years (encompassing untrained and trained individuals). Advanced RT approaches, such as electrical stimulation, isokinetic training, velocity-based training, and blood flow restriction training, were excluded. Within-subject, weighted standardized mean differences (SMDs) of the pre-intervention to post-intervention tests were calculated for both dynamic and isometric muscle strength measures using a random-effects model. Univariate sub-group analyses of RT status, intervention length, complexity (i.e., single-joint or multi-joint exercises), and body segments (i.e., upper and lower body) were independently computed. Random-effects meta-regressions were computed to examine if dynamic RT effects on dynamic and isometric muscle strength are predicted by RT effects on muscle hypertrophy or muscle activity.

RESULTS

Overall, 43 studies with 1660 participants across 72 different RT interventions were eligible for inclusion. The overall effect on dynamic strength was significant and moderate magnitude (SMD = 0.98, 95% confidence interval 0.91-1.06, p < 0.001), whereas the transfer to non-trained isometric strength measures was significant but small (SMD = 0.42, 95% confidence interval 0.35-0.49, p < 0.001). Sub-analyses demonstrated moderate-to-large task-specific effects (range SMD; 95% confidence interval 0.75-1.30) of conducting dynamic RT and only small-to-medium effects (range SMD; 0.29-0.70) of the transferability of muscle strength to the non-trained isometric contraction form. Muscle hypertrophy and activity changes did not significantly predict dynamic RT effects on dynamic and isometric muscle strength (p ≥ 0.222).

CONCLUSIONS

Our findings demonstrated task specificity of dynamic RT, as dynamic strength increased with a two-fold larger effect size than non-trained isometric muscle strength. Medium-to-large effects were observed for the dynamic strength improvements in the different sub-group analyses with small-to-medium effects in the isometric improvements. The limited transferability of dynamic (task-specific) strength to non-trained isometric contractions suggests that these two strength outcomes represent different neuromuscular domains.

Does Unilateral High-Load Resistance Training Influence Strength Change in the Contralateral Arm Also Undergoing High-Load Training?

Training one limb with a high-load has been shown to augment strength changes in the opposite limb training with a low-load (via cross-education of strength), indicating that within-subject models can be problematic when investigating strength changes. This study examined if the cross-education of strength from unilateral high-load training could augment the strength changes in the opposite arm undergoing the same unilateral high-load training. 160 participants were randomized to one of four groups: (1) training on the dominant arm followed by the non-dominant arm (D + ND), (2) training on the dominant arm only (D-Only), (3) training on the non-dominant arm only (ND-Only), and (4) a non-exercise control. All exercise groups performed 18 sessions of unilateral high-load elbow flexion exercise over 6 weeks. Participants were compared for changes in 1RM strength and muscle thickness. Changes in strength of the non-dominant arm were greater in D + ND (2.7 kg) and ND-Only (2.6 kg) compared to D-Only (1.5 kg) and control (-0.2 kg), while the changes were greater in D-Only compared to control. The same finding was observed in the dominant arm. Only the arms being directly trained observed increases in muscle thickness. Unilateral high-load resistance training increased strength in the opposite untrained arm, without changes in muscle thickness. This cross-education of strength did not augment the strength changes in the contralateral arm undergoing the same unilateral high-load training. However, it does not necessarily indicate that within-subject models are methodologically sound to investigate strength change if both limbs are trained with a high-load.

Cross-Education of Muscular Endurance: A Scoping Review

BACKGROUND

It is well established that performing unilateral resistance training can increase muscle strength not only in the trained limb but also in the contralateral untrained limb, which is widely known as the cross-education of strength. However, less attention has been paid to the question of whether performing unilateral resistance training can induce cross-education of muscular endurance, despite its significant role in both athletic performance and activities of daily living.

OBJECTIVES

The objectives of this scoping review were to provide an overview of the existing literature on cross-education of muscular endurance, as well as discuss its potential underlying mechanisms and offer considerations for future research.

METHODS

A scoping review was conducted on the effects of unilateral resistance training on changes in muscular endurance in the contralateral untrained limb. This scoping review was conducted in PubMed, SPORTDiscus, and Scopus.

RESULTS

A total of 2000 articles were screened and 21 articles met the inclusion criteria. Among the 21 included studies, eight studies examined the cross-education of endurance via absolute (n = 6) or relative (n = 2) muscular endurance test, while five studies did not clearly indicate whether they examined absolute or relative muscular endurance. The remaining eight studies examined different types of muscular endurance measurements (e.g., time to task failure, total work, and fatigue index).

CONCLUSION

The current body of the literature does not provide sufficient evidence to draw clear conclusions on whether the cross-education of muscular endurance is present. The cross-education of muscular endurance (if it exists) may be potentially driven by neural adaptations (via bilateral access and/or cross-activation models that lead to cross-education of strength) and increased tolerance to exercise-induced discomfort. However, the limited number of available randomized controlled trials and the lack of understanding of underlying mechanisms provide a rationale for future research.

Unilateral high-load resistance training induced a similar cross-education of strength between the dominant and non-dominant arm

It was previously hypothesized that the cross-education of strength is asymmetrical, where a greater transfer of strength is observed from the dominant to the non-dominant limb. The purpose of this study was to examine if the magnitude of cross-education of strength differed between dominant and non-dominant limbs following unilateral high-load resistance training. One hundred and twenty-two participants were randomized to one of the three groups: 1) training on the dominant arm (D-Only), 2) training on the non-dominant arm (ND-Only) and 3) a time-matched non-exercise control (Control). The training groups completed 6 weeks (18 sessions) of unilateral elbow flexion exercise. Each training session started with one-repetition maximum (1RM) training (≤ five attempts), followed by four sets of high-load exercise (i.e. 8-12RM). Strength changes of the untrained arm were compared between groups. Changes in the strength of the untrained arm were greater in D-Only (1.5 kg) and ND-Only (1.3 kg) compared to Control (-0.2 kg), without differences between D-Only and ND-Only. Unilateral resistance training increased strength in the opposite untrained arm, and the magnitude of this effect was similar regardless of which arm was trained. However, there is still considerable uncertainty on this topic and additional research is warranted to confirm the current findings.

Skeletal Muscle Adaptations to High-Load Resistance Training With Pre-Exercise Blood Flow Restriction

ABSTRACT

Hammert, WB, Moreno, EN, Martin, CC, Jessee, MB, and Buckner, SL. Skeletal muscle adaptations to high-load resistance training with pre-exercise blood flow restriction. J Strength Cond Res 37(12): 2381-2388, 2023-This study aimed to determine if blood flow restriction (BFR) could augment adaptations to a high-load training protocol that was inadequate for muscle growth. Forty nontrained individuals had each arm assigned to 1 of 3 elbow flexion protocols: (a) high-load resistance training [TRAD; 4 sets to muscular failure at 70% 1 repetition maximum (1RM)], (b) low repetition high-load resistance training with pre-exercise BFR (PreBFR; 4 sets of 3 repetitions at 70% 1RM + 3 min of pre-exercise BFR), and (c) low repetition high-load resistance training (LRTRAD); 4 sets of 3 repetitions at 70% 1RM). Muscle thickness (MT), 1RM strength, and local muscular endurance (LME) of the elbow flexors were measured before and after 8 weeks. An alpha level of 0.05 was used for all comparisons. For the 50% site, MT increased for TRAD (0.211 cm, 95% confidence interval [95% CI]: 0.143-0.280), PreBFR (0.105 cm, 95% CI: 0.034-0.175), and LRTRAD (0.073 cm, 95% CI: 0.000-0.146). The change for TRAD was greater than PreBFR and LRTRAD. For the 60% site, MT increased for TRAD (0.235 cm, 95% CI: 0.153-0.317), PreBFR (0.097 cm, 95% CI: 0.014-0.180), and LRTRAD (0.082 cm, 95% CI: 0.000-0.164). The change for TRAD was greater than PreBFR and LRTRAD. For the 70% site MT increased for TRAD (0.308 cm, 95% CI: 0.247-0.369), PreBFR (0.103 cm, 95% CI: 0.041-0.166), and LRTRAD (0.070 cm, 95% CI: 0.004-0.137). The change for TRAD was greater than PreBFR and LRTRAD. One repetition maximum and LME significantly increased for each condition, with no differences between conditions. Collapsed across conditions 1RM strength increased 2.094 kg (95% CI: 1.771-2.416) and LME increased 7.0 repetitions (95% CI: 5.7-8.3). In conclusion, the application of BFR to low-repetition, high-load training did not enhance the adaptative response.

Branched-chain amino acids plus vitamin D supplementation promote increased muscle strength following lumbar surgery for lumbar spinal stenosis: a randomized trial

BACKGROUND CONTEXT

Adequate nutrition is essential to address the surgical stress response and mitigate loss of muscle mass, strength, and functionality in older adults with lumbar spinal stenosis (LSS). However, it is unknown whether amino acids and/or vitamin D are beneficial in older adults following lumbar surgery for LSS.

PURPOSE

To evaluate whether branched-chain amino acids (BCAA) plus vitamin D supplementation could attenuate the loss of muscle mass and strength, accelerate the return of functional mobility, and improve clinical outcomes following lumbar surgery for LSS.

STUDY DESIGN/SETTING

A single-center, single-blind randomized controlled trial.

PATIENT SAMPLE

Eighty patients who received lumbar surgery for LSS.

OUTCOME MEASURES

The primary outcome was the Zurich claudication questionnaire (ZCQ), and secondary outcomes included knee muscle strength, muscle mass measured by bioelectrical impedance analysis, gait speed and a timed up-and-go test (TUG) at 12 weeks postoperatively. Follow-up assessment was performed for the ZCQ at 52 weeks postoperatively.

METHODS

Patients ingested the supplementation (BCAA group: BCAA plus vitamin D, Nonamino acid group: nonamino acid) twice daily for 3 weeks from the day after surgery, and received two hours of postoperative inpatient rehabilitation 5 times a week.

RESULTS

No significant differences were observed in the mean changes on the ZCQ between the two groups at 12 weeks and 52 weeks. At 2 weeks postoperatively, the nonamino acid group showed significant deterioration compared with the BCAA group for strengths of knee extensor and knee flexor (p < .01). At 12 weeks, the BCAA group showed significant improvements in knee extensor strength and knee flexor strength compared with the nonamino acid group (p <.01). There were no significant differences in mean changes of muscle mass, maximum gait speed, and TUG at 12 weeks between two groups.

CONCLUSIONS

BCAA plus vitamin D supplementation did not improve LSS-related clinical outcomes after lumbar surgery for LSS, even though muscle strength increased. Future studies should focus on long-term outcomes for muscle mass and physical function, including development of sarcopenia and frailty.

Cross-education in people with Parkinson's disease, a short-term randomized controlled trial

INTRODUCTION

People with Parkinson's disease usually have a major impairment on one side of the body. It is hypothesized that unilateral resistance training may improve strength on the most affected limb when compared to bilateral resistance training.

AIM

1) To confirm that short-term unilateral resistance training improves strength on the most affected limb in people with PD. 2) To investigate if short-term unilateral resistance training reduces asymmetry.

METHODS

Seventeen individuals with Parkinson's disease were randomly assigned to unilateral resistance group (UTG, n = 9) and bilateral resistance group (BTG, n = 8). Twenty-four sessions of resistance training were performed. The nine-hole peg and box and blocks tests were performed to assess motor control of the upper limbs. The handgrip strength and isokinetic dynamometry were performed to assess the upper and lower limbs strength, respectively. All tests were assessed unilaterally at baseline (T0), during (T12), and at the end of the intervention (T24). Friedman's ANOVA was used to determine within group differences across the three time-points. In the event of significance, post-hoc analyses were performed using the Wilcoxon signed rank test. The U Mann-Whitney was used to determine between group differences at a specific time point.

RESULTS

The BTG was significantly better than the UTG group at T24 compared to T12 with respect to peak torque at 60°/s and 180°/s (p < 0.05).

CONCLUSION

Short-term bilateral resistance training is better than unilateral resistance training to improve strength for lower limbs most affected in people with Parkinson's disease.

The effectiveness of unilateral isokinetic resistance training on cross-education is independent of contraction velocity: a case of female dorsiflexors and plantar flexors

The large body of published literature has shown that the effects of strength training can transfer from trained to untrained homologous limb muscles after unilateral training. These effects on strength have been shown to be very specific to the type and speed of training contraction. The aim of this study was to investigate the effects of a 4-week unilateral slow and fast velocity isokinetic concentric training, to compare the effects, and thus investigate whether these effects are speed-specific. Forty-four healthy female students allocated to slow training, fast training, or control performed 12 isokinetic concentric-concentric plantar/dorsal flexors training sessions (3 × 4 weeks) using their nondominant leg. Participants in the two experimental groups showed statistically significant gains in strength in both the trained (ranging from 8 to 41%) and untrained leg (5-26%), thus showing cross-education on strength effects. The present study demonstrated that 4 weeks (12 training sessions) of unilateral isokinetic resistance training in the concentric mode improved the strength of contralateral, untrained homologous muscles to the same extent, regardless of the contraction velocity used in females. Furthermore, the amount of concentric overload (50% more than during 60°/s) did not appear to affect the increase in strength gains. Therefore, practitioners are encouraged to use both training speeds when strength gains in the contralateral leg are the primary goal. If the training time is limited, however, training with a higher contraction speed is recommended.

Quantifying the Generality of Strength Adaptation: A Meta-Analysis

BACKGROUND

Isotonic exercise is the most common mode of strength training. Isotonic strength is often measured in the movement that was exercised, but isometric and isokinetic movements are also commonly used to quantify changes in muscular strength. Previous research suggests that increasing strength in one movement may not lead to an increase in strength in a different movement. Quantifying the increase in strength in a movement not trained may be important for understanding strength training adaptations and making recommendations for resistance exercise and rehabilitation programs.

OBJECTIVE

To quantify changes in non-specific strength relative to a control.

DESIGN

A systematic review and random effects meta-analysis was conducted investigating the effects of isotonic strength training on isotonic and isokinetic/isometric strength.

SEARCH AND INCLUSION

This systematic review was conducted in Google scholar, PubMed, Academic Search Premier, and MENDELEY. To be included in this review paper the article needed to meet the following criteria: (1) report sufficient data for our variables of interest (i.e., changes in isotonic strength and changes in isokinetic or isometric strength); (2) include a time-matched non-exercise control; (3) be written in English; (4) include healthy human participants over the age of 18 years; (5) the participants had to train and test isotonically; (6) the participants had to be tested isokinetically or isometrically on a device different from that they trained on; (7) the non-specific strength task had to test a muscle involved in the training (i.e., could not have trained chest press and test handgrip strength); and (8) the control group and the experimental group had to perform the same number of strength tests.

RESULTS

We completed two separate searches. In the original search a total of 880 papers were screened and nine papers met the inclusion criteria. In the secondary search a total of 2594 papers were screened and three additional papers were added (total of 12 studies). The overall effect of resistance training on changes in strength within a movement that was not directly trained was 0.8 (Cohen's d) with a standard error of 0.286. This overall effect was significant (t = 2.821, p = 0.01) and the 95% confidence interval (CI) is 0.22-1.4. The overall effect of resistance training on strength changes within a movement that was directly trained was 1.84 (Cohen's d) with a standard error of 0.296. This overall effect was significant (t = 6.221, p < 0.001) and the 95% CI is 1.23-2.4.

CONCLUSION

The results of our meta-analysis suggest that strength increases in both the specific and non-specific strength tests. However, the smaller effect size associated with non-specific strength suggests that it will be difficult for a single study to meaningfully investigate the transfer of strength training adaptions.

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.

Loaded inter-set stretch may selectively enhance muscular adaptations of the plantar flexors

The purpose of this study was to evaluate differences in changes in muscle strength and muscle thickness (MT) of the plantar flexor muscles between traditional resistance training (RT) involving passive rest and RT combined with inter-set stretch in the calf raise exercise. Employing a within-subject design, 21 young, healthy men performed plantar flexion exercises twice per week in both a traditional RT (TRAD) format and combined with a 20-second inter-set stretch (STRETCH). One leg was randomly assigned to the TRAD condition and the contralateral leg performed the STRETCH condition throughout the 8-week study period. Dependent variables included MT of the lateral gastrocnemius (LG), medial gastrocnemius (MG) and the soleus (SOL), and isometric strength of the plantar flexors. Results indicated a potential beneficial hypertrophic effect of STRETCH compared to TRAD for the SOL [0.7 mm, CI90% = (0, 1.6)], while the LG had more ambiguous effects [0.4 mm (-0.4, 1.3)] and MG effects were equivocal [0 mm (-0.6, 0.7)]. In general, LG demonstrated greater standardized growth [z = 1.1 (1, 1.3)] as compared to MG [z = 0.3 (0.2, 0.5)] and SOL [z = 0.3 (0.2, 0.5)]. Measures of isometric strength showed a modest advantage to STRETCH. In conclusion, loaded inter-set stretch may enhance MT of the soleus but effects on the gastrocnemii appear uncertain or unlikely in untrained men; plantar flexor strength appears to be modestly enhanced by the interventional strategy.

Effect of different eccentric tempos on hypertrophy and strength of the lower limbs

The purpose of this study was to evaluate the effects of altering the duration of the eccentric phase in isotonic contractions on muscle hypertrophy and strength of the quadriceps femoris. Ten healthy young adults (8 men and 2 women: Height: 173.3 ± 9.6 cm: Body mass: 69.84 ± 10.88 kg; Body fat: 19.47 ± 8.42%; Age: 25.3 ± 4.8 years) performed unilateral isotonic knee extension exercise, whereby each leg was randomly allocated to perform the eccentric phase of movement with a duration of either 2 seconds (G2S) or 4 seconds (G4S). Both conditions carried out the concentric phase of each repetition at a 1 second duration with no rest in the transition phases. Each condition performed 5 sets using 70% of 1 repetition maximum until muscle failure with 3 minutes of rest between sets for 8 weeks. The change in muscle strength was assessed by 1RM knee extension and muscle thickness was assessed by A-mode ultrasound. For each outcome variable, linear mixed-effects models were fit using restricted maximum likelihood. Hedges’ g effect sizes were calculated to provide insights into the magnitude of effects. Results showed all muscles increased in size over time; mean effects were similar in all muscles except for the vastus medialis, which favored the G4S condition. Conversely, only a trivial and highly variable effect was observed between interventions for strength gain. Our results suggest different eccentric durations produce similar increases in hypertrophy of the vastus lateralis and rectus femoris; however, the vastus medialis showed greater growth from the slower eccentric duration. Eccentric duration did not differentially affect strength-related adaptations.

A scoping review of the contralateral effects of unilateral peripheral stimulation on neuromuscular function

It is known that resistance exercise using one limb can affect motor function of both the exercised limb and the unexercised contralateral limb, a phenomenon termed cross-education. It has been suggested that cross-education has clinical implications, e.g. in rehabilitation for orthopaedic conditions or post-stroke paresis. Much of the research on the contralateral effect of unilateral intervention on motor output is based on voluntary exercise. This scoping review aimed to map the characteristics of current literature on the cross-education caused by three most frequently utilised peripheral neuromuscular stimulation modalities in this context: electrical stimulation, mechanical vibration and percutaneous needling, that may direct future research and translate to clinical practice. A systematic search of relevant databases (Ebsco, ProQuest, PubMed, Scopus, Web of Science) through to the end of 2020 was conducted following the PRISMA Extension for Scoping Review. Empirical studies on human participants that applied a unilateral peripheral neuromuscular stimulation and assessed neuromuscular function of the stimulated and/or the unstimulated side were selected. By reading the full text, the demographic characteristics, context, design, methods and major findings of the studies were synthesised. The results found that 83 studies were eligible for the review, with the majority (53) utilised electrical stimulation whilst those applied vibration (18) or needling (12) were emerging. Although the contralateral effects appeared to be robust, only 31 studies claimed to be in the context of cross-education, and 25 investigated on clinical patients. The underlying mechanism for the contralateral effects induced by unilateral peripheral stimulation remains unclear. The findings suggest a need to enhance the awareness of cross-education caused by peripheral stimulation, to help improve the translation of theoretical concepts to clinical practice, and aid in developing well-designed clinical trials to determine the efficacy of cross-education therapies.

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.

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.

Systematic review and meta-analysis of the effect of protein and amino acid supplements in older adults with acute or chronic conditions

The loss of lean body mass, muscle strength and physical function causes significant problems in older adults. Protein and amino acid supplements can preserve muscle strength but the effect on function is variable. We conducted a systematic literature review and meta-analysis to investigate the effect of protein and amino acid supplementation on fat-free mass, muscle strength and physical function in malnourished, frail, sarcopenic, dependent or elderly with acute or chronic conditions, with or without rehabilitation exercise. Databases searched included Medline, BIOSIS, CINAHL, Cochrane Library, EBM Reviews, Embase, Pre-Medline, ProQuest, PubMed and Scopus. Retrieved articles were assessed by two reviewers using the Cochrane Risk of Bias (ROB) Tool. In all, thirty nine randomised controlled trails (n 4274) were included. The studies used a range of protein or essential amino acid (EAA) supplements in a variety of settings, including hospital, community and long-term care. Only seven studies had low ROB and no effect of supplementation was found on any outcomes. Analysis of all thirty-nine studies suggest protein and EAA supplements may improve fat-free mass, muscle strength and physical function (standardised mean difference 0·21-0·27, all P<0·005), but significant heterogeneity and ROB was evident. Predetermined subgroup analysis found undernourished elderly benefitted most; EAA were the most effective supplements and small beneficial effects were seen without rehabilitation exercise. The high heterogeneity and few studies with low ROB limits the conclusions and more high quality studies are needed to determine the best nutritional strategies for the maintenance of strength and function with increasing age.

The Bottom-Up Rise Strength Transfer in Elderly After Endurance and Resistance Training: The BURST

The phenomenon of strength gain is highly relevant for sarcopenia and clinical aspect linked to aging. Recent advancements drive the interest toward the exercise-related cross-talk between distant tissues. We demonstrated the cross-talk between lower and upper limbs, we named the Bottom-Up Rise Strength Transfer (BURST), mainly linked to endurance training. In our opinion, this effect can be mainly related to systemic factors, likely circulating myokines and extracellular vesicles (recently defined in terms of “exerkines” and “exersomes”) whit an eventual concomitant reduction of a sub-clinical chronic inflammation. The neuronal mechanisms, even if to our sight less likely involved in this adaptation, need to be deeply investigated. Further studies are needed to better characterize the exercise-related BURST, concerning the specificity of different protocols and the underlying physiological mechanisms.

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.

The cross education of strength and skill following unilateral strength training in the upper and lower limbs

Cross education is the strength gain or skill improvement transferred to the contralateral limb following unilateral training or practice. The present study examined the transfer of both strength and skill following a strength training program. Forty participants (20M, 20F) completed a 6-wk unilateral training program of dominant wrist flexion or dorsiflexion. Strength, force variability, and muscle activity were assessed pretraining, posttraining, and following 6 wk of detraining (retention). Analyses of covariance compared the experimental limb (trained or untrained) to the control (dominant or nondominant). There were no sex differences in the training response. Cross education of strength at posttraining was 6% ( P < 0.01) in the untrained arm and 13% ( P < 0.01) in the untrained leg. Contralateral strength continued to increase following detraining to 15% in the arm ( P < 0.01) and 14% in the leg ( P < 0.01). There was no difference in strength gains between upper and lower limbs ( P > 0.05). Cross education of skill (force variability) demonstrated greater improvements in the untrained limbs compared with the control limbs during contractions performed without concurrent feedback. Significant increases in V-wave amplitude ( P = 0.02) and central activation ( P < 0.01) were highly correlated with contralateral strength gains. There was no change in agonist amplitude or motor unit firing rates in the untrained limbs ( P > 0.05). The neuromuscular mechanisms mirrored the force increases at posttraining and retention supporting central drive adaptations of cross education. The continued strength increases at retention identified the presence of motor learning in cross education, as confirmed by force variability.

NEW & NOTEWORTHY

We examined cross education of strength and skill following 6 wk of unilateral training and 6 wk of detraining. A novel finding was the continued increase in contralateral strength following both training and detraining. Neuromuscular adaptations were highly correlated with strength gains in the trained and contralateral limbs. Motor learning was evident in the trained and contralateral limbs during contractions performed without concurrent feedback.

Comparison of sustained-release and rapid-release β-alanine formulations on changes in skeletal muscle carnosine and histidine content and isometric performance following a muscle-damaging protocol

β-alanine supplementation increases muscle carnosine content and improves anaerobic exercise performance by enhancing intracellular buffering capacity. β-alanine ingestion in its traditional rapid-release formulation (RR) is associated with the symptoms of paresthesia. A sustained-release formulation (SR) of β-alanine has been shown to circumvent paresthesia and extend the period of supply to muscle for carnosine synthesis. The purpose of this investigation was to compare 28 days of SR and RR formulations of β-alanine (6 g day^-1) on changes in carnosine content of the vastus lateralis and muscle fatigue. Thirty-nine recreationally active men and women were assigned to one of the three groups: SR, RR, or placebo (PLA). Participants supplementing with SR and RR formulations increased muscle carnosine content by 50.1% (3.87 mmol kg^-1ww) and 37.9% (2.62 mmol kg^-1ww), respectively. The change in muscle carnosine content in participants consuming SR was significantly different (p = 0.010) from those consuming PLA, but no significant difference was noted between RR and PLA (p = 0.077). Although participants ingesting SR experienced a 16.4% greater increase in muscle carnosine than RR, fatigue during maximal voluntary isometric contractions was significantly attenuated in both SR and RR compared to PLA (p = 0.002 and 0.024, respectively). Symptoms of paresthesia were significantly more frequent in RR compared to SR, the latter of which did not differ from PLA. Results of this study demonstrated that only participants consuming the SR formulation experienced a significant increase in muscle carnosine. Differences in the muscle carnosine response between these formulations may have practical significance for athletic populations in which small changes may have important implications on performance.

Neurophysiological adaptations in the untrained side in conjunction with cross-education of muscle strength: a systematic review and meta-analysis

We reviewed the evidence from randomized controlled trials (RCTs) focusing on the neurophysiological adaptations in the untrained side associated with cross-education of strength (CE) and pooled data into definite effect estimates for neurophysiological variables assessed in chronic CE studies. Furthermore, scoping directions for future research were provided to enhance the homogeneity and comparability of studies investigating the neural responses to CE. The magnitude of CE was 21.1 ± 18.2% (mean ± SD; P < 0.0001) in 22 RCTs ( n = 467 subjects) that measured at least 1 neurophysiological variable in the untrained side, including the following: electromyography (EMG; 14 studies); motor evoked potential (MEP; 8 studies); short-interval intracortical inhibition (SICI), recruitment curve, and M wave (6 studies); cortical silent period (cSP; 5 studies); interhemispheric inhibition, intracortical facilitation (ICF), and H reflex (2 studies); and V wave, short-interval ICF, short-latency afferent inhibition, and long-latency afferent inhibition (1 study). Only EMG, MEP, ICF, cSP, and SICI could be included in the meta-analysis (18 studies, n = 387). EMG ( P = 0.26, n = 235) and MEP amplitude ( P = 0.11, n = 145) did not change in the untrained limb after CE. cSP duration ( P = 0.02, n = 114) and SICI ( P = 0.001, n = 95) decreased in the untrained hemisphere according to body region and type and intensity of training. The magnitude of CE did not correlate with changes in these transcranial magnetic stimulation (TMS) measures. The design of this meta-analytical study and the lack of correlations prevented the ability to link mechanistically the observed neurophysiological changes to CE. Notwithstanding the limited amount of data available for pooling, the use of TMS to assess the ipsilateral neurophysiological responses to unilateral training still confirms the central neural origin hypothesis of chronic CE induced by strength training. However, how these neural adaptations contribute to CE remains unclear.

The cross education of strength and skill following unilateral strength training in the upper and lower limbs

Cross education is the strength gain or skill improvement transferred to the contralateral limb following unilateral training or practice. The present study examined the transfer of both strength and skill following a strength training program. Forty participants (20M, 20F) completed a 6-wk unilateral training program of dominant wrist flexion or dorsiflexion. Strength, force variability, and muscle activity were assessed pretraining, posttraining, and following 6 wk of detraining (retention). Analyses of covariance compared the experimental limb (trained or untrained) to the control (dominant or nondominant). There were no sex differences in the training response. Cross education of strength at posttraining was 6% ( P < 0.01) in the untrained arm and 13% ( P < 0.01) in the untrained leg. Contralateral strength continued to increase following detraining to 15% in the arm ( P < 0.01) and 14% in the leg ( P < 0.01). There was no difference in strength gains between upper and lower limbs ( P > 0.05). Cross education of skill (force variability) demonstrated greater improvements in the untrained limbs compared with the control limbs during contractions performed without concurrent feedback. Significant increases in V-wave amplitude ( P = 0.02) and central activation ( P < 0.01) were highly correlated with contralateral strength gains. There was no change in agonist amplitude or motor unit firing rates in the untrained limbs ( P > 0.05). The neuromuscular mechanisms mirrored the force increases at posttraining and retention supporting central drive adaptations of cross education. The continued strength increases at retention identified the presence of motor learning in cross education, as confirmed by force variability.

NEW & NOTEWORTHY

We examined cross education of strength and skill following 6 wk of unilateral training and 6 wk of detraining. A novel finding was the continued increase in contralateral strength following both training and detraining. Neuromuscular adaptations were highly correlated with strength gains in the trained and contralateral limbs. Motor learning was evident in the trained and contralateral limbs during contractions performed without concurrent feedback.

Does ipsilateral corticospinal excitability play a decisive role in the cross-education effect caused by unilateral resistance training? A systematic review

INTRODUCTION

Unilateral resistance training has been shown to improve muscle strength in both the trained and the untrained limb. One of the most widely accepted theories is that this improved performance is due to nervous system adaptations, specifically in the primary motor cortex. According to this hypothesis, increased corticospinal excitability (CSE), measured with transcranial magnetic stimulation, is one of the main adaptations observed following prolonged periods of training. The principal aim of this review is to determine the degree of adaptation of CSE and its possible functional association with increased strength in the untrained limb.

DEVELOPMENT

We performed a systematic literature review of studies published between January 1970 and December 2016, extracted from Medline (via PubMed), Ovid, Web of Science, and Science Direct online databases. The search terms were as follows: (transcranial magnetic stimulation OR excitability) AND (strength training OR resistance training OR force) AND (cross transfer OR contralateral limb OR cross education). A total of 10 articles were found.

CONCLUSION

Results regarding increased CSE were inconsistent. Although the possibility that the methodology had a role in this inconsistency cannot be ruled out, the results appear to suggest that there may not be a functional association between increases in muscle strength and in CSE.

Skin temperature response to unilateral training measured with infrared thermography

This study aimed to identify the skin temperature (Tsk) behavior to understand the acute cross-effect after unilateral training of lower-limbs. Seventeen healthy young men (weight, 75.2±5.5 kg; height, 1.8±0.1 m; age, 22.5±1.6 years) were divided into two groups: high-trained (n=8) and low-trained (n=9). All participants performed: (a) one-repetition maximum (1RM) testing protocol on the leg press, (b) a unilateral training protocol (4×10 repetitions at 70% of 1RM for leg press and 4×10 repetitions at 50% of 1RM for knee extension). Pre- and posttraining thermal images were recorded. The main results showed that independent of the limb (exercised vs. nonexercised), differences between low- and high-trained were observed for all regions of interest (ROI) except for the anterior knee: posttraining, 30-min and 60-min posttraining in nonexercised limb. The increase of contralateral Tsk was more than 50% on the ROIs corresponding to the exercises muscles 30-min post-training in low-trained but was not so high in high-trained (P<0.05). Low-trained subjects incremented more the Tsk than high-trained in both legs after exercise. In conclusion, we observed an acute contralateral Tsk effect to unilateral training on the Tsk of the nonexercised limb, reliant on the training level of the subject.

Evidence of homologous and heterologous effects after unilateral leg training in youth

The positive effects of unilateral training on contralateral muscles (cross education) has been demonstrated with adults for over a century. There is limited evidence for cross education of heterologous muscles. Cross education has not been demonstrated with children. It was the objective of this study to investigate cross-education training in children examining ipsilateral and contralateral homologous and heterologous muscles. Forty-eight male children (aged 10-13 years) were assessed for unilateral, ipsilateral and contralateral lower limb strength, power and endurance (1-repetition maximum (RM) leg press, knee extensors (KE) and flexors (KF) maximum voluntary isometric contractions (MVIC), countermovement jump, muscle endurance test (leg press repetitions with 60% 1RM)), and upper body unilateral MVIC elbow flexors (EF) and handgrip strength. An 8-week training program involved 2 unilateral leg press resistance-training groups (high load/low repetitions: 4-8 sets of 5RM, and low load/high repetitions: 1-2 sets of 20RM) and control (untrained) group. All muscles exhibited improvements of 6.1% to 89.1%. The trained limb exhibited greater adaptations than the untrained limb for leg press 1RM (40.3% vs. 25.2%; p = 0.005), and 60% 1RM leg press (104.1% vs. 73.4%; p = 0.0001). The high load/low repetition training induced (p < 0.0001) greater improvements than low load/high repetition with KE, KF, EF MVIC and leg press 1RM. This is the first study to demonstrate cross-education effects with children and that the effects of unilateral training involve both contralateral homologous and heterologous muscles with the greatest strength-training responses from high-load/low-repetition training.

Cross-education of muscular strength following unilateral resistance training: a meta-analysis

PURPOSE

Cross-education (CE) of strength is a well-known phenomenon whereby exercise of one limb can induce strength gains in the contralateral untrained limb. The only available meta-analyses on CE, which date back to a decade ago, estimated a modest 7.8% increase in contralateral strength following unilateral training. However, in recent years new evidences have outlined larger contralateral gains, which deserve to be systematically evaluated. Therefore, the aim of this meta-analysis was to appraise current data on CE and determine its overall magnitude of effect.

METHODS

Five databases were searched from inception to December 2016. All randomized controlled trials focusing on unilateral resistance training were carefully checked by two reviewers who also assessed the eligibility of the identified trials and extracted data independently. The risk of bias was assessed using the Cochrane Risk-of-Bias tool.

RESULTS

Thirty-one studies entered the meta-analysis. Data from 785 subjects were pooled and subgroup analyses by body region (upper/lower limb) and type of training (isometric/concentric/eccentric/isotonic-dynamic) were performed. The pooled estimate of CE was a significant 11.9% contralateral increase (95% CI 9.1-14.8; p < 0.00001; upper limb: + 9.4%, p < 0.00001; lower limb: + 16.4%, p < 0.00001). Significant CE effects were induced by isometric (8.2%; p = 0.0003), concentric (11.3%; p < 0.00001), eccentric (17.7%; p = 0.003) and isotonic-dynamic training (15.9%; p < 0.00001), although a high risk of bias was detected across the studies.

CONCLUSIONS

Unilateral resistance training induces significant contraction type-dependent gains in the contralateral untrained limb. Methodological issues in the included studies are outlined to provide guidance for a reliable quantification of CE in future studies.

Influence of Skeletal Muscle Carnosine Content on Fatigue during Repeated Resistance Exercise in Recreationally Active Women

Carnosine is a naturally occurring intramuscular dipeptide that is thought to attenuate fatigue during high-intensity exercise. Carnosine content is influenced by various factors, including gender and diet. Despite research reporting that carnosine content is lower in women compared to men and lower in vegetarians compared to omnivores, no investigations have examined carnosine content in women based on dietary protein intake and its effect on muscle fatigue. Twenty recreationally active women were assigned to either a high (HI; n = 5), moderate (MOD; n = 10), or low (LO; n = 5) group based upon intramuscular carnosine content of the vastus lateralis. Each participant underwent two unilateral maximal voluntary isometric contractions (MVIC) of the knee extensors separated by an isokinetic exercise protocol consisting of five sets of 50 repeated maximal unilateral contractions. Magnitude-based inferences were used to analyze group differences. Percent decline in rate of force development and peak torque (PT) during the MVICs and changes in PT and mean torque during the muscle-fatiguing protocol were lower in HI compared to both MOD and LO. Additionally, absolute and relative dietary protein intake were greater in HI compared to MOD or LO. Results indicated that greater intramuscular carnosine content was reflective of greater dietary protein intake and that individuals with higher carnosine content displayed a greater attenuation of fatigue compared to those with lower carnosine.

Improvement of Eye Alignment in Adult Strabismic Monkeys by Sustained IGF-1 Treatment

Purpose

The goal of this study was to determine if continuous application of insulin-like growth factor-1 (IGF-1) could improve eye alignment of adult strabismic nonhuman primates and to assess possible mechanisms of effect.

Methods

A continuous release pellet of IGF-1 was placed on one medial rectus muscle in two adult nonhuman primates (M1, M2) rendered exotropic by the alternating monocular occlusion method during the first months of life. Eye alignment and eye movements were recorded for 3 months, after which M1 was euthanized, and the lateral and medial rectus muscles were removed for morphometric analysis of fiber size, nerve, and neuromuscular density.

Results

Monkey 1 showed a 40% reduction in strabismus angle, a reduction of exotropia of approximately 11° to 14° after 3 months. Monkey 2 showed a 15% improvement, with a reduction of its exotropia by approximately 3°. The treated medial rectus muscle of M1 showed increased mean myofiber cross-sectional areas. Increases in myofiber size also were seen in the contralateral medial rectus and lateral rectus muscles. Similarly, nerve density increased in the contralateral medial rectus and yoked lateral rectus.

Conclusions

This study demonstrates that in adult nonhuman primates with a sensory-induced exotropia in infancy, continuous IGF-1 treatment improves eye alignment, resulting in muscle fiber enlargement and altered innervational density that includes the untreated muscles. This supports the view that there is sufficient plasticity in the adult ocular motor system to allow continuous IGF-1 treatment over months to produce improvement in eye alignment in early-onset strabismus.

The Cross-Education Phenomenon: Brain and Beyond

Objectives: Unilateral resistance training produces strength gains in the untrained homologous muscle group, an effect termed “cross-education.” The observed strength transfer has traditionally been considered a phenomenon of the nervous system, with few studies examining the contribution of factors beyond the brain and spinal cord. In this hypothesis and theory article, we aim to discuss further evidence for structural and functional adaptations occurring within the nervous, muscle, and endocrine systems in response to unilateral resistance training. The limitations of existing cross-education studies will be explored, and novel potential stakeholders that may contribute to the cross-education effect will be identified.

Design: Critical review of the literature.

Method: Search of online databases.

Results: Studies have provided evidence that functional reorganization of the motor cortex facilitates, at least in part, the effects of cross-education. Cross-activation of the “untrained” motor cortex, ipsilateral to the trained limb, plays an important role. While many studies report little or no gains in muscle mass in the untrained limb, most experimental designs have not allowed for sensitive or comprehensive investigation of structural changes in the muscle.

Conclusions: Increased neural drive originating from the “untrained” motor cortex contributes to the cross-education effect. Adaptive changes within the muscle fiber, as well as systemic and hormonal factors require further investigation. An increased understanding of the physiological mechanisms contributing to cross-education will enable to more effectively explore its effects and potential applications in rehabilitation of unilateral movement disorders or injury.

The Need for Standardized Assessment of Muscle Quality in Skeletal Muscle Function Deficit and Other Aging-Related Muscle Dysfunctions: A Symposium Report

A growing body of scientific literature suggests that not only changes in skeletal muscle mass, but also other factors underpinning muscle quality, play a role in the decline in skeletal muscle function and impaired mobility associated with aging. A symposium on muscle quality and the need for standardized assessment was held on April 28, 2016 at the International Conference on Frailty and Sarcopenia Research in Philadelphia, Pennsylvania. The purpose of this symposium was to provide a venue for basic science and clinical researchers and expert clinicians to discuss muscle quality in the context of skeletal muscle function deficit and other aging-related muscle dysfunctions. The present article provides an expanded introduction concerning the emerging definitions of muscle quality and a potential framework for scientific inquiry within the field. Changes in muscle tissue composition, based on excessive levels of inter- and intra-muscular adipose tissue and intramyocellular lipids, have been found to adversely impact metabolism and peak force generation. However, methods to easily and rapidly assess muscle tissue composition in multiple clinical settings and with minimal patient burden are needed. Diagnostic ultrasound and other assessment methods continue to be developed for characterizing muscle pathology, and enhanced sonography using sensors to provide user feedback and improve reliability is currently the subject of ongoing investigation and development. In addition, measures of relative muscle force such as specific force or grip strength adjusted for body size have been proposed as methods to assess changes in muscle quality. Furthermore, performance-based assessments of muscle power via timed tests of function and body size estimates, are associated with lower extremity muscle strength may be responsive to age-related changes in muscle quality. Future aims include reaching consensus on the definition and standardized assessments of muscle quality, and providing recommendations to address critical clinical and technology research gaps within the field.