Foam Rolling Acute Effects on Myofascial Tissue Stiffness and Muscle Strength: A Systematic Review and Meta-Analysis.

ABSTRACT: Glänzel, MH, Rodrigues, DR, Petter, GN, Pozzobon, D, Vaz, MA, and Geremia, JM. Foam rolling acute effects on myofascial tissue stiffness and muscle strength: a systematic review and meta-analysis. J Strength Cond Res 37(4): 951-968, 2023-Foam rolling (FR) is widely used in rehabilitation and physical training. However, the effects of FR on myofascial tissue stiffness and muscle strength remain unclear. This study aimed to perform a systematic review with meta-analysis of trials that tested the FR acute effects during warm-up on the myofascial tissue stiffness and muscle strength in healthy adults or athletes. This systematic review (CRD42021227048) was performed according to Cochrane's recommendations, with searches performed in PubMed, Web of Science, Embase, and PEDro databases. Syntheses of included studies' data were performed, and the PEDro scale was used to assess the methodological quality of the studies. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluations approach. Twenty included studies assessed trunk and thigh fascial tissue stiffness, and thigh and calf muscle stiffness, whereas muscle strength was assessed in the knee extensors and flexors, and plantar flexors muscles. Qualitative analysis showed decreases in fascial ( n = 2) and muscle ( n = 5) stiffness after FR. However, the meta-analysis showed no effects of FR on myofascial tissue stiffness. Both qualitative and quantitative analyses showed no effects of FR on isometric muscle strength, eccentric torque, and rate of force development. However, the knee extensor concentric torque increased after FR. Foam rolling increases the knee extensor concentric torque, but it does not acutely change the myofascial tissue stiffness and isometric muscle strength. However, evidence of these studies provides low certainty to state that FR does not change these parameters. Therefore, high methodological quality studies should be performed to better ascertain the effects of FR on the myofascial tissue stiffness and muscle strength.

Enhancing Adaptations to Neuromuscular Electrical Stimulation Training Interventions.

Neuromuscular electrical stimulation (NMES) applied to skeletal muscles is an effective rehabilitation and exercise training modality. However, the relatively low muscle force and rapid muscle fatigue induced by NMES limit the stimulus provided to the neuromuscular system and subsequent adaptations. We hypothesize that adaptations to NMES will be enhanced by the use of specific stimulation protocols and adjuvant interventions.

Effect of photobiomodulation therapy on performance and running economy in runners: A randomized double-blinded placebo-controlled trial.

The objective of this study was to evaluate effects of photobiomodulation therapy (PBMT) on the 3000 m running performance (primary outcome), running economy (RE), metabolic cost and ratings of perceived exertion during running (secondary outcomes). Twenty male endurance athletes performed 4-min treadmill rectangular test at 12 km.h-1 monitored by a gas analyser. After that, PBMT or placebo in each lower limb was applied, followed performed a maximum test of 3000 m. Immediately after 3000 m test, the athletes repeated the treadmill test. Another application of PBMT/placebo was done after the treadmill test, and athletes went back to the laboratory 24 h later to repeat the treadmill test. After a 72 h interval, athletes repeated all procedures with another treatment intervention (PBMT/placebo). Athletes performed the 3000 m running test ~7s faster when treated with PBMT with similar effort score compared placebo condition. The RE remains unchanged immediately post 3000 m running test, nonetheless RE measured post-24 h improved by 5% with PBMT application without changes in metabolic cost. The PBMT pre- and post-conditioning enhanced the 3000 m running performance and improved RE 24 h following the 3000 m test. However, no changes on ratings of perceived exertion and metabolic cost with the application of PBMT.

Effects of photobiomodulation therapy associated with resistance training in elderly men: a randomized double-blinded placebo-controlled trial.

PURPOSE: The purpose of this study was to investigate the effects of photobiomodulation therapy (PBMT) combined with resistance training on knee extensors muscle mass, strength and functional capacity in elderly men. METHODS: In this randomized double-blinded placebo-controlled trial, healthy elderly men (age 60-80 years) completed 12 weeks of resistance training (2×/week) with application of placebo (n = 13) or active PBMT (n = 11) on quadriceps muscles (850 nm, 240 J per limb) before each training session. Leg press and knee extension one-repetition maximum (1RM) tests, isometric and concentric peak torques, rectus femoris (RF) and vastus lateralis (VL) muscle thickness, timed up-and-go (TUG) and chair rise-to-standing (CRS) tests were performed before and after the intervention period. RESULTS: There were significant improvements in all outcomes for both groups (p < 0.05), except for RF muscle thickness for the placebo group (p = 0.09). Large effect sizes (ES > 0.8) were observed for leg press and leg extension 1RM and CRS tests for both groups, as well as for TUG test for PBMT group. Isokinetic peak torque for both groups and TUG for placebo group had moderate increases (ES > 0.5). Muscle thicknesses and isometric peak torque had small increases (ES > 0.2) in both groups. Both null hypothesis analysis and magnitude-based inference support similar effects of PBMT and placebo treatments. CONCLUSION: Different than previously evidenced in young subjects, PBMT with the parameters used in this study did not provide any additional benefits in comparison to placebo application on muscle mass, strength and functional capacity of healthy elderly men engaged in a resistance training program.

Echo Intensity Reliability for the Analysis of Different Muscle Areas in Athletes.

Lanferdini, FJ, Manganelli, BF, Lopez, P, Klein, KD, Cadore, EL, and Vaz, MA. Echo intensity reliability for the analysis of different muscle areas in athletes. J Strength Cond Res 33(12): 3353-3360, 2019-Skeletal muscles' echo intensity (EI) is used as a parameter to evaluate muscle damage and muscle quality after exercise or training. However, recent muscle EI studies have used regions of interest (ROIs) of different sizes for assessing muscle damage and muscle quality, which may lead to different results if the different ROIs from the same muscle are not reliable. Although a maximum rectangular ROI (RET-ROI), included in the muscles' anatomical cross-sectional area, can be used to represent the maximum muscle ROI (MAX-ROI), no studies were found that investigated the reliability of the evaluations of different ROIs for the EI of superficial vs. deep muscles of the thigh. In addition, no studies have evaluated different ROIs in cyclists, at different days and analyzed by different raters. The aim of this study was to evaluate the EI reliability of rectus femoris (RF) and vastus intermedius (VI) muscles of cyclists. Twenty cyclists visited the laboratory 4 times for the evaluation of RF and VI muscles transversal ultrasound images. Echo intensity was determined from grayscale mean values by 2 examiners who performed the analysis with 3 different ROIs: MAX-ROI, RET-ROI, and 1-cm ROI (1CM-ROI). The between-ROI EI data reliability showed a strong correlation in both RF (r ≥ 0.79) and VI (r ≥ 0.87) muscles. Bland-Altman tests demonstrated high agreement among RF ROI muscle areas (p > 0.05), with no agreement between the VI areas (p < 0.05). Only the RF muscle MAX-ROI, RET-ROI, and 1CM-ROI areas are similar for EI analysis, with no similarities for the same VI muscle areas.

Low-level laser therapy improves the VO2 kinetics in competitive cyclists.

Some evidence supports that low-level laser therapy (LLLT) reduces neuromuscular fatigue, so incrementing sports performance. A previous randomized controlled trial of our group showed increased exercise tolerance in male competitive cyclists treated with three different LLLT doses (3, 6, and 9 J/diode; or 135, 270, and 405 J/thigh) before time-to-exhaustion cycling tests. Now, the present study was designed to evaluate the effects of these LLLT doses on the VO2 kinetics of athletes during cycling tests. Twenty male competitive cyclists (29 years) participated in a crossover, randomized, double-blind, and placebo-controlled trial. On the first day, the participants performed an incremental cycling test to exhaustion to determine maximal oxygen uptake (VO2MAX) and maximal power output (POMAX), as well as a familiarization with the time-to-exhaustion test. In the following days (2 to 5), all participants performed time-to-exhaustion tests at POMAX. Before the exhaustion test, different doses of LLLT (3, 6, and 9 J/diode; or 135, 270, and 405 J/thigh, respectively) or placebo were applied bilaterally to the quadriceps muscle. All exhaustion tests were monitored online by an open-circuit spirometry system in order to analyze the VO2 amplitude, VO2 delay time, time constant (tau), and O2 deficit. Tau and O2 deficit were decreased with LLLT applications compared to the placebo condition (p < 0.05). No differences (p > 0.05) were found between the experimental conditions for VO2 amplitude and VO2 delay time. In conclusion, LLLT decreases tau and O2 deficit during time-to-exhaustion tests in competitive cyclists, and these changes in VO2 kinetics response can be one of the possible mechanisms to explain the ergogenic effect induced by LLLT.

Four Weeks of Nordic Hamstring Exercise Reduce Muscle Injury Risk Factors in Young Adults.

Ribeiro-Alvares, JB, Marques, VB, Vaz, MA, and Baroni, BM. Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res 32(5): 1254-1262, 2018-The Nordic hamstring exercise (NHE) is a field-based exercise designed for knee-flexor eccentric strengthening, aimed at prevention of muscle strains. However, possible effects of NHE programs on other hamstring injury risk factors remain unclear. The purpose of this study was to investigate the effects of a NHE training program on multiple hamstring injury risk factors. Twenty physically active young adults were allocated into 2 equal-sized groups: control group (CG) and training group (TG). The TG was engaged in a 4-week NHE program, twice a week, 3 sets of 6-10 repetitions; while CG received no exercise intervention. The knee flexor and extensor strength were assessed through isokinetic dynamometry, the biceps femoris long head muscle architecture through ultrasound images, and the hamstring flexibility through sit-and-reach test. The results showed that CG subjects had no significant change in any outcome. TG presented higher percent changes than CG for hamstring isometric peak torque (9%; effect size [ES] = 0.27), eccentric peak torque (13%; ES = 0.60), eccentric work (18%; ES = 0.86), and functional hamstring-to-quadriceps torque ratio (13%; ES = 0.80). The NHE program led also to increased fascicle length (22%; ES = 2.77) and reduced pennation angle (-17%; ES = 1.27) in biceps femoris long head of the TG, without significant changes on muscle thickness. In conclusion, a short-term NHE training program (4 weeks; 8 training sessions) counteracts multiple hamstring injury risk factors in physically active young adults.

Effectiveness of pedalling retraining in reducing bilateral pedal force asymmetries.

Previous studies have been limited to describe asymmetries during pedalling and suggest possible repercussion on performance and/or injury risks. However, few studies have presented strategies to mitigate asymmetries. The purpose of this study was to assess the effectiveness of a pedalling retraining intervention to reduce bilateral pedal force asymmetries. Twenty cyclists were assessed and 10 enrolled in a pedalling retraining method receiving visual and verbal feedback of pedal forces. The asymmetry index was computed for comparison of bilateral peak pedal forces and used during retraining (12 trials at 70% of peak power). Significantly larger asymmetry was observed for asymmetrical cyclists at the first three trials (P < 0.01 and ES = 1.39), which was reduced when post-retraining was compared to measures from symmetrical cyclists (P = 0.69 and ES = 0.18). Cyclists with larger asymmetry (>20%) in bilateral pedal forces reduce their asymmetries using sessions of pedalling retraining and achieve asymmetry indices similar to symmetrical cyclists.

Are the Responses to Resistance Training Different Between the Preferred and Nonpreferred Limbs?

Humans preferentially recruit limbs to functionally perform a range of daily tasks, which may lead to performance asymmetries. Because initial training status plays an important role in the rate of progression during resistance training, could asymmetries between the preferred and nonpreferred limbs lead to different magnitudes of strengthening during a resistance training program? This issue motivated this study, in which 12 healthy and physically active men completed a 4-week control period followed by a 12-week isokinetic resistance training program, performed twice a week, including 3-5 sets of 10 maximal eccentric contractions for each limb. Every 4 weeks, knee extensor peak torques at concentric, isometric, and eccentric tests were measured using an isokinetic dynamometer and the sum of quadriceps muscle thickness was determined by ultrasound images. Before training, concentric peak torque was similar between limbs but isometric and eccentric peak torques were significantly smaller in the nonpreferred compared with the preferred limb (4.9 and 5.8%, respectively). Bilateral strength symmetry remained constant throughout the training period for concentric tests. For eccentric and isometric tests, symmetry was reached at the fourth and eighth training weeks, respectively. After 12 weeks, between-limb percent nonsignificant differences were -0.62% for isometric and -1.93% for eccentric tests. The sum of knee extensor muscle thickness had similar values before training and presented similar changes throughout the study for both the preferred and the nonpreferred limbs. In conclusion, the nonpreferred limb presents higher strength gain than the preferred limb at the initial phase of an isokinetic resistance training program, and this increased strength gain is not associated with muscle hypertrophy.

Joint Torques and Patellofemoral Force During Single-Leg Assisted and Unassisted Cycling.

CONTEXT: Unassisted single-leg cycling should be replaced by assisted single-leg cycling, given that this last approach has potential to mimic joint kinetics and kinematics from double-leg cycling. However, there is need to test if assisting devices during pedaling effectively replicate joint forces and torque from double-leg cycling. OBJECTIVES: To compare double-leg, single-leg assisted, and unassisted cycling in terms of lower-limb kinetics and kinematics. DESIGN: Cross-sectional crossover. SETTING: Laboratory. PARTICIPANTS: 14 healthy nonathletes. INTERVENTIONS: Two double-leg cycling trials (240 ± 23 W) and 2 single-leg trials (120 ± 11 W) at 90 rpm were performed for 2 min using a bicycle attached to a cycle trainer. Measurements of pedal force and joint kinematics of participants' right lower limb were performed during double- and single-leg trials. For the single-leg assisted trial, a custom-made adaptor was used to attach 10 kg of weight to the contralateral crank. MAIN OUTCOME MEASURES: Peak hip, knee, and ankle torques (flexors and extensors) along with knee-flexion angle and peak patellofemoral compressive force. RESULTS: Reduced peak hip-extensor torque (10%) and increased peak knee-flexor torque (157%) were observed at the single-leg assisted cycling compared with the double-leg cycling. No differences were found for peak patellofemoral compressive force or knee-flexion angle comparing double-leg with single-leg assisted cycling. However, single-leg unassisted cycling resulted in larger peak patellofemoral compressive force (28%) and lower knee-flexion angle (3%) than double-leg cycling. CONCLUSIONS: These results suggest that although single-leg assisted cycling differs for joint torques, it replicates knee loads from double-leg cycling.

Comparison of kinetics, kinematics, and electromyography during single-leg assisted and unassisted cycling.

To use single-leg cycling training for varying populations, it is important to understand whether a counterweight attached to the contralateral crank during single-leg cycling drills replicates the effects of the opposite leg in the ipsilateral leg. Therefore, we compared single-leg assisted cycling using a counterweight on the contralateral crank for joint kinetics, kinematics, and lower-limb muscle activation. Fourteen healthy nonathletes performed 2 bilateral cycling trials (240 ± 23 W and 90 ± 2 rpm) and 2 single-leg trials (120 ± 11 W and 90 ± 2 rpm) for measurements of pedal force, joint kinematics, and muscle activation of their right lower limb. For 1 single-leg trial, a custom-made adaptor was used to attach 10 kg of weight to the contralateral leg. Total force applied on the pedal, pedal force effectiveness, the mean joint angles and range of motion, mechanical work at the crank, hip, knee, and ankle joints, electromyography, pedaling cadence, and right crank mechanical work were assessed. Biceps femoris (87%), vastus lateralis (15%), rectus femoris (57%), tibialis anterior (57%), and gastrocnemius medialis (12%) activations were larger in the single-leg assisted trial compared with the bilateral trial. Lower total pedal force (17%) and increased index of effectiveness (16%) also indicate mechanical differences in single-leg cycling using a counterweight on the contralateral crank than conventional bilateral cycling. Single-leg assisted training should be used with caution because of potential differences in muscle recruitment and pedaling kinetics compared with bilateral cycling.

Water-Based Concurrent Training Improves Peak Oxygen Uptake, Rate of Force Development, Jump Height, and Neuromuscular Economy in Young Women.

The study investigated the effects of different intrasession exercise sequences on the cardiorespiratory and neuromuscular adaptations induced by water-based concurrent training in young subjects. Twenty-six healthy young women (25.1 ± 2.9 years) were placed into 2 water-based concurrent training groups: resistance before (RA, n = 13) or after (AR, n = 13) aerobic training. Subjects trained resistance and aerobic training during 12 weeks, 2 times per week performing both exercise types in the same training session. Peak oxygen uptake (V[Combining Dot Above]O2peak), rate of force development (RFD) obtained during an isometric peak torque knee extension protocol, jump height, and neuromuscular economy (normalized electromyography at 80% of pretraining knee extension isometric peak torque) in young women were determined. After training, there was a significant increase (p < 0.001) in both RA and AR in the V[Combining Dot Above]O2peak, with no differences between groups (7 vs. 5%). The maximal isometric knee extension RFD showed significant increases (p = 0.003) after training (RA: 19 vs. AR: 30%), and both groups presented similar gains. In addition, the countermovement jump height also increased (p = 0.034) after training (RA: 5% vs. AR: 6%), with no difference between groups. After training, there were significant improvements on vastus lateralis (p < 0.001) (RA: -13% vs. AR: -20%) and rectus femoris (p = 0.025) (RA: -17% vs. AR: -7%) neuromuscular economy, with no difference between groups. In conclusion, 12 weeks of water-based concurrent training improved the peak oxygen uptake, RFD, jump height, and neuromuscular economy in young women independent from the intrasession exercise sequence.

Effects of acute dehydration on neuromuscular responses of exercised and nonexercised muscles after exercise in the heat.

Dehydration can impair aerobic performance, but its effects on muscular strength are still unclear. This study evaluated the effect of dehydration induced by cycling in the heat on exercised (knee extensors) and nonexercised (elbow flexors) muscles' strength and activation. Ten healthy recreationally active and nonacclimatized men (age, 22.71 ± 2.21 years old; body mass (BM), 77.94 ± 7.35 kg; height, 1.76 ± 6.46 m; body fat, 18.93 ± 3.01%) cycled in the heat in 2 separate sessions: dehydrated (DHY) and euhydrated (EUH). Dehydrated session led to a 2% BM loss, and water ingestion prevented the water loss in the euhydrated session. Knee extensor and elbow flexor maximal isometric torques and muscle activation were assessed before and after exercising in both sessions. Knee extensor torque decreased 15.8% (p < 0.001; 294.27 ± 44.82-247.16 ± 40.54) in dehydrated session, whereas no significant reduction (2.98%; p = 0.348; 291.99 ± 48.37-281.74 ± 38.65) was observed in the euhydrated session. No significant session-time interaction (p = 0.098) was observed for elbow flexor responses (DHY, 67.51 ± 14.53-62.95 ± 13.60; EUH, 68.26 ± 13.06-67.87 ± 13.89). Muscle activation capacity was unaffected by the hydration status. Maintenance of euhydration state during cycling in the heat may attenuate strength impairments caused by water loss in exercised muscle groups.

Anthropometric, neuromuscular, physiologic and training variables as determinants to laboratory cycling performance.

BACKGROUND: The goal of this study was to verify whether anthropometric, physiological and neuromuscular factors, as well as training characteristics, could predict cycling performance during maximal incremental and time-to-exhaustion tests. METHODS: Twenty cyclists were evaluated: Anthropometric variables, knee extensor muscle activation and architecture, training history, and training volume were assessed. Second ventilatory threshold (VT2), maximal oxygen uptake (VO2MAX), and maximal power output (POMAX) were assessed during the incremental test. Muscle architecture of the vastus lateralis (VL) and rectus femoris (RF) muscles was evaluated bilaterally to calculate the mean thighs' muscle thickness, pennation angle and fascicle length, at rest condition. After that, time-to-exhaustion test at POMAX was performed. Muscle activation of the VL, RF and vastus medialis (VM) was evaluated of both legs. RESULTS: Cyclists' height (r2=0.37), experience time and training volume (r2=0.46) were predictors of POMAX (P<0.02), while cadence (r2=0.30) was the only predictive variable for the time-to-exhaustion performance (P<0.01). CONCLUSIONS: These results suggest that training characteristics and experience are important when training for incremental cycling conditions, whereas cadence (and its determinant variables) should be looked at during maximal and exhaustive conditions.

Distal overactivation of gastrocnemius medialis in persistent plantarflexion weakness following Achilles tendon repair.

Structural alterations of the triceps surae and Achilles tendon (AT) can promote plantarflexion weakness one-year following an AT repair, influencing the activation strategies of the Gastrocnemius Medialis (GM) muscle. However, this is yet to be demonstrated. We aimed to determine whether patients with plantar flexion weakness one-year after AT repair show altered GM spatial activation. In this cross-sectional and case-control study, ten middle-aged men (age 34 ± 7 years old, and 12.9 ± 1.1 months post-surgery) with a high AT total rupture score who attended conventional physiotherapy for six months after surgery, and ten healthy control men (age 28 ± 9 years old), performed maximal and submaximal (40, 60 and 90%) voluntary isometric plantarflexion contractions on a dynamometer. The peak plantar flexor torque was determined by isokinetic dynamometry and the GM neuromuscular activation was measured with a linear surface-electromyography (EMG) array. Overall EMG activation (averaged channels) increased when the muscle contraction levels increased for both groups. EMG spatial analysis in AT repaired group showed an increased activation located distally at 85-99%, 75-97%, and 79-97% of the electrode array length for 40%, 60%, and 90% of the maximal voluntary isometric contractions, respectively. In conclusion, patients with persistent plantar flexion weakness after AT rupture showed higher distal overactivation in GM.

Interferential therapy effect on mechanical pain threshold and isometric torque after delayed onset muscle soreness induction in human hamstrings.

This study was undertaken to examine the acute effect of interferential current on mechanical pain threshold and isometric peak torque after delayed onset muscle soreness induction in human hamstrings. Forty-one physically active healthy male volunteers aged 18-33 years were randomly assigned to one of two experimental groups: interferential current group (n = 21) or placebo group (n = 20). Both groups performed a bout of 100 isokinetic eccentric maximal voluntary contractions (10 sets of 10 repetitions) at an angular velocity of 1.05 rad · s(-1) (60° · s(-1)) to induce muscle soreness. On the next day, volunteers received either an interferential current or a placebo application. Treatment was applied for 30 minutes (4 kHz frequency; 125 µs pulse duration; 80-150 Hz bursts). Mechanical pain threshold and isometric peak torque were measured at four different time intervals: prior to induction of muscle soreness, immediately following muscle soreness induction, on the next day after muscle soreness induction, and immediately after the interferential current and placebo application. Both groups showed a reduction in isometric torque (P < 0.001) and pain threshold (P < 0.001) after the eccentric exercise. After treatment, only the interferential current group showed a significant increase in pain threshold (P = 0.002) with no changes in isometric torque. The results indicate that interferential current was effective in increasing hamstrings mechanical pain threshold after eccentric exercise, with no effect on isometric peak torque after treatment.

Effects of workload level on the timing of concentric-eccentric contractions during cycling.

BACKGROUND: The mechanical energy required to drive the cranks during cycling depends on concentric and eccentric muscle actions. However, no study to date provided clear evidence on how workload levels affect concentric and eccentric muscle actions during cycling. Therefore, the aim of this study was to investigate the workload effects on the timing of lower limb concentric and eccentric muscle actions, and on joint power production. METHODS: Twenty-one cyclists participated in the study. At the first session, maximal power output (POmax) and power output at the first (POVT1) and second (POVT2) ventilatory thresholds were determined during an incremental cycling test. At the second session, cyclists performed three trials (2 min/each) in the workloads determined from their POmax, POVT1 and POVT2, acquiring data of lower limb muscle activation, pedal forces and kinematics. Concentric and eccentric timings were computed from muscles' activations and muscle-tendon unit excursions along with hip, knee and ankle joints' power production. RESULTS: Longer rectus femoris eccentric activation (62%), vastus medialis concentric (66%) and eccentric activation (26%), and biceps femoris concentric (29%) and eccentric (133%) activation at POmax were observed compared to POVT1. Longer positive (12%) and shorter negative (12%) power were observed at the knee joint for POmax compared to POVT1. CONCLUSIONS: We conclude that, to sustain higher workload levels, cyclists improved the timing of power transmission from the hip to the knee joint via rectus femoris eccentric, vastus medialis concentric and eccentric and biceps femoris concentric and eccentric contractions.

Can we replace exercises targeted on core/hip muscles by exercises targeted on leg/foot muscles in women with patellofemoral pain? A randomized controlled trial.

OBJECTIVE: To verify the effects of replacing exercises targeted on core/hip muscles by exercises targeted on leg/foot muscles in a rehabilitation program for patellofemoral pain (PFP). DESIGN: Randomized Controlled Trial. PARTICIPANTS: Fifty women with PFP. METHODS: PFP participants were randomized into the standard rehabilitation group (SRG, n = 25) or distal exercise group (DEG, n = 25). Knee pain, patient-reported function, dynamic knee valgus and muscle strength were measured at baseline and after six and twelve weeks of the program start. RESULTS: SRG and DEG presented similar responses to rehabilitation (except for muscle strengthening). Knee pain reduced after 6 weeks (SRG: -37.7%, ES = 1.23; DEG: -30%, ES = 0.93) and 12 weeks (SRG: -47.4%, ES = 1.53; DEG: -43.3%, ES = 1.46). Patient-reported function improved after 6 weeks (SRG: +7.3%, ES = 0.45; DEG: +3.8%, ES = 0.22) and 12 weeks (SRG: +14.1%, ES = 0.80; DEG: +8.8%, ES = 0.50). Dynamic knee valgus reduced after 12 weeks (SRG: -29.7%, ES = 0.38; DEG: -34.5%, ES = 0.32). Both groups experienced increases in knee extension strength (SRG: +9%, ES = 0.28; DEG: +6%, ES = -0.29), but only SRG had strength gains for hip abduction (+10%, ES = 0.36) and extension (+11%, ES = 0.44). CONCLUSION: Exercises targeted on core/hip muscles can be replaced by exercises targeted on leg/foot muscles in a lower limb exercise-based rehabilitation program for women with PFP. CLINICAL TRIAL REGISTRATION: NCT03663595.

Reliability of knee extensor neuromuscular structure and function and functional tests' performance.

INTRODUCTION: The aim of this study was to evaluate the intra and inter-rater and inter-analyzer reliability of neuromuscular variables and functional tests. METHODS: Cross-sectional crossover design. Two independent raters and analyzers evaluated twenty-two healthy subjects. Knee-extensor strength was assessed from three maximal voluntary isometric contractions. Muscle activation was obtained from the vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) muscles. VL and RF muscles' architecture [fascicle length (FL), pennation angle (PA), muscle thickness (MT)] was obtained at rest by ultrasound. The time from five sit-to-stand (STS) trials, and the distance from the 6-min walk test (6MWT) were obtained. Intraclass correlation coefficient was determined and classified as strong (r = 0.75-1.00), moderate (r = 0.40-0.74), and weak (r < 0.40). RESULTS: Strong intra-rater reliability values were observed for strength (r = 0.97), muscle activation [VL (r = 0.91); RF (r = 0.92); VM (r = 0.80)], VL [FL (r = 0.90); PA (r = 0.94); MT (r = 0.99)] and RF [MT (r = 0.85)] muscle architecture, STS (r = 0.95), and 6MWT (r = 0.98). Inter-rater reliability also presented strong values for strength (r = 0.97), muscle activation [VL (r = 0.94); RF (r = 0.79); VM (r = 0.78)], muscle architecture VL [PA (r = 0.81) and MT (r = 0.88)] and RF [MT (r = 0.80)], STS (r = 0.93), and 6MWT (r = 0.98). A moderate correlation VL muscle architecture [FL (r = 0.69)]. Inter-analyzer muscle architecture reliability presented strong VL [FL (r = 0.77); PA (r = 0.76); MT (r = 0.91)] and RF [MT (r = 0.99)]. CONCLUSION: The high intra and inter-rater and inter-analyzer reliability values for most variables is evidence that they can be used for clinical evaluation. Muscle architecture might need a longer training period by different raters and analyzers to increase reliability.

Heliox improves oxygen delivery and utilization during dynamic exercise in patients with chronic obstructive pulmonary disease.

RATIONALE: Normoxic heliox (mixture of 79% He and 21% O(2)) may enhance exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). It remains to be determined whether part of these beneficial effects could be ascribed to increased O(2) delivery (O(2)DEL) to locomotor muscles. OBJECTIVES: To investigate the effects of heliox on peripheral O(2)DEL and utilization during exercise in moderate to severe COPD. METHODS: Twelve mildly hypoxic or nonhypoxemic men (FEV(1) = 45.0 +/- 13.0% predicted) underwent constant-work rate tests (70-80% peak) to the limit of tolerance while receiving heliox or room air. Near-infrared spectroscopy determined changes (Delta) in leg muscle deoxygenation (deoxyhemoglobin concentration [HHb], an index of fractional O(2) extraction), and surface electromyography estimated muscle fiber recruitment (n = 5). Q and Sp(O(2)) were monitored by impedance cardiography and pulse oximetry, respectively. MEASUREMENTS AND MAIN RESULTS: Heliox significantly decreased dynamic hyperinflation and increased exercise tolerance compared with room air (640 +/- 95 s vs. 371 +/- 100 s; P < 0.01). Heliox also accelerated on-exercise dynamics of Q, which were accompanied by faster O(2) uptake kinetics and slower Delta[HHb] responses (P < 0.05). During steady-state exercise, Sp(O(2))-corrected Delta[HHb] values decreased with heliox despite no significant changes in cardiac output. Muscle fiber recruitment and leg effort scores were also diminished (P < 0.05). On a multiple regression analysis, reductions in dynamic hyperinflation, dyspnea, and Delta[HHb] were independently related to improvements in exercise tolerance with heliox (R(2) = 0.91; P < 0.01). CONCLUSIONS: Heliox increases lower limb O(2)DEL and utilization during dynamic exercise in patients with moderate to severe COPD. These effects enhance exercise tolerance in this patient population.