The effects of sustained, low- and high-intensity isometric tasks on performance fatigability and the perceived responses that contributed to task termination.

PURPOSE: The present study examined the effects of sustained, isometric low- versus high-intensity tasks on time to task failure (TTF), performance fatigability (PF), ratings of perceived exertion (RPE), and the perceived causes of task termination from a post-test questionnaire (PTQ). METHODS: Ten men (mean ± SD: age = 21.1 ± 2.3 years; height = 180.2 ± 5.7 cm; body mass = 79.5 ± 8.8 kg) performed maximal voluntary isometric contractions (MVICs) before and after fatiguing, isometric forearm flexion tasks anchored to the torque corresponding to RPE values of 2 (TRQ2FT = 23.8 ± 7.1 N·m) and 8 (TRQ8FT = 60.9 ± 11.4 N·m). In addition, the subjects completed a PTQ which surveyed whether the perceived sensations of fatigue or pain, and/or the psychological factors of loss of focus and motivation contributed to the decision to terminate the task. Repeated measures ANOVAs, Wilcoxon-Signed Rank tests, and Spearman's Rank-Order Correlations were used to analyze the data. RESULTS: Across the fatiguing tasks, there were similar decreases in MVIC torque (95.2 ± 20.3 vs. 68.9 ± 15.6 N·m; p < 0.001) and RPE values (p = 0.122) at task failure for TRQ2FT (7.4 ± 2.7) and TRQ8FT (8.9 ± 1.0), but a longer (p = 0.005) TTF for the TRQ2FT (245.0 ± 177.0 s) than TRQ8FT (36.8 ± 11.1 s). CONCLUSIONS: Despite reaching task failure, the subjects were able to perform MVICs that were 100-300% greater than the target torque values within seconds of terminating the tasks. Thus, we hypothesized that task failure was not caused by an inability to produce sufficient torque to sustain the tasks, but rather an unwillingness to continue the task.

Effects of continuous cycling training on motor unit firing rates, input excitation, and myosin heavy chain of the vastus lateralis in sedentary females.

This study examined the effects of continuous endurance training on motor unit (MU) mean firing rates (MFR), percent myosin heavy chain (%MHC) isoforms, and muscle cross-sectional area (mCSA) of the vastus lateralis (VL). Twelve females completed 5-weeks of continuous cycling-training (CYC), while 8 females were controls (CON). Participants performed maximal voluntary contractions (MVCs) and 40% MVCs of the knee extensors before (PRE) and after the 5-week treatment period at the same absolute pre-treatment submaximal torque (POSTABS) and relative to post-treatment MVCs (POSTREL). Surface electromyographic (EMG) signals were decomposed with the Precision Decomposition III algorithm. MU firing times and waveforms were validated with reconstruct-and-test and spike trigger average procedures. MFRs at steady torque, recruitment thresholds (RT), and normalized EMG amplitude (N-EMGRMS) were analyzed. Y-intercepts and slopes were calculated for the MFR vs. RT relationships. MHC isoforms and mCSA were determined with muscle biopsies and ultrasonography. CYC decreased MVCs and type IIX %MHC isoform without changes in mCSA. The slopes for the MFR vs. RT relationships decreased for CYC during POSTREL and POSTABS while N-EMGRMS increased for POSTABS with no differences between PRE and POSTREL. Type I %MHC isoform was correlated with the slope for the MFR vs. RT relationship during POSTABS and POSTREL for CYC. This study provides evidence that decreases in the MFRs of higher threshold MUs post-CYC is likely a function of changes in input excitation (POSTABS) and the firing frequency-excitation relationships (POSTREL). Evidence is provided that MHC isoforms influence the firing rate scheme of the muscle following short-term training.

Increased pulse wave velocity in persons with spinal cord injury: the effect of the renin-angiotensin-aldosterone system.

Increased pulse wave velocity (PWV), a marker of cardiovascular disease (CVD), has been reported in otherwise healthy individuals with spinal cord injury (SCI) compared with age-matched uninjured controls. Due to decentralized descending sympathetic vascular control, individuals with injuries above T6 are prone to orthostatic hypotension and, as a result, depend on the renin-angiotensin-aldosterone system (RAAS) to maintain orthostatic blood pressure (BP). The purpose of this study was to determine resting PWV, a noninvasive surrogate of central arterial stiffness, in individuals with cervical (C4-T1; n = 11) and thoracic (T6-T12; n = 11) SCI, compared with age-matched controls (controls; n = 11). Next, our aim was to describe group differences in BP, plasma norepinephrine (NE), and renin response to head-up tilt (HUT). Finally, we sought to determine the relationship between PWV and the orthostatic change in BP, NE, and the plasma renin during HUT among the groups. PWV was significantly increased in both cervical (8.81 ± 1.91 m/s) and thoracic (7.36 ± 1.58 m/s) SCI compared with the controls (5.53 ± 0.95 m/s; P < 0.05). The change from supine to 60° HUT in BP and NE was significantly reduced and change in plasma renin was significantly increased in the cervical group compared with the thoracic and control groups. Group affiliation and change in plasma renin were significant predictors of PWV (R2 = 0.63, P = 0.001). These data suggest that dependency on the RAAS for orthostatic BP maintenance may be associated with increased PWV and risk of CVD in the SCI population.NEW & NOTEWORTHY Our novel findings suggest that increased arterial stiffness in individuals with SCI may be due to greater dependency on the RAAS to maintain hemodynamic stability during an orthostatic challenge. Asymptomatic orthostatic hypotension can occur in persons with SCI during transition from the supine to the seated position and during other upright activities of daily living; however, it is seldom addressed by clinicians.

Effects of Transspinal Direct Current Stimulation on Cycling Perception of Effort and Time to Exhaustion.

ABSTRACT: Ciccone, AB, Fry, AC, Emerson, DM, Gallagher, PM, Herda, TJ, and Weir, JP. Effects of transspinal direct current stimulation on cycling perception of effort and time to exhaustion. J Strength Cond Res 35(2): 347-352, 2021-In the past decade, researchers have investigated the efficacy of transspinal direct current stimulation (tsDCS) on the central nervous system and afferent neuron function in humans. Recently, data have suggested it may be possible for such tsDCS-induced changes in neuromuscular function to enhance performance. This study used noninvasive thoracic spine tsDCS to determine if cycling performance and perception of effort could be modulated by tsDCS. In 3 different stimulation conditions, anodal, cathodal, and sham, subjects cycled at 80% of their maximal aerobic capacity until exhaustion and reported their rating of perceived exertion (RPE) every minute. From this period, we compared the RPE responses over the first 3 minutes and time to exhaustion. There was no significant difference in time to exhaustion between anodal (408 ± 121 seconds), cathodal (413 ± 168 seconds), and sham (440 ± 189 seconds) conditions (p = 0.58). There was no significant difference in RPE from minutes 1-3 (collapsed across time) between anodal (12.9 ± 2.4 arbitrary units (AUs)), cathodal (13.3 ± 2.2 AUs), and sham (12.9 ± 2.1 AUs) conditions (p = 0.51). These data suggest tsDCS condition did not influence cycling performance or perception of effort during high-intensity cycling. Therefore, thoracic spine and lower abdominal montage delivering a current density of 0.071 mA·cm-2 for 20 minutes likely does not substantially improve high-intensity cycling work capacity. Therefore, more research is needed to investigate the efficacy of tsDCS and which stimulation methods may and may not enhance human performance.

Double-blinded, placebo-controlled crossover trial to determine the effects of midodrine on blood pressure during cognitive testing in persons with SCI.

STUDY DESIGN: Clinical trial. OBJECTIVES: Individuals with spinal cord injury (SCI) above T6 experience impaired descending cortical control of the autonomic nervous system, which predisposes them to hypotension. However, treatment of hypotension is uncommon in the SCI population because there are few safe and effective pharmacological options available. The primary aim of this investigation was to test the efficacy of a single dose of midodrine (10 mg), compared with placebo, to increase and normalize systolic blood pressure (SBP) between 110 and 120 mmHg during cognitive testing in hypotensive individuals with SCI. Secondary aims were to determine the effects of midodrine on cerebral blood flow velocity (CBFv) and global cognitive function. SETTING: United States clinical research laboratory. METHODS: Forty-one healthy hypotensive individuals with chronic (≥1-year post injury) SCI participated in this 2-day study. Seated SBP, CBFv, and cognitive performance were monitored before and after administration of identical encapsulated tablets, containing either midodrine or placebo. RESULTS: Compared with placebo, midodrine increased SBP (4 ± 13 vs. 18 ± 24 mmHg, respectively; p < 0.05); however, responses varied widely with midodrine (-15.7 to +68.6 mmHg). Further, the proportion of SBP recordings within the normotensive range did not improve during cognitive testing with midodrine compared with placebo. Although higher SBP was associated with higher CBFv (p = 0.02), global cognitive function was not improved with midodrine. CONCLUSIONS: The findings indicate that midodrine increases SBP and may be beneficial in some hypotensive patients with SCI; however, large heterogeneity of responses to midodrine suggests careful monitoring of patients following administration. CLINICAL TRIALS REGISTRATION: NCT02307565.

Transcranial Direct Current Stimulation of the Temporal Lobe Does Not Affect High-Intensity Work Capacity.

Ciccone, AB, Deckert, JA, Schlabs, CR, Tilden, MJ, Herda, TJ, Gallagher, PM, and Weir, JP. Transcranial direct current stimulation of the temporal lobe does not affect high-intensity work capacity. J Strength Cond Res 33(8): 2074-2086, 2019-Stimulation of the left insular cortex may affect heart rate variability (HRV) and exercise effort perception. These studies investigated the effects transcranial direct current stimulation (tDCS) and electrode orientation on HRV and repeated maximal knee extensions. In study 1, after sham stimulation, anodal left temporal lobe stimulation, or anodal right temporal lobe stimulation, 10 male and 10 female subjects (age = 21.0 ± 1.5 years) completed 50 maximum isokinetic extensions at 180°·s. There was a significant effect of stimulation condition on HRV for only 1 (SD2; p = 0.037; η = 0.159) of 5 HRV metrics. There was no significant effect on isokinetic fatigue percent or isokinetic work (all p ≥ 0.278; all η ≤.065). It has been proposed that placing the cathode electrode on the shoulder may differentially affect tDCS. Therefore, in study 2, the effects of electrode orientation on tDCS-induced changes in HRV was assessed in 10 healthy females and 8 healthy males (21.6 ± 2.5 years) who completed cephalic, extracephalic, and sham trials. In the cephalic montage, the anode was placed over the left temporal lobe and the cathode was placed over right prefrontal cortex. In the extracephalic montage, the cathode was placed on the shoulder on the same side of the body as the anode. Neither cephalic nor extracephalic montages affected HRV (all p ≥ 0.152; all η ≤.105). These data suggest that anodal tDCS of the insular cortex has little effect on HRV, and does not improve high-intensity exercise performance in the current population. Therefore, anodal tDCS applied over the left temporal lobe is not recommended for high-intensity performance enhancement.

Mechanomyographic responses during recruitment curves in the soleus muscle.

INTRODUCTION: In this study we examined relationships among mechanomyographic (MMG), electromyographic (EMG), and peak twitch torque (PTT) responses as well as test-retest reliability when recorded during recruitment curves in the soleus muscle. METHODS: PTT, EMG (M-wave, H-reflex), and MMG responses were recorded during recruitment curves in 16 subjects (age 24 ± 2 years) on 2 separate days. The sum of the M-wave and H-reflex (M+H) was calculated. Correlations among variables and test-retest reliability were determined. RESULTS: MMG was correlated with PTT (mean r = 0.93, range r = 0.59-0.99), the M-wave (0.95, 0.04-0.98), and M+H (0.91, 0.42-0.97), but was unrelated to the H-reflex (-0.06, -0.56 to 0.47). Reliability was consistently high among most variables, but normalizing to the maximum value improved MMG reliability and the minimum detectable change. CONCLUSION: MMG responses predicted 86%-90% of the variability in PTT, M-wave, and M+H; thus, MMG may be a useful alternative for estimating twitch torque and maximal activation. Muscle Nerve 56: 107-116, 2017.

Reminder: RMSSD and SD1 are identical heart rate variability metrics.

Assessment of heart rate variability (HRV) is a common approach to examine cardiac autonomic nervous system modulation that has been employed in a variety of settings. Frequently, both the root mean square of successive differences (RMSSD) and SD1, which is a Poincaré plot component, have been used to quantify short-term heart rate variability. It is not typically appreciated, however, that RMSSD and SD1 are identical metrics of HRV. As a reminder to clinicians and researchers who use and study HRV, we show both empirically and mathematically that RMSSD and SD1 are identical metrics. Because the homology between RMSSD and SD1 is not commonly known, the inclusion of both measures has been reported in many recent publications. The inappropriate use of such redundant data may affect the interpretation of HRV studies. Muscle Nerve 56: 674-678, 2017.

Influences of Interelectrode Distance and Innervation Zone on Electromyographic Signals.

The purpose of the present study was to examine the effects of electrode placements centered over and offset from the innervation zone (IZ) with different interelectrode distances (IED) on the time and frequency domain parameters of the electromyographic (EMG) signal during a fatiguing submaximal, isometric workout. 11 adults performed an isometric leg extension muscle action at 50% maximal voluntary isometric contraction (MVIC) to exhaustion. Electromyographic amplitude and frequency parameters were determined from electrode placements with different IED centered over, at proximal offset, at distal offset, and away from the IZ at 10, 50, and 100% of the time to exhaustion using an electrode array. There were greater absolute EMG amplitude and lower absolute EMG frequency for electrode placements over and offset from the IZ, but lower absolute EMG amplitude over than offset from the IZ regardless of IED at each time-point during the time to exhaustion. The absolute EMG frequency values were affected by the location relative to the IZ and IED of the electrode placements, and were greater for distal offset vs. proximal offset electrode placements at each time-point. Normalization of the EMG amplitude and EMG frequency values to MVIC eliminated differences due to IED and electrode placements during the fatiguing workout.

Noninvasive Assessment of Skeletal Muscle Myosin Heavy Chain Expression in Trained and Untrained Men.

Fry, AC, Housh, TJ, Cramer, JB, Weir, JP, Beck, TW, Schilling, BK, Miller, JD, and Nicoll, JX. Noninvasive assessment of skeletal muscle myosin heavy chain expression in trained and untrained men. J Strength Cond Res 31(9): 2355-2362, 2017-Numerous conditions and types of physical activity (e.g., exercise, aging, and muscle-related diseases) can influence muscle fiber types and the proteins expressed. To date, muscle fibers can only be characterized by actually obtaining a tissue sample using the invasive muscle biopsy procedure. Mechanomyography (MMG) is the assessment of the vibration properties of contracting skeletal muscle and has been proposed as a possible noninvasive method for muscle fiber analysis. Therefore, the purpose of this project was to examine the feasibility of using MMG and muscle performance measures to noninvasively assess muscle fiber characteristics. Fifteen men (5 endurance-trained, 5 weight-trained, and 5 sedentary) provided muscle samples from their vastus lateralis muscle. These samples were analyzed for relative myosin heavy chain (MHC) protein expression, which is highly correlated with % muscle fiber type areas. Additionally, each subject performed several muscle performance tests, and MMG of the quadriceps was assessed during a knee extension exercise. Multiple regression was used to develop prediction equations for determining relative muscle content of MHC types I, IIa, and IIx. A combination of MMG and knee extension performance variables estimated types I, IIa, and IIx MHCs with approximately 80% accuracy. Although preliminary, these data suggest that muscle performance tests in addition to MMG assessments during a simple muscle performance task (knee extension) can be used to estimate muscle fiber type composition in a healthy male population. Such methods could ultimately be used to noninvasively monitor muscle health and fitness.

Acute bouts of exercise induce a suppressive effect on lymphocyte proliferation in human subjects: A meta-analysis.

OBJECTIVE: Lymphocyte proliferative responses are commonly used to assess immune function in clinical settings, yet it is unclear how proliferative capacity is altered by exercise. This analysis aims to quantitatively assess the proliferative response of lymphocytes following an acute bout of exercise. METHODS: Electronic databases were searched for articles containing the keywords "exercise" OR "acute" OR "aerobic" OR "resistance training" OR "immune function" AND "proliferation" AND "lymphocyte." Initial results yielded 517 articles of which 117 were reviewed in full. Twenty-four articles met the inclusion criteria. Calculated standardized mean difference (SMD) and corresponding standard errors (SE) were integrated using random-effect models. RESULTS: Analyses uncovered evidence for suppression of proliferative capacity following acute exercise in general (SMD=-0.18, 95% CI: -0.21, -0.16) with long duration, high intensity exercise exhibiting a moderate suppressive effect (SMD=-0.55, 95% CI: -0.86, -0.24). Discordant proliferative responses for long duration, high intensity exercise in competitive versus non-competitive settings were identified with enhanced proliferation (SMD=0.46, 95% CI: 0.03, 0.89) observed following competitive events and a large suppressive effect detected for similar activities outside of a competitive environment (SMD: -1.28, 95% CI: -1.61, -0.96) (p=0.02). CONCLUSION: Evidence suggests lymphocyte proliferation is suppressed following acute bouts of exercise, with exercise lasting longer than one hour having a greater magnitude of effect regardless of exercise intensity. Variations in observed effect sizes across intensity, duration, and competitive environment further highlight our need to acknowledge the impact of study designs in advancing our understanding of exercise immunology.

Orthostatic hypotension and orthostatic hypertension in American veterans.

PURPOSE: Abnormal blood pressure (BP) response to orthostatic maneuvers may predict adverse health outcomes. Orthostatic hypotension (OH) is defined as a fall in BP of ≥20/10 mmHg, and orthostatic hypertension (OHTN) is defined as an increase in systolic BP (SBP) of ≥20 mmHg, with standing. Herein, we document the prevalence of OH and OHTN in American veterans. METHODS: The influence of demographic characteristics, life habits, co-incident medical conditions, and prescription medication use on these prevalence rates and associations between abnormal orthostatic BP responses and severity of self-reported symptoms of fatigue, dizziness, trouble concentrating, and head and neck discomfort were determined. RESULTS: 286 veterans participated; 14 % were classified with OH, 22 % with OHTN, and 64 % with normal BP responses to standing (reference group). An increased prevalence of the diagnosis of diabetes mellitus (27 %) and hypertension (63 %) was noted, which did not differ by orthostatic BP classification. Veterans with OH were older than the reference group and were prescribed more antihypertensive medications than the reference and OHTN groups. While the prevalence of OH increased with age, the prevalence of OHTN was comparable in young (20-30 years) and old (70+ years) veterans (17 vs. 19 %, respectively). The severity of fatigue and dizziness was increased in veterans with OH and OHTN compared to the reference group. CONCLUSION: These data suggest a relatively high prevalence of OH and OHTN, which is associated with increased self-reported severity of fatigue and dizziness in American veterans, findings which may adversely impact long-term health outcomes.

Time Course of Changes in Neuromuscular Parameters During Sustained Isometric Muscle Actions.

Smith, CM, Housh, TJ, Herda, TJ, Zuniga, JM, Camic, CL, Bergstrom, HC, Smith, DB, Weir, JP, Hill, EC, Cochrane, KC, Jenkins, NDM, Schmidt, RJ, and Johnson, GO. Time course of changes in neuromuscular parameters during sustained isometric muscle actions. J Strength Cond Res 30(10): 2697-2702, 2016-The objective of the present study was to identify the time course of changes in electromyographic (EMG) and mechanomyographic (MMG) time and frequency domain parameters during a sustained isometric muscle action of the leg extensors at 50% maximal voluntary isometric contraction. The EMG and MMG signals were measured from the vastus lateralis of 11 subjects to identify when motor unit activation strategies changed throughout the sustained isometric muscle action. The EMG amplitude (muscle activation) had a positive linear relationship (p = 0.018, r = 0.77) that began to increase at the initiation of the muscle action and continued until task failure. Electromyographic frequency (motor unit action potential conduction velocity) and MMG frequency (global motor unit firing rate) had negative quadratic relationships (p = 0.002, R = 0.99; p = 0.015, R = 0.94) that began to decrease at 30% of the time to exhaustion. The MMG amplitude (motor unit activation) had a cubic relationship (p = 0.001, R = 0.94) that increased from 10 to 30% of the time to exhaustion, then decreased from 40 to 70% of the time to exhaustion, and then markedly increased from 70% to task failure. The time course of changes in the neuromuscular parameters suggested that motor unit activation strategies changed at approximately 30 and 70% of the time to exhaustion during the sustained isometric muscle action. These findings indicate that the time course of changes in neuromuscular responses provide insight into the strategies used to delay the effects of fatigue and are valuable tools for quantifying changes in the fatiguing process during training programs or supplementation research.

Motor unit control strategies of endurance- versus resistance-trained individuals.

INTRODUCTION: We examined motor unit (MU) control properties of resistance-trained (RT) and endurance-trained (ET) individuals. METHODS: Five RT (age 25 ± 4 years) and 5 ET (age 19 ± 1 years) subjects participated. Surface electromyography (EMG) data were recorded from the vastus lateralis during isometric trapezoid muscle actions at 40% and 70% of maximal voluntary contraction. Decomposition and wavelet transform techniques were applied to the EMG signals to extract the firing events of single MUs and EMG intensity across the frequency spectrum. RESULTS: There were significant differences between RT and ET for the mean MU firing rate and derecruitment threshold versus recruitment threshold relationships and EMG intensity at various wavelet bands during the linearly increasing, steady force, and linearly decreasing segments of the trapezoid contraction. CONCLUSIONS: MU behavior is altered as a function of training status and is likely the result of differences in the physical properties of the MU.

Prevalence of abnormal systemic hemodynamics in veterans with and without spinal cord injury.

OBJECTIVE: Increased prevalence of heart rate and blood pressure abnormalities are evident in persons with spinal cord injury (SCI), but age, comorbid medical conditions, and prescription medication use may contribute. To determine differences in the prevalence of cardiac acceleration (heart rate ≥80 beats per minute), hypotension (blood pressure ≤110/70mmHg), orthostatic hypotension (OH) (-20/-10mmHg with upright positioning), and hypertension (HTN) (blood pressure ≥140/90mmHg) in veterans with and without SCI. DESIGN: Observational trial. SETTING: Medical center. PARTICIPANTS: Subjects included veterans with SCI (n=62; cervical: tetraplegia, C3-8; high thoracic, T1-5; low thoracic, T7-L2) and veterans without SCI (n=160). INTERVENTIONS: None. MAIN OUTCOME MEASURES: We assessed medical history, prescription medication use, and heart rate and blood pressure during a routine clinical visit. Prevalence rates of cardiac acceleration, hypotension, OH, and HTN were calculated using binary logistic regression analysis with 95% confidence intervals. The influence of SCI status, age, smoking status, cardiovascular diagnoses, and use of prescribed antihypertensive medications on the prevalence of abnormal heart rate and blood pressure recordings was determined. RESULTS: The diagnosis of HTN was reduced in the high thoracic and tetraplegia groups compared with the non-SCI and low thoracic groups. Use of antihypertensive medications was increased in the low thoracic group compared with the other 3 groups and was increased in the non-SCI group compared with the tetraplegia group. The prevalence of cardiac acceleration was reduced, and the prevalence of systolic hypotension was increased in the tetraplegia group. The prevalence of diastolic hypotension was increased in all SCI groups compared with the non-SCI group. For all analyses, increased prevalence of abnormal heart rate and blood pressure recordings was not further explained by the covariates, with the exception of age, cardiovascular diagnoses, and antihypertensive medications in the cardiac acceleration model; however, SCI status remained significant and was the dominant predictor variable. CONCLUSIONS: Our data suggest that SCI status contributes to the prevalence of cardiac acceleration and systolic and diastolic hypotension regardless of cardiovascular medical conditions or prescription antihypertensive medication use.

Methods comparison: assessing agreement of physiological parameters obtained from exercise on two different cycle ergometers.

The purpose of this study was to determine the agreement of physiological parameters measured during exercise testing on 2 devices at established power outputs (POs). Ten trained male cyclists were recruited. The devices used for comparison were the Lode stationary bicycle ergometer (SBE) (Lode Excalibur) and the PowerTap Pro+ (BPT) (Saris Cycling Group) mobile ergometer. The physiological parameters recorded at established PO (50, 100, 150, 200, 250 W) were heart rate (HR), oxygen consumption ((Equation is included in full-text article.)), pulmonary ventilation (VE), blood lactate, and ratings of perceived exertion (RPE). Subjects were randomized once to the SBE and 3 times to a bicycle equipped with a BPT. After 15 minutes of unloaded pedaling, the trial began with 5 minutes of cycling at 50 W. Intensity increased by 50 W every 5 minutes up to 250 W. Physiological measures were recorded at each PO. Bland-Altman plots were constructed including computation of the ratio of half the range of limits of agreement and the mean of the pairwise means along with bivariate regression calculations for analysis of the linear association between device measurements. Moderate to good agreement was found for HR with agreement improving as PO increased. Comparisons of (Equation is included in full-text article.)found agreement increased as the PO increased. VE, RPE, and lactate did not consistently provide similar measures across trials. The level of agreement between HR and (Equation is included in full-text article.)when comparing the SBE and BPT suggests that the PowerTap Pro+ is a sufficient tool for estimating PO and associated physiological parameters in the field.

Effects of 6 weeks of aerobic exercise combined with conjugated linoleic acid on the physical working capacity at fatigue threshold.

The purpose of this study was to examine the effects of conjugated linoleic acid (CLA) supplementation in conjunction with 6 weeks of aerobic exercise training on the physical working capacity at the fatigue threshold (PWCFT), timed sit-ups, and the standing long jump. Thirty-three untrained to moderately trained men (mean ± SD; age = 21.6 ± 2.8 years) participated in this double-blind, placebo-controlled study and were randomly assigned to either a CLA (Clarinol A-80; n = 17) or placebo (PLA; sunflower oil; n = 16) group. Before and after 6 weeks of aerobic training (50% VO2peak for 30 minutes, twice per week) and supplementation (8 ml CLA or PLA per day), each subject completed an incremental cycle ergometer test to exhaustion to determine the PWCFT, maximal number of sit-ups in 1 minute, and the standing long jump. There were no differences (all p ≥ 0.23) between the CLA and PLA groups for the analysis of covariance-adjusted posttest mean values for PWCFT, sit-ups, or standing long jump. The PWCFT increased from pre- to posttraining in the CLA (p = 0.003) and PLA (p = 0.003) groups. There were no differences (p > 0.05) from pre- to posttraining for sit-ups and standing long jump in either the CLA or PLA groups. There was no effect of CLA on the training-induced increases in PWCFT, nor were there any effects of CLA or aerobic training on the maximum number of sit-ups or standing long jump. Thus, CLA had no ergogenic benefits on this model of aerobic training-induced improvements in neuromuscular fatigue, or on field tests of muscle endurance and power.

Treatment of Orthostatic Hypotension During Acute Inpatient Rehabilitation After Spinal Cord Injury: Usual Care vs. Anti-hypotensive Therapy.

BACKGROUND: To compare the pharmacological treatment of hypotension and orthostatic hypotension (OH) initiated based upon a blood pressure (BP) threshold, regardless of symptoms (TXT), to usual care pharmacological treatment of symptomatic hypotension (UC), during acute inpatient rehabilitation (AIR) following spinal cord injury (SCI). METHODS: Block randomization, based on the neurological level of injury as: cervical lesions (C1-C8); high thoracic lesions (T1-T5), and low thoracic lesions (T6-T12), was used to determine responses to the primary question "was the therapy session affected by low BP or concern for low BP development?" Study participants and therapists were unaware of the group assignment. RESULTS: A total of 66 participants enrolled; 25 (38%) in the TXT group, 29 (44%) in the UC group, and 12 (18%) withdrew. Responses to the primary question were recorded for 32 participants, 15 in the TXT, and 17 in the UC group. There was an average of 81 ±â€…51 therapy sessions/participant in the TXT and 60 ±â€…27 sessions/participant in the UC group. Of those therapy sessions, low BP or concerns for low BP affected an average of 9 ±â€…8 sessions/participant in the TXT group and 10 ±â€…12 sessions/participant in the UC group. Neither the total number of therapy sessions (P = 0.16) nor group assignment (P = 0.83) significantly predicted the number of sessions affected by low BP. CONCLUSIONS: These data are not conclusive but indicate that the treatment of asymptomatic hypotension and OH does not increase time spent in therapy compared to UC treatment of symptomatic hypotension and OH in newly injured patients with SCI. CLINICAL TRIALS REGISTRATION: #NCT02919917.

Hemodynamic effects of L-threo-3,4-dihydroxyphenylserine (Droxidopa) in hypotensive individuals with spinal cord injury.

OBJECTIVES: To determine the effect of an escalating dose of droxidopa (100, 200, and 400 mg) compared with placebo on seated blood pressure (BP) in hypotensive individuals with spinal cord injury (SCI). Secondarily, we aimed to determine the effect of droxidopa on (1) supine BP and heart rate, (2) the change in BP and heart rate when these individuals were transferred from the supine to the seated position, and (3) adverse event (AE) reporting. DESIGN: Open-label dose titration trial. SETTING: A Veterans Administration Medical Center. PARTICIPANTS: Participants with SCI (C3-T12) (N=10) were studied during 4 laboratory visits. Subjects visited the laboratory for about 5 hours on each visit, which incorporated a 30-minute seated baseline, a 30- to 60-minute supine, and a 4-hour seated postdrug observation. INTERVENTIONS: Placebo on visit 1, droxidopa 100 mg on visit 2, droxidopa 200 mg on visit 3, and droxidopa 400 mg on visit 4. MAIN OUTCOME MEASURES: BP and heart rate changes from baseline to the postdrug period, orthostatic heart rate and BP responses, and subjective AE reporting. RESULTS: Seated BP was significantly elevated with 400 mg droxidopa compared with placebo and 100 mg droxidopa for 3 hours and was elevated for 2 hours compared with 200 mg droxidopa. Increase in supine BP was not worsened following droxidopa, and the expected fall in BP when transferred to the seated position was prevented with droxidopa 200 and 400 mg. There were no significant differences in the heart rate response or AE reporting among the study visits. CONCLUSIONS: Our preliminary findings suggest that droxidopa, at the doses tested, does not cause excessive increases in supine BP and the 400-mg dose appears to be effective at increasing seated BP for up to 3 hours in persons with SCI.

A prospective report on the prevalence of heart rate and blood pressure abnormalities in veterans with spinal cord injuries.

OBJECTIVE: Decentralized autonomic cardiovascular regulation may lead to increased prevalence of heart rate (HR) and blood pressure (BP) abnormalities in veterans with SCI. In addition, comorbid medical conditions and prescription medication use may increase HR and BP abnormalities. These abnormalities include bradycardia, and tachycardia, hypotension, hypertension as well as autonomic dysreflexia and orthostatic hypotension; the prevalence of which is unknown. DESIGN: HR and BP data were measured during a routine annual physical examination in 64 veterans with SCI. Measurements of HR and BP were recorded in the seated and supine positions to document the influence of body position and to document intra-subject variability in these assessments. RESULTS: All subjects were chronically injured (20 ± 14 years), 33 subjects were tetraplegic (T: C3-C8), nine had high paraplegia (HP: T1-T6), and 22 had low paraplegia (LP: T7-L2). Regardless of position, the prevalence of bradycardia was increased in the T group, whereas prevalence of tachycardia was increased in the HP and LP groups. Systolic hypotension was more common in the T and HP groups than the LP group and positional effects were most evident in the T group. Systolic hypertension was comparable in the T and HP groups but was twice as prevalent in the LP group. Increased prevalence of individuals with three or more medical conditions and prescribed three or more medications which might influence HR and BP was observed. CONCLUSION: Decentralized autonomic regulation, comorbid medical conditions, and prescription medication use in veterans with SCI result in HR and BP abnormalities; our data suggest that these abnormalities vary depending on the level of injury and orthostatic positioning.