Evaluating the between-day reliability and likelihood of change of a test battery incorporating vastus lateralis muscle thickness, ankle-brachial pressure index, maximal voluntary torque, and six-minute walk test in patients with claudication.

OBJECTIVE: The study aims to evaluate the between-day reliability of a proposed test battery for patients with claudication that can be used for monitoring the effectiveness of exercise interventions and other therapeutic strategies tailored to this patient population. METHODS: Twenty-five men with claudication were recruited. The test battery consisted of the Vastus Lateralis muscle thickness (VL-MT), ankle-brachial pressure index (ABI), unilateral isometric knee extension maximal voluntary torque (MVT) and 6-minute walk test (6MWT). A single investigator conducted the tests for each patient on two separate testing sessions (T1 and T2) 5-7 days apart. RESULTS: Good to excellent reliability was observed for VL-MT (ICC = 0.95, 95% LOA = ±3.10 mm, SEM = 0.81 mm), ABI (ICC = 0.97, 95% LOA = ±0.10, SEM = 0.02), MVT (ICC = 0.97, 95% LOA = ±24.0 N·m, SEM = 6.31 N·m), 6MWT distance (ICC = 0.99, 95% LOA = ±39.6 m, SEM = 11.0 m), 6MWT time to claudication (ICC = 0.99, 95% LOA = ±30.8 s, SEM = 7.8 s), and 6MWT ratings of pain (ICC = 0.87, 95% LOA = ±2.4 CR-10+, SEM = 0.7 CR-10+ ). Analysis derived from reliability data indicates a change of 1.4 mm for VL-MT, 0.14 for ABI, 12 N·m for MVT, 25 m for 6MWT distance, 15 s for 6MWT time to claudication and 1 CR-10+ for 6MWT ratings of pain is required to be interpreted as the minimum 'likely' change (76% chance). CONCLUSIONS: The test battery provides a reliable assessment of patients with claudication and can be widely used to evaluate the effects of exercise programmes and other therapeutic interventions. For the individual, changes in VL-MT, ABI, MVT, and 6MWT greater than the minimum likely change as a result of an exercise programme or an intervention are likely changes and less influenced by error associated with the test.

Low-intensity resistance exercise with blood flow restriction for patients with claudication: A randomized controlled feasibility trial.

BACKGROUND: Claudication is a common and debilitating symptom of peripheral artery disease, resulting in poor exercise performance and quality of life (QoL). Supervised exercise programs are an effective rehabilitation for patients with claudication, but they are poorly adhered to, in part due to the high pain and effort associated with walking, aerobic, and resistance exercise. Low-intensity resistance exercise with blood flow restriction (BFR) represents an alternative exercise method for individuals who are intolerant to high-intensity protocols. The aim of this study was to evaluate the feasibility of a supervised BFR program in patients with claudication. METHODS: Thirty patients with stable claudication completed an 8-week supervised exercise program and were randomized to either BFR (n = 15) or a control of matched exercise without BFR (control; n = 15). Feasibility, safety, and efficacy were assessed. RESULTS: All success criteria of the feasibility trial were met. Exercise adherence was high (BFR = 78.3%, control = 83.8%), loss to follow up was 10%, and there were no adverse events. Clinical improvement in walking was achieved in 86% of patients in the BFR group but in only 46% of patients in the control group. Time to claudication pain during walking increased by 35% for BFR but was unchanged for the control. QoL for the BFR group showed improved mobility, ability to do usual activities, pain, depression, and overall health at follow up. CONCLUSION: A supervised blood flow restriction program is feasible in patients with claudication and has the potential to increase exercise performance, reduce pain, and improve QoL. (Clinicaltrials.gov Identifier: NCT04890275).

The effect of a prior eccentric lowering phase on concentric neuromechanics during multiple joint resistance exercise in older adults.

Aging involves a marked decline in physical function and especially muscle power. Thus, optimal resistance exercise (RE) to improve muscle power is required for exercise prescription. An eccentric lowering phase immediately before a concentric lift (ECC-CON) may augment concentric power production, due to various proposed mechanisms (e.g., elastic recoil, pre-activation, stretch reflex, contractile history), when compared with a concentric contraction alone (CON-Only). This study compared the effect of a prior eccentric lowering phase on older adult concentric power performance (ECC-CON vs. CON-Only) during a common multiple joint isoinertial RE (i.e., leg press) with a range of loads. Twelve healthy older adult males completed two measurement sessions, consisting of ECC-CON and CON-Only contractions, performed in a counterbalanced order using 20-80% of one repetition maximum [% 1RM] loads on an instrumented isoinertial leg press dynamometer that measured power, force, and velocity. Muscle activation was assessed with surface electromyography (sEMG). For mean power ECC-CON>CON-Only, with a pronounced effect of load on the augmentation of power by ECC-CON (+19 to +55%, 35-80% 1RM, all p < 0.032). Similarly, for mean velocity ECC-CON>CON-Only, especially as load increased (+15 to 54%, 20-80% 1RM, all p < 0.005), but mean force showed more modest benefits of ECC-CON (+9 to 14%, 50-80% 1RM, all p < 0.05). In contrast, peak power and velocity were similar for ECC-CON and CON-Only with all loads. Knee and hip extensor sEMG were similar for both types of contractions. In conclusion, ECC-CON contractions produced greater power, and velocity performance in older adults than CON-Only and may provide a superior stimulus for chronic power development.

Effect of long-term maximum strength training on explosive strength, neural, and contractile properties.

The purpose of this cross-sectional study was to compare explosive strength and underpinning contractile, hypertrophic, and neuromuscular activation characteristics of long-term maximum strength-trained (LT-MST; ie, ≥3 years of consistent, regular knee extensor training) and untrained individuals. Sixty-three healthy young men (untrained [UNT] n = 49, and LT-MST n = 14) performed isometric maximum and explosive voluntary, as well as evoked octet knee extension contractions. Torque, quadriceps, and hamstring surface EMG were recorded during all tasks. Quadriceps anatomical cross-sectional area (QACSAMAX ; via MRI) was also assessed. Maximum voluntary torque (MVT; +66%) and QACSAMAX (+54%) were greater for LT-MST than UNT ([both] p < 0.001). Absolute explosive voluntary torque (25-150 ms after torque onset; +41 to +64%; [all] p < 0.001; 1.15≤ effect size [ES]≤2.36) and absolute evoked octet torque (50 ms after torque onset; +43, p < 0.001; ES = 3.07) were greater for LT-MST than UNT. However, relative (to MVT) explosive voluntary torque was lower for LT-MST than UNT from 100 to 150 ms after contraction onset (-11% to -16%; 0.001 ≤ p ≤ 0.002; 0.98 ≤ ES ≤ 1.11). Relative evoked octet torque 50 ms after onset was lower (-10%; p < 0.001; ES = 1.14) and octet time to peak torque longer (+8%; p = 0.001; ES = 1.18) for LT-MST than UNT indicating slower contractile properties, independent from any differences in torque amplitude. The greater absolute explosive strength of the LT-MST group was attributable to higher evoked explosive strength, that in turn appeared to be due to larger quadriceps muscle size, rather than any differences in neuromuscular activation. In contrast, the inferior relative explosive strength of LT-MST appeared to be underpinned by slower intrinsic/evoked contractile properties.

Fast and ballistic contractions involve greater neuromuscular power production in older adults during resistance exercise.

PURPOSE: Neuromuscular power is critical for healthy ageing. Conventional older adult resistance training (RT) guidelines typically recommend lifting slowly (2-s; CONV), whereas fast/explosive contractions performed either non-ballistically (FAST-NB) or ballistically (FAST-B, attempting to throw the load) may involve greater acute power production, and could ultimately provide a greater chronic power adaptation stimulus. To compare the neuromechanics (power, force, velocity, and muscle activation) of different types of concentric isoinertial RT contractions in older adults. METHODS: Twelve active older adult males completed three sessions, each randomly assigned to one type of concentric contraction (CONV or FAST-NB or FAST-B). Each session involved lifting a range of loads (20-80%1RM) using an instrumented isoinertial leg press dynamometer that measured power, force, and velocity. Muscle activation was assessed with surface electromyography (sEMG). RESULTS: Peak and mean power were markedly different, according to the concentric contraction explosive intent FAST-B > FAST-NB > CONV, with FAST-B producing substantially more power (+ 49 to 1172%, P ≤ 0.023), force (+ 10 to 136%, P < 0.05) and velocity (+ 55 to 483%, P ≤ 0.025) than CONV and FAST-NB contractions. Knee and hip extensor sEMG were typically higher during FAST-B than CON (all P < 0.02) and FAST-NB (≤ 50%1RM, P ≤ 0.001). CONCLUSIONS: FAST-B contractions produced markedly greater power, force, velocity and muscle activation across a range of loads than both CONV or FAST-NB and could provide a more potent RT stimulus for the chronic development of older adult power.

Overreaching and overtraining in strength sports and resistance training: A scoping review.

To date, little is known about overreaching (OR) and the overtraining syndrome (OTS) in strength sports and resistance training (RT) populations. However, the available literature may elucidate the occurrence of both conditions in these populations. A scoping review was conducted. SPORTDiscus, Scopus and Web of Science were searched in a robust and systematic manner, with relevant articles analysed. 1170 records were retrieved during an initial search, with a total of 47 included in the review. Two broad themes were identified during data extraction: 1) overreaching in strength sports; 2) overreaching and overtraining syndrome in RT. Short-term periods of OR achieved with either high-volume or high-intensity RT can elicit functional OR (FOR) but there is also evidence that chronic high-volume and/or intensity RT can lead to non-functional overreaching (NFOR). There is minimal evidence to suggest that true OTS has occurred in strength sports or RT based on the studies entered during this review. More research is needed to develop robust guiding principles for practitioners. Additionally, due to the heterogeneous nature of the existing literature, future research would benefit from the development of practical tools to identify and diagnose the transition from FOR to NFOR, and subsequently OTS in strength athletes and RT populations. ABBREVIATIONS: RT: Resistance training; OR: Overreaching; FOR: Functional overreaching; NFOR: Non-functional overreaching; OTS: Overtraining syndrome; WP: Weightlifting performance.

Neural adaptations after 4 years vs 12 weeks of resistance training vs untrained.

The purpose of this study was to compare the effect of resistance training (RT) duration, including years of exposure, on agonist and antagonist neuromuscular activation throughout the knee extension voluntary torque range. Fifty-seven healthy men (untrained [UNT] n = 29, short-term RT [12WK] n = 14, and long-term RT [4YR] n = 14) performed maximum and sub-maximum (20%-80% maximum voluntary torque [MVT]) unilateral isometric knee extension contractions with torque, agonist and antagonist surface EMG recorded. Agonist EMG, including at MVT, was corrected for the confounding effects of adiposity (ie, muscle-electrode distance; measured with ultrasonography). Quadriceps maximum anatomical cross-sectional area (QACSAMAX ; via MRI) was also assessed. MVT was distinct for all three groups (4YR +60/+39% vs UNT/12WK; 12WK +15% vs UNT; 0.001 < P ≤ 0.021), and QACSAMAX was greater for 4YR (+50/+42% vs UNT/12WK; [both] P < 0.001). Agonist EMG at MVT was +44/+33% greater for 4YR /12WK ([both] P < 0.001) vs. UNT, but did not differ between RT groups. The torque-agonist EMG relationship of 4YR displayed a right/down shift with lower agonist EMG at the highest common torque (196 Nm) compared to 12WK and UNT (0.005 ≤ P ≤ 0.013; Effect size [ES] 0.90 ≤ ES ≤ 1.28). The torque-antagonist EMG relationship displayed a lower slope with increasing RT duration (4YR < 12WK < UNT; 0.001 < P ≤ 0.094; 0.56 ≤ ES ≤ 1.31), and antagonist EMG at the highest common torque was also lower for 4YR than UNT (-69%; P < 0.001; ES = 1.18). In conclusion, 4YR and 12WK had similar agonist activation at MVT and this adaptation may be maximized during early months of RT. In contrast, inter-muscular coordination, specifically antagonist coactivation was progressively lower, and likely continues to adapt, with prolonged RT.

Biceps femoris long head muscle fascicle length does not differ between sexes.

Hamstring strain injury (HSI) rates are higher for males vs. females. This cross-sectional study investigated if inherent differences in biceps femoris long head (BFLH) fascicle length (Lf) exist between recreationally active males and females (i.e., individuals without specific training practice history). Twenty-four young healthy participants (12 males; 12 females) had their BFLH muscle architecture (Lf, pennation angle [θp], and muscle thickness [MT]) measured using B-mode ultrasonography. Eccentric and isometric knee flexion strength were also assessed. BFLH Lf did not differ between sexes when expressed in absolute terms (males, 81.5 ± 14.7 mm; females, 73.6 ± 15.9 mm, P = 0.220, effect size (ES) = 0.52) or relative to femur length (0.140 ≤ P ≤ 0.220, ES = 0.63). Similarly, BFLH θp did not differ between sexes (P = 0.650) but BFLH MT was 18.9% larger for males vs. females (P = 0.024, ES = 0.99). Isometric and eccentric knee flexion strength was greater for males vs. females in absolute terms ([both] P < 0.001, 2.00 ≤ ES ≤ 2.27) and relative to body mass ([both] P < 0.001, 1.93 ≤ ES ≤ 2.13). In conclusion, factors other than BFLH Lf seem likely to be implicated in higher male vs. female HSI rates.

The influence of patellar tendon and muscle-tendon unit stiffness on quadriceps explosive strength in man.

NEW FINDINGS: What is the central question of this study? Do tendon and/or muscle-tendon unit stiffness influence rate of torque development? What is the main finding and its importance? In our experimental conditions, some measures of relative (to maximal voluntary torque and tissue length) muscle-tendon unit stiffness had small correlations with voluntary/evoked rate of torque development over matching torque increments. However, absolute and relative tendon stiffness were unrelated to voluntary and evoked rate of torque development. Therefore, the muscle aponeurosis but not free tendon influences the relative rate of torque development. Factors other than tissue stiffness more strongly determine the absolute rate of torque development. The influence of musculotendinous tissue stiffness on contractile rate of torque development (RTD) remains opaque. In this study, we examined the relationships between both patellar tendon (PT) and vastus lateralis muscle-tendon unit (MTU) stiffness and the voluntary and evoked knee-extension RTD. Fifty-two healthy untrained men completed duplicate laboratory sessions. Absolute and relative RTD were measured at 50 N m or 25% maximal voluntary torque (MVT) increments from onset and sequentially during explosive voluntary and evoked octet isometric contractions (supramaximal stimulation; eight pulses at 300 Hz). Isometric MVT was also assessed. Patellar tendon and MTU stiffness were derived from simultaneous force and ultrasound recordings of the PT and vastus lateralis aponeurosis during constant RTD ramp contractions. Absolute and relative (to MVT and resting tissue length) stiffness (k) was measured over identical torque increments as RTD. Pearson's correlations tested relationships between stiffness and RTD measurements over matching absolute/relative torque increments. Absolute and relative PT k were unrelated to equivalent voluntary/evoked (r = 0.020-0.255, P = 0.069-0.891). Absolute MTU k was unrelated to voluntary or evoked RTD (r ≤ 0.191, P ≥ 0.184), but some measures of relative MTU k were related to relative voluntary/evoked RTD (e.g. RTD for 25-50% MVT, r = 0.374/0.353, P = 0.007/0.014). In conclusion, relative MTU k explained a small proportion of the variance in relative voluntary and evoked RTD (both ≤19%), despite no association of absolute MTU k or absolute/relative PT k with equivalent RTD measures. Therefore, the muscle-aponeurosis component but not free tendon was associated with relative RTD, although it seems that an overriding influence of MVT negated any relationship of absolute MTU k and absolute RTD.

Changes in agonist neural drive, hypertrophy and pre-training strength all contribute to the individual strength gains after resistance training.

PURPOSE: Whilst neural and morphological adaptations following resistance training (RT) have been investigated extensively at a group level, relatively little is known about the contribution of specific physiological mechanisms, or pre-training strength, to the individual changes in strength following training. This study investigated the contribution of multiple underpinning neural [agonist EMG (QEMGMVT), antagonist EMG (HEMGANTAG)] and morphological variables [total quadriceps volume (QUADSVOL), and muscle fascicle pennation angle (QUADSθ p)], as well as pre-training strength, to the individual changes in strength after 12 weeks of knee extensor RT. METHODS: Twenty-eight healthy young men completed 12 weeks of isometric knee extensor RT (3/week). Isometric maximum voluntary torque (MVT) was assessed pre- and post-RT, as were simultaneous neural drive to the agonist (QEMGMVT) and antagonist (HEMGANTAG). In addition QUADSVOL was determined with MRI and QUADSθ p with B-mode ultrasound. RESULTS: Percentage changes (∆) in MVT were correlated to ∆QEMGMVT (r = 0.576, P = 0.001), ∆QUADSVOL (r = 0.461, P = 0.014), and pre-training MVT (r = -0.429, P = 0.023), but not ∆HEMGANTAG (r = 0.298, P = 0.123) or ∆QUADSθ p (r = -0.207, P = 0.291). Multiple regression analysis revealed 59.9% of the total variance in ∆MVT after RT to be explained by ∆QEMGMVT (30.6%), ∆QUADSVOL (18.7%), and pre-training MVT (10.6%). CONCLUSIONS: Changes in agonist neural drive, quadriceps muscle volume and pre-training strength combined to explain the majority of the variance in strength changes after knee extensor RT (~60%) and adaptations in agonist neural drive were the most important single predictor during this short-term intervention.

Age-Related Loss of Muscle Mass, Strength, and Power and Their Association With Mobility in Recreationally-Active Older Adults in the United Kingdom.

To investigate reasons for the age-related reduction in physical function, we determined the relationships between muscle size, strength, and power with 6-min walk distance (6MWD) and timed up-and-go performance in 49 young (23 ± 3.1 years) and 66 healthy, mobile older adults (72 ± 5 years). While muscle mass, determined by DXA and MRI, did not correlate with performance in the older adults, power per body mass, determined from a countermovement jump, did correlate. The 40% lower jumping power observed in older adults (p < .05) was due to a lower take-off velocity, which explained 34% and 42% of the variance in 6MWD in older women and men, respectively (p < .01). The lower velocity was partly attributable to the higher body mass to maximal force ratio, but most was due to a lower intrinsic muscle speed. While changes in muscle function explain part of the age-related reduction in functional performance, ~60% of the deficit remains to be explained.

Knee extensor fatigue resistance of young and older men and women performing sustained and brief intermittent isometric contractions.

INTRODUCTION: Susceptibility to muscle fatigue during aging could depend on muscle activation patterns. METHODS: Young (mean age, 22 years) and older (mean age 70 years) men and women completed two fatigue tests of knee extensor muscles using voluntary and electrically stimulated contractions. RESULTS: Older subjects displayed a shift to the left of the torque-frequency relationship and held a sustained voluntary isometric contraction at 50% maximal strength for significantly longer than young (P < 0.001). Young and old showed similar fatigue during electrically induced, intermittent isometric contractions (1-s on, 1-s off for 2 min), but women fatigued less than men (P = 0.001). Stronger muscles fatigued more quickly, and slower contractile properties were associated with longer sustained contractions. CONCLUSIONS: The slowing and weakness of older muscle was associated with superior fatigue resistance during sustained isometric contractions. Young and old showed similar fatigue following a series of brief, intermittent contractions, but women fatigued less than men.

Physiological and functional evaluation of healthy young and older men and women: design of the European MyoAge study.

Within the European multi-centre MyoAge project, one workpackage was designed to investigate the contribution of age-related changes to muscle mass, contractile characteristics and neural control in relation to reductions in mobility in older age. The methodology has been described here. Test centres were located in Manchester, UK; Paris, France; Leiden, The Netherlands; Tartu, Estonia and Jyväskylä, Finland. In total, 182 young (18-30 years old, 52.2 % female) and 322 older adults (69-81 years old, 50 % female) have been examined. The participants were independent living, socially active and free from disease that impaired mobility levels. The older participants were selected based on physical activity levels, such that half exceeded current recommended physical activity levels and the other half had lower physical activity levels than is recommended to maintain health. Measurements consisted of blood pressure; anthropometry and body composition (dual-energy X-ray absorptiometry and magnetic resonance imaging); lung function; standing balance and cognitive function (CANTAB). Mobility was assessed using the Timed Up and Go, a 6 min walk, activity questionnaires and accelerometers to monitor habitual daily activities. Muscle strength, power, fatigue and neural activation were assessed using a combination of voluntary and electrically stimulated contractions. Fasting blood samples and skeletal muscle biopsies were collected for detailed examination of cell and molecular differences between young and older individuals. The results from this study will provide a detailed insight into "normal, healthy" ageing, linking whole-body function to the structure and function of the neuromuscular system and the molecular characteristics of skeletal muscle.

The effect of specific bioactive collagen peptides on function and muscle remodeling during human resistance training.

AIM: Bioactive collagen peptides (CP) have been suggested to augment the functional, structural (size and architecture), and contractile adaptations of skeletal muscle to resistance training (RT), but with limited evidence. This study aimed to determine if CP vs. placebo (PLA) supplementation enhanced the functional and underpinning structural, and contractile adaptations after 15 weeks of lower body RT. METHODS: Young healthy males were randomized to consume either 15 g of CP (n = 19) or PLA (n = 20) once every day during a standardized program of progressive knee extensor, knee flexor, and hip extensor RT 3 times/wk. Measurements pre- and post-RT included: knee extensor and flexor isometric strength; quadriceps, hamstrings, and gluteus maximus volume with MRI; evoked twitch contractions, 1RM lifting strength, and architecture (with ultrasound) of the quadriceps. RESULTS: Percentage changes in maximum strength (isometric or 1RM) did not differ between-groups (0.684 ≤ p ≤ 0.929). Increases in muscle volume were greater (quadriceps 15.2% vs. 10.3%; vastus medialis (VM) 15.6% vs. 9.7%; total muscle volume 15.7% vs. 11.4%; [all] p ≤ 0.032) or tended to be greater (hamstring 16.5% vs. 12.8%; gluteus maximus 16.6% vs. 12.9%; 0.089 ≤ p ≤ 0.091) for CP vs. PLA. There were also greater increases in twitch peak torque (22.3% vs. 12.3%; p = 0.038) and angle of pennation of the VM (16.8% vs. 5.8%, p = 0.046), but not other muscles, for CP vs. PLA. CONCLUSIONS: CP supplementation produced a cluster of consistent effects indicating greater skeletal muscle remodeling with RT compared to PLA. Notably, CP supplementation amplified the quadriceps and total muscle volume increases induced by RT.

The Effect of Specific Bioactive Collagen Peptides on Tendon Remodeling during 15 wk of Lower Body Resistance Training.

PURPOSE: Collagen peptide supplementation has been reported to enhance synthesis rates or growth in a range of musculoskeletal tissues and could enhance tendinous tissue adaptations to resistance training (RT). This double-blind placebo-controlled study aimed to determine if tendinous tissue adaptations, size (patellar tendon cross-sectional area (CSA) and vastus lateralis (VL) aponeurosis area), and mechanical properties (patellar tendon), after 15 wk of RT, could be augmented with collagen peptide (CP) versus placebo (PLA) supplementation. METHODS: Young healthy recreationally active men were randomized to consume either 15 g of CP ( n = 19) or PLA ( n = 20) once every day during a standardized program of lower-body RT (3 times a week). Measurements pre- and post-RT included patellar tendon CSA and VL aponeurosis area (via magnetic resonance imaging), and patellar tendon mechanical properties during isometric knee extension ramp contractions. RESULTS: No between-group differences were detected for any of the tendinous tissue adaptations to RT (ANOVA group-time, 0.365 ≤ P ≤ 0.877). There were within-group increases in VL aponeurosis area (CP, +10.0%; PLA, +9.4%), patellar tendon stiffness (CP, +17.3%; PLA, +20.9%) and Young's modulus (CP, +17.8%; PLA, +20.6%) in both groups (paired t -tests (all), P ≤ 0.007). There were also within-group decreases in patellar tendon elongation (CP, -10.8%; PLA, -9.6%) and strain (CP, -10.6%; PLA, -8.9%) in both groups (paired t -tests (all), P ≤ 0.006). Although no within-group changes in patellar tendon CSA (mean or regional) occurred for CP or PLA, a modest overall time effect ( n = 39) was observed for mean (+1.4%) and proximal region (+2.4%) patellar tendon CSA (ANOVA, 0.017 ≤ P ≤ 0.048). CONCLUSIONS: In conclusion, CP supplementation did not enhance RT-induced tendinous tissue remodeling (either size or mechanical properties) compared with PLA within a population of healthy young men.

Comparative Perceptual, Affective, and Cardiovascular Responses between Resistance Exercise with and without Blood Flow Restriction in Older Adults.

Older adults and patients with chronic disease presenting with muscle weakness or musculoskeletal disorders may benefit from low-load resistance exercise (LLRE) with blood flow restriction (BFR). LLRE-BFR has been shown to increase muscle size, strength, and endurance comparable to traditional resistance exercise but without the use of heavy loads. However, potential negative effects from LLRE-BFR present as a barrier to participation and limit its wider use. This study examined the perceptual, affective, and cardiovascular responses to a bout of LLRE-BFR and compared the responses to LLRE and moderate-load resistance exercise (MLRE). Twenty older adults (64.3 ± 4.2 years) performed LLRE-BFR, LLRE and MLRE consisting of 4 sets of leg press and knee extension, in a randomised crossover design. LLRE-BFR was more demanding than LLRE and MLRE through increased pain (p ≤ 0.024, d = 0.8-1.4) and reduced affect (p ≤ 0.048, d = -0.5--0.9). Despite this, LLRE-BFR was enjoyed and promoted a positive affective response (p ≤ 0.035, d = 0.5-0.9) following exercise comparable to MLRE. This study supports the use of LLRE-BFR for older adults and encourages future research to examine the safety, acceptability, and efficacy of LLRE-BFR in patients with chronic disease.

COVID-19 patients require multi-disciplinary rehabilitation approaches to address persisting symptom profiles and restore pre-COVID quality of life.

BACKGROUND: Long-COVID diagnosis is prominent, and our attention must support those experiencing debilitating and long-standing symptoms. To establish patient pathways, we must consider the societal and economic impacts of sustained COVID-19. Accordingly, we sought to determine the pertinent areas impacting quality of life (QoL) following a COVID-19 infection. RESEARCH METHODS: Three hundred and eighty-one participants completed a web-based survey (83% female, 17% male) consisting of 70 questions across 7 sections (demographics, COVID-19 symptoms; QoL; sleep quality; breathlessness; physical activity and mental health). Mean age, height, body mass and body mass index (BMI) were 42 ± 12 years, 167.6 ± 10.4 cm, 81.2 ± 22.2 kg, and 29.1 ± 8.4 kg.m2, respectively. RESULTS: Participant health was reduced because of COVID-19 symptoms ('Good health' to 'Poor health' [P < 0.001]). Survey respondents who work reported ongoing issues with performing moderate (83%) and vigorous (79%) work-related activities. CONCLUSIONS: COVID-19 patients report reduced capacity to participate in activities associated with daily life, including employment activities. Bespoke COVID-19 support pathways must consider multi-disciplinary approaches that address the holistic needs of patients to restore pre-pandemic quality of life and address experienced health and wellbeing challenges.Plain Language Summary: The long-term impact of long-COVID has a dramatic impact upon daily activities and lifestyle. The development of bespoke support pathways to support patients must address the physical and psychological considerations to adequately restore pre-COVID quality of life and address broader societal and economic implications, especially for those that are of working age.

The Human Muscle Size and Strength Relationship: Effects of Architecture, Muscle Force, and Measurement Location.

PURPOSE: This study aimed to determine the best muscle size index of muscle strength by establishing if incorporating muscle architecture measurements improved the human muscle size-strength relationship. The influence of calculating muscle force and the location of anatomical cross-sectional area (ACSA) measurements on this relationship were also examined. METHODS: Fifty-two recreationally active men completed unilateral isometric knee extension strength assessments and magnetic resonance imaging scans of the dominant thigh and knee to determine quadriceps femoris size variables (ACSA along the length of the femur, maximum ACSA (ACSAMAX), and volume (VOL)) and patellar tendon moment arm. Ultrasound images (two sites per constituent muscle) were analyzed to quantify muscle architecture (fascicle length, pennation angle) and, when combined with VOL (from magnetic resonance imaging), facilitated calculation of quadriceps femoris effective PCSA (EFFPCSA) as potentially the best muscle size determinant of strength. Muscle force was calculated by dividing maximum voluntary torque by the moment arm and addition of antagonist torque (derived from hamstring EMG). RESULTS: The associations of EFFPCSA (r = 0.685), ACSAMAX (r = 0.697), or VOL (r = 0.773) with strength did not differ, although qualitatively VOL explained 59.8% of the variance in strength, ~11%-13% greater than EFFPCSA or ACSAMAX. All muscle size variables had weaker associations with muscle force than maximum voluntary torque. The association of strength-ACSA at 65% of femur length (r = 0.719) was greater than for ACSA measured between 10%-55% and 75%-90% (r = -0.042-0.633) of femur length. CONCLUSIONS: In conclusion, using contemporary methods to assess muscle architecture and calculate EFFPCSA did not enhance the muscle strength-size association. For understanding/monitoring muscle size, the major determinant of strength, these findings support the assessment of muscle volume, which is independent of architecture measurements and was most highly correlated with strength.

Neural adaptations to long-term resistance training: evidence for the confounding effect of muscle size on the interpretation of surface electromyography.

This study compared elbow flexor (EF; experiment 1) and knee extensor (KE; experiment 2) maximal compound action potential (Mmax) amplitude between long-term resistance trained (LTRT; n = 15 and n = 14, 6 ± 3 and 4 ± 1 yr of training) and untrained (UT; n = 14 and n = 49) men, and examined the effect of normalizing electromyography (EMG) during maximal voluntary torque (MVT) production to Mmax amplitude on differences between LTRT and UT. EMG was recorded from multiple sites and muscles of EF and KE, Mmax was evoked with percutaneous nerve stimulation, and muscle size was assessed with ultrasonography (thickness, EF) and magnetic resonance imaging (cross-sectional area, KE). Muscle-electrode distance (MED) was measured to account for the effect of adipose tissue on EMG and Mmax. LTRT displayed greater MVT (+66%-71%, P < 0.001), muscle size (+54%-56%, P < 0.001), and Mmax amplitudes (+29%-60%, P ≤ 0.010) even when corrected for MED (P ≤ 0.045). Mmax was associated with the size of both muscle groups (r ≥ 0.466, P ≤ 0.011). Compared with UT, LTRT had higher absolute voluntary EMG amplitude for the KE (P < 0.001), but not the EF (P = 0.195), and these differences/similarities were maintained after correction for MED; however, Mmax normalization resulted in no differences between LTRT and UT for any muscle and/or muscle group (P ≥ 0.652). The positive association between Mmax and muscle size, and no differences when accounting for peripheral electrophysiological properties (EMG/Mmax), indicates the greater absolute voluntary EMG amplitude of LTRT might be confounded by muscle morphology, rather than providing a discrete measure of central neural activity. This study therefore suggests limited agonist neural adaptation after LTRT.NEW & NOTEWORTHY In a large sample of long-term resistance-trained individuals, we showed greater maximal M-wave amplitude of the elbow flexors and knee extensors compared with untrained individuals, which appears to be at least partially mediated by differences in muscle size. The lack of group differences in voluntary EMG amplitude when normalized to maximal M-wave suggests that differences in muscle morphology might impair interpretation of voluntary EMG as an index of central neural activity.