Physiological and perceptual responses to acute arm cranking with blood flow restriction.

INTRODUCTION: Lower-body aerobic exercise with blood flow restriction (BFR) offers a unique approach for stimulating improvements in muscular function and aerobic capacity. While there are more than 40 reports documenting acute and chronic responses to lower-body aerobic exercise with BFR, responses to upper-body aerobic exercise with BFR are not clearly established. PURPOSE: We evaluated acute physiological and perceptual responses to arm cranking with and without BFR. METHODS: Participants (N = 10) completed 4 arm cranking (6 × 2 min exercise, 1 min recovery) conditions: low-intensity at 40%VO2peak (LI), low-intensity at 40%VO2peak with BFR at 50% of arterial occlusion pressure (BFR50), low-intensity at 40%VO2peak with BFR at 70% of arterial occlusion pressure (BFR70), and high-intensity at 80%VO2peak (HI) while tissue oxygenation, cardiorespiratory, and perceptual responses were assessed. RESULTS: During exercise, tissue saturation for BFR50 (54 ± 6%), BFR70 (55 ± 6%), and HI (54 ± 8%) decreased compared to LI (61 ± 5%, all P < 0.01) and changes in deoxyhemoglobin for BFR50 (11 ± 4), BFR70 (15 ± 6), and HI (16 ± 10) increased compared to LI (4 ± 2, all P < 0.01). During recovery intervals, tissue saturation for BFR50 and BFR70 decreased further and deoxyhemoglobin for BFR50 and BFR70 increased further (all P < 0.04). Heart rate for BFR70 and HI increased by 9 ± 9 and 50 ± 15b/min, respectively, compared to LI (both P < 0.02). BFR50 (8 ± 2, 1.0 ± 1.0) and BFR70 (10 ± 2, 2.1 ± 1.4) elicited greater arm-specific perceived exertion (6-20 scale) and pain (0-10 scale) compared to LI (7 ± 1, 0.2 ± 0.5, all P < 0.05) and pain for BFR70 did not differ from HI (1.7 ± 1.9). CONCLUSION: Arm cranking with BFR decreased tissue saturation and increased deoxyhemoglobin without causing excessive cardiorespiratory strain and pain.

Development of a prediction equation to estimate lower-limb arterial occlusion pressure with a thigh sphygmomanometer.

INTRODUCTION: Previous investigators have developed prediction equations to estimate arterial occlusion pressure (AOP) for blood flow restriction (BFR) exercise. Most equations have not been validated and are designed for use with expensive cuff systems. Thus, their implementation is limited for practitioners. PURPOSE: To develop and validate an equation to predict AOP in the lower limbs when applying an 18 cm wide thigh sphygmomanometer (SPHYG18cm). METHODS: Healthy adults (n = 143) underwent measures of thigh circumference (TC), skinfold thickness (ST), and estimated muscle cross-sectional area (CSA) along with brachial and femoral systolic (SBP) and diastolic (DBP) blood pressure. Lower-limb AOP was assessed in a seated position at the posterior tibial artery (Doppler ultrasound) using a SPHYG18cm. Hierarchical linear regression models were used to determine predictors of AOP. The best set of predictors was used to construct a prediction equation to estimate AOP. Performance of the equation was evaluated and internally validated using bootstrap resampling. RESULTS: Models containing measures of either TC or thigh composition (ST and CSA) paired with brachial blood pressures explained the most variability in AOP (54%) with brachial SBP accounting for majority of explained variability. A prediction equation including TC, brachial SBP, and age showed good predictability (R2 = 0.54, RMSE = 7.18 mmHg) and excellent calibration. Mean difference between observed and predicted values was 0.0 mmHg and 95% Limits of Agreement were ± 18.35 mmHg. Internal validation revealed small differences between apparent and optimism adjusted performance measures, suggesting good generalizability. CONCLUSION: This prediction equation for use with a SPHYG18cm provided a valid way to estimate lower-limb AOP without expensive equipment.

Impact of health behaviors on community well-being and resilience: teaching K-12 students with Jenga!

We developed a hands-on activity using the game Jenga to demonstrate the links between health behaviors, chronic and infectious diseases, and community well-being and resilience. For the activity, K-12 students worked together in small teams (4-8 students) and were given two Jenga towers (tower A and tower B), each representing a community of individuals. The goal was to keep both towers standing. Teams were presented with strips of paper labeled with either a "health behavior" (e.g., nutrition, body weight maintenance, physical activity) or a "disease" (e.g., heart disease, diabetes, COVID-19) and instructions on whether to add or remove blocks from each tower. When presented with a health behavior, students added blocks to tower A for positive health behaviors (e.g., not smoking) and removed blocks from tower B for negative health behaviors (e.g., smoking). When a disease was presented students removed blocks from both towers, but fewer blocks were removed from tower A compared with tower B, demonstrating lower disease rates or severity in that community. As the activity progressed, tower A retained more blocks than tower B. For the finale, students observed that the greater strength and stability of tower A allowed it to withstand a simulated natural disaster such as an earthquake better than tower B. This activity was delivered to 15 science classes and 225 students ranging from 6th to 12th grade. Students were able to describe the connections between positive health behaviors and lower rates of disease and how, taken together, these impact community health, well-being, and resilience.NEW & NOTEWORTHY We describe how K-12 students played Jenga to learn about the connections between health living habits, disease, and community well-being and resilience.

Knee extension with blood flow restriction: Impact of cuff pressure on hemodynamics.

INTRODUCTION: Blood flow restriction (BFR) exercise has emerged as a method of increasing muscle size and strength with low intensity resistance training. While the cuff pressures used during BFR are typically a percentage of resting arterial occlusion pressure (AOP), the impact these cuff pressures have on blood flow during lower body exercise is unknown. PURPOSE: To determine how various cuff pressures impact blood flow and tissue perfusion during exercise. METHODS: Eleven healthy male participants completed four sets of knee extension (30 reps per set at 30% max torque) with 0%, 60%, 80%, and 100% of arterial occlusion pressure (AOP) was applied to the proximal portion of the thigh. Femoral artery blood flow, tissue oxygenation, and central hemodynamics were continuously recorded before, during, and after exercise. Electromyography (EMG) amplitude was recorded from the vastus lateralis during exercise. RESULTS: Blood flow increased during exercise compared to rest across all cuff pressures (p < 0.001), however compared to 0%, the absolute blood flow was reduced by 34 ± 17%, 45 ± 22%, and 72 ± 19% for 60, 80, and 100% AOP, respectively. Furthermore, each cuff pressure resulted in similar relative changes in blood flow before, during, and after exercise. During exercise, tissue saturation index (TSI) decreased as cuff pressure increased (p ≤ 0.005) with the exception of 80 to 100% AOP. Deoxyhemoglobin increased (p ≤ 0.001) with cuff pressure. CONCLUSION: Our data indicate that while BFR knee extension elicits an absolute hyperemic response at cuff pressures up to 100% resting AOP, the relative reductions in blood flow are consistent across rest, exercise and recovery.

Moving student research forward during the COVID-19 pandemic.

The COVID--19 pandemic has impacted undergraduate and graduate student research. With the uncertainty right now, it is a challenge for faculty to offer clear guidance for how students can proceed with their research and capstone projects. In this brief editorial, we offer suggestions for moving student research forward during the COVID-19 pandemic.

Developing a science outreach program and promoting "PhUn" all year with rural K-12 students.

Demonstrating how science relates to human health is an important step for generating K-12 student interest in health-related careers. Science outreach is often performed in urban areas; however, ~20% of K-12 schools are in rural areas. Michigan Technological University is located in Michigan's upper peninsula, which accounts for 30% of the state's land mass but only 3% of the total population. Our goal was to create a science outreach program for reaching K-12 students in our rural region. We assembled a team of undergraduate and graduate students, staff, and faculty to implement science outreach with K-12 students. Specifically, we leveraged existing national and international science outreach events [Physiology Friday, Physiology Understanding (PhUn) Week, National Biomechanics Day] to offer hands-on physiology and biomechanics activities during the year. Between 2016 and 2019, we connected with 31 K-12 schools and impacted 327 elementary (19%), 351 middle school (21%), and 1,018 high school (60%) students (total impact 1,696). Over 90% of the outreach visits took place at the K-12 schools. The hands-on activities were delivered by more than 85 undergraduate and graduate students and 10 faculty. Together, the supportive culture and resources within the department (e.g., outreach coordinator, participation from students and faculty, grant funding) were key to developing the program. We recommend starting with a single outreach event, working as a team, and being flexible with K-12 schools. The program also provided service-learning and professional development opportunities for undergraduate and graduate students and faculty. Our robust science outreach program promoted "PhUn" all year-round with rural K-12 students.

Eccentric Arm Cycling: A Potential Exercise for Wheelchair Users.

OBJECTIVE: To compare metabolic, cardiorespiratory, and perceptual responses to acute eccentric and traditional concentric arm cycling in a cohort of wheelchair users. DESIGN: Single-group repeated measures. SETTING: Exercise physiology laboratory. PARTICIPANTS: A convenience sample of 7 manual wheelchair users (45±15 y; 87±21 kg; 1.8±0.1 m; time in wheelchair 17±14 y) volunteered. INTERVENTIONS: Participants performed 5-minute trials of eccentric and concentric arm cycling at (1) isometabolic rate (35% of peak oxygen consumption) and (2) isopower output (80W). Exercise trials were performed on an eccentric/concentric arm cycle ergometer that integrated with a personal wheelchair. MAIN OUTCOME MEASURES: Primary measures included power output, oxygen consumption, heart rate, ventilation, blood lactate, and perceived exertion. Secondary measures assessed included perceived muscle soreness, likability, frequency of use, and duration of use. RESULTS: At isometabolic rate, power production during eccentric arm cycling was ∼3× greater than concentric arm cycling (80±36 vs 26±10 W; P<.01). When exercising at isopower output, oxygen consumption during eccentric arm cycling was ∼1/2 that of concentric arm cycling (0.66±0.15 vs 1.30±0.65 L/min; P=.03). Heart rate and perceived exertion were also substantially lower during eccentric arm cycling (both P<.05). Muscle soreness assessed 24-72 hours postexercise was minimal (<1.0 cm). Preference scores and anticipated frequency and duration of use did not differ between eccentric arm cycling and concentric arm cycling (all P>.05). CONCLUSION: Eccentric arm cycling provided a metabolically efficient (high-force, low-energy cost) and usable (wheelchair accessible, safe, likable) exercise for wheelchair users. Implementation of eccentric arm cycling with this population is promising but additional research is needed to confirm this possibility.

Limb blood flow and tissue perfusion during exercise with blood flow restriction.

INTRODUCTION: Exercise with blood flow restriction (BFR) is emerging as an effective modality for improving muscular function in clinical and athletic populations. Selection of cuff pressure is critical because it should maximize metabolic stress without completely occluding blood flow or compromising user safety. It is unknown how cuff pressures determined at rest influence blood flow hemodynamics during exercise. PURPOSE: We evaluated changes in blood flow and tissue perfusion before, during, and after exercise with BFR. METHODS: Ten males performed rhythmic handgrip exercise (30 contractions, 30% MVC) at 0%, 60%, 80%, 100%, and 120% of limb occlusion pressure (LOP). Brachial artery blood flow and tissue saturation were assessed using Doppler ultrasound and near-infrared spectroscopy, respectively. RESULTS: At rest blood flow generally decreased with increased pressure (0% > 60% ≈ 80% > 100% ≈ 120% LOP). During 60% and 80% LOP conditions, blood flow increased during exercise from rest and decreased after exercise (all P < 0.05). Compared to 0% LOP, relative blood flow at 60% and 80% LOP decreased by 22-47% at rest, 22-48% during exercise, and 52-71% after exercise (all P < 0.05). Increased LOP decreased tissue saturation during exercise with BFR (P < 0.05). Heart rate, mean arterial pressure, and cardiac output did not differ across LOP. CONCLUSION: At pressures below LOP the cardiovascular system overcame the external pressure and increased blood flow to exercising muscles. Relative reductions in blood flow at rest were similar to those during exercise. Thus, the relative occlusion measured at rest approximated the degree of occlusion during exercise. Moderate cuff pressures increased metabolic stress without completely occluding blood flow.

Exercise with Blood Flow Restriction to Improve Quadriceps Function Long After ACL Reconstruction.

Quadriceps atrophy and weakness can persist for years after anterior cruciate ligament reconstruction (ACLR). We evaluated the effectiveness of a home-based blood flow restriction (BFR) exercise program to increase quadriceps size and strength several years after ACLR. Nine adults with ACLR (5±2 yrs post-surgery, ≤90% symmetry in quadriceps size and strength) and nine uninjured controls volunteered. ACLR participants exercised at home for 25 min, 5×/wk for 4 wks (single-leg knee extension, bodyweight half-squats, walking). Blood flow in only the involved leg was restricted using a thigh cuff inflated to 50% of limb occlusion pressure. Rectus femoris and vastus lateralis thickness and knee extensor strength were measured before and after training. Baseline and post-training symmetry (involved leg/uninvolved leg) indices were compared to uninjured controls. Rectus femoris and vastus lateralis thickness and knee extensor strength in the involved leg increased by 11±5%, 10±6%, and 20±14%, respectively (all P<0.01). Compared to baseline, post-training knee extensor strength symmetry increased from 88±4 to 99±5% (P<0.01) and did not differ from uninjured controls (99±5%, P=0.95). Implementation of BFR exercise at home was feasible, safe and effective. Results extend upon early post-operative application of BFR exercise for ACLR recovery and demonstrate that BFR can improve quadriceps function long after ACLR.

An outside-the-box activity to demonstrate how humans and animals turn.

Developing hands-on activities that engage and excite K-12 students is critical for stimulating interest in science-based careers. We created an activity for high school students that required them to integrate biology and physics concepts to experience how humans and animals maneuver through their environments (i.e., turning). Understanding how turning works is important because it accounts for up to 50% of daily walking steps and is needed for survival when animals elude predators and capture prey. For this activity, student groups used 2 × 4 lumber, wood screws, and a power drill to build an apparatus that, when connected to the body, altered rotational inertia (object's resistance to change in angular motion, I = mass × radius2). Students navigated through a slalom course with the apparatus (increased radius and rotational inertia) and without the apparatus (mass-matched control). Times to complete the course were compared between trials to determine the influence of rotational inertia on turning performance. Students compiled their data, graphed their results, and found that increased rotational inertia decreased turning performance. Results were connected to sports, rehabilitation, and dinosaur evolution. This activity was implemented during local, regional, national, and international outreach events and adapted for use in undergraduate courses as well (total impact, 250 students). At the end of the activity, students were able to 1) describe whether their results supported their hypothesis; 2) explain how radius influences rotational inertia and turning performance; and 3) apply results to real-world examples. Students and teachers appreciated this "outside-the-box" activity with an engineering twist and found it entertaining.

Influence of the Lower Body on Seated Arm Cranking Performance.

During upper-body tasks, use of the lower body is important for minimizing physiological strain and maximizing performance. The lower body has an integral role during standing upper-body tasks, however, it is less clear if it is also important during seated upper-body tasks. We determined the extent to which the lower body influenced seated arm cranking performance. Eleven males performed incremental (40+20 W·3 min-1) and short-duration maximal effort (5 s, 120 rpm) arm cranking trials with and without lower-body restriction. The lower body was restricted by securing the legs to the seat and suspending them off the floor. Upper-body peak oxygen consumption (V̇O2peak) and maximal power were determined. At the end of the incremental protocol, lower-body restriction reduced V̇O2peak by 14±12% (P<0.01) compared to normal arm cranking. At greater submaximal stages (60-100% isotime) heart rate, ventilation, RER, and arm-specific exertion increased to a greater extent (all P<0.05) with lower-body restriction. During short duration maximal arm cranking, lower-body restriction decreased maximal power by 23±9% (P<0.01). Results indicated that lower-body restriction limited aerobic capacity, increased physiological strain during high-intensity submaximal exercise, and compromised maximal power generating capacity. These results imply that use of the lower body is critical when performing seated arm cranking. Our findings have implications for exercise testing, training and rehabilitation.

Chronic eccentric arm cycling improves maximum upper-body strength and power.

INTRODUCTION: Eccentric leg cycling (cycle ergometry adapted to impose muscle lengthening contractions) offers an effective exercise for restoring lower-body muscular function, maintaining health, and improving performance in clinical and athletic populations. PURPOSE: We extended this model to the upper body and evaluated the effectiveness of a 7-week eccentric arm cycling (ECCarm) intervention to improve upper-body muscular function. We also explored whether ECCarm would alter arterial function. METHODS: Participants performed ECCarm (n = 9) or concentric arm cycling (CONarm; n = 8) 3×/week while training intensity increased (5-20 min, 60-70% upper-body peak heart rate). Maximum elbow extensor strength, upper-body concentric power, and peripheral and central arterial stiffness were assessed before and after training. RESULTS: During training, heart rates and perceived exertion did not differ between groups (~68% upper-body peak heart rate, ~12 Borg units, both P > 0.05), whereas power during ECCarm was ~2× that for CONarm (122 ± 43 vs. 59 ± 20 W, P < 0.01). Muscle soreness for ECCarm was greater than CONarm (P = 0.02), however, soreness was minimal for both groups (<0.50 cm). Following training, ECCarm exhibited greater changes in elbow extensor strength (16 ± 10 vs. 1 ± 9%, P = 0.01) and upper-body power (6 ± 8 vs. -3 ± 7%, P < 0.01) compared to CONarm. Peripheral and central arterial stiffness did not change for either group (both P > 0.05). CONCLUSION: Upper-body eccentric exercise improved dynamic muscular function while training at low exertion levels. Results occurred with minimal soreness and without compromising arterial function. ECCarm findings parallel eccentric leg cycling findings and indicate that eccentric cycle ergometry offers a robust model for enhancing upper-body muscular function. ECCarm could have applications in rehabilitation and sport training.

Back to the future! Revisiting the physiological cost of negative work as a team-based activity for exercise physiology students.

We implemented a team-based activity in our exercise physiology teaching laboratory that was inspired from Abbott et al.'s classic 1952 Journal of Physiology paper titled "The physiological cost of negative work." Abbott et al. connected two bicycles via one chain. One person cycled forward (muscle shortening contractions, positive work) while the other resisted the reverse moving pedals (muscle lengthening contractions, negative work), and the cost of work was compared. This study was the first to link human whole body energetics with isolated muscle force-velocity characteristics. The laboratory activity for our students (n = 35) was designed to reenact Abbott et al.'s experiment, integrate previously learned techniques, and illustrate differences in physiological responses to muscle shortening and lengthening contractions. Students (11-12 students/laboratory section) were split into two teams (positive work vs. negative work). One student from each team volunteered to cycle against the other for ~10 min. The remaining students in each team were tasked with measuring: 1) O2 consumption, 2) heart rate, 3) blood lactate, and 4) perceived exertion. Students discovered that O2 consumption during negative work was about one-half that of positive work and all other physiological parameters were also substantially lower. Muscle lengthening contractions were discussed and applied to rehabilitation and sport training. The majority of students (>90%) agreed or strongly agreed that they stayed engaged during the activity and it improved their understanding of exercise physiology. All students recommended the activity be performed again. This activity was engaging, emphasized teamwork, yielded clear results, was well received, and preserved the history of classic physiological experiments.

Noncircular Chainrings Do Not Influence Maximum Cycling Power.

Noncircular chainrings could increase cycling power by prolonging the powerful leg extension/flexion phases, and curtailing the low-power transition phases. We compared maximal cycling power-pedaling rate relationships, and joint-specific kinematics and powers across 3 chainring eccentricities (CON = 1.0; LOWecc = 1.13; HIGHecc = 1.24). Part I: Thirteen cyclists performed maximal inertial-load cycling under 3 chainring conditions. Maximum cycling power and optimal pedaling rate were determined. Part II: Ten cyclists performed maximal isokinetic cycling (120 rpm) under the same 3 chainring conditions. Pedal and joint-specific powers were determined using pedal forces and limb kinematics. Neither maximal cycling power nor optimal pedaling rate differed across chainring conditions (all p > .05). Peak ankle angular velocity for HIGHecc was less than CON (p < .05), while knee and hip angular velocities were unaffected. Self-selected ankle joint-center trajectory was more eccentric than HIGHecc with an opposite orientation that increased velocity during extension/flexion and reduced velocity during transitions. Joint-specific powers did not differ across chainring conditions, with a small increase in power absorbed during ankle dorsiflexion with HIGHecc. Multiple degrees of freedom in the leg, crank, and pedal system allowed cyclists to manipulate ankle angular velocity to maintain their preferred knee and hip actions, suggesting maximizing extension/flexion and minimizing transition phases may be counterproductive for maximal power.