Use of Exercise Training to Enhance the Power-Duration Curve: A Systematic Review.

ABSTRACT: Hurd, KA, Surges, MP, and Farrell, JW. Use of exercise training to enhance the power-duration curve: a systematic review. J Strength Cond Res 37(3): 733-744, 2023-The power/velocity-duration curve consists of critical power (CP), the highest work rate at which a metabolic steady state can obtained, and W' (e.g., W prime), the finite amount of work that can be performed above CP. Significant associations between CP and performance during endurance sports have been reported resulting in CP becoming a primary outcome for enhancement following exercise training interventions. This review evaluated and summarized the effects of different exercise training methodologies for enhancing CP and respective analogs. A systematic review was conducted with the assistance of a university librarian and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ten studies met the criteria for inclusion and were reviewed. Four, 2, 2, 1, and 1 articles included swimming, cycling, resistance training, rowing, and running, respectively. Improvements in CP, and respective analogs, were reported in 3 swimming, 2 cycling, and 1 rowing intervention. In addition, only 2 cycling and 1 swimming intervention used CP, and respective analogs, as an index of intensity for prescribing exercise training, with one cycling and one swimming intervention reporting significant improvements in CP. Multiple exercise training modalities can be used to enhance the power/velocity-duration curve. Significant improvements in CP were often reported with no observed improvements in W' or with slight decreases. Training may need to be periodized in a manner that targets enhancements in either CP or W' but not simultaneously.

Current status of neuroprotective and neuroregenerative strategies in multiple sclerosis: A systematic review.

BACKGROUND: Immune-mediated demyelination and consequent degeneration of oligodendrocytes and axons are hallmark features of multiple sclerosis (MS). Remyelination declines in progressive MS, causing permanent axonal loss and irreversible disabilities. Strategies aimed at enhancing remyelination are critical to attenuate disease progression. OBJECTIVE: We systematically reviewed recent advances in neuroprotective and regenerative therapies for MS, covering preclinical and clinical studies. METHODS: We searched three biomedical databases using defined keywords. Two authors independently reviewed articles for inclusion based on pre-specified criteria. The data were extracted from each study and assessed for risk of bias. RESULTS: Our search identified 7351 studies from 2014 to 2020, of which 221 met the defined criteria. These studies reported 262 interventions, wherein 92% were evaluated in animal models. These interventions comprised protein, RNA, lipid and cellular biologics, small molecules, inorganic compounds, and dietary and physiological interventions. Small molecules were the most highly represented strategy, followed by antibody therapies and stem cell transplantation. CONCLUSION: While significant strides have been made to develop regenerative treatments for MS, the current evidence illustrates a skewed representation of the types of strategies that advance to clinical trials. Further examination is thus required to address current barriers to implementing experimental treatments in clinical settings.

Effects of Group Running on the Training Intensity Distribution of Collegiate Cross-Country Runners.

ABSTRACT: Farrell III, JW, Dunn, A, Cantrell, GS, Lantis, DJ, Larson, DJ, and Larson, RD. Effects of group running on the training intensity distribution of collegiate cross-country runners. J Strength Cond Res 35(10): 2862-2869, 2021-Collegiate cross-country training is often conducted and prescribed in a group setting. This may result in the application of an inappropriate training stimulus to athletes due to potentially different physiological responses to the same training prescription. The aim of this investigation was to quantify the training intensity distribution (TID) of a collegiate cross-country team and the associated physiological adaptions. Sixteen subjects, 8 male subjects and 8 female subjects, performed a graded exercise test before and after observational period to determine peak oxygen consumption (V̇o2peak), the speed (S@), heart rate (HR@), and oxygen consumption (V̇o2@) associated with 2 and 4 mmol·L-1 of blood lactate. Training intensity distribution was quantified by assessing time spent in 3 intensity zones calculated as zone 1 (low intensity, HR values HR@2 and HR@4). No statistical differences were observed between male subjects and female subjects for percent of training time spent in zones 1, 2, and 3. No significant interactions were observed between sex and time for performance variables. Male subjects and female subjects improved V̇o2peak, S@4, and V̇o2@4 with male subjects also increasing V̇o2@2. No significant differences were observed between male subjects and female subjects when comparing percent changes for variables. Examining individual data showed that 2 female subjects experienced performance decrements and trained proportionally more in zones 2 and 3 compared with the overall group. The TID and performance decrements of the 2 highlighted subjects suggest that conducting training in a group setting may potentially be detrimental for some collegiate runners.

Aerobic Exercise Supplemented With Muscular Endurance Training Improves Onset of Blood Lactate Accumulation.

Farrell III, JW, Lantis, DJ, Ade, CJ, Cantrell, GS, and Larson, RD. Aerobic exercise supplemented with muscular endurance training improves onset of blood lactate accumulation. J Strength Cond Res 32(5): 1376-1382, 2018-Studies have shown that when aerobic exercise is supplemented with muscular endurance training metabolic adaptions occur that result in the delay of the onset of blood lactate accumulation (OBLA). However, previous studies have not explored any submaximal cardiorespiratory adaptations that may result from this training protocol. The aim of the current investigation was to evaluate the effect of supplementing an aerobic exercise training program with a muscular endurance training program on various cardiorespiratory and metabolic measurements. Fourteen aerobically active men performed an incremental exercise test to determine the OBLA, gas exchange threshold (GET), and maximal oxygen uptake (V[Combining Dot Above]O2max). Maximal strength was measured using 1 repetition maximum (1RM) for leg press (LP), leg curl (LC), and leg extension (LE). Eight subjects supplemented their aerobic activity (experimental [EX] group) with 8 weeks of muscular endurance training, while 6 continued their regular aerobic activity (control [CON] group). No significant group differences were observed for all pretraining variables. After 8 weeks of training, no significant differences in body mass, GET, and V[Combining Dot Above]O2max were observed for either group. However, the EX group showed a significant improvement for both absolute and relative V[Combining Dot Above]O2 at OBLA compared with the CON group. Leg curl and LE 1RM assessments for the EX group showed a significant improvement compared with CON group. Muscular endurance training did not improve GET and V[Combining Dot Above]O2max, but significantly increased V[Combining Dot Above]O2 at OBLA, LP, and LC. These findings suggest that this training protocol maybe useful in the development of submaximal aerobic performance and leg strength for endurance athletes.

Eight Weeks of High-Volume Resistance Training Improves Onset of Blood Lactate in Trained Individuals.

Lantis, DJ, Farrell, JW, III, Cantrell, GS, and Larson, RD. Eight weeks of high volume resistance training improves onset of blood lactate in trained individuals. J Strength Cond Res 31(8): 2176-2182, 2017-The purpose of this study was to determine if onset of blood lactate (OBLA) using the fixed at 4 mmol·L method could be delayed by supplementing high-volume resistance training (HVRT) to existing endurance training programs. There were 20 male subjects who participated in the study; 11 experimental (EX) (22.8 ± 4.6 years) and 9 controls (CON) (23.2 ± 5.8 years). An incremental cycling test was performed to determine maximal oxygen uptake, OBLA, maximum power, and time to exhaustion. Additionally, strength of the leg press (LP), leg curl (LC), and leg extension (LE) was assessed in both groups. Participants continued their ongoing endurance training, whereas the EX group supplemented their training with HVRT twice weekly for 8 weeks, performing 4 sets of 15 repetitions of LP, LC, and LE. Change score (post-pre) analysis was measured, using t-tests to compare the differences between groups, to eliminate outside variables that may have affected testing performance. Significance was set at p ≤ 0.05. No significant group differences in baseline measures were observed. A significant difference was observed for OBLA at 4 mmol·L (EX: 18.17 ± 15.36 W and CON: -3.52 ± 20.13 W, p < 0.02). A significant difference was observed for LP (EX: 39.09 ± 25.87 kg and CON: 4.22 ± 34.65 kg, p < 0.02) and LC (EX: 22.84 ± 8.7 kg and CON: -1.47 ± 8.2 kg, p < 0.01). Supplementing HVRT in endurance-trained individuals delayed OBLA at 4 mmol·L and improved leg strength. The HVRT used in the current study may be a useful training style for endurance-trained individuals.

Intensity Distribution of Collegiate Cross-Country Competitions.

The primary purpose of the current investigation was to perform an intensity distribution analysis of a collegiate cross-country (CC) competition, with a secondary purpose to compare race times (RT) with modeled performance times (MPT). Participants completed an incremental treadmill test to determine gas exchange threshold (GET), while the three-minute all-out test was conducted on a 400 m outdoor track to determine critical velocity (CV) and D prime (D'). GET and CV were used as physiological markers for the intensity zones based on heart rate (HR) and running velocity (RV), while CV and D' were used to determine modeled performance times. Participants wore a Global Positioning System (GPS) watch and heart rate (HR) monitor during competition races. Statistically, less time was spent in HR Zone 1 (12.1% ± 13.7%) compared to Zones 2 (37.6% ± 30.2%) and 3 (50.3% ± 33.7%), while a statically greater amount of time was spent in RV Zone 2 (75.0% ± 20.7%) compared to Zones 1 (8.4% ± 14.0%) and 3 (16.7% ± 19.1%). RTs (1499.5 ± 248.5 seconds (s)) were statistically slower compared to MPTs (1359.6 ± 192.7 s). The observed differences in time spent in each zone are speculated to be related to the influence of environmental conditions on internal metrics and difference in the kinetics of HR and running velocity. Differences in RTs and MPTs are likely due to the MPT equation modeling all-out performance and not considering race strategies.

Acute Oxygen Consumption Response to Fast Start High-Intensity Intermittent Exercise.

The current investigation compared the acute oxygen consumption (VO2) response of two high-intensity interval exercises (HIIE), fast start (FSHIIE), and steady power (SPHIIE), which matched w prime (W') depletion. Eight cyclists completed an incremental max test and a three-minute all-out test (3MT) to determine maximal oxygen consumption (VO2max), critical power (CP), and W'. HIIE sessions consisted of 3 X 4 min intervals interspersed by 3 min of active recovery, with W' depleted by 60% (W'target) within each working interval. SPHIIE depleted the W'target consistently throughout the 3 min intervals, while FSHIIE depleted the W'target by 50% within the first minute, with the remaining 50% depleted evenly across the remainder of the interval. The paired samples t-test revealed no differences in the percentage of training time spent above 90% of VO2max (PT ≥ 90% VO2max) between SPHIIE and FSHIIE with an average of 25.20% and 26.07%, respectively. Pairwise comparisons indicated a difference between minute 1 peak VO2, minute 2, and minute 3, while no differences were present between minutes 2 and 3. The results suggest that when HIIE formats are matched based on W' expenditure, there are no differences in PT ≥ 90% VO2max or peak VO2 during each interval.

THE EFFECTS OF EXERCISE TRAINING ON UPPER EXTREMITY FUNCTION FOR PERSONS WITH MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW.

Objective: To evaluate the effects of exercise training on upper extremity physical function and physiological fitness outcomes in persons with multiple sclerosis (PwMS). Methods: A search of 3 electronic databases (EMBASE, CINAHL, and ovidMEDLINE) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The included studies were randomized control trials that reported at least one outcome measure related to upper extremity function, contained a component of exercise training, and included PwMS. Results: Of the 1381 articles retrieved from the electronic databases, 8 articles met the specific inclusion criteria. All the included articles incorporated strength training exercises into the rehabilitation intervention. Reported outcomes included the 9 Hole Peg Test (9HPT), Action Research Arm Test (ARAT), and Fugl-Meyer Assessment, with 3, 3, and 0 reporting significant improvements, respectively. Only grip strength was included as a physiological fitness outcome, with 2 articles reporting significant improvements. Conclusion: The results of this review suggest that strength training may elicit improvements in functional and physiological upper extremity outcomes for PwMS. Several limitations of the current review must be noted, including a limited number of studies and the combination of strength training with other rehabilitative modalities.

Effect of Functional Electrical Stimulation Cycling Exercise on Lower Limb Strength Asymmetry in Persons With Multiple Sclerosis.

Background: Lower limb strength asymmetry (ie, significant difference between contralateral limbs) has been associated with mobility impairment in persons with multiple sclerosis (MS). However, whether an adaptive exercise modality can be used to modify lower limb strength and potentially improve mobility is unclear. The effect of functional electrical stimulation (FES) cycling on lower limb strength asymmetry in persons with MS with mobility impairment was assessed, and the association between change in lower limb strength asymmetries and changes in functional and self-reported mobility outcomes was explored. Methods: Eight adults with MS (Expanded Disability Status Scale scores, 5.5-6.5) were included. Outcomes included knee extensor and knee flexor strength asymmetry, Timed 25-Foot Walk (T25FW) test, 2-Minute Walk Test (2MWT), Timed Up and Go (TUG) test, and 12-item Multiple Sclerosis Walking Scale (MSWS-12). Participants received 24 weeks (3 times per week) of FES cycling or passive leg cycling. Results: The FES condition demonstrated a small decrease in knee extensor (d = -0.33) and knee flexor (d = -0.23) strength asymmetry compared with passive leg cycling. With both groups combined, weak-to-strong associations were observed between change in knee extensor asymmetry and change in T25FW test time (rs = -0.43), 2MWT time (rs = -0.24), TUG test time (rs = 0.55), and MSWS-12 score (rs = 0.43). Moderate correlations were observed between change in knee flexor asymmetry and change in T25FW test time (rs = -0.31), TUG test time (rs = 0.33), and MSWS-12 score (rs = 0.35). Conclusions: FES cycling may be an efficacious exercise modality for reducing lower limb strength asymmetry and improving mobility in persons with MS.

Persons with Multiple Sclerosis Exhibit Strength Asymmetries in both Upper and Lower Extremities.

OBJECTIVE: To characterize strength asymmetries in the upper and lower extremities in persons with multiple sclerosis (PwMS) with severe disability, and examine associations between asymmetries and functional, symptomatic, and participatory outcomes. DESIGN: Cross-sectional. SETTING: University research laboratory. PARTICIPANTS: 25 PwMS with Expanded Disability Status Scale scores between 6.0-8.0. MAIN OUTCOME MEASURES: Bilateral strength and asymmetry scores for muscle groups at the ankle, knee, and shoulder joints in addition to grip strength. RESULTS: Significant differences were observed between all contralateral strength measures, with asymmetry scores ranging between 20-32%. A high prevalence of asymmetry (i.e., score>10%) was observed for all strength measures, with 92% of participants having four or more affected measures. Significant associations were observed between dorsiflexion asymmetry and physical health-related quality of life (ρ= -0.69; p<0.001), and between shoulder flexion asymmetry and lower extremity function (ρ= -0.62; p=0.001). Plantarflexion (ρ= 0.61; p=0.003) and knee flexion (ρ= 0.63; p=0.002) asymmetry were significantly associated with lower extremity functional asymmetry. CONCLUSIONS: A high prevalence of asymmetry in the upper and lower extremities was observed, with asymmetry scores exceeding those previously reported in PwMS with mild-to-moderate disability. Rehabilitation strategies should consider a full body approach to address strength asymmetries.

The Effect of Exercise Training on Gait, Balance, and Physical Fitness Asymmetries in Persons With Chronic Neurological Conditions: A Systematic Review of Randomized Controlled Trials.

Background: Persons with chronic neurological conditions (CNCs) often present with asymmetrical impairments, creating significant differences between contralateral limbs in body functions. These asymmetries have been associated with reduced mobility and balance, and are often targeted for reduction during rehabilitation. Exercise training has established benefits for persons with CNCs, and may have positive effects on asymmetry outcomes. Objectives: The purpose of this review was to summarize the current evidence for the effects exercise training on gait, balance, and physical fitness asymmetry in randomized control trials (RCTs) of persons with CNCs. Methods: A search of four electronic databases (EMBASE, CINAHL, SPORTdiscus, and ovidMEDLINE) was conducted following the structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The search retrieved 3,493 articles, with 465 articles assessed for eligibly, and nine articles meeting the criteria for inclusion. Of the included articles, five incorporated resistance exercise, three incorporated aerobic exercise, and one incorporated combined exercise (i.e., resistance and aerobic exercise). Gait asymmetry improved significantly in four studies after resistance, aerobic, and combined exercise. Significant improvements in weight bearing asymmetry were reported in three studies after resistance exercise. One study reported significant improvements in both gait and balance asymmetry after resistance exercise. Conclusions: Preliminary evidence suggests that exercise training, as a component of rehabilitation, may have positive effects on gait and balance asymmetry in persons with CNCs. Several limitations of the current literature were noted, including a limited number of studies, combination of exercise with other rehabilitation modalities, a lack of reporting on exercise prescriptions (e.g., number of repetitions, intensity), and variability in the calculation of asymmetry outcomes. These limitations prevent definitive conclusions on the effects of exercise training on asymmetry outcomes. Future trials are needed to determine the potential of exercise training for reducing asymmetry in persons with CNCs.

Evaluation of Power Production Asymmetry during Cycling in Persons with Multiple Sclerosis.

Lower limb asymmetries have been observed in persons with multiple sclerosis (PwMS), and have been associated with mobility impairment. An incremental cycling test was performed on a cycle ergometer to determine peak power output (PPO) and peak oxygen consumption (VO2peak). Then, participants cycled at 50%, 60%, and 70% of their PPO to assess the contribution of each lower limb to power production. Two-way repeated measures ANOVA was used to detect group × intensity differences in power production asymmetry. Eight PwMS and six healthy individuals (Non-MS) completed the study. No statistically significant (p > 0.05) group × intensity interactions or main effects were present when examining between-limb differences in power production. The current data do not indicate a statistically significant difference in power production asymmetry between groups and exercise intensities. Previous research has established a 10% difference between contralateral limbs as a threshold for asymmetry. The average asymmetry in power production in PwMS exceeded the 10% threshold at all measured outputs, suggesting the presence of asymmetry in power production.