The effects of supramaximal versus submaximal intensity eccentric training when performed until volitional fatigue.

PURPOSE: Our purpose was to compare supramaximal versus submaximal intensity eccentric training performed until volitional fatigue. METHODS: Thirty-two young adults (19 males) were randomized into one of three groups: (1) ECC110 performed eccentric (ECC) only contractions at 110% of concentric (CON) 1-repetition maximum (1RM); (2) ECC80 performed ECC only contractions at 80% of CON 1RM; (3) a control group. Training progressed from 3 to 6 sets of unilateral ECC training of the elbow flexors over 8 weeks, with each set performed until volitional fatigue. Elbow flexors muscle thickness (via ultrasound) and 1RM were assessed pre- and post-training. Rating of perceived exertion (RPE) and muscle soreness was self-reported. RESULTS: Both ECC110 (+0.25 cm) and ECC80 (+0.21 cm) showed a greater post-training increase in muscle thickness compared to control (-0.01 cm) (p < 0.05), with no differences between ECC110 and ECC80. ECC80 (+1.23 kg) showed a greater post-training increase in strength compared to control (p < 0.05), while ECC110 (+0.76 kg) had no significant difference post-training vs. control (-0.01 kg). ECC80 had significantly lower average RPE scores than ECC110 (p < 0.05). CONCLUSIONS: Both supramaximal intensity eccentric training and submaximal intensity eccentric training are effective for increasing muscle size, but submaximal eccentric training is perceived to require less exertion than supramaximal training. These findings suggest that submaximal eccentric training may be an ideal strategy to increase muscle size and strength in individuals whose needs warrant training at a lower level of exertion.

Creatine supplementation does not alter neuromuscular recovery after eccentric exercise.

INTRODUCTION: The purpose of this study was to investigate the effects of creatine (CR) supplementation on recovery after eccentric exercise (ECC). METHODS: Fourteen men were assigned randomly to ingest 0.3 g/kg of CR or placebo (PL) before and during recovery (48 hours) from 6 sets of 8 repetitions of ECC. Maximal voluntary contraction (MVC), voluntary activation (VA), muscle thickness (MT), electromyography (EMG), contractile properties, and soreness were assessed. RESULTS: MVC, evoked twitch torque, and rate of torque development decreased for both groups immediately after ECC and recovered at 48 hours. MT increased and remained elevated at 48 hours for both groups. Soreness increased similarly for both groups. EMG activation was higher for CR versus PL only at 48 hours. There were no group differences for torque, total work, or fatigue index during ECC. CONCLUSIONS: CR supplementation before and during recovery from ECC had no effect on strength, voluntary activation, or indicators of muscle damage. Muscle Nerve 54: 487-495, 2016.

The effect of bovine colostrum supplementation in older adults during resistance training.

Bovine colostrum is the first milk secreted by cows after parturition and has high levels of protein, immunoglobulins, and various growth factors. We determined the effects of 8 weeks of bovine colostrum supplementation versus whey protein during resistance training in older adults. Males (N = 15, 59.1 ± 5.4 y) and females (N = 25, 59.0 ± 6.7 y) randomly received (double-blind) 60 g/d of colostrum or whey protein complex (containing 38 g protein) while participating in a resistance training program (12 exercises, 3 sets of 8-12 reps, 3 days/ week). Strength (bench press and leg press 1-RM), body composition (by dual energy x-ray absorptiometry), muscle thickness of the biceps and quadriceps (by ultrasound), cognitive function (by questionnaire), plasma insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP, as a marker of inflammation), and urinary N-telopeptides (Ntx, a marker of bone resorption) were determined before and after the intervention. Participants on colostrum increased leg press strength (24 ± 29 kg; p < .01) to a greater extent than participants on whey protein (8 ± 16 kg) and had a greater reduction in Ntx compared with participants on whey protein (-15 ± 40% vs. 10 ± 42%; p < .05). Bench press strength, muscle thickness, lean tissue mass, bone mineral content, and cognitive scores increased over time (p < .05) with no difference between groups. There were no changes in IGF-1 or CRP. Colostrum supplementation during resistance training was beneficial for increasing leg press strength and reducing bone resorption in older adults. Both colostrum and whey protein groups improved upper body strength, muscle thickness, lean tissue mass, and cognitive function.

Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of cross-education (contralateral effect of unilateral strength training) during recovery from unilateral distal radius fractures on muscle strength, range of motion (ROM), and function. DESIGN: Randomized controlled trial (26-wk follow-up). SETTING: Hospital, orthopedic fracture clinic. PARTICIPANTS: Women older than 50 years with a unilateral distal radius fracture. Fifty-one participants were randomized and 39 participants were included in the final data analysis. INTERVENTIONS: Participants were randomized to standard rehabilitation (Control) or standard rehabilitation plus strength training (Train). Standard rehabilitation included forearm casting for 40.4±6.2 days and hand exercises for the fractured extremity. Nonfractured hand strength training for the training group began immediately postfracture and was conducted at home 3 times/week for 26 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was peak force (handgrip dynamometer). Secondary outcomes were ROM (flexion/extension; supination/pronation) via goniometer and the Patient Rated Wrist Evaluation questionnaire score for the fractured arm. RESULTS: For the fractured hand, the training group (17.3±7.4kg) was significantly stronger than the control group (11.8±5.8kg) at 12 weeks postfracture (P<.017). There were no significant strength differences between the training and control groups at 9 (12.5±8.2kg; 11.3±6.9kg) or 26 weeks (23.0±7.6kg; 19.6±5.5kg) postfracture, respectively. Fractured hand ROM showed that the training group had significantly improved wrist flexion/extension (100.5°±19.2°) than the control group (80.2°±18.7°) at 12 weeks postfracture (P<.017). There were no significant differences between the training and control groups for flexion/extension ROM at 9 (78.0°±20.7°; 81.7°±25.7°) or 26 weeks (104.4°±15.5°; 106.0°±26.5°) or supination/pronation ROM at 9 (153.9°±23.9°; 151.8°±33.0°), 12 (170.9°±9.3°; 156.7°±20.8°) or 26 weeks (169.4°±11.9°; 162.8°±18.1°), respectively. There were no significant differences in Patient Rated Wrist Evaluation questionnaire scores between the training and control groups at 9 (54.2±39.0; 65.2±28.9), 12 (36.4±37.2; 46.2±35.3), or 26 weeks (23.6±25.6; 19.4±16.5), respectively. CONCLUSIONS: Strength training for the nonfractured limb after a distal radius fracture was associated with improved strength and ROM in the fractured limb at 12 weeks postfracture. These results have important implications for rehabilitation strategies after unilateral injuries.

Timing of creatine supplementation does not influence gains in unilateral muscle hypertrophy or strength from resistance training in young adults: a within-subject design.

BACKGROUND: Creatine supplementation, in close proximity to resistance training sessions, may be an important strategy to augment muscle accretion and strength. The purpose of this study was to examine the effects of creatine supplementation immediately before compared to immediately after unilateral resistance training on hypertrophy and strength. METHODS: Using a counter-balanced, double-blind, repeated measures within-subject design, ten recreationally active participants (7 males; 3 females; age: 23±5 years; height: 174±9 cm; body mass: 73.5±9.7 kg) were randomized to supplement with creatine monohydrate (0.1 g/kg of body mass) immediately before and placebo immediately after training one side of the body and placebo immediately before and creatine immediately after training the other side of the body on alternate days. Resistance training consisted of elbow flexion and knee extension (3-6 sets at 80% 1-repetition maximum [1-RM]) for 8 weeks. Prior to and following training, muscle thickness (elbow flexors and leg extensors; ultrasonography) and strength (1-RM for the elbow flexors and knee extensors) was assessed. RESULTS: There was a significant increase over time for muscle thickness, strength, and relative strength (P<0.01), with no differences between creatine ingestion strategies. Total training volume performed was similar between conditions (P=0.56). CONCLUSIONS: Creatine supplementation, immediately before or immediately after unilateral resistance training, produces similar gains in muscle hypertrophy and strength in young adults.

Neural and morphological changes in response to a 20-day intense eccentric training protocol.

The purpose of this study was to examine the time course of adaptation through 20 days of eccentric training and 5 days of detraining. A total of 22 untrained subjects trained one arm every 2nd day for 20 days. Subjects performed maximal isokinetic eccentric biceps brachii training at 90 degrees /s (six sets of eight reps). Muscle thickness (reported in cm) via ultrasound, strength (reported in Nm) and muscle activation (electromyography) were measured before, during, and after training (nine time points). Strength in the trained arm decreased after 8 days of training (65.6 +/- 4.1 to 57.5 +/- 3.5; p < 0.05) and remained decreased throughout the study. Agonist muscle activation amplitude of the trained arm increased after 14 days of training (p < 0.05) and remained elevated throughout the study. Antagonist muscle activation decreased after 20 days of training (p < 0.05). Muscle thickness increased after 8 days of training (3.66 +/- 0.11 to 3.90 +/- 0.12; p < 0.05) and remained above baseline until the end of training (3.97 +/- 0.12). After 5 days of detraining, muscle thickness decreased (3.97 +/- 0.12 vs. 3.85 +/- 0.11; p < 0.05), but remained higher than baseline (p < 0.05). Muscle thickness did not change significantly in the untrained arm at any time point. In conclusion, the early increase in biceps brachii muscle thickness coupled with a significant decrease in strength is an indicator of muscle damage leading to swelling and impaired muscle function. The persistent decrease in strength, despite an increase in muscle activation, suggests that the recovery interval was inadequate to allow complete repair of muscle damage. Intense eccentric training performed every 2nd day leads to a prolonged impairment of muscle strength in previously untrained individuals.

Strength training the free limb attenuates strength loss during unilateral immobilization.

The objective was to determine if strength training the free limb during a 3-wk period of unilateral immobilization attenuates strength loss in the immobilized limb through cross-education. Thirty right-handed participants were assigned to three groups. One group (n = 10) wore a cast and trained the free arm (Cast-Train). A second group (n = 10) wore a cast and did not train (Cast). A third group (n = 10) received no treatment (control). Casts were applied to the nondominant (left) wrist and hand by a physician. Strength training was maximal isometric ulnar deviation (right hand) 5 days/wk. Peak torque (dynamometer), electromyography (EMG), and muscle thickness (ultrasound) were assessed in both arms before and after the intervention. Cast-Train improved right arm strength [14.3 (SD 5.0) to 17.7 (SD 4.8) N x m; P < 0.05] with no significant muscle hypertrophy [3.73 (SD 0.43) to 3.84 (SD 0.52) cm; P = 0.09]. The immobilized arm of Cast-Train did not change in strength [13.9 (SD 4.3) to 14.2 (SD 4.6) N x m] or muscle thickness [3.61 (SD 0.51) to 3.57 (SD 0.43) cm]. The immobilized arm of Cast decreased in strength [12.2 (SD 3.8) to 10.4 (SD 2.5) N x m; P < 0.05] and muscle thickness [3.47 (SD 0.59) to 3.32 (SD 0.55) cm; P < 0.05]. Control showed no changes in the right arm [strength: 15.3 (SD 6.1) to 14.3 (SD 5.8) N x m; muscle thickness: 3.57 (SD 0.68) to 3.52 (SD 0.75) cm] or left arm [strength: 14.5 (SD 5.3) to 13.7 (SD 6.1) N x m; muscle thickness: 3.55 (SD 0.77) to 3.51 (SD 0.70) cm]. Agonist muscle activation remained unchanged after the intervention for both arms [right: 302 (SD 188) to 314 (SD 176) microV; left: 261 (SD 139) to 288 (SD 151) microV] with no group differences. Strength training of the free limb attenuated strength loss in the immobilized limb during unilateral immobilization. Strength training may have prevented muscle atrophy in the immobilized limb.

Changes in Fat Mass Following Creatine Supplementation and Resistance Training in Adults ≥50 Years of Age: A Meta-Analysis.

Aging is associated with an increase in fat mass which increases the risk for disease, morbidity and premature mortality. Creatine supplementation in combination with resistance training has been shown to increase lean tissue mass in adults ≥50 years of age; however, the synergetic effects of creatine and resistance training on fat mass in this population are unclear. Creatine metabolism plays an important role in adipose tissue bioenergetics and energy expenditure. Thus, the combination of creatine supplementation and resistance training may decrease fat mass more than resistance training alone. The purpose of this review is two-fold: (1) to perform meta-analyses on studies involving creatine supplementation during resistance training on fat mass in adults ≥50 years of age, and (2) to discuss possible mechanistic actions of creatine on reducing fat mass. Nineteen studies were included in our meta-analysis with 609 participants. Results from the meta-analyses showed that adults ≥50 years of age who supplemented with creatine during resistance training experienced a greater reduction in body fat percentage (0.55%, p = 0.04) compared to those on placebo during resistance training. Despite no statistical difference (p = 0.13), adults supplementing with creatine lost ~0.5 kg more fat mass compared to those on placebo. Interestingly, there are studies which have linked mechanism(s) explaining how creatine may influence fat mass, and these data are also discussed.

Sleep and Exercise in Emergency Medicine Residents: An Observational Pilot Study Exploring the Utility of Wearable Activity Monitors for Monitoring Wellness.

Introduction Burnout is well-documented in residents and emergency physicians. Wellness initiatives are becoming increasingly prevalent, but there is a lack of data supporting their efficacy. In some populations, a relationship between sleep, exercise, and wellness has been documented; however, this relationship has not been established in emergency medicine (EM) residents or physicians. We aim to determine whether a wearable activity monitor is a feasible method of evaluating exercise and sleep quality and quantity in emergency medicine residents and if these assessments are associated with greater perceived wellness. Methods Twenty EM residents from two training sites wore a wearable activity monitor (Fitbit ChargeTM, Fitbit, Inc., San Francisco, CA, USA) during a four-week EM rotation. The Fitbit recorded data on sleep quantity (minutes sleeping) and quality (sleep disruptions), as well as exercise quantity and quality (daily step count, daily active minutes performing activity of 3 - 6, and > 6 metabolic equivalents). Participants completed an end-of-rotation Perceived Wellness Survey (PWS), which provided information on six domains of personal wellness (psychological, emotional, social, physical, spiritual, and intellectual). PWS levels were compared between groups of subjects with higher or lower levels of activity and sleep (i.e., above and below the median subject-averaged values) using the Mann-Whitney U test. Other subject characteristics were similarly assessed for their association with PWS. When a possible confounding effect was seen, the data was stratified and reviewed using a scatterplot. Results Of the 28 eligible residents, 23 agreed to participate. Of these, 20 and 16 wore the device for at least 50% of the respective days and nights during the observation period. Two devices were lost. One PWS was not completed. There was no statistically significant correlation between resident perceived wellness survey scores, sleep interruptions, average daily sleep minutes, daily step count, or average daily active minutes for the sample overall. However, first-year residents and residents from years two to five reported different median PWS scores of 13.9 and 17.1, respectively. Further exploration by the training group suggested that step counts may correlate with wellness in participants in their first year of residency, while the quantity of sleep may have an association with wellness in participants in years two through five of their residency. Conclusion Using wearable activity monitor devices to capture sleep and exercise data among residents does not seem to be an effective approach. Our data does not support our hypothesis that overall resident wellness was associated with exercise and sleep quality and quantity as measured by such a device. These results are counterintuitive and may be complicated by several measurement-related limitations and the possibility that benefits depend on the stage of training.

Direct and indirect measurement of neuromuscular fatigue in Canadian football players.

This study assessed the effects of a fatiguing game simulation (G-Sim) on the balance of collegiate Canadian football players. The purpose of the study was to evaluate postural control as a potential tool for monitoring neuromuscular fatigue (NMF) in collision-based team sports. Fifteen male Canadian football players were recruited (mean±SD: age 21.8±1.6 years, weight 97.6±14.7 kg). Indirect NMF measures (postural sway and countermovement jump (CMJ)) were performed 24 h before (TBase), immediately before (TPre) and after (TPost), and 24 h (T24) and 48 h after (T48) a Canadian football G-Sim. Peak isometric knee extensor torque of a maximal voluntary contraction (MVC) and electrically evoked tetani at 20 Hz (P20) and 80 Hz (P80) were also recorded as direct NMF measures at TBase, TPre, TPost, and T48. At TPost, we observed significant declines in MVC, P20, and the MVC/P80 ratio (-15.3%, -15.7%, and -12.1%, respectively; n=12) along with reductions in CMJ takeoff velocity and peak power (-6.9% and -6.5%, respectively; n=12) and larger area of the center of pressure trajectory (95.2%; n=10) during a 60-s postural sway task. All variables were no longer different than baseline by T48. Acute neuromuscular impairment in this cohort is likely attributable to alterations in excitation-contraction coupling due to structural damage and central activation failure. Congruency between the direct and indirect measures of NMF suggests monitoring postural sway has the potential to identify both neuromuscular and somatosensory alterations induced by acute game-induced fatigue in collision-based team sports players.

Changes in functional magnetic resonance imaging cortical activation with cross education to an immobilized limb.

PURPOSE: The purpose of this study was to assess cortical activation associated with the cross-education effect to an immobilized limb, using functional magnetic resonance imaging. METHODS: Fourteen right-handed participants were assigned to two groups. One group (n = 7) wore a cast and strength trained the free arm (CAST-TRAIN). The second group (n = 7) wore a cast and did not strength train (CAST). Casts were applied to the nondominant (left) wrist and hand. Strength training was maximal isometric handgrip contractions (right hand) 5 d·wk(-1). Peak force (handgrip dynamometer), muscle thickness (ultrasound), EMG, and cortical activation (functional magnetic resonance imaging) were assessed before and after the intervention. RESULTS: CAST-TRAIN improved right handgrip strength by 10.7% (P < 0.01) with no change in muscle thickness. There was a significant group × time interaction for strength of the immobilized arm (P < 0.05). Handgrip strength of the immobilized arm of CAST-TRAIN was maintained, whereas the immobilized arm of CAST significantly decreased by 11% (P < 0.05). Muscle thickness of the immobilized arm decreased by an average of 3.3% (P < 0.05) for all participants and was not different between groups after adjusting for baseline differences. There was a significant group × time interaction for EMG activation (P < 0.05), where CAST-TRAIN showed an increasing trend and CAST showed a decreasing trend, pooled across arms. For the immobilized arm of CAST-TRAIN, there was a significant increase in contralateral motor cortex activation after training (P < 0.05). For the immobilized arm of CAST, there was no change in motor cortex activation. CONCLUSIONS: Handgrip strength training of the free limb attenuated strength loss during unilateral immobilization. The maintenance of strength in the immobilized limb via the cross-education effect may be associated with increased motor cortex activation.

The effects of ibuprofen on muscle hypertrophy, strength, and soreness during resistance training.

High doses of ibuprofen have been shown to inhibit muscle protein synthesis after a bout of resistance exercise. We determined the effect of a moderate dose of ibuprofen (400 mg x d(-1)) consumed on a daily basis after resistance training on muscle hypertrophy and strength. Twelve males and 6 females (approximately 24 years of age) trained their right and left biceps on alternate days (6 sets of 4-10 repetitions), 5 d x week(-1), for 6 weeks. In a counter-balanced, double-blind design, they were randomized to receive 400 mg x d(-1) ibuprofen immediately after training their left or right arm, and a placebo after training the opposite arm the following day. Before- and after-training muscle thickness of both biceps was measured using ultrasound and 1 repetition maximum (1 RM) arm curl strength was determined on both arms. Subjects rated their muscle soreness daily. There were time main effects for muscle thickness and strength (p < 0.01). Ibuprofen consumption had no effect on muscle hypertrophy (muscle thickness of biceps for arm receiving ibuprofen: pre 3.63 +/- 0.14, post 3.92 +/- 0.15 cm; and placebo: pre 3.62 +/- 0.15, post 3.90 +/- 0.15 cm) and strength (1 RM of arm receiving ibuprofen: pre 18.6 +/- 2.8, post 23.4 +/- 3.5 kg; and placebo: pre 18.8 +/- 2.8, post 22.8 +/- 3.4 kg). Muscle soreness was elevated during the first week of training only, but was not different between the ibuprofen and placebo arm. We conclude that a moderate dose of ibuprofen ingested after repeated resistance training sessions does not impair muscle hypertrophy or strength and does not affect ratings of muscle soreness.