Acute effects of NIV on peripheral muscle function and aerobic performance in patients with chronic obstructive pulmonary disease: a pilot study.

BACKGROUND: Non-invasive ventilation (NIV) reduces respiratory load and demands on peripheral muscles. METHODS: This study aims to evaluate the acute effects of bi-level NIV on peripheral muscle function during isokinetic exercise and aerobic performance in chronic obstructive pulmonary disease (COPD) patients. This is a pilot crossover study performed with a non-probabilistic sample of 14 moderate to very severe COPD patients. Procedures carried out in two days. Dyspnea, quality of life, lung function, respiratory muscle strength, functional capacity (6-min walk test-6MWT), and isokinetic assessment of the quadriceps were assessed. Blood samples (lactate, lactate dehydrogenase, and creatine kinase concentration) were also collected. Right after, NIV was performed for 30 min (bi-level or placebo, according to randomization) followed by new blood sample collection, 6MWT, and isokinetic dynamometer tests. Before and after evaluations, the subjective perception of dyspnea and fatigue in the lower limbs was quantified. After a wash-out period of seven days, participants returned, and all assessments were performed again. RESULTS: NIV showed improvements in perceived exertion and dyspnea after isokinetic exercise (p < 0.02 and p < 0.05, respectively). CONCLUSIONS: NIV improves the perception of dyspnea and fatigue during the isokinetic exercise.

Repetition Failure Occurs Earlier During Low-Load Resistance Exercise With High But Not Low Blood Flow Restriction Pressures: A Systematic Review and Meta-analysis.

ABSTRACT: Cerqueira, MS, Lira, M, Mendonça Barboza, JA, Burr, JF, Wanderley e Lima, TB, Maciel, DG, and De Brito Vieira, WH. Repetition failure occurs earlier during low-load resistance exercise with high but not low blood flow restriction pressures: a systematic review and meta-analysis. J Strength Cond Res XX(X): 000-000, 2021-High-load and low-load resistance training (LL-RT) performed to failure are considered effective for improving muscle mass and strength. Alternatively, LL-RT with blood flow restriction (LL-BFR) may accelerate repetition failure and has been suggested to be more time efficient than LL-RT. This study explores the evidence for the effects of LL-BFR vs. LL-RT on repetition failure. A systematic literature search was conducted in the PubMed, CINAHL, Web of Science, CENTRAL, Scopus, SPORTDiscus, and PEDro databases. Meta-analyses of mean differences and 95% confidence intervals (CIs) were performed using a random-effects model. Subgroup analyses were conducted for both the high and low blood flow restriction pressures. The search identified n = 10 articles that met the inclusion criteria. The meta-analysis comprised a total of 218 healthy subjects. Low-load resistance training with blood flow restriction with high pressures (≥50% arterial occlusion pressure [AOP]) precipitate repetition failure in ∼14.5 fewer repetitions (95% CI -19.53 to -9.38) compared with LL-RT, whereas the use of low pressures (<50% AOP) stimulated repetition failure with ∼1.4 fewer repetitions (95% CI -3.11 to 0.37); however, this difference was not statistically significant. Repetition failure has been demonstrated to be an important normalizing variable when comparing the hypertrophic and strength effects resulting from resistance training and occurs earlier during low-load resistance exercise with high but not low blood flow restriction pressures.

Photobiomodulation increases mitochondrial citrate synthase activity in rats submitted to aerobic training.

This study investigated the effects of photobiomodulation by low-laser laser therapy (LLLT) on the activities of citrate synthase (CS) and lactate dehydrogenase (LDH) and the anaerobic threshold (AT) in rats submitted to treadmill exercise. Fifty-four rats were allocated into four groups: rest control (RCG), rest laser (RLG), exercise control (ECG), and exercise laser (ELG). The infrared LLLT was applied daily on the quadriceps, gluteus maximum, soleus, and tibialis anterior muscles. Muscle samples (soleus, tibialis anterior, and cardiac muscles) were removed 48 h after the last exercise session for spectrophotometric analysis of the CS and LDH. The CS activity (µmol/protein) in ELG (16.02 and 0.49) was significantly greater (P < 0.05) than RCG (2.34 and 0.24), RLG (6.25 and 0.17), and ECG (6.76 and 0.26) in the cardiac and soleus muscles, respectively. The LDH activity (in 1 Mm/protein) in soleus muscle was smaller (P < 0.05) for ELG (0.33) compared to ECG (0.97), RLG (0.79), and RCG (1.07). For cardiac muscle, the LDH activity was smaller (P < 0.05) in ELG (1.38) compared to ECG (1.91) and RCG (2.55). The ECG and ELG showed increases in the maximum speed and a shift of the AT to higher effort levels after the training period, but no differences occurred between the exercised groups. In conclusion, the aerobic treadmill training combined with LLLT promotes an increase of oxidative capacity in this rat model, mainly in muscles with greater aerobic capacity.

Low-level laser therapy combined to functional exercise on treatment of fibromyalgia: a double-blind randomized clinical trial.

This study aims to investigate the effects of low-level laser therapy (LLLT) combined to a functional exercise program on treatment of FM. A double-blind and placebo-controlled randomized clinical trial composed of 22 women divided into two groups: placebo group (functional exercise program associated with placebo phototherapy n = 11) and laser group (same exercise program associated with active phototherapy; n = 11). Each session lasted from 40 to 60 min and was performed three times a week for 8 weeks. Phototherapy (808 nm, 100 mW, 4 J, and 142.85 J/cm2 per point) was bilaterally applied to different points of the quadriceps (8), hamstrings (6), and triceps sural muscles (3) immediately after each exercise session. Pre- and post-intervention evaluations regarding pain (sites, intensity, and threshold), functional performance (balance, functional tests), muscle performance (flexibility and isokinetic variables), depression, and quality of life were conducted. A reduction in pain and improvement in functional and muscular performance, depression, and quality of life were observed in both groups (p < 0.05); however, with no significant differences between them (p > 0.05). In conclusion, the benefic effects of functional exercise were not improved by combination with LLLT.

Metalloproteinase Changes in Diabetes.

Matrix metalloproteinases (MMPs) constitute a group of over 20 structurally-related proteins which include a Zn(++) ion binding site that is essential for their proteolytic activities. These enzymes play important role in extracellular matrix turnover in order to maintain a proper balance in its synthesis and degradation. MMPs are associated to several physiological and pathophysiological processes, including diabetes mellitus (DM). The mechanisms of DM and its complications is subject of intense research and evidence suggests that MMPs are implicated with the development and progression of diabetic microvascular complications such as nephropathy, cardiomyopathy, retinopathy and peripheral neuropathy. Recent data has associated DM to changes in the tendon structure, including abnormalities in fiber structure and organization, increased tendon thickness, volume and disorganization obtained by image and a tendency of impairing biomechanical properties. Although not fully elucidated, it is believed that DM-induced MMP dysregulation may contribute to structural and biomechanical alterations and impaired process of tendon healing.

Effect of low-level laser therapy (808 nm) on markers of muscle damage: a randomized double-blind placebo-controlled trial.

The aim of this randomized double-blind placebo-controlled study was to investigate the effect of low-level laser therapy (LLLT) on markers of muscle damage (creatine kinase (CK) and strength performance) in the biceps brachii. Twenty-two physically active men were randomized into two groups: placebo and laser. All volunteers were submitted to an exercise-induced muscle damage protocol for biceps brachii (biceps curl, 10 sets of 10 repetitions with load of 50% of one-repetition maximum test (1RM)). Active LLLT (808 nm; 100 mW; 35.7 W/cm(2), 357.14 J/cm(2) per point, energy of 1 J per point applied for 10 s on four points of the biceps brachii belly of each arm) or placebo was applied between the sets of the biceps curl exercise. CK activity and maximum strength performance (1RM) were measured before, immediately after, 24, 48, and 72 h after the exercise-induced muscle damage protocol. There was an increase in CK activity after the muscle damage protocol in both groups; however, this increase was attenuated in the laser group compared to the placebo group at 72 h (placebo = 841 vs. laser = 357%; p < 0.05). Maximum strength performance was decreased immediately after the muscle damage protocol in both groups (p < 0.05), but at 24, 48, and 72 h, and it returned to the baseline level in both groups. In conclusion, the LLLT attenuated CK activity 72 h after the muscle damage protocol but did not have a positive effect on the recovery of strength performance.

Peak torque angle, acceleration time and time to peak torque as additional parameters extracted from isokinetic test in professional soccer players: a cross-sectional study.

This study investigated additional and traditional variables from isokinetic test of thigh muscles in soccer players across different field positions. One hundred and eighty-nine athletes performed maximal concentric isokinetic knee contractions on dominant (DL) and non-dominant limb (NDL) at 60º/s and 240º/s. The additional outcomes peak torque angle (AngPT), acceleration time (AcT) and time to peak torque (TPT) and traditional outcomes Peak torque (PT), total work (TW) and power (Pw) were extracted from the exam. Goalkeepers (GK), side backs (SB), central backs (CB), central defender midfielders (CDM), central attacking midfielders (CAM) and forwards (FW) were considered. Comparisons between limbs and positions demonstrated that SB extensors of the DL presented TPT lower (p = 0.006) and AngPT higher (p = 0.011) than NDL at 60°/s. CDM extensors of the DL showed lower TPT at 60°/s (p = 0.003) and 240°/s (p = 0.024). CAM flexors of the DL showed lower TPT (p = 0.026) and AcT (p = 0.021) at 240°/s than NDL. CB, CDM and CAM extensors of the NDL showed higher PT, TW and Pw than DL (p < 0.05). In conclusion, there are muscle imbalances between limbs in SB, CDM and CAM and across different field positions.

Low-Load Blood-Flow Restriction Exercise to Failure and Nonfailure and Myoelectric Activity: A Meta-Analysis.

OBJECTIVE: To compare the short- and long-term effects of low-load resistance training with blood-flow restriction (LL-BFR) versus low- (LL-RT) or high- (HL-RT) load resistance training with free blood flow on myoelectric activity and investigate the differences between failure (exercise performed to volitional failure) and nonfailure (exercise not performed to volitional failure) protocols. DATA SOURCES: We identified sources by searching the MEDLINE, PubMed, CINAHL, Web of Science, CENTRAL, Scopus, SPORTDiscus, and PEDro electronic databases. STUDY SELECTION: We screened the titles and abstracts of 1048 articles using our inclusion criteria. A total of 39 articles were selected for further analysis. DATA EXTRACTION: Two reviewers independently assessed the methodologic quality of each study and extracted the data. A meta-analytic approach was used to compute standardized mean differences (SMDs) ± 95% CIs. Subgroup analyses were conducted for both failure and nonfailure protocols. DATA SYNTHESIS: The search identified 39 articles that met the inclusion criteria. Regarding the short-term effects, LL-BFR increased muscle excitability compared with LL-RT during nonfailure protocols (SMD = 0.61; 95% CI = 0.34, 0.88), whereas HL-RT increased muscle excitability compared with LL-BFR during failure (SMD = -0.61; 95% CI = -1.01, -0.21) and nonfailure (SMD = -1.13; 95% CI = -1.94, -0.33) protocols. Concerning the long-term effects, LL-BFR increased muscle excitability compared with LL-RT during exercises performed to failure (SMD = 1.09; 95% CI = 0.39, 1.79). CONCLUSIONS: Greater short-term muscle excitability levels were observed in LL-BFR than in LL-RT during nonfailure protocols. Conversely, greater muscle excitability was present during HL-RT than LL-BFR, regardless of volitional failure. Furthermore, LL-BFR performed to failure increased muscle excitability in the long term compared with LL-RT.

Should We Trust Perceived Effort for Loading Control and Resistance Exercise Prescription After ACL Reconstruction?

CONTEXT: The rating of perceived effort (RPE) is a common method used in clinical practice for monitoring, loading control, and resistance training prescription during rehabilitation after rupture and anterior cruciate ligament reconstruction (ACLR). It is suggested that the RPE results from the integration of the afferent feedback and corollary discharge in the motor and somatosensory cortex, and from the activation of brain areas related to emotions, affect, memory, and pain (eg, posterior cingulate cortex, precuneus, and prefrontal cortex). Recent studies have shown that rupture and ACLR induce neural adaptations in the brain commonly associated with the RPE. Therefore, we hypothesize that RPE could be affected because of neural adaptations induced by rupture and ACLR. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: RPE could be directly altered by changes in the activation of motor cortex, posterior cingulate cortex, and prefrontal cortex. These neural adaptations may be induced by indirect mechanisms, such as the afferent feedback deficit, pain, and fear of movement (kinesiophobia) that patients may feel after rupture and ACLR. CONCLUSION: Using only RPE for monitoring, loading control, and resistance training prescription in patients who had undergone ACLR could lead to under- or overdosing resistance exercise, and therefore, impair the rehabilitation process. STRENGTH-OF-RECOMMENDATION TAXONOMY: 3C.

Can Skin Temperature Be Altered After Different Magnitudes of Eccentric Exercise-Induced Muscle Damage?

Purpose: This study aimed to assess skin temperature (Tsk) changes after different magnitudes of exercise-induced muscle damage (EIMD) of the elbow flexor muscles and investigate whether Tsk is related to indirect markers of EIMD. Methods: Thirty healthy active men were randomly allocated to the mild (MiDG) (n = 15) or moderate (MoDG) (n = 15) muscle damage group. Muscle damage in elbow flexor muscles was induced by 10 (for MiDG) or 30 (for MoDG) maximal eccentric isokinetic contractions at 60 degrees/s. Tsk, maximal voluntary isometric contraction (MVIC), delayed-onset muscle soreness (DOMS), plasma creatine kinase (CK) activity, range of motion (ROM), and pressure pain threshold (PPT) were measured before and up to 72 hr after EIMD. Results: Tsk increased only immediately after EIMD (p < .05; f = 1.44) in the MoDG (4.2%) and MiDG (4.6%), returning to near baseline values 30 min after EIMD and remaining so thereafter. In addition, there was no intergroup difference (p > .05) at any of the times analyzed, or correlation between Tsk and most indirect markers of EIMD. Conclusions: In conclusion, Tsk should not be considered an indirect marker of mild or moderate muscle damage in active men, since alterations in this variable last less than 30 min after damaging exercise and showed no correlation with most indirect markers of EIMD.

Effects of Individualized Ischemic Preconditioning on Protection Against Eccentric Exercise-Induced Muscle Damage: A Randomized Controlled Trial.

BACKGROUND: The effects of ischemic preconditioning (IPC) versus a deceptive sham protocol on indirect markers of exercise-induced muscle damage (EIMD) after the application of individualized occlusion pressure were examined. The goal of using a sham protocol is to control for the potential effect of placebo. HYPOTHESIS: IPC would surpass the sham protocol in protecting against EIMD. STUDY DESIGN: A randomized, double-blinded, clinical trial. LEVEL OF EVIDENCE: Level 1. METHODS: Thirty healthy young men were randomly assigned to an eccentric exercise for the knee extensor muscles preceded by IPC (4 × 5 minutes of individualized total occlusion pressure) or sham protocol (4 × 5 minutes using 20 mm Hg). Maximal voluntary isometric torque (MVIT), rate of torque development, muscle soreness, pressure pain threshold, knee range of motion, thigh girth, and creatine kinase (CK) activity were assessed before IPC or sham protocol and up to 72 hours after the eccentric EIMD. Affective valence and perceived exertion were also evaluated. RESULTS: MVIT decreased 17.1% in the IPC and 18.1% in the sham groups, with no differences between groups. Differences from baseline were observed in the sham group for muscle soreness at 48 hours (P < 0.001) and 72 hours (P = 0.02), and for CK activity at 72 hours (P = 0.04). Muscle soreness was reduced in the IPC group at 48 hours compared with the sham group (∆ = 15.8 mm; P = 0.008) but without achieving the minimal clinically important difference. IPC induced a smaller perceived exertion than the sham protocol (∆ = 1.1 a.u.; P = 0.02). The remaining outcomes were not statistically different in both groups. CONCLUSION: IPC does not surpass the sham protocol to protect against mild EIMD of the knee extensors muscles. CLINICAL RELEVANCE: Although IPC is a noninvasive, low-cost, and easy-to-administer intervention, the IPC effects can, in part, be explained by the placebo effect. In addition, individualized IPC promotes attenuation in perceived exertion during eccentric exercise.

Effects of blood flow restriction without additional exercise on strength reductions and muscular atrophy following immobilization: A systematic review.

Purpose: To investigate whether blood flow restriction (BFR) without concomitant exercise mitigated strength reduction and atrophy of thigh muscles in subjects under immobilization for lower limbs. Methods: The following databases were searched: PubMed, CINAHL, PEDro, Web of Science, Central, and Scopus. Results: The search identified 3 eligible studies, and the total sample in the identified studies consisted of 38 participants. Isokinetic and isometric torque of the knee flexors and extensors was examined in 2 studies. Cross-sectional area of thigh muscles was evaluated in 1 study, and thigh girth was measured in 2 studies. The BFR protocol was 5 sets of 5 min of occlusion and 3 min of free flow, twice daily for approximately 2 weeks. As a whole, the included studies indicate that BFR without exercise is able to minimize strength reduction and muscular atrophy after immobilization. It is crucial to emphasize, however, that the included studies showed a high risk of bias, especially regarding allocation concealment, blinding of outcome assessment, intention-to-treat analyses, and group similarity at baseline. Conclusion: Although potentially useful, the high risk of bias presented by original studies limits the indication of BFR without concomitant exercise as an effective countermeasure against strength reduction and atrophy mediated by immobilization.

Effects of blood flow restriction exercise with very low load and low volume in patients with knee osteoarthritis: protocol for a randomized trial.

BACKGROUND: Knee osteoarthritis (OA) is characterized by chronic pain, physical dysfunction, and reduced quality of life. Low-load resistance exercises with blood flow restriction (BFR) have presented results similar to those of high-intensity resistance exercise (HIRE) without BFR provided that the exercise volume in both is paired. However, it is unclear whether BFR exercise with reduced load and volume generates clinical improvements similar to those of HIRE. The aim of the proposed study is to evaluate the effects of BFR resistance exercise with very low load and low volume against HIRE in patients with knee OA for the outcomes of knee pain, muscle performance, physical function, disease severity, quality of life, perceived exertion during the exercises, adherence, and patient satisfaction with treatment. METHODS: This two-arm, prospectively registered, randomized controlled trial with blinded assessors and volunteers will involve 40 patients with knee OA. Two weekly treatment sessions will be provided for 12 weeks. Patients will perform very low-load (10% of 1-RM) and low-volume BFR exercise or HIRE (60% of 1-RM) for strengthening thigh muscles. The primary outcome will be the knee pain measured after 12 weeks of treatment. The secondary outcomes include knee pain 6 months after randomization, physical function, disease severity, quality of life, muscle performance, knee pain and perceived exertion during exercise, adherence, and patient satisfaction with treatment. DISCUSSION: If the improvements in the outcomes are similar in the two groups, BFR exercise with reduced load and volume may be an interesting alternative in the treatment of knee OA, especially when exercises with high loads generate joint pain. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (REBEC), RBR-6pcrfm . Registered on July 10, 2018.

Effect of photobiomodulation and exercise on early remodeling of the Achilles tendon in streptozotocin-induced diabetic rats.

The aim of this study was to compare the treatment effects of laser photobiomodulation (LPBM) therapy and aerobic exercise on the biomechanical properties, tissue morphology and the expression of tendon matrix molecules during early remodeling of Achilles tendon (AT) injury in diabetic rats. Animals were randomly assigned to five groups: injured non diabetic (I, n = 15), injured diabetic (ID, n = 15), injured diabetic plus LPBM (IDL, n = 16), injured diabetic plus aerobic exercise (IDE, n = 16) and injured diabetic plus aerobic exercise and LPBM (IDEAL, n = 17). Type 1 diabetes was induced via a single intravenous injection of Streptozotocin at a dose of 40 mg/kg. A partial tenotomy was performed in the right AT. LPBM was performed with an indium-gallium-aluminum-phosphide 660 nm 10 mW laser device (spot size 0.04 cm2, power density 250 mW/cm2, irradiation duration 16 s, energy 0.16 J, energy density 4 J/cm2) on alternate days for a total of 9 sessions over 3 weeks (total energy 1.44 J), using a stationary contact technique to a single point over the dorsal aspect of the AT. Moderate aerobic exercise was performed on a motorized treadmill (velocity 9 m/min for 60 minutes). At 3 weeks post-injury, biomechanical analyzes as well as assessment of fibroblast number and orientation were performed. Collagen 1 (Col1) and 3 (Col3) and matrix metalloproteinases (MMPs) -3 and 13 protein distributions were studied by immunohistochemistry; while Col1 and Col3 and MMP-2 and 9 gene expression were assessed by quantitative RT-PCR (qRT-PCR). IDEAL exhibited significant increases in several biomechanical parameters in comparison to the other groups. Moreover, IDEAL presented stronger Col1 immunoreactivity when compared to ID, and weaker Col3 immunoreactivity than IDE. Both IDL and IDEAL demonstrated weaker expression of MMP-3 in comparison to I, while IDL presented no expression of MMP-13 when compared to ID. ID, IDL and IDE showed an increased number of fibroblasts in comparison to I, while IDEAL decreased the number of these cells in comparison to ID and IDE. IDL and IDEAL groups exhibited decreased angular dispersion among the fibroblasts when compared to I. The gene expression results showed that IDE demonstrated a downregulation in Col1 mRNA expression in comparison to I and ID. IDEAL demonstrated upregulation of Col1 mRNA expression when compared to IDL or IDE alone and increased MMP-2 expression when compared to IDL and IDE. MMP-9 expression was upregulated in IDEAL when compared to I, IDL and IDE. Our results suggest a beneficial interaction of combining both treatment strategies i.e., aerobic exercise and LPBM, on the biomechanical properties, tissue morphology and the expression of matrix molecules in diabetic tendons.

Use of low-level laser therapy (808 nm) to muscle fatigue resistance: a randomized double-blind crossover trial.

OBJECTIVE: The purpose of this study was to investigate whether low-level laser (light) therapy (LLLT) can provide fatigue resistance via maximum repetitions (RM) with an isokinetic dynamometer, and decrease electromyography fatigue index (EFI). BACKGROUND DATA: LLLT has been used to increase muscle performance when applied before or after intense exercises. MATERIALS AND METHODS: This study was a randomized, double-blind, crossover trial with placebo. Seven young men (21±3 years of age) who were clinically healthy, were allocated into two groups: active laser (LLLT) and placebo laser (Placebo). Both groups were assessed at baseline, at one training session, and at the end of this study. Baseline and final assessments recorded the number of RM of knee flexion-extensions using an isokinetic dynamometer at 60 degrees/sec in conjunction with EFI recorded by median frequency. The training sessions consisted of three sets of 20 RM of knee flexion-extensions using an isokinetic dynamometer at 60 degrees/sec plus LLLT (808 nm, 100 mW, 4 J), or placebo, applied to quadriceps femoris muscles between sets, and after the last series of this exercise. After 1 week (washout period), all volunteers were exchanged among groups and then all assessments were repeated. RESULTS: LLLT group increased RM (52%; p=0.002) with a small EFI for the vastus medialis (p=0.004) and rectus femoris (p=0.004). CONCLUSIONS: These results suggest an increased muscle fatigue resistance when LLLT is applied during rest intervals, and after the last series of intense exercises.

Overview of ultrasound usage trends in orthopedic and sports physiotherapy.

BACKGROUND: The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil. METHODS: A brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage. RESULTS: Our data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication. CONCLUSION: A Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects.