Gender-specific associations between physical functioning, bone quality, and fracture risk in older people.

The aim of this study was to investigate which parameters of physical functioning are associated with bone quality and fracture risk and whether gender-specific differences exist within these associations. We studied 1,486 participants of the Longitudinal Aging Study Amsterdam. As measures of physical functioning, handgrip strength, physical performance, and level of physical activity were assessed. To assess bone quality, broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at baseline using quantitative ultrasound and bone mineral density (BMD) at baseline and after 3 years by dual-energy X-ray absorptiometry. In addition, fracture incidence over 6 years was assessed. After adjustment for confounders (age, serum 25[OH]D, smoking, and body weight), in men, physical performance was positively related to BUA, SOS, and BMD cross-sectionally and to BMD longitudinally. Using Cox proportional hazards model, in men higher handgrip strength and physical performance were associated with reduced fracture risk after adjustment for confounders (hazard ratio [HR] 0.96, 95 % confidence interval [CI] 0.92-0.99, and HR 0.89, 95 % CI 0.80-0.98, respectively). In women, a moderate level of physical activity was related to reduced fracture risk (HR 0.57, 95 % CI 0.33-0.99). In conclusion, in men, higher handgrip strength and physical performance are related to higher bone quality and reduced fracture risk, whereas in women, a moderate to high level of physical activity is associated with reduced fracture risk. These measurements may contribute to the identification of individuals at high fracture risk. Both the causality of and explanations for gender-specific differences in these relationships remain subject to further studies.

CaMKII content affects contractile, but not mitochondrial, characteristics in regenerating skeletal muscle.

BACKGROUND: The multi-meric calcium/calmodulin-dependent protein kinase II (CaMKII) is the main CaMK in skeletal muscle and its expression increases with endurance training. CaMK family members are implicated in contraction-induced regulation of calcium handling, fast myosin type IIA expression and mitochondrial biogenesis. The objective of this study was to investigate the role of an increased CaMKII content for the expression of the contractile and mitochondrial phenotype in vivo. Towards this end we attempted to co-express alpha- and beta-CaMKII isoforms in skeletal muscle and characterised the effect on the contractile and mitochondrial phenotype. RESULTS: Fast-twitch muscle m. gastrocnemius (GM) and slow-twitch muscle m. soleus (SOL) of the right leg of 3-month old rats were transfected via electro-transfer of injected expression plasmids for native α/ß CaMKII. Effects were identified from the comparison to control-transfected muscles of the contralateral leg and non-transfected muscles. α/ß CaMKII content in muscle fibres was 4-5-fold increased 7 days after transfection. The transfection rate was more pronounced in SOL than GM muscle (i.e. 12.6 vs. 3.5%). The overexpressed α/ß CaMKII was functional as shown through increased threonine 287 phosphorylation of ß-CaMKII after isometric exercise and down-regulated transcripts COXI, COXIV, SDHB after high-intensity exercise in situ. α/ß CaMKII overexpression under normal cage activity accelerated excitation-contraction coupling and relaxation in SOL muscle in association with increased SERCA2, ANXV and fast myosin type IIA/X content but did not affect mitochondrial protein content. These effects were observed on a background of regenerating muscle fibres. CONCLUSION: Elevated CaMKII content promotes a slow-to-fast type fibre shift in regenerating muscle but is not sufficient to stimulate mitochondrial biogenesis in the absence of an endurance stimulus.

The identification of genetic pathways involved in vascular adaptations after physical deconditioning versus exercise training in humans.

Physical inactivity and exercise training result in opposite adaptations of vascular structure. However, the molecular mechanisms behind these adaptations are not completely understood. We used a unique study design to examine both vascular characteristics of the superficial femoral artery (using ultrasound) and gene expression levels (from a muscle biopsy) in human models for physical deconditioning and exercise training. Initially, we compared able-bodied control subjects (n = 6) with spinal cord-injured individuals (n = 8) to assess the effects of long-term deconditioning. Subsequently, able-bodied control subjects underwent short-term lower limb deconditioning using 3 weeks of unilateral limb suspension. Spinal cord-injured individuals were examined before and after 6 weeks of functional electrical stimulation exercise training. Baseline femoral artery diameter and hyperaemic flow were lower after short- and long-term deconditioning and higher after exercise training, whilst intima-media thickness/lumen ratio was increased with short- and long-term deconditioning and decreased with exercise training. Regarding gene expression levels of vasculature-related genes, we found that groups of genes including the vascular endothelial growth factor pathway, transforming growth factor ß1 and extracellular matrix proteins were strongly associated with vascular adaptations in humans. This approach resulted in the identification of important genes that may be involved in vascular adaptations after physical deconditioning and exercise.

Neuromuscular properties of the thigh muscles in patients with Ehlers-Danlos syndrome.

INTRODUCTION: Ehlers-Danlos syndrome (EDS), a connective tissue disorder, may lead to impaired contractile function of lower limb muscles. METHODS: To test this hypothesis and to understand the possible mechanisms involved, isometric function of the thigh muscles was investigated at different joint angles (30°, 60°, and 90° of knee flexion) in 7 tenascin-X (TNX)-deficient EDS patients. RESULTS: There was reduced maximal voluntary torque of the knee extensors (but not knee flexors) across all joint angles in the patients. Time to reach maximal rate of torque development was delayed, and voluntary activation capacity was reduced in patients compared with controls, particularly at 30°. CONCLUSIONS: EDS is associated with muscle weakness, most likely due to increased compliance of the series-elastic component of muscle tissue and failure of maximal voluntary muscle activation. Further research is required to understand the influence of reduced voluntary activation on the severe fatigue reported by EDS patients.

Relation between aerobic capacity and walking ability in older adults with a lower-limb amputation.

OBJECTIVES: To determine the relative aerobic load, walking speed, and walking economy of older adults with a lower-limb prosthesis, and to predict the effect of an increased aerobic capacity on their walking ability. DESIGN: Cross-sectional. SETTING: Human motion laboratory at a rehabilitation center. PARTICIPANTS: Convenience sample of older adults (n=36) who underwent lower-limb amputation because of vascular deficiency or trauma and able-bodied controls (n=21). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak aerobic capacity and oxygen consumption while walking were determined. The relative aerobic load and walking economy were assessed as a function of walking speed, and a data-based model was constructed to predict the effect of an increased aerobic capacity on walking ability. RESULTS: People with a vascular amputation walked at a substantially higher (45.2%) relative aerobic load than people with an amputation because of trauma. The preferred walking speed in both groups of amputees was slower than that of able-bodied controls and below their most economical walking speed. We predicted that a 10% increase in peak aerobic capacity could potentially result in a reduction in the relative aerobic load of 9.1%, an increase in walking speed of 17.3% and 13.9%, and an improvement in the walking economy of 6.8% and 2.9%, for people after a vascular or traumatic amputation, respectively. CONCLUSIONS: Current findings corroborate the notion that, especially in people with a vascular amputation, the peak aerobic capacity is an important determinant for walking ability. The data provide quantitative predictions on the effect of aerobic training; however, future research is needed to experimentally confirm these predictions.

Effects of self-reported osteoarthritis on physical performance: a longitudinal study with a 10-year follow-up.

BACKGROUND AND AIMS: Osteoarthritis (OA) of the knee or hip is associated with limitations in activities of daily life. There are only a few long-term studies on how knee or hip OA affects the course of physical performance. The aim of this study was to investigate the effects of knee or hip OA on physical performance during a follow-up period of 10 years. METHODS: Participants in the Longitudinal Aging Study Amsterdam with self-reported hip or knee OA (N = 155) were prospectively followed for 10 years on 4 occasions from the onset of OA and compared to participants without OA (N = 1004). Physical performance was tested with walk, chair stand and balance tests. Scores for each test were summed to a total performance score (range 0-12), higher scores indicating better performance. Generalized estimating equations were used to analyze differences between participants with and without OA, unadjusted as well as adjusted for confounders. RESULTS: There was a significant interaction between OA and sex (P = 0.068). Both in men and women, total performance was lower for participants with OA, with greater differences in men. Chair stand and walking performance (P < 0.05), but not balance, were lower in participants with OA. After adjustment for confounders, these associations remained significant in men but not in women. Additional analyses correcting for follow-up duration and attrition showed lower performance scores for men and women with OA. CONCLUSIONS: OA negatively affected physical performance 3-6 years after it was first reported. Performance in men with OA was more affected than in women.

Effect of stimulation intensity on assessment of voluntary activation.

INTRODUCTION: The interpolated twitch technique is often used to assess voluntary activation (VA) of skeletal muscles. We investigated VA and the voluntary torque-superimposed torque relationship using either supramaximal nerve stimulation or better tolerated submaximal muscle stimulation, which is often used with patients. METHODS: Thirteen healthy subjects performed maximal and submaximal isometric knee extensions with superimposed maximal or submaximal doublets (100 Hz). RESULTS: Superimposed torque relative to potentiated resting doublets was smaller with maximal nerve than with submaximal muscle stimulation. Maximal VA was 87 ± 7% and 93 ± 5% for submaximal muscle and maximal nerve stimulation, respectively. The individual voluntary torque-superimposed torque relationships were more linear for submaximal muscle stimulation, possibly leading to less overestimation of VA. CONCLUSIONS: Submaximal muscle stimulation can be used to estimate VA in the knee extensors. It is less painful, and overestimation of VA may be less compared with maximal nerve stimulation.

Peak oxygen consumption in older adults with a lower limb amputation.

OBJECTIVE: To investigate whether the aerobic capacity of older adults who underwent a lower limb amputation is associated with the presence, cause (traumatic or vascular), and level of amputation (transtibial or transfemoral). DESIGN: Cross-sectional descriptive. SETTING: Human motion laboratory at a rehabilitation center. PARTICIPANTS: Older subjects (n=36) who underwent lower limb amputation and age-matched, able-bodied controls (n=21). All subjects were able to walk for a minimum of 4 minutes. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Peak oxygen consumption (Vo(2)(peak)) was measured using open-circuit respirometry while performing a discontinuous, graded, 1-legged, peak cycle exercise test. RESULTS: After correcting for age, body mass index, and sex, the multiple linear regression analysis revealed that subjects who underwent amputation had a 13.1% lower aerobic capacity compared with able-bodied controls (P=.021). Differentiation among etiologies revealed that subjects with a vascular amputation had a lower Vo(2)(peak) of 29.1% compared with able-bodied controls (P<.001), whereas traumatic amputees did not differ from able-bodied controls (P=.127). After correcting for etiology, no association between level of amputation and Vo(2)(peak) was found (P=.534). CONCLUSIONS: Older adults who underwent an amputation because of vascular deficiency had a lower aerobic capacity compared with able-bodied controls and people with a traumatic amputation. The level of amputation was not associated with Vo(2)(peak).

The effects of imagery training on fast isometric knee extensor torque development.

We hypothesized that imagery training would improve the fast onset of neuromuscular activation and thereby fast knee extensor isometric torque development. Forty young healthy participants, not involved in strength training, were assigned to one of four groups: physical training, imagery training, placebo training or control. The three training groups had three 15 min sessions per week for 4 weeks, with a 90 ° knee angle but were tested also at 120 °. At 90 ° knee angle, maximal torque increased (-8%) similarly in all three training groups. The torque-time integral (contractile impulse) over the first 40 ms after torque onset (TTI40) increased (P < 0.05) after physical training (by -100%), but only at 90 °. This increase was significantly different from the delta values (change pre to post) in the control and placebo groups, whereas delta values in the imagery group were similar to those in the placebo group. The increases in TTI40 following physical training were related (r (2) = 0.81, P < 0.05) to significant increases of knee extensor rectified surface EMG at torque onset (EMG40). In conclusion, only physical training led to a knee angle specific increase of contractile impulse that was significantly different from placebo and controls and that was related to improved onset of neuromuscular activation.

Partial hexokinase II knockout results in acute ischemia-reperfusion damage in skeletal muscle of male, but not female, mice.

Cellular studies have demonstrated a protective role of mitochondrial hexokinase against oxidative insults. It is unknown whether HK protective effects translate to the in vivo condition. In the present study, we hypothesize that HK affects acute ischemia-reperfusion injury in skeletal muscle of the intact animal. Male and female heterozygote knockout HKII (HK(+/-)), heterozygote overexpressed HKII (HK(tg)), and their wild-type (WT) C57Bl/6 littermates mice were examined. In anesthetized animals, the left gastrocnemius medialis (GM) muscle was connected to a force transducer and continuously stimulated (1-Hz twitches) during 60 min ischemia and 90 min reperfusion. Cell survival (%LDH) was defined by the amount of cytosolic lactate dehydrogenase (LDH) activity still present in the reperfused GM relative to the contralateral (non-ischemic) GM. Mitochondrial HK activity was 72.6 +/- 7.5, 15.7 +/- 1.7, and 8.8 +/- 0.9 mU/mg protein in male mice, and 72.7 +/- 3.7, 11.2 +/- 1.4, and 5.9 +/- 1.1 mU/mg in female mice for HK(tg), WT, and HK(+/-), respectively. Tetanic force recovery amounted to 33 +/- 7% for male and 17 +/- 4% for female mice and was similar for HK(tg), WT, and HK(+/-). However, cell survival was decreased (p = 0.014) in male HK(+/-) (82 +/- 4%LDH) as compared with WT (98 +/- 5%LDH) and HK(tg) (97 +/- 4%LDH). No effects of HKII on cell survival was observed in female mice (92 +/- 2% LDH). In conclusion, in this mild model of acute in vivo ischemia-reperfusion injury, a partial knockout of HKII was associated with increased cell death in male mice. The data suggest for the first time that HKII mediates skeletal muscle ischemia-reperfusion injury in the intact male animal.

Intrinsic properties of the knee extensor muscles after subacute stroke.

UNLABELLED: Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke. OBJECTIVE: To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke. DESIGN: Case-control study. SETTING: Rehabilitation center research laboratory. PARTICIPANTS: Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery. RESULTS: No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001). CONCLUSIONS: The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation.

Leg dominancy in relation to fast isometric torque production and squat jump height.

We hypothesized that maximal unilateral isometric knee extensor torque, the rate of torque development during maximally fast isometric contractions and unilateral squat jump performance would be better with the dominant than non-dominant leg. Limb dominancy was established using the step up, balance recovery, and ball kick test. On two days, eight men (21.5 +/- 2.2 years, means +/- SD) performed unilateral maximal isometric contractions with their knee extensors (120 degrees knee angle) with superimposed electrical stimulation to determine maximal torque and voluntary activation for both limbs. In addition, maximally fast isometric contractions without countermovement and unilateral squat jumps (SJ) starting from 120 degrees knee angles were performed. Torque time integral (contractile impulse) over the first 40 ms after torque onset (TTI40) and maximal rates of torque development (MRTD) during voluntary and maximal electrical nerve stimulation were used to quantify initial torque rise. Limb dominancy tests were very consistent, but none of the parameters was (or tended to be) significantly different between limbs, neither during maximal electrical stimulation nor during voluntary attempts. Between limbs there were significant relationships for voluntary TTI40 (r (2) = 0.94) and maximal SJ height (r (2) = 0.88) and both parameters were significantly related in both limbs (r (2) = 0.69 and 0.75). In conclusion, unilateral fast torque generating capacity, muscle activation and squat jump performance were similar in both limbs, but differed substantially among subjects, with strong correlations between fast voluntary isometric torque development and jump height. These findings further challenge the concept of lower limb dominancy in dynamometry testing in sports and rehabilitation.

Gated dynamic 31P MRS shows reduced contractile phosphocreatine breakdown in mice deficient in cytosolic creatine kinase and adenylate kinase.

We developed a new dedicated measurement protocol for dynamic (31)P MRS analysis in contracting calf muscles of the mouse, using minimally invasive assessment of the contractile force combined with the acquisition of spectroscopic data gated to muscle contraction and determination of phosphocreatine (PCr) recovery rate and ATP contractile cost. This protocol was applied in a comparative study of six wild type (WT) mice and six mice deficient in cytosolic creatine kinase and adenylate kinase isoform 1 (MAK(-/-) mice) using 70 repeated tetanic contractions at two contractions per minute. Force levels during single contractions, and metabolite levels and tissue pH during resting conditions were similar in muscles of MAK(-/-) and WT mice. Strikingly, muscle relaxation after contraction was significantly delayed in MAK(-/-) mice, but during repeated contractions, the decrease in the force was similar in both mouse types. Gated data acquisition showed a negligible PCr breakdown in MAK(-/-) immediately after contraction, without a concomitant decrease in ATP or tissue pH. This protocol enabled the determination of rapid PCr changes that would otherwise go unnoticed due to intrinsic low signal-to-noise ratio (SNR) in mouse skeletal muscles combined with an assessment of the PCr recovery rate. Our results suggest that MAK(-/-) mice use alternative energy sources to maintain force during repeated contractions when PCr breakdown is reduced. Furthermore, the absence of large increases in adenosine diphosphate (ADP) or differences in force compared to WT mice in our low-intensity protocol indicate that creatine kinase (CK) and adenylate kinase (AK) are especially important in facilitating energy metabolism during very high energy demands.

Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke.

OBJECTIVE: (1) To examine the isometric strength, speed, and fatigue resistance of the knee extensors of the paretic limb and nonparetic limb in patients with stroke and compare these with able-bodied subjects. (2) To relate the contractile properties with different indices of functional performance. DESIGN: Case-control study. SETTING: Rehabilitation center research laboratory. PARTICIPANTS: Eighteen stroke patients and 10 able-bodied controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximal voluntary torque (MVT), maximal rate of torque development, time to maximal rate of torque development, half relaxation time ((1/2)RT), and fatigue index. Scores on the Functional Ambulation Category scale, Berg Balance Scale, and Rivermead Mobility Index as well as distance walked during the six-minute walk test were obtained. RESULTS: MVT of the paretic leg was lower than of the nonparetic leg (P<.05), and both limbs had lower MVT than controls (P<.05). Both the paretic and the nonparetic leg showed longer (1/2)RT compared with controls (P<.05). The fatigue index was reduced in the paretic leg (P<.05) but not in the nonparetic leg compared with controls. MVT and fatigue index of the paretic leg were related to indices of functional performance (r=0.49-0.64; P<.05). CONCLUSIONS: Apart from bilateral weakness, knee extensors in patients with stroke showed a lower rate of torque development and relaxation (both paretic and nonparetic leg) and lower fatigue resistance (paretic leg only) than controls, which in part may be a consequence of changes within the muscles. Strength and fatigue resistance relate to functional performance, indicating that these muscle properties should be addressed during rehabilitation. However, future research is needed to elucidate the efficacy of exercise programs.

The clinical utility of the GOLD classification of COPD disease severity in pulmonary rehabilitation.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has introduced a four-stage classification of chronic obstructive pulmonary disease (COPD) severity. The present study investigated the discriminatory capacity of the GOLD classification for health status outcomes in patients with COPD. An additional analysis was performed to investigate the discriminatory capacity of a multidimensional staging system, i.e. the Body-Mass Index, Degree of Airflow Obstruction and Dyspnea, and Exercise Capacity Index (BODE index) for the outcome of quality of life. Retrospective analysis was performed on 253 COPD patients (30% stage II, 48% stage III, 22% stage IV), referred for outpatient pulmonary rehabilitation. Pulmonary function, exercise capacity, dyspnoea and quality of life were evaluated. Analyses of variance were used to detect differences between GOLD stages and BODE index quartiles, and scatterplots of individual responses were produced as well. The GOLD classification discriminated between stages for pulmonary function (p<0.001), exercise capacity (p<0.001), dyspnoea (p<0.001) and the activities section (p=0.001) of the St. George Respiratory Questionnaire (SGRQ). The BODE index discriminated between quartiles for the activities section (p<0.001), impacts section (p=0.04) and the total score (p=0.01) of the SGRQ. Scatterplots revealed marked inter-individual variation within each GOLD stage or BODE index quartile, and considerable overlap between stages for all health status outcomes. These findings show that the GOLD classification indeed can be used to discern groups of COPD patients, but due to large inter-individual variability it does not seem adequate as a basis for individual management plans in rehabilitation. The BODE index appeared to discriminate slightly better for quality of life, however, it still leaves a significant part of the variance unexplained.

Effects of electric stimulation-assisted cycling training in people with chronic stroke.

OBJECTIVE: To evaluate whether leg cycling training in subjects with chronic stroke can improve cycling performance, aerobic capacity, muscle strength, and functional performance and to determine if electric stimulation (ES) to the contralateral (paretic) leg during cycling has additional effects over cycling without ES. DESIGN: A randomized controlled trial, with a partial double-blind design. SETTING: A rehabilitation center. PARTICIPANTS: Twelve stroke patients (range, 18-70 y), more than 5 months poststroke, with lower-extremity hemiparesis. INTERVENTION: Subjects were randomly assigned to groups that performed cycling exercise, one with ES evoking muscle contractions and a control group with ES not evoking muscle contractions. Subjects, blinded for group assignment, trained twice a week for 6 weeks. MAIN OUTCOME MEASURES: Changes in aerobic capacity and maximal power output, functional performance, and lower-limb muscle strength. RESULTS: Aerobic capacity and maximal power output significantly increased by 13.8%+/-19.1% and 38.1%+/-19.8%, but muscle strength was not significantly enhanced after training. Functional performance improved (ie, scores on the Berg Balance Scale increased by 6.9%+/-5.8% (P=.000) and the six-minute walk test improved by 14.5%+/-14.1% (P=.035). There was no significant effect on the Rivermead Mobility Index (P=.165). Training-induced changes were not significantly different between the 2 groups. Changes in cycling performance and aerobic capacity were not significantly related to changes in functional performance. CONCLUSIONS: This study showed that a short cycling training program on a semirecumbent cycle ergometer can markedly improve cycling performance, aerobic capacity, and functional performance of people with chronic stroke. The use of ES had no additional effects in this specific group of subjects with chronic stroke.

Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke.

The objective of this study was to assess the nature of muscle weakness in both legs after stroke compared with able-bodied control individuals and to examine whether there is a relationship between the degree of muscle weakness and coactivation of knee extensors and flexors as well as voluntary activation capacity of knee extensors of both paretic and non-paretic legs and indices of functional performance. Maximal voluntary isometric torques of knee extensors (MVCe) and flexors (MVCf) were determined in 14 patients (bilaterally) and 12 able-bodied controls. Simultaneous measurements were made of torque and surface EMG from agonist and antagonist muscles. Coactivation was calculated. Supramaximal triplets were evoked with electrical stimulation to estimate maximal torque capacity and degree of voluntary activation of knee extensors. MVCs, activation and coactivation parameters were correlated to scores of seven functional performance tests. MVCe, MVCf and voluntary activation were lower in paretic lower limb (PL) compared with both non-paretic lower limb (NL) and control. Besides, all these parameters of NL were also lower than control. Electrically evoked torque capacity of knee extensors of PL was about 60% of both NL and control, which were not significantly different from each other. Strong significant correlations between strength, as well as voluntary activation, and functional performance were found. Coactivation did not correlate well with functional performance. Thus, whereas for NL activation failure can explain weakness, for PL both activation failure and reduced intrinsic torque capacity are responsible for the severe weakness. Activation capacity and muscle strength correlated strongly to functional performance, while coactivation did not.

Correction: Aerobic Exercise Training in Post-Polio Syndrome: Process Evaluation of a Randomized Controlled Trial.

[This corrects the article DOI: 10.1371/journal.pone.0159280.].

Changes in antagonist muscles' coactivation in response to strength training in older women.

BACKGROUND: The purpose of this study was to assess changes in neuromuscular function of the plantarflexor and dorsiflexor muscles after 1 year of strength training of these muscles in elderly women. Twelve participants were assigned to a training (74.2 +/- 3.1 years) group and eight to a nontraining group (73.6 +/- 4.3 years). METHODS: Isometric maximum voluntary contractions (MVC) and muscle activation based on surface electromyography (EMG) were recorded before and after the 12-month training program at six different joint angles. RESULTS: After training (in the training group), (a) plantarflexion (PF) MVC increased on average by 14.4% (p <.05) across ankle joint angles from -20 degrees dorsiflexion (DF) to +30 degrees PF, (b) DF MVC decreased by 5.7% (p <.05), (c) PF EMG root mean square increased on average by 22.3% (p <.05), and (d) PF antagonists' coactivation increased on average by 7.5% across the tested joint angles. No changes were observed in the nontraining group. CONCLUSIONS: The present results show a significant increase in antagonist muscle coactivation with strength training in older women. The hypothesis is put forward that with a training-induced gain in agonist muscles' torque, stabilization of the ankle joint by increasing antagonist coactivation is needed because of a changed ratio of maximal PF torque to maximal DF torque.

Isometric knee-extensor torque development and jump height in volleyball players.

PURPOSE: The goal of the present study was to determine the contribution of the intrinsic muscle properties and muscle activation of the knee extensors to the maximal rate of unilateral isometric torque development and to relate both factors to maximal bilateral jumping performance in experienced jumpers. On the basis of previous studies, we hypothesized that maximal rate of torque development during maximal effort isometric contractions and jump height would depend on the subjects' ability for maximal muscle activation rather than on the muscle's contractile properties. METHODS: Eleven male elite volleyball players (20 +/- 2 yr, means +/- SD) performed squat jumps starting from a 120 degrees knee angle (SJ120; full extension = 180 degrees ) and countermovement jumps. In addition, maximal voluntary and electrically evoked unilateral isometric knee-extension torque development (120 degrees angle) was obtained. Torque time integral for the first 40 ms after torque onset (TTI40) and (time to) maximal rate of torque development (MRTD) were calculated. Muscle activation was quantified using surface EMG. RESULTS: Voluntary TTI40 was significantly related to the preceding EMG (r2 = 0.83) and negatively related to the time to MRTD (r2 = 0.64). Voluntary MRTD and TTI40 were not related to their respective values obtained during electrical stimulation (r2 < 0.04). Only electrically evoked MRTD was significantly related to jump height (e.g., r2 = 0.70 for SJ120). CONCLUSIONS: As expected initial maximal voluntary isometric torque development correlated with muscle activation and not with muscle contractile speed. However, unexpectedly, only the latter could predict jump performance in skilled jumpers.