Influence of acetaminophen and ibuprofen on in vivo patellar tendon adaptations to knee extensor resistance exercise in older adults.

Millions of older individuals consume acetaminophen or ibuprofen daily and these same individuals are encouraged to participate in resistance training. Several in vitro studies suggest that cyclooxygenase-inhibiting drugs can alter tendon metabolism and may influence adaptations to resistance training. Thirty-six individuals were randomly assigned to a placebo (67 ± 2 yr old), acetaminophen (64 ± 1 yr old; 4,000 mg/day), or ibuprofen (64 ± 1 yr old; 1,200 mg/day) group in a double-blind manner and completed 12 wk of knee extensor resistance training. Before and after training in vivo patellar tendon properties were assessed with MRI [cross-sectional area (CSA) and signal intensity] and ultrasonography of patellar tendon deformation coupled with force measurements to obtain stiffness, modulus, stress, and strain. Mean patellar tendon CSA was unchanged (P > 0.05) with training in the placebo group, and this response was not influenced with ibuprofen consumption. Mean tendon CSA increased with training in the acetaminophen group (3%, P < 0.05), primarily due to increases in the mid (7%, P < 0.05) and distal (8%, P < 0.05) tendon regions. Correspondingly, tendon signal intensity increased with training in the acetaminophen group at the mid (13%, P < 0.05) and distal (15%, P = 0.07) regions. When normalized to pretraining force levels, patellar tendon deformation and strain decreased 11% (P < 0.05) and stiffness, modulus, and stress were unchanged (P > 0.05) with training in the placebo group. These responses were generally uninfluenced by ibuprofen consumption. In the acetaminophen group, tendon deformation and strain increased 20% (P < 0.05) and stiffness (-17%, P < 0.05) and modulus (-20%, P < 0.05) decreased with training. These data suggest that 3 mo of knee extensor resistance training in older adults induces modest changes in the mechanical properties of the patellar tendon. Over-the-counter doses of acetaminophen, but not ibuprofen, have a strong influence on tendon mechanical and material property adaptations to resistance training. These findings add to a growing body of evidence that acetaminophen has profound effects on peripheral tissues in humans.

Resistance exercise and cyclooxygenase (COX) expression in human skeletal muscle: implications for COX-inhibiting drugs and protein synthesis.

We have shown that ibuprofen and acetaminophen block cyclooxygenase (COX) synthesis of prostaglandin PGF(2alpha) and the muscle protein synthesis increase following resistance exercise. Confusingly, these two drugs are purported to work through different mechanisms, with acetaminophen apparently unable to block COX and ibuprofen able to nonspecifically block COX-1 and COX-2. A recently discovered intron-retaining COX, now known to have three variants, has been shown to be sensitive to both drugs. We measured the expression patterns and levels of the intron 1-retaining COX-1 variants (-1b1, -1b2, and -1b3), COX-1, and COX-2 at rest and following resistance exercise to help elucidate the COX through which PGF(2alpha), ibuprofen, and acetaminophen regulate muscle protein synthesis. Skeletal muscle biopsy samples were taken from 16 individuals (8M, 8F) before, 4, and 24 h after a bout of resistance exercise and analyzed using real-time RT-PCR. Relatively few individuals expressed the intron 1-retaining COX-1b variants (COX-1b1, -1b2, and -1b3) at any time point, and when expressed, these variants were in very low abundance. COX-1 was the most abundant COX mRNA before exercise and remained unchanged (P > 0.05) following exercise. COX-2 was not expressed before exercise, but increased significantly (P < 0.05) at 4 and 24 h after exercise. The inconsistent and low levels of expression of the intron 1-retaining COX-1 variants suggest that these variants are not likely responsible for the inhibition of PGF(2alpha) production and skeletal muscle protein synthesis after resistance exercise by ibuprofen and acetaminophen. Skeletal muscle-specific inhibition of COX-1 or COX-2 by these drugs should be considered.

The effect of strenuous aerobic exercise on skeletal muscle myofibrillar proteolysis in humans.

Relatively little is known about the dynamics of the skeletal muscle protein pool following aerobic exercise. Myofibrillar protein synthesis has recently been shown to be substantially elevated for 3 days after a strenuous 60 min bout of one-legged aerobic exercise, and this increase was surprisingly equal to or greater than what has been shown numerous times following resistance exercise over the same time course. Because net protein accretion is the sum of protein synthesis and degradation, we sought to directly measure skeletal muscle myofibrillar proteolysis in five healthy young males in response to an identical strenuous 60 min aerobic exercise bout and at the same time points (rest, 6, and 24 h post-exercise and 48 and 72 h post-exercise in a subset of subjects). We measured skeletal muscle myofibrillar proteolysis by monitoring the release of the natural tracer 3-methylhistidine (3MH) from the vastus lateralis muscle into the interstitial space via microdialysis. Skeletal muscle interstitial 3MH concentration was no different (P>0.05) from rest (5.16+/-0.38 nmol/mL) after 6 (5.37+/-0.55 nmol/mL), 24 (5.40+/-0.26 nmol/mL), 48 (5.50+/-0.74 nmol/mL), or 72 h (4.73+/-0.28 nmol/mL). These results suggest that proteolysis of the myofibrillar fraction of skeletal muscle is relatively refractory to an intense aerobic exercise stimulus for up to 3 days, despite the large increase in synthesis of this muscle fraction following the same exercise stimulus. The apparent net myofibrillar protein accretion in the hours and days after exercise may occur in order to offset the large elevation in mixed muscle proteolysis that has been shown during similar bouts of intense one-legged aerobic exercise.