Exercise volume load in women with breast cancer: Study protocol for the ABRACE randomized clinical trial.

Background: An increased number of breast cancer patients are challenged by acute and persistent treatment side effects. Oncology guidelines have been establishing physical exercise to counteract several treatment-related toxicities throughout cancer care. However, evidence regarding the optimal dose-response, feasibility, and the minimal resistance exercise volume and/or intensity remains unclear. The ABRACE Study will assess the impact of different resistance training volumes (i.e., single or multiple sets) combined with aerobic exercise on physical and psychological outcomes of breast cancer patients undergoing primary treatment. Methods: This study is a randomized, controlled, three-armed parallel trial. A total of 84 participants, aged ≥18 years, with breast cancer stages I-III, initiating adjuvant or neoadjuvant chemotherapy (≤50% of sessions completed) will be randomized to multiple sets resistance training plus aerobic training group, single set resistance training plus aerobic training group or control group. Neuromuscular and cancer-related fatigue (primary outcomes), muscle strength, muscle thickness, muscle quality by echo intensity, body composition, cardiorespiratory capacity, functional performance, upper-body endurance and quality of life will be measured before and after the 12-week intervention. Our analysis will follow the intention-to-treat approach and per-protocol criteria, with additional sub-group analysis. Discussion: Findings support prescribing exercise during chemotherapy for breast cancer and elucidate the potential role of different resistance training volumes as a management strategy for physical and psychological impairments in women with early-stage breast cancer. Our main hypothesis is for superiority in physical and psychological outcomes for both training groups compared to the control group, with no difference between single or multiple sets groups. Trial registration: Clinical trials NCT03314168.

Ultrasonographic findings in long COVID: A cross-sectional study of 312 patients.

Background: Fatigue and muscle weakness are common complaints in COVID-19 survivors. However, little is still known about the skeletal muscle qualitative and quantitative characteristics after hospitalization due to moderate and severe COVID-19. Objectives: To assess rectus femoris and vastus intermedius muscle thickness (MT) and rectus femoris echo intensity (EI) and to establish its association with demographic, clinical, functional, and inflammatory parameters in long COVID patients after hospital discharge. Methods: Cross-sectional study with 312 COVID-19 patients (53.53% male; age: 54.59 ± 13.50 years), with a laboratory-confirmed diagnosis of COVID-19. Patients were assessed 3-11 months after hospital discharge. We evaluated MT of the right rectus femoris and vastus intermedius and EI of the right rectus femoris using a portable ultrasound system, 6-13 MHz, broadband linear transducer. We corrected EI using the subcutaneous fat thickness. Ultrasonographic parameters were tested in association with demographic (sex and age); functional (Handgrip strength measurement, Timed Up and Go, 1 min Sit-to-Stand test, EuroQoL-5 Dimensions-5 Levels, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post-COVID-19 Functional Status, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT), Medical Research Council (MRC) sum score, Borg Dyspnea Scale, MRC Dyspnea score, Visual Analogue Scale (VAS), Epworth Sleepiness Scale, Insomnia Severity Index, Functional Independence Measurement (FIM), and Functional Oral Intake Scale); clinical (length of hospital stay, intubation, and presence of comorbidities such as systemic hypertension, diabetes, obesity, chronic obstructive pulmonary disease, asthma), and inflammatory data assessed by the C-reactive protein and D-dimer serum concentrations. Results: Rectus femoris MT was associated with age, handgrip strength, Epworth Sleepiness Scale, and subcutaneous fat thickness (r2 = 27.51%; p < 0.0001). Vastus intermedius MT was associated with age, pain intensity, handgrip strength, Epworth Sleepiness scale, FIM, and time since hospital discharge (r2 = 21.12%; p < 0.0001). Rectus femoris EI was significantly associated with the male sex, TUG, Epworth Sleepiness Scale, and C-Reactive Protein levels (r2 = 44.39%; p < 0.0001). Mean MT of rectus femoris and vastus intermedius are significantly different (p < 0.001). Conclusion: After hospital discharge, long COVID patients present qualitative and quantitative skeletal muscle characteristics associated with a combination of demographic, clinical, and functional parameters.

Changes in supramaximal M-wave amplitude at different regions of biceps brachii following eccentric exercise of the elbow flexors.

PURPOSE: Previous evidence from surface electromyograms (EMGs) suggests that exercise-induced muscle damage (EIMD) may manifest unevenly within the muscle. Here we investigated whether these regional changes were indeed associated with EIMD or if they were attributed to spurious factors often affecting EMGs. METHODS: Ten healthy male subjects performed 3 × 10 eccentric elbow flexions. Maximal voluntary contraction (MVC), muscle soreness and ultrasound images from biceps brachii distal and proximal regions were measured immediately before (baseline) and during each of the following 4 days after the exercise. Moreover, 64 monopolar surface EMGs were detected while 10 supramaximal pulses were applied to the musculocutaneous nerve. The innervation zone (IZ), the number of electrodes detecting largest M-waves and their centroid longitudinal coordinates were assessed to characterize the spatial distribution of the M-waves amplitude. RESULTS: The MVC torque decreased (~ 25%; P < 0.001) while the perceived muscle soreness scale increased (~ 4 cm; 0 cm for no soreness and 10 cm for highest imaginable soreness; P < 0.005) across days. The echo intensity of the ultrasound images increased at 48 h (71%), 72 h (95%) and 96 h (112%) for both muscle regions (P < 0.005), while no differences between regions were observed (P = 0.136). The IZ location did not change (P = 0.283). The number of channels detecting the greatest M-waves significantly decreased (up to 10.7%; P < 0.027) and the centroid longitudinal coordinate shifted distally at 24, 48 and 72 h after EIMD (P < 0.041). CONCLUSION: EIMD consistently changed supramaximal M-waves that were detected mainly proximally from the biceps brachii, suggesting that EIMD takes place locally within the biceps brachii.

Superficial and deep lumbar multifidus layers of asymptomatic individuals: intraday and interday reliability of the echo intensity measurement.

INTRODUCTION: Ultrasonography has been used to understand the functional and biomechanical aspects of the lumbar multifidus muscle in vivo. To characterize the multifidus echogenicity, the peculiarities of their superficial and deep layers must be considered. PURPOSE: The present paper aimed to characterize the lumbar multifidus echo intensity (EI), in both superficial and deep layers, in ultrasonography images acquired in longitudinal and transversal orientations. METHODS: Evaluator obtained two images in each side of the lumbar of the volunteer, who was lying on prone position. Ultrasonography images were taken with probe in transversal and longitudinal orientations. EI was estimated by means average value of the grayscale distribution histogram, by extracting from region of interest of the superficial and deep layer. All participants returned for a second test day. Two-way MANOVA test was applied to compare EI measurements, considering layers and side factors. The reliability and variability were analyzed by the intraclass correlation coefficient and standard error measurements (SEM), respectively. Two-way MANOVA found significant difference between the layers in the transversal and longitudinal images, but not between the sides. RESULTS: Interdays reliability ranged of reasonable to excellent, and SEM values were lower than 17.08%. The superficial layer of the multifidus muscle showed higher EI values than the deeper one. CONCLUSIONS: These analyses can serve as a basis for future studies approaching multifidus of the people with low back pain.

Effects of long-term concurrent training to failure or not in muscle power output, muscle quality and cardiometabolic risk factors in older men: A secondary analysis of a randomized clinical trial.

This study investigated the effects of concurrent training performed either with repetitions to failure or not to failure in muscle power, muscle quality (MQ), peak oxygen uptake (VO2peak), and visceral fat in older men. This is an ancillary analysis of a randomized controlled trial. 36 older men (mean age ± SD; 67.1 ± 5.1 years) were randomized into three groups: one performing repetitions to failure (RFG, n = 13), another performing repetitions not to failure and 50% of the repetitions of the RFG (NFG, n = 12), and third performing repetitions not to failure with equal training volume of the RFG (ENFG, n = 11). The training was performed twice a week for 20 weeks at intensities ranging from 65 to 80% of maximal strength. In each session, the individuals started with strengthening exercises and then performed aerobic exercise (i.e., walking) on a treadmill. The primary endpoint was change from baseline to post-20 wk of absolute and relative muscle power output during squat and countermovement jump, ultrasound measurements for MQ using quadriceps echo intensity, and visceral fat thickness, as well as their VO2peak through a maximal incremental test on a treadmill. All training groups improved similarly and significantly jump height (ranging from 9 to 16%) and all their muscle power outcomes (mean change ranging from 2 to 7%) (P < .001). In addition, all groups significantly decreased visceral fat thickness (ranging from -11 to -21%) (P < .001), and significantly increased VO2peak (ranging from 4 to 8%) (P < .01), with no differences between groups. No changes were observed in the MQ outcomes. Concurrent training performed using repetitions to failure or not to failure promoted similar gains in the muscle power output, aerobic capacity, and visceral fat in healthy older men.

Non-Uniformity of Elbow Flexors Damage Induced by an Eccentric Protocol in Untrained Men.

Muscle structure disorganization is a consequence of intense eccentric contractions, with symptoms that characterize exercise-induced muscle damage (EIMD). To date, few studies have described EIMD parameters at different muscle sites. The aim of the present study was to analyse indirect markers of EIMD at two elbow flexors sites over three days. Eleven healthy untrained men were submitted to a session of three sets of 10 eccentric elbow flexion repetitions on an isokinetic dynamometer. The isometric peak torque (PT), muscle soreness, elbow flexors oedema, (normalized muscle thickness [MT]) and echo-intensity (EI) were measured. There was a significant decrease in PT immediately after (Post) and 10 min, 24 h, 48 h and 72 h after intervention compared to that at baseline (p < 0 .05). MT% increased after 72 h compared with that immediately, 10 min and 24 h after intervention (p < 0.05). No statistical changes were observed in muscle soreness and oedema between the two muscle sites. With respect to EI%, significant differences were observed for the 24 h, 48 h and 72 h measures compared with those of the Post, 10 min and 24 h measures for both muscle sites; at the distal site, EI% was significantly higher than at the proximal site for measures after 24 h (p < 0.05). The presence of differences in EI% 24 h after eccentric training on distal sites of elbow flexors indicates non-uniform EIMD in this region.

Texture analysis of ultrasound images is a sensitive method to follow-up muscle damage induced by eccentric exercise.

The grey level of co-occurrence matrix (GLCM) is a texture analysis approach accounting for spatial distribution of the pixels from an image and can be a promising method for exercise-induced muscle damage (EIMD) studies. We followed up the time changes of two GLCM texture parameters and echo intensity (EI) on ultrasound images after eccentric contractions. Thirteen untrained women performed two sets of ten elbow flexions eccentric contractions. Ultrasound images were acquired at baseline and 24 h, 48 h, 72 h and 96 h after exercise. Two GLCM texture parameters were calculated for the brachialis muscle: contrast (CON) and correlation (COR). Peak torque, EI, muscle thickness (MT) and soreness were measured. The peak torque and soreness decreased immediately after the intervention in comparison with all the measures. MT increased immediately after the intervention remaining for 72 h (P<0·05). Significant increases (P<0·05) were observed for COR (48, 72 and 96 h) and EI only at 72 and 96 h. The increasing COR represents high similarity between grey levels, which could be observed on US images after few days on eccentric training for elbow flexors.

Sonographic Measurement of the Quadriceps Muscle in Patients With Chronic Obstructive Pulmonary Disease: Functional and Clinical Implications.

OBJECTIVES: The purpose of this study was to determine the association between functionality as assessed by the 6-minute walking test (6MWT), maximal voluntary contraction of the quadriceps (MVCQ), and quadriceps thickness and echo intensity as measured by sonography, in patients with chronic obstructive pulmonary disease (COPD). METHODS: Maximal voluntary contraction of the quadriceps and the thickness and echo intensity of the rectus femoris and vastus intermedius were evaluated in 20 patients with COPD. Functionality was assessed by the 6MWT. Differences between the evaluated muscles were determined by the Student t test. Pearson and Spearman rank correlation coefficients were used to analyze relationships between variables of interest, according to data characteristics. Finally, multivariate regression models were applied. RESULTS: There was a positive correlation between MVCQ and rectus femoris and vastus intermedius thickness (r = 0.427; P = .030; r = 0.469; P= .018, respectively) and a negative correlation between MVCQ and rectus femoris and vastus intermedius echo intensity (r= -0.500; P= .012; r= -0.482; P= .016). No correlation was found between MVCQ and the 6MWT (r = 0.319; P = .085). Multivariate regression analysis showed that the rectus femoris echo intensity, vastus intermedius echo intensity, and vastus intermedius thickness explained 70% of the variance in the distance walked during the 6MWT. CONCLUSIONS: These results indicate that, in patients with COPD, both quadriceps force and exercise capacity are associated with quantitative (thickness) and qualitative (echo intensity) characteristics of the quadriceps. Consequently, comprehensive assessments of peripheral muscles should simultaneously include both measurements.

Early resistance training-induced increases in muscle cross-sectional area are concomitant with edema-induced muscle swelling.

PURPOSE: It has been proposed that skeletal muscle shows signs of resistance training (RT)-induced muscle hypertrophy much earlier (i.e., ~3-4 weeks of RT) than previously thought. We determined if early increases in whole muscle cross-sectional area (CSA) during a period of RT were concomitant with edematous muscle swelling and thus not completely attributable to hypertrophy. METHODS: We analyzed vastus lateralis muscle ultrasound CSA images and their respective echo intensities (CSA-USecho) at the beginning (T1), in the 3rd week of RT (T2) and at the end (T3) of a 10-week RT period in ten untrained young men. Functional parameters [training volume (TV = load × reps × sets) and maximal voluntary contraction (MVC)] and muscle damage markers (myoglobin and interleukin-6) were also assessed. RESULT: Muscle CSA increased significantly at T2 (~2.7%) and T3 (~10.4%) versus T1. Similarly, CSA-USecho increased at T2 (~17.2%) and T3 (~13.7%). However, when CSA-USecho was normalized to the increase in muscle CSA, only T2 showed a significantly higher USecho versus T1. Additionally, TV increased at T2 and T3 versus T1, but MVC increased only at T3. Myoglobin and Interleukin-6 were elevated at T2 versus T1, and myoglobin was also higher at T2 versus T3. CONCLUSION: We propose that early RT-induced increases in muscle CSA in untrained young individuals are not purely hypertrophy, since there is concomitant edema-induced muscle swelling, probably due to muscle damage, which may account for a large proportion of the increase. Therefore, muscle CSA increases (particularly early in an RT program) should not be labeled as hypertrophy without some concomitant measure of muscle edema/damage.

Low- and high-volume strength training induces similar neuromuscular improvements in muscle quality in elderly women.

The aim of this study was to compare the effects of low- and high-volume strength training on strength, muscle activation and muscle thickness (MT) of the lower- and upper-body, and on muscle quality (MQ) of the lower-body in older women. Twenty apparently healthy elderly women were randomly assigned into two groups: low-volume (LV, n=11) and high-volume (HV, n=9). The LV group performed one-set of each exercise, while the HV group performed three-sets of each exercise, twice weekly for 13 weeks. MQ was measured by echo intensity obtained by ultrasonography (MQEI), strength per unit of muscle mass (MQST), and strength per unit of muscle mass adjusted with an allometric scale (MQAS). Following training, there was a significant increase (p≤0.001) in knee extension 1-RM (31.8±20.5% for LV and 38.3±7.3% for HV) and in elbow flexion 1-RM (25.1±9.5% for LV and 26.6±8.9% for HV) and in isometric maximal strength of the lower-body (p≤0.05) and upper-body (p≤0.001), with no difference between groups. The maximal electromyographic activation for both groups increased significantly (p≤0.05) in the vastus medialis and biceps brachii, with no difference between groups. All MT measurements of the lower- and upper-body increased similarly in both groups (p≤0.001). Similar improvements were also observed in MQEI (p≤0.01), MQST, and MQAS (p≤0.001) for both groups. These results demonstrate that low- and high-volume strength training promote similar increases in neuromuscular adaptations of the lower- and upper-body, and in MQ of the lower-body in elderly women.