Blood flow restriction augments the cross-education effect of isometric handgrip training.

INTRODUCTION: The application of blood flow restriction (BFR) to low-intensity exercise may be able to increase strength not only in the trained limb but also in the homologous untrained limb. Whether this effect is repeatable and how that change compares to that observed with higher intensity exercise is unknown. PURPOSE: Examine whether low-intensity training with BFR enhances the cross-education of strength compared to exercise without BFR and maximal efforts. METHODS: A total of 179 participants completed the 6-week study, with 135 individuals performing isometric handgrip training over 18 sessions. Participants were randomly assigned to one of four groups: 1) low-intensity (4 × 2 min of 30% MVC; LI, n = 47), 2) low-intensity with blood flow restriction (LI + 50% arterial occlusion pressure; LI-BFR, n = 41), 3) maximal effort (4 × 5 s of 100% MVC; MAX, n = 47), and 4) non-exercise control (CON, n = 44). RESULTS: LI-BFR was the only group that observed a cross-education in strength (CON: 0.64 SD 2.9 kg, LI: 0.95 SD 3.6 kg, BFR-LI: 2.7 SD 3.3 kg, MAX: 0.80 SD 3.1 kg). In the trained hand, MAX observed the greatest change in strength (4.8 SD 3.3 kg) followed by LI-BFR (2.8 SD 4.0 kg). LI was not different from CON. Muscle thickness did not change in the untrained arm, but ulna muscle thickness was increased within the trained arm of the LI-BFR group (0.06 SD 0.11 cm). CONCLUSION: Incorporating BFR into low-intensity isometric training led to a cross-education effect on strength that was greater than all other groups (including high-intensity training).

The effects of branched-chain amino acids on muscle protein synthesis, muscle protein breakdown and associated molecular signalling responses in humans: an update.

Branched-chain amino acids (BCAA: leucine, isoleucine and valine) are three of the nine indispensable amino acids, and are frequently consumed as a dietary supplement by athletes and recreationally active individuals alike. The popularity of BCAA supplements is largely predicated on the notion that they can stimulate rates of muscle protein synthesis (MPS) and suppress rates of muscle protein breakdown (MPB), the combination of which promotes a net anabolic response in skeletal muscle. To date, several studies have shown that BCAA (particularly leucine) increase the phosphorylation status of key proteins within the mechanistic target of rapamycin (mTOR) signalling pathway involved in the regulation of translation initiation in human muscle. Early research in humans demonstrated that BCAA provision reduced indices of whole-body protein breakdown and MPB; however, there was no stimulatory effect of BCAA on MPS. In contrast, recent work has demonstrated that BCAA intake can stimulate postprandial MPS rates at rest and can further increase MPS rates during recovery after a bout of resistance exercise. The purpose of this evidence-based narrative review is to critically appraise the available research pertaining to studies examining the effects of BCAA on MPS, MPB and associated molecular signalling responses in humans. Overall, BCAA can activate molecular pathways that regulate translation initiation, reduce indices of whole-body and MPB, and transiently stimulate MPS rates. However, the stimulatory effect of BCAA on MPS rates is less than the response observed following ingestion of a complete protein source providing the full complement of indispensable amino acids.

Sex segregation in strength sports: Do equal-sized muscles express the same levels of strength between sexes?

OBJECTIVES: Concerns have been raised against the current two-sex binary category in sports competitions. The thesis states that if males and females were separated based on muscle size, it would negate the strength advantage between the sexes. We tested the possible sex differences in various strength outcomes when pair-matched for muscle thickness. METHODS: A total of 16 different data sets (n = 963) were assessed to pair-match females with males who had a muscle thickness value within 2%. We further compared the competition performances of the smallest male weight class within the International Powerlifting Federation (IPF) to different weight classes in females. RESULTS: Overall, 76%-88% of the strength assessments were greater in males than females with pair-matched muscle thickness, regardless of contraction types (i.e., isotonic, isometric, isokinetic). Additionally, males in the lightest weight division in the IPF largely outperformed females in heavier weight divisions. CONCLUSIONS: Our results would suggest that segregation based on muscle mass or surrogates of muscle mass (e.g., lean body mass) might not be an appropriate classification to create fair competition within strength sports. This is not to refute the concept of the desegregation of the two-sex binary category but to present data that raises important concerns about the potential sex-based differences in strength performance.

Acute social isolation alters neurogenomic state in songbird forebrain.

Prolonged social isolation has negative effects on brain and behavior in humans and other social organisms, but neural mechanisms leading to these effects are not understood. Here we tested the hypothesis that even brief periods of social isolation can alter gene expression and DNA methylation in higher cognitive centers of the brain, focusing on the auditory/associative forebrain of the highly social zebra finch. Using RNA sequencing, we first identified genes that individually increase or decrease expression after isolation and observed general repression of gene sets annotated for neurotrophin pathways and axonal guidance functions. We then pursued 4 genes of large effect size: EGR1 and BDNF (decreased by isolation) and FKBP5 and UTS2B (increased). By in situ hybridization, each gene responded in different cell subsets, arguing against a single cellular mechanism. To test whether effects were specific to the social component of the isolation experience, we compared gene expression in birds isolated either alone or with a single familiar partner. Partner inclusion ameliorated the effect of solo isolation on EGR1 and BDNF, but not on FKBP5 and UTS2B nor on circulating corticosterone. By bisulfite sequencing analysis of auditory forebrain DNA, isolation caused changes in methylation of a subset of differentially expressed genes, including BDNF. Thus, social isolation has rapid consequences on gene activity in a higher integrative center of the brain, triggering epigenetic mechanisms that may influence processing of ongoing experience.

Effect of Increased Pressure Pain Threshold on Resistance Exercise Performance With Blood Flow Restriction.

ABSTRACT: Kataoka, R, Song, JS, Bell, ZW, Wong, V, Spitz, RW, Yamada, Y, and Loenneke, JP. Effect of increased pressure pain threshold on resistance exercise performance with blood flow restriction. J Strength Cond Res 37(6): 1204-1210, 2023-This study aimed to examine whether increasing pressure pain threshold (PPT) through isometric handgrip exercise (HG) affects the number of repetitions completed and discomfort with knee extension exercise (KE) with blood flow restriction (BFR), and examine whether performing additional exercise leads to a further increase in PPT. Forty-one participants completed 2 trials: rest followed by low-load KE with BFR at 80% of resting arterial occlusion pressure (Rest + KE BFR) and low-intensity (30% of maximal strength) HG exercise followed by KE with BFR (HG + KE BFR). Pressure pain threshold was measured before and after exercise at the forearm and tibialis anterior. Results are presented as median difference (95% credible interval). Pressure pain threshold increased at the forearm (Bayes factor [BF 10 ]: 5.2 × 10 7 ) and tibialis anterior (BF 10 : 1.5 × 10 6 ) after HG exercise. However, this did not lead to greater repetitions being completed with BFR exercise (0.2 [-0.1, 0.6] repetitions, BF 10 : 0.07). Pressure pain threshold after BFR exercise was not augmented over that observed with HG exercise (0.02 [-0.15, 0.2] kg·cm -2 , BF 10 : 0.175) at the forearm. More data are needed in the lower body to determine which model best fits the data (BF 10 : 0.84). Discomfort with BFR exercise was not different between conditions (1.0 [-2.3, 4.4] arbitrary units, BF 10 : 0.10). The pain-reducing effect of prior exercise did not change the repetitions completed with BFR exercise, suggesting that the change in PPT may not have been great enough to alter performance. Performing additional exercise did not elicit further increases in PPT nor was perceived discomfort to BFR exercise altered by changes in PPT.

Hypoalgesia following isometric handgrip exercise with and without blood flow restriction is not mediated by discomfort nor changes in systolic blood pressure.

The purpose was to examine the effect of isometric handgrip exercise with and without blood flow restriction on exercise-induced hypoalgesia at a local and non-local site, and its underlying mechanisms. Sixty participants (21 males & 39 females, 18-35 years old) completed 3 trials: four sets of 2-minute isometric handgrip exercise at 30% of maximum handgrip strength; isometric handgrip exercise with blood flow restriction at 50% of arterial occlusion pressure; and a non-exercise time-matched control. Pain thresholds increased similarly in both exercise conditions at a local (exercise conditions: ~0.45 kg/cm2, control: ~-0.04 kg/cm2) and non-local site (exercise conditions: ~0.37 kg/cm2, control: ~-0.16 kg/cm2). Blood flow restriction induced greater feelings of discomfort compared to exercise alone [median difference (95% credible interval) of 4.5 (0.5, 8.6) arbitrary units]. Blood pressure increased immediately after exercise (systolic: 10.3 mmHg, diastolic: 7.7 mmHg) and decreased in recovery. There was no within participant correlation between changes in discomfort and pressure pain threshold. A bout of isometric handgrip exercise with or without blood flow restriction can provide exercise-induced hypoalgesia at a local and non-local site. However, discomfort and changes in systolic blood pressure do not explain this response.

Can Individuals Be Taught to Sense the Degree of Vascular Occlusion? A Comparison of Methods and Implications for Practical Blood Flow Restriction.

ABSTRACT: Bell, ZW, Spitz, RW, Wong, V, Yamada, Y, Song, JS, Abe, T, and Loenneke, JP. Can individuals be taught to sense the degree of vascular occlusion? A comparison of methods and implications for practical blood flow restriction. J Strength Cond Res 36(12): 3359-3365, 2022-The study objective was to determine whether subjects could be conditioned to a relative blood flow restriction pressure in the lower body and compare 2 separate conditioning methods (unconstrained vs. constrained). Thirty-five subjects completed 4 visits, involving measurements for arterial occlusion and pressure estimations at 5 minutes and 24 hours after conditioning. The constrained method involved applying 40% of measured arterial occlusion 11 times, along with 10% above and below this pressure. The unconstrained method was time-matched, involving a series of inflations to 40% arterial occlusion for 12 seconds and then deflated for 22 seconds. Data are presented as mean differences (95% credible interval) unless otherwise noted. The absolute error between conditioning methods was found to be similar at 5 minutes (-1.1 [-5.9, 3.7] mm Hg) and 24 hours (-2.4 [-7, 2.2] mm Hg) after conditioning. The constant error differed between methods at 5 minutes [-8.2 (-14.4, -1.9) mm Hg] but was similar at 24 hours (-2.5 [-8.5, 3.6] mm Hg; H0: 0.680; H1: 0.068; and H2: 0.252) after conditioning. The bias and 95% limits of agreement for the unconstrained method were -3.9 (-33.8, 25.9) mm Hg at 5 minutes and -2.9 (-32, 26.1) mm Hg at 24 hours. The agreement for the constrained method was 4.2 (-28, 36.5) mm Hg at 5 minutes and -0.54 (-37.3, 36.2) mm Hg at 24 hours. Conditioning methods produced similar levels of absolute error, indicating that either method may offer a viable means of pressure application. Most estimates were between 20 and 60% of arterial occlusion pressure. Additional conditioning sessions may be needed to narrow this range at the individual level.

The Effect of Blood Flow Restriction Therapy on Recovery After Experimentally Induced Muscle Weakness and Pain.

ABSTRACT: Wong, V, Dankel, SJ, Spitz, RW, Bell, ZW, Viana, RB, Chatakondi, RN, Abe, T, and Loenneke, JP. The effect of blood flow restriction therapy on recovery after experimentally induced muscle weakness and pain. J Strength Cond Res 36(4): 1147-1152, 2022-The purpose was to determine if blood flow restriction with no external load could be used as a means of active therapy after experimentally induced fatigue and soreness. Twelve women and 7 men (aged 18-35 years) participated in a randomized controlled trial using a within-subject design. The study intervention was 3 consecutive visits. Visit 1 included the fatiguing/soreness-inducing protocol for the elbow flexors, which was performed only once during the study. Torque was measured before/after to confirm individuals began in a weakened state. Subjects then completed blood flow restriction therapy on one arm and the sham therapy on the other. Subjects performed elbow flexion/contraction with no external load on both arms. Torque was measured once more 10 minutes after the fatiguing/soreness-inducing protocol. Twenty-four hours later, soreness and torque were assessed in each arm, followed by another bout of therapy. Forty-eight hours after the initial visit, soreness and torque were measured again. There were no differences (median difference [95% credible interval]) in the recovery of torque between the blood flow restriction and sham therapy conditions at 10 minutes (0.5 [-2.7, 3.8] N·m), 24 hours (-2.34 [-6, 1.14] N·m), or 48 hours (-1.94 [-5.45, 1.33] N·m). There were also no differences in ratings of soreness at 24 hours (-2.48 [-10.05, 5.05]) or 48 hours (2.58 [-4.96, 10.09]). Our results indicate that this specific model of blood flow restriction therapy did not enhance the recovery of the muscle compared with a sham condition without the application of pressure.

Blood Flow Restricted Exercise and Discomfort: A Review.

ABSTRACT: Spitz, RW, Wong, V, Bell, ZW, Viana, RB, Chatakondi, RN, Abe, T, and Loenneke, JP. Blood flow restricted exercise and discomfort: A review. J Strength Cond Res 36(3): 871-879, 2022-Blood flow restriction exercise involves using a pneumatic cuff or elastic band to restrict arterial inflow into the muscle and block venous return out of the muscle during the exercise bout. The resultant ischemia in conjunction with low-load exercise has shown to be beneficial with increasing muscle size and strength. However, a limitation of using blood flow restriction (BFR) is the accompanying discomfort associated with this type of exercise. Factors that may influence discomfort are applied pressure, width of the cuff, cuff material, sex, and training to failure. The goal of this review was to evaluate the existing literature and elucidate how these factors can be manipulated to reduce discomfort during exercise as well as provide possible directions for future research. Thirty-eight different studies were located investigating BFR and discomfort. It was found that BFR training causes more discomfort than exercise without BFR. However, chronic use of BFR may increase tolerability, but discomfort may still be elevated over traditional non-blood flow restricted exercise. Discomfort can be attenuated by the application of lower applied pressures and stopping short of task failure. Finally, in the upper body, wider cuffs seem to increase ratings of discomfort compared with more narrow cuffs. In conclusion, applying the proper-sized cuff and making the applied pressure relative to both the individual and the cuff applied may attenuate discomfort. Reducing discomfort during exercise may help increase adherence to exercise and rehabilitation programs.

The Relationship Between Muscle Size and Strength Does not Depend on Echo Intensity in Healthy Young Adults.

Muscle quality is typically defined as muscle strength relative to muscle size. Echo intensity has gained popularity as an index of skeletal muscle quality. There is common agreement that muscle size is related to strength at baseline and echo intensity is purported to impact this relationship. Thus, the purpose of this study was to examine whether echo intensity can be used as a physiological marker for muscle quality by investigating the moderating effect of echo intensity on the relationship between muscle size and strength. A sample of 96 participants was used for the upper body analysis and a separate sample of 96 participants was used for the lower body analysis. Echo intensity, muscle thickness, and strength measurements were measured on each limb. For strength, participants performed unilateral elbow flexion (upper body analysis) and knee extension (lower body analysis) to quantify 1-repetition maximum. Muscle thickness and echo intensity were determined from images captured using B-mode ultrasound. Muscle size correlated with muscle strength for all limbs. However, the relationship between muscle size and strength was not significantly moderated by echo intensity for Arm 1 (b = 0.042, p = 0.54) or Arm 2 (b = -0.002, p = 0.97). At the proximal site, no significant moderating effect of echo intensity was found in Leg 1 (b = 0.037, p = 0.67) or Leg 2 (b = -0.085, p = 0.29). Similarly, no significant moderating effect was observed at the distal site for Leg 1 (b = 0.03, p = 0.69) or Leg 2 (b = -0.026, p = 0.75). The results would indicate that the relationship between muscle size and strength does not depend on echo intensity. Therefore, the use of echo intensity as an index of muscle quality in healthy young adults may need to be reconsidered.

Skeletal muscle size distribution in large-sized male and female athletes.

OBJECTIVE: In healthy adults, it is generally accepted that women have less upper body muscle mass compared to men. However, it is unknown whether there are sex differences in skeletal muscle distribution in highly trained large-sized athletes. Our aim was to compare the skeletal muscle size distribution between large-sized male and female athletes. METHODS: Ten female athletes (>80 kg body mass) and twenty-one male athletes (>100 kg body mass) had muscle thickness (MT) and subcutaneous adipose tissue thickness measured by ultrasound at nine sites on the anterior and posterior aspects of the body. Total muscle mass (SM) was estimated from an ultrasound-derived prediction equation. Body fat percentage and fat-free mass were calculated from ultrasound measured subcutaneous fat thickness. RESULTS: The average SM in female athletes (30.0 kg) was approximately 70% of the mean value of the male athletes (45.3 kg).With respect to MT, the relative values of femaleto male athletes were 68% to 78% in the upper body and 85% to 92% in the lower body. Similar results were observed when analyzing data for male and female athletes (n = 5 each) who were pair matched for height. CONCLUSION: The relative values of MT for female/male athletes were higher in the lower body compared to the upper body. This is similar to that observed in healthy non-athletes indicating that this difference is not due to resistance training. The lower muscle mass in the arms and trunk of females appears to be a true sex difference but the cause of this difference is unknown.

The Water-Fat Separation Method for Determining the Fat-free Component of Subcutaneous Adipose Tissue in Humans: A Brief Review.

Fat-free mass as well as lean soft tissue mass is a surrogate for skeletal muscle mass and is often used for the normalization of several physiological variables or for the diagnosing of low muscle mass in older adults. However, both fat-free mass and lean tissue mass include nonskeletal muscle components such as the fat-free component of adipose tissue fat cells. A technique known as water-fat MRI provides a noninvasive and radiation-free assessment of the fat-free component of adipose tissue in humans. However, if this method is impractical or unavailable, some authors suggest that a constant value for the fat-free component of adipose tissue can be used as an indirect estimate. The purpose of this review is to examine the fat fraction percentage of white (subcutaneous) adipose tissue in adolescents and young/middle-aged/older adults measured by water-fat MRI and provide discussion on how the fat-free adipose tissue values from the water-fat separation method compare with the constant value used in previous studies. Calculated mean values for the percentage of fat fraction in subcutaneous adipose tissue were 86.9% in the overall sample, 86.4% in adolescents (3 studies), and 87.1% in young, middle-aged and older adults (7 studies). This is similar to the 85% value proposed in the classical studies but in the majority of studies the 85% estimate was outside of the 95% confidence interval (CI) of the water-fat MRI estimate. There may be several factors to consider that may affect the fat fraction percentage (e.g. reliability of the MRI estimate, age, sex, obesity, etc.), however, at this time there is insufficient evidence to determine the effect of each of these variables. If the measurement is reliable, then this might suggest that the 85% constant may need to be altered to better reflect the water-fat MRI estimate.

The Impact of Ultrasound Probe Tilt on Muscle Thickness and Echo-Intensity: A Cross-Sectional Study.

INTRODUCTION/BACKGROUND: To determine the influence of ultrasound probe tilt on reliability and overall changes in muscle thickness and echo-intensity. MATERIALS AND METHODS: Thirty-six individuals had a total of 15 images taken on both the biceps brachii and tibialis anterior muscles. These images were taken in 2° increments with the probe tilted either upward (U) or downward (D) from perpendicular (0°) to the muscle (U6°, U4°, U2°, 0°, D2°, D4°, and D6°). All images were then saved, stored, and analyzed using Image-J software for echo-intensity and muscle thickness measures. Mean values (2-3 measurements within each probe angle) were compared across each probe angle, and reliability was assessed as if the first measure was taken perpendicular to the muscle, but the second measure was taken with the probe tilted to a different angle (to assume unintentional adjustments in reliability from probe tilt). RESULTS: Tilting the probe as little as 2° produced a significant 4.7%, and 10.5% decrease in echo-intensity of the tibialis anterior and biceps brachii muscles, respectively, while changes in muscle thickness were negligible (<1%) at all probe angles. The reliability for muscle thickness was greater than that of echo-intensity when the probe was held perpendicular at both measurements (∼1% vs 3%), and the impact that probe tilt had on reliability was exacerbated for echo-intensity measurements (max coefficient of variation: 24.5%) compared to muscle thickness (max coefficient of variation: 1.5%). CONCLUSION: While muscle thickness is less sensitive to ultrasound probe tilt, caution should be taken to ensure minimal probe tilt is present when taking echo-intensity measurements as this will alter mean values and reduce reliability. Echo-intensity values should be interpreted cautiously, particularly when comparing values across technicians/studies where greater alterations in probe tilt is likely.

Why is low body fat rarely seen in large-sized male athletes?

OBJECTIVES: It is unknown why low body fat is rarely seen in large-sized athletes (>100 kg body mass). The aim of this review was to examine the relationship between body mass and body composition (fat mass and fat-free mass) in elite male athletes, and to discuss the possible reasons why low body fat is rarely seen in large-sized male athletes. METHODS: A search using two electronic databases was conducted. Eighteen studies estimated body composition in elite athletes by dual-energy X-ray absorptiometry, totaling 2249 elite male athletes and 72 data points. RESULTS: Our results indicated that low body fat (eg, less than 10% body fat) was rarely seen in large-sized male athletes over 100 kg body mass. The larger the body mass, the higher the fat-free mass, with fat-free mass leveling off when body mass exceeds approximately 120 kg. CONCLUSION: Possible reasons for this are unknown but we provide some ideas for why this might occur. The two different stages to consider with respect to skeletal muscle growth: the amount of growth during development and the amount of growth as a result of long-term resistance training. In certain sporting events, a large body mass may be favored. However, the large-sized athletes have to balance any potential positive influence of body mass on sports performance with the potential negative factors associated with body fat accumulation. Further research is warranted, as there is currently limited evidence on this topic.

Influence of sex and resistance training status on orofacial muscle strength and morphology in healthy adults between the ages of 18 and 40: A cross-sectional study.

OBJECTIVE: To compare the orofacial muscle strength and facial muscle thickness between resistance-trained and non-resistance trained men and women. METHODS: Resistance-trained (25 men and 22 women) and non-resistance trained (21 men and 30 women) adults (18-40 years) had standard measurements of orofacial muscle strength (ie, anterior tongue elevation, cheek compression, and lip compression) and ultrasound measurements of facial muscle thickness. Body composition (percent fat, etc.) was estimated using ultrasound prediction Equations. A Bayesian analysis of variance (ANOVA) with between subject factors of training status (yes/no) and sex (man/woman) were used to determine differences in muscle size and strength. RESULTS: Body mass, height, and percent fat were similar between resistance-trained and non-resistance trained individuals, while appendicular lean mass was higher in resistance-trained. There were no differences in orofacial muscle strength between resistance-trained and non-resistance trained. However, men had greater strength in every task except for anterior tongue strength which was similar between sexes (men: 66 vs women: 64 kPa). Handgrip strength was greater in men and in those who were resistance-trained. The frontalis muscle was greater in women than in men and in those who were non-resistance-trained than those resistance-trained. None of the other muscles differed by training status, however, all were greater in men. CONCLUSION: Results from our cross-sectional study would suggest that exercise-stimulation to the facial muscles during resistance training of the limbs and trunk did not reach a level where orofacial muscle strength could be changed. Sex differences in facial muscle thickness are very unique, although the reasons are unclear.

Skeletal muscle mass in female athletes: The average and the extremes.

OBJECTIVES: To examine the absolute and relative skeletal muscle mass (SM) in female athletes and to discuss the potential upper limit of whole-body muscle mass between large sized female and male athletes. METHODS: Forty-five female athletes and forty-five recreationally active females (control) had muscle thickness measured by ultrasound at nine sites on the anterior and posterior aspects of the body. SM was estimated from an ultrasound-derived prediction equation. Body fat percentage and fat-free mass (FFM) were calculated from ultrasound measured subcutaneous fat thickness. To eliminate fat-free component of adipose tissue (FFAT), we calculated FFM minus FFAT (FFM-FFAT). RESULTS: FFM, FFM-FFAT, and muscle mass were markedly higher in athletes. Fat Mass was similar (Athlete: 14.9 kg vs Control: 12.9 kg [median value]). The large-sized female athletes had approximately 9 to 11 kg FFAT which corresponds to about 10% to 15% of FFM. Seven of the female athletes had more than 60 kg of FFM-FFAT, the largest of whom had 77.0 kg of FFM-FFAT. SM increased in a parabolic fashion reaching a value of 35 kg SM beyond 100 kg body mass. Only one of the athletes had a SM index of more than 13 kg/m2 . CONCLUSIONS: Female athletes had much greater muscle mass than controls. In large-sized female athletes, the influence of FFAT needs to be considered when interpreting their FFM. In addition, the largest SM index in female athletes was 13.2 kg/m2 , which was approximately 77% of that observed with the largest male athlete ever recorded. This difference appears similar to that observed in nonathletes.

Does resistance training increase aponeurosis width? The current results and future tasks.

PURPOSE: The aponeurosis, a sheet of fibrous tissue, is the deep and superficial fascia where muscle fibers attach in pennate muscles. It is quite possible that the aponeurosis size increases in response to resistance training-induced fiber hypertrophy due to an increase in connection area. As a result, it leads to an increase in anatomical muscle cross-sectional area. However, attention has not been paid to aponeurosis area changes. This review sought to determine whether muscle hypertrophy changes aponeurosis width following short-term resistance training using an equation we modified [post/pre changes in aponeurosis width (AWpost/pre) = post/pre changes in anatomical cross-sectional area (CSApost/pre) ÷ post/pre changes in pennation angle (PApost/pre) ÷ post/pre changes in fascicle length (FLpost/pre)]. METHODS: A search using two electronic databases (PubMed and Google Scholar) was conducted. Nine studies measured CSApost/pre, PApost/pre, and FLpost/pre of the vastus lateralis muscle by ultrasound and magnetic resonance imaging. RESULTS: There was a statistically significant 2.73 [95% CI 1.11, 4.36; p = 0.009] cm2 increase in CSApost/pre along with a statistically significant 1.21° [95% CI 0.44, 1.97; p = 0.002] increase in PApost/pre and a statistically significant 0.36 cm [95% CI 0.19, 0.54; p = 0.0002] increase in FLpost/pre. These results yield an estimated 1% reduction in aponeurosis width. CONCLUSION: Our results suggest that while muscle CSA, pennation angle, and fascicle length all increase following short-term resistance training, the aponeurosis width is not altered.

The Perceived Tightness Scale Does Not Provide Reliable Estimates of Blood Flow Restriction Pressure.

CONTEXT: The perceived tightness scale is suggested to be an effective method for setting subocclusive pressures with practical blood flow restriction. However, the reliability of this scale is unknown and is important as the reliability will ultimately dictate the usefulness of this method. OBJECTIVE: To determine the reliability of the perceived tightness scale and investigate if the reliability differs by sex. DESIGN: Within-participant, repeated-measures. SETTING: University laboratory. PARTICIPANTS: Twenty-four participants (12 men and 12 women) were tested over 3 days. MAIN OUTCOME MEASURES: Arterial occlusion pressure (AOP) and the pressure at which the participants rated a 7 out of 10 on the perceived tightness scale in the upper arm and upper leg. RESULTS: The percentage coefficient of variation for the measurement was approximately 12%, with no effect of sex in the upper (median δ [95% credible interval]: 0.016 [-0.741, 0.752]) or lower body (median δ [95% credible interval]: 0.266 [-0.396, 0.999]). This would produce an overestimation/underestimation of ∼25% from the mean perceived pressure in the upper body and ∼20% in the lower body. Participants rated pressures above their AOP for the upper body and below for the lower body. At the group level, there were differences in participants' ratings for their relative AOP (7 out of 10) between day 1 and days 2 and 3 for the lower body, but no differences between sexes for the upper or lower body. CONCLUSIONS: The use of the perceived tightness scale does not provide reliable estimates of relative pressures over multiple visits. This method resulted in a wide range of relative AOPs within the same individual across days. This may preclude the use of this scale to set the pressure for those implementing practical blood flow restriction in the laboratory, gym, or clinic.

A method to standardize the blood flow restriction pressure by an elastic cuff.

Blood flow restriction training using a practical (non-pneumatic) elastic cuff has recently increased in popularity. However, a criticism of this method is that the pressure applied and the amount of blood flow restriction induced is unknown. The aim was to quantify blood flow following the application of an elastic cuff and compare that to what is observed using a more traditional pressurized nylon cuff. Thirty-five young participants (16 men and 19 women) visited the laboratory once for testing. In a randomized order (one condition per arm), an elastic cuff (5 cm wide) was applied to one arm and blood flow was measured following the cuff being pulled to two distinct lengths; 10% and 20% of the resting length based on arm circumference. The other arm would follow a similar protocol but use a pressurized nylon cuff (5 cm wide) and be inflated to 40% and 80% of the individuals resting arterial occlusion pressure. There was a main effect of pressure for blood flow with it decreasing in a pressure-dependent manner (High < Low, P < 0.001). The mean difference (95% CI) in blood flow between cuffs was -5.9 (-18.9, 7.0) % for the lower pressure and -4.0 (-13.2, 5.1) % for the higher pressure. When the relative changes for each cuff were separated by sex, there were no differences in the changes from Pre (P ≥ 0.509). The application of a pressure relative to the initial belt length, which is largely dependent upon arm circumference, appears to provide one method to standardize the practical blood flow restriction pressure for future research.

The influence of biological sex and cuff width on muscle swelling, echo intensity, and the fatigue response to blood flow restricted exercise.

The purpose was to determine if the muscle swelling, echo intensity, and fatigue responses to blood flow restriction differs based on cuff width (Experiment 1), applied pressure (Experiment 2), and sex. Ultrasound of muscle was taken before and after exercise. In Experiment 1 (n = 96), men swelled more than women and more with a narrow cuff than a wide cuff (0.60 cm vs. 0.52 cm). Expressed as a percentage change, there were no longer differences between cuffs (Narrow: 15% vs. Wide: 14%) or sex (Men: 14% vs. Women: 15%). Echo intensity remained unchanged. Women required more repetitions to reach task failure in sets 2, 3, and 4. In Experiment 2 (n = 87), men swelled more than women (Men: 0.46 cm vs. Women: 0.31 cm). Expressed as a percentage change, there were no differences. Echo intensity decreased in both conditions and to a greater extent with a higher applied pressure. If the acute muscle swelling response is important for initiating long term adaptation, then our results indicate that neither cuff width, sex, nor applied pressure will differentially impact the adaptation observed via this mechanism. Changes in echo intensity were inconsistent and the utility of this measurement may need to be reconsidered.