Strength and power changes of the human plantar flexors and knee extensors in response to resistance training in old age

Hypertrophy Training Following A Total Hip Replacement: A Literature Review

Hip OA is becoming more common, with a greater number of younger individuals undergoing total hip arthroplasty (THA). These individuals have the desire to return to considerable loading and in some instances return to sport. The purpose of this review was to investigate the current guidelines and/or protocols for hypertrophy or strengthening in individuals who have undergone total hip arthroplasty. A total of 16 papers were identified, some of which also addressed total knee arthroplasty. There is no consensus for the best practice for a hypertrophy program following THA especially regarding when a direct anterior approach was used during hip arthroplasty. Further research is needed as this is a growing area in rehabilitation. This review aims to bridge the gap by offering a comprehensive synthesis of the available literature on postoperative rehabilitation after THA, with a specific emphasis on identifying the most effective muscular strengthening and hypertrophy training programs for patients undergoing anterior approach hip surgery.

Triceps surae muscle hypertrophy is greater after standing versus seated calf-raise training

Background: The triceps surae muscle plays important roles in fundamental human movements. However, this muscle is relatively unresponsive to resistance training (difficult to hypertrophy) but prone to atrophy with inactivity compared with other muscles. Thus, identifying an effective training modality for the triceps surae is warranted. This study compared triceps surae muscle hypertrophy after standing/knee-extended versus seated/knee-flexed plantarflexion (calf-raise) training, where the gastrocnemius is lengthened and shortened, respectively. Methods: Fourteen untrained adults conducted calf-raise training with one leg in a standing/knee-extended position and the other leg in a seated/knee 90°-flexed position at 70% of one-repetition maximum. Each leg performed 10 repetitions/set, 5 sets/session, 2 sessions/week for 12 weeks. Before and after the intervention, magnetic resonance imaging scans were obtained to assess muscle volume of each and the whole triceps surae. Results: Muscle volume significantly increased in all three muscles and the whole triceps surae for both legs (p ≤ 0.031), except for the gastrocnemius muscles of the seated condition leg (p = 0.147-0.508). The changes in muscle volume were significantly greater for the standing than seated condition leg in the lateral gastrocnemius (12.4% vs. 1.7%), medial gastrocnemius (9.2% vs. 0.6%), and whole triceps surae (5.6% vs. 2.1%) (p ≤ 0.011), but similar between legs in the soleus (2.1% vs. 2.9%, p = 0.410). Conclusion: Standing calf-raise was by far more effective, therefore recommended, than seated calf-raise for inducing muscle hypertrophy of the gastrocnemius and consequently the whole triceps surae. This result and similar between-condition hypertrophy in the soleus collectively suggest that training at long muscle lengths promotes muscle hypertrophy.

Effects of Power Training on Functional Capacity Related to Fall Risk in Older Adults: A Systematic Review and Meta-analysis

OBJECTIVE

Functional capacity is 1 of the main risk factors for falls among older adults. The aim of this systematic review and meta-analysis was to determine the effect of power training on functional capacity test (FCT) related to fall risk in older adults.

DATA SOURCES

Systematic searches were conducted in 4 databases, including PubMed, Web of Science, Scopus, and SPORTDiscus, from inception to November 2021.

STUDY SELECTION

Randomized controlled trials (RCTs) assessing the effect of power training on functional capacity compared with another type of training program or control group in older adults with the ability to exercise independently.

DATA EXTRACTION

Two independent researchers evaluated eligibility and used the PEDro scale to assess risk of bias. The information extracted was related to article identification (authors, country and year of publication), participant characteristics (sample, sex, and age), strength training protocols (exercises/intensity/weeks), and the outcome of the FCT used related to fall risk. The Cochran Q statistic and I2 statistics was used to assess heterogeneity. Random-effects model were conducted to pool the effect sizes expressed as mean differences (MD).

DATA SYNTHESIS

Twelve studies (478 subjects) were selected for systematic review. A meta-analysis comprised 6 studies (217 subjects) where the outcome measure was the 30-second Sit to Stand (30s-STS) test, and another comprised 4 studies (142 subjects) where the outcome measure was the timed Up and Go (TUG) test. There was an improvement in performance in favor of the experimental group in both the TUG subgroup (MD -0.31 s; 95% CI -0.63, 0.00 s; P=.05), and the 30s-STS subgroup (MD 1.71 reps; 95% CI -0.26, 3.67 reps; P=.09).

CONCLUSIONS

In conclusion, power training increases functional capacity related to fall risk further than other types of exercise in older adults.

Human skeletal muscle-specific atrophy with aging: a comprehensive review

Age-related skeletal muscle atrophy appears to be a muscle group-specific process, yet only a few specific muscles have been investigated and our understanding in this area is limited. This review provides a comprehensive summary of the available information on age-related skeletal muscle atrophy in a muscle-specific manner, nearly half of which comes from the quadriceps. Decline in muscle-specific size over ∼50 yr of aging was determined from 47 cross-sectional studies of 982 young (∼25 yr) and 1,003 old (∼75 yr) individuals and nine muscle groups: elbow extensors (-20%, -0.39%/yr), elbow flexors (-19%, -0.38%/yr), paraspinals (-24%, -0.47%/yr), psoas (-29%, -0.58%/yr), hip adductors (-13%, -0.27%/yr), hamstrings (-19%, -0.39%/yr), quadriceps (-27%, -0.53%/yr), dorsiflexors (-9%, -0.19%/yr), and triceps surae (-14%, -0.28%/yr). Muscle-specific atrophy rate was also determined for each of the subcomponent muscles in the hamstrings, quadriceps, and triceps surae. Of all the muscles included in this review, there was more than a fivefold difference between the least (-6%, -0.13%/yr, soleus) to the most (-33%, -0.66%/yr, rectus femoris) atrophying muscles. Muscle activity level, muscle fiber type, sex, and timeline of the aging process all appeared to have some influence on muscle-specific atrophy. Given the large range of muscle-specific atrophy and the large number of muscles that have not been investigated, more muscle-specific information could expand our understanding of functional deficits that develop with aging and help guide muscle-specific interventions to improve the quality of life of aging women and men.

Influence of lower-limb muscular and tendon mechanical properties and strength on countermovement jump performance

BACKGROUND

The aim of the study is to examine the relationship between measures of muscle and tendon mechanical properties and strength on countermovement jump (CMJ) performance.

METHODS

Twenty-six physically active participants (males; N.=16: females; N.=10) were tested. Testing comprised of measuring the mechanical properties of lower limb muscles and tendons using myotonometry, isometric and isokinetic knee extensor strength through dynamometry, and CMJ's with a force platform.

RESULTS

Large positive correlations were observed between CMJ jump height and Achilles tendon stiffness (N/m) (r=0.56) and Achilles tendon tone (Hz) (r=0.553). Large negative correlations were found between CMJ height and Achilles tendon elasticity (r=-0.658), and Achilles tendon relaxation (r=-0.572), and Achilles tendon creep (r=-0.589). Large correlations (r=0.592 to 0.659) were observed between CMJ height and all measures of isometric and isokinetic dynamometry measures. Achilles tendon stiffness, elasticity level and relaxation, and isokinetic peak concentric torque (N.m) explained 63% of this variance.

CONCLUSIONS

Greater stiffness of the Achilles tendon may improve CMJ performance due to the improved transfer of concentric and eccentric force of the knee extensor muscles. Practitioners need to implement specific interventions to target increasing Achilles tendon stiffness to improve countermovement jump performance.

Maximal fascicle shortening velocity measurements in human medial gastrocnemius muscle in vivo

This study evaluated the maximal fascicle shortening velocity under near-no-load conditions. In addition, we determined whether the rate of torque development during ballistic contraction was related to maximal fascicle shortening velocity. Under passive and active conditions, the medial gastrocnemius muscle fascicle shortening velocity was measured using ultrasonography at 300, 400, 500, 600, 700, 800, 900, and 1000 ° s-1 . The maximal fascicle shortening velocity was defined as the fascicle shortening velocity under the lowest angular velocity that satisfied the following two conditions; (1) the difference in torque values between passive and active conditions was below 2.4 Nm and (2) the difference in fascicle shortening velocities between passive and active conditions was below 10 mm s-1 . The rate of torque development was analyzed during the periods of 32, 48, 96, 152, and 200 ms after the onset of contraction during ballistic contraction. At the angular velocity (678.6 ± 147.7 ° s-1 ) that satisfied the two previously mentioned conditions, the exerted torque and the maximal fascicle shortening velocity were 1.4 ± 1.3 Nm and 251.0 ± 40.5 mm s-1 . No significant correlations were found between the maximal fascicle shortening velocity and the rate of torque development at each time point. In conclusion, the maximal fascicle shortening velocity was quantified when the angular velocity satisfied the two conditions. Furthermore, the rate of torque development, often used as an indicator of muscle velocity, did not represent the maximal fascicle shortening velocity.

Reproducibility of isokinetic measures of the knee and ankle muscle strength in community-dwelling older adults without and with Alzheimer's disease

BACKGROUND

To interpret changes of muscle strength in older adults with Alzheimer's disease (AD), determining the reliability of outcome measures is necessary. Therefore, the purpose of the present study was to investigate the relative and absolute intra-rater reliability of concentric isokinetic measures of the knee and ankle muscle strength in community-dwelling older adults without and with AD in the mild and moderate stages.

METHODS

A methodological study was conducted. The participants were submitted to two isokinetic evaluations with an interval of three to seven days. The evaluations consisted of knee extension and flexion at 60°/s (five repetitions) and 180°/s (15 repetitions) and plantar flexion and dorsiflexion of the ankle at 30°/s (five repetitions). The measures of interest were peak torque, average peak torque and total work. The intraclass correlation coefficient two-way mixed model of a single-measure (ICC_3,1), standard error of measurement (SEM) and minimal detectable change at the 95% confidence interval (MDC₉₅) were calculated. The ICC_3,1 was interpreted based on Munro's classification. Standard error of measurement and MDC₉₅ were analyzed in absolute and relative values (percentage of error [SEM%] and change [MDC₉₅%]).

RESULTS

A total of 62 older adults were included and allocated to the three groups: mild-AD (n = 22, 79.9 years, 15 female and seven male), moderate-AD (n = 20, 81.6 years, 15 female and five male) and without-AD (n = 20, 74.3 years, 10 female and seven male). The ICCs_3,1 of the measures of knee were high/very high in the three groups (0.71-0.98). The ICCs_3,1 of the measures of ankle were high/very high in the mild-AD group (0.78-0.92), moderate/high/very high in the moderate-AD group (0.63-0.93) and high/very high in the group without-AD (0.84-0.97). The measurements of knee extensors at 60°/s, knee extensors (peak torque and total work), with the exception of peak torque in the mild-AD group, and flexors (average peak torque) at 180°/s, and ankle dorsiflexors at 30°/s had the lowest of SEM% and MDC95% in the three groups.

CONCLUSION

Concentric isokinetic measures are reliable for the assessment of knee and ankle muscle strength in community-dwelling older adults without and with AD in the mild and moderate stages.

Fish oil administration combined with resistance exercise training improves strength, resting metabolic rate, and inflammation in older adults

BACKGROUND

While fish oil (FO) has attracted great attention due to their health-enhancing properties, its potential to enhance benefits from resistance exercise training (RET) has not been fully elucidated yet.

AIMS

The aim of this study was to investigate effects of FO administration during 12 weeks of programmed RET on muscular strength, resting metabolic rate (RMR), and systemic inflammation in healthy older adults.

METHODS

Twenty-eight healthy older adults were randomly assigned to three experimental groups: sedentary control (CON), resistance exercise training (RET), or RET combined with FO (RET-FO). A one-repetition (1RM) of maximum muscle strength, RMR, substrate oxidation, and blood inflammatory biomarkers were assessed before and after the intervention. Statistical significance was set at p ≤ 0.05.

RESULTS

1RM muscle strength was significantly increased in RET and RET-FO while substantially decreased in CON. RMR greatly increased in RET and RET-FO with no change in CON. RET-FO exhibited significantly increased fatty acid oxidation, but no change was found in CON and RET. Systemic interleukin 6 (IL-6) and C-reactive protein (CRP) were significantly decreased from baseline in RET-FO while no change was observed in CON and RET.

CONCLUSION

Our data indicate chronic RET reversed aging-induced loss of muscle strength and improved RMR, while FO administration combined with RET appears to enhance fat metabolism and mildly reduce some indicators of systemic inflammation.

Is handgrip strength a marker of muscle and physical function of the lower limbs? Sex differences in older adults with obesity

BACKGROUND AND AIMS

In this cross-sectional study we investigate the association between handgrip strength (HGS) and muscle function of the lower limbs and the predictors of the appendicular lean mass index (ALMI) in older adults with obesity of both sexes.

METHODS AND RESULTS

Eighty-four older (67 ± 5 years) men (N = 44) and women (N = 40) with obesity (body mass index (BMI) 33 ± 4 kg/m²) performed: the HGS, isokinetic knee extensors (KE) and flexors (KF) muscle strength and power and Short Physical Performance Battery (SPPB). The correlation between HGS and lower limbs muscle function was evaluated, and four multiple hierarchical linear models were built to assess the contribution of each ALMI predictor (i.e., HGS, BMI, SPPB, muscle strength and power). In men, HGS was weakly-to-moderately associated (p < 0.05) with KE, KF muscle function and physical performance. In women, HGS showed a weak association (p < 0.05) with KE muscle function. The significant predictors of ALMI were only the BMI in women, whereas in the group of men BMI, KE maximal strength and power better explain the variance in ALMI than HGS alone.

CONCLUSION

Our results suggest that HGS should not be used alone as a marker of lower muscle nor physical function. Sex differences exist with the BMI that is a contributor of ALMI both in men and women. However, at least in the group of men, markers related to strength and power of the lower limbs can better describe variations in ALMI compared to HGS in this kind of population.

CLINICAL TRIAL REGISTRATION

NA.

Functional improvements to 6 months of physical activity are not related to changes in size or density of multiple lower-extremity muscles in mobility-limited older individuals

Older adults are encouraged to engage in multicomponent physical activity, which includes aerobic and muscle-strengthening activities. The current work is an extension of the Vitality, Independence, and Vigor in the Elderly 2 (VIVE2) study - a 6-month multicenter, randomized, placebo-controlled trial of physical activity and nutritional supplementation in community dwelling 70-year-old seniors. Here, we examined whether the magnitude of changes in muscle size and quality differed between major lower-extremity muscle groups and related these changes to functional outcomes. We also examined whether daily vitamin-D-enriched protein supplementation could augment the response to structured physical activity. Forty-nine men and women (77 ± 5 yrs) performed brisk walking, muscle-strengthening exercises for the lower limbs, and balance training 3 times weekly for 6 months. Participants were randomized to daily intake of a nutritional supplement (20 g whey protein + 800 IU vitamin D), or a placebo. Muscle cross-sectional area (CSA) and radiological attenuation (RA) were assessed in 8 different muscle groups using single-slice CT scans of the hip, thigh, and calf at baseline and after the intervention. Walking speed and performance in the Short Physical Performance Battery (SPPB) were also measured. For both CSA and RA, there were muscle group × time interactions (P < 0.01). Significant increases in CSA were observed in 2 of the 8 muscles studied, namely the knee extensors (1.9%) and the hip adductors (2.8%). For RA, increases were observed in 4 of 8 muscle groups, namely the hip flexors (1.1 HU), hip adductors (0.9 HU), knee extensors (1.2 HU), and ankle dorsiflexors (0.8 HU). No additive effect of nutritional supplementation was observed. While walking speed (13%) and SPPB performance (38%) improved markedly, multivariate analysis showed that these changes were not associated with the changes in muscle CSA and RA after the intervention. We conclude that this type of multicomponent physical activity program results in significant improvements in physical function despite relatively small changes in muscle size and quality of some, but not all, of the measured lower extremity muscles involved in locomotion.

Ligament mechanics of ageing and osteoarthritic human knees

Knee joint ligaments provide stability to the joint by preventing excessive movement. There has been no systematic effort to study the effect of OA and ageing on the mechanical properties of the four major human knee ligaments. This study aims to collate data on the material properties of the anterior (ACL) and posterior (PCL) cruciate ligaments, medial (MCL) and lateral (LCL) collateral ligaments. Bone-ligament-bone specimens from twelve cadaveric human knee joints were extracted for this study. The cadaveric knee joints were previously collected to study ageing and OA on bone and cartilage material properties; therefore, combining our previous bone and cartilage data with the new ligament data from this study will facilitate subject-specific whole-joint modelling studies. The bone-ligament-bone specimens were tested under tensile loading to failure, determining material parameters including yield and ultimate (failure) stress and strain, secant modulus, tangent modulus, and stiffness. There were significant negative correlations between age and ACL yield stress (p = 0.03), ACL failure stress (p = 0.02), PCL secant (p = 0.02) and tangent (p = 0.02) modulus, and LCL stiffness (p = 0.046). Significant negative correlations were also found between OA grades and ACL yield stress (p = 0.02) and strain (p = 0.03), and LCL failure stress (p = 0.048). However, changes in age or OA grade did not show a statistically significant correlation with the MCL tensile parameters. Due to the small sample size, the combined effect of age and the presence of OA could not be statistically derived. This research is the first to report tensile properties of the four major human knee ligaments from a diverse demographic. When combined with our previous findings on bone and cartilage for the same twelve knee cadavers, the current ligament study supports the conceptualisation of OA as a whole-joint disease that impairs the integrity of many peri-articular tissues within the knee. The subject-specific data pool consisting of the material properties of the four major knee ligaments, subchondral and trabecular bones and articular cartilage will advance knee joint finite element models.

Aging, Osteo-Sarcopenia, and Musculoskeletal Mechano-Transduction

The decline in the mass and function of bone and muscle is an inevitable consequence of healthy aging with early onset and accelerated decline in those with chronic disease. Termed osteo-sarcopenia, this condition predisposes the decreased activity, falls, low-energy fractures, and increased risk of co-morbid disease that leads to musculoskeletal frailty. The biology of osteo-sarcopenia is most understood in the context of systemic neuro-endocrine and immune/inflammatory alterations that drive inflammation, oxidative stress, reduced autophagy, and cellular senescence in the bone and muscle. Here we integrate these concepts to our growing understanding of how bone and muscle senses, responds and adapts to mechanical load. We propose that age-related alterations in cytoskeletal mechanics alter load-sensing and mechano-transduction in bone osteocytes and muscle fibers which underscores osteo-sarcopenia. Lastly, we examine the evidence for exercise as an effective countermeasure to osteo-sarcopenia.

Effect of sex and fatigue on quiet standing and dynamic balance and lower extremity muscle stiffness

PURPOSE

The purpose of the present study was to determine whether there are sex differences in fatigue-induced changes in quiet standing and dynamic balance and establish whether changes in muscle torque and resting stiffness may explain the potential sex differences in balance responses.

METHODS

Sixteen recreationally active men (age; 24.8 ± 5.0 years, height; 178.2 ± 5.6 cm, mass; 77.8 ± 13.2 kg) and 10 women (age; 21.0 ± 1.6 years, height; 167 ± 5.3 cm, mass; 61.3 ± 8.9 kg) were assessed for postural sway, Y balance test performance, isokinetic and isometric knee extensor torque and resting stiffness of the vastus lateralis (VL), gastrocnemius lateralis (GL) and Achilles tendon (AT) before and immediately after fatiguing exercise. The fatigue protocol consisted of five sets of 20-drop jumps.

RESULTS

The fatiguing exercise elicited similar magnitude (effects size; ES) reductions in muscle torque (men; ES = 0.45-0.80, women; ES = 0.46-0.52), dynamic balance (men; ES = 0.45-0.74, women; ES = 0.47-0.79) and resting VL stiffness (men; ES = 0.46, women; ES = 0.36) in men and women (all p < 0.05). For quiet standing balance, fatigue induced an increase in postural sway metrics (ES = 0.64-1.28) and reduction in resting GL stiffness (ES = 0.40) in men (both p < 0.001) but not women (p > 0.05).

CONCLUSION

Fatiguing exercise, when producing a similar level of force reduction, induces similar magnitude reductions in dynamic postural control and resting VL stiffness in men and women. Distinct deteriorations in quiet standing balance in men but not women were accompanied by modifications in calf muscle stiffness following exercise-induced muscle fatigue.

Muscle Belly Gearing Positively Affects the Force-Velocity and Power-Velocity Relationships During Explosive Dynamic Contractions

Changes in muscle shape could play an important role during contraction allowing to circumvent some limits imposed by the fascicle force–velocity (F–V) and power–velocity (P–V) relationships. Indeed, during low-force high-velocity contractions, muscle belly shortening velocity could exceed muscle fascicles shortening velocity, allowing the muscles to operate at higher F–V and P–V potentials (i.e., at a higher fraction of maximal force/power in accordance to the F–V and P–V relationships). By using an ultrafast ultrasound, we investigated the role of muscle shape changes (vastus lateralis) in determining belly gearing (muscle belly velocity/fascicle velocity) and the explosive torque during explosive dynamic contractions (EDC) at angular accelerations ranging from 1000 to 4000°.s^–2. By means of ultrasound and dynamometric data, the F–V and P–V relationships both for fascicles and for the muscle belly were assessed. During EDC, fascicle velocity, belly velocity, belly gearing, and knee extensors torque data were analysed from 0 to 150 ms after torque onset; the fascicles and belly F–V and P–V potentials were thus calculated for each EDC. Absolute torque decreased as a function of angular acceleration (from 80 to 71 Nm, for EDC at 1000 and 4000°.s^–1, respectively), whereas fascicle velocity and belly velocity increased with angular acceleration (P < 0.001). Belly gearing increased from 1.11 to 1.23 (or EDC at 1000 and 4000°.s^–1, respectively) and was positively corelated with the changes in muscle thickness and pennation angle (the changes in latter two equally contributing to belly gearing changes). For the same amount of muscle’s mechanical output (force or power), the fascicles operated at higher F–V and P–V potential than the muscle belly (e.g., P–V potential from 0.70 to 0.56 for fascicles and from 0.65 to 0.41 for the muscle belly, respectively). The present results experimentally demonstrate that belly gearing could play an important role during explosive contractions, accommodating the largest part of changes in contraction velocity and allowing the fascicle to operate at higher F–V and P–V potentials.

Full characterisation of knee extensors' function in ageing: effect of sex and obesity

BACKGROUND/OBJECTIVES

Muscle function is a marker of current and prospective health/independence throughout life. The effects of sex and obesity (OB) on the loss of muscle function in ageing remain unresolved, with important implications for the diagnosis/monitoring of sarcopenia. To characterise in vivo knee extensors' function, we compared muscles torque and power with isometric and isokinetic tests in older men (M) and women (W), with normal range (NW) of body mass index (BMI) and OB.

SUBJECTS/METHODS

In 70 sedentary older M and W (69 ± 5 years), NW and OB (i.e. BMI < 30 kg m^-2 and ≥30 kg m^-2, respectively) we tested the right knee's extensor: (i) isometric torque at 30°, 60°, 75° and 90° knee angles, and (ii) isokinetic concentric torque at 60, 90, 150, 180 and 210° s^-1 angular speeds. Maximal isometric T-angle, maximal isokinetic knee-extensor torque-velocity, theoretical maximal shortening velocity, maximal power, optimal torque and velocity were determined in absolute units, normalised by body mass (BM) and right leg lean mass (LLM_R) and compared over sex, BMI categories and angle or angular speeds by three-way ANOVA.

RESULTS

In absolute units, relative to BM and LLM_R, sex differences were found in favour of M for all parameters of muscle function (main effect for sex, p < 0.05). OB did not affect either absolute or relative to LLM_R isometric and isokinetic muscle function (main effect for BMI, p > 0.05); however, muscle function indices, when adjusted for BM, were lower in both M and W with OB compared to NW counterparts (p < 0.05).

CONCLUSIONS

We confirmed sex differences in absolute, relative to BM and LLM_R muscle function in favour of men. While overall muscle function and muscle contractile quality is conserved in individuals with class I OB, muscle function normalised for BM, which defines the ability to perform independently and safely the activities of daily living, is impaired in comparison with physiological ageing.

Sex Differences in Lower Limb Proprioception and Mechanical Function Among Healthy Adults

Twenty-four healthy adults, including 12 females and 12 males, participated in the study. Each female participant completed three trials in three different phases of one menstrual cycle, which included follicular, ovulatory, and luteal phases. The study aimed to investigate whether there is any difference in joint kinetic sense, neuromuscular coordination, and isokinetic muscle strength (a) between healthy males and females at different phases of the menstrual cycle and (b) between females at different phases of the menstrual cycle. The outcome measures included the number of jumps in the square-hop test and ankle and knee proprioception, which were assessed by an electric-driven movable frame rotated at 0.4 deg/s and isokinetic muscle strength measured by a computerized dynamometer (Biodex). For the square-hop test (p = .006), ankle dorsiflexion/plantar flexion (p < .05), knee flexion/extension (p < .05), the relative peak torque of the isokinetic muscle strength at the 60° and 180° knee flexion/extension (p < .001), and the 30° and 120° ankle plantar flexion/dorsiflexion (p < .05) between females and males showed significant differences. For the females at different phases of the menstrual cycle, significant differences were found on ankle dorsiflexion (p = .003), plantar flexion (p = .023), knee extension (p = .029), the square-hop test (p = .036), and relative peak torque of isokinetic muscle strength at 180° knee flexion (p = .029). This study demonstrated that there are sex differences in lower limb proprioception and mechanical function. Females at ovulatory and luteal phases have better lower limb proprioception than at the follicular phase.

Velocity-based resistance training: impact of velocity loss in the set on neuromuscular performance and hormonal response

This study aimed to compare the effects of 2 resistance training (RT) programs with different velocity losses (VLs) allowed in each set: 10% (VL10%) versus 30% (VL30%) on neuromuscular performance and hormonal response. Twenty-five young healthy males were randomly assigned into 2 groups: VL10% (n = 12) or VL30% (n = 13). Subjects followed a velocity-based RT program for 8 weeks (2 sessions per week) using only the full-squat (SQ) exercise at 70%-85% 1-repetition maximum (1RM). Repetition velocity was recorded in all training sessions. A 20-m running sprint, countermovement jump (CMJ), 1RM, muscle endurance, and electromyogram (EMG) during SQ exercise and resting hormonal concentrations were assessed before and after the RT program. Both groups showed similar improvements in muscle strength and endurance variables (VL10%: 7.0%-74.8%; VL30%: 4.2%-73.2%). The VL10% resulted in greater percentage increments in CMJ (9.2% vs. 5.4%) and sprint performance (-1.5% vs. 0.4%) than VL30%, despite VL10% performing less than half of the repetitions than VL30% during RT. In addition, only VL10% showed slight increments in EMG variables, whereas no significant changes in resting hormonal concentrations were observed. Therefore, our results suggest that velocity losses in the set as low as 10% are enough to achieve significant improvements in neuromuscular performance, which means greater efficiency during RT. Novelty The VL10% group showed similar or even greater percentage of changes in physical performance compared with VL30%. No significant changes in resting hormonal concentrations were observed for any training group. Curvilinear relationships between percentage VL in the set and changes in strength and CMJ performance were observed.

Advanced Age Redistributes Positive but Not Negative Leg Joint Work during Walking

Supplemental digital content is available in the text.

Introduction

Advanced age brings a distal-to-proximal redistribution of positive joint work during walking that is relevant to walking performance and economy. It is unclear whether negative joint work is similarly redistributed in old age. Negative work can affect positive work through elastic energy return in gait. We determined the effects of age, walking speed, and grade on positive and negative joint work in young and older adults.

Methods

Bilateral ground reaction force and marker data were collected from healthy young (age = 22.5 yr, n = 18) and older (age = 76.0 yr, n = 22) adults walking on a split-belt instrumented treadmill at 1.1, 1.4, and 1.7 m·s⁻¹ at each of three grades (0%, 10%, and −10%). Subjects also performed maximal voluntary eccentric, isometric, and concentric contractions for the knee extensors (120°·s⁻¹, 90°·s⁻¹, and 0°·s⁻¹) and plantarflexors (90°·s⁻¹, 30°·s⁻¹, and 0°·s⁻¹).

Results

Compared with young adults, older adults exhibited a distal-to-proximal redistribution of positive leg joint work during level (P < 0.001) and uphill (P < 0.001) walking, with larger differences at faster walking speeds. However, the distribution of negative joint work was unaffected by age during level (P = 0.150) and downhill (P = 0.350) walking. Finally, the age-related loss of maximal voluntary knee extensor (P < 0.001) and plantarflexor (P = 0.001) strength was smaller during an eccentric contraction versus concentric contraction for the knee extensors (P < 0.001) but not for the plantarflexors (P = 0.320).

Conclusion

The distal-to-proximal redistribution of positive joint work during level and uphill walking is absent for negative joint work during level and downhill walking. Exercise prescription should focus on improving ankle muscle function while preserving knee muscle function in older adults trying to maintain their independence.

Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

Physical Exercise in the Oldest Old

Societies are progressively aging, with the oldest old (i.e., those aged >80-85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so-called age-related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age-related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or "exercise mimetics" in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse-induced negative adaptations in those oldest old people who are unable to do physical exercise. © 2019 American Physiological Society. Compr Physiol 9:1281-1304, 2019.

Heterogeneity in the vasodilatory function of individual extremities

Objectives

Heterogeneity and homogeneity in the flow-mediated dilation of the human body's individual extremities are not fully understood, and the relationship between flow-mediated dilation and local muscle activity is unclear. We assessed the flow-mediated dilation of four individual extremities and sought to determine the contribution of local muscle activity (evaluated as muscle strength) to the flow-mediated dilation in each extremity.

Methods

Thirteen healthy young right-handed nonactive males participated. The flow-mediated dilation in the brachial and popliteal arteries at both arms and legs was assessed by ultrasound Doppler. Muscle strength was evaluated as the grip strength and knee extension.

Results

There was a significant difference in the brachial artery (BA)-FMD values between the subjects' dominant and non-dominant sides (8.0 ± 2.8 vs. 5.5 ± 2.2%, p < 0.05), whereas the two sides showed similar popliteal artery (PA)-FMD values. There was no significant correlation in flow-mediated dilation between the dominant brachial artery and popliteal artery. The BA-FMD was significantly correlated with the grip strength in both upper extremities (dominant: r = 0.562, non-dominant: r = 0.548; p < 0.05, respectively).

Conclusion

These results demonstrated heterogeneity in the flow-mediated dilation of individual extremities. We observed that local muscle activity can affect the local vascular function. Measurements of vasodilatory function in individual extremities should thus be carefully considered.

The Role of Recovery Lower Limb Segments in Post-Slip Determination of Falls Due to Instability or Limb Collapse

Slip-related falls can be induced by instability or limb collapse, but the key factors that determine these two fall causations remain unknown. The purpose of this study was to investigate the factors that contribute towards instability-induced and limb-collapse-induced slip-related falls by investigating 114 novel slip trials. The segment angles and moments of the recovery limb after slip-onset from pre-left-touchdown (pre-LTD) to post-left-touchdown (post-LTD) were calculated, and logistic regression was used to detect which variable contributed most to instability-induced and limb-collapse-induced falls. The results showed that recovery from instability was determined by the angle of the thigh at LTD (87.7%), while recovery from limb collapse was determined by the angle of the shank at post-LTD (90.4%). Correspondingly, instability-induced falls were successfully predicted (81.5%) based on the initial thigh angle at pre-LTD and the following peak thigh moment, while limb-collapse-induced falls were successfully predicted (85.5%) based on the initial shank angle at LTD and the following peak shank moment. According to our findings, taking a shorter recovery step and/or increasing the counterclockwise moment of the thigh after pre-LTD would help individuals resist instability-induced falls, while taking a larger recovery step and/or increasing the clockwise moment of the shank post-LTD would help resist limb-collapse-induced falls. The findings of this study are crucial for future clinical applications, because individually tailored reactive balance training could be provided to reduce vulnerability to specific types of falls and improve recovery rates post-slip exposure.

Jump training with blood flow restriction has no effect on jump performance

This study investigated whether jump training with blood flow restriction (BFR) improves jump performance compared to jump training without BFR under similar exercise intensity in healthy young humans. The participants were twenty healthy males who were assigned to either jump training with BFR (n = 10) or jump training without BFR [control (CON); n = 10] groups. All subjects completed five sets of 10 repetitions with one-minute intervals of half-squat jumps (SJ) at maximal effort, four days a week for four weeks. In the BFR group, circulatory occlusion around both thigh muscles was applied at a pressure of 200 mmHg, and physical characteristics, muscle strength and jump performance were evaluated before and after training. A significant main effect of training period on lean body mass, percentage of body fat and leg circumference in both groups was observed (P < 0.05). For jump training with BFR, only knee flexion strength increased (P < 0.05), while in the CON group, both knee extension and flexion strength increased (P < 0.05). BFR training did not improve SJ or counter-movement jumps (CMJ) (P > 0.05), whereas training without BFR (CON) improved the performance of both jumps (SJ: pre 35.7 ± 5.1 vs. post 38.9 ± 4.1 cm, P = 0.002: CMJ: pre 41.6 ± 3.6 vs. post 44.6 ± 3.8 cm, P < 0.001). These results indicate that jump training with BFR may not be an effective strategy for improving jump performance.

Physical strategies to prevent disuse-induced functional decline in the elderly

Disuse situations can have serious adverse health consequences in the elderly, including mainly functional impairment with subsequent increase in the risk of falls or morbimortality. The present review provides clinicians and care givers with detailed and practical information on the feasibility and effectiveness of physical strategies that are currently available to prevent or attenuate the functional decline that occurs secondarily to disuse situations in the elderly, notably in the hospital setting. In this context, active approaches such as resistance exercises and maximal voluntary contractions, which can be performed both isometrically and dynamically, are feasible during most immobilization situations including in hospitalized old people and represent powerful tools for the prevention of muscle atrophy. Aerobic exercise should also be prescribed whenever possible to reduce the loss of cardiovascular capacity associated with disuse periods. Other feasible strategies for patients who are unwilling or unable to perform volitional exercise comprise neuromuscular electrical stimulation, vibration, and blood flow restriction. However, they should ideally be applied synchronously with voluntary exercise to obtain synergistic benefits.

Gait kinetics in children with clubfeet treated surgically or with the Ponseti method: A meta-analysis

BACKGROUND

Currently, the Ponseti method is the gold standard for treatment of clubfeet. For long-term functional evaluation of this method, gait analysis can be performed. Previous studies have assessed gait differences between Ponseti treated clubfeet and healthy controls.

RESEARCH QUESTION/PURPOSE

The aims of this systematic review were to compare the gait kinetics of Ponseti treated clubfeet with healthy controls and to compare the gait kinetics between clubfoot patients treated with the Ponseti method or surgically.

METHODS

A systematic search was performed in Embase, Medline Ovid, Web of Science, Scopus, Cochrane, Cinahl ebsco, and Google scholar, for studies reporting on gait kinetics in children with clubfeet treated with the Ponseti method. Studies were excluded if they only used EMG or pedobarography. Data were extracted and a risk of bias was assessed. Meta-analyses and qualitative analyses were performed.

RESULTS

Nine studies were included, of which five were included in the meta-analyses. The meta-analyses showed that ankle plantarflexor moment (95% CI -0.25 to -0.19) and ankle power (95% CI -0.89 to -0.60, were significantly lower in the Ponseti treated clubfeet compared to the healthy controls. No significant difference was found in ankle dorsiflexor and plantarflexor moment, and ankle power between clubfeet treated with surgery compared to the Ponseti method.

SIGNIFICANCE

Differences in gait kinetics are present when comparing Ponseti treated clubfeet with healthy controls. However, there is no significant difference between surgically and Ponseti treated clubfeet. These results give more insight in the possibilities of improving the gait pattern of patients treated for clubfeet.

Functional capacity improves in-line with neuromuscular performance after 12 weeks of non-linear periodization strength training in the elderly

BACKGROUND

While it is accepted that resistance training can improve functional capacity in older individuals, the neuromuscular source of this improvement has yet to be identified.

AIM

This study investigated the link between improved neuromuscular performance and functional capacity after a 12-week resistance training period in untrained healthy older individuals.

METHODS

Fifteen older men and women (60-71 years) adhered to a 4-week control period, followed by 12 weeks of non-linear resistance training for the lower limbs. Maximum dynamic leg press strength (1-RM), maximum isometric knee extension torque and rate of torque development (RTD) were evaluated at - 4, 0, 4, 8, and 12 weeks, and muscle activity was assessed at 0, 4, 8, and 12 weeks. Functional capacity tests (chair rise, stair ascent and descent, and timed up and go) were performed at - 4, 0, and 12 weeks.

RESULTS

No changes occurred during the control period, but the group increased their 1-RM strength (from 142 ± 53 to 198 ± 43 kg, p = 0.001), which was accompanied by an increase in vastus lateralis activation (p = 0.008) during the intervention. Increase was observed at all RTD time intervals at week 8 (p < 0.05). Significant improvements in all the functional capacity tests were observed at week 12 (p < 0.05).

DISCUSSION

Despite the expected increase in strength, RTD, muscle activity, and functional capacity, there was no significant relationship between the changes in neuromuscular performance and functional capacity. While resistance training elicits various positive improvements in healthy older individuals, actual strength gain did not influence the gain in functional capacity.

CONCLUSION

The present study highlights the exact cause that improved the functional capabilities during resistance training are currently unknown.

Higher Training Frequency Is Important for Gaining Muscular Strength Under Volume-Matched Training

Background: This study investigated the effect of volume-matched strength training programs with different frequency and subsequent detraining on muscle size and strength.

Methods: During a training period of 11 weeks, untrained subjects (age: 22.3 ± 0.9 years, height: 173.1 ± 4.8 cm and body mass: 66.8 ± 8.4 kg) performed knee-extension exercise at 67% of their estimated one-repetition maximum either one session per week (T1 group: 6 sets of 12 repetitions per session; n = 10) or three sessions per week (T3 group: 2 sets of 12 repetitions per session; n = 10). Rating of perceived exertion (RPE) and muscle stiffness were measured as an index of muscle fatigue and muscle damage, respectively. The magnitude of muscle hypertrophy was assessed with thigh circumference and the quadriceps muscle thickness. The changes in muscle strength were measured with isometric maximum voluntary contraction torque (MVC).

Results: During the training period, RPE was significantly higher in the T1 than in the T3 (p < 0.001). After 11 weeks of training, both groups exhibited significant improvements in thigh circumference, muscle thickness, and MVC compared with baseline values. However, there was a significant group difference in MVC improvement at week 11 (T1: 43.5 ± 15.5%, T3: 65.2 ± 23.2%, p < 0.05). After 6 weeks of detraining, both groups showed the significant decreases in thigh circumference and muscle thickness from those at the end of training period, while no significant effect of detraining was observed in MVC.

Conclusion: These results suggest that three training sessions per week with two sets are recommended for untrained subjects to improve muscle strength while minimizing fatigue compared to one session per week with six sets.

High-intensity flywheel exercise and recovery of atrophy after 90 days bed--rest

Aims

To investigate differential muscle atrophy during bed-rest, the impact of a high-intensity concentric-eccentric (flywheel) resistance exercise countermeasure and muscle recovery after bed-rest.

Methods

Twenty-five healthy male subjects underwent 90 dayshead-down tilt bed-rest. Volume of individual lower-limb muscles was measured via MRI before, twice during and four times up to 1 year after bed-rest. Subjects were either inactive (n=16) or performed flywheel exercise every third day of bed-rest (n=9). Functional performance was assessed via countermovement jump.

Results

On ‘intent-to-treat’ analysis, flywheel prevented atrophy in the vasti (p<0.001) and reduced atrophy in the hip adductor/extensor adductor magnus (p=0.001) and ankle dorsiflexors/toe flexors (soleus (p<0.001), gastrocnemius medialis (p<0.001), gastrocnemius lateralis (p=0.02), and tibialis posterior with flexor digitorum longus (p=0.04)). Flywheel exercise was not effective for the hamstrings, gracilis, sartorius, peroneals and anterior tibial muscles. Muscle atrophy in vasti, soleus, gastrocnemius medialis, gastrocnemius lateralis and adductor magnus correlated with losses in countermovement jump performance. Muscle volume recovered within 90 days after bed-rest, however long-term after bed-rest, the inactive subjects only showed significantly increased muscle volume versus prebed-rest in a number of muscles including soleus (+4.3%), gastrocnemius medialis (+3.9%) and semimembranosus (+4.3%). This was not associated with greater countermovement jump performance.

Conclusion

The exercise countermeasure was effective in preventing or reducing atrophy in the vasti, adductor magnus and ankle dorsiflexors/toe flexors but not the hamstrings, medial thigh muscles or peroneals and dorsiflexor muscles.

Trial registration number

NCT00311571; results.

The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis

OBJECTIVES

In older adults, there is a blunted responsiveness to resistance training and reduced muscle hypertrophy compared with younger adults. There is evidence that both exercise training and vitamin D supplementation may benefit musculoskeletal health in older adults, and it is plausible that in combination their effects may be additive. The aim of this systematic review was to evaluate the effectiveness of combined resistance exercise training and vitamin D₃ supplementation on musculoskeletal health in older adults.

DATA SOURCES

A comprehensive search of electronic databases, including Science Direct, Medline, PubMed, Google Scholar and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL accessed by Wiley Science) was conducted. Eligible studies were randomised controlled trials including men and women (aged ≥65 years or mean age ≥65 years); enlisting resistance exercise training and vitamin D₃ supplementation; including outcomes of muscle strength, function, muscle power, body composition, serum vitamin D/calcium status or quality of life comparing results with a control group. The review was informed by a preregistered protocol (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015020157).

RESULTS

Seven studies including a total of 792 participants were identified. Studies were categorised into two groups; group 1 compared vitamin D₃ supplementation and exercise training versus exercise alone (describing the additive effect of vitamin D₃ supplementation when combined with resistance exercise training) and group 2 compared vitamin D₃ supplementation and exercise training versus vitamin D₃ supplementation alone (describing the additive effect of resistance exercise training when combined with vitamin D₃ supplementation).Meta-analyses for group 1 found muscle strength of the lower limb to be significantly improved within the intervention group (0.98, 95% CI 0.73 to 1.24, p<0.001); all other outcomes showed small but non-significant positive effects for the intervention group. The short physical performance battery (SPPB), timed up and go (TUG), muscle strength of the lower limb and femoral neck bone mineral density showed significantly greater improvements in the intervention group for group 2 comparisons.

CONCLUSIONS

This review provides tentative support for the additive effect of resistance exercise and vitamin D₃ supplementation for the improvement of muscle strength in older adults. For other functional variables, such as SPPB and TUG, no additional benefit beyond exercise was shown. Further evidence is required to draw firm conclusions or make explicit recommendations regarding combined exercise and vitamin D₃ supplementation.

Lower limb explosive strength capacity in elderly women: effects of resistance training and healthy diet

The effects of 24 wk of resistance training combined with a healthy diet on lower limb explosive strength capacity were investigated in a population of healthy elderly women. Participants ( n = 63; 67.5 ± 0.4 yr) were randomized into three groups; resistance training (RT), resistance training and healthy diet (RT-HD), and control (CON). Progressive resistance training was performed at a load of 75–85% one-repetition maximum. A major adjustment in the healthy dietary approach was an n-6/n-3 polyunsaturated fatty acid (PUFA) ratio below 2. Lower limb maximal strength, explosive force capacity during dynamic and isometric movements, whole body lean mass, and physical function were assessed. Whole body lean mass significantly increased by 1.5 ± 0.5% in RT-HD only. Isometric strength performance during knee extension as well as the performance in the five sit-to-stand and single-leg-stance tests increased similarly in RT and RT-HD. Improvements in dynamic peak power and time to reach peak power (i.e shorter time) during knee extension occurred in both RT (+15.7 ± 2.6 and −11.0 ± 3.8%, respectively) and RT-HD (+24.6 ± 2.6 and −20.3 ± 2.7%, respectively); however, changes were significantly larger in RT-HD. Similarly, changes in peak force and rate of force development during squat jump were higher in RT-HD (+58.5 ± 8.4 and +185.4 ± 32.9%, respectively) compared with RT (+35.7 ± 6.9 and +105.4 ± 22.4%, respectively). In conclusion, a healthy diet rich in n-3 PUFA can optimize the effects of resistance training on dynamic explosive strength capacity during isolated lower limb movements and multijoint exercises in healthy elderly women.

NEW & NOTEWORTHY Age-related decline in lower limb explosive strength leads to impaired ability to perform daily living tasks. The present randomized controlled trial demonstrates that a healthy diet rich in n-3 polyunsaturated fatty acid (n-3 PUFA) enhances resistance training-induced gains in dynamic explosive strength capacity during isolated lower limb movements and multijoint exercises in healthy elderly women. This supports the use of strategies combining resistance training and dietary changes to mitigate the decline in explosive strength capacity in older adults.

Impact of creatine supplementation in combination with resistance training on lean mass in the elderly

BACKGROUND

Human ageing is a process characterized by loss of muscle mass, strength, and bone mass. We aimed to examine the efficacy of low-dose creatine supplementation associated with resistance training on lean mass, strength, and bone mass in the elderly.

METHODS

This was a 12-week, parallel-group, double-blind, randomized, placebo-controlled trial. The individuals were randomly allocated into one of the following groups: placebo plus resistance training (PL + RT) and creatine supplementation plus resistance training (CR + RT) . The participants were assessed at baseline and after 12 weeks. The primary outcomes were lean mass and strength, assessed by dual energy X-ray absorptiometry (DXA) and ten-repetition maximal tests (10 RM), respectively. Secondary outcomes included the lumbar spine, right and left femoral neck, both femur and whole body bone mineral density (BMD), and whole body bone mineral content (BMC), assessed by DXA.

RESULTS

The CR + RT group had superior gains in lean mass when compared with the PL + RT group (P = 0.02). Changes in the 10 RM tests in bench press and leg press exercises, body composition, BMD, and BMC of all assessed sites did not significantly differ between the groups (P > 0.05).

CONCLUSIONS

Twelve weeks of low-dose creatine supplementation associated with resistance training resulted in increases in lean mass in the elderly.

The impact of strength training on skeletal muscle morphology and architecture in children and adolescents with spastic cerebral palsy: A systematic review

AIM

The aim of this study was to systematically review the current literature to determine the impact of strength training on skeletal muscle morphology and architecture in individuals aged 4-20 years with spastic type cerebral palsy.

METHODS

A comprehensive search for randomised and non-randomised controlled trials, cohort studies and cross-comparison trials was performed on five electronic databases. Included studies were graded according to level of evidence and assessed for methodological quality using the Downs and Black scale. Quantitative data was analysed using effect sizes.

RESULTS

Six of 304 articles met the inclusion criteria. Methodological quality of the included papers ranged from 14 to 19 (out of 32). A large effect was found on muscle cross-sectional area following strength training, with small to moderate effects on muscle volume and thickness.

CONCLUSION AND IMPLICATIONS

There is preliminary evidence that strength training leads to hypertrophy in children and adolescents with CP. A paucity of studies exist measuring morphological and architectural parameters following strength training in these individuals. Overall low study methodological quality along with heterogeneous study design, dissimilar outcome measures, and lack of adequate control groups, indicated that care is needed when interpreting the results of these studies in isolation.

The Current Understanding of Sarcopenia: Emerging Tools and Interventional Possibilities

The purpose of this review is to provide health practitioners and physicians the most current state of the research on sarcopenia, its consequences, and to offer a summary of consensus guidelines for identification based on the most recent and compelling investigations and analyses. To accomplish this, the causes and consequences of sarcopenia will be described, and definitions and screening methods are updated. Importantly, interventional recommendations for sarcopenia will be discussed with a special emphasis on the effects of resistance training on sarcopenia-related outcomes. Furthermore, due to the increasing usage of hormone treatment as a strategy to combat sarcopenia, special consideration on the effects of hormone changes with aging and as interventions will be briefly reviewed.

Creatine supplementation in the aging population: effects on skeletal muscle, bone and brain

This narrative review aims to summarize the recent findings on the adjuvant application of creatine supplementation in the management of age-related deficits in skeletal muscle, bone and brain metabolism in older individuals. Most studies suggest that creatine supplementation can improve lean mass and muscle function in older populations. Importantly, creatine in conjunction with resistance training can result in greater adaptations in skeletal muscle than training alone. The beneficial effect of creatine upon lean mass and muscle function appears to be applicable to older individuals regardless of sex, fitness or health status, although studies with very old (>90 years old) and severely frail individuals remain scarce. Furthermore, there is evidence that creatine may affect the bone remodeling process; however, the effects of creatine on bone accretion are inconsistent. Additional human clinical trials are needed using larger sample sizes, longer durations of resistance training (>52 weeks), and further evaluation of bone mineral, bone geometry and microarchitecture properties. Finally, a number of studies suggest that creatine supplementation improves cognitive processing under resting and various stressed conditions. However, few data are available on older adults, and the findings are discordant. Future studies should focus on older adults and possibly frail elders or those who have already experienced an age-associated cognitive decline.

Surface electromyography activity of the rectus abdominis, internal oblique, and external oblique muscles during forced expiration in healthy adults

We aimed to characterize rectus abdominis, internal oblique, and external oblique muscle activity in healthy adults under expiratory resistance using surface electromyography. We randomly assigned 42 healthy adult subjects to 3 groups: 30%, 20%, and 10% maximal expiratory intraoral pressure (PEmax). After measuring 100% PEmax and muscle activity during 100% PEmax, the activity and maximum voluntary contraction of each muscle during the assigned experimental condition were measured. At 100% PEmax, the external oblique (p<0.01) and internal oblique (p<0.01) showed significantly elevated activity compared with the rectus abdominis muscle. Furthermore, at 20% and 30% PEmax, the external oblique (p<0.05 and<0.01, respectively) and the internal oblique (p<0.05 and<0.01, respectively) showed significantly elevated activity compared with the rectus abdominis muscle. At 10% PEmax, no significant differences were observed in muscle activity. Although we observed no significant difference between 10% and 20% PEmax, activity during 30% PEmax was significantly greater than during 20% PEmax (external oblique: p<0.05; internal oblique: p<0.01). The abdominal oblique muscles are the most active during forced expiration. Moreover, 30% PEmax is the minimum intensity required to achieve significant, albeit very slight, muscle activity during expiratory resistance.

Strength and Power Training Effects on Lower Limb Force, Functional Capacity, and Static and Dynamic Balance in Older Female Adults

It has been proposed that muscle power is more effective to prevent falls than muscle force production capacity, as rapid reactions are required to allow the postural control. This study aimed to compare the effects of strength and power training on lower limb force, functional capacity, and static and dynamic balance in older female adults. Thirty-seven volunteered healthy women had been allocated into the strength-training group (n = 14; 69 ± 7.3 years, 155 ± 5.6 cm, 72 ± 9.7 kg), the power-training group (n = 12; 67 ± 7.4 years, 153 ± 5.5 cm, 67.2 ± 7 kg), and control group (n = 11; 65 ± 3.1 years, 154 ± 5.6 cm, 70.9 ± 3 kg). After 12 weeks of training, the strength-training and power-training groups increased significantly maximum dynamic strength (29% and 27%), isometric strength (26% and 37%), and step total time (13% and 14%, dynamic balance), respectively. However, only the power-training group increased the rate of torque development (55%) and the functional capacity in 30-second chair stand (22%) and in time up and go tests (-10%). Empirically, power training may reduce the risk of injuries due to lower loads compared to strength training, and consequently, the physical effort demand during the training session is lower. Therefore, power training should be recommended as attractive training stimuli to improve lower limb force, functional capacity, and postural control of older female adults.

Resistance exercise training increases lower limb speed of strength generation during stair ascent and descent in people with diabetic peripheral neuropathy

AIM

To examine the effects of a 16-week resistance exercise training intervention on the speed of ankle and knee strength generation during stair ascent and descent, in people with neuropathy.

METHODS

A total of 43 people: nine with diabetic peripheral neuropathy, 13 with diabetes but no neuropathy and 21 healthy control subjects ascended and descended a custom-built staircase. The speed at which ankle and knee strength were generated, and muscle activation patterns of the ankle and knee extensor muscles were analysed before and after a 16-week intervention period.

RESULTS

Ankle and knee strength generation during both stair ascent and descent were significantly higher after the intervention than before the intervention in the people with diabetes who undertook the resistance exercise intervention (P < 0.05). Although muscle activations were altered by the intervention, there were no observable patterns that underpinned the observed changes.

CONCLUSIONS

The increased speed of ankle and knee strength generation observed after the intervention would be expected to improve stability during the crucial weight acceptance phase of stair ascent and descent, and ultimately contribute towards reducing the risk of falling. Improvements in muscle strength as a result of the resistance exercise training intervention are likely to be the most influential factor for increasing the speed of strength generation. It is recommended that these exercises could be incorporated into a multi-faceted exercise programme to improve safety in people with diabetes and neuropathy.

Does vitamin-D intake during resistance training improve the skeletal muscle hypertrophic and strength response in young and elderly men? - a randomized controlled trial

Introduction

Recent studies have shown that vitamin-D intake can improve skeletal muscle function and strength in frail vitamin-D insufficient individuals. We investigated whether vitamin-D intake can improve the muscular response to resistance training in healthy young and elderly individuals, respectively.

Methods

Healthy untrained young (n = 20, age 20–30) and elderly (n = 20, age 60–75) men were randomized to 16 weeks of daily supplementary intake of either 48 μg of vitamin-D + 800 mg calcium (Vitamin-D-group) or 800 mg calcium (Placebo-group) during a period and at a latitude of low sunlight (December-April, 56°N). During the last 12 weeks of the supplementation the subjects underwent progressive resistance training of the quadriceps muscle. Muscle hypertrophy, measured as changes in cross sectional area (CSA), and isometric strength of the quadriceps were determined. Muscle biopsies were analyzed for fiber type morphology changes and mRNA expression of vitamin-D receptor (VDR), cytochrome p450 27B1 (CYP27B1) and Myostatin.

Results

In the vitamin-D groups, serum 25(OH)D concentration increased significantly and at week 12 was significantly different from placebo in both young men (71.6 vs. 50.4 nmol/L, respectively) and elderly men (111.2 vs. 66.7 nmol/L, respectively). After 12 weeks of resistance training, quadriceps CSA and isometric strength increased compared to baseline in young (CSA p < 0.0001, strength p = 0.005) and elderly (CSA p = 0.001, strength p < 0.0001) with no difference between vitamin-D and placebo groups. Vitamin-D intake and resistance training increased strength/CSA in elderly compared to young (p = 0.008). In the young vitamin-D group, the change in fiber type IIa percentage was greater after 12 weeks training (p = 0.030) and Myostatin mRNA expression lower compared to the placebo group (p = 0.006). Neither resistance training nor vitamin-D intake changed VDR mRNA expression.

Conclusion

No additive effect of vitamin-D intake during 12 weeks of resistance training could be detected on either whole muscle hypertrophy or muscle strength, but improved muscle quality in elderly and fiber type morphology in young were observed, indicating an effect of vitamin-D on skeletal muscle remodeling.

Trial registration

ClinicalTrials with nr. NCT01252381

Electronic supplementary material

The online version of this article (doi:10.1186/s12986-015-0029-y) contains supplementary material, which is available to authorized users.