Load magnitude affects patellar tendon mechanical properties but not collagen or collagen cross-linking after long-term strength training in older adults

Greater Protein Intake Emphasizing Lean Beef Does Not Affect Resistance Training-Induced Adaptations in Skeletal Muscle and Tendon of Older Women: A Randomized Controlled Feeding Trial

BACKGROUND

Although experimental research supports that resistance training (RT), especially with greater dietary protein intake, improves muscle mass and strength in older adults, comparable research on tendons is needed.

OBJECTIVES

We assessed the effects of a protein-rich diet emphasizing lean beef, compared with 2 control diets, on RT-induced changes in skeletal muscle and tendon size and strength in older women.

METHODS

We randomly assigned women [age: 66 ± 1 y, body mass index (BMI): 28 ± 1] to groups that consumed 1) 0.8 g total protein/kg body weight/day from mixed food sources (normal protein control, n = 16); 2) 1.4 g/kg/d protein from mixed food sources (high protein control, n = 17); or 3) 1.4 g/kg/d protein emphasizing unprocessed lean beef (high protein experimental group, n = 16). Participants were provided with all foods and performed RT 3 times/wk, 70% of 1-repetition maximum for 12 wk. We measured quadriceps muscle volume via magnetic resonance imaging (MRI). We estimated patellar tendon biomechanical properties and cross-sectional area (CSA) using ultrasound and MRI.

RESULTS

Dietary intake did not influence RT-induced increases in quadriceps strength (P < 0.0001) or muscle volume (P < 0.05). We noted a trend for an RT effect on mean tendon CSA (P = 0.07), with no differences among diets (P > 0.05). Proximal tendon CSA increased with RT (P < 0.05) with no difference between dietary groups (P > 0.05). Among all participants, midtendon CSA increased with RT (P ≤ 0.05). We found a decrease in distal CSA in the 0.8 g group (P < 0.05) but no change in the 1.4 g group (P > 0.05). Patellar tendon MRI signal or biomechanical properties were unchanged.

CONCLUSIONS

Our findings indicated that greater daily protein intake, emphasizing beef, did not influence RT-induced changes in quadriceps muscle strength or muscle volume of older women. Although we noted trends in tendon CSA, we did not find a statistically significant impact of greater daily protein intake from beef on tendon outcomes. This trial was registered at clinicaltrials.gov as NCT04347447.

Structure and function of Achilles and patellar tendons following moderate slow resistance training in young and old men

The aim of this study was to investigate the effect of aging and resistance training with a moderate load on the size and mechanical properties of the patellar (PT) and Achilles tendon (AT) and their associated aponeuroses; medial gastrocnemius (MG) and vastus lateralis (VL). Young (Y55; 24.8 ± 3.8 yrs, n = 11) and old men (O55; 70.0 ± 4.6 yrs, n = 13) were assigned to undergo a training program (12 weeks; 3 times/week) of moderate slow resistance training [55% of one repetition maximum (RM)] of the triceps surae and quadriceps muscles. Tendon dimensions were assessed using 1.5 T magnetic resonance imaging before and after 12 weeks. AT and PT cross sectional area (CSA) were determined every 10% of tendon length. Mechanical properties of the free AT, MG aponeurosis, PT, and VL aponeurosis were assessed using ultrasonography (deformation) and tendon force measurements. CSA of the AT but not PT was greater in O55 compared with Y55. At baseline, mechanical properties were generally lower in O55 than Y55 for AT, MG aponeurosis and VL aponeurosis (Young's modulus) but not for PT. CSA of the AT and PT increased equally in both groups following training. Further, for a given force, stiffness and Young's modulus also increased equally for VL aponeurosis and AT, for boths groups. The present study highlights that except for the PT, older men have lower tendon (AT, MG aponeurosis, and VL aponeurosis) mechanical properties than young men and 12-weeks of moderate slow resistance training appears sufficient to improve tendon size and mechanical adaptations in both young and older men. New and Noteworthy: These novel findings suggest that short-term moderate slow resistance training induces equal improvements in tendon size and mechanics regardless of age.

Time to treat the tendon rupture induced by surgery: early hypertrophy of the patellar tendon graft site predicts strong quadriceps after ACLR with bone-patellar tendon-bone autograft

PURPOSE

Quadriceps dysfunction is ubiquitous after anterior cruciate ligament reconstruction, especially when using bone-patellar tendon-bone (BPTB) autografts. The role of patellar tendon hypertrophy after graft harvest on knee extensor strength is unknown. The purpose of this study was to determine the predictive ability of patellar tendon (PT) and quadriceps muscle (Quad) cross-sectional area (CSA) on knee extensor strength 1-2 months after ACLR using BPTB autografts.

METHODS

This is a cross-sectional analysis of a cohort 1-2 months after ACLR using BPTB autograft. Peak knee extensor torque, and PT and Quad CSA measured using ultrasound imaging, were collected in 13 males and 14 females. Simple linear regressions compared quadriceps strength index (QI) against limb symmetry index (LSI) in PT and Quad CSA. Multiple linear regressions with sequential model comparisons predicting peak knee extensor torque were performed for each limb. The base model included demographics. Quad CSA was added in the first model, then PT CSA was added in the second model.

RESULTS

Both PT (p < 0.001, R2 = 0.693) and Quadriceps CSA (p = 0.013, R2 = 0.223) LSI had a positive linear relationship with QI. In the involved limb, addition of PT CSA significantly improved the model (R2 = 0.781, ΔR2 = 0.211, p for ΔR2 < 0.001). In the uninvolved limb, the addition of Quad CSA improved the model, but the addition of PT CSA did not.

CONCLUSION

PT LSI was more predictive of QI than Quad CSA LSI. Involved limb PT CSA mattered more in predicting peak knee extensor torque than did Quad CSA, but in the uninvolved limb, Quad CSA was the most important predictor of peak knee extensor torque. Graft site patellar tendon hypertrophy is key for strong quadriceps early after ACLR. Early targeted loading via exercise to promote healing of the graft site patellar tendon may bring patients a step closer to winning their battle against quadriceps dysfunction.

LEVEL OF EVIDENCE

Level I.

Effect of Aging on Tendon Biology, Biomechanics and Implications for Treatment Approaches

Tendon aging is associated with an increasing prevalence of tendon injuries and/or chronic tendon diseases, such as tendinopathy, which affects approximately 25% of the adult population. Aged tendons are often characterized by a reduction in the number and functionality of tendon stem/progenitor cells (TSPCs), fragmented or disorganized collagen bundles, and an increased deposition of glycosaminoglycans (GAGs), leading to pain, inflammation, and impaired mobility. Although the exact pathology is unknown, overuse and microtrauma from aging are thought to be major causative factors. Due to the hypovascular and hypocellular nature of the tendon microenvironment, healing of aged tendons and related injuries is difficult using current pain/inflammation and surgical management techniques. Therefore, there is a need for novel therapies, specifically cellular therapy such as cell rejuvenation, due to the decreased regenerative capacity during aging. To augment the therapeutic strategies for treating tendon-aging-associated diseases and injuries, a comprehensive understanding of tendon aging pathology is needed. This review summarizes age-related tendon changes, including cell behaviors, extracellular matrix (ECM) composition, biomechanical properties and healing capacity. Additionally, the impact of conventional treatments (diet, exercise, and surgery) is discussed, and recent advanced strategies (cell rejuvenation) are highlighted to address aged tendon healing. This review underscores the molecular and cellular linkages between aged tendon biomechanical properties and the healing response, and provides an overview of current and novel strategies for treating aged tendons. Understanding the underlying rationale for future basic and translational studies of tendon aging is crucial to the development of advanced therapeutics for tendon regeneration.

Patellar tendon elastic properties derived from in vivo loading and kinematics

Patellar complications frequently limit the success of total knee arthroplasty. In addition to the musculoskeletal forces themselves, patellar tendon elastic properties are essential for driving patellar loading. Elastic properties reported in the literature exhibit high variability and appear to differ according to the methodologies used. Specifically in total knee arthroplasty patients, only limited knowledge exists on in vivo elastic properties and their corresponding loads. For the first time, we report stiffness, Young's modulus, and forces of the patellar tendon, derived from four patients with telemetric total knee arthroplasties using a combined imaging and measurement approach. To achieve this, synchronous in vivo telemetric assessment of tibio-femoral contact forces and fluoroscopic assessment of knee kinematics, along with full body motion capture and ground reaction forces, fed musculoskeletal multi-body models to quantify patellar tendon loading and elongation. Mechanical patellar tendon properties were calculated during a squat and a sit-stand-sit activity, with resulting tendon stiffness and Young's modulus ranging from 511 to 1166 N/mm and 259 to 504 MPa, respectively. During these activities, the patellar tendon force reached peak values between 1.31 and 2.79 bodyweight, reaching levels of just ∼0.5 bodyweight below the tibio-femoral forces. The results of this study provide valuable input data for mechanical simulations of the patellar tendon and the whole resurfaced knee.

Ex vivo study correlating the stiffness of the ovine patellar tendon to age and weight

Tendons play a crucial role in the musculoskeletal system. In humans, tendon injuries, especially chronic tendinopathy, are very common and the patellar tendon is a frequent location for tendinopathy or injuries. The biomechanical characteristics of the patellar tendon, such as elasticity and stiffness, are of paramount importance and constitute major outcome measures in research studies. We aimed to assess whether the stiffness of the healthy ovine patellar tendon changes with age and weight in a population of normal animals. Sixty-eight 'patella-patellar tendon-tibial tuberosity' units from thirty-four Ile-de-France ewes of body mass 65 to 95 kg, euthanized for reasons other than musculoskeletal diseases, underwent a tensile test providing a measure of the tendon stiffness. Animals were sorted into three categories of age (1-2 yo, 3-5 yo, 6-10 yo). We found a positive but not significant correlation between age category and stiffness (r = 0.22, p = 0.27). There was a significantly positive correlation between weight and stiffness (r = 0.39, p = 0.04). In conclusion, the study characterized biomechanical properties of healthy tendons, provided useful reference values, and established the basis for future biomechanical tests on healing tendons in sheep. The most appropriate sheep population for those future studies would be non-overweight young adults presenting with no lameness.

Metabolic and molecular responses of human patellar tendon to concentric- and eccentric-type exercise in youth and older age

Exercise training can induce adaptive changes to tendon tissue both structurally and mechanically; however, the underlying compositional changes that contribute to these alterations remain uncertain in humans, particularly in the context of the ageing tendon. The aims of the present study were to determine the molecular changes with ageing in patellar tendons in humans, as well as the responses to exercise and exercise type (eccentric (ECC) and concentric (CON)) in young and old patellar tendon. Healthy younger males (age 23.5 ± 6.1 years; n = 27) and older males (age 68.5 ± 1.9 years; n = 27) undertook 8 weeks of CON or ECC training (3 times per week; at 60% of 1 repetition maximum (1RM)) or no training. Subjects consumed D₂O throughout the protocol and tendon biopsies were collected after 4 and 8 weeks for measurement of fractional synthetic rates (FSR) of tendon protein synthesis and gene expression. There were increases in tendon protein synthesis following 4 weeks of CON and ECC training (P < 0.01; main effect by ANOVA), with no differences observed between young and old males, or training type. At the transcriptional level however, ECC in young adults generally induced greater responses of collagen and extracellular matrix-related genes than CON, while older individuals had reduced gene expression responses to training. Different training types did not appear to induce differential tendon responses in terms of protein synthesis, and while tendons from older adults exhibited different transcriptional responses to younger individuals, protein turnover changes with training were similar for both age groups.

An Examination of Two Resistance Training Frequency Techniques in Morphological and Functional Adaptations of the Patellar Tendon

The aim of the present study was to investigate the effects of distinct resistance training frequencies with equated-volume conditions in morphological and functional adaptations of the patellar tendon. Twenty-seven recreationally resistance-trained subjects (men [n=17] and women [n=10]) (age: 20.8 ± 1.9 years [range 18 to 25 years]; height: 1.73 ± 9.8 cm; total body mass = 73.2 ± 11.7 kg; previous RT experience = 3.3 ± 1.6 years) volunteered to participate in this study. A total of 16 training sessions were performed during the study period. Each subject's leg was randomly allocated to one of the following training protocols: 2 training sessions/week (2x) or 4 training sessions/week (4x). Measurements of tendon cross sectional area (CSA) and length were performed through ultrasound imaging. One repetition maximum test was performed to assess patellar tendon force (PTF) unilaterally. For CSA (2x: Δ= -1.3%; 4x: Δ= -0.9%), and length (2x: Δ= -0.4%; 4x: Δ= 1.2%), no significant differences were observed within or between conditions (all p > 0.05). For PTF, a significant difference was observed between conditions (mean difference = 0.05 [-125 to 224] p= 0.001). In conclusion, the leg extension exercise performed 2 vs 4x/week induces similar patellar tendon morphological responses. However, the increase in force seems to be enhanced by a lower weekly training frequency associated with a longer intervention period.

Concurrent validity and intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness

Introduction

Assessment of tendon stiffness in vivo traditionally involves maximal muscle contractions, which can be challenging in pain populations. Alternative methods are suggested, although the clinimetric properties are sparse. This study investigated the concurrent validity and the intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness.

Methods

Patellar tendon stiffness was assessed in 17 healthy adults with (a) the dynamometer and B-mode ultrasonography method (DBUS) and (b) the strain elastography method. Correlations between the two methods were analysed using Kendall’s Tau-b. The relative reliability of both methods was evaluated using intraclass correlation coefficient (ICC). The absolute reliability was presented by Bland–Altman plots, standard error of measurement (SEM) and minimum detectable change (MDC).

Results

No correlation was found between the two methods, irrespective of reference tissue in strain elastography (Kendall’s Tau-b Hoffa = –0.01 (p = 1.00), Kendall’s Tau-b subcutis = 0.04 (p = 0.87)). Tracking of the tendon elongation in the DBUS method had good to excellent relative reliability (ICC = 0.95 (95% confidence interval – CI: 0.85–0.98)) and high absolute reliability (SEM = 0.04 mm (1%), MDC = 0.11 mm (3%)). The strain elastography method had good to excellent relative reliability, regardless of reference tissue (ICC Hoffa = 0.95 (95% CI: 0.86–0.98), ICC subcutis = 0.94 (95% CI: 0.82–0.98)), but low absolute reliability (SEM Hoffa = 0.06 (20%), MDC Hoffa = 0.18 (60%), SEM subcutis = 0.12 (41%), MDC subcutis = 0.32 (110%)).

Conclusions

No concurrent validity existed for DBUS and strain elastography, suggesting that the two methods measure different tendon properties. The overall reliability for the DBUS method was high, but the absolute reliability was low for strain elastography stiffness ratios. Therefore, the strain elastography method may not be recommended for tracking differences in patellar tendon stiffness in healthy adults.

Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial

Background

There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested.

The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR.

Methods

Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430.

Results

CS improved by 22.7 points for the STR group and by 23,7 points for the HTR (p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference.

Conclusion

We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.

Mechanical properties of human patellar tendon collagen fibrils. An exploratory study of aging and sex

Tendons are connective tissues that transmit mechanical forces from muscle to bone and consist mainly of nano-scale fibrils of type I collagen. Aging has been associated with reduced mechanical function of tendons at the whole-tendon level and also with increased glycation of tendon collagen fibrils. Yet, the mechanical effects of aging at the fibril level remain unknown. In vitro glycation has previously been reported to substantially increase fibril strength and stiffness in young rats, suggesting a potentially large effect of aging through the glycation mechanism. We therefore expected that aging would have a similar major impact on fibril mechanical properties. In addition, differences in fibril mechanical properties between men and women have never been studied. This study investigated human patellar tendon biopsies from young (26 ± 4 years) and elderly (66 ± 1 years), men and women by measuring the mechanical properties of individual collagen fibrils using a custom nano-mechanical device. There were no major mechanical differences with either age or sex, but there were modestly greater failure stress (22%) and tensile modulus at both low and high strain (16% and 26% respectively) in the elderly group. No significant differences in mechanical properties were observed between men and women. The slightly greater strength and stiffness in the elderly group are in contrasts to the age-related deficits observed for whole-tendons in vivo, although the study was not designed to investigate these minor differences.

Immediate Effect of Whole Body Vibration on Knee Extensor Tendon Stiffness in Hemiparetic Stroke Patients

Background and Objectives: Whole body vibration is widely used to enhance muscle performance, but evidence of its effects on the tendon stiffness of the knee extensor tendon in stroke remains inconclusive. Our study was aimed to determine the difference in patellar and quadriceps tendon stiffness between hemiparetic and unaffected limbs in stroke patients and to investigate the immediate effect of whole body vibration on tendon stiffness. Materials and Methods: The patellar and quadriceps tendon stiffness of first-ever hemiplegic stroke patients was evaluated with elastography to compare the differences between hemiparetic and unaffected limbs. After one 20 min session of whole body vibration exercise in the standing position, tendon stiffness was again measured to evaluate the immediate effects of whole body vibration on tendon stiffness. Results: The results showed no significant differences in the tendon stiffness of the patellar and quadriceps tendons between hemiparetic and unaffected limbs. However, significant associations were found between the tendon stiffness of the patellar and quadriceps tendons and knee extensor spasticity on the hemiparetic side (ρ = 0.62; p = 0.044). There were no significant changes in tendon stiffness after a single session of whole body vibration. Conclusions: In conclusion, knee extensor tendon stiffness in hemiparetic limbs is positively correlated to the degree of knee extensor spasticity in stroke patients. However, a single session of whole body vibration does not alter tendon stiffness.

Advanced glycation end productions and tendon stem/progenitor cells in pathogenesis of diabetic tendinopathy

Tendinopathy is a challenging complication observed in patients with diabetes mellitus. Tendinopathy usually leads to chronic pain, limited joint motion, and even ruptured tendons. Imaging and histological analyses have revealed pathological changes in various tendons of patients with diabetes, including disorganized arrangement of collagen fibers, microtears, calcium nodules, and advanced glycation end product (AGE) deposition. Tendon-derived stem/ progenitor cells (TSPCs) were found to maintain hemostasis and to participate in the reversal of tendinopathy. We also discovered the aberrant osteochondrogenesis of TSPCs in vitro. However, the relationship between AGEs and TSPCs in diabetic tendinopathy and the underlying mechanism remain unclear. In this review, we summarize the current findings in this field and hypothesize that AGEs could alter the properties of tendons in patients with diabetes by regulating the proliferation and differentiation of TSPCs in vivo.

Habitual side-specific loading leads to structural, mechanical and compositional changes in the patellar tendon of young and senior life-long male athletes

Effects of life-long physical activity on tendon function have been investigated in cross-sectional studies, but these are at risk of "survivorship" bias. Here, we investigate if life-long side-specific loading is associated with greater cross-sectional area (CSA), mechanical properties, cell density (DNA content) and collagen cross-link composition of the male human patellar tendon (PT), in vivo. Nine seniors and six young male life-long elite badminton players and fencers were included. CSA of the PT obtained by 3-tesla MRI, and ultrasonography-based bilateral PT mechanics were assessed. Collagen fibril characteristics, enzymatic cross-links, non-enzymatic glycation (autofluorescence), collagen and DNA content were measured biochemically in PT biopsies. The elite athletes had a ≥15% side-to-side difference in maximal knee extensor strength, reflecting chronic unilateral sport-specific loading patterns. The PT CSA was greater on the lead extremity compared with the non-lead extremity (17 %, p=0.0001). Furthermore, greater tendon stiffness (18 %, p=0.0404) together with lower tendon stress (22 %, p=0.0005) and tendon strain (18 %, p=0.0433) were observed on the lead extremity. No effects were demonstrated from side-to-side for glycation, enzymatic cross-link, collagen, and DNA content (50%, p=0.1160). Moreover, tendon fibril density was 87±28 fibrils/μm² on the lead extremity and 68±26 fibrils/μm² on the non-lead extremity (28%, p=0.0544). Tendon fibril diameter was 86±14 nm on the lead extremity and 94±14 nm on the non-lead extremity (-9%, p=0.1076). These novel data suggest that life-long side-specific loading in males yields greater patellar tendon size and stiffness possibly with concomitant greater fibril density but without changes of collagen cross-link composition.

Muscle and tendon adaptations to moderate load eccentric vs. concentric resistance exercise in young and older males

Resistance exercise training (RET) is well-known to counteract negative age-related changes in both muscle and tendon tissue. Traditional RET consists of both concentric (CON) and eccentric (ECC) contractions; nevertheless, isolated ECC contractions are metabolically less demanding and, thus, may be more suitable for older populations. However, whether submaximal (60% 1RM) CON or ECC contractions differ in their effectiveness is relatively unknown. Further, whether the time course of muscle and tendon adaptations differs to the above is also unknown. Therefore, this study aimed to establish the time course of muscle and tendon adaptations to submaximal CON and ECC RET. Twenty healthy young (24.5 ± 5.1 years) and 17 older males (68.1 ± 2.4 years) were randomly allocated to either isolated CON or ECC RET which took place 3/week for 8 weeks. Tendon biomechanical properties, muscle architecture and maximal voluntary contraction were assessed every 2 weeks and quadriceps muscle volume every 4 weeks. Positive changes in tendon Young's modulus were observed after 4 weeks in all groups after which adaptations in young males plateaued but continued to increase in older males, suggesting a dampened rate of adaptation with age. However, both CON and ECC resulted in similar overall changes in tendon Young's modulus, in all groups. Muscle hypertrophy and strength increases were similar between CON and ECC in all groups. However, pennation angle increases were greater in CON, and fascicle length changes were greater in ECC. Notably, muscle and tendon adaptations appeared to occur in synergy, presumably to maintain the efficacy of the muscle-tendon unit.

Effects of Power-Oriented Resistance Training With Heavy vs. Light Loads on Muscle-Tendon Function in Older Adults: A Study Protocol for a Randomized Controlled Trial

Background

Power-oriented resistance training (PRT) is one of the most effective exercise programs to counteract neuromuscular and physical function age-related declines. However, the optimal load that maximizes these outcomes or the load-specific adaptations induced on muscle power determinants remain to be better understood. Furthermore, to investigate whether these adaptations are potentially transferred to an untrained limb (i.e., cross-education phenomenon) could be especially relevant during limb-immobilization frequently observed in older people (e.g., after hip fracture).

Methods

At least 30 well-functioning older participants (>65 years) will participate in a within-person randomized controlled trial. After an 8-week control period, the effects of two 12-week PRT programs using light vs. heavy loads will be compared using an unilateral exercise model through three study arms (light-load PRT vs. non-exercise; heavy-load PRT vs. non-exercise; and light- vs. heavy- load PRT). Muscle-tendon function, muscle excitation and morphology and physical function will be evaluated to analyze the load-specific effects of PRT in older people. Additionally, the effects of PRT will be examined on a non-exercised contralateral limb.

Discussion

Tailored exercise programs are largely demanded given their potentially greater efficiency preventing age-related negative consequences, especially during limb-immobilization. This trial will provide evidence supporting the use of light- or heavy-load PRT on older adults depending on individual needs, improving decision making and exercise program efficacy.

Clinical Trial Registration

NCT03724461 registration data: October 30, 2018.

Mechanical Characteristics of Heavy vs. Light Load Ballistic Resistance Training in Older Adults

Rodriguez-Lopez, C, Alcazar, J, Sánchez-Martín, C, Ara, I, Csapo, R, and Alegre, LM. Mechanical characteristics in heavy vs. light load ballistic resistance training in older adults. J Strength Cond Res XX(X): 000-000, 2020-Although power-oriented resistance training (RT) is strongly recommended to counter age-related neuromuscular function declines, there is still controversy about which intensities of load should be used to elicit optimal training adaptations. Knowledge of the mechanical characteristics of power-oriented RT performed at different intensities might help to better understand the training stimulus that triggers load-dependent adaptations in older adults. Using a cross-over design, 15 well-functioning older volunteers (9 men and 6 women; 73.6 ± 3.8 years) completed 2 volume × load-matched ballistic RT sessions with heavy (HL: 6 × 6 × 80% 1-repetition maximum [1RM]) and light-load (LL: 6 × 12 × 40% 1RM) on a horizontal leg press exercise. Electromyographic (EMG) and mechanical variables (work, force, velocity, and power) as well as intraset neuromuscular fatigue (i.e., relative losses in force, velocity, and power) were analyzed. More concentric mechanical work was performed in the LL training session, compared with HL (36.2 ± 11.2%; p < 0.001). Despite the higher mean EMG activity of the quadriceps femoris muscle (13.2 ± 21.1%; p = 0.038) and greater concentric force (35.2 ± 7.6%; p < 0.001) during HL, higher concentric velocity (41.0 ± 12.7%, p < 0.001) and a trend toward higher concentric power (7.2 ± 18.9%, p = 0.075) were found for LL. Relative velocity losses were similar in both sessions (≈10%); however, relative force losses were only found in LL (7.4 ± 6.5%, p = 0.003). Considering the greater mechanical work performed and concentric power generated, ballistic RT using LL may, therefore, represent a stronger stimulus driving training adaptations as compared with volume × load-matched heavy-load training. Relative losses in force and power should be monitored in addition to velocity losses during ballistic RT.

Effect of testing temperature on the nanostructural response of tendon to tensile mechanical overload

Despite many in vitro mechanical experiments of tendon being conducted at room temperature, few assessments have been made to determine how the structural response of tendon to mechanical overload may vary with ambient temperature. We explored whether damage to the collagen nanostructure of tendon resulting from tensile rupture varies with temperature. Use of bovine tail tendons in combination with NaBH₄ crosslink stabilization treatment allowed us to probe the mechanisms underlying the observed changes. Untreated tendons and NaBH₄-stabilized tendons were pulled to rupture at temperatures of 24, 37, and 55 °C. Of nine mechanical parameters measured from the resulting stress-strain curves, only yield stress differed between the tendons tested at 37 and 24 °C. When tested at 55 °C, untreated tendons showed large reductions in ultimate strength and toughness, while NaBH₄-stabilized tendons showed smaller reductions. Differential scanning calorimetry was used to assess damage to the collagen fibril nanostructure of tendons resulting from rupture, with samples from the ruptured tendons compared to samples from the same tendons removed prior to loading. While there was indication that overload-induced molecular packing disruption to collagen fibrils may be heightened at 37 °C, statistical increases in damage compared to that occurring at 24 °C were only seen when testing was conducted at 55 °C. The results show that the temperature sensitivity of tendon to ramp loading depends on crosslinking within the tissue. In poorly crosslinked tissues, collagen may be more susceptible to mechanical damage when tested at physiologic temperature compared to room temperature. For tendons with a high density of thermally stable crosslinks, such as the human Achilles or patellar tendons, testing at room temperature should produce comparable results to testing at physiologic temperature.

Muscle-tendon morphology and function following long-term exposure to repeated and strenuous mechanical loading

We mapped structural and functional characteristics of muscle-tendon units in a population exposed to very long-term routine overloading. Twenty-eight military academy cadets (age = 21.00 ± 1.1 years; height = 176.1 ± 4.8 cm; mass = 73.8 ± 7.0 kg) exposed for over 24 months to repetitive overloading were profiled via ultrasonography with a senior subgroup of them (n = 11; age = 21.4 ± 1.0 years; height = 176.5 ± 4.8 cm; mass = 71.4 ± 6.6 kg) also tested while walking and marching on a treadmill. A group of eleven ethnicity- and age-matched civilians (age = 21.6 ± 0.7 years; height = 176.8 ± 4.3 cm; mass = 74.6 ± 5.6 kg) was also profiled and tested. Cadets and civilians exhibited similar morphology (muscle and tendon thickness and cross-sectional area, pennation angle, fascicle length) in 26 out of 29 sites including the Achilles tendon. However, patellar tendon thickness along the entire tendon was greater (P < .05) by a mean of 16% for the senior cadets compared with civilians. Dynamically, cadets showed significantly smaller ranges of fascicle length change and lower shortening velocity in medial gastrocnemius during walking (44.0% and 47.6%, P < .05-.01) and marching (27.5% and 34.3%, P < .05-.01) than civilians. Furthermore, cadets showed lower normalized soleus electrical activity during walking (22.7%, P < .05) and marching (27.0%, P < .05). Therefore, 24-36 months of continuous overloading, primarily occurring under aerobic conditions, leads to more efficient neural and mechanical behavior in the triceps surae complex, without any major macroscopic alterations in key anatomical structures.

Regional collagen turnover and composition of the human patellar tendon

Tendon pathology (tendinopathy) typically occurs in specific regions of a tendon, and growth in response to exercise also appears to be more pronounced in specific regions. In a previous study in animals we found evidence of regional differences in tendon turnover, but whether the turnover of human patellar tendon differs in different regions still remains unknown. Patellar tendons were obtained from cadavers of healthy men and women (body donation program, n = 5 donors, >60 yr of age). Samples were taken from 10 different regions along the length, width, and thickness of the tendon. Turnover was measured by ¹⁴C bomb pulse dating and also estimated from the accumulation of advanced glycation end products (AGEs) by fluorescence (340/460 nm) in addition to measurement of specific AGEs by mass spectrometry. Composition in terms of collagen, glycosaminoglycans (GAGs), and DNA was also assessed in each region. ¹⁴C results showed that all tendon regions had a similar ¹⁴C concentration, which was equal to the average atmospheric ¹⁴C concentration during the first 15 yr of the person's life. Fluorescence normalized to dry weight did not differ between regions, nor did specific AGEs. Higher GAG content was observed in the proximal and near the distal insertion of the tendon. In conclusion, healthy human patellar tendon displays no regional differences in collagen turnover throughout life.NEW & NOTEWORTHY Tendon injuries and tendinopathies typically occur in specific regions of the tendon, but the reason for this specificity is not well understood. A potential factor in injury susceptibility is tissue turnover, and previous work suggests that the tendon core has practically no turnover during adult life; however, it is not known whether this is true for other regions of the tendon. Our present results on healthy human patellar tendon clearly demonstrate that turnover does not differ between regions and thereby cannot explain differences in injury susceptibility. The findings also indicate that all regions of the tendon are formed simultaneously during skeletal maturation and do not turn over appreciably during adulthood. This is an important finding because little is known about tendon growth during maturation in humans.