Short-term immobilization after eccentric exercise. Part II: creatine kinase and myoglobin

Temporal tracking of cysteine 34 oxidation of plasma albumin as a biomarker of muscle damage following a bout of eccentric exercise

PURPOSE

Exercise-induced muscle damage (EIMD) results in the generation of reactive oxygen species (ROS), but little is known about the temporal profile of change in ROS post-EIMD and how ROS levels relate to the onset of and recovery from EIMD. Our primary aim was to examine the effect of EIMD on the pattern of change in the blood level of thiol-oxidised albumin, a marker of oxidative stress.

METHODS

Seven male participants were subjected on separate days to eccentric muscle contraction to cause EIMD or a no-exercise condition. After each session, the participants collected daily dried blood spots to measure thiol-oxidised albumin and returned to the laboratory every 2 days for the assessment of indirect markers of EIMD, namely maximal voluntary contraction (MVC), delayed onset muscle soreness (DOMS), creatine kinase (CK), and myoglobin.

RESULTS

Eccentric exercise resulted in a significant decrease in MVC and increase in DOMS, CK, myoglobin, and thiol-oxidised albumin with the latter reaching above baseline level within 24-48 h post-exercise. All the markers of EIMD returned to baseline level within 6 days post-exercise, but not the level of thiol-oxidised albumin which remained elevated for 10 days after exercise. There was a moderate correlation between changes in thiol-oxidised albumin and DOMS, but no significant relationship between any other markers of muscle damage.

CONCLUSION

The levels of thiol-oxidised albumin increase in response to EIMD and remain elevated for several days post-exercise. The temporal pattern of change in the level of thiol-oxidised albumin suggests that this may be a useful biomarker of muscle repair post-EIMD.

The Effects of Near-Infrared Phototherapy Preirradiation on Lower-Limb Muscle Strength and Injury After Exercise: A Systematic Review and Meta-analysis

OBJECTIVE

To assess near-infrared preirradiation effects on postexercise lower-limb muscle damage and function and determine optimal dosage.

DATA SOURCES

PubMed, Embase, Cochrane Library, EBSCO, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were systematically searched (2009-2023).

STUDY SELECTION

Randomized controlled trials of near-infrared preirradiation on lower-limb muscles after fatigue exercise were incorporated into the meta-analysis. Out of 4550 articles screened, 21 met inclusion criteria.

DATA EXTRACTION

The included studies' characteristics were independently extracted by 2 authors, with discrepancies resolved through discussion or by a third author. Quality assessment was performed using the Cochrane risk of bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation System.

DATA SYNTHESIS

In 21 studies, near-infrared preirradiation on lower-limb muscles inhibited the decline in peak torque (standardized mean difference [SMD], 1.33; 95% confidence interval [CI], 1.08-1.59; p<.001; increasing 27.97±4.87N·m), reduced blood lactate (SMD, -0.2; 95% CI, -0.37 to -0.03; p=.272; decreasing 0.54±0.42mmol/L), decreased creatine kinase (SMD, -2.11; 95% CI, -2.57 to -1.65; p<.001; decreasing 160.07±27.96U/L), and reduced delayed-onset muscle soreness (SMD, -0.53; 95% CI, -0.81 to 0.24; p<.001). Using a 24-hour cutoff revealed 2 trends: treatment effectiveness depended on power and energy density, with optimal effects at 24.16 J/cm2 and 275 J/cm2 for energy, and 36.81 mW/cm2 and 5495 mW/cm2 for power. Noting that out of 21 studies, 19 are from Brazil, 1 from the United States, and 1 from Australia, and the results exhibit high heterogeneity.

CONCLUSIONS

Although we would have preferred a more geographic dispersion of laboratories, our findings indicate that near-infrared preirradiation mitigates peak torque decline in lower-limb muscles. Influenced by energy and power density with a 24-hour threshold, optimal energy and power densities are observed at 24.16 J/cm2, 275 J/cm2, 36.81 mW/cm2, and 5495 mW/cm2, respectively. Laser preirradiation also reduces blood lactate, creatine kinase, and delayed-onset muscle soreness.

The Association of Serum Calprotectin with Fitness Indicators and Biochemical Markers in High-Level Athletes: A Continuous Dynamic Monitoring during One Competitive Season

The objective was to determine the associations between several biochemical indicators and the dynamics of concentration change across four physical fitness phases over the period of a competitive season. Furthermore, associations between serum calprotectin and biomarkers of inflammation or muscle injury and physical indicators were examined.

SUBJECTS AND METHODS

Twenty professional male water polo players (median age: 28 (22-42)) were included in this study. Serum creatine kinase activity was determined by the automated photometric UV method. The concentrations of calprotectin, C-reactive protein, and myoglobin were measured using an automated immunoturbidimetric method, while an automated immunochemistry method was employed for interleukin-6, troponin I, and cortisol determination. Tests of repeated strength, maximal strength, and static strength were used to evaluate physical activity.

RESULTS

Serum calprotectin concentrations expressed in median and IQR were significantly different: T1: 2.92 g/mL (2.47; 3.86); T2: 2.35 g/mL (1.26; 2.87); T3: 2.27 g/mL (1.60; 3.27); and T4: 1.47 g/mL (1.04; 2.85) (p = 0.004). Cortisol concentration and CK activity showed significant changes among phases (p = 0.049 and p = 0.014, respectively). Each physical activity examined showed a significant seasonal decrease (all p values were 0.001). Calprotectin serum concentration and indicators of muscular injury, inflammation, and physical activity were found to be correlated during particular stages of the seasonal examination.

CONCLUSIONS

Calprotectin values determined throughout one competitive season decreased as training intensity among water polo players increased. Serum calprotectin concentrations and indicators were related to biochemical markers of inflammation and muscle damage.

Acute Responses of Youth Elite Players to a Football Match in Terms of Blood Markers

The current study verified the acute responses of participants to a football match in terms of blood markers. Sixteen elite U-18 male football players were divided into two groups: experimental (EG, n = 10), who played a friendly football match; and control (CG), who were not exposed to any physical exertion. Intravenous blood samples were collected from both groups at baseline, pre-match, half-time, and post-match. The blood analysis consisted of four groups: immunological (leukocytes, platelets, and cortisol), muscle damage (creatine kinase and lactate dehydrogenase), metabolic (lactate, glucose, erythrocytes, hematocrit, hemoglobin, and urea), and electrolytic (sodium, calcium, and potassium). Edwards' training impulse demonstrated that the first half was more demanding than the second half (p = 0.020). Significant changes between time points and groups were observed for leukocytes (pre-match: 6920 ± 1949; post-match: 13,890 ± 3292; p ≤ 0.05) and cortisol (pre-match: 10.78 ± 3.63; post-match: 19.15 ± 7.40; p ≤ 0.05). CK (pre-match: 516.50 ± 248.38; post-match: 713.70 ± 308.20; p ≤ 0.05) and LDH (pre-match: 348.80 ± 36.49; post-match: 414.80 ± 26.55; p ≤ 0.05) increased significantly across the time points for the EG, with no difference between the groups, however. Raised lactate (pre-match: 1.05 ± 0.32; post-match: 3.24 ± 1.60; p ≤ 0.05) and glucose (pre-match: 72.54 ± 9.76; post-match: 101.42 ± 19.87; p ≤ 0.05) differences between the groups at half-time were also observed. These current findings provide helpful information to better understand football match demands regarding physiological effects.

Muscle Damage, Inflammation, and Muscular Performance following the Physical Ability Test in Professional Firefighters

Proper monitoring of fatigue and muscular damage may be used to decrease the high levels of cardiovascular disease, overuse musculoskeletal injuries, and workers compensation claims within the profession of firefighting. The purpose of this study was to examine muscle damage, muscular fatigue, and inflammation responses following a typical firefighting shift. Twenty-four professional firefighters completed two Physical Ability Tests to standardize the tasks typically performed in a day of work, and to elicit similar physiological responses. Participants were then monitored for 48 h. Prior to, and 48 h following the Physical Ability Tests, participants were evaluated for changes in strength, power, range-of-motion, as well as blood markers including myoglobin and c-reactive protein. Following the Physical Ability Tests, significant differences in myoglobin (p < 0.05), grip strength (p < 0.05), vertical jump (p < 0.05), and sit-and-reach (p < 0.05) were observed. No difference in c-reactive protein was observed (p > 0.05). After 24 hours following a shift, firefighters exhibited decreased strength, power, and range-of-motion. This may lead to decreases in performance and an increased risk of injury.

Blood-Based Biomarkers for Managing Workload in Athletes: Considerations and Recommendations for Evidence-Based Use of Established Biomarkers

Blood-based biomarkers can provide an objective individualized measure of training load, recovery, and health status in order to reduce injury risk and maximize performance. Despite enormous potentials, especially owing to currently evolving technology, such as point-of-care testing, and advantages, in terms of objectivity and non-interference with the training process, there are several pitfalls in the use and interpretation of biomarkers. Confounding variables such as preanalytical conditions, inter-individual differences, or an individual chronic workload can lead to variance in resting levels. In addition, statistical considerations such as the detection of meaningful minimal changes are often neglected. The lack of generally applicable and individual reference levels further complicates the interpretation of level changes and thus load management via biomarkers. Here, the potentials and pitfalls of blood-based biomarkers are described, followed by an overview of established biomarkers currently used to support workload management. Creatine kinase is discussed in terms of its evidence for workload management to illustrate the limited applicability of established markers for workload management to date. We conclude with recommendations for best practices in the use and interpretation of biomarkers in a sport-specific context.

The pathophysiology of rhabdomyolysis in ungulates and rats: towards the development of a rodent model of capture myopathy

Capture myopathy (CM), which is associated with the capture and translocation of wildlife, is a life-threatening condition that causes noteworthy morbidity and mortality in captured animals. Such wildlife deaths have a significant impact on nature conservation efforts and the socio-economic wellbeing of communities reliant on ecotourism. Several strategies are used to minimise the adverse consequences associated with wildlife capture, especially in ungulates, but no successful preventative or curative measures have yet been developed. The primary cause of death in wild animals diagnosed with CM stems from kidney or multiple organ failure as secondary complications to capture-induced rhabdomyolysis. Ergo, the development of accurate and robust model frameworks is vital to improve our understanding of CM. Still, since CM-related complications are borne from biological and behavioural factors that may be unique to wildlife, e.g. skeletal muscle architecture or flighty nature, certain differences between the physiology and stress responses of wildlife and rodents need consideration in such endeavours. Therefore, the purpose of this review is to summarise some of the major etiological and pathological mechanisms of the condition as it is observed in wildlife and what is currently known of CM-like syndromes, i.e. rhabdomyolysis, in laboratory rats. Additionally, we will highlight some key aspects for consideration in the development and application of potential future rodent models.

Serum biomarkers for the assessment of muscle damage in various surgical approaches in primary total hip arthroplasty: a systematic review of comparative studies

PURPOSE

Using serum biomarkers, this systematic review assessed soft tissue injury following different total hip arthroplasty surgical approaches. The purposes were to determine if there is any advantage between the standard and minimal invasive approaches, and to compare tissue damage of the respective surgical approaches using biomarkers such as creatine kinase, myoglobin, c-reactive protein, erythrocyte sedimentation rate, skeletal troponin and interleukins.

METHOD

A search in Pubmed/MEDLINE, Scopus and Web of Science databases was conducted in October 2021 with the use of PRISMA guidelines. Search items were ("biomarkers" OR "markers" OR "tissue damage" OR "muscle damage") AND "approach" AND ("total hip arthroplasty" OR "total hip replacement"). Inclusion criteria were prospective, randomized, controlled trials or prospective, comparative studies, comparing serum markers for muscle damage in two or more surgical approaches for primary total hip arthroplasty. Exclusion criteria were study protocols, case reports, systematic reviews, meta-analyses, studies in non-English language or without available full text, and studies not recording biomarkers of muscle damage.

RESULTS

Initial search revealed 508 studies; after subtraction of duplicates, and exclusion criteria, 31 studies remained for analysis. No advantage between different approaches was found when evaluating biomarkers, and no specific biomarkers had a distinct role in tissue damage in total hip arthroplasty. Anterior and minimally invasive approaches were associated with lower values of soft tissue (creatine kinase) and inflammation (c-reactive protein) biomarkers compared to the standard approaches.

CONCLUSION

Measurement of serum biomarkers after primary total hip arthroplasty for the estimation of tissue damage has unclear or little clinical value.

TRIAL REGISTRATION

PROSPERO Registration: CRD42022303959.

Serum myoglobin as predictor of acute kidney injury and 90-day mortality in patients with rhabdomyolysis after exertional heatstroke: an over 10-year intensive care survey

OBJECTIVE

Rhabdomyolysis (RM) in exertional heatstroke (EHS) often leads to multiple organ dysfunction including acute kidney injury (AKI). Studies have shown that serum creatine kinase (CK) >1000 U/L as a serological diagnostic criterion for RM does not reflect the risk of AKI or mortality.

METHODS

This longitudinal cohort study included all patients with EHS who were admitted to intensive care unit between January 2008 and June 2019. Serum myoglobin (sMb) was studied as the serological marker of RM and compared with CK. Outcome events were AKI and 90-day mortality.

RESULTS

A total of 161 patients were enrolled, of whom 52 (32.3%) had sMb ≥1000 ng/mL. Patients with sMb ≥1000 ng/mL had higher SOFA score, higher APACHE II score, lower GCS score, and higher incidence of disseminated intravascular coagulation, acute myocardial injury, acute liver injury, AKI, and 90-day mortality than patients with sMb <1000 ng/mL. Lymphocytes, neutrophils, D-Dimer were risk factors for AKI in patients with sMb ≥1000 ng/mL. Curve fitting showed a curved relationship between sMb and EHS-induced AKI but not CK. sMb ≥1000 ng/mL showed better predictive ability for AKI (area under curve: 0.786). APACHE II, SOFA, and GCS scores were risk factors for 90-day mortality in patients with sMb ≥1000 ng/mL.

CONCLUSION

Serum myoglobin is a better predictor of AKI and 90-day mortality than CK in patients with RM after EHS.

Admission serum myoglobin and the development of acute kidney injury after major trauma

BACKGROUND

Myoglobin and creatine kinase (CK) are both established markers of muscle injury but their hospital admission values have never been compared to predict post-traumatic acute kidney injury (AKI).

METHODS

An observational registry study of consecutive trauma patients admitted to a major regional trauma centre. The primary outcome was stage 1 or more AKI in the first 7 days after trauma. We assessed the association of hospital admission myoglobin or CK with development of AKI both alone and when added to two existing risk prediction models for post traumatic AKI.

RESULTS

Of the 857 trauma patients (median age 36 [25-52], 96% blunt trauma, median ISS of 20 [12-47]) included, 102 (12%) developed AKI. Admission myoglobin performed better than CK to predict AKI any stage with an AUC-ROC of 0.74 (95% CI 0.68-0.79) and 0.63 (95% CI 0.57-0.69), respectively (p < 0.001). Admission myoglobin also performed better than CK to predict AKI stage 2 or 3 [AUC-ROC of 0.79 (95% CI 0.74-0.84) and 0.74 (95% CI 0.69-0.79), respectively (p < 0.001)] with a best cutoff value of 1217 µg/L (sensitivity 74%, specificity 77%). Admission myoglobin added predictive value to two established models of AKI prediction and showed significant ability to reclassify subjects regarding AKI status, while admission CK did not. Decision curve analysis also revealed that myoglobin added net benefit to established predictive models. Admission myoglobin was better than CK at predicting development of significant rhabdomyolysis.

CONCLUSIONS

Admission myoglobin better predicts the development of AKI and severe rhabdomyolysis after major trauma. Admission myoglobin should be added in established predictive models of post-traumatic AKI to early identify high-risk patients.

Investigating myotoxicity following Australian red-bellied black snake (Pseudechis porphyriacus) envenomation

Background

Myotoxicity is one of the common clinical manifestations of red-bellied black snake (Pseudechis porphyriacus) envenomation characterised by elevated creatine kinase (CK) concentrations of greater than 1000 U/L. This study aimed to investigate the occurrence of myotoxicity in patients following envenomation.

Methods/Principal findings

Patient characteristics and serial blood samples (timed venom concentrations and CK concentrations, pre- and post- antivenom) from 114 patients (median age 41, 2-90y; 80 male) were extracted from the Australian Snakebite Project database. Patients were categorised into three groups based on peak CK concentrations [no myotoxicity (<1000 U/L), mild (1000–10,000 U/L) and severe (>10,000 U/L)]. The odds of (mild or severe) myotoxicity was lower in patients that received early antivenom (within 6 hours post-bite) compared to those that received late or no antivenom (odd ratio was 0.186; 95% confidence interval, 0.052–0.664). A population pharmacokinetic-pharmacodynamic (PKPD) model was developed to describe the relationship between the time course of venom (a mixture of toxins) and effect (elevated CK). In addition, a kinetic-pharmacodynamic (KPD) model was developed to describe the relationship between time course of a theoretical toxin and effect. Model development and parameter estimation was performed using NONMEM v7.3. No single set of parameter values from either the PKPD or KPD models were found that could accurately describe the time course of different levels of severity of myotoxicity. The predicted theoretical toxin half-life from the KPD model was 11 ± 3.9 hours compared to the half-life of venom of 5.3 ± 0.36 hours. This indicates that the putative causative toxin’s concentration-time profile does not parallel that of venom.

Conclusion

Early antivenom administration reduces the incidence of myotoxicity. The venom concentration profile does not appear to be the driver for myotoxicity following envenomation. Additional factors that affect the sensitivity of the patient to snake venom/toxins must be explored to understand the relationship with myotoxicity.

Post-match recovery profile of leukocyte cell subsets among professional soccer players

This study assessed the impact of cumulative match time on the distribution of CD45+ cell subtests in the capillary blood of professional soccer players. Twenty-two males (aged 18-30 years) took part in the 36-week study. Participants playing up to 540 in cumulative match time and less than 30 min in each single match during the observation period formed the control group. White blood cell (WBC) phenotyping and creatine kinase (CK) plasma activity analyses were performed. Also, counts for WBC subsets were determined. No significant differences in the hematological parameters or lymphocyte and NK cell percentages were observed between the control and study groups. Changes in the T cell percentage were significant during weeks 11 and 30 and in Th and Tc cell percentages during weeks 2 and 26. Significant correlations were found between the cumulative match time and Th, NK, and B cell percentages; monocyte counts; and CK activity in the control group. However, for the study group, correlations were found between cumulative match time and Th, Tc, and B cell percentages; CK activity; and the CK ratio. Our study suggests that the distribution of CD45+ cells might be a useful tool for monitoring the immune status of professional soccer players.

Urinary N-terminal fragment of titin: A surrogate marker of serum creatine kinase activity after exercise-induced severe muscle damage

We aimed to evaluate whether changes in the noninvasively assessed urinary N-terminal fragment of titin (U-titin) concentration may be associated with those of serum creatine kinase (CK) activity, transverse relaxation time (T₂), maximal voluntary contraction (MVC) torque, range of motion (ROM), and muscle soreness, following high-intensity eccentric exercise. Twenty-eight healthy young men performed 30 maximal isokinetic (120°/s) eccentric elbow flexor contractions using an isokinetic dynamometer. U-titin concentration, serum CK activity, T₂, MVC torque, ROM, and muscle soreness were measured before and after a maximum of 4 days. Both U-titin concentration and serum CK activity increased post-exercise in a similar manner, though the former elevated slightly earlier (p < 0.05). The peak values of log U-titin concentration following eccentric exercise were strongly correlated with those of log serum CK activity (r = 0.90, p < 0.05) and T₂ (r = 0.84, p < 0.05). There were moderate correlations between peak values of U-titin concentration and those of MVC torque (r = 0.69, p < 0.05) and ROM decline rate (r = 0.45, p < 0.05). These results suggest that in healthy young men, the non-invasive marker, U-titin, may be used as a serum CK surrogate following exercise-induced severe muscle damage.

Sex-Related Differences After a Single Bout of Maximal Eccentric Exercise in Response to Acute Effects: A Systematic Review and Meta-analysis

Morawetz, D, Blank, C, Koller, A, Arvandi, M, Siebert, U, and Schobersberger, W. Sex-related differences after a single bout of maximal eccentric exercise in response to acute effects: a systematic review and meta-analysis. J Strength Cond Res 34(9): 2697-2707, 2020-The most prominent effects after unaccustomed eccentric exercise are muscle damage, muscle soreness, strength loss, and higher concentrations of muscle proteins in the plasma. The aim of this systematic review is to evaluate sex-related differences in these acute effects. A systematic literature search in MEDLINE following the PRISMA guidelines was performed. Inclusion criteria were the difference in absolute outcomes between sexes in eccentric muscle strength, strength loss after eccentric exercise, blood concentrations of creatine kinase (CK), and delayed onset muscle soreness (DOMS). Results for maximal eccentric torque and CK data were pooled using a random-effect meta-analysis. A meta-regression was conducted to explain heterogeneity. Based on the 23 included trials, men showed significantly higher absolute eccentric strength. No sex-related differences were detected when normalizing strength for body mass, cross-sectional area of the muscle, or fat-free mass. Women displayed a tendency toward greater relative strength loss immediately after exercise. The absolute CK concentrations of men were significantly higher after exercise-induced muscle damage. No significant difference was found between sexes in DOMS. Untrained men and women display similar responses in all measures of relative muscle strength and DOMS. Apart from the enzymatic activity after exercise and the levels of absolute eccentric torque, there is no evidence for sex-related differences immediately after eccentric exercise. Therefore, eccentric training might have the same impact on men and women. One potential sex difference with practical relevance would be the possible difference in fatigue pattern immediately after eccentric exercise.

Markers of muscle damage and strength performance in professional football (soccer) players during the competitive period

Background

The present study investigated the impact of competitive soccer on the short-term changes in isometric strength of the adductor muscle group during the competitive season.

Methods

In this cohort study we evaluated the association between a serum marker of muscle damage [creatine phosphokinase (CPK)] and isometric strength of the adductor muscles of the hip in 30 professional football players (age: 26.7±2.9 years) during two seasons of the national top-level championship. Serum CPK level was determined the day before the match, 12–20, 36–48, 60–72 h after the match. The maximum voluntary isometric contraction force of the adductor muscles complex was determined immediately after having taken blood samples.

Results

There was evidence of a statistically significant positive association between age, body mass index (BMI), percentage of body fat, and muscle strength, and between weight and muscle strength. There was evidence of a statistically significant negative association between the level of CPK and the maximum isometric strength of the adductors of soccer players. Changes in CPK levels were associated with the muscle strength recovery trend (P<0.001). The strength/CPK ratio at different time points had a U-shaped curve.

Conclusions

Exercise induced muscle damage significantly affects the strength of the adductor muscle group of professional soccer players during the competitive period. The lower the CPK level, the greater the athletes' strength at a given time point. Also, the greater the decrease in CPK level, the greater the rate of strength restoration.

Diagnosis and prognosis for exercise-induced muscle injuries: from conventional imaging to emerging point-of-care testing

With the development of modern society, we have witnessed a significant increase of people who join in sport exercises, which also brings significantly increasing exercise-induced muscle injuries, resulting in reduction and even cessation of participation in sports and physical activities. Although severely injured muscles can hardly realize full functional restoration, skeletal muscles subjected to minor muscle injuries (e.g., tears, lacerations, and contusions) hold remarkable regeneration capacity to be healed without therapeutic interventions. However, delayed diagnosis or inappropriate prognosis will cause exacerbation of the injuries. Therefore, timely diagnosis and prognosis of muscle injuries is important to the recovery of injured muscles. Here, in this review, we discuss the definition and classification of exercise-induced muscle injuries, and then analyze their underlying mechanism. Subsequently, we provide detailed introductions to both conventional and emerging techniques for evaluation of exercise-induced muscle injuries with focus on emerging portable and wearable devices for point-of-care testing (POCT). Finally, we point out existing challenges and prospects in this field. We envision that an integrated system that combines physiological and biochemical analyses is anticipated to be realized in the future for assessing muscle injuries.

Changes in Oxidative Stress, Inflammation, and Muscle Damage Markers Following Diet and Beetroot Juice Supplementation in Elite Fencers

The aim of this study was to assess the impact of diet and active substances in beetroot juice on the parameters of oxidative stress, inflammation, and muscle damage as well as on the maximum rate of oxygen uptake (VO_2max) in elite fencers (10 women, 10 men). Athletes during four weeks realized dietary recommendations (ID) and, after that, diet with freeze-dried beetroot juice supplementation (ID&BEET). At baseline and after each stage, fasting antioxidants, biomarkers of oxidative stress, inflammation, and skeletal muscle damage were measured, and a VO_2max test was performed. Only after ID&BEET was a significant increase of VO_2max observed, and changes of this parameter were negatively related with changes of serum lactate dehydrogenase (∆LDH) activity, as well as with serum ∆β-carotene and malondialdehyde concentration (∆MDA). Additionally, positive relationships were observed between ∆β-carotene versus changes of the serum concentration of advanced oxidation protein products (∆AOPP), changes of serum glutathione peroxidase activity (∆GPx3) versus both changes of physical activity level and ∆LDH, as well as erythrocyte glutathione peroxidase activity (∆GPx1) versus ∆LDH. To summarize, we showed that long-term beetroot juice supplementation increases lipid peroxidation, and improvement of VO_2max after ID&BEET seems to be dependent on LDH activity, as well as on the serum concentration of MDA and β-carotene.

Impaired microvascular reactivity after eccentric muscle contractions is not restored by acute ingestion of antioxidants or dietary nitrate

Unaccustomed eccentric exercise leads to impaired microvascular function but the underlying mechanism is unknown. In this study, we evaluated the role of oxidative stress and of nitric oxide (NO) bioavailability. Thirty young men and women performed eccentric contractions of the tibialis anterior (TA) muscle (ECC), with the contralateral leg serving as nonexercising control (CON). Participants were randomized into three groups ingesting an antioxidant cocktail (AO), beetroot juice (BR) or placebo 46 h postexercise. At baseline and 48 h postexercise, hyperemic responses to brief muscle contractions and 5 min of cuff occlusion were assessed bilaterally in the TA muscles using blood oxygen level dependent (BOLD) magnetic resonance imaging. Eccentric contractions resulted in delayed time-to-peak (~22%; P < 0.001), blunted peak (~21%; P < 0.001) and prolonged time-to-half relaxation (~12%, P < 0.001) in the BOLD response to brief contractions, with no effects of AO or BR, and no changes in CON. Postocclusive time-to-peak was also delayed (~54%; P < 0.001) in ECC, with no effects of AO or BR, and no changes in CON. Impaired microvascular reactivity after eccentric contractions is confined to the exercised tissue, and is not restored with acute ingestion of AO or BR. Impairments in microvascular reactivity after unaccustomed eccentric contractions may result from structural changes within the microvasculature that can diminish muscle blood flow regulation during intermittent activities requiring prompt adjustments in oxygen delivery.

Effect of Body Fat Percentage on Muscle Damage Induced by High-Intensity Eccentric Exercise

This study aimed to investigate the impact of percent body fat (%BF) on muscle damage after high-intensity eccentric exercise. Thirty healthy male undergraduates (mean age: 22.0 ± 2 years, height: 176.9 ± 5 cm, weight: 75.8 ± 11.6 kg) participated in this study, and they were classified according to their %BF into a high %fat group (HFG, ≥20%, n = 15) and a low %fat group (LFG, ≤15%, n = 15). For eccentric exercise, two sets of 25 reps were performed on a modified preacher curl machine using the elbow flexor muscle. Maximal isometric strength, muscle soreness (passive and active), creatine kinase (CK), and myoglobin (Mb) were measured as indices of muscle damage. The data were analyzed with repeated measures ANOVA. The results show that there is a significant group–time interaction for both CK and Mb after eccentric exercise (p = 0.007, p = 0.015, respectively), with a greater increase in the HFG than in the LFG. However, there was no significant group–time interaction for maximal isometric strength and muscle soreness (passive and active) (p > 0.05). These results suggest that %BF is a factor that alters the muscle damage indices CK and Mb, which indicate membrane disruption, after eccentric exercise.

Large increases in plasma fast skeletal muscle troponin I after whole-body eccentric exercises

OBJECTIVES

It has been reported that plasma fast skeletal muscle troponin I (fsTnI) but not slow skeletal muscle troponin I (ssTnI) increases after a bout of eccentric exercise of the elbow flexors. The present study compared the first and second bouts of whole-body eccentric exercises for changes in plasma fsTnI and ssTnI concentrations.

DESIGN

Observational study in an experimental group.

METHODS

Fifteen sedentary men (20-25 y) performed nine eccentric exercises targeting arm, leg and trunk muscles, and repeated them two weeks later. Blood samples were taken before and for five days following each bout, and plasma ssTnI and fsTnl concentrations were measured by enzyme-linked immunosorbent assays. Their changes were compared between bouts and their relationships to plasma CK activity and myoglobin concentrations were analysed.

RESULTS

Plasma fsTnI concentration increased after the first bout and peaked at 4 days post-exercise (2152-40,295 ng/mL), but no significant increases were evident after the second bout. Plasma ssTnI concentration did not change significantly from the baseline (<0.08 ng/mL) after either bout. Peak plasma fsTnI concentration was significantly (p < 0.005) correlated with peak plasma CK activity (peak: 23,238-207,304 IU/L, r = 0.727) and myoglobin concentration (1047-3936 μg/L, r = 0.625) after the first bout.

CONCLUSIONS

These results suggest that plasma TnI concentrations are more specific biomarker of muscle damage than plasma CK activity and myoglobin concentration. It seems that the whole-body eccentric exercises induced damage preferentially to fast-twitch muscle fibres, and increases in plasma CK activity and myoglobin concentration after eccentric exercise may reflect fast-twitch muscle fibre damage.

Plasmapheresis Effect on Hematological and Biochemical Parameters in Athletic Horses Subjected to Exercise

To evaluate the effect of plasmapheresis on clinical, hematological, and biochemical parameters after exercise, a plasmapheresis session was realized on six jumping horses (plasmapheresis group) that underwent three consecutive days of physical graded exercise. The control group (n = 6) went through the same exercise but not subjected to the plasmapheresis session. Seventeen milliliters of plasma/kg of body weight was harvested from each horse. The procedure was well tolerated by the horses. The plasmapheresis leads to a significant increase of the hemoglobin, hematocrit, red blood cell, white blood cell, and lymphocytes counts. Plasmapheresis induced a very significant decrease (P < .001) of albumin and globulin levels and of total protein, which were reestablished 24 hours later. Plasmapheresis also generated a very significant increase (P < .001) in sodium levels and a significant decline of potassium (P < .05) and calcium (P < .01) levels. Several other biochemical variables remained unchanged. Results also showed that, after a significant rise of lactate, aspartate aminotransferase, and creatine kinase levels which are subsequent to the exercise, the plasmapheresis session induced a very significant continuous decrease (P < .001) of these parameters. The present work has demonstrated that the plasmapheresis is able to modify the physiology after exercise and to affect both the hematology and the biochemistry of the blood hematobiochemical parameters in horses subjected to physical exercise.

Comparison of Selected CD45+ Cell Subsets' Response and Cytokine Levels on Exhaustive Effort Among Soccer Players

Background

Immunological alterations may led to the reduction in capacity and endurance levels in elite athletes by e.g. increased susceptibility to infections. There is a need to explain the impact of intensive physical effort on the CD4⁺ memory T cell subsets.

Methods

Fourteen participants median aged 19 years old (range 17–21 years) were recruited form Pogoń Szczecin S.A., soccer club. They performed progressive efficiency test on mechanical treadmill until exhaustion twice: during preparatory phases to spring and autumn competition rounds. We examined the influence of exhaustive effort on the selected CD45⁺, especially CD4⁺ memory T cell subsets and inflammation markers determined before, just after the test and during recovery time.

Results

Significant changes in total CD45⁺ cells and decrease in T lymphocytes percentage after the run was observed. Significant fluctuations in T cells’ distribution were related not only to the changes in Th or Tc subsets but also to increase in naïve T cell percentage during recovery. Increase in TNF-α and IL-8 post-exercise, IL-6 and IL-10 plasma levels in recovery was also found.

Conclusions

The novel finding of our study is that the run performed on mechanical treadmill caused a significant release of CD4⁺ T naïve cells into circulation. Post-exercise increase in circulating NK cells is related with fast biological response to maximal effort. However, at the same time an alternative mechanism enhancing inflammation is involved.

Can Match-Mimicking Intermittent Practice Be Used as a Simulatory Training Mode of Competition Using Olympic Time Frame in Elite Taekwondo Athletes?

Aim: The physiological realities between Taekwondo (TKD) simulation kicking training and TKD competition according to the Olympic time frame remain unclear. The purpose of this study is to establish an Olympic match-simulated kicking model and compare its effects with real TKD competition on physiological challenges and hormonal responses during serial matches in elite athletes.

Method: Sixteen elite TKD athletes randomly were assigned into either a TKD match-simulated kicking group (TMSK; N = 8, age: 21.3 ± 0.2 years) or a simulated TKD competition group (STC; N = 8, age: 21.6 ± 0.5 years). Both groups performed either simulated kicking or TKD competitions in the same time-course order, and all physiological parameters and blood sampling time-points were identical between groups. The heart rate (HR) and rating of perceived exertion (RPE) were recorded during each match-simulated kicking and TKD competition session. Blood samples were obtained before competition (Pre-Comp.), after competition—in ths case meaning four consecutive matches (End-Comp.), and 24 h after the first match (Next day) for determination of biomarkers of muscle damage (myoglobin and CK), hematological profiles, and hormonal profiles (testosterone and cortisol).

Results: The responses of HR, RPE, and blood lactate levels during the consecutive testing sessions showed no differences between TMSK and STC. The changes in CK and myoglobin were greater in STC (p < 0.05), and a greater decrease in red blood cell (RBC) loss was observed in the STC group (p < 0.05). Compared with TMSK, the inflammatory state, reflected by the ratios of neutrophils-to-lymphocyte (NLR) and platelets-to-lymphocyte (PLR), was higher in STC (p < 0.05). Moreover, the catabolic state (cortisol/testosterone) was greater in STC than in TMSK (p < 0.05).

Conclusion: We demonstrated that, compared with TMSK, the STC produced greater muscle damage, inflammatory responses, and catabolic stress in the Olympic competition time frame in elite male TKD athletes. Although TMSK is capable of eliciting similar physiological challenges as TKD competition, the muscle damage and hormonal profiles provoked by TMSK were not comparable to TKD competition. Our findings provide science-based data and better understanding for coaches, athletes, and sports scientists to develop TKD-specific training programs for Olympic preparation.

Aqua Cycling Does Not Affect Recovery of Performance, Damage Markers, and Sensation of Pain

Wahl, P, Sanno, M, Ellenberg, K, Frick, H, Böhm, E, Haiduck, B, Goldmann, J-P, Achtzehn, S, Brüggemann, G-P, Mester, J, and Bloch, W. Aqua cycling does not affect recovery of performance, damage markers, and sensation of pain. J Strength Cond Res 31(1): 162-170, 2017-To examine the effects of aqua cycling (AC) vs. passive recovery (P) on performance, markers of muscle damage, delayed onset of muscle soreness (DOMS), and the persons perceived physical state (PEPS) after 300 countermovement jumps (CMJs). Twenty male participants completed 300 CMJs. Afterward, they were randomly assigned to either the P group or the AC group, the latter performing 30 minutes of AC. Before, directly after the 300 CMJs, after the recovery session, and up to 72 hours post, performance of leg extensor muscles, damage markers, the PEPS, and DOMS were measured. Jumping height during 300 CMJs significantly decreased in both groups (AC: 13.4% and P: 14.6%). Maximal isometric strength (AC: 21% and P: 22%) and dynamic fatigue test (AC: 35% and P: 39%) of leg extensor muscles showed significant decreases in both groups. Myoglobin, creatine kinase, and lactate dehydrogenase significantly increased over time in both groups. Each of the 4 dimensions of the PEPS and DOMS showed significant changes over time. However, no significant differences between both groups were found for any of the parameters. Coaches and athletes should be aware that vertical jumping-induced fatigue decreases the ability to generate maximal isometric and submaximal dynamic force for more than 3 days after training. A single 30-minute session of AC was not able to attenuate the effects on muscular performance, markers of muscle damage, DOMS, or the PEPS compared with passive rest.

Longer application of kinesio taping would be beneficial for exercise-induced muscle damage

Kinesio taping (KT) has been widely used to prevent muscle pain and to improve range of motion in clinical settings. However, no previous research has examined how long KT should be applied to muscle following damaging exercise. The aim of this study was to investigate the effect of the duration of KT application on markers of muscle damage following eccentric exercise. Thirty-two male subjects participated in the study and were randomly assigned to one of the following groups: control (CON), KT-post, KT-30 min, or KT-24 hr. Eccentric exercise consisted of 2 sets of 25 contractions of elbow flexors using the non-dominant arm. Maximal isometric strength, muscle soreness (SOR), range of motion, and creatine kinase activity were measured before, immediately after, and at 24, 48, 72, and 96 hr after exercise. The KT-24 hr group showed lesser muscle damage and a faster recovery time than the CON and KT-post groups. Both the KT-30 min and KT-24 hr groups showed lesser SOR than CON and KT-post groups. These findings suggested that prolonged application of KT had a positive effect on markers of muscle damage.

Pre-Exercise Infrared Low-Level Laser Therapy (810 nm) in Skeletal Muscle Performance and Postexercise Recovery in Humans, What Is the Optimal Dose? A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

AIM

This study aimed to evaluate the medium-term effects of low-level laser therapy (LLLT or photobiomodulation) in postexercise skeletal muscle recovery and performance enhancement and to identify the optimal dose of 810 nm LLLT.

MATERIALS AND METHODS

A randomized, double-blind, placebo-controlled trial was performed, with voluntary participation of 28 high-level soccer athletes. We analyzed maximum voluntary contraction (MVC), delayed onset muscle soreness (DOMS), creatine kinase (CK) activity, and interleukin-6 (IL-6) expression. The assessments were performed before exercise protocols, after 1 min, and 1, 24, 48, 72, and 96 h after the end of eccentric exercise protocol used to induce fatigue. LLLT was applied before eccentric exercise protocol with a cluster with five diodes, and dose of 10, 30, or 50 J (200 mW and 810 nm) in six sites of quadriceps.

RESULTS

LLLT increased (p < 0.05) MVC from immediately after exercise to 24 h with 50 J dose, and from 24 to 96 h with 10 J dose. Both 10 J then 50 J dose decreased (p < 0.05) CK and IL-6 with better results in favor of 50 J dose. However, LLLT had no effect in decreasing DOMS. No differences (p > 0.05) were found for 30 J dose in any of the outcomes measured.

CONCLUSIONS

Pre-exercise LLLT, mainly with 50 J dose, significantly increases performance and improves biochemical markers related to skeletal muscle damage and inflammation.

The relationship of creatine kinase variability with body composition and muscle damage markers following eccentric muscle contractions

[Purpose]

The purpose of the study was to investigate the relationship between CK variability and body composition and muscle damage markers following eccentric exercise.

[Methods]

Total 119 healthy male subjects were recruited to perform 50 eccentric contractions consisted of 2 sets of 25 contractions. Then, blood creatine kinase (CK) activity was analyzed to divide into three groups based on their CK activity levels. Maximum isometric strength (MIS), muscle soreness (SOR) and body composition data were obtained before and after exercise.

[Results]

The results showed that high CK responders had a significant decrease in MIS (p<0.001) and greater SOR (p<0.01) following eccentric exercise compared to low CK responders. Percent body fat was also higher in high responders compared to low responders (p=0.014). Peak CK activity was significantly correlated with MIS and SOR but no correlation with % body fat, muscle mass, and body mass index.

[Conclusion]

CK variability following eccentric exercise is closely related to MIS and SOR and % body fat may be a potent factor for CK variability.

Acute effects of static active or dynamic active stretching on eccentric-exercise-induced hamstring muscle damage

OBJECTIVES

To examine whether an acute bout of active or dynamic hamstring-stretching exercises would reduce the amount of muscle damage observed after a strenuous eccentric task and to determine whether the stretching protocols elicit similar responses.

DESIGN

A randomized controlled clinical trial.

METHODS

Thirty-six young male students performed 5 min of jogging as a warm-up and were allocated to 1 of 3 groups: 3 min of static active stretching (SAS), 3 min of dynamic active stretching (DAS), or control (CON). All subjects performed eccentric exercise immediately after stretching. Heart rate, core temperature, maximal voluntary isometric contraction, passive hip flexion, passive hamstring stiffness (PHS), plasma creatine kinase activity, and myoglobin were recorded at prestretching, at poststretching, and every day after the eccentric exercises for 5 d.

RESULTS

After stretching, the change in hip flexion was significantly higher in the SAS (5°) and DAS (10.8°) groups than in the CON (-4.1°) group. The change in PHS was significantly higher in the DAS (5.6%) group than in the CON (-5.7%) and SAS (-6.7%) groups. Furthermore, changes in muscle-damage markers were smaller in the SAS group than in the DAS and CON groups.

CONCLUSIONS

Prior active stretching could be useful for attenuating the symptoms of muscle damage after eccentric exercise. SAS is recommended over DAS as a stretching protocol in terms of strength, hamstring range of motion, and damage markers.

Effects of pre-irradiation of low-level laser therapy with different doses and wavelengths in skeletal muscle performance, fatigue, and skeletal muscle damage induced by tetanic contractions in rats

This study aimed to evaluate the effects of low-level laser therapy (LLLT) immediately before tetanic contractions in skeletal muscle fatigue development and possible tissue damage. Male Wistar rats were divided into two control groups and nine active LLLT groups receiving one of three different laser doses (1, 3, and 10 J) with three different wavelengths (660, 830, and 905 nm) before six tetanic contractions induced by electrical stimulation. Skeletal muscle fatigue development was defined by the percentage (%) of the initial force of each contraction and time until 50 % decay of initial force, while total work was calculated for all six contractions combined. Blood and muscle samples were taken immediately after the sixth contraction. Several LLLT doses showed some positive effects on peak force and time to decay for one or more contractions, but in terms of total work, only 3 J/660 nm and 1 J/905 nm wavelengths prevented significantly (p < 0.05) the development of skeletal muscle fatigue. All doses with wavelengths of 905 nm but only the dose of 1 J with 660 nm wavelength decreased creatine kinase (CK) activity (p < 0.05). Qualitative assessment of morphology revealed lesser tissue damage in most LLLT-treated groups, with doses of 1-3 J/660 nm and 1, 3, and 10 J/905 nm providing the best results. Optimal doses of LLLT significantly delayed the development skeletal muscle performance and protected skeletal muscle tissue against damage. Our findings also demonstrate that optimal doses are partly wavelength specific and, consequently, must be differentiated to obtain optimal effects on development of skeletal muscle fatigue and tissue preservation. Our findings also lead us to think that the combined use of wavelengths at the same time can represent a therapeutic advantage in clinical settings.

Effect of whole-body periodic acceleration on exercise-induced muscle damage after eccentric exercise

PURPOSE

To examine the effects of whole-body periodic acceleration (pGz) on exercise-induced-muscle-damage (EIMD) -related symptoms induced by unaccustomed eccentric arm exercise.

METHODS

Seventeen active young men (23.4 ± 4.6 y) made 6 visits to the research facility over a 2-wk period. On day 1, subjects performed a 1-repetition-maximum (1RM) elbow-flexion test and were randomly assigned to the pGz (n = 8) or control group (n = 9). Criterion measurements were taken on day 2, before and immediately after performance of the eccentric-exercise protocol (10 sets, 10 repetitions using 120% 1RM) and after the recovery period. During subsequent sessions (24, 48, 72, and 96 h) these data were collected before pGz or passive recovery. Measurements included isometric strength (maximal voluntary contraction [MVC]), blood markers (creatine kinase, myoglobin, IL-6, TNF-α, TBARS, PGF2α, protein carbonyls, uric acid, and nitrites), soreness, pain, circumference, and range of motion (ROM).

RESULTS

Significantly higher MVC values were seen for pGz throughout the recovery period. Within-group differences were seen in myoglobin, IL-6, IL-10, protein carbonyls, soreness, pain, circumference, and ROM showing small negative responses and rapid recovery for the pGz condition.

CONCLUSION

Our results demonstrate that pGz can be an effective tool for the reduction of EIMD and may contribute to the training-adaptation cycle by speeding up the recovery of the body due to its performance-loss-lessening effect.

Effects of estrogen fluctuation during the menstrual cycle on the response to stretch-shortening exercise in females

The aim of this study was to investigate whether variation in estrogen levels during the menstrual cycle influences susceptibility to exercise-induced muscle damage after stretch-shortening cycle exercise. Physically active women (n = 18; age = 20.2 ± 1.7 yr) participated in this research. The subjects performed one session of 100 maximal drop jumps on day 1 or 2 of the follicular phase and another identical session on day 1 or 2 of the ovulatory phase; the order of the sessions was randomized. Quadriceps femoris muscle peak torque evoked by electrical stimulation and maximal voluntary contraction, muscle pain, and CK activity were measured before and at various times up to 72 h after exercise. It was found that the high estrogen level during the ovulatory phase might be related to an earlier return to baseline muscle strength after strenuous stretch-shortening cycle exercise in that phase compared with the follicular phase. The estrogen effect appears to be highly specific to the damaged site because the differences in most EIMD markers (CK, soreness, and low-frequency fatigue) between the two menstrual cycle phases were small.

Cytokine and satellite cell responses to muscle damage: interpretation and possible confounding factors in human studies

It is plausible that multiple muscle biopsies following a muscle damaging intervention can exacerbate the inflammatory and subsequent satellite cell responses. To elucidate confounding effects of muscle biopsy procedure on satellite cell number, indirect markers of damage and the inflammatory response following acute downhill running (DHR) were investigated. 10 healthy male participant were divided into a non-exercising control (n = 4) and DHR (12 × 5min bouts, 10 % decline at 85 % VO(2)max) (n = 6) group. Blood samples were taken pre, post and every 24 h for 9 days. Serum was analysed for creatine kinase (CK), myoglobin (Mb), lactate dehydrogenase (LDH), TNF-α, IL-6 and IL-10. Muscle biopsies taken on days 1 and 2 post intervention from opposing legs were analysed for Pax7(+) satellite cells. In the DHR group, Mb (536 ± 277 ng mL(-1)), IL-6 (12.6 ± 4.7 pg mL(-1)) and IL-10 (27.3 ± 11.5 pg mL(-1)) peaked immediately post DHR, while CK (2651 ± 1911 U L(-1)), LDH (202 ± 47 U L(-1)) and TNF-α (25.1 ± 8.7 pg mL(-1)) peaked on day 1. A 30 % increase in Pax7(+) satellite cells on day 1 in the DHR group was no longer apparent on day 2. H&E staining show evidence of phagocytosis in the DHR group. No significant changes over time were observed in the control group for any of the variables measured. Events observed in the DHR group were as a result of the intervention protocol and subsequent muscle damage. The relationship between SC proliferation and pro-inflammatory cytokine release appears to be complex since the IL-6/IL-10 response time differs significantly from the TNF-α response.

Creatine-kinase- and exercise-related muscle damage implications for muscle performance and recovery

The appearance of creatine kinase (CK) in blood has been generally considered to be an indirect marker of muscle damage, particularly for diagnosis of medical conditions such as myocardial infarction, muscular dystrophy, and cerebral diseases. However, there is controversy in the literature concerning its validity in reflecting muscle damage as a consequence of level and intensity of physical exercise. Nonmodifiable factors, for example, ethnicity, age, and gender, can also affect enzyme tissue activity and subsequent CK serum levels. The extent of effect suggests that acceptable upper limits of normal CK levels may need to be reset to recognise the impact of these factors. There is a need for standardisation of protocols and stronger guidelines which would facilitate greater scientific integrity. The purpose of this paper is to examine current evidence and opinion relating to the release of CK from skeletal muscle in response to physical activity and examine if elevated concentrations are a health concern.

Seven weeks of instability and traditional resistance training effects on strength, balance and functional performance

The objective of the study was to compare the effect of a 7-week unstable and stable resistance training program on measures of strength, balance, and functional performance. Forty participants were divided into unstable or stable resistance training groups. Training was conducted twice a week for 7 weeks. Pre- and post-testing measures included leg extension strength, static and dynamic balance, sit-ups, long jump, hopping test for time, shuttle run, and sprint. Results showed that there was no overall difference between unstable and stable resistance training and the training effects were independent of gender. All measures except sprint time improved with training. Interaction effects demonstrated that unstable resistance training did provide an advantage for number of sit-ups performed (p = 0.03; 8.9%) and the right leg hopping test (6.2%; p = 0.0001). This study has demonstrated that instability resistance training may be considered as effective as traditional stable resistance training for inexperienced resistance trainers. Based on the present study and the literature, instability resistance training should be incorporated in conjunction with traditional stable training to provide a greater variety of training experiences without sacrificing training benefits.

Minimally invasive total hip arthroplasty: a randomized controlled prospective trial

INTRODUCTION

Advantages of minimally invasive total hip arthroplasty (THA) are controversially discussed.

METHOD

In this prospective study 51 patients (52 hips) were randomly allocated to a classical lateral or a minimally invasive approach (modification of the Hardinge-approach). Operating time, intraoperative blood loss, postoperative hemoglobin, muscle enzymes CK and myoglobin were recorded. Radiologically the positioning of the prosthesis was analyzed. WOMAC- and Harris Hip Score (HHS) were assessed preoperatively, at discharge, at 6 weeks and 3 months.

RESULTS

In the minimally invasive group there was a shorter length of surgery, the scores in the WOMAC and HHS were slightly better at discharge and at the 3 months- examination, myoglobin-rise was slightly less. The positioning of the prosthesis was good in both groups. Minimally invasive THA led to a quicker recovery, at 3 months postoperative there was still a slight difference to the standard group.

CONCLUSION

If these slight differences subside has to be examined in studies with a longer follow-up.

Effect of resistive exercise on muscle damage in water and on land

The purpose of this study was to compare the effects of resistance exercise in water and on land on blood levels of creatine kinase (CK), a known indirect marker of muscle damage. Nine men (age: 23 +/- 1.58 years; weight: 79.37 +/- 11.15 kg; height: 176.33 +/- 4.09 cm), who had not practiced resistance training for at least 6 months before this experiment, performed 3 sets of maximum elbow flexion and extension exercises in water and on land, separated by 2-minute periods of rest. A 10-repetition maximum test was used to load control on land with free weights, and in water the exercise was performed at maximum velocity with aquatic resistance equipment. The duration of the exercise in water was the same as that performed on land, to reproduce the same metabolic route. Plasma CK activity was determined using a commercially available kit (Labtest Enzymatic-UV) before exercise, after exercise, and at 24 and 48 hours after exercise. Significant increases in CK were found at 48 hours postexercise on land (preexercise land: 160.75 +/- 96.05 UxL; 48 hours: 326.87 +/- 240.84 UxL), and significant differences were found between land and water (preexercise water: 147.75 +/- 46.48 UxL; 48 hours: 121.75 +/- 30.86 UxL) for this measure. However, no significant differences were found in water. In conclusion, the water environment influenced the absence of significant muscle damage. This type of exercise protocol may be appropriate for situations in which limited muscle tissue damage is desired.

Isokinetic eccentric exercise of quadriceps femoris does not affect running economy

The purpose of this study was to investigate whether running economy is affected by isokinetic eccentric exercise designed to cause muscle damage. Twenty-four young healthy men performed 120 maximal voluntary eccentric actions at each thigh's quadriceps muscle at an angular velocity of 60 degrees .s. The participants were then randomly divided into 2 equal groups, 1 of which exercised 24 hours later, while the other group rested. Muscle damage indicators (i.e., serum creatine kinase, delayed onset muscle soreness, and eccentric, concentric, and isometric peak torque) and running economy indicators (i.e., oxygen consumption, pulmonary ventilation, respiratory exchange ratio, respiratory rate, and heart rate during treadmill running at 2.2 and 3.3 m.s) were assessed prior to and 48 hours following the eccentric exercise. All muscle damage indicators changed significantly in both groups (p < 0.05) in a way suggestive of considerable muscle damage. Running economy indicators of the exercise group demonstrated only an elevation of respiratory rate at 48 hours (p < 0.05) and a tendency to lower economy compared to the resting group. It can be concluded that isokinetic eccentric exercise applied to the quadriceps femoris muscles did not affect running economy 48 hours later and that resting during this period tended to result in more economical running compared to exercising at 24 hours.

Fabp3 as a biomarker of skeletal muscle toxicity in the rat: comparison with conventional biomarkers

Fatty acid binding protein 3 (Fabp3) has been used as a serological biomarker of cardiac injury, but its utility as a preclinical biomarker of injury to skeletal muscle is not well described. Fabp3 concentrations were determined for tissues from Sprague-Dawley rats and found to occur at highest concentrations in cardiac muscle and in skeletal muscles containing an abundance of type I fibers, such as the soleus muscle. Soleus is also a primary site of skeletal muscle (SKM) injury caused by lipid-lowering peroxisome proliferator-activated receptor alpha (PPAR-alpha) agonists. In rats administered repeat doses of a PPAR-alpha agonist, the kinetics and amplitude of plasma concentrations of Fabp3 were consistent with plasma compound concentrations and histopathology findings of swollen, hyalinized, and fragmented muscle fibers with macrophage infiltration. Immunohistochemical detection of Fabp3 revealed focal depletion of Fabp3 protein from injured SKM fibers which is consistent with increased serum Fabp3 concentrations in treated rats. We then assessed the predictivity of serological Fabp3 for SKM necrosis in short duration toxicology studies. Rats were treated with various doses of 27 different compounds, and the predictivity of serological biomarkers was assessed relative to histology in individual rats and in treatment groups. Under these study conditions, Fabp3 was the most useful individual biomarker based on concordance, sensitivity, positive and negative predictive values, and false negative rate. In addition, the combination of Fabp3 and aspartate aminotransferase (AST) had greater diagnostic value than the conventional combination of creatine kinase-MM isoenzyme (CK) and AST.

Eccentric training impairs NF-kappaB activation and over-expression of inflammation-related genes induced by acute eccentric exercise in the elderly

The present study was aimed to investigate in elderly humans changes in NF-kappaB activation and in the expression of the inflammation-related genes inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and interleukin-6 (IL-6) induced in peripheral blood mononuclear cells (PBMC) by acute eccentric exercise and by submaximal eccentric training. Eleven subjects, aged 66-75 years, carried out 2 bouts of eccentric exercise separated by 8 weeks of training. Following the first bout, NF-kappaB activation, and protein level of p50/p65 subunits, phospho-IkappaBalpha and phospho-IKKalpha increased, while IkappaBalpha protein level was significantly reduced. This was accompanied by a significant increase in iNOS, COX-2 and IL-6 mRNA protein level and protein content. Changes were significantly attenuated following the second exercise bout. In conclusion, acute eccentric exercise increases NF-kappaB activation and the expression of several inflammation-related genes in PBMC from elderly individuals. Regular eccentric training might be an effective method of preventing undesirable inflammatory responses induced by eccentric exercise.

The upper values of plasma creatine kinase of professional soccer players during the Brazilian National Championship

The current schedule of the Brazilian Soccer Championship may not give players enough recovery time between games. This could increase the chances of muscle damage and impaired performance. We hypothesized that plasma creatine kinase (CK) activity could be a reliable indirect marker of muscle overload in soccer players, so we sought to identify the reference values for upper limits of CK activity during a real-life elite competition. This study analyzed changes in plasma CK activity in 128 professional soccer players at different times during the Brazilian Championship. The upper limits of the 97.5th and 90th percentiles determined for CK activity were 1.338U/L and 975U/L, respectively, markedly higher than values previously reported in the literature. We also evaluated a team monthly throughout the Championship. The upper limit of the 90th percentile, 975U/L, was taken as the decision limit. Six players showing plasma CK values higher than this were asked to decrease their training for 1 week. These players presented lower CK values afterwards. Only one player with a CK value higher than the decision limit (1800U/L 1 day before a game) played on the field and was unfortunately injured during the game. The CK activity in all the other players showed a significant decrease over the course of the Championship, and the values became more homogeneous at the end. The results presented here suggest that plasma CK upper limit values can be used as a practical alternative for early detection of muscle overload in competing soccer players.

Effect of carbohydrate-protein supplement timing on acute exercise-induced muscle damage

PURPOSE

To determine if timing of a supplement would have an effect on muscle damage, function and soreness.

METHODS

Twenty-seven untrained men (21 +/- 3 yrs) were given a supplement before or after exercise. Subjects were randomly assigned to a pre exercise (n = 9), received carbohydrate/protein drink before exercise and placebo after, a post exercise (n = 9), received placebo before exercise and carbohydrate/protein drink after, or a control group (n = 9), received placebo before and after exercise. Subjects performed 50 eccentric quadriceps contractions on an isokinetic dynamometer. Tests for creatine kinase (CK), maximal voluntary contraction (MVC) and muscle soreness were recorded before exercise and at six, 24, 48, 72, and 96 h post exercise. Repeated measures ANOVA were used to analyze data.

RESULTS

There were no group by time interactions however, CK significantly increased for all groups when compared to pre exercise (101 +/- 43 U/L) reaching a peak at 48 h (661 +/- 1178 U/L). MVC was significantly reduced at 24 h by 31.4 +/- 14.0%. Muscle soreness was also significantly increased from pre exercise peaking at 48 h.

CONCLUSION

Eccentric exercise caused significant muscle damage, loss of strength, and soreness; however timing of ingestion of carbohydrate/protein supplement had no effect.

Localization and quantification of muscle damage by magnetic resonance imaging following step exercise in young women

Eccentric exercise affects muscles differentially according to intensity, duration, and previous exposure to the specific exercise activity. We used T2-weighted magnetic resonance imaging sequences to localize and quantify muscle damage following step exercise and to determine correlations between transverse relaxation time (T2) and other markers of muscle damage. Eight women performed two-step exercise bouts (30 min) separated by 8 weeks. Blood samples, MR scans, measurements of muscle strength, and muscle soreness were obtained immediately before, after, and up to 9 days after each bout. Resting muscle T2 (40.3+/-0.6 ms) increased exclusively in m. Adductor magnus (AM) in the thigh performing eccentric contractions and peaked 3 days after bout 1 (73.5+/-9.7 ms, P<0.05). Plasma creatine kinase (CK) activity peaked on day 3 after bout 1 and correlated with T2 in AM (r=0.96, P<0.001). After bout 2 CK and T2 were almost unaffected. This indicates that T2-weighted MRI can be applied to identify muscles from which enzymes are being released into the circulation.

Exertional Rhabdomyolysis during a 246-km Continuous Running Race

BACKGROUND

To evaluate the effect of continuous, moderate-intensity ultra-endurance running exercise on skeletal muscle and hepatic damage, as indicated by serum enzyme activity measured immediately following the race.

METHODS

Thirty-nine runners of the Spartathlon race (a 246-km continuous race from Athens to Sparta, Greece) who managed to complete the race within the 36-h limit participated in this study. Mean finishing time of the study participants was 33.3+/-0.5 h and their average age, height, and body mass were 41+/-1 yr, 174+/-1 cm, and 67.5+/-1.1 kg, respectively. Blood samples, taken a day before and immediately after completion of the race, were assayed for the following variables: creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (gamma-GT).

RESULTS

A dramatic increase in most of muscle and liver damage indicators was observed. The mean values for CK, LDH, AST, and ALT after the race were 43,763+/-6,764, 2,300+/-285, 1,182+/-165, and 264+/-37 IU.L, respectively. These values were 29,384+/-4,327, 585+/-89, 5,615+/-902, and 1,606+/-331% higher than the corresponding values before the race (P<0.001) for CK, LDH, AST, and ALT, respectively. However, there was not a significant increase in gamma-GT levels.

CONCLUSION

Muscle and liver damage indicators were elevated at the highest level ever reported as a result of prolonged exercise, although no severe symptoms that required hospitalization were observed in any of the participants. The data suggest that even moderate-intensity exercise of prolonged duration can induce asymptomatic exertional rhabdomyolysis.

CK-MM autoantibodies: Prevalence, immune complexes, and effect on CK clearance

Although the blood level of creatine kinase (CK) is the most commonly used marker of muscle injury, there is marked interindividual variability in this measure. Part of this variability may be attributed to variability in the rate of CK clearance from the circulation. In this study, we assessed the possibility that CK-MM autoantibodies form immune complexes with CK following muscle injury and subsequently affect the CK clearance rate. Using an enzyme-linked immunosorbent assay, CK-MM autoantibodies were detected in all 25 human subjects studied but the levels varied greatly. Using protein A-sepharose, the percentage of the plasma CK activity found in immune complexes was determined to be correlated with the CK-MM autoantibody level at lower CK levels (<1,022 U/L). When CK-MM antibodies were administered to mice, plasma CK activity following a bolus CK injection was reduced by 11%-32%. We conclude that CK-MM autoantibodies can modulate the rate of CK clearance from the circulation. Thus, the relatively low blood CK levels seen in some individuals following injury may be attributed partly or entirely to an autoantibody-enhanced clearance of CK.