Prevention of downhill walking-induced muscle damage by non-damaging downhill walking

The acute and repeated bout effects of multi-joint eccentric exercise on physical function and balance in older adults

PURPOSE

Eccentric muscle actions generate high levels of force at a low metabolic cost, making them a suitable training modality to combat age-related neuromuscular decline. The temporary muscle soreness associated with high intensity eccentric contractions may explain their limited use in clinical exercise prescription, however any discomfort is often alleviated after the initial bout (repeated bout effect). Therefore, the aims of the present study were to examine the acute and repeated bout effects of eccentric contractions on neuromuscular factors associated with the risk of falling in older adults.

METHODS

Balance, functional ability [timed up-and-go and sit-to-stand], and lower-limb maximal and explosive strength were measured in 13 participants (67.6 ± 4.9 year) pre- and post-eccentric exercise (0, 24, 48, and 72 hr) in Bout 1 and 14 days later in Bout 2. The eccentric exercise intervention was performed on an isokinetic unilateral stepper ergometer at 50% of maximal eccentric strength at 18 step‧min-1 per limb for 7 min (126 steps per limb). Two-way repeated measures ANOVAs were conducted to identify any significant effects (P ≤ 0.05).

RESULTS

Eccentric strength significantly decreased (- 13%) in Bout 1 at 24 hr post-exercise; no significant reduction was observed at any other time-point after Bout 1. No significant reductions occurred in static balance or functional ability at any time-point in either bout.

CONCLUSION

Submaximal multi-joint eccentric exercise results in minimal disruption to neuromuscular function associated with falls in older adults after the initial bout.

The Effects of Pre-conditioning on Exercise-Induced Muscle Damage: A Systematic Review and Meta-analysis

BACKGROUND

Several studies have utilised isometric, eccentric and downhill walking pre-conditioning as a strategy for alleviating the signs and symptoms of exercise-induced muscle damage (EIMD) following a bout of damaging physical activity.

OBJECTIVES

This systematic review and meta-analysis examined the effects of pre-conditioning strategies on indices of muscle damage and physical performance measures following a second bout of strenuous physical activity.

DATA SOURCES

PubMed, CINAHL and Scopus.

ELIGIBILITY CRITERIA

Studies meeting the PICO (population, intervention/exposure, comparison, and outcome) criteria were included in this review: (1) general population or "untrained" participants with no contraindications affecting physical performance; (2) studies with a parallel design to examine the prevention and severity of muscle-damaging contractions; (3) outcome measures were compared using baseline and post-intervention measures; and (4) outcome measures included any markers of indirect muscle damage and muscular contractility measures.

PARTICIPANTS

Individuals with no resistance training experiences in the previous 6 or more months.

INTERVENTIONS

A single bout of pre-conditioning exercises consisting of eccentric or isometric contractions performed a minimum of 24 h prior to a bout of damaging physical activity were compared to control interventions that did not perform pre-conditioning prior to damaging physical activity.

STUDY APPRAISAL

Kmet appraisal system.

SYNTHESIS METHODS

Quantitative analysis was conducted using forest plots to examine standardised mean differences (SMD, i.e. effect size), test statistics for statistical significance (i.e. Z-values) and between-study heterogeneity by inspecting I2.

RESULTS

Following abstract and full-text screening, 23 articles were included in this paper. Based on the meta-analysis, the pre-conditioning group exhibited lower levels of creatine kinase at 24 h (SMD =  - 1.64; Z = 8.39; p = 0.00001), 48 h (SMD =  - 2.65; Z = 7.78; p = 0.00001), 72 h (SMD =  - 2.39; Z = 5.71; p = 0.00001) and 96 h post-exercise (SMD =  - 3.52; Z = 7.39; p = 0.00001) than the control group. Delayed-onset muscle soreness was also lower for the pre-conditioning group at 24 h (SMD =  - 1.89; Z = 6.17; p = 0.00001), 48 h (SMD =  - 2.50; Z = 7.99; p = 0.00001), 72 h (SMD =  - 2.73; Z = 7.86; p = 0.00001) and 96 h post-exercise (SMD =  - 3.30; Z = 8.47; p = 0.00001). Maximal voluntary contraction force was maintained and returned to normal sooner in the pre-conditioning group than in the control group, 24 h (SMD = 1.46; Z = 5.49; p = 0.00001), 48 h (SMD = 1.59; Z = 6.04; p = 0.00001), 72 h (SMD = 2.02; Z = 6.09; p = 0.00001) and 96 h post-exercise (SMD = 2.16; Z = 5.69; p = 0.00001). Range of motion was better maintained by the pre-conditioning group compared with the control group at 24 h (SMD = 1.48; Z = 4.30; p = 0.00001), 48 h (SMD = 2.20; Z = 5.64; p = 0.00001), 72 h (SMD = 2.66; Z = 5.42; p = 0.00001) and 96 h post-exercise (SMD = 2.5; Z = 5.46; p = 0.00001). Based on qualitative analyses, pre-conditioning activities were more effective when performed at 2-4 days before the muscle-damaging protocol compared with immediately prior to the muscle-damaging protocol, or 1-3 weeks prior to the muscle-damaging protocol. Furthermore, pre-conditioning activities performed using eccentric contractions over isometric contractions, with higher volumes, greater intensity and more lengthened muscle contractions provided greater protection from EIMD.

LIMITATIONS

Several outcome measures showed high inter-study heterogeneity. The inability to account for differences in durations between pre-conditioning and the second bout of damaging physical activity was also limiting.

CONCLUSIONS

Pre-conditioning significantly reduced the severity of creatine kinase release, delayed-onset muscle soreness, loss of maximal voluntary contraction force and the range of motion decrease. Pre-conditioning may prevent severe EIMD and accelerate recovery of muscle force generation capacity.

Different Influencing Factors for Risk of Falls Between Men and Women while Descending from Mount Fuji

INTRODUCTION

Annually, approximately 250,000 people climb Mount Fuji in Japan. Nonetheless, only few studies have examined the prevalence of falls and related factors on Mount Fuji.

METHODS

We conducted a questionnaire survey of 1061 participants (703 men and 358 women) who had climbed Mount Fuji. The following information was collected: age, height, body weight, luggage weight, experience on Mount Fuji, experience on other mountains, presence or absence of a tour guide, single-day climber or overnight-stay lodger, information on the downhill trail (volcanic gravel, long distance, and the risk of falls), presence or absence of trekking poles, shoe type, shoe sole condition, and fatigue feeling.

RESULTS

The fall rate in women (174/358; 49%) was greater than that in men (246/703; 35%). A prediction model using multiple logistic regression (no fall, 0; fall, 1) indicated that the following factors decreased the risk of falls: male sex, younger age, previous experience on Mount Fuji, having information about long-distance downhill trails, wearing hiking shoes or mountaineering boots rather than other types of shoes (eg, running shoes, sneakers) or worn-out shoes, and not feeling fatigued. Additionally, the following factors may decrease the risk of falls in women only: experience hiking on any other mountains, not being part of a guided tour, and using trekking poles.

CONCLUSIONS

Women had a higher risk of falls on Mount Fuji than men. Specifically, having less experience on any other mountains, being part of a guided tour, and nonuse of trekking poles may relate to higher risks of falls in women. These results suggest that different precautionary measures for men and women are useful.

Division of loading time in reloading the disused atrophic soleus muscle induces proximal muscle injury

[Purpose] This study aimed to compare the effects of loading time division in reloading atrophied muscles in different muscle long-axis regions. [Materials and Methods] We divided 8-week-old male Wistar rats into control (CON), 14-day hindlimb suspension (HS), 7-day hindlimb suspension followed by 60-min reloading for 7 consecutive days (WO), and 7-day hindlimb suspension followed by 60-min reloading on two separate occasions for 7 days (WT) groups. After the experimental period, muscle fibre cross-sectional area and necrotic fibre/central nuclei fibre ratio were measured in the soleus muscle's proximal, middle, and distal regions. [Results] The necrotic fibre/central nuclei fibre ratio was higher in the WT group than in the other groups in the proximal region. Proximal muscle fibre cross-sectional area was higher in the CON group than in the other groups. In the middle region, only HS group had muscle fibre cross-sectional area lower than the CON group. Similarly, muscle fibre cross-sectional area of the HS group was lower than the CON and WT groups in the distal region. [Conclusion] When reloading atrophied muscles, dividing the loading time can inhibit atrophy in the distal region but induce muscle injury in the proximal region.

Protective effect by low-intensity downhill running training against muscle damage and oxidative stress after high-intensity downhill running in rats

This study examined the effects of low-intensity eccentric exercise training performed before high-intensity eccentric exercise on muscle damage markers, oxidative stress and antioxidant defense. Twenty-two rats were divided into 3 groups; control (CON; n = 6), high-intensity eccentric exercise (HE; n = 8) and low-intensity eccentric exercise training plus high-intensity eccentric exercise (LET + HE; n = 8). Rats in the HE group performed HE at once. Rats in the LET + HE group performed LET and then HE protocol was applied. Blood and vastus intermedius muscle samples were taken 24 hours after the last exercise session for analyses of muscle damage, oxidative stress, and antioxidant defense markers. Muscle damage markers were higher in the HE group than the CON (137%-488%) and the LET + HE groups (82%-110%) (P < 0.05). Oxidative stress marker was higher in the HE group than the CON (65%) and the LET + HE (50%) groups (P < 0.05). Antioxidant defense markers were higher in the LTE + HE group than the HE group (39%-51%) (P < 0.05). In conclusion, low-intensity eccentric exercise training performed before high-intensity eccentric exercise conferred a protective effect against muscle damage by reducing oxidative stress and increasing antioxidant defense.

Effect of Application of Repeated Downhill Walking Bouts on Ankle Isokinetic Parameters in Children with Obesity

BACKGROUND

Obesity among children became of high concern. Obesity can affect many health aspects including muscular strength. Downhill walking is a useful intervention to enhance muscular strength, especially in older adults.

OBJECTIVE

The current study's purpose was to investigate the effect of repeated bouts of downhill walking on ankle isokinetic parameters in children with obesity.

METHODS

32 obese male children aged from 8 to 12 years engaged in the study. The children were divided into two groups: the level walking group (LWG) (n = 16) and the downhill walking group (DWG) (n = 16). Participants in both groups walked 20 minutes on the treadmill, two sessions per week for 6 weeks, with a speed of 5 km/h, and the treadmill slope used for the DWG was set at -20%. Isokinetic dynamometry (Cybex 6000) was used to analyze the normalized eccentric and concentric torque of both ankle dorsiflexors and plantar flexors of the dominant leg in all participants.

RESULTS

The normalized peak torques for eccentric plantar flexion, concentric plantar flexion, eccentric dorsiflexion, and concentric dorsiflexion significantly increased by 38.66%, 23.87%, 38.58%, and 15.51%, respectively, after repeated bouts of downhill walking. Level walking resulted in nonsignificant improvement in the muscular torques.

CONCLUSION

Downhill walking is a beneficial intervention in improving ankle muscular torques of obese children.

Knee biomechanics of patients with total knee replacement during downhill walking on different slopes

PURPOSE

The purpose of this study was to compare knee biomechanics of the replaced limb to the non-replaced limb of total knee replacement (TKR) patients and healthy controls during walking on level ground and on decline surfaces of 5°, 10°, and 15°.

METHODS

Twenty-five TKR patients and 10 healthy controls performed 5 walking trials on different decline slopes on a force platform and an instrumented ramp system. Two analyses of variance, 2 × 2 (limb × group) and 2 × 4 (limb × decline slope), were used to examine selected biomechanics variables.

RESULTS

The replaced limb of TKR patients had lower peak loading-response and push-off knee extension moment than the non-replaced and the matched limb of healthy controls. No differences were found in loading-response and push-off knee internal abduction moments among replaced, non-replaced, and matched limb of healthy controls. The knee flexion range of motion, peak loading-response vertical ground reaction force, and peak knee extension moment increased across all slope comparisons between 0° and 15° in both the replaced and non-replaced limb of TKR patients.

CONCLUSION

Downhill walking may not be appropriate to include in early stage rehabilitation exercise protocols for TKR patients.

Downhill hiking improves low-grade inflammation, triglycerides, body weight and glucose tolerance

Exercise is a well-established tool for cardiovascular risk reduction. Particularly eccentric exercise, which essentially means walking downwards could favour more people becoming physically active. With the present controlled study, we tested the hypothesis that eccentric exercise can improve insulin sensitivity, triglyceride handling, body mass index, glucose tolerance and inflammation. We allocated 127 healthy sedentary individuals to one of two groups: (i) an active group of 102 individuals walking downwards a predefined route three to five times per week over two months, covering a difference in altitude of 540 m; for the upward route a cable car was used, for which adherence was recorded electronically and (ii) a matched control group of 25 individuals who stayed sedentary. Fasting and postprandial metabolic profiles were obtained at baseline and after two months. Compared to baseline, eccentric exercise significantly improved HOMA insulin resistance (1.94 ± 1.65 vs. 1.71 ± 1.36 (µU⁻¹ ml) × ((mmol/l)⁻¹22.5); p = 0.038) and resulted in a decrease in fasting glucose (97 ± 15 vs. 94 ± 9 mg dl⁻¹; p = 0.025) and glucose tolerance (238 ± 50 vs. 217 ± 47 mg dl⁻¹ h⁻¹; p < 0.001), whereas these parameters did not change significantly in the control group. Eccentric exercise significantly improved triglyceride tolerance (1923 ± 1295 vs. 1670 ± 1085 mg dl⁻¹ h⁻¹; p = 0.003), whereas triglyceride tolerance remained unchanged in the control group (p = 0.819). Furthermore, body mass index (27.7 ± 4.3 vs. 27.4 ± 4.3 kg m⁻²; p = 0.003) and C-reactive protein (0.27 ± 0.42 vs. 0.23 ± 0.25 mg dl⁻¹; p = 0.031) were significantly lowered in the eccentric exercise group but not in the control group. Downhill walking, a type of exercise is a promising unusual exercise modality with favorable effects on body mass index, insulin action, on postprandial glucose and triglyceride handling and on C-reactive protein.

ClinicalTrials.gov Identifier: NCT00386854.

Delayed Impairment of Postural, Physical, and Muscular Functions Following Downhill Compared to Level Walking in Older People

Transient symptoms of muscle damage emanating from unaccustomed eccentric exercise can adversely affect muscle function and potentially increase the risk of falling for several days. Therefore, the aims of the present study were to investigate the shorter- and longer-lasting temporal characteristics of muscle fatigue and damage induced by level (i.e., concentrically biased contractions) or downhill (i.e., eccentrically biased contractions) walking on postural, physical, and muscular functions in older people. Nineteen participants were matched in pairs for sex, age and self-selected walking speed and allocated to a level (n = 10, age = 72.3 ± 2.9 years) or downhill (n = 9, age = 72.1 ± 2.2 years) walking group. Postural sway, muscle torque and power, physical function (5× and 60 s sit-to-stand; STS), and mobility (Timed-Up-and-Go; TUG) were evaluated at baseline (pre-exercise), 1 min, 15 min, 30 min, 24 h, and 48 h after 30 min of level (0% gradient) or downhill (−10% gradient) walking on a treadmill. Following downhill walking, postural sway (+66 to 256%), TUG (+29%), 60 s STS (+29%), five times STS (−25%) and concentric power (−33%) did not change at 1–30 min post exercise, but were significantly different (p < 0.05) at 24 and48 h post-exercise when compared to baseline (p < 0.05). Muscle torque decreased immediately after downhill walking and remained impaired at 48 h post-exercise (−27 to −38%). Immediately following level walking there was an increase in postural sway (+52 to +98%), slower TUG performance (+29%), fewer STS cycles in 60 s (−23%), slower time to reach five STS cycles (+20%) and impaired muscle torque (−23%) and power (−19%) which returned to baseline 30-min after exercise cessation (p > 0.05). These findings have established for the first time distinct impairment profiles between concentric and eccentric exercise. Muscle damage emanating from eccentrically biased exercise can lead to muscle weakness, postural instability and impaired physical function persisting for several days, possibly endangering older adult’s safety during activities of daily living by increasing the risk of falls.

The effectiveness of low intensity exercise and blood flow restriction without exercise on exercise induced muscle damage: A systematic review

OBJECTIVE

To investigate the evidence and provide clinical recommendations for low intensity exercises(LIE) and blood flow restriction(BFR) without exercise on reducing the effects of exercise induced muscle damage(EIMD).

METHOD

PubMed, Embase, Web of science, and PEDro(Physiotherapy Evidence Database) were searched up to December 2019 for studies that included LIE or BFR without exercise and their effect on EIMD.

RESULTS

Out of 3192 studies, 23 were included with 17 on LIE and 6 on BFR without exercise. 11 studies demonstrated positive effects for LIE on EIMD, with two level 2 and nine level 3 studies. Two level 2 and two level 3 studies found benefits for BFR without exercise on reducing the negative effects of EIMD, while two level 2 studies found did not find benefits for BFR without exercise.

CONCLUSION

Moderate to low levels of evidence supported LIE, particularly in the form of protective low load eccentric exercise, in reducing the negative effects of EIMD. Conflicting moderate to low levels of evidence was found regarding BFR without exercise. There does seem to be potential benefit for BFR without exercise in untrained individuals. Clinicians can provide clinical recommendations as LIE and BFR without exercise reducing EIMD.

Relationships between resting blood flow and the indices of muscle damage after eccentric contractions

PURPOSE

The aim of the study is to examine the relationships between increments in resting blood flow and isometric maximal voluntary contraction (MVC) force reduction, muscle soreness, and swelling after eccentric contractions (ECs).

METHODS

Twenty-one young healthy men (age 20.8 ± 1.6 years; height 172.0 ± 5.3 cm; weight 64.9 ± 7.7 kg) were recruited for this study. All participants performed right arm ECs in five sets of 20 repetitions with 3 min of rest between the sets. The dumbbell weight corresponded to 60% MVC force of isometric contraction of elbow flexors with 90° elbow joint angle. Resting forearm blood flow (FBF), the MVC force, the muscle thickness (MT), and muscle soreness of elbow flexors, heart rate (HR), and blood pressure (BP) of brachial artery were measured before, 24 and 48 h after ECs.

RESULTS

Average and peak resting FBF after ECs significantly changed from the average values before ECs (21% and 39% increase, respectively, P < 0.01). However, resting HR and BP were not significantly different after ECs. Average increase in resting FBF showed a significant relationship with average isometric MVC force reduction (r =  - 0.45, P < 0.05), peak isometric MVC force reduction (r =  - 0.48, P < 0.05), average muscle soreness (r = 0.49, P < 0.05), and peak muscle soreness (r = 0.49, P < 0.05). Moreover, stepwise multiple regression analysis revealed that average increased resting FBF was explained by isometric MVC force reduction and muscle soreness (adjusted R² = 0.33).

CONCLUSIONS

These results suggested that increments in resting blood flow reflect muscle damage, and increased resting blood flow may be a result of acute inflammatory response induced by muscle damage.

The Impact of Protein Supplementation on Exercise-Induced Muscle Damage, Soreness and Fatigue Following Prolonged Walking Exercise in Vital Older Adults: A Randomized Double-Blind Placebo-Controlled Trial

Background: It is unknown whether protein supplementation can enhance recovery of exercise-induced muscle damage in older adults who have a disturbed muscle protein synthetic response. We assessed whether protein supplementation could attenuate exercise-induced muscle damage and soreness after prolonged moderate-intensity walking exercise in older adults. Methods: In a double-blind, placebo-controlled intervention study, 104 subjects (81% male, ≥65 years) used either a protein (n = 50) or placebo supplement (n = 54) during breakfast and directly after exercise. Within a walking event, study subjects walked 30/40/50 km per day on three consecutive days. Muscle soreness and fatigue were determined with a numeric rating scale, and creatine kinase (CK) concentrations and serum inflammation markers were obtained. Results: Habitual protein intake was comparable between the protein (0.92 ± 0.27 g/kg/d) and placebo group (0.97 ± 0.23 g/kg/d, p = 0.31). At baseline, comparable CK concentrations were found between the protein and the placebo group (110 (IQR: 84–160 U/L) and 115 (IQR: 91–186 U/L), respectively, p = 0.84). Prolonged walking (protein: 32 ± 9 km/d, placebo: 33 ± 6 km/d) resulted in a cumulative increase of CK in both the protein (∆283 (IQR: 182–662 U/L)) and placebo group (∆456 (IQR: 209–885 U/L)) after three days. CK elevations were not significantly different between groups (p = 0.43). Similarly, no differences in inflammation markers, muscle soreness and fatigue were found between groups. Conclusions: Protein supplementation does not attenuate exercise-induced muscle damage, muscle soreness or fatigue in older adults performing prolonged moderate-intensity walking exercise.

Preconditioning Contractions Suppress Muscle Pain Markers after Damaging Eccentric Contractions

Inexperienced vigorous exercise, including eccentric contraction (ECC), causes muscle pain and damage. Similar prior light exercise suppresses the development of muscle pain (repeated-bout effect), but the molecular mechanisms behind this are not sufficiently understood. In this study, the influence of a nondamaging preconditioning ECC load (Precon) on muscle pain-related molecules and satellite cell-activating factors was investigated at the mRNA expression level. Nine-week-old male Wistar rats (n=36) were divided into 2 groups: a group receiving only a damaging ECC (100 contractions) load (non-Precon) and a group receiving a nondamaging ECC (10 contractions) load 2 days before receiving the damaging ECC load (Precon). ECC was loaded on the left leg, and the right leg was regarded as the intact control (CTL). The medial head of the gastrocnemius muscle from all rats was excised 2 or 4 days after the damaging ECC loading, and the relative mRNA expression levels of muscle pain- and satellite cell-related molecules were quantitated using real-time RT PCR. Precon suppressed increases in MHC-embryonic and MHC-neonatal mRNA expressions. Enhancement of HGF, Pax7, MyoD, and myogenin mRNA expression was also suppressed, suggesting that Precon decreased the degree of muscle damage and no muscle regeneration or satellite cell activation occurred. Similarly, increases in mRNA expression of muscle pain-related molecules (BKB₂ receptor, COX-2, and mPGEC-1) were also suppressed. This study clearly demonstrated that at the mRNA level, prior light ECC suppressed muscle damage induced by later damaging ECC and promoted recovery from muscle pain.

Localization of damage in the human leg muscles induced by downhill running

We investigated localization of damage within the knee extensors (KEs) and plantar flexors (PFs) induced by downhill running (DR) by using transverse relaxation time (T₂)-weighted magnetic resonance imaging (MRI). Fourteen young adults performed 45-min DR (-15% slope) at their maximal tolerable velocity. At pre- and 24, 48, and 72 h post-exercise, T₂-MRI was scanned and T₂ values for each muscle composing KEs and PFs at proximal, middle, and distal sites were calculated. Maximal isometric torque and rate of torque development (RTD: 0-30, 0-50, 0-100, 0-200 ms) were also measured. Maximal torque significantly decreased in KEs (14-17%) and PFs (6-8%) at 24-48 h post-exercise, with greater reductions for KEs. RTD in all phases, except for 0-200 ms in PFs, significantly decreased in KEs (11-42%) and PFs (13-23%) at least at one time point post-exercise. T₂ significantly increased at several sites (3-5%) in both muscle groups at 24 and/or 48 h post-exercise. Among the T₂-increased sites, the peak effect size (Cohen's d) regarding T₂ change was pronounced at proximal (1.05) and middle (1.64) vastus intermedius compared to the other sites (0.72-0.77). These results suggest that DR induces damage in both KEs and PFs, and especially affects proximal-middle sites of the vastus intermedius.