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Jonvik KL, Paulussen KJM, Danen SL, Ceelen IJM, Horstman AM, Wardenaar FC, VAN Loon LJC, VAN Dijk JW. Protein Supplementation Does Not Augment Adaptations to Endurance Exercise Training. Med Sci Sports Exerc 2020; 51:2041-2049. [PMID: 31525168 PMCID: PMC6798744 DOI: 10.1249/mss.0000000000002028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. Introduction Recently, it has been speculated that protein supplementation may further augment the adaptations to chronic endurance exercise training. We assessed the effect of protein supplementation during chronic endurance exercise training on whole-body oxidative capacity (V˙O2max) and endurance exercise performance. Methods In this double-blind, randomized, parallel placebo-controlled trial, 60 recreationally active males (age, 27 ± 6 yr; body mass index, 23.8 ± 2.6 kg·m−2; V˙O2max, 47 ± 6 mL·min−1·kg−1) were subjected to 12 wk of triweekly endurance exercise training. After each session and each night before sleep, participants ingested either a protein supplement (PRO; 28.7 g casein protein) or an isoenergetic carbohydrate placebo (PLA). Before and after the 12 wk of training, V˙O2max and endurance exercise performance (~10-km time trial) were assessed on a cycle ergometer. Muscular endurance (total workload achieved during 30 reciprocal isokinetic contractions) was assessed by isokinetic dynamometry and body composition by dual-energy x-ray absorptiometry. Mixed-model ANOVA was applied to assess whether training adaptations differed between groups. Results Endurance exercise training induced an 11% ± 6% increase in V˙O2max (time effect, P < 0.0001), with no differences between groups (PRO, 48 ± 6 to 53 ± 7 mL·min−1·kg−1; PLA, 46 ± 5 to 51 ± 6 mL·min−1·kg−1; time–treatment interaction, P = 0.50). Time to complete the time trial was reduced by 14% ± 7% (time effect, P < 0.0001), with no differences between groups (time–treatment interaction, P = 0.15). Muscular endurance increased by 6% ± 7% (time effect, P < 0.0001), with no differences between groups (time–treatment interaction, P = 0.84). Leg lean mass showed an increase after training (P < 0.0001), which tended to be greater in PRO compared with PLA (0.5 ± 0.7 vs 0.2 ± 0.6 kg, respectively; time–treatment interaction, P = 0.073). Conclusion Protein supplementation after exercise and before sleep does not further augment the gains in whole-body oxidative capacity and endurance exercise performance after chronic endurance exercise training in recreationally active, healthy young males.
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Affiliation(s)
- Kristin L Jonvik
- Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - Kevin J M Paulussen
- Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - Shiannah L Danen
- Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - Ingrid J M Ceelen
- Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | | | - Floris C Wardenaar
- Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - Luc J C VAN Loon
- Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS.,Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Jan-Willem VAN Dijk
- Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
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Wright TJ, Dillon EL, Durham WJ, Chamberlain A, Randolph KM, Danesi C, Horstman AM, Gilkison CR, Willis M, Richardson G, Hatch SS, Jupiter DC, McCammon S, Urban RJ, Sheffield‐Moore M. A randomized trial of adjunct testosterone for cancer-related muscle loss in men and women. J Cachexia Sarcopenia Muscle 2018; 9:482-496. [PMID: 29654645 PMCID: PMC5989774 DOI: 10.1002/jcsm.12295] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/20/2017] [Accepted: 01/31/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer cachexia negatively impacts cancer-related treatment options, quality of life, morbidity, and mortality, yet no established therapies exist. We investigated the anabolic properties of testosterone to limit the loss of body mass in late stage cancer patients undergoing standard of care cancer treatment. METHODS A randomized, double-blind, placebo-controlled phase II clinical trial was undertaken to assess the potential therapeutic role of adjunct testosterone to limit loss of body mass in patients with squamous cell carcinoma of the cervix or head and neck undergoing standard of care treatment including chemotherapy and chemoradiation. Patients were randomly assigned in blocks to receive weekly injections of either 100 mg testosterone enanthate or placebo for 7 weeks. The primary outcome was per cent change in lean body mass, and secondary outcomes included assessment of quality of life, tests of physical performance, muscle strength, daily activity levels, resting energy expenditure, nutritional intake, and overall survival. RESULTS A total of 28 patients were enrolled, 22 patients were studied to completion, and 21 patients were included in the final analysis (12 placebo, nine testosterone). Adjunct testosterone increased lean body mass by 3.2% (95% confidence interval [CI], 0-7%) whereas those receiving placebo lost 3.3% (95% CI, -7% to 1%, P = 0.015). Although testosterone patients maintained more favourable body condition, sustained daily activity levels, and showed meaningful improvements in quality of life and physical performance, overall survival was similar in both treatment groups. CONCLUSIONS In patients with advanced cancer undergoing the early phase of standard of care therapy, adjunct testosterone improved lean body mass and was also associated with increased quality of life, and physical activity compared with placebo.
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Affiliation(s)
- Traver J. Wright
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - E. Lichar Dillon
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - William J. Durham
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - Albert Chamberlain
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - Kathleen M. Randolph
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - Christopher Danesi
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - Astrid M. Horstman
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - Charles R. Gilkison
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - Maurice Willis
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
| | - Gwyn Richardson
- Department of Gynecologic OncologyThe University of Texas Medical BranchGalvestonTX77555USA
| | - Sandra S. Hatch
- Department of Radiation OncologyThe University of Texas Medical BranchGalvestonTX77555USA
| | - Daniel C. Jupiter
- Department of Preventive Medicine and Community HealthThe University of Texas Medical BranchGalvestonTX77555USA
| | - Susan McCammon
- Department of OtolaryngologyThe University of Texas Medical BranchGalvestonTX77555USA
| | - Randall J. Urban
- Department of Internal MedicineThe University of Texas Medical BranchGalvestonTX77555USA
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Groen BBL, Horstman AM, Hamer HM, de Haan M, van Kranenburg J, Bierau J, Poeze M, Wodzig WKWH, Rasmussen BB, van Loon LJC. Post-Prandial Protein Handling: You Are What You Just Ate. PLoS One 2015; 10:e0141582. [PMID: 26556791 PMCID: PMC4640549 DOI: 10.1371/journal.pone.0141582] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/08/2015] [Indexed: 01/07/2023] Open
Abstract
Background Protein turnover in skeletal muscle tissue is highly responsive to nutrient intake in healthy adults. Objective To provide a comprehensive overview of post-prandial protein handling, ranging from dietary protein digestion and amino acid absorption, the uptake of dietary protein derived amino acids over the leg, the post-prandial stimulation of muscle protein synthesis rates, to the incorporation of dietary protein derived amino acids in de novo muscle protein. Design 12 healthy young males ingested 20 g intrinsically [1-13C]-phenylalanine labeled protein. In addition, primed continuous L-[ring-2H5]-phenylalanine, L-[ring-2H2]-tyrosine, and L-[1-13C]-leucine infusions were applied, with frequent collection of arterial and venous blood samples, and muscle biopsies throughout a 5 h post-prandial period. Dietary protein digestion, amino acid absorption, splanchnic amino acid extraction, amino acid uptake over the leg, and subsequent muscle protein synthesis were measured within a single in vivo human experiment. Results 55.3±2.7% of the protein-derived phenylalanine was released in the circulation during the 5 h post-prandial period. The post-prandial rise in plasma essential amino acid availability improved leg muscle protein balance (from -291±72 to 103±66 μM·min-1·100 mL leg volume-1; P<0.001). Muscle protein synthesis rates increased significantly following protein ingestion (0.029±0.002 vs 0.044±0.004%·h-1 based upon the muscle protein bound L-[ring-2H5]-phenylalanine enrichments (P<0.01)), with substantial incorporation of dietary protein derived L-[1-13C]-phenylalanine into de novo muscle protein (from 0 to 0.0201±0.0025 MPE). Conclusion Ingestion of a single meal-like amount of protein allows ~55% of the protein derived amino acids to become available in the circulation, thereby improving whole-body and leg protein balance. About 20% of the dietary protein derived amino acids released in the circulation are taken up in skeletal muscle tissue following protein ingestion, thereby stimulating muscle protein synthesis rates and providing precursors for de novo muscle protein synthesis. Trial Registration trialregister.nl 3638
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Affiliation(s)
- Bart B. L. Groen
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Department of Human Movement Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Astrid M. Horstman
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Department of Human Movement Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Henrike M. Hamer
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Department of Human Movement Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michiel de Haan
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Janneau van Kranenburg
- Department of Human Movement Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jörgen Bierau
- Laboratory Biochemical Genetics, Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Will K. W. H. Wodzig
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Blake B. Rasmussen
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Luc J. C. van Loon
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Department of Human Movement Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
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Abstract
The combination of age-related muscle loss (sarcopenia) and the diagnosis of cancer (and the onset of cachexia) is likely a metabolic challenge that skeletal muscle of older cancer patients is not prepared to handle. Albeit to a smaller extent than healthy older controls, the skeletal muscle of older cancer patients is still acutely anabolic to the provision of amino acids. To provide an anabolic stimulus to skeletal muscle during a time when it is susceptible to an advanced rate of breakdown due to cancer- and tumor-related factors, enhanced intake of protein and amino acid sources might be necessary and should likely be higher than the current US recommended daily intake of 0.8 g protein/kg body weight/day. Future studies should investigate whether the acute effects of amino acids on muscle protein anabolism can be sustained over a longer period of time in the presence of cancer cachexia in older patients.
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Affiliation(s)
- Astrid M Horstman
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
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Sheffield-Moore M, Wiktorowicz JE, Soman KV, Danesi CP, Kinsky MP, Dillon EL, Randolph KM, Casperson SL, Gore DC, Horstman AM, Lynch JP, Doucet BM, Mettler JA, Ryder JW, Ploutz-Snyder LL, Hsu JW, Jahoor F, Jennings K, White GR, McCammon SD, Durham WJ. Sildenafil increases muscle protein synthesis and reduces muscle fatigue. Clin Transl Sci 2013; 6:463-8. [PMID: 24330691 DOI: 10.1111/cts.12121] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Reductions in skeletal muscle function occur during the course of healthy aging as well as with bed rest or diverse diseases such as cancer, muscular dystrophy, and heart failure. However, there are no accepted pharmacologic therapies to improve impaired skeletal muscle function. Nitric oxide may influence skeletal muscle function through effects on excitation-contraction coupling, myofibrillar function, perfusion, and metabolism. Here we show that augmentation of nitric oxide-cyclic guanosine monophosphate signaling by short-term daily administration of the phosphodiesterase 5 inhibitor sildenafil increases protein synthesis, alters protein expression and nitrosylation, and reduces fatigue in human skeletal muscle. These findings suggest that phosphodiesterase 5 inhibitors represent viable pharmacologic interventions to improve muscle function.
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Dillon EL, Basra G, Horstman AM, Casperson SL, Randolph KM, Durham WJ, Urban RJ, Diaz-Arrastia C, Levine L, Hatch SS, Willis M, Richardson G, Sheffield-Moore M. Cancer cachexia and anabolic interventions: a case report. J Cachexia Sarcopenia Muscle 2012; 3:253-63. [PMID: 22585408 PMCID: PMC3505578 DOI: 10.1007/s13539-012-0066-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 04/09/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Standard-of-care (SOC) cancer treatments are primarily aimed at reducing size and progression of a tumor. There is a need for successful supplemental anabolic therapies to combat cancer cachexia in addition to these SOC treatment modalities. Anabolic interventions, including testosterone and amino acid supplements, may be beneficial in reducing and/or reversing muscle wasting in these patient populations. METHODS A 48-year-old Caucasian female with recurrent cervical cancer was scheduled to receive three 21-day cycles of cisplatin and topetecan chemotherapy. She qualified, consented, and enrolled into a blinded interventional pilot study where she received daily whey protein (10 g, three times per day with meals) and a weekly injection of testosterone enanthate (100 mg intramuscular) before and during the SOC chemotherapy treatment period. Body composition, serum inflammatory markers, mixed muscle protein synthesis and breakdown rates, physical function, fatigue, and quality of life were assessed before and after the intervention period. RESULTS Body composition, as assessed by an increase in body weight and lean body mass and reduction in fat mass; physical function; fatigue; and quality of life each improved across the entire intervention period despite general increases in inflammatory markers and no improvements in muscle protein turnover towards the end of the intervention. CONCLUSIONS Concomitant treatment of oral amino acids and testosterone may be a viable therapeutic option for fighting cachexia and improving body composition and quality of life during chemotherapeutic treatment of recurrent cervical cancer. These positive outcomes may be attainable over time despite overall poor inflammatory status.
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Affiliation(s)
- Edgar L Dillon
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555-0569, USA
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Lammers G, van Duijnhoven NTL, Hoenderop JG, Horstman AM, de Haan A, Janssen TWJ, de Graaf MJJ, Pardoel EM, Verwiel ETP, Thijssen DHJ, Hopman MTE. The identification of genetic pathways involved in vascular adaptations after physical deconditioningversusexercise training in humans. Exp Physiol 2012; 98:710-21. [DOI: 10.1113/expphysiol.2012.068726] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Horstman AM, Dillon EL, Urban RJ, Sheffield-Moore M. The role of androgens and estrogens on healthy aging and longevity. J Gerontol A Biol Sci Med Sci 2012; 67:1140-52. [PMID: 22451474 DOI: 10.1093/gerona/gls068] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aging is associated with a loss of sex hormone in both men (andropause) and women (menopause). In men, reductions in testosterone can trigger declines in muscle mass, bone mass, and in physical function. In women, the impact of the loss of sex hormones, such as estradiol, on bone is well elucidated, but evidence is limited on whether the loss of estradiol negatively affects muscle mass and physical function. However, deficiencies in multiple anabolic hormones have been shown to predict health status and longevity in older persons. Thus, consideration should be given as to whether targeted hormone replacement therapies may prove effective at treating clinical conditions, such as age-related sarcopenia, cancer cachexia, and/or acute or chronic illnesses. If initiated carefully in the appropriate clinical population, hormone replacement therapies in men and women may prevent and reverse muscle and bone loss and functional declines and perhaps promote healthy aging and longevity.
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Affiliation(s)
- Astrid M Horstman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1060, USA.
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Mulder ER, Horstman AM, Gerrits K, Massa M, Kleine BU, de Haan A, Belavý DL, Felsenberg D, Zwarts M, Stegeman DF. Enhanced physiological tremor deteriorates plantar flexor torque steadiness after bed rest. J Electromyogr Kinesiol 2010; 21:384-93. [PMID: 21131213 DOI: 10.1016/j.jelekin.2010.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/18/2010] [Accepted: 10/18/2010] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the effectiveness of resistance training to preserve submaximal plantar flexor (PF) torque steadiness following 60 days of bed rest (BR). Twenty-two healthy male subjects underwent either BR only (CTR, n=8), or BR plus resistance training (RT, n=14). The magnitude of torque fluctuations during steady submaximal isometric PF contractions (20%, 40%, 60% and 80% of maximum) were assessed before and after BR. Across contraction intensities, torque fluctuations (coefficient of variation, CV) increased more (P<0.05) after BR for CTR (from 0.31±0.10 to 0.92±0.63; P<0.001), than for RT (from 0.30±0.09 to 0.54±0.27; P<0.01). A shift in the spectral content of torque fluctuations towards increased rhythmic activity between 6.5 and 20Hz was observed in CTR only (P<0.05). H-reflex amplitude (H(max)/M(max) ratio) declined across groups from 0.57±0.18 before BR to 0.44±0.14 following BR (P<0.01) without correlation to CV. The present study showed that increased torque fluctuation after BR resulted from enhanced physiological tremor. Resistance training prevented the spectral shift in isometric PF torque fluctuation and offset ∼50% of the decline in performance associated with long-term BR.
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Affiliation(s)
- Edwin R Mulder
- Institute of Aerospace Medicine, Division of Space Physiology, German Space Center, Cologne, Germany.
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Seynnes OR, Maffiuletti NA, Horstman AM, Narici MV. Increased H-reflex excitability is not accompanied by changes in neural drive following 24 days of unilateral lower limb suspension. Muscle Nerve 2010; 42:749-55. [PMID: 19229968 DOI: 10.1002/mus.21228] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to determine whether the gain in soleus H-reflex excitability induced by unilateral lower limb suspension (ULLS) is associated with changes in neural drive to the plantar flexor muscles. Six male subjects (23 ± 2 years, 187 ± 7 cm, 79 ± 9 kg) underwent 24 days of ULLS of the dominant limb. Plantar flexor maximal voluntary contraction (MVC) torque, activation capacity (twitch interpolation), soleus maximal electromyographic (EMG) activity, Hoffman (H)-reflex, and the first volitional (V) wave normalized to the compound muscle action potential (M-wave) were quantified before and after ULLS. Following ULLS, MVC torque decreased by 15% (P < 0.05). However, neither activation capacity nor EMG activity was significantly altered after the suspension. The V-wave remained unchanged consistently after ULLS, whereas the H-reflex increased significantly (+20%). Furthermore, there was no significant relationship between changes in H-reflex and V-wave over the ULLS period. These findings indicate that 24 days of ULLS can result in a substantial reduction of muscle strength without any apparent change in voluntary activation capacity. H-reflex and V-wave findings suggest that the spinal adaptations that underlie the unloading-induced increase in resting soleus H-reflex excitability did not significantly affect the efferent motor output to the plantar flexor muscles.
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Affiliation(s)
- Olivier R Seynnes
- Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Alsager, UK.
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Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke. Arch Phys Med Rehabil 2010; 91:123-8. [PMID: 20103406 DOI: 10.1016/j.apmr.2009.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 08/31/2009] [Accepted: 09/02/2009] [Indexed: 11/17/2022]
Abstract
UNLABELLED Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke. OBJECTIVE To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke. DESIGN Case-control study. SETTING Rehabilitation center research laboratory. PARTICIPANTS Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery. RESULTS No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001). CONCLUSIONS The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation.
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Affiliation(s)
- Astrid M Horstman
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands.
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Mulder ER, Horstman AM, Stegeman DF, de Haan A, Belavý DL, Miokovic T, Armbrecht G, Felsenberg D, Gerrits KH. Influence of vibration resistance training on knee extensor and plantar flexor size, strength, and contractile speed characteristics after 60 days of bed rest. J Appl Physiol (1985) 2009; 107:1789-98. [DOI: 10.1152/japplphysiol.00230.2009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spaceflight and bed rest (BR) result in loss of muscle mass and strength. This study evaluated the effectiveness of resistance training and vibration-augmented resistance training to preserve thigh (quadriceps femoris) and calf (triceps surae) muscle cross-sectional area (CSA), isometric maximal voluntary contraction (MVC), isometric contractile speed, and neural activation (electromyogram) during 60 days of BR. Male subjects participating in the second Berlin Bed Rest Study underwent BR only [control (CTR), n = 9], BR with resistance training (RE; n = 7), or BR with vibration-augmented resistance training (RVE; n = 7). Training was performed three times per week. Thigh CSA and MVC torque decreased by 13.5 and 21.3%, respectively, for CTR (both P < 0.001), but were preserved for RE and RVE. Calf CSA declined for all groups, but more so ( P < 0.001) for CTR (23.8%) than for RE (10.7%) and RVE (11.0%). Loss in calf MVC torque was greater ( P < 0.05) for CTR (24.9%) than for RVE (12.3%), but not different from RE (14.8%). Neural activation at MVC remained unchanged in all groups. For indexes related to rate of torque development, countermeasure subjects were pooled into one resistance training group (RT, n = 14). Thigh maximal rate of torque development (MRTD) and contractile impulse remained unaltered for CTR, but MRTD decreased 16% for RT. Calf MRTD remained unaltered for both groups, whereas contractile impulse increased across groups (28.8%), despite suppression in peak electromyogram (12.1%). In conclusion, vibration exposure did not enhance the efficacy of resistance training to preserve thigh and calf neuromuscular function during BR, although sample size issues may have played a role. The exercise regimen maintained thigh size and MVC strength, but promoted a loss in contractile speed. Whereas contractile speed improved for the calf, the exercise regimen only partially preserved calf size and MVC strength. Modification of the exercise regimen seems warranted.
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Affiliation(s)
- Edwin R. Mulder
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam; and
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Department of Clinical Neurophysiology, Nijmegen, The Netherlands
| | - Astrid M. Horstman
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam; and
| | - Dick F. Stegeman
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam; and
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Department of Clinical Neurophysiology, Nijmegen, The Netherlands
| | - Arnold de Haan
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam; and
- Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Manchester, United Kingdom; and
| | - Daniel L. Belavý
- Centre for Muscle and Bone Research, Charité Campus Benjamin Franklin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Tanja Miokovic
- Centre for Muscle and Bone Research, Charité Campus Benjamin Franklin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Gabi Armbrecht
- Centre for Muscle and Bone Research, Charité Campus Benjamin Franklin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Dieter Felsenberg
- Centre for Muscle and Bone Research, Charité Campus Benjamin Franklin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Karin H. Gerrits
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam; and
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Horstman AM, Gerrits KH, Janssen TW, de Haan A. Intrinsic Muscle Properties Of The M. Quadriceps Femoris After Subacute Stroke. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000356160.49969.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Horstman AM, Beltman MJ, Gerrits KH, Koppe P, Janssen TW, Elich P, de Haan A. Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke. Clin Physiol Funct Imaging 2008; 28:251-61. [PMID: 18355344 DOI: 10.1111/j.1475-097x.2008.00802.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The objective of this study was to assess the nature of muscle weakness in both legs after stroke compared with able-bodied control individuals and to examine whether there is a relationship between the degree of muscle weakness and coactivation of knee extensors and flexors as well as voluntary activation capacity of knee extensors of both paretic and non-paretic legs and indices of functional performance. Maximal voluntary isometric torques of knee extensors (MVCe) and flexors (MVCf) were determined in 14 patients (bilaterally) and 12 able-bodied controls. Simultaneous measurements were made of torque and surface EMG from agonist and antagonist muscles. Coactivation was calculated. Supramaximal triplets were evoked with electrical stimulation to estimate maximal torque capacity and degree of voluntary activation of knee extensors. MVCs, activation and coactivation parameters were correlated to scores of seven functional performance tests. MVCe, MVCf and voluntary activation were lower in paretic lower limb (PL) compared with both non-paretic lower limb (NL) and control. Besides, all these parameters of NL were also lower than control. Electrically evoked torque capacity of knee extensors of PL was about 60% of both NL and control, which were not significantly different from each other. Strong significant correlations between strength, as well as voluntary activation, and functional performance were found. Coactivation did not correlate well with functional performance. Thus, whereas for NL activation failure can explain weakness, for PL both activation failure and reduced intrinsic torque capacity are responsible for the severe weakness. Activation capacity and muscle strength correlated strongly to functional performance, while coactivation did not.
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Affiliation(s)
- Astrid M Horstman
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
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