•Neuromuscular activity is suppressed during maximal eccentric muscle contraction in untrained subjects, evidenced by decreased electromyography signal amplitude, attenuated evoked H-reflex ...responses, increased autogenic motor neuron inhibition, and decreased excitability in descending corticospinal motor pathways.•Heavy-load resistance training yields marked gains in eccentric muscle strength owing to increased excitability of spinal motor neurons, decreased presynaptic or postsynaptic inhibition of spinal motor neurons, and likely also involving elevated descending motor drive from supraspinal centers.•Increased eccentric muscle strength induced by heavy-load resistance training provides an important basis for enhanced neuromuscular performance in athletes, as well as nonathletes, including older adults and clinical patients.
Neuromuscular activity is suppressed during maximal eccentric (ECC) muscle contraction in untrained subjects owing to attenuated levels of central activation and reduced spinal motor neuron (MN) excitability indicated by reduced electromyography signal amplitude, diminished evoked H-reflex responses, increased autogenic MN inhibition, and decreased excitability in descending corticospinal motor pathways. Maximum ECC muscle force recorded during maximal voluntary contraction can be increased by superimposed electrical muscle stimulation only in untrained individuals and not in trained strength athletes, indicating that the suppression in MN activation is modifiable by resistance training. In support of this notion, maximum ECC muscle strength can be increased by use of heavy-load resistance training owing to a removed or diminished suppression in neuromuscular activity. Prolonged (weeks to months) of heavy-load resistance training results in increased H-reflex and V-wave responses during maximal ECC muscle actions along with marked gains in maximal ECC muscle strength, indicating increased excitability of spinal MNs, decreased presynaptic and/or postsynaptic MN inhibition, and elevated descending motor drive. Notably, the use of supramaximal ECC resistance training can lead to selectively elevated V-wave responses during maximal ECC contraction, demonstrating that adaptive changes in spinal circuitry function and/or gains in descending motor drive can be achieved during maximal ECC contraction in response to heavy-load resistance training.
The evaluation of rate of force development during rapid contractions has recently become quite popular for characterising explosive strength of athletes, elderly individuals and patients. The main ...aims of this narrative review are to describe the neuromuscular determinants of rate of force development and to discuss various methodological considerations inherent to its evaluation for research and clinical purposes. Rate of force development (1) seems to be mainly determined by the capacity to produce maximal voluntary activation in the early phase of an explosive contraction (first 50–75 ms), particularly as a result of increased motor unit discharge rate; (2) can be improved by both explosive-type and heavy-resistance strength training in different subject populations, mainly through an improvement in rapid muscle activation; (3) is quite difficult to evaluate in a valid and reliable way. Therefore, we provide evidence-based practical recommendations for rational quantification of rate of force development in both laboratory and clinical settings.
Adaptive changes can occur in the nervous system in response to training. Electromyography studies have indicated adaptation mechanisms that may contribute to an increased efferent neuronal outflow ...with training, including increases in maximal firing frequency, increased excitability and decreased presynaptic inhibition of spinal motor neurons, and downregulation of inhibitory pathways.
This study aimed to assess the validity and functional relevance of a standardized procedure to assess lower limb muscle power by means of the 30-s sit-to-stand (STS) test when compared to leg ...extension power (LEP), traditional STS performance and handgrip strength. A total of 628 community-dwelling older subjects (60-93 years) from the Copenhagen Sarcopenia Study were included. Physical performance was assessed by the 30-s STS and 10-m maximal gait speed tests. Handgrip strength and LEP were recorded by a hand-held dynamometer and the Nottingham power rig, respectively. STS muscle power was calculated using the subjects' body mass and height, chair height and the number of repetitions completed in the 30-s STS test. We found a small albeit significant difference between LEP and unilateral STS power in older men (245.5 ± 88.8 vs. 223.4 ± 81.4 W; ES = 0.26; p < 0.05), but not in older women (135.9 ± 51.9 vs. 138.5 ± 49.6 W; ES = 0.05; p > 0.05). Notably, a large positive correlation was observed between both measures (r = 0.75; p < 0.001). Relative STS power was more strongly related with maximal gait speed than handgrip strength, repetition-based STS performance and relative LEP after adjusting for age (r = 0.53 vs 0.35-0.45; p < 0.05). In conclusion, STS power obtained from the 30-s STS test appeared to provide a valid measure of bilateral lower limb power and was more strongly related with physical performance than maximal handgrip strength, repetition-based STS performance and LEP.
Heavy-load strength training (HLT) is generally considered the Gold Standard exercise modality for inducing gains in skeletal muscle strength. However, use of heavy external exercise loads may be ...contraindicative in frail individuals. Low-load resistance exercise combined with partial blood-flow restriction (LL-BFR exercise) may offer an effective alternative for increasing mechanical muscle strength and size. The aim of this study was to compare the effect of LL-BFR training to HLT on maximal muscle strength gains. Prospero registration-id (CRD42014013382).
A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post-intervention changes in maximal muscle strength. A random-effects meta-analysis with standardized mean differences (SMD) was used.
Of 1413 papers identified through systematic search routines, sixteen papers fulfilled the inclusion criteria, totalling 153 participants completing HLT and 157 completing LL-BFR training. The magnitude of training-induced gains in maximal muscle strength did not differ between LL-BFR training and HLT (SMD of -0.17 (95% CI: -0.40; 0.05)). Low between-study heterogeneity was noted (I
= 0.0%, Chi
P = 9.65).
Low-load blood-flow-restricted training appears equally effective of producing gains in maximal voluntary muscle strength compared to HLT in 20- to 80-year-old healthy and habitually active adults.
Summary
Rate of force development (RFD) refers to the ability of the neuromuscular system to increase contractile force from a low or resting level when muscle activation is performed as quickly as ...possible, and it is considered an important muscle strength parameter, especially for athletes in sports requiring high‐speed actions. The assessment of RFD has been used for strength diagnosis, to monitor the effects of training interventions in both healthy populations and patients, discriminate high‐level athletes from those of lower levels, evaluate the impairment in mechanical muscle function after acute bouts of eccentric muscle actions and estimate the degree of fatigue and recovery after acute exhausting exercise. Notably, the evaluation of RFD in human skeletal muscle is a complex task as influenced by numerous distinct methodological factors including mode of contraction, type of instruction, method used to quantify RFD, devices used for force/torque recording and ambient temperature. Another important aspect is our limited understanding of the mechanisms underpinning rapid muscle force production. Therefore, this review is primarily focused on (i) describing the main mechanical characteristics of RFD; (ii) analysing various physiological factors that influence RFD; and (iii) presenting and discussing central biomechanical and methodological factors affecting the measurement of RFD. The intention of this review is to provide more methodological and analytical coherency on the RFD concept, which may aid to clarify the thinking of coaches and sports scientists in this area.
Randomized sham-controlled clinical trial.
The objective of this study is to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation, on the ...development of lower limb muscle strength and gait function during rehabilitation of spinal cord injury (SCI).
SCI rehabilitation hospital in Viborg, Denmark.
Twenty individuals with SCI were randomized to receive rTMS (REAL, n = 11) or sham stimulation (SHAM, n = 9) and usual care for 4 weeks. rTMS (20 Hz, 1800 pulses per session) or sham stimulation was delivered over leg M1 Monday-Friday before lower limb resistance training or physical therapy. Lower limb maximal muscle strength (MVC) and gait function were assessed pre- and post intervention. Lower extremity motor score (LEMS) was assessed at admission and at discharge.
One individual dropped out due to seizure. More prominent increases in total leg (effect size (ES): 0.40), knee flexor (ES: 0.29), and knee extensor MVC (ES: 0.34) were observed in REAL compared to SHAM; however, repeated-measures ANOVA revealed no clear main effects for any outcome measure (treatment p > 0.15, treatment × time p > 0.76, time p > 0.23). LEMS improved significantly for REAL at discharge, but not for SHAM, and REAL demonstrated greater improvement in LEMS than SHAM (p < 0.02). Similar improvements in gait performance were observed between groups.
High-frequency rTMS may increase long-term training-induced recovery of lower limb muscle strength following SCI. The effect on short-term recovery is unclear. Four weeks of rTMS, when delivered in conjunction with resistance training, has no effect on recovery of gait function, indicating a task-specific training effect.
Background:
Anterior cruciate ligament (ACL) rupture is a serious injury with a high prevalence worldwide, and subsequent ACL reconstructions (ACLR) appear to be most commonly performed using ...hamstring-derived (semitendinosus tendon) autografts. Recovery of maximal muscle strength to ≥90% of the healthy contralateral limb is considered an important criterion for safe return to sports. However, the speed of developing muscular force (ie, the rate of force development RFD) is also important for the performance of many types of activities in sports and daily living, yet RFD of the knee extensor and flexor muscles has apparently never been examined in patients who undergo ACLR with hamstring autograft (HA).
Purpose:
To examine potential deficits in RFD, maximal muscle strength (ie, maximal voluntary isometric contraction MVIC), and functional capacity of ACLR-HA limbs in comparison with the healthy contralateral leg and matched healthy controls 3 to 9 months after surgery.
Study Design:
Cross-sectional study; Level of evidence: 3.
Methods:
A total of 23 young patients who had undergone ACLR-HA 3 to 9 months earlier were matched by age to 14 healthy controls; both groups underwent neuromuscular screening. Knee extensor and flexor MVIC and RFD, as well as functional capacity (single-leg hop for distance SLHD test, timed single-leg sit-to-stand STS test), were assessed on both limbs. Furthermore, patient-reported knee function (Knee injury and Osteoarthritis Outcome Score) was assessed.
Results:
Knee extensor and flexor MVIC and RFD were markedly compromised in ACLR-HA limbs compared with healthy contralateral limbs (MVIC for extensor and flexor, 13% and 26%, respectively; RFD, 14%-17% and 32%-39%) and controls (MVIC, 16% and 31%; RFD, 14%-19% and 30%-41%) (P < .05-.001). Further, ACLR-HA limbs showed reduced functional capacity (reduced SLHD and STS performance) compared with contralateral limbs (SLHD, 11%; STS, 14%) and controls (SLHD, 20%; STS, 31%) (P < .01-.001). Strength (MVIC) and functional (SLHD) parameters were positively related to the duration of time after surgery (P < .05), although this relationship was not observed for RFD and STS.
Conclusion:
Knee extensor and flexor RFD and maximal strength, as well as functional single-leg performance, remained substantially reduced in ACLR-HA limbs compared with noninjured contralateral limbs and healthy controls 3 to 9 months after reconstructive surgery.
Background
Despite no international consensus on the diagnostic criteria for sarcopenia, low lean mass, muscle strength, and physical function are important risk factors for disability, frailty, and ...mortality in older individuals, as well as in a wide range of patients with muscle loss. Here, we provide a population‐based reference material of total and regional lean body mass, muscle strength/power parameters, and physical function in a healthy cohort of Danish men and women across the lifespan.
Methods
Volunteers aged 20–93 years from the Copenhagen City Heart Study were invited to establish a Danish reference material (Copenhagen Sarcopenia Study) on lean mass characteristics appendicular lean mass (ALM), iDXA, GE Lunar, muscle function handgrip strength (HGS), Jamar dynamometer and leg extension power (LEP), Nottingham Power Rig, and physical function 30 s sit‐to‐stand test (STS), 10‐m maximal and habitual gait speed (GS).
Results
A total of 1305 participants 729 women (age: 56.4 ± 18.9 years, height: 1.66 ± 0.01 m, body mass index: 24.6 ± 4.3 kg/m2 and 576 men, age: 57.0 ± 17.5 years, height: 1.80 ± 0.07 m, body mass index: 26.0 ± 3.9 kg/m2 completed all measurements and were included in the present analysis. Lean mass characteristics (TLM, ALM, and ALM/h2) decreased with increasing age in both men and women (P < 0.001). Men demonstrated larger absolute and relative total ALM and higher HGS and LEP compared with women at all age intervals (P < 0.001). HGS and LEP decreased progressively with age in both men and women (P < 0.01); 30 s STS performance, habitual GS, and maximal GS decreased at an accellerated rate of decline with increasing age in both men and women (P < 0.001). Habitual GS was reduced in men and women aged ≥70 years, while maximal GS was reduced from the age of ≥60 years compared with young adults (P < 0.001). Regardless of sex, 30 s STS was reduced from the age of ≥50 years compared with the young reference group (P < 0.001)
Conclusions
While the power‐based measurements (LEP and 30 s STS) started to decline already at age +50 years, less power‐based parameters (GS and HGS) and lean mass characteristics (TLM, ALM, and ALM/h2) remained unaltered until after the age of +70 years. Notably, the cut‐off thresholds derived in the present study differed from earlier reference data, which underlines the importance of obtaining updated and local reference materials.
Young, adolescent female athletes are at particular high risk of sustaining a non-contact anterior cruciate ligament (ACL) injury during sport. Through the last decades much attention has been ...directed toward various anatomical and biomechanical risk factors for non-contact ACL injury, and important information have been retrieved about the influence of external loading factors on ACL injury risk during given sports-specific movements. However, much less attention has been given to the aspect of neuromuscular control during such movements and only sparse knowledge exists on the specific muscle activation patterns involved during specific risk conditions. Therefore, the aim of this narrative review was (1) to describe anatomical aspects, strength aspects and biomechanical aspects relevant for the understanding of ACL non-contact injury mechanisms in young female athletes, and (2) to review the existing literature on lower limb muscle activation in relation to risk of non-contact ACL-injury and prevention of ACL injury in young female athletes. Studies investigating muscle activity patterns associated with sports-specific risk situations were identified, comprising cohort studies, intervention studies and prospective studies. Based on the retrieved studies, clear gender-specific differences in muscle activation and coordination were identified demonstrating elevated quadriceps activity and reduced hamstring activity in young female athletes compared to their male counterparts, and suggesting young female athletes to be at elevated risk of non-contact ACL injury. Only few studies (
= 6) examined the effect of preventive exercise-based intervention protocols on lower limb muscle activation during sports-specific movements. A general trend toward enhanced hamstring activation was observed during selected injury risk situations (e.g., sidecutting and drop landings). Only a single study examined the association between muscle activation deficits and ACL injury risk, reporting that low medial hamstring activation and high vastus lateralis activation prior to landing was associated with an elevated incidence of ACL-injury. A majority of studies were performed in adult female athletes. The striking paucity of studies in adolescent female athletes emphasizes the need for increased research activities to examine of lower limb muscle activity in relation to non-contact ACL injury in this high-risk athlete population.
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