Gilberto Laurentino

Resistance Training with Vascular Occlusion in Inclusion Body Myositis: A Case Study

UNLABELLED Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy that produces remarkable muscle weakness. Resistance training with vascular occlusion has been shown to improve muscle strength and cross-sectional area in other muscle wasting conditions. PURPOSE We evaluated the efficacy of a moderate-intensity resistance training program combined with vascular occlusion by examining functional capacity, muscle morphology, and changes in the expression of genes related to muscle protein synthesis and proteolysis in a patient with IBM. METHODS A 65-yr-old man with IBM resistant to all proposed treatments underwent resistance training with vascular occlusion for 12 wk. Leg press one-repetition maximum; thigh cross-sectional area; balance, mobility, and muscle function; quality of life; and blood markers of inflammation and muscle damage were assessed at baseline and after the 12-wk program. The messenger RNA (mRNA) expression levels of mechanogrowth factor, mammalian target of rapamycin, atrogin-1, and muscle RING finger-1 were also quantified. RESULTS After the 12-wk training program, the patients leg press one-repetition maximum, balance and mobility function, and thigh cross-sectional area increased 15.9%, 60%, and 4.7%, respectively. All Short Form-36 Health Survey Questionnaire subscales demonstrated improvements as well, varying from 18% to 600%. mRNA expression of mechanogrowth factor increased 3.97-fold, whereas that of atrogin-1 decreased 0.62-fold. Muscle RING finger-1 and mammalian target of rapamycin mRNA levels were only slightly altered, 1.18- and 1.28-fold, respectively. Importantly, the exercise did not induce disease flare. CONCLUSIONS We describe a novel, and likely the first, nonpharmacological therapeutic tool that might be able to counteract the muscle atrophy and the declining strength that usually occur in IBM.

Changes in Exercises Are More Effective Than in Loading Schemes to Improve Muscle Strength

Abstract Fonseca, RM, Roschel, H, Tricoli, V, de Souza, EO, Wilson, JM, Laurentino, GC, Aihara, AY, de Souza Leão, AR, and Ugrinowitsch, C. Changes in exercises are more effective than in loading schemes to improve muscle strength. J Strength Cond Res 28(11): 3085–3092, 2014—This study investigated the effects of varying strength exercises and loading scheme on muscle cross-sectional area (CSA) and maximum strength after 4 strength training loading schemes: constant intensity and constant exercise (CICE), constant intensity and varied exercise (CIVE), varied intensity and constant exercise (VICE), varied intensity and varied exercise (VIVE). Forty-nine individuals were allocated into 5 groups: CICE, CIVE, VICE, VIVE, and control group (C). Experimental groups underwent twice a week training for 12 weeks. Squat 1 repetition maximum was assessed at baseline and after the training period. Whole quadriceps muscle and its heads CSA were also obtained pretraining and posttraining. The whole quadriceps CSA increased significantly (p ⩽ 0.05) in all of the experimental groups from pretest to posttest in both the right and left legs: CICE: 11.6 and 12.0%; CIVE: 11.6 and 12.2%; VICE: 9.5 e 9.3%; and VIVE: 9.9 and 11.6%, respectively. The CIVE and VIVE groups presented hypertrophy in all of the quadriceps muscle heads (p ⩽ 0.05), whereas the CICE and VICE groups did not present hypertrophy in the vastus medialis and rectus femoris (RF), and in the RF muscles, respectively (p > 0.05). The CIVE group had greater strength increments than the other training groups (effect size confidence limit of the difference [ESCLdiff] CICE: 1.41−1.56; VICE: 2.13–2.28; VIVE: 0.59–0.75). Our findings suggest: (a) CIVE is more efficient to produce strength gains for physically active individuals; (b) as long as the training intensity reaches an alleged threshold, muscle hypertrophy is similar regardless of the training intensity and exercise variation.

Vascular occlusion training for inclusion body myositis: a novel therapeutic approach.

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise function and quality of life. Moreover, clinical practice suggests that, unlike other inflammatory myopathies, the majority of IBM patients are not responsive to treatment with immunosuppressive or immunomodulatory drugs to counteract disease progression. Additionally, conventional resistance training programs have been proven ineffective in restoring muscle function and muscle mass in these patients. Nevertheless, we have recently observed that restricting muscle blood flow using tourniquet cuffs in association with moderate intensity resistance training in an IBM patient produced a significant gain in muscle mass and function, along with substantial benefits in quality of life. Thus, a new non-pharmacological approach for IBM patients has been proposed. Herein, we describe the details of a proposed protocol for vascular occlusion associated with a resistance training program for this population.

Vastus lateralis muscle cross-sectional area ultrasonography validity for image fitting in humans.

Abstract Lixandrão, ME, Ugrinowitsch, C, Bottaro, M, Chacon-Mikahil, MPT, Cavaglieri, CR, Min, LL, de Souza, EO, Laurentino, GC, and Libardi, CA. Vastus lateralis muscle cross-sectional area ultrasonography validity for image fitting in humans. J Strength Cond Res 28(11): 3293–3297, 2014—The present study aimed to determine the concurrent validity of ultrasound (US) measurement of the vastus lateralis muscle (VL) cross-sectional area (CSA) having magnetic resonance imaging (MRI) as the gold standard measurement, in a heterogeneous sample of participants. Thirty-one individuals (52.44 ± 16.37 years; 1.67 ± 0.11 m; 75.25 ± 13.82 kg) volunteered to participate in the study. All the images were performed in the right leg. Image-fitting technique (US) and computerized planimetry technique (US and MRI) were used to determine the VL CSA. The typical error (TE) of measurement was used to determine the concurrent validity of the US measurements. Our results demonstrated good validity of the US compared with the MRI measurements (TE = 0.37 cm2; coefficient of variation = 1.75%). The Bland-Altman plot demonstrated bias of 0.07 ± 0.53 cm2 and limits of agreement of 0.96–1.11 cm2. Based on our TE, bias and limits of agreement, we concluded that the US image-fitting technique is valid to assess the VL CSA in a heterogeneous sample of participants. Thereby, US can be used instead of MRI to assess changes in skeletal muscle morphology.

Blood Flow in Humans Following Low-Load Exercise with and without Blood Flow Restriction

Blood flow restriction (BFR) in combination with exercise has been used to increase muscle size and strength using relatively low loads (20%-30% 1-repetition maximum (1RM)). In research, the range of applied pressures based on a percentage of arterial occlusion pressure (AOP), is wide. The purpose of the study is to measure the blood flow response before exercise, following each set of exercise, and postexercise to low-load elbow flexion combined with no restriction (NOBFR), 40% of AOP (40BFR), and 80% of AOP (80BFR). One hundred and fifty-two participants volunteered; 140 completed the protocol (women = 75, men = 65). Participants were counter-balanced into 1 of 3 conditions. Following AOP and 1RM measurement, ultrasound was used to measure standing blood flow at rest in the right brachial artery. Participants performed 4 sets of elbow flexion at 30% 1RM. Blood flow was measured between sets and at 1 and 5 min postexercise. Blood flow decreased following inflation, with no difference between conditions (p < 0.001). Men had greater blood flow than women in all conditions at all time points (p < 0.001). Resting hyperemia decreased with pressure (NOBFR > 40BFR > 80BFR, p < 0.001). Blood flow increased from rest to after set 1 regardless of condition. Following cuff deflation, blood flow increased in both the 80BFR and 40BFR conditions. The reduction in hyperemia during BFR is pressure-dependent. Contrary to previous investigations, blood flow was increased above baseline following exercise.

The effects of water-based exercise in combination with blood flow restriction on strength and functional capacity in post-menopausal women

Water-based exercise and low-intensity exercise in combination with blood flow restriction (BFR) are two methods that have independently been shown to improve muscle strength in those of advancing age. The objective of this study was to assess the long-term effect of water-based exercise in combination with BFR on maximum dynamic strength and functional capacity in post-menopausal women. Twenty-eight women underwent an 8-week water-based exercise program. The participants were randomly allocated to one of the three groups: (a) water exercise only, (b) water exercise + BFR, or (c) a non-exercise control group. Functional capacity (chair stand test, timed up and go test, gait speed, and dynamic balance) and strength testing were tested before and after the 8-week aquatic exercise program. The main findings were as follows: (1) water-based exercise in combination with BFR significantly increased the lower limb maximum strength which was not observed with water-based exercise alone and (2) water-based exercise, regardless of the application of BFR, increased functional performance measured by the timed up and go test over a control group. Although we used a healthy population in the current study, these findings may have important implications for those who may be contraindicated to using traditional resistance exercise. Future research should explore this promising modality in these clinical populations.

Blood flow restriction increases metabolic stress but decreases muscle activation during high-load resistance exercise: Blood Flow Restriction Training

Introduction: We investigated differences in metabolic stress (lactate) and muscle activation (electromyography; EMG) when high‐load resistance exercise (HL) is compared with a condition in which blood flow restriction (BFR) is applied during the exercise or during the rest interval. Methods: Twelve participants performed HL with BFR during the intervals (BFR‐I), during the set (BFR‐S), and without BFR. Each condition consisted of 3 sets of 8 repetitions with knee extension at 70% of 1‐repetition maximum. Lactate and root mean square (RMS) from the surface EMG of the vastus lateralis were calculated. Results: Lactate increased in all protocols but was higher with BFR‐I than with BFR‐S and HL. RMS decreased under all conditions, with a larger effect size in BFR‐I (1.47) than in BFR‐S (0.66) and HL (0.59). Discussion: BFR‐I increases lactate, possibly as a result of reduced restoration of ATP. Muscle activation seems to be impacted by mechanical stress but may be reduced by metabolic stress. Muscle Nerve 57: 107–111, 2018

Effects of different intensities of resistance training with equated volume load on muscle strength and hypertrophy

Abstract The present study investigated the effects of different intensities of resistance training (RT) on elbow flexion and leg press one-repetition maximum (1RM) and muscle cross-sectional area (CSA). Thirty men volunteered to participate in an RT programme, performed twice a week for 12 weeks. The study employed a within-subject design, in which one leg and arm trained at 20% 1RM (G20) and the contralateral limb was randomly assigned to one of the three conditions: 40% (G40); 60% (G60), and 80% 1RM (G80). The G20 started RT session with three sets to failure. After G20 training, the number of sets was adjusted for the other contralateral limb conditions with volume-matched. CSA and 1RM were assessed at pre, post-6 weeks, and post-12 weeks. There was time effect for CSA for the vastus lateralis (VL) (8.9%, 20.5%, 20.4%, and 19.5%) and elbow flexors (EF) (11.4%, 25.3%, 25.1%, and 25%) in G20, G40, G60, and G80, respectively (p > .05). G80 showed higher CSA than G20 for VL (19.5% vs. 8.9%) and EF (25% vs. 11.4%) at post-12 weeks (p < .05). There was time effect for elbow flexion and unilateral leg press strength for all groups post-12 weeks (p < .05). However, the magnitude of increase was higher in G60 and G80. In conclusion, when low to high intensities of RT are performed with volume-matched, all intensities were effective for increasing muscle strength and size; however, 20% 1RM was suboptimal in this regard, and only the heavier RT intensity (80% 1RM) was shown superior for increasing strength and CSA compared to low intensities.

Blood flow restricted resistance training attenuates myostatin gene expression in a patient with inclusion body myositis.

Inclusion body myositis is a rare idiopathic inflammatory myopathy that produces extreme muscle weakness. Blood flow restricted resistance training has been shown to improve muscle strength and muscle hypertrophy in inclusion body myositis. Objective: The aim of this study was to evaluate the effects of a resistance training programme on the expression of genes related to myostatin (MSTN) signalling in one inclusion body myositis patient. Methods: A 65-year-old man with inclusion body myositis underwent blood flow restricted resistance training for 12 weeks. The gene expression of MSTN, follistatin, follistatin-like 3, activin II B receptor, SMAD-7, MyoD, FOXO-3, and MURF-2 was quantified. Results: After 12 weeks of training, a decrease (25%) in MSTN mRNA level was observed, whereas follistatin and follistatin-like 3 gene expression increased by 40% and 70%, respectively. SMAD-7 mRNA level was augmented (20%). FOXO-3 and MURF-2 gene expression increased by 40% and 20%, respectively. No change was observed in activin II B receptor or MyoD gene expression. Conclusions: Blood flow restricted resistance training attenuated MSTN gene expression and also increased expression of myostatin endogenous inhibitors. Blood flow restricted resistance training evoked changes in the expression of genes related to MSTN signalling pathway that could in part explain the muscle hypertrophy previously observed in a patient with inclusion body myositis.

EFEITO DA ORDEM DOS EXERCÍCIOS DE FORÇA SOBRE O VOLUME, O LACTATO E O DESEMPENHO

ABSTRACT Introduction: The alternation between body segments for prescription of strength training (ST) is widely used; however, its effects remain unknown. Objective: To verify the acute effect of the manipulation of the order of ST exercises, alterna -ting body segments, on the maximum dynamic force (1 RM) of lower limbs (LL) and upper limbs (UL), blood lactate [La] concentration, subjective perception of effort (SPE) and the total training volume (TV). Methods: Eighteen men (23.1±3.8 years; 78.4±8.6 kg; 1.72±0.06 m) performed three ST conditions: condition A: (bench press, shoulder press, preacher arm curl, half squat, leg press, leg extension); condition B (half squat, leg press, leg extension, bench press, shoulder press, preacher arm curl) and condition C (bench press, half squat, shoulder press, leg press, preacher arm curl, leg extension). The exercises were performed in three sets of 10 RM. The 1 RM tests for LL and UL were performed in the initial weeks and after the experimental conditions. Blood samples were taken at rest [T0], immediately after [IA], 3 [T3], and 5 minutes [T5] after each condition. SPE of UL, LL, and general, and VT were measured at the end of each condition. Results: The 1 RM was reduced after the session in all conditions for both UL (A = -19.4%, B = -23.0%, C = -22.8%) and LL (A = -16.2 %, B = -15.3%, C = -16.1%) with no difference between conditions. The SPE presented similar results between the conditions (Condition A=8.4, Condition B=8.7, Condition C=8.7). There was a significant increase in La at time T3 of condition C compared to the other conditions: (C=7.29 mmol.L