Kaelin C. Young

Rehabilitation of an osteochondral fracture using blood flow restricted exercise: A case review

OBJECTIVES In this case review we report on a bodybuilder who used a practical model of blood flow restriction (BFR) training to successfully rehabilitate himself following an injury to his right knee. RESULTS The patient originally thought he had torn his meniscus however repeat radiographs and magnetic resonance imaging (MRI) confirmed an osteochondral fracture. The patient initially sought out a low load alternative to help with the maintenance of skeletal muscle mass. However, following rehabilitation with low load BFR resistance training, radiographs indicated that the bone had begun to heal suggesting that this type of training may also benefit bone. CONCLUSIONS In conclusion, this case review provides evidence that practical BFR using knee wraps can serve as an effective stimulus during rehabilitation from a knee injury.

Blood flow restriction: rationale for improving bone.

Low intensity exercise with blood flow restriction has been shown to increase muscle hypertrophy and strength similar to high intensity resistance exercise. Interestingly, low intensity resistance exercise to failure has shown the same muscle protein synthesis response as higher intensity exercise, questioning the need for blood flow restriction during low intensity exercise. The purpose of this manuscript is to discuss the mechanisms and potential benefits of blood flow restricted exercise on bone adaptation and provide rationale as to why low load resistance exercise to failure would be unlikely to produce these benefits. The studies completed thus far support the hypothesis that training with blood flow restriction may provide not only a novel modality to induce adaptation in muscle but also bone, which was previously thought to only occur with higher intensity/impact exercise. We hypothesize that the main mechanism behind the proposed favorable bone responses observed thus far is through increased intramedullary pressure and interstitial fluid flow within the bone caused by venous occlusion. Therefore, although similar muscular benefits may be observed from low intensity exercise performed to failure (e.g. strength, hypertrophy, and endurance), the response of bone might be different, highlighting the potential importance of the blood flow restriction stimulus.

Acute bone marker responses to whole-body vibration and resistance exercise in young women.

Whole-body vibration (WBV) augments the musculoskeletal effects of resistance exercise (RE). However, its acute effects on bone turnover markers (BTM) have not been determined. This study examined BTM responses to acute high-intensity RE and high-intensity RE with WBV (WBV+RE) in young women (n=10) taking oral contraceptives in a randomized, crossover repeated measures design. WBV+RE exposed subjects to 5 one-minute bouts of vibration (20 Hz, 3.38 peak-peak displacement, separated by 1 min of rest) before RE. Fasting blood samples were obtained before (Pre), immediately after WBV (PostVib), immediately after RE (IP), and 30-min after RE (P30). Bone alkaline phosphatase did not change at any time point. Tartrate-resistant acid phosphatase 5b significantly increased (p<0.05) from the Pre to PostVib, then decreased from IP to P30 for both conditions. C-terminal telopeptide of type I collagen (CTX) significantly decreased (p<0.05) from Pre to PostVib and from Pre to P30 only for WBV+RE. WBV+RE showed a greater decrease in CTX than RE (-12.6% ± 4.7% vs -1.13% ± 3.5%). In conclusion, WBV was associated with acute decreases in CTX levels not elicited with RE alone in young women.

Mechanical scale and load cell underwater weighing: a comparison of simultaneous measurements and the reliability of methods.

Moon, JR, Stout, JR, Walter, AA, Smith, AE, Stock, MS, Herda, TJ, Sherk, VD, Young, KC, Lockwood, CM, Kendall, KL, Fukuda, DH, Graef, JL, Cramer, JT, Beck, TW, and Esposito, EN. Mechanical scale and load cell underwater weighing: a comparison of simultaneous measurements and the reliability of methods. J Strength Cond Res 25(3): 652-661, 2011-Both load cell and mechanical scale-based hydrostatic weighing (HW) systems are used for the measurement of underwater weight. However, there has been no direct comparison of the 2 methods. The purpose of the current investigation was to simultaneously compare a load cell and mechanical scale for use in HW. Twenty-seven men and women (mean ± SD, age: 22 ± 2 years) participated in the 2-day investigation. Each subject completed 2 HW assessments 24 hours apart. Single-day comparisons of all trials for both days revealed no significant difference between the mechanical scale and the load cell (mean difference < 0.016 kg, p > 0.05). True underwater weight values were not significantly different between methods for either days (mean difference < 0.014 kg, p > 0.05) and accounted for a mean difference in percent fat (%FAT) of <0.108%. The 95% limits of agreement indicated a maximum difference between methods of 0.53% FAT. Both methods produced similar reliability SEM values (mechanical SEM < 0.72%FAT, load cell SEM < 0.75%FAT). In conclusion, there was no difference between mechanical scale and load cell measurements of underwater weights and the added precision of the load cell only marginally (<0.16%FAT) improved day-to-day reliability. Either a mechanical scale or load cell can be used for HW with similar accuracy and reliability in young adults with a body mass index of 18.7-34.4 (5-25%FAT).

Molecular, neuromuscular, and recovery responses to light versus heavy resistance exercise in young men

Recent evidence suggests that resistance training with light or heavy loads to failure results in similar adaptations. Herein, we compared how both training modalities affect the molecular, neuromuscular, and recovery responses following exercise. Resistance‐trained males (mean ± SE: 22 ± 2 years, 84.8 ± 9.0 kg, 1.79 ± 0.06 m; n = 15) performed a crossover design of four sets of leg extensor exercise at 30% (light RE) or 80% (heavy RE) one repetition maximum (1RM) to repetition failure, and heavy RE or light RE 1 week later. Surface electromyography (EMG) was monitored during exercise, and vastus lateralis muscle biopsies were collected at baseline (PRE), 15 min (15mPOST), and 90 min following RE (90mPOST) for examination of molecular targets and fiber typing. Isokinetic dynamometry was also performed before (PRE), immediately after (POST), and 48 h after (48hPOST) exercise. Dependent variables were analyzed using repeated measures ANOVAs and significance was set at P ≤ 0.05. Repetitions completed were greater during light RE (P < 0.01), while EMG amplitude was greater during heavy RE (P ≤ 0.01). POST isokinetic torque was reduced following light versus heavy RE (P < 0.05). Postexercise expression of mRNAs and phosphoproteins associated with muscle hypertrophy were similar between load conditions. Additionally, p70s6k (Thr389) phosphorylation and fast‐twitch fiber proportion exhibited a strong relationship after both light and heavy RE (r > 0.5). While similar mRNA and phosphoprotein responses to both modalities occurred, we posit that heavy RE is a more time‐efficient training method given the differences in total repetitions completed, lower EMG amplitude during light RE, and impaired recovery response after light RE.

Whey protein-derived exosomes increase protein synthesis and hypertrophy in C2­C12 myotubes

We sought to examine potential amino acid independent mechanisms whereby hydrolyzed whey protein (WP) affects muscle protein synthesis (MPS) and anabolism in vitro. Specifically, we tested (1) whether 3-h and 6-h treatments of WP, essential amino acids, or l-leucine (Leu) affected MPS, and whether 6-h treatments with low-, medium-, or high doses of WP versus Leu affected MPS; (2) whether knockdown of the primary Leu transporter affected WP- and Leu-mediated changes in MPS, mammalian target of rapamycin (mTOR) signaling responses, or both, following 6-h treatments; (3) whether exosomes isolated from WP (WP-EXO) affected MPS, mTOR signaling responses, or both, compared with untreated (control) myotubes, following 6-h, 12-h, and 24-h treatments, and whether they affected myotube diameter following 24-h and 48-h treatments. For all treatments, 7-d post-differentiated C2C12 myotubes were examined. In experiment 1, 6-h WP treatments increased MPS compared with control (+46%), Leu (+24%), and essential amino acids (+25%). Moreover, the 6-h low-, medium-, and high WP treatments increased MPS by approximately 40 to 50% more than corresponding Leu treatments. In experiment 2 (LAT short hairpin RNA-transfected myotubes), 6-h WP treatments increased MPS compared with control (+18%) and Leu (+19%). In experiment 3, WP-EXO treatments increased MPS over controls at 12h (+18%) and 24h (+45%), and myotube diameters increased with 24-h (+24%) and 48-h (+40%) WP-EXO treatments compared with controls. The WP-EXO treatments did not appear to operate through mTOR signaling; instead, they increased mRNA and protein levels o eukaryotic initiation factor 4A. Bovine-specific microRNA following 24-h WP-EXO treatments were enriched in myotubes (chiefly miR-149-3p, miR-2881), but were not related to hypertrophic gene targets. To summarize, hydrolyzed WP-EXO increased skeletal MPS and anabolism in vitro, and this may be related to an unknown mechanism that increases translation initiation factors rather than enhancing mTOR signaling or the involvement of bovine-specific microRNA.

Aging in rats differentially affects markers of transcriptional and translational capacity in soleus and plantaris muscle

Alterations in transcriptional and translational mechanisms occur during skeletal muscle aging and such changes may contribute to age-related atrophy. Herein, we examined markers related to global transcriptional output (i.e., myonuclear number, total mRNA and RNA pol II levels), translational efficiency [i.e., eukaryotic initiation and elongation factor levels and muscle protein synthesis (MPS) levels] and translational capacity (ribosome density) in the slow-twitch soleus and fast-twitch plantaris muscles of male Fischer 344 rats aged 3, 6, 12, 18, and 24 months (n = 9–10 per group). We also examined alterations in markers of proteolysis and oxidative stress in these muscles (i.e., 20S proteasome activity, poly-ubiquinated protein levels and 4-HNE levels). Notable plantaris muscle observations included: (a) fiber cross sectional area (CSA) was 59% (p < 0.05) and 48% (p < 0.05) greater in 12 month vs. 3 month and 24 month rats, respectively, suggesting a peak lifetime value near 12 months and age-related atrophy by 24 months, (b) MPS levels were greatest in 18 month rats (p < 0.05) despite the onset of atrophy, (c) while regulators of ribosome biogenesis [c-Myc and upstream binding factor (UBF) protein levels] generally increased with age, ribosome density linearly decreased from 3 months of age and RNA polymerase (Pol) I protein levels were lowest in 24 month rats, and d) 20S proteasome activity was robustly up-regulated in 6 and 24 month rats (p < 0.05). Notable soleus muscle observations included: (a) fiber CSA was greatest in 6 month rats and was maintained in older age groups, and (b) 20S proteasome activity was modestly but significantly greater in 24 month vs. 3/12/18 month rats (p < 0.05), and (c) total mRNA levels (suggestive of transcriptional output) trended downward in older rats despite non-significant between-group differences in myonuclear number and/or RNA Pol II protein levels. Collectively, these findings suggest that plantaris, not soleus, atrophy occurs following 12 months of age in male Fisher rats and this may be due to translational deficits (i.e., changes in MPS and ribosome density) and/or increases in proteolysis rather than increased oxidative stress and/or alterations in global transcriptional mechanisms.

Cross talk between androgen and Wnt signaling potentially contributes to age-related skeletal muscle atrophy in rats

We sought to determine whether age-related gastrocnemius muscle mass loss was associated with parallel decrements in androgen receptor (AR) or select Wnt signaling markers. To test this hypothesis, serum-free and total testosterone (TEST) and gastrocnemius AR and Wnt signaling markers were analyzed in male Fischer 344 rats that were 3, 6, 12, 18, and 24 mo (mo) old ( n = 9 per group). Free and total TEST was greatest in 6 mo rats, and AR protein and Wnt5 protein levels linearly declined with aging. There were associations between Wnt5 protein levels and relative gastrocnemius mass ( r = 0.395, P = 0.007) as well as AR and Wnt5 protein levels (r = 0.670, P < 0.001). We next tested the hypothesis that Wnt5 affects muscle fiber size by treating C2C12-derived myotubes with lower (75 ng/ml) and higher (150 ng/ml) concentrations of recombinant Wnt5a protein. Both treatments increased myotube size ( P < 0.05) suggesting this ligand may affect muscle fiber size in vivo. We next tested if Wnt5a protein levels were androgen-modulated by examining 10-mo-old male Fischer 344 rats ( n = 10-11 per group) that were orchiectomized and treated with testosterone-enanthate (TEST-E); trenbolone enanthate (TREN), a nonaromatizable synthetic testosterone analogue; or a vehicle (ORX only) for 4 wk. Interestingly, TEST-E and TREN treatments increased Wnt5a protein in the androgen-sensitive levator ani/bulbocavernosus muscle compared with ORX only ( P < 0.05). To summarize, aromatizable and nonaromatizable androgens increase Wnt5a protein expression in skeletal muscle, age-related decrements in muscle AR may contribute Wnt5a protein decrements, and our in vitro data imply this mechanism may contribute to age-related muscle loss. NEW & NOTEWORTHY Results from this study demonstrate androgen and Wnt5 protein expression decrease with aging, and this may be a mechanism involved with age-related muscle loss.

Effects of graded whey supplementation during extreme-volume resistance training

We examined hypertrophic outcomes of weekly graded whey protein dosing (GWP) vs. whey protein (WP) or maltodextrin (MALTO) dosed once daily during 6 weeks of high-volume resistance training (RT). College-aged resistance-trained males (training age = 5 ± 3 years; mean ± SD) performed 6 weeks of RT wherein frequency was 3 d/week and each session involved 2 upper- and 2 lower-body exercises (10 repetitions/set). Volume increased from 10 sets/exercise (week 1) to 32 sets/exercise (week 6), which is the highest volume investigated in this timeframe. Participants were assigned to WP (25 g/d; n = 10), MALTO (30 g/d; n = 10), or GWP (25–150 g/d from weeks 1–6; n = 11), and supplementation occurred throughout training. Dual-energy x-ray absorptiometry (DXA), vastus lateralis (VL), and biceps brachii ultrasounds for muscle thicknesses, and bioelectrical impedance spectroscopy (BIS) were performed prior to training (PRE) and after weeks 3 (MID) and 6 (POST). VL biopsies were also collected for immunohistochemical staining. The GWP group experienced the greatest PRE to POST reduction in DXA fat mass (FM) (−1.00 kg, p < 0.05), and a robust increase in DXA fat- and bone-free mass [termed lean body mass (LBM) throughout] (+2.93 kg, p < 0.05). However, the MALTO group also experienced a PRE to POST increase in DXA LBM (+2.35 kg, p < 0.05), and the GWP and MALTO groups experienced similar PRE to POST increases in type II muscle fiber cross-sectional area (~+300 μm2). When examining the effects of training on LBM increases (ΔLBM) in all participants combined, PRE to MID (+1.34 kg, p < 0.001) and MID to POST (+0.85 kg, p < 0.001) increases were observed. However, when adjusting ΔLBM for extracellular water (ECW) changes, intending to remove the confounder of edema, a significant increase was observed from PRE to MID (+1.18 kg, p < 0.001) but not MID to POST (+0.25 kg; p = 0.131). Based upon DXA data, GWP supplementation may be a viable strategy to improve body composition during high-volume RT. However, large LBM increases observed in the MALTO group preclude us from suggesting that GWP supplementation is clearly superior in facilitating skeletal muscle hypertrophy. With regard to the implemented RT program, ECW-corrected ΔLBM gains were largely dampened, but still positive, in resistance-trained participants when RT exceeded ~20 sets/exercise/wk.

Acute and chronic resistance training downregulates select LINE-1 retrotransposon activity markers in human skeletal muscle

Herein, we examined if acute or chronic resistance exercise affected markers of skeletal muscle long interspersed nuclear element-1 (LINE-1) retrotransposon activity. In study 1, 10 resistance-trained college-aged men performed three consecutive daily back squat sessions, and vastus lateralis biopsies were taken before (Pre), 2 h following session 1 (Post1), and 3 days following session 3 (Post2). In study 2, 13 untrained college-aged men performed a full-body resistance training program (3 days/wk), and vastus lateralis biopsies were taken before ( week 0) and ~72 h following training cessation ( week 12). In study 1, LINE-1 mRNA decreased 42-48% at Post1 and 2 ( P < 0.05), and reverse transcriptase (RT) activity trended downward at Post2 (-37%, P = 0.067). In study 2, LINE-1 mRNA trended downward at week 12 (-17%, P = 0.056) while LINE-1 promoter methylation increased (+142%, P = 0.041). Open reading frame (ORF)2p protein expression (-24%, P = 0.059) and RT activity (-26%, P = 0.063) also trended downward by week 12. Additionally, changes in RT activity versus satellite cell number were inversely associated ( r = -0.725, P = 0.008). Follow-up in vitro experiments demonstrated that 48-h treatments with lower doses (1 μM and 10 μM) of efavirenz and nevirapine (non-nucleoside RT inhibitors) increased myoblast proliferation ( P < 0.05). However, we observed a paradoxical decrease in myoblast proliferation with higher doses (50 μM) of efavirenz and delavirdine. This is the first report suggesting that resistance exercise downregulates markers of skeletal muscle LINE-1 activity. Given our discordant in vitro findings, future research is needed to thoroughly assess whether LINE-1-mediated RT activity enhances or blunts myoblast, or primary satellite cell, proliferative capacity.