Nigel Gleeson

Effects of prior concentric training on eccentric exercise induced muscle damage

Background: Exercise induced muscle damage (EIMD) from strenuous unaccustomed eccentric exercise is well documented. So too is the observation that a prior bout of eccentric exercise reduces the severity of symptoms of EIMD. This has been attributed to an increase in sarcomeres in series. Recent studies have suggested that prior concentric training increases the susceptibility of muscle to EIMD following eccentric exercise. This has been attributed to a reduction of sarcomeres in series, which decreases muscle compliance and changes the length-tension relation of muscle contraction. Objective: To assess the effects of prior concentric training on the severity of EIMD. Methods: Four men and four women (mean (SD) age 21.1 (0.8) years) followed a four week concentric training programme. The elbow flexor musculature of the non-dominant arm was trained at 60% of one repetition maximum dynamic concentric strength performance, three times a week, increasing to 70% by week 3. After three days of rest, participants performed 50 maximal isokinetic eccentric contractions on both arms. All participants gave written informed consent before taking part in this study, which was approved by the school ethics committee. Strength, relaxed arm angle (RAA), arm circumference, and soreness on active extension and flexion were recorded immediately before eccentric exercise, one hour after, and at 24 hour intervals for three days. Data were analysed with fully repeated measures analyses of variance. Results: Strength retention was significantly (p<0.01) greater in the control arm than the trained arm (84.0 (13.7)%, 90.4 (14.7)%, 95.2 (10.5)%, 103.5 (7.6)% v 75.5 (11.3)%, 77.6 (15.3)%, 80.1 (13.9)%, 80.9 (12.5)%) at one, 24, 48, and 72 hours respectively. Similarly, soreness was greater in the trained arm (0.7 (0.6), 3.1 (1.4), 3.0 (1.5), 1.9 (2.3)) than in the untrained arm (0 (0.2), 1.6 (1.3), 1.4 (0.6), 0.6 (0.4)) at one, 24, 48, and 72 hours respectively (p<0.05). Concentric training induced a significant reduction in RAA (165.2 (6.7)° v 157.3 (4.9)°) before the eccentric exercise bout (p<0.01). This was further reduced and remained lower in the trained arm at all time points after the eccentric exercise (p<0.01). The arm circumference of the concentrically trained arm was significantly greater than baseline (p<0.05) at 72 hours (30.3 (2.9) v 29.8 (3.3) cm). Conclusions: These findings extend the understanding of the effects of prior concentric training in increasing the severity of EIMD to an upper limb exercise model. The inclusion of concentric conditioning in rehabilitation programmes tends to exacerbate the severity of EIMD in subsequent unaccustomed exercise. However, where concentric conditioning is indicated clinically, the net effect of conditioning outcome and EIMD may still confer enhanced strength performance and capability to dynamically stabilise a joint system.

Influence of acute endurance activity on leg neuromuscular and musculoskeletal performance

PURPOSE The purpose of this study was to investigate the effect of endurance activities designed to simulate the physiological demands of soccer match-play and training, on leg strength, electromechanical delay, and knee laxity. METHODS Eight recreational soccer players completed four exercise trials in random order: 1) a prolonged intermittent high intensity shuttle run (PHISR) which required subjects to complete a total distance of 9600 m in a form simulating the pattern of physical activity in soccer match-play (activity mode; rest-to-work intervals; approximately 90 min duration), 2) a shuttle-run (SR), (3) a treadmill run (TR) which required subjects to complete an equivalent distance at a running speed corresponding to 70% VO2max, and 4) a control condition consisting of no exercise. RESULTS Results from repeated measures ANOVA revealed significant condition (PHISR; SR; TR; control) by time (pre; mid; post) interactions for peak torque (PT: knee extension and flexion: 1.05 rad.s-1), EMD and anterior tibio-femoral displacement (TFD) (P < 0.05). Impairment to indices of knee joint performance was observed in PHISR, SR, and TR trials. The greatest decrement occurred in PHISR and SR trials (up to 44%). Knee extensor and flexor strength performance near to full knee extension (0.44 rad knee flexion) was not changed following the functionally-relevant endurance activities. CONCLUSIONS Even though strength performance near to full knee extension was preserved following acute endurance activities, the risk of ligamentous injury may be increased by concomitant impairment to EMD and anterior TFD.

Low-volume exercise rehabilitation improves functional capacity and self-reported functional status of dialysis patients

Mercer TH, Crawford C, Gleeson NP, Naish PF: Low-volume exercise rehabilitation improves functional capacity and self-reported functional status of dialysis patients. Am J Phys Med Rehabil 2002;81:162–167. ObjectiveThe purpose of this study was to examine the effects of a program of low-volume exercise rehabilitation on the functional capacity and self-reported functional status of nonanemic dialysis patients. DesignThis was a controlled study in a clinical setting with a repeated measures design. Functional capacity and functional status were assessed before and after 12 wk of exercise rehabilitation or 12 wk of normal activity for two groups of dialysis patients. ResultsMixed-model repeated measures analysis of variance revealed significant group by time interactions characterized by improvements for the exercise rehabilitation group alone in total walk, stair-climb, and stair-descent times of 15 ± 5.8%, 22 ± 11%, and 18 ± 12% respectively. Self-reported walking speed, walking impairment–leg weakness, and walking impairment–shortness of breath were also observed to improve significantly for the exercise rehabilitation group alone by 15 ± 13%, 25 ± 11%, and 28 ± 16%, respectively. ConclusionLow-volume exercise rehabilitation can improve activity of daily living–related functional capacity and self-reported functional status of nonanemic dialysis patients.

The effects of plyometric exercise on unilateral balance performance

Abstract The purpose of this study was to determine the effects of plyometric exercise on unilateral balance performance. Nine healthy adults performed baseline measurements on the dominant limb that consisted of: a 20-s unilateral stability test on a tilt balance board, where a higher stability index represented deterioration in balance performance; isokinetic plantar flexion torque at 0.52 and 3.14 rad · s−1; muscle soreness in the calf region; and resting plantar flexion angle. Plyometric exercise consisted of 200 counter-movement jumps designed to elicit symptoms of muscle damage, after which baseline measurements were repeated at 30 min, 24, 48, and 72 h. Perceived muscle soreness of the calf region increased significantly following the plyometric exercise protocol (F4,32 = 17.24, P < 0.01). Peak torque was significantly reduced after the plyometric exercise protocol (F4,32 = 7.49, P < 0.05), with greater loss of force at the lower angular velocity (F4,32 = 3.46, P < 0.05), while resting plantar flexion angle was not significantly altered compared with baseline values (P > 0.05). The stability index was significantly increased (F4,32 = 3.10, P < 0.05) above baseline (mean 2.3, s = 0.3) at 24 h (3.3, s = 0.4), after which values recovered. These results indicate that there is a latent impairment of balance performance following a bout of plyometric exercise, which has implications for both the use of skill-based activities and for increased injury risk following high-intensity plyometric training.

Effects of Stretching on Performances Involving Stretch-Shortening Cycles

BackgroundAlongside its role in athletic conditioning, stretching has commonly been integrated in warm-up routines prior to athletic performance. Numerous studies have reported detrimental acute effects on strength following stretching. Consequently, athletes have been recommended to discontinue stretching as part of warm-ups. In contrast, studies indicate that chronic stretching performed as a separate bout from training or competition may enhance performance. However, the influence of stretching on complex performances has received relatively little attention.ObjectiveThe purpose of this study was to review both the acute and chronic effects of stretching on performances involving the stretch-shortening cycle (SSC).MethodsA systematic search for literature was undertaken (January 2006–December 2012) in which only randomized controlled trials (RCTs) or studies with repeated measures designs were included. The Physiotherapy Evidence Database (PEDro) rating scale was used for quality assessment of the evidence.ResultsThe review included 43 studies, from which conflicting evidence emerged. Approximately half of the studies assessing the acute effect of static stretching reported a detrimental effect on performance, while the remainder found no effect. In contrast, dynamic stretching showed no negative effects and improved performance in half of the trials. The effect size associated with static and dynamic stretching interventions was commonly low to moderate, indicating that the effect on performance might be limited in practice. Factors were identified that might have contributed to the conflicting results reported across studies, such as type of SSC performance and carrying out dynamic activity between the stretching bout and performance. Few studies since 2006 have addressed the chronic effect of stretching on functional and sports performance. Although negative effects were not reported, robust evidence of the overall beneficial effects within current bibliographic databases remains elusive. Plausible mechanisms for the observed effects from stretching are discussed, as well as possible factors that may have contributed to contradictory findings between studies.LimitationsConsiderable heterogeneity in study design and methods makes comparison between studies challenging. No regression analysis of the contribution of different predictors to variation between trials had previously been performed. Hence, predictors had to be selected on the basis of a qualitative analysis of the predictors that seemed most influential, as well as being identified in previous narrative reviews.ConclusionDifferent types of stretching have differential acute effects on SSC performances. The recommended volume of static stretching required to increase flexibility might induce a negative acute effect on performances involving rapid SSCs, but the effect sizes of these decrements are commonly low, indicating that the acute effect on performance might be limited in practice. No negative acute effects of dynamic stretching were reported. For athletes that require great range of motion (ROM) and speed in their sport, long-term stretching successfully enhances flexibility without negatively affecting performance. Acute dynamic stretching may also be effective in inducing smaller gains in ROM prior to performance without any negative effects being observed.

Single measurement reliability and reproducibility of volitional and magnetically-evoked indices of neuromuscular performance in adults

This study documents intra-session and inter-day reproducibility (coefficient of variation [V%]) and single measurement reliability (intra-class correlations [R(I)]; standard error of a single measurement [SEM%] [95% confidence limits]) of indices of neuromuscular performance elicited during peripheral nerve magnetic stimulation. Twelve adults (five men and seven women) completed 3 assessment sessions on 3 days, during which multiple assessments of knee flexor volitional and magnetically-evoked indices of electromechanical delay (EMD(V); EMD(E)), rate of force development (RFD(V); RFD(E)), peak force (PF(V); P(T)F(E)), and compound muscle action potential latency (LAT(E)) and amplitude (AMP(E)) were obtained. Results showed that magnetically-evoked indices of neuromuscular performance offered statistically equivalent levels of measurement reproducibility (V%: 4.3-31.2%) and reliability (R(I): 0.98-0.51) compared to volitional indices (V%: 3.7-25.2%; R(I): 0.98-0.64), which support the efficacy of both approaches to assessment and the indices PF(V), EMD(V), EMD(E) and LAT(E) offer the greatest practical utility for assessing neuromuscular performance.

The differential effects of PNF versus passive stretch conditioning on neuromuscular performance

Abstract The effects of flexibility conditioning on neuromuscular and sensorimotor performance were assessed near to full knee extension (25°). Eighteen males who were randomly assigned into two groups underwent eight weeks (three-times per week) of flexibility conditioning (hip region/knee flexor musculature; dominant limb) involving either proprioceptive neuromuscular facilitation (PNF) (n=9) or passive stretching (PASS) (n=9). Both modes of flexibility conditioning are popular within contemporary exercise and clinical settings and have demonstrated efficacy in improving range of motion. The contralateral limb and a prior ‘no exercise’ condition were used as controls. The PNF and PASS modes of conditioning improved passive hip flexibility to a similar extent (mean 19.3% vs. baseline, intervention limb, p<0.01) but did not alter knee flexor strength (overall mean 309.6±81 N) or sensorimotor performance (force and positional errors: 2.3±8.2% and 0.48±7.1%). Voluntary and magnetically evoked electromechanical delays (EMDV and EMDE, respectively) were increased but to a greater extent following PASS compared to PNF (PASS: 10.8% and 16.9% lengthening of EMDV and EMDE, respectively vs. PNF: 3.2% and 6.2%, p<0.01).The attenuated change to electromechanical delay (EMD) performance during PNF conditioning suggests a preserved capability for rapid muscle activation, which is important in the maintenance of dynamic joint stability. That PNF was also equally efficacious in flexibility conditioning would suggest that this mode of flexibility training should be used over passive to help preserve dynamic joint stability capabilities at this extended and vulnerable joint position.

Knee joint neuromuscular activation performance during muscle damage and superimposed fatigue

Abstract This study examined the concurrent effects of exercise-induced muscle damage and superimposed acute fatigue on the neuromuscular activation performance of the knee flexors of nine males (age: 26.7±6.1 years; height 1.81±0.05 m; body mass 81.2±11.7 kg [mean±s]). Measures were obtained during three experimental conditions: (i) ‘fatigue-muscle damage’, involving acute fatiguing exercise performed on each assessment occasion plus a single episode of eccentric exercise performed on the first occasion and after the fatigue trial; (ii) ‘fatigue’, involving the fatiguing exercise only; and (iii) ‘control’ consisting of no exercise. Assessments were performed prior to (pre) and at 1 h, 24 h, 48 h, 72 h, and 168 h relative to the muscle damaging eccentric exercise. Repeated-measures analyses of variance (ANOVAs) showed that muscle damage elicited reductions of up to 38%, 24% and 65% in volitional peak force, electromechanical delay and rate of force development compared to baseline and controls, respectively (F [10, 80] = 2.3 to 4.6; P < 0.05) with further impairments (6.2% to 30.7%) following acute fatigue (F [2, 16] = 4.3 to 9.1; P < 0.05). By contrast, magnetically-evoked electromechanical delay was not influenced by muscle damage and was improved during the superimposed acute fatigue (∼14%; F [2, 16] = 3.9; P < 0.05). The safeguarding of evoked muscle activation capability despite compromised volitional performance might reveal aspects of capabilities for emergency and protective responses during episodes of fatigue and antecedent muscle damaging exercise.

The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review

PurposeDespite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature.MethodsA systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool.ResultsThirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III.ConclusionsFindings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II–III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.

Joint angle affects volitional and magnetically-evoked neuromuscular performance differentially

This study examined the volitional and magnetically-evoked neuromuscular performance of the quadriceps femoris at functional knee joint angles adjacent to full extension. Indices of volitional and magnetically-evoked neuromuscular performance (N=15 healthy males, 23.5 ± 2.9 years, 71.5 ± 5.4 kg, 176.5 ± 5.5 cm) were obtained at 25°, 35° and 45° of knee flexion. Results showed that volitional and magnetically-evoked peak force (PF(V) and P(T)F(E), respectively) and electromechanical delay (EMD(V) and EMD(E), respectively) were enhanced by increased knee flexion. However, greater relative improvements in volitional compared to evoked indices of neuromuscular performance were observed with increasing flexion from 25° to 45° (e.g. EMD(V), EMD(E): 36% vs. 11% improvement, respectively; F([2,14])=6.8, p<0.05). There were no significant correlations between EMD(V) and EMD(E) or PF(V) and P(T)F(E), at analogous joint positions. These findings suggest that the extent of the relative differential between volitional and evoked neuromuscular performance capabilities is joint angle-specific and not correlated with performance capabilities at adjacent angles, but tends to be smaller with increased flexion. As such, effective prediction of volitional from evoked performance capabilities at both analogous and adjacent knee joint positions would lack robustness.