Shaiane Silva Tomazoni

Effects of Low-Level Laser Therapy (LLLT) in the Development of Exercise-Induced Skeletal Muscle Fatigue and Changes in Biochemical Markers Related to Postexercise Recovery

STUDY DESIGN Randomized crossover double-blinded placebo-controlled trial. OBJECTIVE To investigate if low-level laser therapy (LLLT) can affect biceps muscle performance, fatigue development, and biochemical markers of postexercise recovery. BACKGROUND Cell and animal studies have suggested that LLLT can reduce oxidative stress and inflammatory responses in muscle tissue. But it remains uncertain whether these findings can translate into humans in sport and exercise situations. METHODS Nine healthy male volleyball players participated in the study. They received either active LLLT (cluster probe with 5 laser diodes; lambda = 810 nm; 200 mW power output; 30 seconds of irradiation, applied in 2 locations over the biceps of the nondominant arm; 60 J of total energy) or placebo LLLT using an identical cluster probe. The intervention or placebo were applied 3 minutes before the performance of exercise. All subjects performed voluntary elbow flexion repetitions with a workload of 75% of their maximal voluntary contraction force until exhaustion. RESULTS Active LLLT increased the number of repetitions by 14.5% (mean +/- SD, 39.6 +/- 4.3 versus 34.6 +/- 5.6; P = .037) and the elapsed time before exhaustion by 8.0% (P = .034), when compared to the placebo treatment. The biochemical markers also indicated that recovery may be positively affected by LLLT, as indicated by postexercise blood lactate levels (P<.01), creatine kinase activity (P = .017), and C-reactive protein levels (P = .047), showing a faster recovery with LLLT application prior to the exercise. CONCLUSION We conclude that pre-exercise irradiation of the biceps with an LLLT dose of 6 J per application location, applied in 2 locations, increased endurance for repeated elbow flexion against resistance and decreased postexercise levels of blood lactate, creatine kinase, and C-reactiveprotein. LEVEL OF EVIDENCE Performance enhancement, level 1b.

Low‐level Laser Therapy Improves Skeletal Muscle Performance, Decreases Skeletal Muscle Damage and Modulates mRNA Expression of COX‐1 and COX‐2 in a Dose‐dependent Manner

We tested if modulation in mRNA expression of cyclooxygenase isoforms (COX‐1 and COX‐2) can be related to protective effects of phototherapy in skeletal muscle. Thirty male Wistar rats were divided into five groups receiving either one of four laser doses (0.1, 0.3, 1.0 and 3.0 J) or a no‐treatment control group. Laser irradiation (904 nm, 15 mW average power) was performed immediately before the first contraction for treated groups. Electrical stimulation was used to induce six tetanic tibial anterior muscle contractions. Immediately after sixth contraction, blood samples were collected to evaluate creatine kinase activity and muscles were dissected and frozen in liquid nitrogen to evaluate mRNA expression of COX‐1 and COX‐2. The 1.0 and 3.0 J groups showed significant enhancement (P < 0.01) in total work performed in six tetanic contractions compared with control group. All laser groups, except the 3.0 J group, presented significantly lower post‐exercise CK activity than control group. Additionally, 1.0 J group showed increased COX‐1 and decreased COX‐2 mRNA expression compared with control group and 0.1, 0.3 and 3.0 J laser groups (P < 0.01). We conclude that pre‐exercise infrared laser irradiation with dose of 1.0 J enhances skeletal muscle performance and decreases post‐exercise skeletal muscle damage and inflammation.

Low-level laser therapy and sodium diclofenac in acute inflammatory response induced by skeletal muscle trauma: effects in muscle morphology and mRNA gene expression of inflammatory markers.

Pharmacological therapy is widely used in the treatment of muscle injuries. On the other hand, low‐level laser therapy (LLLT) arises as a promising nonpharmacological treatment. The aim of this study was to analyze the effects of sodium diclofenac (topical application) and LLLT on morphological aspects and gene expression of biochemical inflammatory markers. We performed a single trauma in tibialis anterior muscle of rats. After 1 h, animals were treated with sodium diclofenac (11.6 mg g‐1 of solution) or LLLT (810 nm; continuous mode; 100 mW; 3.57 W cm−2; 1, 3 or 9 J; 10, 30 or 90 s). Histological analysis and quantification of gene expression (real‐time polymerase chain reaction—RT‐PCR) of cyclooxygenase 1 and 2 (COX‐1 and COX‐2) and tumor necrosis factor‐alpha (TNF‐α) were performed at 6, 12 and 24 h after trauma. LLLT with all doses improved morphological aspects of muscle tissue, showing better results than injury and diclofenac groups. All LLLT doses also decreased (P < 0.05) COX‐2 compared to injury group at all time points, and to diclofenac group at 24 h after trauma. In addition, LLLT decreased (P < 0.05) TNF‐α compared both to injury and diclofenac groups at all time points. LLLT mainly with dose of 9 J is better than topical application of diclofenac in acute inflammation after muscle trauma.

Superpulsed Low-Level Laser Therapy Protects Skeletal Muscle of mdx Mice against Damage, Inflammation and Morphological Changes Delaying Dystrophy Progression

Aim To evaluate the effects of preventive treatment with low-level laser therapy (LLLT) on progression of dystrophy in mdx mice. Methods Ten animals were randomly divided into 2 experimental groups treated with superpulsed LLLT (904 nm, 15 mW, 700 Hz, 1 J) or placebo-LLLT at one point overlying the tibialis anterior muscle (bilaterally) 5 times per week for 14 weeks (from 6th to 20th week of age). Morphological changes, creatine kinase (CK) activity and mRNA gene expression were assessed in animals at 20th week of age. Results Animals treated with LLLT showed very few morphological changes in skeletal muscle, with less atrophy and fibrosis than animals treated with placebo-LLLT. CK was significantly lower (p = 0.0203) in animals treated with LLLT (864.70 U.l−1, SEM 226.10) than placebo (1708.00 U.l−1, SEM 184.60). mRNA gene expression of inflammatory markers was significantly decreased by treatment with LLLT (p<0.05): TNF-α (placebo-control = 0.51 µg/µl [SEM 0.12], - LLLT = 0.048 µg/µl [SEM 0.01]), IL-1β (placebo-control = 2.292 µg/µl [SEM 0.74], - LLLT = 0.12 µg/µl [SEM 0.03]), IL-6 (placebo-control = 3.946 µg/µl [SEM 0.98], - LLLT = 0.854 µg/µl [SEM 0.33]), IL-10 (placebo-control = 1.116 µg/µl [SEM 0.22], - LLLT = 0.352 µg/µl [SEM 0.15]), and COX-2 (placebo-control = 4.984 µg/µl [SEM 1.18], LLLT = 1.470 µg/µl [SEM 0.73]). Conclusion Irradiation of superpulsed LLLT on successive days five times per week for 14 weeks decreased morphological changes, skeletal muscle damage and inflammation in mdx mice. This indicates that LLLT has potential to decrease progression of Duchenne muscular dystrophy.

Using Pre-Exercise Photobiomodulation Therapy Combining Super-Pulsed Lasers and Light-Emitting Diodes to Improve Performance in Progressive Cardiopulmonary Exercise Tests.

CONTEXT Skeletal muscle fatigue and exercise performance are novel areas of research and clinical application in the photobiomodulation field, and positive outcomes have been reported in several studies; however, the optimal measures have not been fully established. OBJECTIVE To assess the acute effect of photobiomodulation therapy (PBMT) combining superpulsed lasers (low-level laser therapy) and light-emitting diodes (LEDs) on muscle performance during a progressive cardiopulmonary treadmill exercise test. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty untrained male volunteers (age = 26.0 ± 6.0 years, height = 175.0 ± 10.0 cm, mass = 74.8 ± 10.9 kg). INTERVENTION(S) Participants received PBMT with either combined superpulsed lasers and LED (active PBMT) or placebo at session 1 and the other treatment at session 2. All participants completed a cardiopulmonary test on a treadmill after each treatment. For active PBMT, we performed the irradiation at 17 sites on each lower limb (9 on the quadriceps, 6 on the hamstrings, and 2 on the gastrocnemius muscles), using a cluster with 12 diodes (four 905-nm superpulsed laser diodes with an average power of 0.3125 mW, peak power of 12.5 W for each diode, and frequency of 250 Hz; four 875-nm infrared LED diodes with an average power of 17.5 mW; and four 640-nm red LED diodes with an average power of 15 mW) and delivering a dose of 30 J per site. MAIN OUTCOME MEASURE(S) Distance covered, time until exhaustion, pulmonary ventilation, and dyspnea score. RESULTS The distance covered (1.96 ± 0.30 versus 1.84 ± 0.40 km, t19 = 2.119, P < .001) and time until exhaustion on the cardiopulmonary test (780.2 ± 91.0 versus 742.1 ± 94.0 seconds, t19 = 3.028, P < .001) was greater after active PBMT than after placebo. Pulmonary ventilation was greater (76.4 ± 21.9 versus 74.3 ± 19.8 L/min, t19 = 0.180, P = .004) and the score for dyspnea was lower (3.0 [interquartile range = 0.5-9.0] versus 4.0 [0.0-9.0], U = 184.000, P < .001) after active PBMT than after placebo. CONCLUSIONS The combination of lasers and LEDs increased the time, distance, and pulmonary ventilation and decreased the score of dyspnea during a cardiopulmonary test.

Isolated and combined effects of photobiomodulation therapy, topical nonsteroidal anti-inflammatory drugs, and physical activity in the treatment of osteoarthritis induced by papain

Abstract. Osteoarthritis (OA) is a chronic inflammatory disease and is characterized as a degenerative process. This study aimed to evaluate and compare the effects of a topical nonsteroidal anti-inflammatory drug (NSAID), physical activity, and photobiomodulation therapy (PBMT) applied alone and/or in combination between them in an experimental model of knee OA. OA was induced by injection of papain in the knees of rats. After 21 days, the animals started to be treated with the above treatment. Histological analysis shows that the experimental model of OA induction causes morphological changes consistent with the disease, and among treatments, the PBMT is the most effective for reducing these changes. Moreover, the results demonstrate that PBMT and NSAID reduce the total number of cells in the inflammatory infiltrate (p<0.05) and PBMT was the most effective for reducing the activity of myeloperoxidase (p<0.05). Finally, we observed that both NSAID and PBMT were effective for reducing the gene expression of MMP-3 (p<0.05), but in relation to the gene expression of MMP-13, PBMT was the most effective treatment (p<0.05). The results of this study indicate that PBMT is the most effective therapy in stopping disease progression, and improving inflammatory conditions observed in OA.

Análise dos efeitos da cinesioterapia e da hidrocinesioterapia sobre a qualidade de vida de pacientes com fibromialgia – um ensaio clínico randomizado

OBJECTIVE: To verify and compare the effects of hydrokinesiotherapy and kinesiotherapy in the quality of life of patients with fibromyalgia. MATERIALS AND METHODS: It was realized a randomized clinical trial, blinded, to observers. To evaluate the quality of life, it was used the generic questionnaire SF- 36 in order to analyze the physical and psychological aspects, in 24 female patients with fibromyalgia, between 30 and 55 years old, placed aleatorialy in two groups: hydrokinesiotherapy and kinesiotherapy. During a period of 23 weeks, the patients were submitted to stretching and aerobic exercises of low intensity with one hour of duration each section (in both groups). RESULTS: It was observed statistically significant increase (p < 0,05) in the majority of the aspects of SF-36 in both groups. CONCLUSION: The hydrokinesiotherapy provides a favorable muscle relaxing to improve the quality of life, however it is not the main factor to decrease the effects of the pathology, since the kinesiotherapy also provided beneficent effects to promote the well being of these patients. Therefore, stretching and aerobic exercises of low intensity employed in both protocols are the probable responsibles by positive effects observed in both therapeutic modalities analysed.

Effect of simvastatin on passive strain-induced skeletal muscle injury in rats

Introduction: HMG‐CoA reductase inhibitors are the most frequently prescribed drugs for treatment of lipid imbalance, but they have side effects, such as myopathy. Our aim was to assess the effect of simvastatin on the inflammatory process induced by skeletal muscle injury. Methods: Rats were divided into experimental groups [control group, simvastatin (20 mg/kg) group, group treated with simvastatin (20 mg/kg) and subjected to injury, and group subjected to injury only]. Histological analysis and analyses of creatine kinase activity and C‐reactive protein were performed. Results: Animals treated with simvastatin exhibited significantly greater morphological and structural skeletal muscle damage in comparison to the control group and injured animals without treatment. Conclusions: Although simvastatin has a small anti‐inflammatory effect in the early stage after a muscle strain injury, the overall picture is negative, as simvastatin increases the extent of damage to muscle morphology. Further studies are needed. Muscle Nerve, 2012

A fototerapia com diodo emissor de luz (LEDT) aplicada pré-exercício inibe a peroxidação lipídica em atletas após exercício de alta intensidade: um estudo preliminar

Oxidative stress is the term generally used to describe the damage caused by imbalance between pro-oxidants and antioxidants in the organism. The increase in the O2 consumption induced by physical exercise is associated with the increase of reactive oxygen species (ROS) being these species inducers of oxidative stress. Although the evidence indicates a probable inhibitory effect of the light emitting diode therapy (LEDT) on the production of ROS, there are no studies observing this effect in humans. This preliminary study has the aim to verify the effects of LEDT applied before high-intensity exercise on lipid peroxidation, measured through blood levels of reactive substances to thiobarbituric acid (TBARS). Six male volleyball athletes were submitted to two situations: active LEDT and placebo LEDT. Performance in the exercise protocol showed no difference (p> 0.05) between the two situations in peak power, average power and fatigue index. The results related to lipid peroxidation were: at active LEDT situation, it was not possible to observe statistically significant difference (p>0.05) between pre and post exercise levels (6.98 ± 0.81 and 7.02 ± 0.47 nmol/mL); at placebo LEDT situation, statistically significant difference (p=0.05) was observed between pre and post exercise levels (7.09 ± 1.28 and 8.43 ± 0.71 nmol/mL). These results show that active LEDT seems to be effective in controlling lipid peroxidation in athletes submitted to intense exercise

A laserterapia de baixa potência melhora o desempenho muscular mensurado por dinamometria isocinética em humanos

Skeletal muscle fatigue is a novel research area in laser therapy, there being few studies carried out. Though low-level laser therapy (LLLT) applied prior to exercise has showed positive results in delaying skeletal muscle fatigue, no studies could be found that measured muscle performance and fatigue by means of isokinetic dynamometry. This clinical trial aims at assessing the effects of LLLT (655 nm, 50 mW and 12 J total energy delivered) on anterior tibialis muscle performance and fatigue by means of isokinetic dynamometry (30 concentric-mode repetitions at 240o.sec-1 angular speed) in 14 healthy male subjects. Results show that, when volunteers had been treated with LLLT prior to exercise, torque peak values (30.91±5.86 N.m) were significantly higher than those of three previous measurements with no LLLT (24.92±7.45 N.m, p<0.001; 26.83±7.74 N.m, p<0.01; and 26.00±7.88 N.m, p<0.001). However, no decrease in fatigue indexes could be found. It may thus be said that LLLT increased skeletal muscle torque in irradiated muscles, but had no effect on muscle fatigue.