Blood Flow Restriction during Walking Does Not Impact Body Composition or Performance Measures in Highly Trained Runners.

Blood flow restriction (BFR) is a commonly used training modality that has been demonstrated to enhance muscle characteristics such as size and function. The purpose of this study was to determine if a 4-week walking program with or without BFR in healthy, active adults has an effect on body composition, anaerobic, and aerobic running performance. Thirty-three participants, randomized among three groups, completed the walking program, which included five sets of 2 min walking intervals with 1 min rest, with or without BFR, or 10 min walking with BFR. Assessments completed before and after the walking program included body composition, 40-yard sprints, and a VO2MAX test on a treadmill. A two-way ANOVA revealed no changes among the groups nor for any variables at any time (p > 0.05). Additionally, one main effect for time indicated the VO2 at V-slope threshold was greater following training for all groups combined (p = 0.001). The results demonstrate that low volume and intensity walking with BFR for 4 weeks did not provide a sufficient stimulus for changing body composition or performance metrics in a group of very active adults. Longer or more isolated exposure of BFR on the limbs may contribute to more pronounced adaptations.

Motor unit firing rates increase in prepubescent youth following linear periodization resistance exercise training.

PURPOSE: The purpose was to examine the effects of 8-weeks (3 days/week) of linear periodization resistance exercise training (RET) on neuromuscular function in prepubescent youth. METHODS: Twenty-five healthy prepubescent youth (11 males, 14 females, age = 9.1 ± 0.8 years) completed the RET (n = 17) or served as controls (CON, n = 8). Isometric maximal voluntary contractions (MVCs) and trapezoidal submaximal contractions at 35 and 60% MVC of the right leg extensors were performed with surface electromyography (EMG) recorded from the leg extensors [vastus lateralis (VL), rectus femoris, and vastus medialis] and flexors (biceps femoris and semitendinosus). EMG amplitude of the leg extensors and flexors were calculated during the MVCs. Motor unit (MU) action potential trains were decomposed from the surface EMG of the VL for the 35 and 60% MVCs. MU firing rates and action potential amplitudes were regressed against recruitment threshold with the y-intercepts and slopes calculated for each contraction. Total leg extensor muscle cross-sectional area (CSA) was collected using ultrasound images. ANOVA models were used to examine potential differences. RESULTS: Isometric strength increased post-RET (P = 0.006) with no changes in leg extensor and flexor EMG amplitude. Furthermore, there were no changes in total CSA or the MU action potential amplitude vs. recruitment threshold relationships. However, there were increases in the firing rates of the higher-threshold MUs post-RET as indicated with greater y-intercepts (P = 0.003) from the 60% MVC and less negative slope (P = 0.004) of the firing rates vs. recruitment threshold relationships at 35% MVC. CONCLUSIONS: MU adaptations contribute to strength increases following RET in prepubescent youth.

Psychological Readiness Is Weakly Related to Physical Function Tests at Return to Sport for Men and Not at All for Women Following Anterior Cruciate Ligament Reconstruction and Rehabilitation.

PURPOSE: To assess the relationships between physical function tests of the operative limb and psychological readiness to return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction (return to sport after injury [ACL-RSI]) by sex. A secondary purpose was to quantify sex-specific differences in physical function test outcomes. METHODS: Patient records were retrospectively identified as cases who performed RTS physical function testing (strength, horizontal hops, vertical jumps, single-leg leg press, and drop landing knee excursion, etc.), and completed a 6-question ACL-RSI survey at the time point they were cleared to RTS. Independent t-tests compared all variables between sex at P ≤ .05. Correlations and regression models were produced per sex to identify factors related to operative limb physical function tests and ACL-RSI scores. RESULTS: With a total of 127 patients (63 men; 64 women), there was no difference in ACL-RSI scores and leg press repetitions between sex (P = .32 and P = .12, respectively). There were sex differences for all other physical performance outcomes (P < .001 for all). To estimate readiness using physical function test scores, the men's regression model identified knee excursion (ß = 0.345; P = .033) as the only contributor to ACL-RSI (R2 = 0.089), whereas there was no relationship between physical performance outcomes and ACL-RSI in women (R2 = 0.00, P = 1.00). CONCLUSIONS: Men and women reported similar ACL-RSI scales, indicating high readiness to return to sport. Likely due to sex-related physiological differences, men performed better at most physical function tests. Further, male ACL-RSI could be predicted using only one physical function outcome and 91% variability of the ACL-RSI coming from other contributors not evaluated, as indicated by R2. No physical function variables predict ACL-RSI in women. The evaluated variables are considered the primary indicators relevant for patients to be permitted to RTS yet cannot adequately predict psychological readiness in these patients. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

A Brief Review of the Literature for Published Dual-Energy X-Ray Absorptiometry Protocols for Athletes.

CONTEXT: Dual-energy x-ray absorptiometry (DXA) is widely known for its utility in diagnosing a patient with osteopenia or osteoporosis; however, its utility in evaluation of body composition and potential athletic performance was previously routinely overlooked. In recent years, athletic programs have begun employing this equipment during athlete screening. However, it is currently unknown how athletic programs are utilizing this information to guide an athlete's training and health. OBJECTIVE: To explore the literature to identify what is known regarding sports performance and athlete health based on body composition recordings. DATA SOURCES: PubMed and Google Scholar databases were searched for this brief review. STUDY SELECTION: A focus was placed on articles within the past 10 years that discussed DXA protocols within athletic populations; 14 articles were included in this brief literature review. STUDY DESIGN: Brief literature review. LEVEL OF EVIDENCE: Level 5. DATA EXTRACTION: One member of the research team searched the literature and retrieved articles with the purpose of analyzing and/or explaining DXA imaging in body composition analysis of active persons (primarily athletes). RESULTS: Quality assurance scans with a phantom calibration block as well as athlete prescreening condition and activity standardization was routinely recommended. However, only 1 study reported a specific DXA protocol for athletes, and only 1 study described guidelines for how to report DXA results in athletic populations, suggesting it is plausible yet difficult due to the small changes detectable. CONCLUSION: Due to the limited literature as well as a lack of reference values for specific athletic populations, the authors of this review recommend using the current Nana et al (Int J Sport Nutr Exerc Metab 2015;25:198-215) DXA protocol for performing DXA scans in the athletic population as well as current Hind et al (J Clin Densitom 2018;21:429-443) guidelines for distributing the information.

Comparison of the H:Q Ratio Between the Dominant and Nondominant Legs of Soccer Players: A Meta-analysis.

CONTEXT: Soccer players often have a dominant (D) leg, which could influence the relative strength between the quadriceps and hamstrings. The hamstring-to-quadriceps (H:Q) ratio can be assessed on a dynamometer at various velocities to provide information on injury risk. OBJECTIVE: To assess the concentric hamstrings and concentric quadriceps strength ratio (conventional H:Q ratio) assessed in D and nondominant (ND) legs at various speeds in male soccer players. DATA SOURCES: A systematic literature search was completed from inception to 2020 in PubMed, Academic Search Ultimate, CINAHL, and SPORTDiscus. STUDY SELECTION: Keywords associated with the H:Q ratio were connected with terms for soccer players. Titles and abstracts were screened by 2 reviewers based on inclusion and exclusion criteria related to sex, playing level, language, and measurement. A total of 81 studies were reviewed and 17 studies (21%) were used. STUDY DESIGN: A meta-analysis with random effects modeling generated standardized mean differences with 95% CIs between legs and speeds. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: A total of 38 cohorts were identified, with 14, 13, and 11 cohorts assessed at low, intermediate, and high velocities, respectively. The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies from the National Institutes of Health was used. RESULTS: The mean H:Q ratio at low velocities was 59.8 ± 9.5% in D leg and 58.6 ± 9.9% in ND leg, 64.2 ± 10.7% (D) and 63.6 ± 11.3% (ND) at the intermediate velocity, and 71.9 ± 12.7% (D) and 72.8 ± 12.7% (ND) at the high velocity. Low, intermediate, and high velocities had small effects of 0.13, 0.10, and -0.06, respectively. CONCLUSION: Conventional H:Q ratios vary across velocities but did not differ between D and ND limbs in male soccer players. This study may provide the foundation to establish norms and clinically meaningful differences.

Acute muscle swelling effects of a knee rehabilitation exercise performed with and without blood flow restriction.

This study assessed the acute effect of adding blood flow restriction (BFR) to quad sets on muscle-cross sectional area (mCSA), muscle thickness (MT), echo intensity (EI), and subcutaneous fat-normalized EI (EINORM) of the superficial quadriceps muscles. Twelve males and 12 females (mean±SD; age (yrs): 21.4±2.9; stature (m): 1.76±0.1; body mass (kg): 77.7±2.9) performed 70 repetitions (one set of 30, three sets of 15 repetitions) of bodyweight quad sets separately on each leg, with or without BFR (CON) applied. Rating of perceived exertion was recorded following each set. Panoramic ultrasound images of the vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF) were captured prior to (PRE), immediately after (IMM-POST), 30- (30-POST), and 60-minutes after (60-POST) after exercise. Sex x condition x time repeated measures ANOVAs assessed differences at p<0.05 for each muscle and dependent variable separately. Although males had larger VM and VL mCSA and VL MT (p<0.05), there were no acute changes from PRE to IMM-POST (p>0.05). There was a 3-way interaction in VL mCSA (p = 0.025) which indicated BFR was greater than CON at IMM-POST by 7.6% (p = 0.019) for males only. Females had greater EI in the VM and VL than males (p<0.05), yet males had greater EINORM for each muscle (p>0.05) and EINORM did not change over time or treatment (p>0.05). The lack of changes in MT, EI, and EINORM indicate that unloaded quad sets do not provide a stimulus to promote fluid shifts or acute changes in muscle size with the exception of IMM-POST in the VL for males. Future research should attempt to elucidate the acute muscular responses of BFR application for lightly loaded rehabilitation exercises in the clinical populations for which they are prescribed.

Evaluation of raw segmental bioelectrical impedance variables throughout anterior cruciate ligament reconstruction rehabilitation.

Background.Raw bioelectrical impedance analysis (BIA) variables are related to physical function in healthy and diseased populations. Therefore, BIA may be an insightful, noninvasive method of assessment to track following anterior cruciate ligament reconstruction (ACLR).Objectives.Evaluate phase angle, reactance and impedance at 50 kHz (PhA50, Xc50, andZ50, respectively) in the operative (OP) and non-operative (NOP) limbs during ACLR rehabilitation.Approach.Seventeen patient (12 M, 5 F; 18.8 ± 4.8 years) clinic reports were evaluated prior to ACLR (PRE), two- (2 W), six- (6 W), and twelve-weeks (12 W) post-ACLR and at return to sport testing (RTS).Setting.All observations occurred during the participant's physical therapy visits.Measurements.A multi-frequency BIA device measured segmental PhA, Xc, andZ. Linear mixed effects models were used to assess any leg and time interaction and changes over leg and time, independently. Any interactions or main effects were considered significant atp< 0.05.Main results.Significant legxtime interactions were observed for each variable. PhA50and Xc50of NOP were higher (p< 0.001) than OP at each time point by an average of by 0.9° and 4.9 Ω, respectively. In OP, PhA50and Xc50decreased from PRE to 2 W and increased from 6 to 12 W and 12 W to RTS (p< 0.01, for all). At RTS, PhA50and Xc50were similar to PRE in OP (p> 0.05). ForZ50, the OP leg did not change over time (p> 0.05).Z50was greater in NOP at 2 and 6 W (p< 0.01, for both). There were differences in PhA50in NOP between PRE and 6 W and from 6 W to RTS (p< 0.05 for both). Xc50did not change (p> 0.05), andZ50PRE was lower than at 2 W (p< 0.05).Significance.A multi-frequency BIA device can detect changes in segmental BIA variables following ACLR.

Skeletal muscle analysis of panoramic ultrasound is reliable across multiple raters.

Ultrasound devices are common in muscle physiology laboratories due to their ease of use and validity to assess skeletal muscle characteristics. The current study assessed the reliability of ultrasound skeletal muscle image analysis across multiple raters with limited experience. Vastus lateralis (VL), rectus femoris (RF), and first dorsal interosseus (FDI) images were separately analyzed by three novice raters to determine muscle thickness (MT), cross-sectional area (CSA), and echo-intensity (EI). Separate analyses of variance (ANOVA) assessed statistical differences between and within raters. Intra-class correlation coefficients (ICC) between (inter-rater) and within (intra-rater) raters, the standard error of the measurement (SEM) and minimal difference needed to be considered real were calculated. Inter-rater reliability was high for the VL and RF (ICC: 0.984-0.999), while the FDI was lower (0.614-0.962). Further, intra-rater reliability was greater than 0.961 for each rater. SEM values calculated for inter-rater reliability expressed as a percentage of the mean ranged from 0.4-5.8% across variables. Similarly, SEM values for intra-rater reliability were between 0.8-5.8%, 0.6-3.6%, and 0.4-3.2% for Raters 1, 2 and 3, respectively. Despite this, significant differences (p<0.05) between raters were observed for RF MT and EI, VL CSA and EI, and FDI MT, suggesting that potentially more measurement trials or greater practice time may be necessary to reduce systematic error among multiple raters. Post-image acquisition processing is reliable among and within raters as determined through ICCs and SEMs. This study provided consistent results among three separate novice raters given the same training, a unique yet realistic setting in muscle physiology laboratories.

Acute Effects of Static and Ballistic Stretching on Muscle-Tendon Unit Stiffness, Work Absorption, Strength, Power, and Vertical Jump Performance.

ABSTRACT: Gesel, FJ, Morenz, EK, Cleary, CJ, and LaRoche, DP. Acute effects of static and ballistic stretching on muscle-tendon unit stiffness, work absorption, strength, power, and vertical jump performance. J Strength Cond Res 36(8): 2147-2155, 2022-The purpose of this study was to evaluate the effects of static and ballistic stretching on muscle-tendon unit (MTU) stiffness, work absorption (WA), strength, power, and countermovement vertical jump (CMJ) performance. Using a within-subject design, 22 subjects performed 3 separate experimental conditions: no-stretching, ballistic stretching, and static stretching for the quadriceps, hamstrings, gluteus, and plantarflexor muscle groups. After each condition, plantarflexor MTU stiffness, WA, isometric strength, and power were measured, followed by a CMJ on a force plate to obtain peak center of mass velocity, peak power, rate of force development, peak force, work, and vertical jump height. Repeated measures analysis of variance with Bonferroni corrected post-hoc tests were used to detect differences between conditions for plantarflexor and CMJ measures. An acute bout of static stretching significantly reduced WA by 12% ( p = 0.049) and isokinetic power by 8% ( p = 0.047) compared with the control condition but ballistic stretching did not ( p = 0.624, p = 0.692, respectively). Significant positive correlations existed between MTU stiffness, WA, strength, and power ( r = 0.64-0.77, p < 0.001). Despite significant positive correlations between MTU stiffness, WA, and CMJ performance measures ( r = 0.40-0.72, p < 0.001), neither static nor ballistic stretching affected CMJ performance ( p > 0.05). These data show that stiffer MTU that absorb more work (energy) are associated with greater muscle force, power, and CMJ performance. Although an acute bout of static stretching impaired MTU passive-elastic properties and power production, neither static nor ballistic stretching impaired isometric strength or CMJ performance.

Agreement between multifrequency BIA and DXA for assessing segmental appendicular skeletal muscle mass in older adults.

BACKGROUND: Aging presents changes in muscle mass that may lead to sarcopenia. Identifying safe, quick, and accessible methods to assess muscle mass is imperative. AIMS: The purpose of this investigation was to compare the assessments of appendicular skeletal muscle mass (ASMM), fat-free mass (FFM), and fat mass (FM) between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). METHODS: Seventy-three healthy, community-dwelling, physically active males (n = 19) and females (n = 54) (BMI = 27.1 ± 4.3 kg m-2) between the ages of 55-85 years underwent total-body BIA and DXA. ASMM was estimated via BIA from a previously published regression equation while DXA ASMM was calculated as the sum of the measured total arm lean mass and total leg lean mass. Paired-samples t tests with a significance level of p < 0.05 were conducted, while agreement between the methods was assessed via Bland-Altman plots. RESULTS: In comparison to DXA, the chosen BIA equation overestimated ASMM (21.61 ± 5.82 kg vs. 18.82 ± 4.81 kg) and FFM (49.57 ± 9.94 kg vs. 46.22 ± 10.11 kg) and underestimated FM (24.59 ± 8.28 kg vs. 27.13 ± 10.01 kg), all p < 0.001. Visual inspection of the Bland-Altman plots revealed wide limits of agreement. Female participants were more clustered around the mean than male participants. DISCUSSION: The multifrequency BIA device and chosen ASMM estimation equation resulted in wide limits of agreement and significantly different comparisons to the reference method of DXA. CONCLUSION: Future research should continue to investigate and validate methodologies to screen older individuals for characteristics of aging-related diseases, such as sarcopenia.

Postactivation Potentiation in Blood Flow-Restricted Complex Training.

Cleary, CJ and Cook, SB. Postactivation potentiation in blood flow-restricted complex training. J Strength Cond Res 34(4): 905-910, 2020-Complex training uses a high-load (HL) resistance exercise to elicit postactivation potentiation (PAP) that is typically observed through enhanced plyometric performance. Blood flow-restricted (BFR) resistance exercise uses low loads to induce similar muscular adaptations to HL resistance exercise; however, the efficacy and feasibility of BFR complex training are unknown. Fifteen college-aged men (mean ± SD; age: 20.3 ± 0.9 years; relative back-squat one-repetition maximum [1RM]: 1.78 ± 0.3 kg·kg) with at least 2 years of resistance training experience completed 3 sessions: a familiarization session with 1RM testing, and 2 complex training sessions of 3 presquat vertical jumps (VJs), condition-specific back squats (HL: 5 repetitions at 85% 1RM, BFR: 30 repetitions at 30% 1RM), and a single postsquat VJ. Postactivation potentiation was calculated as (postsquat VJ height ÷ max presquat VJ height) [BULLET OPERATOR] 100. Electromyography (EMG) of the vastus lateralis and hamstrings was collected, quantified to root mean square values, and normalized to peak 1RM activity. Postsquat VJ height was significantly reduced in both conditions, and PAP did not occur because it was less than 100% (HL: 96.1 ± 5.1%, BFR: 90.8 ± 7.8%, p = 0.010). Vastus lateralis and hamstrings EMG amplitude was highest (p < 0.001) in the HL condition. High-load and BFR complex training decreased subsequent VJ height in these individuals, and this might have been due to an ineffective complex training protocol and individual factors such as training status and relative strength.

Core Stability and Athletic Performance in Male and Female Lacrosse Players.

This study determined the relationship of core stability with power production, agility, and dynamic stability of collegiate lacrosse players and whether core stability is more evident in these performance variables in either males or females. Twenty male and female collegiate lacrosse players (20.3 ± 1.0 years, 173.2 ± 11.8 cm, 72.6 ± 13.0 kg) performed the pro-agility shuttle, the countermovement jump (CMJ), the Star Excursion Balance Test (SEBT), and prone, right lateral, and left lateral planks on two sessions-familiarization and testing. Independent T-tests were used to compare sexes. SPSS 24.0 was used; significance was accepted at p < 0.05. Pearson correlations were used to compare the relationship of core stability to the performance variables in participants. There was a significant relationship found between the prone plank and pro-agility shuttle in all participants (r = -0.50). No significant relationships were found between core stability and performance variables. A significant difference was found in the pro-agility shuttle (p = 0.001) and the CMJ (p = 0.001) but not in core stability or dynamic stability. Agility, power production, and dynamic stability were not related to core stability in neither male or female lacrosse players. There were no significant differences in core stability and dynamic stability between males and females. A significant difference was found in dynamic stability in the SEBT right leg and left leg composite scores between sexes. From these results, it is suggested that core stability may not directly influence the performance variables in collegiate male and female lacrosse players.

Progression of Blood Flow Restricted Resistance Training in Older Adults at Risk of Mobility Limitations.

Blood flow restriction (BFR) resistance training leads to increased muscle mass and strength but the progression leading to adaptations may be different as strength gains are often to a lesser magnitude than high-load (HL) training. The impact of training loads and repetitions on older adults' muscle mass and strength following BFR or HL training was evaluated. Twenty-one older adults (67-90 years) classified as being at risk of mobility limitations were randomly assigned to HL (n = 11) or BFR (n = 10) knee extension (KE) and flexion (KF) training twice per week for 12 weeks. Strength was measured with 10-repetition maximum (10-RM) tests and isometric contractions. Cross-sectional area (CSA) of the quadriceps and hamstrings was measured. HL and BFR interventions increased 10-RM KF and isometric strength (P < 0.05) and hamstrings CSA increased an average of 4.8 ± 5.9% after HL and BFR training (time main effect P < 0.01). There were no differences between the training groups (time x group interactions P > 0.05). The rate of progression of KF training load and repetitions was comparable (time × group interactions of each variable P > 0.05). The groups averaged an increase of 0.50 ± 25 kg⋅week-1 and 1.8 ± 0.1.7 repetitions⋅week-1 of training (time main effects P < 0.05). The HL training group experienced greater improvements in KE 10-RM strength than the BFR group (60.7 ± 36.0% vs. 35.3 ± 25.5%; P = 0.03). In both groups, isometric KE strength increased 17.3 ± 18.5% (P = 0.001) and there were no differences between groups (P = 0.24). Quadriceps CSA increased (time main effect P < 0.01) and to similar magnitudes (time x group interaction P = 0.62) following HL (6.5 ± 3.1%) and BFR training (7.8 ± 8.2%). The HL group experienced accelerated progression of load when compared to BFR (0.90 ± 0.60 kg⋅week-1 vs. 30 ± 0.21 kg⋅week-1; P = 0.006) but was not different when expressed in relative terms. BFR training progressed at a rate of 3.6 ± 1.3 repetitions⋅week-1 while the HL group progressed at 2.2 ± 0.43 repetitions⋅week-1 (P = 0.003). HL training led to greater increases in KE 10-RM and it may be attributed to the greater load and/or faster rate of progression of the load throughout the 12-week training period and the specificity of the testing modality. Incorporating systematic load progression throughout BFR training periods should be employed to lead to maximal strength gains.