Characterizing the Exponential Profile of W' Recovery Following Partial Depletion.

PURPOSE: The aim of this study was to characterize W' recovery kinetics in response to a partial W' depletion. We hypothesized that W' recovery following partial depletion would be better described by a biexponential than by a monoexponential model. METHODS: Nine healthy men performed a ramp incremental exercise test, three to five constant load trials to determine critical power and W', and ten experimental trials to quantify W' depletion. Each experimental trial consisted of two constant load work bouts (WB1 + WB2) interspersed by a recovery interval. WB1 was designed to evoke a 25% or 75% W' depletion (DEP 25% + DEP 75% ). Subsequently, participants recovered for 30, 60, 120, 300 or 600 s, and then performed WB2 to exhaustion in order to calculate the observed W' recovery (W' OBS ). W' OBS data were fitted using monoexponential and biexponential models, both with a variable and a fixed model amplitude. Root mean square error (RMSE) and Akaike information criterion (AIC c ) were calculated to evaluate the models' goodness-of-fit. RESULTS: The biexponential model fits were associated with overall lower RMSE values (0.4-5.0%) compared to the monoexponential models (2.9-8.0%). However, ΔAIC c resulted in negative values (-15.5 and -23.3) for the model fits where the amplitude was free, thereby favoring the use of a monoexponential model for both depletion conditions. For the model fits where the amplitude was fixed at 100%, ΔAIC c was negative for DEP 25% (-15.0), but positive for DEP 75% (11.2). W' OBS values were strongly correlated between both depletion conditions ( r = 0.92), and positively associated with V̇O 2peak , CP and GET ( r = 0.67-0.77). CONCLUSIONS: The present study results did not provide evidence in favor of a biexponential modeling technique to characterize W' recovery following partial depletion. Moreover, we demonstrated that fixed t values were insufficient to model W' recovery across different depletion levels, and that W' recovery was positively associated with aerobic fitness. These findings underline the importance of employing variable and individualized t values in future predictive W' models.

Application and performance of heart-rate-based methods to estimate oxygen consumption at different exercise intensities in postmenopausal women.

PURPOSE: Heart rate (HR) is a widespread method to estimate oxygen consumption ( V ˙ O2), exercise intensity, volume, and energy expenditure. Still, accuracy depends on lab tests or using indexes like HRnet and HRindex. This study addresses HR indexes' applicability in postmenopausal women (PMW), who constitute over 50% of the aging population and may have unique characteristics (e.g., heart size) affecting HR use. METHODS: Fourteen PMW underwent a cycling ramp incremental test to establish the relationships between V ˙ O2 (in MET) and absolute HR, HRnet, and HRindex. In a second group of ten PMW, population-specific and general equations were tested to predict MET and energy expenditure during six constant work exercises at various intensities. Pulmonary gas exchange and HR were continuously measured using a metabolic cart. Correlations, Bland-Altman analysis, and two-way RM-ANOVA were used to compare estimated and measured values. RESULTS: Strong linear relationships between the three HR indexes and MET were found in Group 1. In Group 2, population-specific equations showed medium-to-high correlations, precision, and no significant biases when estimating MET and energy expenditure. HRnet and HRindex outperformed absolute HR in accuracy. General HR equations had similar correlations but exhibited larger biases and imprecision. Statistical differences between measured and estimated values were observed at all intensities with general equations. CONCLUSION: This investigation confirms the suitability of HR for estimating aerobic metabolism in one of the most significant aging populations. However, it emphasizes the importance of considering individual variability and developing population-specific models when utilizing HR to infer metabolism.

Combined Biologic Augmentation Strategies with Collagen Patch Graft, Microfractures, and Platelet Concentrate Injections Improve Functional and Structural Outcomes of Arthroscopic Revision Rotator Cuff Repair.

BACKGROUND: Arthroscopic revision rotator cuff repair (ARRCR) is challenging. Biologic strategies seem to be promising. The aim was to evaluate the effectiveness of the combination of microfractures of the greater tuberosity, augmentation with collagen patch graft, and platelet concentrate injections in ARRCR. METHODS: A retrospective comparative study was conducted on patients that underwent ARRCR with a minimum follow-up of two years. Patients in the augmentation group underwent ARRCR combined with microfractures, collagen patch graft, and postoperative subacromial injections of platelet concentrate. A standard rotator cuff repair was performed in the control group. PRIMARY OUTCOME: Constant-Murley score (CMS). SECONDARY OUTCOMES: disease-specific, health-related quality of life using the Disabilities of the Arm, Shoulder, and Hand (DASH) score; assessment of tendon integrity with magnetic resonance at least six months after surgery. Significance was set at p < 0.05. RESULTS: Forty patients were included. Mean follow-up was 36.2 ± 8.7 months. The mean CMS was greater in the augmentation group (p = 0.022). No differences could be found for DASH score. Healing failure rate was higher in the control group (p = 0.002). CONCLUSION: Biologic augmentation of ARRCR using a combination of microfractures, collagen patch graft, and subacromial injections of platelet concentrate is an effective strategy in improving tendon healing rate. LEVEL OF EVIDENCE: retrospective cohort study, level III.

BLU-DAT: a new reliable and accurate arthrometer for measuring anterior knee laxity.

PURPOSE: Although many arthrometers have been developed to assess anterior knee laxity, reliability and diagnostic accuracy of these devices are still debated. The aim of the present study was to evaluate the validity of a new arthrometer in the outpatient setting, with the hypothesis that it had good validity in terms of reliability and diagnostic accuracy. METHODS: Seventy-eight subjects (39 with ACL injury and 39 with normal ACL) were tested. ATT was assessed by means of the Lachman test at 30° of flexion with a new testing device (BLU-DAT) under three different loading conditions: 7 kg (69 N), 9 kg (88 N) and maximum (MMT). The tests were performed on both knees to obtain SSD. In the ACL injury group, the tests were performed by two examiners and one of them repeated a second test series. Inter- and intra-observer reliability were assessed with the intraclass correlation coefficients (ICCs) for the average SSD measures. In the normal-ACL group, the analysis was performed with the same testing setup. Side-to-side difference measures of the two groups at every loading condition were compared by Student's t test. Data of test series were dichotomized based on the threshold value of 3-mm SSD as pathological ATT and 2 × 2 contingency tables were used to assess diagnostic accuracy. RESULTS: The ICCs for intra-observer reliability at 7-kg (69 N), 9-kg (88 N) and MMT measurements were 0.781, 0.855 and 0.913, respectively. The ICC for inter-observer reliability at 7-kg (69 N), 9-kg (88 N) and MMT measurements were 0.701, 0.845 and 0.834, respectively. Comparison between the two groups showed a significant mean difference ranging from 3.4 mm for 7-kg (69 N) load to 4.6 mm for MMT. Overall accuracy ranged from 84.6% for 7-kg load to 98.7% for MMT. CONCLUSION: The BLU-DAT has proven to be an instrument with good intra- and inter-observer reliability and very good accuracy in the diagnosis of ACL injuries in the outpatient setting. So, the BLU-DAT can be a new useful tool in everyday clinical practice to assist in the diagnosis of ACL injury. LEVEL OF EVIDENCE: II.

Effect of acute heat exposure on the determination of critical power and W' in women and men.

The goal of this study was to investigate to what extent acute heat exposure would affect the parameters of the power-duration relationship, i.e. CP and W', using multiple constant workload tests to task failure, in women and men. Twenty four young physically active participants (12 men, 12 women) performed 3-5 constant load tests to determine CP and W', both in temperate (TEMP; 18°C) and hot (HOT; 36°C) environmental conditions. A repeated-measures ANOVA was executed to find differences between TEMP and HOT, and between women and men. In HOT, CP was reduced by 6.5% (227 ± 50 vs. 212 ± 47 W), while W' increased 12.4% (16.4 ± 4.4 vs. 18.5 ± 5.6 kJ). No significant two-way sex × temperature interactions were observed, indicating that the environmental conditions did not have a different effect in men compared with women. The intersection of the average curvatures in TEMP and HOT occurred at 137 s and 280 W in women, and 153 s and 397 W in men. Acute heat exposure had an impact on the parameters CP and W', i.e. CP decreased whereas W' increased. The increase in W' might be a consequence of the mathematical modelling for the used test methodology, rather than a physiological accurate value of W' in HOT. No differences induced by heat exposure were observed between women and men.

The determination of CP and W' was done using multiple constant workload tests to task failure and acute heat exposure induced changes in CP (decrease) and W' (increase).The increase in W' with acute heat exposure might be a consequence of the mathematical modelling for the used test methodology, rather than a physiological accurate value of W'.Acute heat exposure had a similar effect on performance parameters in women and men.

Combined Arthroscopic-Assisted Lower Trapezius Tendon Transfer and Superior Capsule Reconstruction for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique.

Primary or revision irreparable rotator cuff tears remain a challenge. Clear algorithms do not exist. Several joint-preserving options are available, but no technique has been definitely proven to be better than another. Although superior capsule reconstruction has been shown to be effective in restoring motion, lower trapezius transfer can provide strong external rotation and abduction moment. The aim of the present article was to describe an easy and reliable technique to combine both options in 1 surgery, aiming to maximize the functional outcome by getting motion and strength back.

Critical power, W' and W' reconstitution in women and men.

PURPOSE: The aim of this study was to compare critical power (CP) and work capacity W', and W' reconstitution (W'REC) following repeated maximal exercise between women and men. METHODS: Twelve women ([Formula: see text]O2PEAK: 2.53 ± 0.37 L·min-1) and 12 men ([Formula: see text]O2PEAK: 4.26 ± 0.30 L·min-1) performed a minimum of 3 constant workload tests, to determine CP and W', and 1 maximal exercise repetition test with three work bouts (WB) to failure, to quantify W'REC during 2 recovery periods, i.e., W'REC1 and W'REC2. An independent samples t test was used to compare CP and W' values between women and men, and a repeated-measures ANOVA was used to compare W'REC as fraction of W' expended during the first WB, absolute W'REC, and normalized to lean body mass (LBM). RESULTS: CP normalized to LBM was not different between women and men, respectively, 3.7 ± 0.5 vs. 4.1 ± 0.4 W·kgLBM-1, while W' normalized to LBM was lower in women 256 ± 29 vs. 305 ± 45 J·kgLBM-1. Fractional W'REC1 was higher in women than in men, respectively, 74.0 ± 12.0% vs. 56.8 ± 9.5%. Women reconstituted less W' than men in absolute terms (8.7 ± 1.2 vs. 10.9 ± 2.0 kJ) during W'REC1, while normalized to LBM no difference was observed between women and men (174 ± 23 vs. 167 ± 31 J·kgLBM-1). W'REC2 was lower than W'REC1 both in women and men. CONCLUSION: Sex differences in W'REC (absolute women < men; fractional women > men) are eliminated when LBM is accounted for. Prediction models of W'REC might benefit from including LBM as a biological variable in the equation. This study confirms the occurrence of a slowing of W'REC during repeated maximal exercise.

Easy Prediction of the Maximal Lactate Steady-State in Young and Older Men and Women.

Maximal Lactate steady-state (MLSS) demarcates sustainable from unsustainable exercise and is used for evaluation/monitoring of exercise capacity. Still, its determination is physically challenging and time-consuming. This investigation aimed at validating a simple, submaximal approach based on blood lactate accumulation ([Δlactate]) at the third minute of cycling in a large cohort of men and women of different ages. 68 healthy adults (40♂, 28♀, 43 ± 17 years (range 19-78), VO2max 45 ± 11 ml-1·kg-1·min-1 (25-68)) performed 3-5 constant power output (PO) trials with a target duration of 30 minutes to determine the PO corresponding to MLSS. During each trial, [Δlactate] was calculated as the difference between the third minute and baseline. A multiple linear regression was computed to estimate MLSS based on [Δlactate], subjects` gender, age and the trial PO. The estimated MLSS was compared to the measured value by paired t-test, correlation, and Bland-Altman analysis. The group mean value of estimated MLSS was 180 ± 51 W, not significantly different from (p = 0.98) and highly correlated with (R2 = 0.89) measured MLSS (180 ± 54 watts). The bias between values was 0.17 watts, and imprecision 18.2 watts. This simple, submaximal, time- and cost-efficient test accurately and precisely predicts MLSS across different samples of healthy individuals (adjusted R2 = 0.88) and offers a practical and valid alternative to the traditional MLSS determination.

A new knee arthrometer demonstrated to be reliable and accurate to assess anterior tibial translation in comparison with stress radiographs.

INTRODUCTION: For several years, many arthrometers have been developed to assess anterior knee laxity. The aim of our study was to evaluate the validity of a new practical and handy testing device with the hypothesis that the new arthrometer had good validity in terms of reliability and accuracy. METHODS: Lachman test was performed on five fresh frozen cadaveric knees by five examiners. Anterior tibial translation (ATT) was measured with a new arthrometer (BLU-DAT) and on lateral stress radiographs. Data on ATT were obtained under 7 kg (69 N), 9 kg (88 N), and maximum manual traction (MMT). Tests were performed on the same specimens before and after arthroscopic ACL excision. Inter-rater reliability of the BLU-DAT measures was assessed with the intraclass correlation coefficient (ICC) for single and average measurements. The Bland-Altman method was used to estimate agreement between the BLU-DAT and stress radiographs. RESULTS: ICC values for single measurements were 0.62, 0.54 and 0.58 for 7-kg, 9-kg and MMT assessment, respectively. Overall reliability was good (ICC = 0.63). ICC values for average measurements were 0.89, 0.85 and 0.88 for 7-kg, 9-kg and MMT assessment, respectively. Overall reliability was very good (ICC = 0.90) SEM ranged from 1.4 mm to 1.6 mm for single measurements and was below 1 mm at each testing condition for average measurements. Analysis of agreement between BLU-DAT and radiographic measurements showed a mean difference equal to 0.83 mm ± 2.1 mm (95% CI: 0.55-1.11). Upper LOA was equal to 4.9 mm (95% CI: 5.39-4.41). Lower LOA was equal to - 3.2 mm (95% CI: - 2.71 to - 3.69). CONCLUSION: Measurement of anterior knee laxity with the BLU-DAT testing device has a good to very good inter-rater reliability and good agreement with a gold standard such as stress radiographs. Cadaveric Diagnostic Study, Level of Evidence IV.

The effect of acute heat exposure on the determination of exercise thresholds from ramp and step incremental exercise.

PURPOSE: The aim of this study was to examine how respiratory (RT) and lactate thresholds (LT) are affected by acute heat exposure in the two most commonly used incremental exercise test protocols (RAMP and STEP) for functional evaluation of aerobic fitness, exercise prescription and monitoring training intensities. METHODS: Eleven physically active male participants performed four incremental exercise tests, two RAMP (30 W·min-1) and two STEP (40 W·3 min-1), both in 18 °C (TEMP) and 36 °C (HOT) with 40% relative humidity to determine 2 RT and 16 LT, respectively. Distinction was made within LT, taking into account the individual lactate kinetics (LTIND) and fixed value lactate concentrations (LTFIX). RESULTS: A decrease in mean power output (PO) was observed in HOT at LT (-6.2 ± 1.9%), more specific LTIND (-5.4 ± 1.4%) and LTFIX (-7.5 ± 2.4%), compared to TEMP, however not at RT (-1.0 ± 2.7%). The individual PO difference in HOT compared to TEMP over all threshold methods ranged from -53 W to +26 W. Mean heart rate (HR) did not differ in LT, while it was increased at RT in HOT (+10 ± 8 bpm). CONCLUSION: This study showed that exercise thresholds were affected when ambient air temperature was increased. However, a considerable degree of variability in the sensitivity of the different threshold concepts to acute heat exposure was found and a large individual variation was noticed. Test design and procedures should be taken into account when interpreting exercise test outcomes.

Physical Preparation of a World-Class Lightweight Men's Double Sculls Team for the Tokyo 2020 Olympics.

PURPOSE: To analyze the physical profile and training program of a world-class lightweight double sculls rowing crew toward the Tokyo 2020 Olympics. METHOD: A case study in which both rowers performed physical testing in November 2020 and April 2021 (anthropometrics, incremental rowing test, and power profiling). The training program (38 wk) in the buildup to the Olympics was analyzed, providing insight into training characteristics (volume; contribution of rowing, alternative, and strength training; prescribed and recorded [heart rate] training-intensity distribution). The entire period was split into 3 phases: preparation period (8 wk), competition period 1 (11 wk), and competition period 2 (9 wk), and training characteristics were compared. RESULTS: In the April 2021 testing, rower A (1.89 m, 74.6 kg, 4.4% body fat) had a peak oxygen uptake of 5.8 L·min-1 (77.8 mL·min-1·kg-1) and a peak power output of 491 W. Rower B (1.82 m, 70.6 kg, 7.8% body fat) had a peak oxygen uptake of 5.5 L·min-1 (77.9 mL·min-1·kg-1) and a peak power output of 482 W. The mean weekly training volume was 14 hours 47 minutes (4 h 5 min), of which 58.5% (14.6%) consisted of rowing, 13.4% (6.8%) strength training, and 28.1% (2.6%) alternative training. Heart-rate training-intensity distribution was 77.8% (4.2%) in zone 1, 16.6% (3.7%) in zone 2, and 5.6% (2.8%) in zone 3 with a lower contribution of zone 1 in competition period 1 (P = .029) and competition period 2 (P = .023) compared with the preparation period, and a higher contribution of zone 3 in competition period 1 (P = .018) and competition period 2 (P = .011) compared with the preparation period. CONCLUSION: The crew combined a high volume of rowing, alternative, and strength training in a pyramidal heart-rate training-intensity distribution throughout the year.

Modeling V̇o2 on-kinetics based on intensity-dependent delayed adjustment and loss of efficiency (DALE).

This study presents and evaluates a new mathematical model of V̇o2 on-kinetics, with the following properties: 1) a progressively slower primary phase following the size-principle of motor unit recruitment, explaining the delayed V̇o2 steady state seen in the heavy exercise intensity domain, and 2) a severe-domain slow component modeled as a time-dependent decrease in efficiency. Breath-by-breath V̇o2 measurements from eight subjects performing step cycling transitions, in the moderate, heavy, and severe exercise domains, were fitted to the conventional three-phase model and the new model. Model performance was evaluated with a residual analysis and by comparing Bayesian (BIC) and corrected Akaike (AICc) information criteria. The residual analysis showed no systematic deviations, except perhaps for the initial part of the primary phase. BIC favored the new model, being 9.3 (SD 7.1) lower than the conventional model whereas AICc was similar between models. Compared with the conventional three-phase model, the proposed model distinguishes between the kinetic adaptations in the heavy and severe domains by predicting a delayed steady-state V̇o2 in the heavy and no steady-state V̇o2 in the severe domain. This allows to determine when stable oxygen costs of exercise are attainable and it also represents a first step in defining time-dependent oxygen costs when stable energy conversion efficiency is not attainable.NEW & NOTEWORTHY We propose and assess a new minimalistic integrated model for the V̇o2 on-kinetics, inspired by the currently available best evidence of the underlying mechanisms. We show that the model provides a similar fit as the conventionally used three-phase model, even though a stricter data fitting method is used for the proposed model. The proposed model clarifies misconceptions related to the V̇o2 slow component's behavior, by clearly predicting that steady-state V̇o2 is attainable in the moderate and heavy exercise intensity domains. Furthermore, the model opens new possibilities for assessing oxygen cost during severe intensity exercise without the fallible assumption of time-constant energy-conversion efficiency.

Performance and Anthropometrics of Classic Powerlifters: Which Characteristics Matter?

ABSTRACT: Ferrari, L, Colosio, AL, Teso, M, and Pogliaghi, S. Performance and anthropometrics of classic powerlifters: Which characteristics matter? J Strength Cond Res 36(4): 1003-1010, 2022-The purpose of this study is: (a) provide normative performance and anthropometric data of Southern European classic powerlifters of both sexes; (b) determine the possible relationships between these variables and performance; and (c) develop population-specific predictive equations for single lifts and overall powerlifting performance. During an unofficial national-level competition, we recruited 74 athletes (51 men and 23 women) and recorded their individual, anthropometric, and performance characteristics and divided them into sex and 2 performance categories based on their Wilks points. Weaker (<370 Wilks points) and stronger (>370 Wilks points) athletes of both sexes were compared by two-way analysis of variance. Simple correlation and multiple linear regression between individual/anthropometric characteristics and performance were modeled. We applied a step-forward multiple linear regression model to predict single lifts and overall performance. All parameters significantly differed between sexes (p < 0.05 for all comparisons). Stronger male athletes had a significantly larger neck (42 ± 2.8 cm; effect size [ES] = 0.59), and flexed (40.6 ± 3.3 cm; ES = 1.18) and relaxed upper-arm (37.5 ± 3.1 cm; ES = 1.34) and thigh girths (63.6 ± 7.0 cm; ES = 0.77) compared to weaker male athletes. Furthermore, stronger women had significantly larger flexed (32.6 ± 3.3 cm; ES = 0.88) and relaxed upper-arm (33 ± 1.5 cm; ES = 2.28) and chest girths (99.3 ± 9.2 cm; ES = 1.10) compared to weaker female athletes. A combination of experience, fat mass, and upper-limb and lower-limb muscle mass indexes can accurately and precisely predict overall and individual lift performance (r2 ≥ 0.83 for all the predictions). This is the first study to provide normative performance and anthropometric data in Southern European male and female powerlifters.

Repeated Passive Mobilization to Stimulate Vascular Function in Individuals of Advanced Age Who Are Chronically Bedridden: A Randomized Controlled Trial.

BACKGROUND: Vascular dysfunction and associated disorders are major side effects of chronic bed rest, yet passive mobilization as a potential treatment has only been theorized so far. This study investigated the effects of passive mobilization treatment on vascular function in older, chronically bedridden people. METHOD: The study sample was 45 chronically bedridden people of advanced age (mean age: 87 years; 56% female; mean bed rest: 4 years) randomly assigned to a treatment (n = 23) or a control group (CTRL, n = 22). The treatment group received passive mobilization twice daily (30 minutes, 5 times/wk) for 4 weeks. A kinesiologist performed passive mobilization by passive knee flexion/extension at 1 Hz in one leg (treated leg [T-leg] vs control leg [Ctrl-leg]). The CTRL group received routine treatment. The primary outcome was changes in peak blood flow (∆peak) as measured with the single passive leg movement test at the common femoral artery. RESULTS: ∆Peak was increased in both legs in the Treatment group (+90.9 mL/min, p < .001, in T-leg and +25.7 mL/min, p = .039 in Ctrl-leg). No difference in peak blood flow after routine treatment was found in the CTRL group. CONCLUSION: Improvement in vascular function after 4 weeks of passive mobilization was recorded in the treatment group. Passive mobilization may be advantageously included in standard clinical practice as an effective strategy to treat vascular dysfunction in persons with severely limited mobility.

An Intensity-dependent Slow Component of HR Interferes with Accurate Exercise Implementation in Postmenopausal Women.

PURPOSE: We tested the hypothesis that a slow component of HR (i.e., scHR) occurs in all intensity domains, greater than the slow component of oxygen uptake (scV˙O2), and we developed an equation to predict it across exercise intensities. METHOD: Eighteen healthy, postmenopausal women (54 ± 4 yr) performed on a cycle ergometer: i) a ramp incremental test for thresholds and V˙O2max detection; ii) 30-min constant work exercise at 40%, 50%, 60%, 70%, and 80% V˙O2max for the measurement of scHR, scV˙O2, stroke volume, and body temperature (T°). scHR and scV˙O2 were compared by two-way repeated-measures ANOVA (intensity and variable). Pearson correlation was calculated between the slow component of all variables, relative intensity, and domain. scHR (in beats per minute) was predicted with a linear model based on exercise intensity relative to the respiratory compensation point (RCP). RESULTS: A positive scHR was present in all domains, twice the size of scV̇O2 (P < 0.001), and significantly correlated with the slow components of V̇O2 (r2 = 0.46), T° (r2 = 0.52), and relative intensity (r2 = 0.66). A linear equation accurately predicts scHR based on %RCP (r2 = 0.66, SEE = 0.15). CONCLUSIONS: A mismatch exists between the slow components of HR and metabolic intensity. Whenever exercise is prescribed based on HR, target values should be adjusted over time to grant that the desired metabolic stimulus is maintained throughout the exercise session.

Metabolic instability vs fibre recruitment contribution to the [Formula: see text] slow component in different exercise intensity domains.

This study focused on the steady-state phase of exercise to evaluate the relative contribution of metabolic instability (measured with NIRS and haematochemical markers) and muscle activation (measured with EMG) to the oxygen consumption ([Formula: see text]) slow component ([Formula: see text]) in different intensity domains. We hypothesized that (i) after the transient phase, [Formula: see text], metabolic instability and muscle activation tend to increase differently over time depending on the relative exercise intensity and (ii) the increase in [Formula: see text] is explained by a combination of metabolic instability and muscle activation. Eight active men performed a constant work rate trial of 9 min in the moderate, heavy and severe intensity domains. [Formula: see text], root mean square by EMG (RMS), deoxyhaemoglobin by NIRS ([HHb]) and haematic markers of metabolic stability (i.e. [La-], pH, HCO3-) were measured. The physiological responses in different intensity domains were compared by two-way RM-ANOVA. The relationships between the increases of [HHb] and RMS with [Formula: see text] after the third min were compared by simple and multiple linear regressions. We found domain-dependent dynamics over time of [Formula: see text], [HHb], RMS and the haematic markers of metabolic instability. After the transient phase, the rises in [HHb] and RMS showed medium-high correlations with the rise in [Formula: see text] ([HHb] r = 0.68, p < 0.001; RMS r = 0.59, p = 0.002). Moreover, the multiple linear regression showed that both metabolic instability and muscle activation concurred to the [Formula: see text] (r = 0.75, [HHb] p = 0.005, RMS p = 0.042) with metabolic instability possibly having about threefold the relative weight compared to recruitment. Seventy-five percent of the dynamics of the [Formula: see text] was explained by [HHb] and RMS.

Arthroscopic Superior Capsule Reconstruction With Doubled Autologous Semitendinosus Tendon Graft.

Massive and irreparable rotator cuff tears remain a difficult condition to treat. Fatty infiltration of the muscles and excessive retraction of the tendons predispose to high failure rates of arthroscopic repair techniques. In recent years, studies on the superior capsule have shown that it plays a key role in reducing superior humeral head translation and restoring balance to the force couples required for dynamic shoulder function. Superior capsule reconstruction has become common in clinical practice. Several techniques with different types of grafts have been described, such as fascia lata autograft, dermal allograft patch, and long head of the biceps tendon autograft. More recently, an open technique with semitendinosus tendon autograft has been proposed. Our aim is to describe an all-arthroscopic technique for superior capsule reconstruction using a doubled semitendinosus tendon autograft in a box-shaped configuration. We believe that the technique can combine the advantages of other techniques, such as graft availability, low harvest-site morbidity, limited cost, and mechanical strength.