Effect of Low-Intensity Bloodflow Restriction Training on Nontraumatic Knee Joint Conditions: A Systematic Review and Meta-analysis.

CONTEXT: Nontraumatic knee conditions are common in clinical practice. Existing pharmaceutical and immobilization approaches provide limited pain relief and functional enhancement. Low-intensity bloodflow restriction training (LI-BFRT) is being investigated as a nonpharmacological alternative; however, its efficacy is uncertain. OBJECTIVE: To assess the effectiveness of LI-BFRT for nontraumatic knee conditions and compare it with high-intensity resistance training (HI-RT) and low-intensity resistance training (LI-RT). DATA SOURCES: PubMed, EBSCO, Science Direct, Cochrane Library, China Knowledge Infrastructure, Wanfang Data, and VIP databases were searched until May 30, 2023. STUDY SELECTION: Original randomized controlled trials involving nontraumatic knee joint conditions with interventions consisting mainly of LI-BFRT, HI-RT, or LI-RT. The results assessed mainly pain and muscle performance. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Sample characteristics, study design, country, disease, groups, evaluation time, duration, and outcomes were extracted. RESULTS: A total of 13 randomized controlled trials were included in the systematic review. Compared with pretreatment, LI-BFRT significantly alleviated pain (weighted standardized mean difference [SMD], -1.33; 95% CI, -1.62 to -1.05), with better additional effects on hip muscle training (SMD, -3.14; 95% CI, -4.07 to -2.75). Compared with LI-RT, LI-BFRT significantly relieved pain in male patients (SMD, -1.47; 95% CI, -1.92 to -1.01). LI-BFRT significantly increased quadriceps cross-sectional area (SMD, 0.53; 95% CI, 0.27-0.78), knee extension strength (SMD, 0.84; 95% CI, 0.48-1.2), and leg press strength (SMD, 0.64; 95% CI, 0.34-0.94) compared with pretreatment. Its effects were superior to those of LI-RT and similar to those of HI-RT. However, sex differences in muscle strength improvement were observed. CONCLUSION: In patients with nontraumatic knee joint conditions, LI-BFRT effectively alleviated pain, increased muscle cross-sectional area, and enhanced muscle strength. LI-BFRT showed pain relief comparable with that of LI-RT while surpassing LI-RT in muscle growth and strength improvement.

Sex-specific dose-response effects of a 24-week supervised concurrent exercise intervention on cardiorespiratory fitness and muscular strength in young adults: The ACTIBATE randomized controlled trial.

Concurrent training has been postulated as an appropriate time-efficient strategy to improve physical fitness, yet whether the exercise-induced adaptations are similar in men and women is unknown. An unblinded randomized controlled trial was conducted to investigate sex-specific dose-response effects of a 24-week supervised concurrent exercise training program on cardiorespiratory fitness and muscular strength in young adults. One hundred and forty-four sedentary adults aged 18-25 years were assigned to either (i) a control group (n = 54), (ii) a moderate intensity exercise group (MOD-EX, n = 46), or (iii) a vigorous intensity exercise group (VIG-EX, n = 44) by unrestricted randomization. Cardiorespiratory fitness (VO2max ), hand grip strength, and one-repetition maximum of leg press and bench press were evaluated at baseline and after the intervention. A total of 102 participants finished the intervention (Control, n = 36; 52% women, MOD-EX, n = 37; 70% women, and VIG-EX, n = 36; 72% women). In men, VO2max significantly increased in the MOD-EX (~8%) compared with the control group and in the VIG-EX group after the intervention (~6.5%). In women, VO2max increased in the MOD-EX and VIG-EX groups (~5.5%) compared with the control group after the intervention. There was a significant increment of leg press in the MOD-EX (~15.5%) and VIG-EX (~18%) groups compared with the control group (~1%) in women. A 24-week supervised concurrent exercise was effective at improving cardiorespiratory fitness and lower body limbs muscular strength in young women-independently of the predetermined intensity-while only at moderate intensity improved cardiorespiratory fitness in men.

Exploring the Low Force-High Velocity Domain of the Force-Velocity Relationship in Acyclic Lower-Limb Extensions.

PURPOSE: To compare linear and curvilinear models describing the force-velocity relationship obtained in lower-limb acyclic extensions, considering experimental data on an unprecedented range of velocity conditions. METHODS: Nine athletes performed lower-limb extensions on a leg-press ergometer, designed to provide a very broad range of force and velocity conditions. Previously inaccessible low inertial and resistive conditions were achieved by performing extensions horizontally and with assistance. Force and velocity were continuously measured over the push-off in six resistive conditions to assess individual force-velocity relationships. Goodness of fit of linear and curvilinear models (second-order polynomial function, Fenn and Marsh's, and Hill's equations) on force and velocity data were compared via the Akaike Information Criterion. RESULTS: Expressed relative to the theoretical maximal force and velocity obtained from the linear model, force and velocity data ranged from 26.6 ± 6.6 to 96.0 ± 3.6% (16-99%) and from 8.3 ± 1.9 to 76.6 ± 7.0% (5-86%), respectively. Curvilinear and linear models showed very high fit (adjusted r2 = 0.951-0.999; SEE = 17-159N). Despite curvilinear models better fitting the data, there was a ~ 99-100% chance the linear model best described the data. CONCLUSION: A combination between goodness of fit, degrees of freedom and common sense (e.g., rational physiologically values) indicated linear modelling is preferable for describing the force-velocity relationship during acyclic lower-limb extensions, compared to curvilinear models. Notably, linearity appears maintained in conditions approaching theoretical maximal velocity. Using horizontal and assisted lower-limb extension to more broadly explore resistive/assistive conditions could improve reliability and accuracy of the force-velocity relationship and associated parameters.

Foot Cooling between Interval Bouts Enhances Repeated Lower Limb Power Performance: The Role of Delaying Fatigue.

This study aimed to investigate whether interbout foot cooling (FC) may enhance repeated lower limb power performance and the corresponding physiological responses based on interset FC, which has been demonstrated to enhance leg-press performance. In a repeated-measures crossover design, ten active men (aged 21.5 ± 1.5 years, exercising >3 times per week) performed four bouts of 10-s cycle ergometer sprints with interbout FC at 10°C water for 2.5 min or non-cooling (NC) with a 5-day interval. The results indicated that FC elicited higher total work (27.57 ± 5.66 kJ vs. 26.55 ± 5.76 kJ) and arousal scores than NC (p < 0.05). Furthermore, under the NC condition, participants decreased mean power (p < 0.05) with no alteration of vastus lateralis (VL) electromyography (EMG) activities after the second bout; whereas under the FC condition, participants maintained steady mean power accompanied by increased VL EMG activities in the last two bouts (p < 0.05). Jointly, participants had higher mean power ([3rd = 10.14 ± 1.15 vs. 9.37 ± 1.30; 4th = 9.79 ± 1.22 vs. 9.23 ± 1.27] W/kg) and VL EMG activities in the last two bouts under the FC than NC condition (p < 0.05). However, perceived exertion and the heart rate were comparable between the two conditions (p > 0.05). In conclusion, interbout FC elicited a higher arousal level and repeated lower limb power performance, which could be explained by delaying peripheral fatigue via increasing excitatory drive and recruiting additional motor units to compensate for fatigue-related responses and power decrements.

Transfer Effects of a Multiple-Joint Isokinetic Eccentric Resistance Training Intervention to Nontraining-Specific Traditional Muscle Strength Measures.

Relatively few investigations have examined the transfer effects of multiple-joint isokinetic eccentric only (MJIE) resistance training on non-specific measures of muscle strength. This study investigated the transfer effects of a short-term MJIE leg press (Eccentron) resistance training program on several non-specific measures of lower-body strength. Fifteen participants performed Eccentron training three times/week for four weeks and were evaluated on training-specific Eccentron peak force (EccPF), nontraining-specific leg press DCER one-repetition maximum (LP 1 RM), and peak torques of the knee extensors during isokinetic eccentric (Ecc30), isokinetic concentric (Con150) and isometric (IsomPT) tasks before and after the training period. The training elicited a large improvement in EccPF (37.9%; Cohen's d effect size [ES] = 0.86). A moderate transfer effect was observed on LP 1 RM gains (19.0%; ES = 0.48) with the magnitude of the strength improvement being about one-half that of EccPF. A small effect was observed on IsomPT and Ecc30 (ES = 0.29 and 0.20, respectively), however, pre-post changes of these measures were not significant. Con150 testing showed no effect (ES = 0.04). These results suggest a short term MJIE training program elicits a large strength improvement in training-specific measures, a moderate strength gain transfer effect to DCER concentric-based strength of a similar movement (i.e., LP 1 RM), and poor transfer to single-joint knee extension measures.

Review of ankle rehabilitation devices for treatment of equinus contracture.

INTRODUCTION: Equinus contracture is a serious disability and attention should be paid to proper and effective treatment. Most attention is given to neurologically impaired patients, but the incidence of equinus contracture is much higher, for example, in post-traumatic patients. In addition to conventional physical therapy, robotic rehabilitation treatment is one of the promising procedures to precede severe contraction cases and the need for surgery. AREAS COVERED: This study aims to cover the description of different types of stationary and wearable ankle rehabilitation devices suitable for the treatment of equinus contracture and point to deficiency in research, clinical trials, and launch of the market. EXPERT OPINION: This review provides insight into ankle rehabilitation devices with a focus on equinus contracture. Due to the fact that robotic devices successfully restore the condition of patients, attention should not be paid only to those with neurological impairments. This paper points that future research should be effectively linked to clinical practice with the aim of covering a wider range of disabilities and make an effort to successfully introduce devices from development into the practice.

Relative leg press strength relates to activity energy expenditure in older women: Implications for exercise prescription.

Limited work has evaluated how leg press strength (LPS), relative to body mass (i.e., rLPS), affects heart rate (HR) responses during activities of daily living. Such information would prove useful by informing a specific level of rLPS needed to promote independent mobility and physical activity. Secondary analyses were performed on baseline measures of 76 untrained older (65 ± 4 y) women. After familiarization, one-repetition maximum leg press was converted to rLPS by dividing the external load lifted (kg) by body mass (BM). Participants were stratified according to percentile of age-group norms of rLPS: ≤50 % (low, ≤0.99 kg/BM, n = 15), 51-89 % (middle, 1.0-1.31 kg/BM, n = 31), and ≥90 % (high, ≥1.32 kg/BM, n = 30). HR was measured at rest and during laboratory-based tasks including fixed-speed (0.89 m·s-1) non-graded treadmill walking, graded (2.5 %) treadmill walking, and stair stepping. Maximal oxygen uptake (V̇O2max) was measured via indirect calorimetry. Doubly labeled water was used to quantify activity energy expenditure (AEE) over a 14-d period. Relative LPS per group were: 0.85 ± 0.12 (low), 1.16 ± 0.09 (middle), and 1.55 ± 0.25 (high) (p < 0.001). Significant between-group differences in HR emerged during both walking tasks and stair stepping - with the high rLPS group having the lowest HR. AEE between-group comparisons did not yield statistical significance (p = 0.084), however, rLPS correlated with AEE (r = 0.234, p = 0.042) and V̇O2max (r = 0.430, p < 0.001). Such findings suggest a higher rLPS attenuates HR for weight-bearing activities while also demonstrating a significant, albeit modest, positive link to AEE among older women. This information may be especially relevant for informing thresholds of rLPS linked to mobility and functional independence in older women.

Strength and Power Testing of Athletes: Associations of Common Assessments Over Time.

PURPOSE: This study examined the associations among common assessments for measuring strength and power in the lower body of high-performing athletes, including both cross-sectional and longitudinal data. METHODS: A total of 100 participants, including both male (n = 83) and female (n = 17) athletes (21 [4] y, 182 [9] cm, 78 [12] kg), were recruited for the study using a multicenter approach. The participants underwent physical testing 4 times. The first 2 sessions (1 and 2) were separated by ∼1 week, followed by a period of 2 to 6 months, whereas the last 2 sessions (3 and 4) were also separated by ∼1 week. The test protocol consisted of squat jumps, countermovement jumps, jump and reach, 30-m sprint, 1-repetition-maximum squat, sprint cycling, and a leg-press test. RESULTS: There were generally acceptable correlations among all performance measures. Variables from the countermovement jumps and leg-press power correlated strongly with all performance assessments (r = .52-.79), while variables from sprint running and squat-jump power displayed more incoherent correlations (r = .21-.82). For changes over time, the correlations were mostly strong, albeit systematically weaker than for cross-sectional measures. CONCLUSIONS: The associations observed among the performance assessments seem to be consistent for both cross-sectional data and longitudinal change scores. The weaker correlations for change scores are most likely mainly caused by lower between-subjects variations in the change scores than for the cross-sectional data. The present study provides novel information, helping researchers and practitioners to better interpret the relationships across common performance assessment methods.

Supine leg press as an alternative to standing lunge in high-speed stereo radiography.

The standing lunge is an activity commonly used to quantify in-vivo knee kinematics with fluoroscopy. The ability to perform the standing lunge varies between subjects and can necessitate movement accommodations to successfully complete the desired range of motion. We proposed a supine leg press as an alternative to the standing lunge that aimed to provide a similar evaluation of knee motion while increasing the measured range of motion. Tibiofemoral kinematics of 53 non-symptomatic adults (27 men, 26 women, 50.8 ± 7.0 yrs.) were calculated from the tracked high-speed stereo radiography (HSSR) images for supine leg press and standing lunge using CT-segmented bony geometries of the right lower limb. The supine leg press proved to be a useful alternative to the standing lunge while providing 46.2° greater range of motion in knee flexion. The difference in angle-matched kinematics across a 100° flexion range between the leg press and lunge was 0.70° in varus-valgus rotation, 1.5° in internal-external rotation, 1.0 mm in medial-lateral translation, 2.3 mm in anterior-posterior translation, and 0.46 mm in superior-inferior translation for men. The angle-matched difference for women across 100° was 0.58° in varus-valgus rotation, 2.4° internal-external rotation, 0.70 mm medial-lateral translation, 2.1 mm anterior-posterior translation, and 0.78 mm superior-inferior translation. The similar kinematics, while having a greater range of motion, and control of the applied load makes the supine leg press an alternative for quantifying in-vivo knee kinematics.

Strength and Power Testing of Athletes: A Multicenter Study of Test-Retest Reliability.

PURPOSE: This study examined the test-retest reliability of common assessments for measuring strength and power of the lower body in high-performing athletes. METHODS: A total of 100 participants, including both male (n = 83) and female (n = 17) athletes (21 [4] y, 182 [9] cm, and 78 [12] kg), were recruited for this study, using a multicenter approach. The participants underwent physical testing 4 times. The first 2 sessions (1 and 2) were separated by ∼1 week, followed by a period of 2 to 6 months, whereas the last 2 sessions (3 and 4) were again separated by ∼1 week. The test protocol consisted of squat jumps, countermovement jumps, jump and reach, 30-m sprint, 1-repetition-maximum squat, sprint cycling, and a leg-press test. RESULTS: The typical error (%) ranged from 1.3% to 8.5% for all assessments. The change in means ranged from -1.5% to 2.5% for all assessments, whereas the interclass correlation coefficient ranged from .85 to .97. The smallest worthwhile change (0.2 of baseline SD) ranged from 1.2% to 5.0%. The ratio between the typical error (%) and the smallest worthwhile change (%) ranged from 0.5 to 1.2. When observing the reliability across testing centers, considerable differences in reliability were observed (typical error [%] ratio: 0.44-1.44). CONCLUSIONS: Most of the included assessments can be used with confidence by researchers and coaches to measure strength and power in athletes. Our results highlight the importance of controlling testing reliability at each testing center and not relying on data from others, despite having applied the same protocol.

Is Training With Gym Machines Safe After Hip Arthroplasty?-An In Vivo Load Investigation.

Background: Training with gym machines is one of the most popular physical activities after total hip arthroplasty (THA). However, to date, there are no evidence-based recommendations for physical activity after THA, worldwide. The aim of the study is to evaluate the in vivo hip joint loads during exercises on four widely used gym machines in order to provide a source for an evidence-based patient counselling for arthroplasty surgeons. Methods: The in vivo hip joint loads in seven patients (59.6 ± 6.4 years, 28.6 ± 2.1 kg/m2) with instrumented hip implants were assessed. The resulting force (Fres), bending moment (Mbend), and torsional moment (Mtors) were evaluated during the training on leg curl/leg extension machines (loads: 20, 30, and 40 kg), leg press machine [backrest: 10°, 30°, and 60°; load: 50, 75, and 100%BW (bodyweight)], and a rope pull machine (abduction/adduction/flexion/extension; each ipsi- and contralateral; load 10 kg). These loads were compared with the loads during walking on treadmill at 4 km/h (median peak values: Fres 303%BW, Mbend 4.25%BWm, and Mtors 2.70%BWm). Results: In each of the four performed exercises with a total of 23 different load conditions or exercise modes analyzed, a significantly lower or not different load was detected with respect to Fres, Mbend, and Mtors measured while walking with 4 km/h. Nevertheless, Fres and Mbend demonstrated a trend to increased loading during the ipsilateral monopod standing rope pull exercises hip flexion, extension, and abduction. Conclusion: Based on our investigation, we assume that the investigated gym machines and external loads can be considered mainly as low-impact sports (with some exceptions) and thus as safe physical activity after THA. Due to the fact that the examinations were conducted in the mean 17.4 months after THA, the applicability of the results to the immediate postoperative period is limited.

Usability evaluation of an interactive leg press training robot for children with neuromuscular impairments.

BACKGROUND: The use of robotic technology for neurorehabilitative applications has become increasingly important for adults and children with different motor impairments. OBJECTIVE: The aim of this study was to evaluate the technical feasibility and usability of a new interactive leg-press training robot that was developed to train leg muscle strength and control, suitable for children with neuromuscular impairments. METHODS: An interactive robotic training system was designed and constructed with various control strategies, actuators and force/position sensors to enable the performance of different training modes (passive, active resistance, and exergames). Five paediatric patients, aged between 7 and 16 years (one girl, age 13.0 ± 3.7 years, [mean ± SD]), with different neuromuscular impairments were recruited to participate in this study. Patients evaluated the device based on a user satisfaction questionnaire and Visual Analog Scale (VAS) scores, and therapists evaluated the device with the modified System Usability Scale (SUS). RESULTS: One patient could not perform the training session because of his small knee range of motion. Visual Analog Scale scores were given by the 4 patients who performed the training sessions. All the patients adjudged the training with the interactive device as satisfactory. The average SUS score given by the therapists was 61.2 ± 18.4. CONCLUSION: This study proposed an interactive lower limb training device for children with different neuromuscular impairments. The device is deemed feasible for paediatric rehabilitation applications, both in terms of technical feasibility and usability acceptance. Both patients and therapists provided positive feedback regarding the training with the device.

Optimizing Backrest Geometry to Minimize Interfacial Pressure Concentrations in the Mid-to-Lumbar Region During Leg Press Resistance Training.

The leg press is a resistance training (RT) exercise common to both weight- and powerlifting, where spine-related injuries remain prevalent. Here, the elevated loading has the potential to result in increased pressure on vertebral bodies and introduce the risk of spinal injury. This study, therefore, investigates back interfacial pressure under leg press loading conditions and offers design recommendations to minimize spatial pressure concentrations. A pressure mat was used to assess the back-backrest interfacial pressure distribution of 15 subjects executing RT leg-presses at 50% body weight, over 16 different back-support geometries. Real-time forces, knee angles, and pressures were captured. The resulting data show that more prominent (≥2.1 cm) back-supports, positioned 19 cm above the seat pan typically produced greater peak pressures (41.8 ± 7.2 kPa). Conversely, less prominent supports (∼0.7 cm) generally achieved lower peak pressures (with greater distribution). Our data suggest that the most prudent choice for fixed-shape backrests to best distribute interfacial pressure on leg-press devices is to incorporate shallow convex supports (∼0.7 cm) and locate them away from P = 19 cm. The result is surprising as this prominence location is a common ergonomic feature. If an adjustable backrest is considered, peak pressures may be reduced by up to 26 ± 8% (9.7 ± 3.1 kPa) compared to flat geometries.

Reactive Strength as a Metric for Informing Return-to-Sport Decisions: A Case-Control Study.

OBJECTIVE: Current return-to-sport decisions are primarily based on elapsed time since surgery or injury and strength measures. Given data that show rates of successful return to competitive sport at around 55%, there is strong rationale for adopting tools that will better inform return to sport decisions. The authors' objective was to assess reactive strength as a metric for informing return-to-sport decisions. DESIGN: Case-control design. METHODS: Fifteen elite athletes from national sports teams (23 [6.0] y) in the final phase of their return-to-sport protocol following a unilateral knee injury and 16 age-matched control athletes (22 [4.6] y) performed a unilateral isometric strength test and 24-cm drop jump test. Pairwise comparisons were used to determine differences between legs within groups and differences in interleg asymmetry between groups. RESULTS: Strength measures did not distinguish the control from the rehabilitation group; however, clear differences in the degree of asymmetry were apparent between the control and rehabilitation groups for contact time (Cohen d = 0.56; -0.14 to 1.27; 8.2%; P = .113), flight time (d = 1.10; 0.44 to 1.76; 16.0%; P = .002), and reactive strength index (d = 1.27; 0.50 to 2.04; 22.4%; P = .002). CONCLUSION: Reactive strength data provide insight into functional deficits that persist into the final phase of a return-to-sport protocol. The authors' findings support the use of dynamic assessment tools to inform return-to-sport decisions to limit potential for reinjury.

The bilateral limb deficit (BLD) phenomenon during leg press: a preliminary investigation into central and peripheral factors.

BACKGROUND: The bilateral limb deficit (BLD) phenomenon suggests that lower forces are produced with bilateral limb contractions compared to the summed force produced when the same muscles are contracted unilaterally. While interhemispheric inhibition has been suggested as a cause of BLD, the origin of the deficit is yet to be determined. The aim of this study was to investigate central and peripheral factors responsible for the BLD during leg press using surface electromyography (EMG) and electroencephalography (EEG). METHODS: Fourteen adults (age = 23.7 ± 4.7 years old) completed bilateral (BL), unilateral left (UL) and unilateral right (UR) isometric leg press exercises. Bilateral limb ratio (BLR) was calculated similar to previous studies and surface EMG from three muscles of the quadriceps femoris (vastus lateralis, vastus medialis and rectus femoris) was used to measure the level of muscle activation. Movement related cortical potentials (MRCPs) over the left and right motor cortex areas (C3 and C4, respectively) were used to assess brain activity asymmetries reflecting central factors. RESULTS: No significant difference was noted in the mean BLR (BLR = 94.8%), but a subset of ten participants did demonstrate a BLD (BLR = 81.4%, p < 0.01). Mean differences in relative activation were found among the three quadricep muscles (p < 0.001) with the right VM having significantly higher amplitude for the unilateral right (0.347 ± 0.318 mV) and bilateral right (0.436 ± 0.470 mV) conditions, respectively) than either the VL or RF (p < 0.05). The VL had significantly lower amplitudes in all conditions (0.127 ± 0.138 mV; 0.111 ± 0.104 mV; 0.120 ± 0.105 mV; 0.162 ± 0.147 mV for unilateral left, bilateral left, unilateral right, and bilateral right, respectively). However no overall significant differences were noted between bilateral and unilateral conditions. No significant differences in MRCPs were observed between brain activity of the C3 and C4 electrodes in any of the conditions. CONCLUSION: While the sample size was low, this exploratory study noted the presence of BLD however the results did not provide evidence of significant limitations in either the EMG or EEG data.

Early Maximal Strength Training Improves Leg Strength and Postural Stability in Elderly Following Hip Fracture Surgery.

INTRODUCTION: Hip fractures predominantly occur in the geriatric population and results in increased physical inactivity and reduced independency, largely influenced by a downward spiral of ambulatory capacity, related to loss of skeletal muscle strength and postural stability. Thus, effective postoperative treatment, targeting improvements in muscle strength, is sought after. MATERIALS & METHODS: Twenty-one hip fracture patients (>65 yr) were randomized to 8 weeks of either conventional physiotherapy control group (CG), or leg press and hip abduction maximal strength training (MST) 3 times per week. MST was performed applying heavy loads (85-90% of 1 repetition maximum; 1RM) and 4-5 repetitions in 4 sets. Maximal strength (bi- and unilateral 1RM), postural stability (unipedal stance test; UPS), and DEXA-scan bone mineral content/ density (BMC/BMD) were measured before and after the 8-week rehabilitation. RESULTS: Both MST and conventional physiotherapy improved bilateral leg press 1RM by 41 ± 27 kg and 29 ± 17 kg, respectively (both p < 0.01), while unilateral leg press 1RM only increased after MST (within group and between groups difference: both p < 0.05). MST also resulted in an increase in abduction 1RM in both the fractured (5 kg, 95%CI: 2-7; p < 0.01) and healthy limb (6 kg, 95%CI: 3-9; p < 0.01), while no such improvement was apparent in the CG (between groups difference: p < 0.01). Finally, MST improved UPS of the fractured limb (p < 0.05). No differences were observed in BMC or BMD following the 8 weeks. DISCUSSION: Early postoperative MST improved lower extremities maximal muscle strength more than conventional physiotherapy and was accompanied by improvements in postural stability. CONCLUSION: Implementing MST in early rehabilitation after hip fracture surgery should be considered as a relevant treatment to curtail the downward spiral of reduced ambulatory capacity typical for this patient group, possibly reducing the risk of recuring falls and excess mortality. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03030092.

Load-velocity relationship in the horizontal leg-press exercise in older women and men.

This study analyzed the predictive ability of movement velocity to estimate the relative load (i.e., % of one-repetition maximum [1RM]) during the horizontal leg-press exercise in older women and men. Twenty-four women and fourteen men living in community-dwelling centers volunteered to participate in this study. All participants performed a progressive loading test up to 1RM in the horizontal leg-press. The fastest peak velocity (PV) and mean velocity (MV) attained with each weight were collected for analysis. Linear regression equations were modeled for women and men. We observed very strong linear relationships between both velocity variables and the relative load in the horizontal leg-press in women (PV: r2 = 0.93 and standard error of the estimate (SEE) = 5.96% 1RM; MV: r2 = 0.94 and SEE = 5.59% 1RM) and men (PV: r2 = 0.93 and SEE = 5.96% 1RM; MV: r2 = 0.94 and SEE = 5.97% 1RM). The actual 1RM and the estimated 1RM using both the PV and MV presented trivial differences and very strong relationships (r = 0.98-0.99) in both sexes. Men presented significantly higher (p < 0.001-0.05) estimated PV and MV against all relative loads compared to women (average PV = 0.81 vs. 0.69 m·s-1 and average MV = 0.44 vs. 0.38 m·s-1). Our data suggest that movement velocity accurately estimates the relative load during the horizontal leg-press in older women and men. Coaches and researchers can use the proposed sex-specific regression equations in the horizontal leg-press to implement velocity-monitored resistance training with older adults.

Responses to Maximal Strength Training in Different Age and Gender Groups.

PURPOSE: The present study aimed to investigate the potential impact of age, gender, baseline strength, and selected candidate polymorphisms on maximal strength training (MST) adaptations. METHODS: A total of 49 subjects (22 men and 27 women) aged 20-76 years, divided into five age groups, completed an 8 weeks MST intervention. Each MST session consisted of 4 sets with 4 repetitions at ∼85-90% of one-repetition maximum (1RM) intensity in leg-press, three times per week. 1RM was tested pre and post the intervention and blood samples were drawn to genotype candidate polymorphisms ACE I/D (rs1799752), ACTN3 R577X (rs1815739), and PPARGC1A Gly482Ser (rs8192678). RESULTS: All age groups increased leg-press 1RM (p < 0.01), with a mean improvement of 24.2 ± 14.0%. There were no differences in improvements between the five age groups or between male and female participants, and there were no non-responders. Baseline strength status did not correlate with 1RM improvements. PPARGC1A rs8192678 T allele carriers had a 15% higher age- and gender corrected baseline 1RM than the CC genotype (p < 0.05). C allele carriers improved 1RM (%) by 34.2% more than homozygotes for the T allele (p < 0.05). CONCLUSION: To the best of our knowledge, this is the first study to report improvement in leg-press maximal strength regardless of gender, baseline strength status in all age groups. The present study is also first to demonstrate an association between the PPARGC1A rs8192678 and maximal strength and its trainability in a moderately trained cohort. MST may be beneficial for good health and performance of all healthy individuals.

Electromyographic Comparison of Five Lower-Limb Muscles between Single- and Multi-Joint Exercises among Trained Men.

Resistance-training exercises can be classified as either single- or multi-joint exercises and differences in surface electromyography (EMG) amplitude between the two training methods may identify which muscles can benefit from either training modality. This study aimed to compare the surface EMG amplitude of five hip- and knee extensors during one multi-joint (leg press) and two single-joint exercises (knee extension and kickback). Fifteen resistance-trained men completed one familiarization session to determine their unilateral six repetitions maximum (6RM) in the three exercises. During the following experimental session, EMG amplitudes of the vastus lateralis, vastus medialis, rectus femoris, gluteus maximus and biceps femoris of the left leg were measured while performing three repetitions on their respective 6RM loads. The multi-joint exercise leg press produced higher EMG amplitude of the vastus lateralis (ES = 0.92, p = 0.003) than the single-joint exercise knee extension, whereas the rectus femoris demonstrated higher EMG amplitude during the knee extension (ES = 0.93, p = 0.005). The biceps femoris EMG amplitude was higher during the single-joint exercise kickback compared to the leg press (ES = 2.27, p < 0.001), while no significant differences in gluteus maximus (ES = 0.08, p = 0.898) or vastus medialis (ES = 0.056, p = 0.025 were observed between exercises. The difference in EMG amplitude between single- and multi-joint exercises appears to vary depending on the specific exercises and the muscle groups tested. Leg press is a viable and time-efficient option for targeting several hip- and knee extensors during resistance training of the lower limbs, but the single-joint exercises may be preferable for targeting the rectus femoris and biceps femoris.

Effect of Acute Interset Foot Cooling on Lower Limb Strength Training Workout.

PURPOSE: The authors investigated the effect of foot cooling (FC) between sets in a leg press pyramid workout with resistance-trained participants. METHODS: A total of 12 resistance-trained men (age = 21.8 [0.6] y; training experience = 1.7 [1] y) performed a pyramid workout, including 4 sets of 85% to 90% 1-repetition maximum leg press exercise to exhaustion with interset FC or noncooling in a repeated-measures crossover design separated by 5 days. The authors immersed the participants' feet in 10°C water for 2.5 minutes between sets. RESULTS: Two-way repeated-measures analysis of variance revealed that FC elicited significantly higher repetitions and electromyography (EMG) values of the vastus lateralis (simple main effect of condition) than did noncooling (P < .05) in the second (repetitions: 11 [3.5] vs 7.75 [3.2]; EMG: 63.4% [19.4%] vs 54.5% [18.4%]), third (repetitions: 8.9 [3.2] vs 6.4 [2.1]; EMG: 71.5% [17.4%] vs 60.6% [19.4%]), and fourth (repetitions: 7.5 [2.7] vs 5.1 [2.2]; EMG: 75.2% [19.6%] vs 59.3% [23.5%]) sets. The authors also detected a simple main effect of set in the FC and noncooling conditions on repetitions (P < .05) and in the FC condition on the vastus lateralis EMG values. Although the authors observed no time × trial interactions for the rating of perceived exertion, the authors observed main effects on the sets (7.7-9.6 vs 7.9-9.3, P < .05). CONCLUSIONS: Interset FC provides an ergogenic effect on a leg press pyramid workout and may offset fatigue, as indicated by higher repetitions and EMG response, without increasing perceived exertion.