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1.  Surface Electromyographic Amplitude-to-Work Ratios During Isokinetic and Isotonic Muscle Actions 
Journal of Athletic Training  2006;41(3):314-320.
Context: Isokinetic and isotonic resistance training exercises are commonly used to increase strength during musculoskeletal rehabilitation programs. Our study was designed to examine the efficacy of isokinetic and isotonic muscle actions using surface electromyographic (EMG) amplitude-to-work ratios (EMG/WK) and to extend previous findings to include a range of isokinetic velocities and isotonic loads.
Objective: To examine work (WK), surface EMG amplitude, and EMG/WK during concentric-only maximal isokinetic muscle actions at 60, 120, 180, 240, and 300°/s and isotonic muscle actions at 10%, 20%, 30%, 40%, and 50% of the maximal voluntary isometric contraction (MVIC) torque during leg extension exercises.
Design: A randomized, counterbalanced, cross-sectional, repeated-measures design.
Setting: A university-based human muscle physiology research laboratory.
Patients or Other Participants: Ten women (mean age = 22.0 ± 2.6 years) and 10 men (mean age = 20.8 ± 1.7 years) who were apparently healthy and recreationally active.
Intervention(s): Using the dominant leg, each participant performed 5 maximal voluntary concentric isokinetic leg extension exercises at randomly ordered angular velocities of 60, 120, 180, 240, and 300°/s and 5 concentric isotonic leg extension exercises at randomly ordered loads of 10%, 20%, 30%, 40%, and 50% of the isometric MVIC.
Main Outcome Measure(s): Work was recorded by a Biodex System 3 dynamometer, and surface EMG was recorded from the superficial quadriceps femoris muscles (vastus lateralis, rectus femoris, and vastus medialis) during the testing and was normalized to the MVIC. The EMG/WK ratios were calculated as the quotient of EMG amplitude (μVrms) and WK (J) during the concentric phase of each exercise.
Results: Isotonic EMG/WK remained unchanged ( P > .05) from 10% to 50% MVIC, but isokinetic EMG/WK increased ( P < .05) from 60 to 300°/s. Isotonic EMG/WK was greater ( P < .05) than isokinetic EMG/WK for 50% MVIC versus 60°/s, 40% MVIC versus 120°/s, and 30% MVIC versus 180°/s; however, no differences were noted ( P > .05) between 20% MVIC versus 240°/s or 10% MVIC versus 300°/s. An 18% decrease in active range of motion was seen for the isotonic muscle actions, from 10% to 50% MVIC, and a 3% increase in range of motion for the isokinetic muscle actions from 60 to 300°/s was also observed. Furthermore, the peak angular velocities for the isotonic muscle actions ranged from 272.9 to 483.0°/s for 50% and 10% MVIC, respectively.
Conclusions: When considering EMG/WK, peak angular velocity, and range of motion together, our data indicate that maximal isokinetic muscle actions at 240°/s or controlled-velocity isotonic muscle actions at 10%, 20%, or 30% MVIC may maximize the amount of muscle activation per unit of WK done during the early stages of musculoskeletal rehabilitation. These results may be useful to allied health professionals who incorporate open-chain resistance training exercises during the early phases of rehabilitation and researchers who use isotonic or isokinetic modes of resistance exercise to examine muscle function.
PMCID: PMC1569550  PMID: 17043700
range of motion; angular velocity; muscle activation; leg extension; rehabilitation
2.  Movement within foot and ankle joint in children with spastic cerebral palsy: a 3-dimensional ultrasound analysis of medial gastrocnemius length with correction for effects of foot deformation 
In spastic cerebral palsy (SCP), a limited range of motion of the foot (ROM), limits gait and other activities. Assessment of this limitation of ROM and knowledge of active mechanisms is of crucial importance for clinical treatment.
For a comparison between spastic cerebral palsy (SCP) children and typically developing children (TD), medial gastrocnemius muscle-tendon complex length was assessed using 3-D ultrasound imaging techniques, while exerting externally standardized moments via a hand-held dynamometer. Exemplary X-ray imaging of ankle and foot was used to confirm possible TD-SCP differences in foot deformation.
SCP and TD did not differ in normalized level of excitation (EMG) of muscles studied. For given moments exerted in SCP, foot plate angles were all more towards plantar flexion than in TD. However, foot plate angle proved to be an invalid estimator of talocrural joint angle, since at equal foot plate angles, GM muscle-tendon complex was shorter in SCP (corresponding to an equivalent of 1 cm). A substantial difference remained even after normalizing for individual differences in tibia length. X-ray imaging of ankle and foot of one SCP child and two typically developed adults, confirmed that in SCP that of total footplate angle changes (0-4 Nm: 15°), the contribution of foot deformation to changes in foot plate angle (8) were as big as the contribution of dorsal flexion at the talocrural joint (7°). In typically developed individuals there were relatively smaller contributions (10 -11%) by foot deformation to changes in foot plate angle, indicating that the contribution of talocrural angle changes was most important.
Using a new estimate for position at the talocrural joint (the difference between GM muscle–tendon complex length and tibia length, GM relative length) removed this effect, thus allowing more fair comparison of SCP and TD data. On the basis of analysis of foot plate angle and GM relative length as a function of externally applied moments, it is concluded that foot plate angle measurements underestimate angular changes at the talocrural joint when moving in dorsal flexion direction and overestimate them when moving in plantar flexion direction, with concomitant effects on triceps surae lengths.
In SCP children diagnosed with decreased dorsal ROM of the ankle joint, the commonly used measure (i.e. range of foot plate angle), is not a good estimate of rotation at the talocrural joint. since a sizable part of the movement of the foot (or foot plate) derives from internal deformation of the foot.
PMCID: PMC3909357  PMID: 24364826
Cerebral palsy; Ultrasound imaging; m. gastrocnemius medialis; Ankle joint; Ankle moment; Foot deformation
3.  Muscle oxidative metabolism accelerates with mild acidosis during incremental intermittent isometric plantar flexion exercise 
It has been thought that intramuscular ADP and phosphocreatine (PCr) concentrations are important regulators of mitochondorial respiration. There is a threshold work rate or metabolic rate for cellular acidosis, and the decrease in muscle PCr is accelerated with drop in pH during incremental exercise. We tested the hypothesis that increase in muscle oxygen consumption (o2mus) is accelerated with rapid decrease in PCr (concomitant increase in ADP) in muscles with drop in pH occurs during incremental plantar flexion exercise.
Five male subjects performed a repetitive intermittent isometric plantar flexion exercise (6-s contraction/4-s relaxation). Exercise intensity was raised every 1 min by 10% maximal voluntary contraction (MVC), starting at 10% MVC until exhaustion. The measurement site was at the medial head of the gastrocnemius muscle. Changes in muscle PCr, inorganic phosphate (Pi), ADP, and pH were measured by 31P-magnetic resonance spectroscopy. o2mus was determined from the rate of decrease in oxygenated hemoglobin and/or myoglobin using near-infrared continuous wave spectroscopy under transient arterial occlusion. Electromyogram (EMG) was also recorded. Pulmonary oxygen uptake (o2pul ) was measured by the breath-by-breath gas analysis.
EMG amplitude increased as exercise intensity progressed. In contrast, muscle PCr, ADP, o2mus, and o2pul did not change appreciably below 40% MVC, whereas above 40% MVC muscle PCr decreased, and ADP, o2mus, and o2pul increased as exercise intensity progressed, and above 70% MVC, changes in muscle PCr, ADP, o2mus, and o2pul accelerated with the decrease in muscle pH (~6.78). The kinetics of muscle PCr, ADP, o2mus, and o2pul were similar, and there was a close correlation between each pair of parameters (r = 0.969~0.983, p < 0.001).
With decrease in pH muscle oxidative metabolism accelerated and changes in intramuscular PCr and ADP accelerated during incremental intermittent isometric plantar flexion exercise. These results suggest that rapid changes in muscle PCr and/or ADP with mild acidosis stimulate accelerative muscle oxidative metabolism.
PMCID: PMC1079909  PMID: 15720727
4.  Analysis of Isokinetic Knee Extension / Flexion in Male Elite Adolescent Wrestlers 
Wrestling requires strength of the upper and lower body musculature which is critical for the athletic performance. Evaluation of the adolescent’s skeletal muscle is important to understand body movement, especially including those involved in sports. Strength, power and endurance capacity are defined as parameters of skeletal muscle biomechanical properties. The isokinetic dynamometer is an important toll for making this type of evaluation. However, load range phase of range of motion has to be considered to interpret the data correctly. With this in mind we aimed to investigate the lover body musculature contractile characteristics of adolescent wrestlers together with detailed analyses of load range phase of motion. Thirteen boys aged 12 - 14 years participated to this study. Concentric load range torque, work and power of knee extension and flexion were measured by a Cybex Norm dynamometer at angular velocities from 450°/sec to 30°/sec with 30°/sec decrements for each set. None of the wrestlers were able to attain load range for angular velocities above 390°/sec and 420°/sec for extension and flexion respectively. Detailed analyses of the load range resulted in statistically significant differences in the normalized load range peak torque for extension at 270°/sec (1.44 ± 0.28 Nm·kg-1 and 1.14 ± 0.28 Nm·kg-1 for total and load range peak torque respectively, p < 0.05), and for flexion at 300°/sec (1.26 ± 0.28 Nm·kg-1 and 1.03 ± 0.23 Nm·kg-1 for total and load range peak torque respectively, p < 0.05), compared to total peak torque data. Similarly, the significant difference was found for the work values at 90°/sec (1.91 ± 0.23 Nm·kg-1 and 1.59 ± 0.24 Nm·kg-1 for total and load range work respectively for extension and 1.73 ± 0.21 Nm·kg-1 and 1.49 ± 0.19 Nm·kg-1 for total and load range work respectively for flexion, p < 0.05), and was evident at higher angular velocities (p < 0.001) for both extension and flexion. At extension, load range power values were significantly smaller than total power for all angular velocities except 150°/sec (p < 0.05 for 120 and 180°/sec, p < 0.001 for others). Finally, load range flexion power was found to be higher than total power with statistically significance (p < 0.05 for 60, 120, 150, 180, 210, 270 and 300°/sec, p < 0.001 for 240 °/sec). Extra caution is required for correct interpretation of load range data in terms of considering the load range during limb movement. Evaluation of muscle performance of these adolescent wrestlers at regular intervals may give us an opportunity to obtain a healthy maturation profile of these adolescent wrestlers.
Key PointsConsideration of load range for peak torque, work and power calculation resulted significant differences in the data presented by isokinetic dynamometer. Therefore evaluation of the dynamometer data required consideration of the load range for correct analysis and interpretation.Contraction velocity has critical importance in determining the load range attaining ability for a moving limb during load range evaluation. In fact alterations in contraction speed may be due to a number of changes in muscle morphology, subjects’ age and the ratio between type I and type II muscle fiber area.
PMCID: PMC3899666  PMID: 24501564
Wrestling; adolescent; isokinetic dynamometer; muscle; load range
5.  Limb Stress-Rest Perfusion Imaging With Contrast Ultrasound For The Assessment Of Peripheral Arterial Disease Severity 
JACC. Cardiovascular imaging  2008;1(3):343-350.
We hypothesized that lower extremity stress-rest perfusion imaging with contrast-enhanced ultrasound (CEU) could evaluate the severity of peripheral arterial disease (PAD).
Perfusion imaging may provide valuable quantitative information on PAD, particularly in patients with diabetes in whom microvascular functional abnormalities are common.
Twenty-six control subjects and 39 patients with symptomatic PAD, 19 with type-2 diabetes mellitus, were studied. Claudication threshold was determined by a modified treadmill exercise test. Bilateral pulse-volume recordings, ankle-brachial index (ABI), and post-exercise ABI were performed. CEU perfusion imaging of the gastrocnemius and soleus was performed at rest and after 2 min of plantar-flexion exercise.
During exercise, claudication occurred earlier in PAD patients with diabetes than without. Muscle blood flow during plantar-flexion exercise was lower (p<0.05) in patients with PAD (10.4±6.7) and PAD with diabetes (7.9±5.9) compared to control subjects (20.0±9.5). After adjusting for diabetes, the only diagnostic tests that predicted severity of disease defined by claudication threshold were CEU exercise blood flow (odds ratios: 0.67 [95% CI (0.51 to 0.88); p=0.003], and flow reserve (odds ratio: 0.64 [95% CI (0.46 to 0.89), p=0.008]). A multivariate model incorporating all non-invasive diagnostic tests indicated that the best models for predicting severity of disease were the combination of presence of diabetes and either exercise blood flow or flow reserve.
Limb microvascular perfusion imaging during exercise can be evaluated by CEU. Skeletal muscle blood flow during exercise and flow reserve are impaired in patients with PAD and correlate with the severity of symptoms.
PMCID: PMC2651026  PMID: 19356447
6.  Effect of exercise-induced muscle damage on muscle hardness evaluated by ultrasound real-time tissue elastography 
SpringerPlus  2015;4:308.
To assess the effect of exercise-induced muscle damage on muscle hardness and evaluate the relationship between muscle hardness and muscle damage indicators.
Seven men (mean 25.3 years; 172.7 cm; 66.8 kg) performed the single-leg ankle plantar flexion exercise involving both concentric and eccentric contractions (10 sets of 40 repetitions). The hardness of the medial gastrocnemius (MG) was evaluated using ultrasound real-time tissue elastography before, from day 1 to 4, and day 7 after exercise. The strain ratio between the MG and a reference material was calculated. Simultaneously, we evaluated the magnetic resonance T2 value (an index of edema) of the triceps surae, the ankle dorsiflexion range of motion (ROM), and calf muscle soreness. Serum creatine kinase activity was assessed before, 2 and 4 h, and from day 1 to 4 after exercise.
The MG showed lower strain ratio, indicating increased muscle hardness, on day 4 post-exercise (P < 0.01) and higher T2 values on days 1–7 post-exercise (P < 0.01) relative to each pre-exercise value. The ankle dorsiflexion ROM was lower on days 2–4 post-exercise (P < 0.01). The serum creatine kinase markedly increased on days 3 and 4 post-exercise (not significant). The degree of muscle soreness among the post-exercise time points was similar. The decreased strain ratio did not correlate with the increased T2, the decreased joint ROM or muscle soreness.
Muscle hardness increased after strenuous resistance exercise, but the change was not related with muscle edema, decreased joint ROM, or muscle soreness resulting from muscle damage.
PMCID: PMC4488235  PMID: 26155447
Real-time tissue elastography; Magnetic resonance imaging; Muscle hardness; Eccentric contraction; Muscle damage; Muscle edema
7.  Plantar-flexor Static Stretch Training Effect on Eccentric and Concentric Peak Torque – A comparative Study of Trained versus Untrained Subjects 
Journal of Human Kinetics  2012;34:49-58.
The aim of this study was to examine the long-term effects of static stretching of the plantar-flexor muscles on eccentric and concentric torque and ankle dorsiflexion range of motion in healthy subjects. Seventy five healthy male volunteers, with no previous history of trauma to the calf that required surgery, absence of knee flexion contracture and no history of neurologic dysfunction or disease, systemic disease affecting the lower extremities were selected for this study. The participants were divided into three equal groups. The control group did not stretch the plantar-flexor muscles. Two Experimental groups (trained and untrained) were instructed to perform static stretching exercise of 30 second duration and 5 repetitions twice daily. The stretching sessions were carried out 5 days a week for 6 weeks. The dorsiflexion range of motion was measured in all subjects. Also measured was the eccentric and concentric torque of plantar-flexors at angular velocities of 30 and 120°/s pre and post stretching. Analysis of variance showed a significant increase in plantar-flexor eccentric and concentric torque (p < 0.05) of trained and untrained groups, and an increase in dorsiflexion range of motion (p < 0.05) at both angular velocities for the untrained group only. The static stretching program of plantar-flexors was effective in increasing the concentric and eccentric plantarflexion torque at angular velocities of 30 and 120°/s. Increases in plantar-flexors flexibility were observed in untrained subjects.
PMCID: PMC3590825  PMID: 23486840
calf muscle; isokinetic torque; static stretching
8.  Noninvasive optical characterization of muscle blood flow, oxygenation, and metabolism in women with fibromyalgia 
Arthritis Research & Therapy  2012;14(6):R236.
Women with fibromyalgia (FM) have symptoms of increased muscular fatigue and reduced exercise tolerance, which may be associated with alterations in muscle microcirculation and oxygen metabolism. This study used near-infrared diffuse optical spectroscopies to noninvasively evaluate muscle blood flow, blood oxygenation and oxygen metabolism during leg fatiguing exercise and during arm arterial cuff occlusion in post-menopausal women with and without FM.
Fourteen women with FM and twenty-three well-matched healthy controls participated in this study. For the fatiguing exercise protocol, the subject was instructed to perform 6 sets of 12 isometric contractions of knee extensor muscles with intensity steadily increasing from 20 to 70% maximal voluntary isometric contraction (MVIC). For the cuff occlusion protocol, forearm arterial blood flow was occluded via a tourniquet on the upper arm for 3 minutes. Leg or arm muscle hemodynamics, including relative blood flow (rBF), oxy- and deoxy-hemoglobin concentration ([HbO2] and [Hb]), total hemoglobin concentration (THC) and blood oxygen saturation (StO2), were continuously monitored throughout protocols using a custom-built hybrid diffuse optical instrument that combined a commercial near-infrared oximeter for tissue oxygenation measurements and a custom-designed diffuse correlation spectroscopy (DCS) flowmeter for tissue blood flow measurements. Relative oxygen extraction fraction (rOEF) and oxygen consumption rate (rVO2) were calculated from the measured blood flow and oxygenation data. Post-manipulation (fatiguing exercise or cuff occlusion) recovery in muscle hemodynamics was characterized by the recovery half-time, a time interval from the end of manipulation to the time that tissue hemodynamics reached a half-maximal value.
Subjects with FM had similar hemodynamic and metabolic response/recovery patterns as healthy controls during exercise and during arterial occlusion. However, tissue rOEF during exercise in subjects with FM was significantly lower than in healthy controls, and the half-times of oxygenation recovery (Δ[HbO2] and Δ[Hb]) were significantly longer following fatiguing exercise and cuff occlusion.
Our results suggest an alteration of muscle oxygen utilization in the FM population. This study demonstrates the potential of using combined diffuse optical spectroscopies (i.e., NIRS/DCS) to comprehensively evaluate tissue oxygen and flow kinetics in skeletal muscle.
PMCID: PMC3674608  PMID: 23116302
9.  Effect of eccentric exercise-induced muscle damage on electromyographyic activity of quadriceps in untrained healthy females 
Background: The aim of this study was to investigate muscle damage indicators and electromyography activities of quadriceps muscles at 25° of hip flexion in untrained healthy females after an eccentric exercise induced muscle fiber damage.
Methods: A total of 14 healthy females participated in this pre-experimental study. The subjects performed maximal eccentric quadriceps contractions at 25˚ of hip flexion. Maximum voluntary extensor isometric and concentric moments, angle of maximum moment for concentric contractions, perceived pain intensity, and pain pressure threshold were examined before, immediately, 48 hours, 120 hours and 14 days after eccentric exercise. Additionally, electromyography of three parts of quadriceps muscle, knee flexion range of motion and thigh circumference were measured before and after eccentric exercise.
Results: Significant reductions in maximum isometric moment and maximum concentric moment were observed at angular velocity of 60˚ per sec immediately after eccentric exercise (p<0.05). Both maximum isometric moment and maximum concentric moment recovered to the baseline 48 hours after eccentric exercise. Increased pain intensity and decreased knee joint range of motion manifested 48 hours after eccentric exercise. Pain pressure threshold for the quadriceps was higher 14 days after exercise as compared to 48 and 120 hours (p<0.05). No significant changes observed in electromyography and thigh circumference (p>0.05).
Conclusion: Eccentric exercise performed at 25˚ of hip flexion resulted in muscle fiber injuries within the quadriceps muscle. However, electromyography of quadriceps muscle was not significantly different than the baseline. The result indicates that hip joint position may modify the effect of eccentric exercise on muscle activation.
PMCID: PMC4322328  PMID: 25695012
Muscles; electromyography; hip; muscle soreness; exercise
10.  Lower Extremity Passive Range of Motion in Community-Ambulating Stroke Survivors 
Physical therapists may prescribe stretching exercises for individuals with stroke to improve joint integrity and to reduce the risk of secondary musculoskeletal impairment. While deficits in passive range of motion (PROM) exist in stroke survivors with severe hemiparesis and spasticity, the extent to which impaired lower extremity PROM occurs in community-ambulating stroke survivors remains unclear. This study compared lower extremity PROM in able-bodied individuals and independent community-ambulatory stroke survivors with residual stroke-related neuromuscular impairments. Our hypothesis was that the stroke group would show decreased lower extremity PROM in the paretic but not the nonparetic side and that decreased PROM would be associated with increased muscle stiffness and decreased muscle length.
Individuals with chronic poststroke hemiparesis who reported the ability to ambulate independently in the community (n = 17) and age-matched control subjects (n = 15) participated. PROM during slow (5 degrees/sec) hip extension, hip flexion, and ankle dorsiflexion was examined bilaterally using a dynamometer that measured joint position and torque. The maximum angular position of the joint (ANGmax), torque required to achieve ANGmax (Tmax), and mean joint stiffness (K) were measured. Comparisons were made between able-bodied and paretic and able-bodied and nonparetic limbs.
Contrary to our expectations, between-group differences in ANGmax were observed only during hip extension in which ANGmax was greater bilaterally in people post-stroke compared to control subjects (P ≤ 0.05; stroke = 13 degrees, able-bodied = −1 degree). Tmax, but not K, was also significantly higher during passive hip extension in paretic and nonparetic limbs compared to control limbs (P ≤ 0.05; stroke = 40 Nm, able-bodied = 29 Nm). Compared to the control group, Tmax was increased during hip flexion in the paretic and nonparetic limbs of post-stroke subjects (P ≤ 0.05, stroke = 25 Nm, able-bodied = 18 Nm). K in the nonparetic leg was also increased during hip flexion (P ≤ 0.05, nonparetic = 0.52 Nm/degree, able-bodied = 0.37 Nm/degree.)
This study demonstrates that community-ambulating stroke survivors with residual neuromuscular impairments do not have decreased lower extremity PROM caused by increased muscle stiffness or decreased muscle length. In fact, the population of stroke survivors examined here appears to have more hip extension PROM than age-matched able-bodied individuals. The clinical implications of these data are important and suggest that lower extremity PROM may not interfere with mobility in community-ambulating stroke survivors. Hence, physical therapists may choose to recommend activities other than stretching exercises for stroke survivors who are or will become independent community ambulators.
PMCID: PMC3963266  PMID: 18463552
cerebral vascular accident (CVA); hemiparesis; muscle; range of motion (ROM); spasticity
11.  Metabolic abnormality of calf skeletal muscle is improved by localised muscle training without changes in blood flow in chronic heart failure 
Heart  1997;78(5):437-443.
Objective—To investigate whether localised skeletal muscle training, which does not have a great influence on the heart, improves abnormalities of calf muscle metabolism in patients with chronic heart failure.
Methods—Seven cardiac patients in New York Heart Association class II and III undertook a random order crossover trial. Training consisted of unilateral calf plantar flexion exercise. Before and after training, the patients' metabolic responses were examined during the calf exercise test with phosphorus-31 nuclear magnetic resonance spectroscopy (31P-MRS) and calf blood flow with plethysmography. The new Borg scale was employed as a subjective fatigue scale.
Results—In a constant load exercise test (70% of maximum load achieved during the incremental exercise), standardised phosphocreatine and intracellular pH decreased less after training (p < 0.05, repeated measures analysis of variance). The new Borg scale improved significantly after training (p < 0.05). Blood flow did not change significantly in either test.
Conclusions—In patients with chronic heart failure, localised calf skeletal muscle training improved oxidative capacity without changes in calf blood flow. This training also improved the subjective fatigue scale. This training method may therefore alleviate leg fatigue experienced in daily activities.

 Keywords: heart failure;  magnetic resonance spectroscopy;  skeletal muscle;  localised training
PMCID: PMC1892289  PMID: 9415000
12.  Stretch speed‐dependent myofiber damage and functional deficits in rat skeletal muscle induced by lengthening contraction 
Physiological Reports  2014;2(11):e12213.
Exercise involving lengthening contraction (LC) often results in delayed myofiber damage and functional deficits over the ensuing days. The present study examined whether the stretch speed of LC is a determinant of damage severity. Under isoflurane anesthesia, LC was repeatedly induced in rat ankle extensor muscles at different stretch speeds (angular velocities of 50, 100, 200, and 400 deg/sec) over a fixed stretch range of motion (90°). The number of muscle fibers labeled with Evans blue dye, a marker of muscle fiber damage associated with increased membrane permeability, increased with the angular velocity of LC (by 20% of all myofibers at 400 deg/sec). Muscle fibers with cross‐sectional areas in the range of 3600–4800 μm2, corresponding to type IIb fiber size, exhibited the most severe damage as revealed by the largest decrease in the number of fibers 3 days after LC at 200 deg/sec, suggesting that muscle damage occurred preferentially in type IIb myofibers. Isometric torque of dorsiflexion measured 2 days after LC decreased progressively with LC angular velocity (by 68% reduction at 400 deg/sec). The angular velocity of muscle stretch during LC is thus a critical determinant of the degree of damage, and LC appears to damage type IIb fibers preferentially, resulting in a disproportionate reduction in isometric torque. This LC response is an important consideration for the design of physical conditioning and rehabilitation regimens.
Representative triple immunofluorescent images of sections from tibialis anterior 2 days after lengthening contraction at different angular velocities. The number of Evans Blue Dye ‐positive fibers increases with the angular velocity of lengthening contraction.
PMCID: PMC4255819  PMID: 25413330
Evans blue dye; lengthening contraction; stretch speed
13.  Cerebral vascular control is associated with skeletal muscle pH in chronic fatigue syndrome patients both at rest and during dynamic stimulation☆ 
NeuroImage : Clinical  2013;2:168-173.
Cerebral blood flow (CBF) is maintained despite changing systemic blood pressure through cerebral vascular control, with such tight regulation believed to be under local tissue control. Chronic fatigue syndrome (CFS) associates with a wide range of symptoms, including orthostatic intolerance, skeletal muscle pH abnormalities and cognitive impairment. CFS patients are known to have reduced CBF and orthostatic intolerance associates with abnormal vascular regulation, while skeletal muscle pH abnormalities associate with autonomic dysfunction. These findings point to autonomic dysfunction as the central feature of CFS, and cerebral vascular control being influenced by factors outside of the brain, a macroscopic force affecting the stability of regional regulation. We therefore explored whether there was a physiological link between cerebral vascular control and skeletal muscle pH management in CFS.
Seventeen consecutive CFS patients fulfilling the Fukuda criteria were recruited from our local CFS clinical service. To probe the static scenario, CBF and skeletal muscle pH were measured at rest using MRI and 31P magnetic resonance spectroscopy (31P-MRS).
To examine dynamic control, brain functional MRI was performed concurrently with Valsalva manoeuvre (VM), a standard autonomic function challenge, while 31P-MRS was performed during plantar flexion exercise.
Significant inverse correlation was seen between CBF and skeletal muscle pH at rest (r = − 0.67, p < 0.01). Prolonged cerebral vascular constriction during the sympathetic phase of VM was associated with higher pH in skeletal muscle after plantar flexion exercise (r = 0.69, p < 0.008).
In conclusion, cerebral vascular control is closely related to skeletal muscle pH both at rest and after dynamic stimulation in CFS.
► Cerebral vascular control in CFS is affected by factors external to the brain. ► Valsalva manoeuvre performed during fMRI probes cerebral vascular control. ► Cerebral blood flow is associated with skeletal muscle pH at rest in CFS. ► Cerebral vascular control relates to skeletal pH recovery after stimulation in CFS. ► Our results point towards a peripheral or systemic cause for CFS.
PMCID: PMC3777833  PMID: 24179772
Autonomic function; Chronic fatigue syndrome; 31P MR spectroscopy; Cerebral blood flow; Arterial spin labelling (ASL); Dual echo fMRI
Journal of biomechanics  2008;41(11):2492-2497.
Ultrasonography was used to measure pennation angle and electromyography (EMG) to record muscle activity of the human tibialis anterior (TA), lateral gastrocnemius (LG), medial gastrocnemius (MG), and soleus (SOL) muscles during graded isometric ankle plantar and dorsiflexion contractions done on a Biodex dynamometer. Data from eight male and eight female subjects were collected in increments of approximately 25% of maximum voluntary contraction (MVC) ranging from rest to MVC. A significant positive linear relationship (p < 0.05) between normalized EMG and pennation angle for all muscles was observed when subject specific pennation angles at rest and MVC were included in the analysis. These were included to account for gender differences and inter-subject variability in pennation angle. The coefficient of determination, R2, ranged between 0.76 for the TA to 0.87 for the SOL. The EMG-pennation angle relationships have ramifications for use in EMG-driven models of muscle force. The regression equations can be used to characterize fiber pennation angle more accurately and to determine how it changes with contraction intensity, thus providing improved estimates of muscle force when using musculoskeletal models.
PMCID: PMC2548308  PMID: 18579147
ultrasound; regression; optimal pennation angle; sex differences
15.  Reciprocal activation of gastrocnemius and soleus motor units is associated with fascicle length change during knee flexion 
Physiological Reports  2014;2(6):e12044.
While medial gastrocnemius (MG) and soleus (SOL) are considered synergists, they are anatomically exclusive in that SOL crosses only the ankle, while MG crosses both the knee and ankle. Due to the force‐length properties of both active and passive structures, activation of SOL and MG must be constantly regulated to provide the required joint torques for any planned movement. As such, the aim of this study was to investigate the neural regulation of MG and SOL when independently changing their length by changing only the knee joint angle, thus exclusively altering the length of MG fibers. MG and SOL motor units (MU) were recorded intramuscularly along with ultrasound imaging of MG and SOL fascicle lengths, while moving the knee through 60° of rotation and maintaining a low level of voluntary plantar flexor torque. The results showed a reciprocal activation of MG and SOL as the knee was moved into flexion and extension. A clear reduction in MG MU firing rates occurred as the knee was flexed (MG fascicles shortening), with de‐recruitment of most MG MU occurring at close to full knee flexion. A concomitant increase in SOL MU activity was observed while no change in the length of its fascicles was found. The opposite effects were found when the knee was moved into extension. A strong correlation (ICC = 0.78) was found between the fascicle length at which MG MUs were de‐recruited and subsequently re‐recruited. This was stronger than the relationship of de‐recruitment and re‐recruitment with knee angle (ICC = 0.52), indicating that in this instance, muscle fascicle length rather than joint angle is more influential in regulating MG recruitment. Such a reciprocal arrangement like the one presented here for SOL and MG is essential for human voluntary movements such as walking or cycling.
This study show that under dynamic conditions, drive to the medial gastrocnemius muscle is modulated such that motor unit de‐recruitment occurs with progressive medial gastrocnemius fascicle shortening and recruitment occurs with progressive lengthening. Furthermore, the results also indicate that muscle length rather than joint angle accounts for the changes in medial gastrocnemius recruitment during knee flexion and extension. This has important consequences for our understanding of the control of multiarticular joint muscles.
PMCID: PMC4208651  PMID: 24920126
MU recruitment; muscle‐tendon unit length; triceps surae
16.  Arterial spin labeling MRI reproducibly measures peak-exercise calf muscle perfusion in healthy volunteers and patients with peripheral arterial disease 
JACC. Cardiovascular imaging  2012;5(12):1224-1230.
We hypothesized that arterial spin labeling (ASL) magnetic resonance imaging (MRI) at 3 Tesla (T) would be a reliable non-contrast technique for measuring peak exercise calf muscle blood flow in both healthy volunteers and patients with peripheral arterial disease (PAD) and will discriminate between these groups.
Prior work demonstrated the utility of first-pass gadolinium-enhanced calf muscle perfusion MRI in patients with PAD. However, patients with PAD often have advanced renal disease and cannot receive gadolinium.
PAD patients had claudication and an ankle brachial index 0.4–0.9. Age-matched normal subjects (NL) had no PAD risk factors and were symptom-free with exercise. All performed supine plantar flexion exercise in a 3T MRI scanner using a pedal ergometer until exhaustion or limiting symptoms and were imaged at peak exercise with 15 averaged ASL images. Peak perfusion was measured from ASL blood flow images by placing a region of interest in the calf muscle region with the greatest signal intensity. Perfusion was compared between PAD and NL and repeat testing was performed in 12 subjects (5 NL, 7 PAD) for assessment of reproducibility.
Peak exercise calf perfusion (mean±SD) of 15 NL (age 54±9 years) was higher than in 15 PAD (age 64±5 years, ABI 0.70±0.14) (80±23mL/min-100g vs. 49±16mL/min-100g, p<0.001). Five NL performed exercise matched to PAD and again demonstrated higher perfusion (84±25mL/min-100g, p<0.002). As a measure of reproducibility, intra-class correlation coefficient between repeated studies was 0.87 (95% CI 0.61–0.96). Inter-observer reproducibility was 0.96 (95% CI 0.84–0.99).
ASL is a reproducible non-contrast technique for quantifying peak exercise blood flow in calf muscle. Independent of exercise time, ASL discriminates between NL and PAD. This technique may prove useful for clinical trials of therapies for improving muscle perfusion, especially in patients unable to receive gadolinium.
PMCID: PMC3531823  PMID: 23236972
Peripheral arterial disease; Magnetic resonance imaging; Perfusion; Arterial spin labeling
17.  The Protonics Knee Brace Unloads the Quadriceps Muscles in Healthy Subjects 
Journal of Athletic Training  2004;39(1):44-49.
The Protonics brace is a functional resistance brace designed for rehabilitative use in patients with patellofemoral pain syndrome. Our objective was to determine whether the Protonics brace altered quadriceps muscle activity or knee mechanics in healthy subjects.
Design and Setting:
We used a within-subjects design in a laboratory setting.
Nineteen recreationally active college students (10 females, 9 males; age = 22.6 ± 2.8 years; height = 172 ± 9.0 cm, mass = 69.7 ± 12.5 kg) with no history of patellofemoral pain syndrome.
A standard-length Protonics brace was fit to each subject's leg. Surface electromyography of the vastus medialis obliquus, vastus lateralis, and rectus femoris muscles was recorded during a lateral step-down exercise. Lower extremity kinematics and ground reaction force were assessed during stair descent. Subjects performed both tasks under 4 conditions: no brace and brace with low, medium, and high resistance. Electromyography values were normalized to a maximum voluntary isometric contraction. The brace moment was determined by passive testing in an isokinetic dynamometer. Changes in the subject's muscular knee-extension moment were determined by subtracting the extension moment provided by the brace from the total knee-extension moment calculated from motion and force data using an inverse dynamics approach.
Vastus medialis obliquus activity in the brace at the low- and medium-resistance settings was significantly lower than that measured without the brace. Vastus lateralis activity while wearing the brace at medium resistance was significantly less than in the absence of the brace. Regardless of brace setting, vastus medialis obliquus and vastus lateralis activity in the descending phase of the exercise was less than during the ascending phase. A significant interaction was noted between brace setting and phase of the step-down exercise for rectus femoris activity. Significantly less activity was seen in the descending phase than in the ascending phase. Post hoc testing indicated that, in the descending phase, less activity was demonstrated with the brace at the medium and high settings than at the low setting. Muscle activity at the high setting and activity at low resistance were also significantly less than when the brace was not worn in the ascending phase. Knee flexion and extension moment during stair descent were significantly less at the higher resistance settings.
Wearing the Protonics brace at moderate or high resistance during the lateral step-down exercise produced less quadriceps activity compared with not wearing the brace. The knee extensor mechanism was unloaded when the brace was worn during stair descent. These findings indicate that the Protonics brace may unload the quadriceps and therefore decrease the load on the patellofemoral joint.
PMCID: PMC385261  PMID: 15085211
patellofemoral pain; knee; unloading
18.  Hand‐held Dynamometer Positioning Impacts Discomfort During Quadriceps Strength Testing: A Validity and Reliability Study 
A belt‐stabilized hand‐held dynamometer (HHD) offers the ability to quantify quadriceps muscle strength in a clinical environment, but a limitation is participant discomfort at the interface between the HHD and the tibia. The purpose of this study was to quantify the level of discomfort associated with a modified belt‐stabilized HHD configuration compared to a standard belt‐stabilized configuration and an isokinetic dynamometer. The secondary purpose of this study was to determine the validity and reliability of a modified configuration used to measure quadriceps strength compared to the “gold‐standard” isokinetic dynamometer.
Twenty healthy participants (5 males, 15 females; age=24.7±2.2 years, height=171.1±8.8 cm, mass=72.0±18.7 kg) performed maximal knee extension isometric contractions during each of three testing conditions: isokinetic dynamometer, standard configuration with HHD placement on the tibia, and an alternative configuration with the HHD interfaced with the leg of a table. Discomfort was quantified using a Visual Analog Scale (VAS). Differences in discomfort and torque (N•m) associated with the testing positions were determined using Friedman test or repeated measures analysis of variance. Validity was quantified using Pearson correlations and within‐session intrarater reliability was determined using an intraclass correlation coefficient (ICC2,1) and associated confidence intervals (95% CI).
The isokinetic dynamometer configuration resulted in the least discomfort (p< .01) and the modified configuration was more comfortable than the standard configuration (p= .003). There was a significant correlation between measures from the isokinetic dynamometer and the standard configuration (r=.87) and modified configuration (r=.93). Within‐session intrarater reliability was good for both the standard configuration (ICC2,1=0.93) and modified configuration (ICC2,1=0.93) conditions.
The use of the modified belt‐stabilized HHD configuration, where the HHD was interfaced with the leg of a table, offers a more comfortable alternative compared to the standard belt‐stabilized configuration to obtain isometric quadriceps strength measures in a clinical environment. This configuration is also a valid and reliable alternative to the “gold standard” isokinetic dynamometer when testing isometric quadriceps strength at 90° of knee flexion.
Level of Evidence
Diagnostic, Level 3
PMCID: PMC4325289  PMID: 25709864
knee extension; muscle; quadriceps; torque
19.  Effects of Partial Immobilization After Eccentric Exercise on Recovery From Muscle Damage 
Journal of Athletic Training  2005;40(3):197-202.
Context: Short-term strict immobilization of the arm using a cast enhances recovery of muscle function after eccentric exercise.
Objective: To determine if placing one arm in a sling (“light” immobilization) for 4 days after eccentric exercise of the elbow flexor muscles would reduce muscle soreness and enhance recovery compared with the exercised but not immobilized contralateral arm.
Design: Subjects performed 10 sets of 6 maximal isokinetic (90°·s−1) eccentric actions of the elbow flexors of each arm on a Cybex dynamometer, separated by 2 weeks.
Setting: University laboratory.
Patients or Other Participants: Ten healthy subjects (5 men and 5 women) with no history of upper arm injury or resistance training.
Intervention(s): One randomly assigned arm was placed in a sling for 4 days after the 30-minute postexercise measurement to secure the elbow joint at 90°; the contralateral arm received no treatment. The subject removed the sling when showering and sleeping and during postexercise measurements.
Main Outcome Measure(s): We used an activity monitor to record upper arm activity before and after immobilization. We also compared changes in maximal isometric and isokinetic voluntary strength, range of motion, upper arm circumference, plasma creatine kinase activity, and muscle soreness during 7 days postexercise between arms with a 2-way, repeated-measures analysis of variance.
Results: Eccentric exercise resulted in large losses in both isometric and isokinetic maximal voluntary contraction forces (approximately 40%), reduced range of motion (approximately 20%), increased arm circumference (approximately 10 mm), elevated plasma creatine kinase activity (approximately 2000 IU·L−1), and development of delayed-onset muscle soreness. No significant differences were noted between conditions for any measure except upper arm circumference, which increased significantly less for the immobilization than the control arm at 7 days postexercise (P < .05).
Conclusions: Light immobilization had no effect on enhancing recovery of muscle function and delayed-onset muscle soreness after eccentric-exercise–induced muscle damage.
PMCID: PMC1250263  PMID: 16284641
muscle soreness; muscle strength; range of motion; swelling; creatine kinase
20.  Symptomatic and Functional Responses to Concentric-Eccentric Isokinetic Versus Eccentric-Only Isotonic Exercise 
Journal of Athletic Training  2009;44(5):462-468.
Rehabilitation protocols involving eccentric resistance exercise performed with loading more than 100% concentric 1-repetition maximum are effective in increasing muscle function in both healthy and injured populations. The mode of eccentric exercise (isokinetic versus isotonic) may be an important factor in limiting symptoms of delayed-onset muscle soreness and in improving muscle function after training.
To compare functional and symptomatic responses after an eccentric-only (ECC) isotonic exercise protocol and after a combined concentric-eccentric (CON-ECC) isokinetic exercise protocol matched for total exercise volume.
Observational study.
Controlled research laboratory.
Patients or Other Participants:
Twenty-four healthy, untrained, college-aged men (n  =  12) and women (n  =  12).
Participants were randomly assigned to the ECC isotonic or CON-ECC isokinetic exercise group and performed a single bout of resistance exercise involving the elbow flexors.
Main Outcome Measure(s):
Measurements of elbow flexion and extension, isometric strength, and muscle point tenderness were obtained before exercise (baseline) and during follow-up sessions (days 2, 4, 7, and 14). Separate 1-way analyses of variance and repeated-measures analyses of variance were used to determine outcome differences. Tukey post hoc testing was performed when indicated.
At baseline, no differences were present between groups for any measure. The ECC isotonic exercise protocol resulted in a 30% to 36% deficit in muscle strength, a 5% to 7% reduction in elbow flexion, and a 6% to 8% reduction in elbow extension at follow-up days 2 and 4 (P < .01). The CON-ECC isokinetic exercise protocol did not alter muscle strength or range of motion at any time when compared with baseline. Muscle point tenderness increased from baseline on days 2 and 4 in both groups (P < .05) but was not different between groups throughout the recovery period.
Our results indicated more pronounced functional deficits occurred after a single bout of ECC isotonic exercise than with a CON-ECC isokinetic exercise protocol matched for training volume.
PMCID: PMC2742454  PMID: 19771283
muscle soreness; enhanced eccentric exercises; rehabilitation
21.  Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke 
To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter.
Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference.
The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10).
The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion.
PMCID: PMC4183497  PMID: 25003280
cerebrovascular disease; hemiparesis; shoulder complex; muscle strength; physical therapy
22.  Localised Muscle Tissue Oxygenation During Dynamic Exercise With Whole Body Vibration 
Despite increasing use of whole body vibration during exercise an understanding of the exact role of vibration and the supporting physiological mechanisms is still limited. An important aspect of exercise analysis is the utilisation of oxygen, however, there have been limited studies considering tissue oxygenation parameters, particularly during dynamic whole body vibration (WBV) exercise. The aim of this study was to determine the effect of adding WBV during heel raise exercises and assessing changes in tissue oxygenation parameters of the lateral gastrocnemius using Near Infra Red Spectroscopy (NIRS). Twenty healthy subjects completed ten alternating sets of 15 heel raises (vibration vs. no vibration). Synchronous oxygenation and motion data were captured prior to exercise to determine baseline levels, for the duration of the exercise and 20 sec post exercise for the recovery period. Both vibration and no vibration conditions elicited a characteristic increase in deoxyhaemoglobin and decreases in oxyhaemoglobin, total haemoglobin, tissue oxygenation index and normalised tissue haemoglobin index which are indicative of local tissue hypoxia. However, the addition of vibration elicited significantly lower (p < 0. 001) depletions in oxyhaemoglobin, total haemoglobin, normalised tissue haemoglobin index but no significant differences in deoxyhaemoglobin. These findings suggest that addition of vibration to exercise does not increase the cost of the exercise for the lateral gastrocnemius muscle, but does decrease the reduction in local muscle oxygenation parameters, potentially resulting from increased blood flow to the calf or a vasospastic response in the feet. However, further studies are needed to establish the mechanisms underlying these findings.
Key pointsWhole body vibration affects tissue oxygenation of the lateral gastrocnemius.The underlying mechanism could be either increased blood flow or a vasospastic response in the feet.The local metabolic cost of heel raise activity on the lateral gastrocnemius does not appear to be increased by whole body vibration.
PMCID: PMC3737862  PMID: 24149209
Vibration; NIRS; oxygenation; gastrocnemius; Heel raise
23.  Electromyographic Activity of the Biceps Brachii After Exercise-Induced Muscle Damage 
It is well known that strenuous eccentric exercise may result in muscle damage. We proposed that vigorous eccentric exercise (EE) would impair myoelectric activity of the biceps brachii. This study utilised a 7-day prospective time-series design. Ten healthy males performed a session of 70 maximal EE elbow flexion contractions. Analysis of surface electromyography activity (sEMG) was performed on the signals recorded during isometric contractions at 50% (IC50) and 80% (IC80) of maximum voluntary isometric torque (MVT), deriving RMS and MDF as sEMG parameters. Linear regression of the RMS and MDF time-series (20-s sustained IC50 and IC80) was used to extract intercepts and slopes of these signals on each day. Plasma creatine kinase activity (CK), MVT, arm circumference, subjective perception of soreness and elbow joint range of motion were also measured to assess effectiveness of EE to evoke muscle damage. CK increased over resting values until day 5 after EE, and remained significantly (p < 0.05) elevated even on day 7. MVT had decreased to 45% of its initial value by day 2 after EE, and remained significantly depressed for the following 6 days. In addition, muscle soreness and arm circumference increased, and range of motion decreased after EE. A significant shift of MDF intercept towards lower frequencies at both IC50 and IC80 was observed after EE in the exercised arm, and these values gradually recovered within the next 3 days during IC50. Although there were some changes in RMS values, these alterations were persistent in both control and exercised arms, and did not follow a consistent pattern. In conclusion, a prolonged reduction in MDF intercept was observed after EE, but this was not closely time-associated with the biochemical, anthropometric or functional markers of muscle damage. Compared to RMS, MDF was a more consistent measure to reflect changes in sEMG.
Key pointsEMG can be a useful tool to detect exercise-induced muscle damage,MDF decreased after eccentric exercise,This decrease could be related to a reduction in the recruitment of fast twitch fibres, andCompared to RMS, MDF was a more consistent parameter to reflect the changes in EMG after eccentric exercise.
PMCID: PMC3794486  PMID: 24149479
Eccentric exercise; creatine kinase; surface electromyography; median frequency; root mean square
24.  sEMG during Whole-Body Vibration Contains Motion Artifacts and Reflex Activity 
The purpose of this study was to determine whether the excessive spikes observed in the surface electromyography (sEMG) spectrum recorded during whole-body vibration (WBV) exercises contain motion artifacts and/or reflex activity. The occurrence of motion artifacts was tested by electrical recordings of the patella. The involvement of reflex activity was investigated by analyzing the magnitude of the isolated spikes during changes in voluntary background muscle activity. Eighteen physically active volunteers performed static squats while the sEMG was measured of five lower limb muscles during vertical WBV using no load and an additional load of 33 kg. In order to record motion artifacts during WBV, a pair of electrodes was positioned on the patella with several layers of tape between skin and electrodes. Spectral analysis of the patella signal revealed recordings of motion artifacts as high peaks at the vibration frequency (fundamental) and marginal peaks at the multiple harmonics were observed. For the sEMG recordings, the root mean square of the spikes increased with increasing additional loads (p < 0.05), and was significantly correlated to the sEMG signal without the spikes of the respective muscle (r range: 0.54 - 0.92, p < 0.05). This finding indicates that reflex activity might be contained in the isolated spikes, as identical behavior has been found for stretch reflex responses evoked during direct vibration. In conclusion, the spikes visible in the sEMG spectrum during WBV exercises contain motion artifacts and possibly reflex activity.
Key pointsThe spikes observed in the sEMG spectrum during WBV exercises contain motion artifacts and possibly reflex activityThe motion artifacts are more pronounced in the first spike than the following spikes in the sEMG spectrumReflex activity during WBV exercises is enhanced with an additional load of approximately 50% of the body mass
PMCID: PMC4306783  PMID: 25729290
Stretch reflex; vibration training; power spectral density; frequency analysis; filtering; spectral linear interpolation
25.  Effect of multiple set on intramuscular metabolic stress during low-intensity resistance exercise with blood flow restriction 
European Journal of Applied Physiology  2012;112(11):3915-3920.
Our previous study reported that intramuscular metabolic stress during low-intensity resistance exercise was significantly enhanced by combining blood flow restriction (BFR); however, they did not reach the levels achieved during high-intensity resistance exercise. That study was performed using a single set of exercise; however, usual resistance exercise consists of multiple sets with rest intervals. Therefore, we investigated the intramuscular metabolic stress during multiple-set BFR exercises, and compared the results with those during multiple-set high-intensity resistance exercise. Twelve healthy young subjects performed 3 sets of 1-min unilateral plantar flexion (30 repetitions) with 1-min intervals under 4 different conditions: low intensity (L, 20 % 1 RM) and high intensity (H, 65 % 1 RM) without BFR, and L with intermittent BFR (IBFR, only during exercise) and with continuous BFR (CBFR, during rest intervals as well as exercise). Intramuscular metabolic stress, defined as intramuscular metabolites and pH, and muscle fiber recruitment were evaluated by 31P-magnetic resonance spectroscopy. The changes of intramuscular metabolites and pH during IBFR were significantly greater than those in L but significantly lower than those in H. By contrast, those changes in CBFR were similar to those in H. Moreover, the fast-twitch fiber recruitment, evaluating by a splitting Pi peak, showed a similar level to H. In conclusion, the multiple sets of low-intensity resistance exercise with continuous BFR could achieve with the same metabolic stress as multiple sets of high-intensity resistance exercise.
PMCID: PMC3474903  PMID: 22415101
Energetic metabolism; Resistance training; Magnetic resonance spectroscopy; Muscle hypertrophy

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