What causes increased passive stiffness of plantarflexor muscle–tendon unit in children with spastic cerebral palsy? Abstract Purpose The term ‘stiffness’ is commonly used in the literature to refer to various components of ‘hyperresistance’ by which spastic muscles oppose to their passive lengthening, especially in children with cerebral palsy (CP). Originally, stiffness consists of mechanical resistance to passive movement in the absence of any muscle activation. Increased muscle stiffness in CP therefore refers to alterations to the mechanical properties of the tissue. It is closely linked to muscle shortening, yet the two phenomena are not equivalent. Both increased stiffness and shortening are present early in childhood in the plantarflexor muscles of children with spastic CP. Methods This narrative review provides a comprehensive overview of the literature on passive stiffness of the plantarflexor muscles measured at the joint, muscles, fascicles, and fiber level in children with CP. Articles were searched through the Pub’Med database using the keywords “cerebral palsy” AND “stiffness”. Result The ambiguous use of the term ‘stiffness’ has been supported by discrepancies in available results, influenced by heterogeneity in materials, methodologies and characteristics of the participants among studies. Increased stiffness at the joint and muscle belly level may be explained by altered structural properties at the microscopic level. Conclusion This thorough investigation of the literature suggests that the pathophysiology and the time course of the development of stiffness and contracture remain to be elucidated. A consideration of both morphological and mechanical measurements in children with CP is important when describing the alterations in their plantarflexors.

Elite athletes as research model: vitamin D insufficiency associates with elevated central blood pressure in professional handball athletes Abstract Purpose Low vitamin D levels have been associated with elevated blood pressure in the general population. Prospective studies, however, have produced conflicting evidence about the blood pressure-lowering effects of vitamin D supplementation. Cardiorespiratory fitness may modulate the vitamin D–blood pressure association. We therefore examined this association in professional athletes, whose high training load serves as a biological control for physical fitness. Methods 50 male professional handball players (age 26 ± 5 years) were examined. We assessed the central aortic pressure parameters using transfer function-based analysis of oscillometrically obtained peripheral arterial waveforms. Serum 25-OH vitamin D concentrations were determined by chemiluminescent immunoassay. The threshold for insufficiency was set at values of < 30 ng/mL. Results Central blood pressure (cBP) was 98 ± 7/60 ± 10 mmHg. The aortic pulse wave velocity (PWV) was 6.3 ± 1.0 m/s. Nine athletes (18%) displayed insufficient 25-OH vitamin D levels and had a significantly (p < 0.01) higher cBP compared with the 41 (82%) athletes with sufficient 25-OH vitamin D levels (106 ± 5/68 ± 8 vs. 97 ± 7/58 ± 9 mmHg). Central systolic blood pressure (cSBP) in vitamin D-sufficient athletes was significantly lower in comparison to the healthy reference population (97 mmHg vs. 103 mmHg, p < 0.001). This significance of difference was lost in vitamin D-insufficient athletes (106 mmHg vs. 103 mmHg, p = 0.12). Conclusion Significantly raised central systolic and diastolic blood pressure in vitamin D-insufficient elite athletes implicates vitamin D as a potential modifier of vascular functional health.

Modulation of intracortical inhibition and excitation in agonist and antagonist muscles following acute strength training Abstract Purpose Transcranial magnetic stimulation (TMS) usually investigates the corticospinal responses of the agonist muscle to strength training, despite the role of the antagonist muscle in strength development. We examined the intracortical responses from an agonist and antagonist muscle following a single session of heavy-loaded strength training (dominant-arm only) to identify the early antagonistic responses to a single session that may accompany improvements in strength. Methods Corticospinal and motor cortical excitability and inhibition was collected from agonist and antagonist muscles prior to and following a single session of heavy-loaded wrist flexor training in 18 individuals. Training consisted of four sets 6–8 repetitions at 80% of 1-repetition maximum (1-RM). Recruitment curves for corticospinal excitability and inhibition of the right wrist flexor and wrist extensor muscles were constructed and assessed by examining the area under the recruitment curve. Intracortical measures were obtained using paired-pulse TMS. Results Following a single training session, increases in corticospinal excitability were observed in both the agonist and antagonist muscles. This was accompanied by decreases in corticospinal inhibition in both muscles. Intracortical inhibition was reduced and intracortical facilitation was increased for the agonist muscle only. Intracortical measures in the antagonist muscle remained unchanged after training. Conclusions These findings indicate that the corticospinal responses to a single session of strength training are similar between agonist and antagonist muscles, but the intrinsic cortico-cortical circuitry of the antagonist remains unchanged. The corticospinal responses are likely due to increased involvement/co-activation of the antagonist muscle during training as the agonist muscle fatigues.

Unexplained exertional intolerance associated with impaired systemic oxygen extraction Abstract Purpose The clinical investigation of exertional intolerance generally focuses on cardiopulmonary diseases, while peripheral factors are often overlooked. We hypothesize that a subset of patients exists whose predominant exercise limitation is due to abnormal systemic oxygen extraction (SOE). Methods We reviewed invasive cardiopulmonary exercise test (iCPET) results of 313 consecutive patients presenting with unexplained exertional intolerance. An exercise limit due to poor SOE was defined as peak exercise (Ca-vO2)/[Hb] ≤ 0.8 and VO2max < 80% predicted in the absence of a cardiac or pulmonary mechanical limit. Those with peak (Ca-vO2)/[Hb] > 0.8, VO2max ≥ 80%, and no cardiac or pulmonary limit were considered otherwise normal. The otherwise normal group was divided into hyperventilators (HV) and normals (NL). Hyperventilation was defined as peak PaCO2 < [1.5 × HCO3 + 6]. Results Prevalence of impaired SOE as the sole cause of exertional intolerance was 12.5% (32/257). At peak exercise, poor SOE and HV had less acidemic arterial blood compared to NL (pHa = 7.39 ± 0.05 vs. 7.38 ± 0.05 vs. 7.32 ± 0.02, p < 0.001), which was explained by relative hypocapnia (PaCO2 = 29.9 ± 5.4 mmHg vs. 31.6 ± 5.4 vs. 37.5 ± 3.4, p < 0.001). For a subset of poor SOE, this relative alkalemia, also seen in mixed venous blood, was associated with a normal PvO2 nadir (28 ± 2 mmHg vs. 26 ± 4, p = 0.627) but increased SvO2 at peak exercise (44.1 ± 5.2% vs. 31.4 ± 7.0, p < 0.001). Conclusions We identified a cohort of patients whose exercise limitation is due only to systemic oxygen extraction, due to either an intrinsic abnormality of skeletal muscle mitochondrion, limb muscle microcirculatory dysregulation, or hyperventilation and left shift the oxyhemoglobin dissociation curve.

The time course of adaptations in thermoneutral maximal oxygen consumption following heat acclimation Abstract Purpose This study investigated the effects of a 10-day heat acclimation (HA) programme on the time course of changes in thermoneutral maximal oxygen uptake ( \(\dot{V}\) O2max) during and up to 10 days post-HA. Methods Twenty-two male cyclists were assigned to a HA or control (Con) training group following baseline ramp tests of thermoneutral \(\dot{V}\) O2max. Ten days of fixed-intensity (50% baseline \(\dot{V}\) O2max) indoor cycling was performed in either ~ 38.0 °C (HA) or ~ 20 °C (Con). \(\dot{V}\) O2max was re-tested on HA days 5, 10 and post-HA days 1, 2, 3, 4, 5 and 10. Results \(\dot{V}\) O2max initially declined across time in both groups during training (P < 0.05), before increasing in the post-HA period in both groups (P < 0.05). However, \(\dot{V}\) O2max was higher than control by post-HA day 4 in the HA group (P = 0.046). Conclusions The non-linear time course of \(\dot{V}\) O2max adaptation suggests that post-testing should be performed 96-h post-training to identify the maximal change for most individuals. In preparation for training or testing, athletes can augment their aerobic power in thermoneutral environments by performing 10 days HA, but the full effects will manifest at varying stages of the post-HA period.

Autonomic modulation following an acute bout of bench press with and without blood flow restriction Abstract Purpose Traditional resistance exercise decreases vagal tone up to 30 min after an acute bout of resistance exercise, which may increase the risk of cardiovascular events. However, the effects of resistance exercise with blood flow restriction (BFR) on autonomic modulation are unclear. To evaluate autonomic modulation after resistance exercise with and without BFR in resistance-trained men. Methods Eleven young men volunteered for the study. Autonomic modulation was assessed at rest, 15 (Rec 1), and 25 (Rec 2) minutes after low-load bench press with BFR (LL-BFR), traditional high-load bench press (HL), and a control (CON). Autonomic modulation assessments were expressed as natural logarithm (Ln), and included total power (LnTP), low-frequency power (LnLF), high-frequency power (LnHF), sympathovagal balance (LnLF/LnHF ratio), root mean square of the successive differences (LnRMSSD), and the proportion of intervals differing by > 50 ms from the preceding intervals (LnPNN50). A repeated measures ANOVA was used to evaluate conditions (LL-BFR, HL and CON) across time (Rest, Rec1, and Rec2) on autonomic modulation. Results There were significant condition by time interactions for LnTP, LnHF, and LnRMSSD such that they were reduced during recovery after LL-BFR and HL compared to Rest and CON. There were no interactions in the LnLF, LnLF/LnHF ratio, and LnPNN50. Conclusions These data suggest that LL-BFR and HL significantly alter autonomic modulation up to 30 min after exercise with significant reduction after HL compared to LL-BFR when exercise volume is equated.

Changes in oxidative stress, inflammation and muscle damage markers following eccentric versus concentric cycling in older adults Abstract Purpose To compare concentric and eccentric cycling performed by older adults for metabolic demand and post-exercise oxidative stress, inflammation and muscle damage. Methods Eight male and two female healthy older adults (60.4 ± 6.8 years) performed 30 min of moderate-intensity concentric (CONC-M: 50% maximum power output; POmax) and eccentric cycling (ECC-M: 50% POmax) and high-intensity eccentric cycling (ECC-H: 100% POmax) in a randomized order. Average power output (PO), oxygen consumption (VO2), heart rate (HR) and rate of perceived exertion were recorded during cycling. Some indirect markers of muscle damage were assessed before, and immediately, 24 and 48 h after cycling. Markers of oxidative stress (malondialdehyde: MDA, protein carbonyl), antioxidant (total antioxidant capacity, glutathione peroxidase activity: GPx) and inflammation (IL-6, TNF-α) were measured before and 5 min after cycling. Results PO in ECC-H (202.6 ± 78.5 W) was > 50% greater (P < 0.05) than that of CONC-M (98.6 ± 33.1 W) and ECC-M (112.0 ± 42.1 W). VO2 and HR were also greater (P < 0.05) for ECC-H than CONC-M (50% and 17%, respectively) and ECC-M (40% and 23%, respectively). Muscle strength loss at 1 day post-exercise (8–22%), peak soreness (10–62 mm) and creatine kinase activity (30–250 IU/L) after ECC-H were greater (P < 0.05) than those after ECC-M and CONC-M. MDA decreased (P < 0.05) after CONC-M (− 28%) and ECC-M (− 22%), but not after ECC-H. GPx activity increased after all exercises similarly (20–27%). IL-6 increased (P < 0.05) only after ECC-H (18%). Conclusion Oxidative stress was minimal after eccentric cycling, but high-intensity eccentric cycling induced moderate muscle damage and inflammation, which is not desirable for older individuals.

Central cardiovascular hemodynamic response to unilateral handgrip exercise with blood flow restriction Abstract Aim Exercise training with blood flow restriction (BFR) increases muscle size and strength. However, there is limited investigation into the effects of BFR on cardiovascular health, particularly central hemodynamic load. Purpose To determine the effects of BFR exercise on central hemodynamic load (heart rate—HR, central pressures, arterial wave reflection, and aortic stiffness). Methods Fifteen males (age = 25 ± 2 years; BMI = 27 ± 2 kg/m2, handgrip max voluntary contraction-MVC = 50 ± 2 kg) underwent 5-min bouts (counter-balanced, 10 min rest between) of rhythmic unilateral handgrip (1 s squeeze, 2 s relax) performed with a moderate-load (60% MVC) with and without BFR (i.e., 71 ± 5% arterial inflow flow reduction, assessed via Doppler ultrasound), and also with a low-load (40% MVC) with BFR. Outcomes included HR, central mean arterial pressure (cMAP), arterial wave reflection (augmentation index, AIx; wave reflection magnitude, RM%), aortic arterial stiffness (pulse wave velocity, aPWV), and peripheral (vastus lateralis) microcirculatory response (tissue saturation index, TSI%). Results HR increased above baseline and time control for all handgrip bouts, but was similar between the moderate load with and without BFR conditions (moderate-load with BFR =  + 9 ± 2; moderate-load without BFR =  + 8 ± 2 bpm, p < 0.001). A similar finding was noted for central pressure (e.g., moderate load with BFR, cMAP =  + 14 ± 1 mmHg, p < 0.001). No change occurred for RM% or AIx (p > 0.05) for any testing stage. TSI% increased during the moderate-load conditions (p = 0.01), and aPWV increased above baseline following moderate-load handgrip with BFR only (p = 0.012). Conclusions Combined with BFR, moderate load handgrip training with BFR does not significantly augment central hemodynamic load during handgrip exercise in young healthy men.

Eccentric and concentric blood flow restriction resistance training on indices of delayed onset muscle soreness in untrained women Abstract Purpose Unaccustomed exercise can result in delayed onset muscle soreness (DOMS), particularly as a result of the eccentric phase of the muscle contraction. Resistance training combined with venous blood flow restriction (vBFR) may attenuate DOMS, but the available information in this regard is conflicting. Therefore, the purpose of this study was to examine the effects of low-load eccentric vBFR (Ecc-vBFR) and concentric vBFR (Con-vBFR) resistance training on indices of DOMS. Methods Twenty-five previously untrained women completed seven days of either Ecc-vBFR (n = 12) or Con-vBFR (n = 13) forearm flexion resistance training at a velocity of 120° s−1 on an isokinetic dynamometer. The Ecc-vBFR group used a training load that corresponded to 30% of eccentric peak torque and the Con-vBFR group used a training load that corresponded to 30% of concentric peak torque. Results There were no differences between Ecc-vBFR and Con-vBFR at any of the seven training sessions on any of the indices of DOMS. There were no decreases in the maximal voluntary isometric contraction torque which increased at days 6 and 7. Similarly, there were no changes in perceived muscle soreness, pain pressure threshold, elbow joint angle, or edema (as assessed by echo intensity via ultrasound) across the seven training sessions. Conclusions The Ecc-vBFR and Con-vBFR low-load training protocols were not associated with DOMS and there were no differences between protocols when performed using the same relative training intensity. These findings suggested that both unaccustomed eccentric and concentric low-load training did not result in DOMS when combined with vBFR.

Age-related changes to motor synergies in multi-joint and multi-finger manipulative skills: a meta-analysis Abstract Purpose The aim of the current meta-analysis was to examine the extent to which there are differences in upper extremity motor synergies across different age groups in manipulative tasks. Methods The studies that used the uncontrolled manifold method to examine the effect of age on motor synergies in multi-joint and multi-finger tasks were selected. Sixteen relevant studies from 1154 articles were selected for the meta-analysis—4 and 12 studies considered multi-joint kinematics and multi-finger kinetic tasks respectively. Results The results of the meta-analysis suggested reduced strength of synergies in multi-finger task in older adults, but this was not the case for synergies in multi-joint task. Part of this age-related difference in finger function is related to the increased variability in total force in grasping tasks. However, reductions in the strength of multi-finger synergies in hand functions following ageing appear to depend on the characteristics of the task. Conclusions These findings indicate that the cooperation among fingers to stabilise the total required force to apply for grasping and other fine motor skills is less efficient in older adults that might affect the quality of manipulative tasks.