Patients with acute spinal cord injury benefit from normocapnic hyperpnoea training. Caffeines enhancement of maximal voluntary strength and activation in uninjured but not injured muscle. Reduced physical activity increases intermuscular adipose tissue in healthy young adults. The effect of Nordic hamstring strength training on muscle architecture, stiffness, and strength Nonsteroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals. Relationship Between Intensity of Quadriceps Muscle Neuromuscular Electrical Stimulation and Strength Recovery After Total Knee Arthroplasty Injuries during the one repetition maximum assessment in the elderly. Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters. The Influence of Prophylactic Orthoses on Abdominal Strength and Low Back Injury in the Workplace The value of strength training for older adults. Risk Factors for Shoulder and Elbow Injuries in High School Baseball Pitchers Selective strength loss and decreased muscle activity in hamstring injury. Atrophy and impaired muscle protein synthesis during prolonged inactivity and stress. Treatment of hamstring strain in a collegiate pole-vaulter integrating dry needling with an eccentric training program: a resident's case report. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Low-Load Very High-Repetition Resistance Training Attenuates Bone Loss at the Lumbar Spine in Active Post-menopausal Women Sarcopenia in ovarian cancer patients, oncologic outcomes revealing the importance of clinical nutrition: review of literature. Effects of a 12-wk resistance exercise program on skeletal muscle strength in children with burn injuries. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. Response of males and females to high-force eccentric exercise Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation Effects of cold water immersion on the symptoms of exercise-induced muscle damage. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury.
BACKGROUND Functional loss of respiratory muscles in persons with spinal cord injury leads to impaired pulmonary function and respiratory complications . In addition , respiratory complications are responsible for 50 - 67 % of the morbidity in this population . OBJECTIVE To investigate the effects of normocapnic hyperpnoea training in acute spinal cord injury . PATIENTS AND METHODS Fourteen patients were r and omized between control ( sham ) and an experimental normocapnic hyperpnoea training group .  Vital capacity , maximal voluntary ventilation , respiratory muscle strength and endurance , respiratory complications and symptoms were evaluated before , after 4 and 8 weeks of training and after 8 weeks follow-up . RESULTS Maximal voluntary ventilation , respiratory muscle strength and endurance improved significantly in the experimental group compared with the control group ( p < 0.05 ) . Improvements in vital capacity tended to be different from the control group at 8 weeks of training . The Index of Pulmonary Dysfunction decreased after 4 weeks of training and respiratory complications were reported less frequently in the experimental group compared with the control group . CONCLUSION Normocapnic hyperpnoea training in patients with spinal cord injury improved respiratory muscle strength and endurance . Respiratory complications occurred less frequently after training The study 's objective was to determine whether orally ingested caffeine could help overcome excitation-contraction-coupling failure , which has been suggested to explain part of the strength loss associated with eccentric-contraction-induced muscle injury . A sample of 13 college students ( 4 men and 9 women ) was used in a double-blind , repeated- measures experimental design . Each participant performed 2 experimental trials , 1 with each leg , with each trial lasting 4 consecutive days . On a given day , each participant was r and omly assigned to ingest a capsule containing 6 mg/kg of either caffeine or flour ( placebo ) . On the day of and the first 2 days after a bout of 50 injurious eccentric contractions done by the knee extensors , the interpolated-twitch technique was used to assess electrically evoked strength , maximal voluntary isometric contraction ( MVIC ) strength , and percent muscle activation during MVIC both before and after capsule ingestion . These variables were also measured before and after capsule ingestion the day before the eccentric-contraction bout -- when the muscle was uninjured . In injured muscle , caffeine had no effect on any variable . In uninjured muscle , caffeine also had no effect on electrically evoked strength but increased MVIC strength by 10.4 % compared with placebo ( p = .00002 ) , and this was attributed to an increase in muscle activation ( 6.2 % ; p = .01 ) . In conclusion , the data provide no evidence that caffeine ingestion can help overcome excitation-contraction-coupling failure , if it exists , in injured human muscle . The data do indicate that caffeine ingestion can increase MVIC strength and activation in uninjured muscle but not in injured muscle BACKGROUND Recent findings suggest that higher levels of intermuscular adipose tissue ( IMAT ) are associated with glucose dysregulation , lower levels of muscle strength , and a heightened risk of disability . Although several studies have described adaptations in muscle after reduced physical activity , the change in IMAT in healthy young adults is unknown . OBJECTIVE The objective was to determine whether reduced lower limb activity alters IMAT in healthy young adults and to assess whether this change affects muscle strength loss . DESIGN The subjects ( 6 men and 12 women aged 19 - 28 y ) underwent a 4-wk control period , which was followed by 4 wk of unilateral lower limb suspension . Volumes of whole muscle , subcutaneous adipose tissue , and IMAT were assessed by using magnetic resonance imaging in the thigh and calf . Muscle strength was assessed during maximal voluntary isometric contractions . RESULTS No changes were observed in the control period . Reduced physical activity decreased thigh and calf muscle volumes by 7.4 % and 7.9 % ( P < 0.001 ) , respectively ; no significant change in subcutaneous adipose tissue was observed . Additionally , IMAT increased in both regions ; the increase was larger in the calf ( 20 % ) than in the thigh ( 14.5 % ) ( P < or= 0.005 ) and was partially explained by the loss in muscle ( R(2 ) = 26 % ) . The loss in strength was greater in the thigh ( 20.4 % ) than in the calf ( 15 % ) . Strength loss was associated with increases in IMAT ( P = 0.039 ) after adjustment for the loss in muscle , initial strength , initial IMAT , and initial muscle volume . CONCLUSIONS IMAT accumulates markedly after reduced activity in healthy young adults . Increases in IMAT may contribute to losses in muscle strength associated with reduced physical activity , but the mechanism responsible is yet to be determined Purpose Hamstring strain injury is a frequent and serious injury in competitive and recreational sports . While Nordic hamstring ( NH ) eccentric strength training is an effective hamstring injury-prevention method , the protective mechanism of this exercise is not understood . Strength training increases muscle strength , but also alters muscle architecture and stiffness ; all three factors may be associated with reducing muscle injuries . The purpose of this study was to examine the effects of NH eccentric strength training on hamstring muscle architecture , stiffness , and strength . Methods Twenty healthy participants were r and omly assigned to an eccentric training group or control group . Control participants performed static stretching , while experimental participants performed static stretching and NH training for 6 weeks . Pre- and post-intervention measurements included : hamstring muscle architecture and stiffness using ultrasound imaging and elastography , and maximal hamstring strength measured on a dynamometer . Results The experimental group , but not the control group , increased volume ( 131.5 vs. 145.2 cm3 , p < 0.001 ) and physiological cross-sectional area ( 16.1 vs. 18.1 cm2 , p = 0.032 ) . There were no significant changes to muscle fascicle length , stiffness , or eccentric hamstring strength . Conclusions The NH intervention was an effective training method for muscle hypertrophy , but , contrary to common literature findings for other modes of eccentric training , did not increase fascicle length . The data suggest that the mechanism behind NH eccentric strength training mitigating hamstring injury risk could be increasing volume rather than increasing muscle length . Future research is , therefore , warranted to determine if muscle hypertrophy induced by NH training lowers future hamstring strain injury risk BACKGROUND Aging is associated with greater susceptibility to muscle injury and soreness after exercise . Although elderly persons regularly consume nonsteroidal anti-inflammatory drugs ( NSAIDs ) , it is not clear that NSAIDs alleviate muscle dysfunction and /or inflammation following injurious exercise . METHODS In this double-blind crossover study , 10 men and 5 women ( aged 60 + /- 2 years , mean + /- SE ) consumed naproxen sodium or placebo for 10 days after performing 64 unilateral eccentric ( ECC ) knee extensions using 75 % of the ECC 1-repetition maximum .  Strength was measured before , 3 days after , and 10 days after each bout . Injury and soreness were assessed using magnetic resonance images of m. quadriceps femoris ( QF ) and a visual analog scale . RESULTS Three days after exercise , concentric strength loss was greater for placebo ( -32 + /- 9 % ) than NSAID ( -6 + /- 8 % ; p = .0064 ) . Likewise , isometric strength declined less for NSAID than placebo ( -12 + /- 7 % vs -24 + /- 4 % ; p = .0213 ) , and thigh soreness while rising from a chair was greater for placebo ( p < or = .0393 ) than NSAID ( 43 + /- 7 mm vs 26 + /- 7 mm ) . QF cross-sectional area ( cm(2 ) ) showing elevated T(2 ) was 27 % and 35 % greater ( p < or = .0096 ) for placebo on Days 3 and 10 , respectively . CONCLUSIONS Naproxen sodium attenuated muscle injury , strength loss , and soreness following ECC exercise in older individuals and may be beneficial during the early stages of increased physical activity Background Neuromuscular electrical stimulation ( NMES ) can facilitate the recovery of quadriceps muscle strength after total knee arthroplasty ( TKA ) , yet the optimal intensity ( dosage ) of NMES and its effect on strength after TKA have yet to be determined . Objective The primary objective of this study was to determine whether the intensity of NMES application was related to the recovery of quadriceps muscle strength early after TKA . A secondary objective was to quantify quadriceps muscle fatigue and activation immediately after NMES to guide decisions about the timing of NMES during rehabilitation sessions . Design This study was an observational experimental investigation . Methods Data were collected from 30 people who were 50 to 85 years of age and who received NMES after TKA . These people participated in a r and omized controlled trial in which they received either st and ard rehabilitation or st and ard rehabilitation plus NMES to the quadriceps muscle to mitigate strength loss . For the NMES intervention group , NMES was applied 2 times per day at the maximal tolerable intensity for 15 contractions beginning 48 hours after surgery over the first 6 weeks after TKA . Neuromuscular electrical stimulation training intensity and quadriceps muscle strength and activation were assessed before surgery and 3.5 and 6.5 weeks after TKA . Results At 3.5 weeks , there was a significant association between NMES training intensity and a change in quadriceps muscle strength ( R2=.68 ) and activation ( R2=.22 ) . At 6.5 weeks , NMES training intensity was related to a change in strength ( R2=.25 ) but not to a change in activation ( R2=.00 ) . Furthermore , quadriceps muscle fatigue occurred during NMES sessions at 3.5 and 6.5 weeks , whereas quadriceps muscle activation did not change . Limitations Some participants reached the maximal stimulator output during at least 1 treatment session and might have tolerated more stimulation . Conclusions Higher NMES training intensities were associated with greater quadriceps muscle strength and activation after TKA PURPOSE A decrease in strength , and its associated loss of functional ability is common among the elderly . Although resistance training can reverse this decline , associated injuries with frequently used strength assessment s may present a greater risk . METHODS To evaluate the injuries associated with maximal strength evaluations , 83 relatively healthy elderly subjects ( 40 men and 43 women , 65.8 + /- 6.2 years ) with and without prior weight training experience performed 1 repetition maximum testing ( 1 RM ) involving 5 different exercises : chest press , leg extension , abdominal curl , arm curl , and seated calf raise . Subjects were separated into three groups depending on weight training experience , Group 1 had no weight training experience ( n = 32 ) , Group 2 had < 6 months of training ( n = 24 ) , and Group 3 had > 6 months of training ( n = 27 ) . Injury assessment was made 30 minutes , 2 days , and 7 days posttesting . RESULTS Two Group 1 subjects sustained an injury ( 2.4 % of total subjects , 8 % of Group 1 ) . Eighty-one subjects safely completed the 1 RM assessment without injury ( 97.6 % of total ) . Forty-eight of the 83 subjects complained of muscle soreness after testing ( 58 % of total ) . This complaint alone was not sufficient to be categorized as an injury . CONCLUSIONS These results indicate that 1 RM testing is an acceptable tool in strength evaluations in the elderly . Additional pre caution s may be needed in inexperienced , elderly individuals to prevent injury STUDY DESIGN Prospect i ve cohort study . OBJECTIVES In this prospect i ve cohort study of elite sprinters , muscle strength of the hip extensors , as well as of the knee extensors and flexors , was measured to determine a possible relationship between strength deficits and subsequent hamstring injury within 12 months of testing . The method used for testing muscle strength simulated the specific muscle action during late swing and early contact phases when sprinting . BACKGROUND There have been no prospect i ve studies in elite sprinters that examine the concentric and eccentric isokinetic strength of the hip extensors and the quadriceps and hamstring muscles in a manner that reflects their actions in late swing or early contact phases of sprinting . Consequently , the causal relationship between hip and thigh muscle strength and hamstring injury in elite sprinters may not be fully understood . METHODS AND MEASURES Isokinetic testing was performed on 30 male elite sprinters to assess hip extensors , quadriceps , and hamstring muscle strength . The occurrence of hamstring injury among the subjects was determined during the year following the muscle strength measurements . The strength of the hip extensors , quadriceps , and hamstring muscles , as well as the hamstrings-quadriceps and hip extensors- quadriceps ratios were compared . RESULTS Hamstring injury occurred in 6 subjects during the 1-year period . Isokinetic testing at a speed of 60 degrees /s revealed weakness of the injured limb with eccentric action of the hamstring muscles and during concentric action of the hip extensors . When performing a side-to-side comparison for the injured sprinters , the hamstring injury always occurred on the weaker side . Differences in the hamstrings-quadriceps and hip extensors-quadriceps strength ratios were also evident between uninjured and injured limbs , and this was attributable to deficits in hamstring strength . CONCLUSION Hamstring injury in elite sprinters was associated with weakness during eccentric action of the hamstrings and weakness during concentric action of the hip extensors , but only when tested at the slower speed of 60 degrees /s This study was design ed to determine the effect of multimodal intervention and the prevention of back injury , and to evaluate the adverse side effects of using a lumbosacral corset in the workplace . Subjects were 90 male warehouse workers r and omly selected from over 800 employees at a grocery distribution center . Subjects were assigned to three groups : true controls , no back school , no brace orthoses ; back school only ; and back school plus wearing a custom molded lumbosacral orthosis . Comparisons of pre-testing and 6-month follow-up posttesting for abdominal strength , cognitive data , work injury incidence and productivity and use of health care services were evaluated . Controls and training-only group showed no changes in strength productivity or lost time . Orthoses and training-group showed no changes in strength productivity or accident rate ; however , they showed substantially less lost time . This study supports the concept of using education and prophylactic bracing to prevent back injury and reduce time loss . It appears that the use of intermittent prophylactic bracing has no adverse affects on abdominal muscle strength and may contribute to decreased lost time from work injuries Health in older adults can best be measured in terms of functional status . Skeletal muscle strength has been reported to be a determinant of functional status in older individuals . Two major contributors to the decline in muscle function as a person ages are disuse and physical inactivity . Declining muscle function through a loss of muscular strength may decrease functional independence and mobility and increase the risk for falls and injuries , physical frailty , and disability .  Older individuals lacking an appropriate amount of muscular strength may not be able to perform various activities of daily living , which are important indicators of independence Background : Shoulder strength and motion deficits in high school baseball pitchers have been implicated in injury risk . Purpose /Hypothesis : To prospect ively determine if preseason strength and range of motion ( ROM ) are predictive of injury in high school baseball pitchers . It was hypothesized that ROM asymmetries and weakness would be predictive of injury . Study Design : Case-control study ; Level of evidence , 3 . Methods : Preseason strength and ROM measurements  were made on 101 pitchers from 4 different high schools over 4 seasons ( total 166 pitcher-seasons : 25 freshman , 46 junior varsity , and 95 varsity player-seasons ) .  Glenohumeral internal rotation ( IR ) , glenohumeral external rotation , and posterior shoulder ROM  were measured bilaterally . Strength in IR , external rotation , supraspinatus ( empty-can test ) , and scapular retraction  was measured bilaterally ( h and held dynamometer ) . Injury incidence ( injuries per 1000 pitches ) was computed for players categorized as above normal ( ≥1 SD above the mean ) , normal ( within 1 st and ard deviation of the mean ) , and below normal ( ≤1 SD below the mean ) for each potential risk factor . Injury was defined as a missed game or practice because of shoulder or elbow problem . Results : There were 28 upper extremity injuries ( 19 shoulder , 9 elbow ; incidence , 0.58 injuries/1000 pitches ) . There was a trend for supraspinatus weakness to be associated with increased injury risk ( relative risk [ RR ] , 3.60 ; 95 % CI , 0.75 - 17.32 ; P = .09 ) . When analyzing major injuries only ( > 3 missed games ) , preseason supraspinatus weakness was significantly associated with increased injury risk ( RR , 4.58 ; 95 % CI , 1.40 - 15.01 ; P = .02 ) . Paradoxically , pitchers with no IR loss were at increased risk compared with pitchers with ≥20 ° loss ( RR , 4.85 ; 95 % CI , 1.01 - 23.29 ; P = .04 ) . Other ROM and strength measures were unrelated to injury risk . Conclusion : Although excessive loss of IR ROM is thought to be a risk factor for injury , the opposite was the case in this study . The absence of IR ROM loss  in high school pitchers may indicate inadequate prior exposure to pitching , result ing in increased injury risk . Preseason supraspinatus weakness was associated with increased risk for a major injury , and preventative supraspinatus strengthening may be beneficial STUDY DESIGN Cross-sectional , controlled laboratory study . OBJECTIVES To determine whether thigh muscle isokinetic torque patterns and activity , measured by electromyography ( EMG ) , of individuals with hamstring injury differ from control individuals . BACKGROUND Neuromuscular control during thigh muscle strength assessment following hamstring injuries has not been reported . METHODS Fifteen athletes with prior hamstring injury ( hamstring-injured group [ HG ] ) were compared to 15 uninjured athletes ( control group [ CG ] ) . The injuries were incurred 6 weeks to 12 months prior to participation , and all injured athletes had returned to at least partial training . Participants performed 5 isokinetic concentric extensor , concentric flexor , and eccentric flexor torque tests at 60 ° /s in the seated position . Peak torque was determined for each contraction type , as well as average torque for each of 4 time-based movement quartiles . EMG root-mean-squares were calculated in these movement quartiles for the biceps femoris and medial hamstrings . RESULTS No significant differences were found for peak torque for all contractions , when comparing HG injured and uninjured sides to CG bilateral averages . The HG injured limb eccentric flexor torque was significantly lower in the fourth quartile ( approximately 25 ° to 5 ° knee flexion , hamstring lengthened range ) compared to the CG bilateral average ( P = .025 ) . Eccentric flexor biceps femoris and hamstrings EMG root-mean-squares of the HG injured and the uninjured sides were significantly lower in the second to fourth quartiles ( towards the lengthened range ) , compared to the CG bilateral averages ( P<.05 ) . CONCLUSION Decreased strength and EMG activation in a lengthened hamstrings range for the athletes with prior hamstring injury suggested a change in neuromuscular control . Lengthened range assessment of isokinetic eccentric flexor torque may be useful for the assessment of athletes with a prior injury ; however , results should be confirmed with prospect i ve studies CONTEXT We recently demonstrated that 28-d bed rest in healthy volunteers results in a moderate loss of lean leg mass and strength . OBJECTIVE The objective of this study was to quantify changes in muscle protein kinetics , body composition , and strength during a clinical bed rest model reflecting both physical inactivity and the hormonal stress response to injury or illness . DESIGN Muscle protein kinetics were calculated during a primed , continuous infusion ( 0.08 micromol/kg.min ) of 13C6-phenylalanine on d 1 and 28 of bed rest . SETTING The setting for this study was the General Clinical Research Center at the University of Texas Medical Branch . PARTICIPANTS Participants were healthy male volunteers ( n = 6 , 28 + /- 2 yr , 84 + /- 4 kg , 178 + /- 3 cm ) . INTERVENTION During bed rest , hydrocortisone sodium succinate was administered iv ( d 1 and 28 ) and orally ( d 2 - 27 ) to reproduce plasma cortisol concentrations consistent with trauma or illness ( approximately 22 microg/dl ) . MAIN OUTCOME MEASURES We hypothesized that inactivity and hypercortisolemia would reduce lean muscle mass , leg extension strength , and muscle protein synthesis .  RESULTS Volunteers experienced a 28.4 + /- 4.4 % loss of leg extension strength ( P = 0.012 ) and a 3-fold greater loss of lean leg mass ( 1.4 + /- 0.1 kg ) ( P = 0.004 ) compared with our previous bed rest-only model . Net protein catabolism was primarily due to a reduction in muscle protein synthesis [ fractional synthesis rate , 0.081 + /- 0.004 ( d 1 ) vs. 0.054 + /- 0.007%/h ( d 28 ) ; P = 0.023 ] . There was no change in muscle protein breakdown . CONCLUSION Prolonged inactivity and hypercortisolemia represents a persistent catabolic stimulus that exacerbates strength and lean muscle loss via a chronic reduction in muscle protein synthesis BACKGROUND Hamstring strain injuries are among the most common injuries seen in sports . Management is made difficult by the high recurrence rates . Typical time to return to sport varies but can be prolonged with recurrence . Eccentric strength deficits remain post-injury , contributing to reinjury . Eccentric training has shown to be an effective method at prevention of hamstring injury in multiple systematic review s and prospect i ve RCTs but limited prospect i ve rehabilitation literature . Functional dry needling is a technique that has been reported to be beneficial in the management of pain and dysfunction after muscle strains , but there is limited published literature on its effects on rehabilitation or recurrence of injury . PURPOSE The purpose of this case report is to present the management and outcomes of a patient with hamstring strain , treated with functional dry needling and eccentric exercise . CASE DESCRIPTION The subject was an 18-year-old collegiate pole-vaulter who presented to physical therapy with an acute hamstring strain and history of multiple strains on uninvolved extremity . He was treated in Physical Therapy three times per week for 3 weeks with progressive eccentric training and 3 sessions of functional dry needling . OUTCOMES By day 12 , his eccentric strength on the involved extremity was greater than the uninvolved extremity and he reported clinical ly meaningful improvement in outcome scores . By Day 20 , he was able to return to full sports participation without pain or lingering strength deficits . DISCUSSION The patient in this case report was able to return to sport within 20 days and without recurrence . He demonstrated significant decreases in pain and dysfunction with dry needling . He had greater strength on the injured extremity compared to contra-lateral previously injured extremity . CONCLUSIONS This case illustrates the use of functional dry needling and eccentric exercise leading to a favorable outcome in a patient with hamstring strain . LEVEL OF EVIDENCE Level 4 OBJECTIVE To determine the safety and efficacy of an exercise protocol design ed to improve strength , mobility , and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls . DESIGN A r and omized controlled 3-month intervention trial , with an additional 3-month follow-up . SETTING Out-patient geriatric rehabilitation unit . PARTICIPANTS Fifty-seven female geriatric patients ( mean age 82 + /- 4.8 years ; range 75 - 90 ) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times per week for 3 months . Patients of the control group attended a placebo group 3 times a week for 3 months . Both groups received an identical physiotherapeutic treatment 2 times a week , in which strengthening and balance training were excluded . MEASUREMENTS Strength , functional ability , motor function , psychological parameters , and fall rates were assessed by st and ardized protocol s at the beginning ( T1 ) and the end ( T2 ) of intervention . Patients were followed up for 3 months after the intervention ( T3 ) . RESULTS No training-related medical problems occurred in the study group . Forty-five patients ( 79 % ) completed all assessment s after the intervention and follow-up period . Adherence was excellent in both groups ( intervention 85.4 + /- 27.8 % vs control 84.2 + /- 29.3 % ) . The patients in the intervention group increased strength , functional motor performance , and balance significantly . Fall-related behavioral and emotional restrictions were reduced significantly . Improvements persisted during the 3-month follow-up with only moderate losses . For patients of the control group , no change in strength , functional performance , or emotional status could be documented during intervention and follow-up . Fall incidence was reduced nonsignificantly by 25 % in the intervention group compared with the control group ( RR:0.753 CI:0.455 - 1.245 ) . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail , high-risk geriatric patients with a history of injurious falls Abstract This study determined the effect of 6 months of low-load very high-repetition resistance training on bone mineral density ( BMD ) and body composition in nonosteoporotic middle-aged and older women . Fifty healthy , active community-dwelling women aged 56–75 years took part in the two-group , repeated- measures r and omized controlled trial . Participants either undertook 6 months of low-load very high-repetition resistance training in the form of BodyPump ™ or served as control participants . Outcome measures included BMD at the lumbar spine , hip , and total body ; total fat mass ; fat-free soft tissue mass and maximal isotonic strength . Significant group-by-time interactions were found for lumbar spine BMD and maximal strength in favor of the BodyPump ™ group . No favorable effects were found for hip BMD , total body BMD , total fat mass , or fat-free soft tissue mass . Three participants withdrew from the intervention group due to injury or fear of injury associated with training . Under the conditions used in this research , low-load very high-repetition resistance training is effective at attenuating losses in lumbar spine BMD compared to controls in healthy , active women aged over 55 years but did not influence hip and total body BMD or fat mass and fat-free soft tissue mass INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies . Its usual clinical manifestation is at advanced stages , with nutritional impairment , weight loss , and a consequent decline in skeletal muscle mass and strength ( defined as sarcopenia ) . The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types , such as hepatocellular , pancreatic , lung , colon , cervical , metastatic breast , and renal cancer . The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients . METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRSIMA ) statement . The terms " SARCOPENIA " AND " OVARIAN CANCER " were systematic ally used to search PubMed and Scopus data bases . Original reports in English language were identified , with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer . RESULTS A total of 9 studies were considered eligible for the present review . The strength of recommendation was moderate and the level of evidence was low in all selected articles . No prospect i ve studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population . CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients . However , sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated . Prospect i ve trials are awaited in order to obtain a better insight in this topic The posttraumatic response to burn injury leads to marked and prolonged skeletal muscle catabolism and weakness , which persist despite st and ard rehabilitation programs of occupational and physical therapy . We investigated whether a resistance exercise program would attenuate muscle loss and weakness that is typically found in children with thermal injury . We assessed the changes in leg muscle strength and lean body mass in severely burned children with > 40 % total body surface area burned . Patients were r and omized to a 12-wk st and ard hospital rehabilitation program supplemented with an exercise training program ( n = 19 ) or to a home-based rehabilitation program without exercise ( n = 16 ) . Leg muscle strength was assessed before and after the 12-wk rehabilitation or training program at an isokinetic speed of 150 degrees /s . Lean body mass was assessed using dual-energy X-ray absorptiometry . We found that the participation in a resistance exercise program results in a significant improvement in muscle strength , power , and lean body mass relative to a st and ard rehabilitation program without exercise QUESTION Does inspiratory muscle training improve respiratory muscle strength , functional capacity , lung function and quality of life of patients with chronic kidney disease ? Does inspiratory muscle training improve these outcomes more than breathing exercises ? DESIGN Systematic review and meta- analysis of r and omised trials . PARTICIPANTS People with chronic kidney disease undergoing dialysis treatment . OUTCOME MEASURES The primary outcomes were : maximal inspiratory pressure , maximal expiratory pressure , and distance covered on the 6-minute walk test . The secondary outcomes were : forced vital capacity , forced expiratory volume in the first second ( FEV1 ) , and quality of life . RESULTS The search identified four eligible studies . The sample consisted of 110 participants . The inspiratory muscle training used a Threshold ® or PowerBreathe ® device , with a load ranging from 30 to 60 % of the maximal inspiratory pressure and lasting from 6 weeks to 6 months . The studies showed moderate to high risk of bias , and the quality of the evidence was rated low or very low , due to the studies ' method ological limitations . The meta- analysis showed that inspiratory muscle training significantly improved maximal inspiratory pressure ( MD 23 cmH2O , 95 % CI 16 to 29 ) and the 6-minute walk test distance ( MD 80 m , 95 % CI 41 to 119 ) when compared with controls . Significant benefits in lung function and quality of life were also identified . When compared to breathing exercises , significant benefits were identified in maximal expiratory pressure ( MD 6 cmH2O , 95 % CI 2 to 10 ) and FEV1 ( MD 0.24litres 95 % CI 0.14 to 0.34 ) , but not maximal inspiratory pressure or forced vital capacity . CONCLUSION In patients with chronic renal failure on dialysis  , inspiratory muscle training with a fixed load significantly improves respiratory muscle strength , functional capacity , lung function and quality of life . The evidence for these benefits may be influenced by some sources of bias . REGISTRATION PROSPERO ( CRD 42015029986 ) . [ de Medeiros AIC , Fuzari HKB , Rattesa C , Br and ão DC , de Melo Marinho PÉ ( 2017 ) Inspiratory muscle training  improves respiratory muscle strength , functional capacity and quality of life in patients with chronic kidney disease : a systematic review . Journal of Physiotherapy 63 : 76 - 83 ] It has previously been shown that females incur less muscle damage than males after strenuous exercise , but limited data are available for humans . To determine possible differences between the sexes in humans , the response to high-force eccentric exercise was examined in a large sample of women ( n = 83 ) and men ( n = 82 ) . The participants performed a bout of eccentric exercise of the elbow flexors consisting of 70 maximal repetitions .  Isometric strength , resting elbow angle and muscle soreness were measured before , immediately after ( except soreness ) and then daily for 7 days after exercise . There was a significant loss in strength among both groups ( 69 % for women and 63 % for men ) ( P≪0.01 ) immediately after exercise ; at 168 h post-exercise , women still had a 27 % strength loss and men had a 24 % strength loss . No significant difference in strength loss or recovery rate was found between men and women . Soreness reached peak values 32 - 48 h post-exercise ( P≪0.01 ) , with no significant difference between men and women . Range of motion decreased significantly until 3 days after exercise ( 14.6 ° or 0.255 rad loss for women ; 12.2 ° or 0.213 rad loss for men ) ( P≪0.01 ) ; at 168 h post-exercise , the women and men still showed a loss of 4.8 ° ( 0.084 rad ) and 4.0 ° ( 0.07 rad ) , respectively . There was a significant interaction of sex x time ( P≪0.01 ) ; a post-hoc test indicated that the women experienced a greater loss in range of motion at 72 h than men and this difference was maintained to 168 h post-exercise ( P≪0.01 ) . Thus , our results do not support the contention that women have a lower response to eccentric exercise than men Severe muscle atrophy occurs rapidly following traumatic spinal cord injury ( SCI ) . Previous research shows that neuromuscular or ‘ functional ’ electrical stimulation ( FES ) , particularly FES-cycle ergometry ( FES-CE ) can cause muscle hypertrophy in individuals with chronic SCI ( > 1 year post-injury ) . However , the modest degree of hypertrophy in these already atrophied muscles has lessened earlier hopes that FES therapy would reduce secondary impairments of SCI . It is not known whether FES treatments are effective when used to prevent , rather than reverse , muscle atrophy in individuals with acute SCI . This study explored whether unloaded isometric FES contractions ( FES-IC ) or FES-CE decreased subsequent muscle atrophy in individual with acute SCI ( <3 months post-injury ) . Twenty-six subjects , 14–15 weeks post-traumatic SCI , were assigned to control , FES-IC , or FES-CE against progessively increasing resistance . Subjects were involved in the study for 3 or 6 months . Total body lean body mass ( TB-LBM ) , lower limb lean body mass ( LL-LBM ) , and gluteal lean body mass ( G-LBM ) were determined before the study , and at 3 and 6 months using dual energy X-ray absorptiometry ( DEXA ) . Controls lost an average of 6.1 % , 10.1 % , 12.4 % , after 3 months and 9.5 % , 21.4 % , 26.8 % after 6 months in TB-LBM , LL-LBM and G-LBM respectively . Subjects in the FES-IC group consistently lost less lean body mass than controls , however , only 6 month G-LBM loss was significantly attenuated in this group relative to the controls . In the FES-CE group , LL-LBM and G-LBM loss were prevented at both 3 and 6 months , and TB-LBM loss was prevented at 6 months . In addition , FES-CE significantly increased G-LBM and LL-LBM after 6 months of training relative to pre-training levels . Within the control group , there was no significant relationship between LL-LBM loss ( 3 and 6 months ) and the number of days between injury and baseline measurement . In summary , this study shows that FES-CE , but not FES-IC , training prevents muscle atrophy in acute SCI after 3 months of training , and causes significant hypertrophy after 6 months . The magnitude of differences in regionalized LBM between controls and FES-CE subject raises hopes that such treatment may indeed be beneficial in preventing secondary impairments of SCI if employed before extensive post-injury atrophy occurs Cryotherapy is an effective treatment for acute sports injury to soft tissue , although the effect of cryotherapy on exercise-induced muscle damage is unclear . The aim of this study was to assess the effects of cold water immersion on the symptoms of exercise-induced muscle damage following strenuous eccentric exercise . After performing a bout of damage-inducing eccentric exercise ( eight sets of five maximal reciprocal contractions at 0.58 rad x s(-1 ) ) of the elbow flexors on an isokinetic dynamometer , 15 females aged 22.0+/-2.0 years ( mean + /- s ) were allocated to a control group ( no treatment , n = 7 ) or a cryotherapy group ( n = 8) . Subjects in the cryotherapy group immersed their exercised arm in cold water ( 15 degrees C ) for 15 min immediately after eccentric exercise and then every 12 h for 15 min for a total of seven sessions . Muscle tenderness , plasma creatine kinase activity , relaxed elbow angle , isometric strength and swelling ( upper arm circumference ) were measured immediately before and for 3 days after eccentric exercise . Analysis of variance revealed significant ( P < 0.05 ) main effects for time for all variables , with increases in muscle tenderness , creatine kinase activity and upper arm circumference , and decreases in isometric strength and relaxed elbow angle . There were significant interactions ( P<0.05 ) of group x time for relaxed elbow angle and creatine kinase activity . Relaxed elbow angle was greater and creatine kinase activity lower for the cryotherapy group than the controls on days 2 and 3 following the eccentric exercise . We conclude that although cold water immersion may reduce muscle stiffness and the amount of post-exercise damage after strenuous eccentric activity , there appears to be no effect on the perception of tenderness and strength loss , which is characteristic after this form of activity STUDY DESIGN Prospect i ve cohort study without a control group . OBJECTIVES Firstly , to present our 5-week progressive exercise therapy program in the early stage after anterior cruciate ligament ( ACL ) injury . Secondly , to evaluate changes in knee function after completion of the program for patients with ACL injury in general and also when classified as potential copers or noncopers , and , finally , to examine potential adverse events . BACKGROUND Few studies concerning early-stage ACL rehabilitation protocol s exist . Consequently , little is known about the tolerance for , and outcomes from , short-term exercise therapy programs in the early stage after injury . METHODS One-hundred patients were included in a 5-week progressive exercise therapy program , within 3 months after injury . Knee function before and after completion of the program was evaluated from isokinetic quadriceps and hamstrings muscle strength tests , 4 single-leg hop tests , 2 different self- assessment question naires , and a global rating of knee function . A 2-way mixed-model analysis of variance was conducted to evaluate changes from pretest to posttest for the limb symmetry index for muscle strength and single-leg hop tests , and the change in scores for the patient-reported question naires . In addition , absolute values and the st and ardized response mean for muscle strength and single-leg hop tests were calculated at pretest and posttest for the injured and uninjured limb . Adverse events during the 5-week period were recorded . RESULTS The progressive 5-week exercise therapy program led to significant improvements ( P<.05 ) in knee function from pretest to posttest both for patients classified as potential copers and noncopers . St and ardized response mean values for changes in muscle strength and single-leg hop performance from pretest to posttest for the injured limb were moderate to strong ( 0.49 - 0.84 ) , indicating the observed improvements to be clinical ly relevant . Adverse events occurred in 3.9 % of the patients . CONCLUSION Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation , either to improve knee function before ACL reconstruction or as a first step in further nonoperative management . LEVEL OF EVIDENCE Therapy , level 2b
Conclusion Overall , our findings do not support the presence of a secondary loss of strength following an acute muscle injury , and strongly suggest that strength , on average , recovers steadily over the first 3 days post-injury
Background An immediate loss of strength follows virtually all types of muscle injury but there is debate whether the initial strength loss is maximal or if a secondary loss of strength occurs during the first 3 days post-injury .
Objective The objective of this analysis was to conduct a systematic review and meta- analysis of the research literature to determine if a secondary loss of strength occurs after an injurious initiating event .