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Heavy-resistance exercise-induced increases in jump performance are not explained by changes in neuromuscular function. - Scandinavian journal of medicine & science in sports
Post-activation potentiation (PAP) is the increased involuntary muscle twitch response to stimulation following strong contraction. The enhancement to whole-body explosive muscular performance (PE) after heavy-resistance exercise is often attributed to modulations in neuromuscular function that are proposed to reflect PAP, but the evidence to support this is equivocal. We assessed the neuromuscular basis of PE using transcranial magnetic stimulation (TMS) of the primary motor cortex, and electrical stimulation of the femoral nerve. Eleven male athletes performed heavy-resistance exercise with measures of countermovement jump (CMJ) pre- and 8Â min post-exercise. Pre-exercise and after the final CMJ, single- and paired-pulse TMS were delivered during submaximal isometric knee-extensor contractions to measure corticospinal excitability, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF), with motor evoked potentials recorded from rectus femoris. Twitch responses to motor nerve stimulation during and post maximum-knee-extensor contractions were studied to quantify voluntary activation (VA) and potentiated twitch (Qtw,pot ). The experimental protocol successfully induced PE (+4Â Â±Â 1% change in CMJ, PÂ =Â 0.01), but no changes were observed for maximum voluntary force, VA, corticospinal excitability, SICI or ICF (all PÂ >Â 0.05), and Qtw,pot declined (PÂ <Â 0.001). An enhancement of muscular performance after heavy-resistance exercise was not accompanied by PAP, or changes in measures of neuromuscular function.Â© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Augmented supraspinal fatigue following constant-load cycling in the heat. - Scandinavian journal of medicine & science in sports
The development of central fatigue is prominent following exercise-induced hyperthermia, but the contribution of supraspinal fatigue is not well understood. Seven endurance-trained cyclists (meanâ€‰Â±â€‰SD peak O2 uptake, 62.0â€‰Â±â€‰5.6â€‰mL/kg/min) completed two high-intensity constant-load cycling trials (296â€‰Â±â€‰34â€‰W) to the limit of tolerance in a hot (34â€‰Â°C, 20% relative humidity) and, on a separate occasion, for the same duration, a control condition (18â€‰Â°C, 20% relative humidity). Core body temperature (Tc ) was measured throughout. Before and immediately after each trial, twitch responses to supramaximal femoral nerve and transcranial magnetic stimulation were obtained from the knee extensors to assess neuromuscular and corticospinal function, respectively. Exercise time was 11.4â€‰Â±â€‰2.6â€‰min. Peak Tc was higher in the hot compared with control (38.36â€‰Â±â€‰0.43â€‰Â°C vs 37.86â€‰Â±â€‰0.36â€‰Â°C; Pâ€‰=â€‰0.035). Post-exercise reductions in maximal voluntary contraction force (13â€‰Â±â€‰9% vs 9â€‰Â±â€‰5%), potentiated twitch force (16â€‰Â±â€‰12% vs 21â€‰Â±â€‰13%) and voluntary activation (9â€‰Â±â€‰7% vs 7â€‰Â±â€‰7%) were similar in hot and control trials, respectively. However, cortical voluntary activation declined more in the hot compared with the control (8â€‰Â±â€‰3% vs 3â€‰Â±â€‰2%; Pâ€‰=â€‰0.001). Exercise-induced hyperthermia elicits significant central fatigue of which a large portion can be attributed to supraspinal fatigue. These data indicate that performance decrements in the heat might initially originate in the brain.Â© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Muscle Damage Response in Female Collegiate Athletes After Repeated Sprint Activity. - Journal of strength and conditioning research / National Strength & Conditioning Association
Exercise-induced muscle damage (EIMD) is a well-investigated area, however there is a paucity of data surrounding the damage response in females. The aim of this study was to examine the damage responses from a sport-specific bout of repeated sprints in female athletes. Eleven well-trained females (mean Â± SD; age: 22 Â± 3 years; height: 166.6 Â± 5.7 cm; mass: 62.7 Â± 4.5 kg) in the luteal phase of the menstrual cycle completed a repeated sprint protocol designed to induce EIMD (15 Ã— 30 m sprints). Creatine kinase, countermovement jump height, knee extensor maximal voluntary isometric contraction (MVIC) force, delayed onset muscle soreness (DOMS), 30-m sprint time, and limb girth were recorded before, after, 24, 48, and 72 hours after exercise. Creatine kinase was elevated at 24, 48, and 72 hours (p â‰¤ 0.05), peaking at 24 hours (+418%) and returning toward baseline at 72 hours. Countermovement jump height was reduced immediately after, 24, and 48 hours (p â‰¤ 0.05). Sprint performance was also negatively affected immediately after, 24, 48, and 72 hours after exercise. Muscle soreness peaked at 48 hours (p < 0.01) and remained significantly elevated at 72 hours after exercise (p < 0.01). Limb girth and MVIC did not alter over time. This study provides new information on the EIMD response in trained females after a sport-specific bout of repeated sprints. Importantly, this damage response has the potential to negatively affect performance for several days after exercise.
Alterations in Whole-Body Insulin Sensitivity Resulting From Repeated Eccentric Exercise of a Single Muscle Group: A Pilot Investigation. - International journal of sport nutrition and exercise metabolism
Unaccustomed eccentric exercise using large muscle groups elicits soreness, decrements in physical function and impairs markers of whole-body insulin sensitivity; although these effects are attenuated with a repeated exposure. Eccentric exercise of a small muscle group (elbow flexors) displays similar soreness and damage profiles in response to repeated exposure. However, it is unknown whether damage to small muscle groups impacts upon whole-body insulin sensitivity. This pilot investigation aimed to characterize whole-body insulin sensitivity in response to repeated bouts of eccentric exercise of the elbow flexors. Nine healthy males completed two bouts of eccentric exercise separated by 2 weeks. Insulin resistance (updated homeostasis model of insulin resistance, HOMA2-IR) and muscle damage profiles (soreness and physical function) were assessed before, and 48 h after exercise. Matsuda insulin sensitivity indices (ISI Matsuda) were also determined in 6 participants at the same time points as HOMA2-IR. Soreness was elevated, and physical function impaired, by both bouts of exercise (both p < .05) but to a lesser extent following bout 2 (time x bout interaction, p < .05). Eccentric exercise decreased ISI Matsuda after the first but not the second bout of eccentric exercise (time x bout interaction p < .05). Eccentric exercise performed with an isolated upper limb impairs whole-body insulin sensitivity after the first, but not the second, bout.
Mirror illusion reduces motor cortical inhibition in the ipsilateral primary motor cortex during forceful unilateral muscle contractions. - Journal of neurophysiology
Forceful, unilateral contractions modulate corticomotor paths targeting the resting, contralateral hand. However, it is unknown whether mirror-viewing of a slowly moving but forcefully contracting hand would additionally affect these paths. Here we examined corticospinal excitability and short-interval intracortical inhibition (SICI) of the right-ipsilateral primary motor cortex (M1) in healthy young adults under no-mirror and mirror conditions at rest and during right wrist flexion at 60% maximal voluntary contraction (MVC). During the no-mirror conditions neither hand was visible, whereas in the mirror conditions participants looked at the right hand's reflection in the mirror. Corticospinal excitability increased during contractions in the left flexor carpi radialis (FCR) (contraction 0.41 mV vs. rest 0.21 mV) and extensor carpi radialis (ECR) (contraction 0.56 mV vs. rest 0.39 mV), but there was no mirror effect (FCR: P = 0.743, Î·p (2) = 0.005; ECR: P = 0.712, Î·p (2) = 0.005). However, mirror-viewing of the contracting and moving wrist attenuated SICI relative to test pulse in the left FCR by âˆ¼9% compared with the other conditions (P < 0.05, d â‰¥ 0.62). Electromyographic activity in the resting left hand prior to stimulation was not affected by the mirror (FCR: P = 0.255, Î·p (2) = 0.049; ECR: P = 0.343, Î·p (2) = 0.035) but increased twofold during contractions. Thus viewing the moving hand in the mirror and not just the mirror image of the nonmoving hand seems to affect motor cortical inhibitory networks in the M1 associated with the mirror image. Future studies should determine whether the use of a mirror could increase interlimb transfer produced by cross-education, especially in patient groups with unilateral orthopedic and neurological conditions.Copyright Â© 2015 the American Physiological Society.
The clinical psychologist and the management of inpatient pain: a small case series. - Neuropsychiatric disease and treatment
Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients' pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize communication and to resolve a difficult and potentially risk-laden situation. This small case series discusses the benefits derived from the involvement of a clinical psychologist in the management of inpatient pain, and therefore illustrates the need for novel initiatives for inpatient pain services. However, future research is warranted to validate this approach.
Central and peripheral fatigue in male cyclists after 4-, 20-, and 40-km time trials. - Medicine and science in sports and exercise
Few studies have assessed neuromuscular fatigue after self-paced locomotor exercise; moreover, none have assessed the degree of supraspinal fatigue. This study assessed central and peripheral fatigue after self-paced exercise of different durations.Thirteen well-trained male cyclists completed 4-, 20-, and 40-km simulated time trials (TTs). Pre- and immediately post-TT (<2.5 min), twitch responses from the knee extensors to electrical stimulation of the femoral nerve and transcranial magnetic stimulation of the motor cortex were recorded to assess neuromuscular and corticospinal function.Time to complete 4-, 20-, and 40-km TTs was 6.0 Â± 0.2, 31.8 Â± 1.0, and 65.8 Â± 2.2 min at average exercise intensities of 96%, 92%, and 87% of maximum oxygen uptake, respectively. Exercise resulted in significant reductions in maximum voluntary contraction, with no difference between TTs (-18%, -15%, and -16% for 4-, 20-, and 40-km TTs, respectively). Greater peripheral fatigue was evident after 4-km (40% reduction in potentiated twitch) compared with that after 20-km (31%) and 40-km TTs (29%). In contrast, longer TTs were characterized by more central fatigue, with greater reductions in voluntary activation measured by motor nerve (-11% and -10% for 20- and 40-km TTs vs -7% for 4-km TTs) and cortical stimulation (-12% and -10% for 20- and 40-km vs -6% for 4-km).These data demonstrate that fatigue after self-paced exercise is task dependent, with a greater degree of peripheral fatigue after shorter higher-intensity (6 min) TTs and more central fatigue after longer lower-intensity TTs (>30 min).
Neuromuscular fatigability during repeated-sprint exercise in male athletes. - Medicine and science in sports and exercise
This study aimed to determine the pattern of neuromuscular fatigability that manifests during repeated-sprint running exercise.Twelve male participants (mean Â± SD: age, 25 Â± 6 yr; stature, 180 Â± 7 cm; body mass, 77 Â± 7 kg), currently training and competing in intermittent sprint sports, performed a repeated maximal sprint running protocol (12 Ã— 30 m, 30-s rest periods). Pre- and postexercise twitch responses to transcutaneous motor point stimulation and transcranial magnetic stimulation were obtained to assess knee extensor neuromuscular and corticospinal function, respectively. Throughout the protocol, during alternate rest periods, blood lactate samples were taken and a single knee extensor maximal voluntary contraction (MVC) of the knee extensors was performed, with motor point stimulation delivered during and 2 s after, to determine voluntary activation (VA) and peripheral fatigue.The repeated-sprint protocol induced significant increases in sprint time and blood [lactate] from the third sprint onwards (P < 0.001). Furthermore, knee extensor MVC, resting twitch amplitude, and VA were all significantly reduced after two sprints and reached their nadir after sprint 10 (Î”12%, Î”24%, Î”8%, P < 0.01, respectively). In line with a reduction in motor point-derived VA, there was also a reduction in VA measured with transcranial magnetic stimulation (Î”9%, P < 0.05) immediately after exercise.These data are the first to demonstrate the development of neuromuscular fatigability of the knee extensors during and immediately after repeated-sprint exercise. Peripheral and central factors contributing to muscle fatigability were evident after two maximal sprints, and over half of the drop in postexercise MVC was due to supraspinal fatigue. Thus, peripheral, central, and supraspinal factors all contribute to the performance decrement and fatigability of the knee extensors after maximal repeated-sprint activity.
Th17 and Th22 cells in psoriatic arthritis and psoriasis. - Arthritis research & therapy
The aim of this study was to characterize interleukin 17 (IL-17) and interleukin 22 (IL-22) producing cells in peripheral blood (PB), skin, synovial fluid (SF) and synovial tissue (ST) in patients with psoriasis (Ps) and psoriatic arthritis (PsA).Flow cytometry was used to enumerate cells making IL-22 and IL-17, in skin and/or SF and PB from 11 patients with Ps and 12 patients with PsA; skin and PB of 15 healthy controls and SF from rheumatoid arthritis (RA) patients were used as controls. Expression of the interleukin 23 receptor (IL-23R) and chemokine receptors CCR4 and CCR6 was examined. Secretion of IL-17 and IL-22 was measured by ELISA. ST was analysed by immunohistochemical staining of IL-17 and IL-22.Increased frequencies of IL-17+ and IL-22+ CD4+ T cells were seen in PB of patients with PsA and Ps. IL-17 secretion was significantly elevated in both PsA and Ps, whilst IL-22 secretion was higher in PsA compared to Ps and healthy controls. A higher proportion of the CD4+ cells making IL-17 or IL-22 expressed IL-23R and frequencies of IL-17+, CCR6+ and CCR4+ T cells were elevated in patients with Ps and those with PsA. In patients with PsA, CCR6+ and IL-23R + T cells numbers were elevated in SF compared to PB. Increased frequencies of IL-17+ and IL-22+ CD4+ T cells were demonstrated in Ps skin lesions. In contrast, whilst elevated frequencies of CD4+ IL-17+ cells were seen in PsA SF compared to PB, frequencies of CD4+ IL-22+ T cells were lower. Whereas IL-17 expression was equivalent in PsA, osteoarthritis (OA) and RA ST, IL-22 expression was higher in RA than either OA or PsA ST, in which IL-22 was strikingly absent.Elevated frequencies of IL-17 and IL-22 producing CD4+ T cells were a feature of both Ps and PsA. However their differing distribution at disease sites, including lower frequencies of IL-22+ CD4+ T cells in SF compared to skin and PB, and lack of IL-22 expression in ST suggests that Th17 and Th22 cells have common, as well as divergent roles in the pathogenesis of Ps and PsA.
Penicillin to prevent recurrent leg cellulitis. - The New England journal of medicine
Cellulitis of the leg is a common bacterial infection of the skin and underlying tissue. We compared prophylactic low-dose penicillin with placebo for the prevention of recurrent cellulitis.We conducted a double-blind, randomized, controlled trial involving patients with two or more episodes of cellulitis of the leg who were recruited in 28 hospitals in the United Kingdom and Ireland. Randomization was performed according to a computer-generated code, and study medications (penicillin [250 mg twice a day] or placebo for 12 months) were dispensed by a central pharmacy. The primary outcome was the time to a first recurrence. Participants were followed for up to 3 years. Because the risk of recurrence was not constant over the 3-year period, the primary hypothesis was tested during prophylaxis only.A total of 274 patients were recruited. Baseline characteristics were similar in the two groups. The median time to a first recurrence of cellulitis was 626 days in the penicillin group and 532 days in the placebo group. During the prophylaxis phase, 30 of 136 participants in the penicillin group (22%) had a recurrence, as compared with 51 of 138 participants in the placebo group (37%) (hazard ratio, 0.55; 95% confidence interval [CI], 0.35 to 0.86; P=0.01), yielding a number needed to treat to prevent one recurrent cellulitis episode of 5 (95% CI, 4 to 9). During the no-intervention follow-up period, there was no difference between groups in the rate of a first recurrence (27% in both groups). Overall, participants in the penicillin group had fewer repeat episodes than those in the placebo group (119 vs. 164, P=0.02 for trend). There was no significant between-group difference in the number of participants with adverse events (37 in the penicillin group and 48 in the placebo group, P=0.50).In patients with recurrent cellulitis of the leg, penicillin was effective in preventing subsequent attacks during prophylaxis, but the protective effect diminished progressively once drug therapy was stopped. (Funded by Action Medical Research; PATCH I Controlled-Trials.com number, ISRCTN34716921.).
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