Strength gains without muscle injury after strength training in patients with postpolio muscular atrophy

We evaluated changes in the dynamic and isometric strength in the newly weakened quadriceps muscles and asymptomatic triceps muscles of 6 patients with postpolio muscular atrophy (PPMA) after 10 weeks of progressive resistance strength training. Alterations in muscle size were determined with magnetic resonance imaging. Serum creatine kinase levels were measured throughout training, and histological signs of muscle injury and changes in muscle fiber size and types were assessed with muscle biopsies before and after training. Exercise training led to an increase in dynamic strength of 41% and 61% for the two knee extensor tests, and 54% and 71% for the two elbow extensor tests. Up to 20% of the improvement was maintained 5 months after cessation of training. Isometric strength, whole muscle cross-sectional areas of quadriceps and triceps muscles, and serum muscle enzymes did not change. No destructive histopathological changes were noted in the repeat muscle biopsies, and no consistent changes in muscle fiber size or fiber type percentages were observed. These results demonstrate that a supervised resistance training program can lead to significant gains in dynamic strength of both symptomatic and asymptomatic muscles of PPMA patients without serological or histological evidence of muscular damage. © 1996 John Wiley & Sons, Inc.     

Strength-training effectively alleviates skeletal muscle impairments in myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is a multisystemic disease characterized by progressive muscle weakness. The aim of this project is to evaluate the effects of a 12-week lower limb strength training program in 11 men with DM1. Maximal isometric muscle strength, 30-second sit-to-stand, comfortable and maximal 10-m walk test (10 mwt) were evaluated at baseline, 6 and 12 weeks, and at 6 and 9 months. The one-repetition maximum strength evaluation method of the training exercises was completed at baseline, 6 and 12 weeks. Muscle biopsies were taken in the vastus lateralis at baseline and 12 weeks to evaluate muscle fiber typing and size (including atrophy/hypertrophy factors). Performance in strength and functional tests all significantly improved by week 12. Maximal isometric muscle strength of the knee extensors decreased by month 9, while improved walking speed and 30 second sit-to-stand performance were maintained. On average, there were no significant changes in fiber typing or size after training. Further analysis showed that individual abnormal hypertrophy factor at baseline could explain the different changes in muscle size among participants. Strength training induces maximal isometric muscle strength and lasting functional gains in DM1. Abnormal hypertrophy factor could be a key component to identify high and low responders to hypertrophy in DM1.     

Strength training in old age: adaptation of antagonist muscles at the ankle joint

The purpose of this study was to determine whether strength training could reduce the deficit in plantarflexion (PF) maximal voluntary contraction (MVC) torque observed in previous studies in older subjects relative to young adults. Accordingly, the effects of a 6-month strength training program on the muscle and neural properties of the major muscle groups around the ankle were examined. PF and dorsiflexion (DF) isometric MVC torques were measured and surface electromyographic activity of the triceps surae and tibialis anterior muscles was recorded. The strength training program was very effective in improving strength in PF (+24.5%), and it thus reduced the DF-to-PF MVC torque ratio; in addition, it also induced gains in DF (+7.6%). Thus, there must be an improvement in ankle joint stability. In PF, gains were due particularly to a modification of the agonist neural drive; in DF, the gains appeared to be the consequence of a reduction in antagonist coactivation. Our findings indicate that the investigation of one muscle group should always be accompanied by examination of its antagonist muscle group.     

Further observations on forearm flexor weakness in inclusion body myositis

In order to further characterize and provide a possible mechanism for the asymmetrical involvement of forearm muscles in inclusion body myositis (IBM), we measured isometric hand and pinch grip strength, and forearm muscle girth on 15 IBM patients. Forearm muscle strength and girth were significantly greater on the dominant versus nondominant side: mean grip strength, 173.9 vs. 98.8 N; mean pinch strength, 47.6 vs. 29.7 N; and mean forearm girth, 22.5 vs. 19.9 cm. This observation may suggest a role for exercise in delaying the disease progression in IBM. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:659–661, 1998.     

Randomized controlled trial of strength training in post-polio patients

Many post-polio patients develop new muscle weakness decades after the initial illness. However, its mechanism and treatment are controversial. The purpose of this study was to test the hypotheses that: (1) after strength training, post-polio patients show strength improvement comparable to that seen in the healthy elderly; (2) such training does not have a deleterious effect on motor unit (MU) survival; and (3) part of the strength improvement is due to an increase in voluntary motor drive. After baseline measures including maximum voluntary contraction force, voluntary activation index, motor unit number estimate, and the tetanic tension of the thumb muscles had been determined, 10 post-polio patients with hand involvement were randomized to either the training or control group. The progressive resistance training program consisted of three sets of eight isometric contractions, three times weekly for 12 weeks. Seven healthy elderly were also randomized and trained in a similar manner. Changes in the baseline parameters were monitored once every 4 weeks throughout the training period. The trained post-polio patients showed a significant improvement in their strength (P < 0.05). The magnitude of gain was greater than that seen in the healthy elderly (mean +/- SE, 41 +/- 16% vs. 29 +/- 8%). The training did not adversely affect MU survival and the improvement was largely attributable to an increase in voluntary motor drive. We therefore conclude that moderate intensity strength training is safe and effective in post-polio patients.     

A home-based resistance-training program using elastic bands for elderly patients with orthostatic hypotension

Falls are a common hazard in the elderly. Orthostatic hypotension (OH) is prevalent in older patients and contributes to the high incidence of falls. Our aim was to test whether a home-based resistance-training program (HBRT) using elastic resistance bands could safely and effectively increase muscle strength and functional ability, and attenuate the orthostatic fall in blood pressure. Eight subjects (> 60 yrs) underwent orthostatic provocations; muscle strength testing (isometric and dynamic), and a functional test of gait and mobility (Timed Up & Go), at baseline and following 8 weeks of training. Ten exercises were assigned and customized to each participant. At 8 weeks, significant increases occurred in dynamic strength in the chest press (p = 0.017), quadriceps extension (p = 0.017), and leg press (p = 0.025); no significant differences occurred in isometric strength or in blood pressures. Functional mobility increased in 7 of 8 subjects. There were no falls during the investigation period.Conclusion A HBRT program using elastic resistance bands effectively increases dynamic muscle strength in elderly individuals with OH. Although no changes occurred in orthostatic blood pressures, which could be attributed to the limited length of the program, this therapy may be recognized as a safe method to improve strength, functional ability, and promote physical activity – variables that can reduce the incidence of falls and enhance the quality of life in this population.     

Body weight‐supported training in Becker and limb girdle 2I muscular dystrophy

Introduction: We studied the functional effects of combined strength and aerobic anti‐gravity training in severely affected patients with Becker and Limb‐Girdle muscular dystrophies. Methods: Eight patients performed 10‐week progressive combined strength (squats, calf raises, lunges) and aerobic (walk/run, jogging in place or high knee‐lift) training 3 times/week in a lower‐body positive pressure environment. Closed‐kinetic‐chain leg muscle strength, isometric knee strength, rate of force development (RFD), and reaction time were evaluated. Results: Baseline data indicated an intact neural activation pattern but showed compromised muscle contractile properties. Training (compliance 91%) improved functional leg muscle strength. Squat series performance increased 30%, calf raises 45%, and lunges 23%. Conclusions: Anti‐gravity training improved closed‐kinetic‐chain leg muscle strength despite no changes in isometric knee extension strength and absolute RFD. The improved closed‐kinetic‐chain performance may relate to neural adaptation involving motor learning and/or improved muscle strength of other muscles than the weak knee extensors. Muscle Nerve 54 : 239–243, 2016     

A longitudinal study comparing thenar motor unit number estimates to other quantitative tests in patients with amyotrophic lateral sclerosis

The following data were obtained on 21 amyotrophic lateral sclerosis (ALS) patients, aged 36–76 years (mean: 58 years), at baseline and months 4, 8, and 12: thenar motor unit number estimate (MUNE) using multiple point stimulation, mean thenar surface-recorded motor unit action potential negative-peak area, thenar compound muscle action potential amplitude, isometric hand grip strength, total Medical Research Council (MRC) manual muscle testing score, Appel ALS rating scale, and forced vital capacity (FVC). The absolute mean rate of change per month was significantly greater (P < 0.01) for MUNE values than for MRC and FVC values in the 21 ALS patients. In a subset of patients (n = 6) with slowly progressive disease, the absolute mean rate of change per month was significantly greater (P < 0.01) for MUNE values than for all other test values. In addition, MUNE values were the most sensitive index for documenting changes in disease progression over time. © 1997 John Wiley & Sons, Inc. Muscle Nerve, 20, 179–185, 1997.     

A controlled study of intravenous immunoglobulin combined with prednisone in the treatment of IBM

OBJECTIVE: To investigate whether the combination of intravenous immunoglobulin (IVIg) with prednisone improves muscle strength and alters endomysial inflammation in patients with sporadic inclusion body myositis (s-IBM). BACKGROUND: In a previous controlled trial in s-IBM, IVIg did not significantly improve strength in spite of modest benefits in some muscle groups. The possibility that prednisone may have a synergistic effect with IVIg prompted another controlled trial. METHODS: Thirty-six patients with biopsy-proven IBM were randomized to receive IVIg or placebo monthly for 3 months. Before infusions, all patients were started on high-dose prednisone for 3 months. Primary outcome measures were differences in the 1) Quantitative Muscle Strength (QMT) testing; and 2) modified Medical Research Council (MRC) scores, between the patients randomized to IVIg + prednisone compared with those randomized to placebo + prednisone. Repeated open muscle biopsies were performed at random in 24 patients to determine changes in the number of autoinvasive T cells and necrotic muscle fibers. RESULTS: Nineteen patients were randomized to IVIg + prednisone and 17 to placebo + prednisone. No significant change was noted in muscle strength, assessed by QMT and MRC, from baseline to the 2nd, 3rd, or 4th month after treatment between the two groups. The number of necrotic fibers was reduced in the IVIg randomized group (p < 0.01), and the mean number of CD2+ cells was significantly decreased in both groups (p < 0.0001), denoting a steroid effect. CONCLUSION: IVIg combined with prednisone for a 3-month period was not effective in IBM. Endomysial inflammation was significantly reduced after treatment, but the reduction was not of clinical significance.     

Resistance strength training exercise in children with spinal muscular atrophy

Introduction: Preliminary evidence in adults with spinal muscular atrophy (SMA) and in SMA animal models suggests exercise has potential benefits in improving or stabilizing muscle strength and motor function. Methods: We evaluated feasibility, safety, and effects on strength and motor function of a home‐based, supervised progressive resistance strength training exercise program in children with SMA types II and III. Up to 14 bilateral proximal muscles were exercised 3 times weekly for 12 weeks. Results: Nine children with SMA, aged 10.4 ± 3.8 years, completed the resistance training exercise program. Ninety percent of visits occurred per protocol. Training sessions were pain‐free (99.8%), and no study‐related adverse events occurred. Trends in improved strength and motor function were observed. Conclusions: A 12‐week supervised, home‐based, 3‐day/week progressive resistance training exercise program is feasible, safe, and well tolerated in children with SMA. These findings can inform future studies of exercise in SMA. Muscle Nerve 52 : 559–567, 2015     

Effects of resistance training on force steadiness and common drive

The purpose of this study was to investigate the influence of an 8-week resistance training program on force steadiness and common drive for the vastus lateralis muscle. Eight untrained men performed a resistance training program. Before the program and at the end of each week, the subjects performed a trapezoid isometric muscle action of the leg extensors, and bipolar surface electromyographic signals were recorded from the vastus lateralis. The signals were decomposed into action potential trains that were cross-correlated to measure common drive. Force steadiness was quantified as the standard deviation of force during the constant-force portion of the trapezoid muscle action. The training program did not consistently affect force steadiness or common drive for any of the subjects. Although future studies are needed with different muscles and training programs, changes in the overall motor control scheme are not likely with resistance training.     

An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain.

OBJECTIVE: The purpose of this study was to investigate whether an endurance-strength training program is effective in reducing myoelectric manifestations of sternocleidomastoid (SCM) and anterior scalene (AS) muscle fatigue which have been found to be greater in people with chronic neck pain. METHODS: Fifty-eight female patients with chronic non-severe neck pain were randomized into one of two 6-week exercise intervention groups: an endurance-strength training regime for the cervical flexor muscles or a referent exercise intervention involving low load retraining of the cranio-cervical flexor muscles. The primary outcomes were a change in maximum voluntary contraction (MVC) force and change of the initial value and rate of change of the mean frequency, average rectified value and conduction velocity detected from the SCM and AS muscles during sub-maximal isometric cervical flexion contractions at 50, 25 and 10% MVC. RESULTS: At the 7th week follow-up assessment, the endurance-strength training group revealed a significant increase in MVC force and a reduction in the estimates of the initial value and rate of change of the mean frequency for both the SCM and AS muscles (P<0.05). Both exercise groups reported a reduced average intensity of neck pain and reduced neck disability index score (P<0.05). CONCLUSIONS: An endurance-strength exercise regime for the cervical flexor muscles is effective in reducing myoelectric manifestations of superficial cervical flexor muscle fatigue as well as increasing cervical flexion strength in a group of patients with chronic non-severe neck pain. SIGNIFICANCE: Provision of load to challenge the neck flexor muscles is required to reduce the fatigability of the SCM and AS muscles in people with neck pain. Improvements in cervical muscle strength and reduced fatigability may be responsible for the reported efficacy with this type of exercise program.     

Comparison of maximal voluntary isometric contraction and hand-held dynamometry in measuring muscle strength of patients with progressive lower motor neuron syndrome

Context. Maximal voluntary isometric contraction, a method quantitatively assessing muscle strength, has proven to be reliable, accurate and sensitive in amyotrophic lateral sclerosis. Hand-held dynamometry is less expensive and more quickly applicable than maximal voluntary isometric contraction. Objective. To investigate if hand-held dynamometry is as reliable and valid as maximal voluntary isometric contraction in measuring muscle strength in patients with an adult-onset, non-hereditary progressive lower motor neuron syndrome. Design. Two testers performed maximal voluntary isometric contraction and hand-held dynamometry measurements in six muscle groups bilaterally in patients with progressive lower motor neuron syndrome to assess reliability and validity of both the methods. Setting. Outpatient units of an academic medical center. Patients. A consecutive sample of 19 patients with non-hereditary progressive lower motor neuron syndrome (median disease duration 32.5 months, range 10-84) was tested. Outcome measures. Comparison between maximal voluntary strength contractions as measured by hand-held dynamometry and maximal voluntary isometric contraction. Results. Low intra- and interrater variation in all muscle groups were found, intraclass correlation coefficients vary between 0.86 and 0.99 for both methods. Both methods correlated well in all muscle groups with Pearson's correlation coefficients ranged between 0.78 and 0.98. Scatter plots indicated a trend to under-estimate muscle strength above 250 N by hand-held dynamometry as compared with maximal voluntary isometric contraction. Conclusions. For longitudinal evaluation of muscle strength in patients with progressive lower motor neuron syndrome (i.e. between 0 and 250 N), muscle strength can be accurate quantified with both hand-held dynamometry and maximal voluntary isometric contraction. Hand-held dynamometry has the advantage of being cheap and quickly applicable. However, our results indicate that hand-held dynamometry is less sensitive than maximal voluntary isometric contraction in detecting subnormal muscle strength in strong muscle groups (i.e. >250 N), due to limited strength of the tester.     

Training at non‐damaging intensities facilitates recovery from muscle atrophy

Introduction: Resistance training promotes recovery from muscle atrophy, but optimum training programs have not been established. We aimed to determine the optimum training intensity for muscle atrophy. Methods: Mice recovering from atrophied muscles after 2 weeks of tail suspension underwent repeated isometric training with varying joint torques 50 times per day. Results: Muscle recovery assessed by maximal isometric contraction and myofiber cross‐sectional areas (CSAs) were facilitated at 40% and 60% maximum contraction strength (MC), but at not at 10% and 90% MC. At 60% and 90% MC, damaged and contained smaller diameter fibers were observed. Activation of myogenic satellite cells and a marked increase in myonuclei were observed at 40%, 60%, and 90% MC. Conclusions: The increases in myofiber CSAs were likely caused by increased myonuclei formed through fusion of resistance‐induced myofibers with myogenic satellite cells. These data indicate that resistance training without muscle damage facilitates efficient recovery from atrophy. Muscle Nerve 55 : 243–253, 2017     

Skeletal muscle of mice with a mutation in slow α-tropomyosin is weaker at lower lengths

Skeletal muscle function was measured in anaesthetised transgenic mice having a mutation in the TPM3 gene (slow alpha-tropomyosin), a similar mutation as found in some patients with nemaline myopathy, and was compared with control muscles. Measurements of isometric and dynamic muscle performance were done with electrical nerve stimulation at physiological temperatures. No muscle weakness was found in the transgenic muscles when performance was measured at muscle optimum length. This was true not only with full activation but also at lower activation levels, indicating that calcium sensitivity was not affected at this length. Also, fatigability was not affected in these conditions. However, isometric force of the muscles with the mutation in TPM3 was lower at lengths below optimum, with more impairment at decreasing length. As the muscles are active over a large range of different muscle lengths during daily activities, this finding may explain, at least in part, the muscle weakness experienced by patients with nemaline myopathy.     

Skeletal muscle of mice with a mutation in slow alpha-tropomyosin is weaker at lower lengths

Skeletal muscle function was measured in anaesthetised transgenic mice having a mutation in the TPM3 gene (slow alpha-tropomyosin), a similar mutation as found in some patients with nemaline myopathy, and was compared with control muscles. Measurements of isometric and dynamic muscle performance were done with electrical nerve stimulation at physiological temperatures. No muscle weakness was found in the transgenic muscles when performance was measured at muscle optimum length. This was true not only with full activation but also at lower activation levels, indicating that calcium sensitivity was not affected at this length. Also, fatigability was not affected in these conditions. However, isometric force of the muscles with the mutation in TPM3 was lower at lengths below optimum, with more impairment at decreasing length. As the muscles are active over a large range of different muscle lengths during daily activities, this finding may explain, at least in part, the muscle weakness experienced by patients with nemaline myopathy.     

Strength and agility training in adolescents with Down syndrome: A randomized controlled trial

The purpose of this study was to investigate the effects of a proposed strength and agility training program of adolescents with Down syndrome. Ninety-two adolescents were recruited and evenly randomized to two intervention groups (exercise group vs. control group). The mean age for the exercise and the control group was 10.6±3.2 and 11.2±3.5 respectively. The exercise training program consisted of a 5-min treadmill exercise and one 20-min virtual-reality based activity administered three times a week for 6 weeks. Pre- and post-test measures were taken for muscle strength and agility performance. The measured muscle included hip extensor, hip flexor, knee extensor, knee flexors, hip abductors, and ankle plantarflexor. A handheld dynamometer was used to measure the lower extremities muscle strength, and agility performance was assessed by the strength and agility subtests of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition. The exercise group had significant improvements in agility (p=0.02, d=0.80) and muscle strength of all muscle group (all p's<0.05, d=0.51-0.89) assessed in comparison to the control group after the 6-week intervention. Knee muscle groups including both flexors and extensors had the greatest gains among all the muscles measured. A short-term exercise training program used in this study is capable of improving muscle strength and agility performance of adolescents with DS.     

Knee extensor strength, activation, and size in very elderly people following strength training.

Muscle strength, activation, and size were studied in 11 very elderly subjects (8 women and 3 men; age range, 85-97 years) who completed 12 weeks of strength training of the knee extensor muscles. Training increased the maximum amount of weight that could be lifted once (134%; P < 0.05) and maximum voluntary isometric strength, measured as both force recorded at the ankle with the knee flexed 90 degrees (17%, ns) and as torque with the knee flexed 60 degrees (37%; P < 0.05). Anatomical lean quadriceps cross-sectional area (LCSA) measured at midthigh using magnetic resonance imaging increased from 27.5 +/- 9.6 cm2 to 30.2 +/- 10.0 cm2 (9.8%; P < 0. 05) after training. Both before and after training, isometric strength was closely related to LCSA, but training resulted in no significant change in muscle force per unit area of quadriceps muscle. Using the twitch interpolation technique, muscle activation during a maximal voluntary isometric contraction was shown to be incomplete in all subjects before training (ranging from 69% to 93%) and was not significantly increased after training. An increase in skeletal muscle mass may have important functional and metabolic benefits for very elderly people.     

Correlation of clinical function and muscle CT scan images in limb-girdle muscular dystrophy

Knowledge of selective muscle-involvement is useful to the clinician. Therefore we investigated in sarcoglycanopathy and dysferlinopathy: (i) the correlation between clinical scale, MRC scale and CT findings and (ii) the muscles involved. Patients with a definite diagnosis of dysferlinopathy and sacroglycanopathy were tested for their clinical functions and muscle strength and assigned a functional grade. Nineteen muscles were evaluated by CT. In dysferlinopathy, distal lower-limb muscles are involved, while in sarcoglycanopathy proximal muscles are more affected. In both groups, muscles with MRC <3 often had severe abnormalities on CT imaging, while muscles with MRC >4 could be either normal or abnormal. Dysferlinopathy and sarcoglycanopathy have different and selective muscle involvement. This may affect certain types of functional activity. There is a possible relationship between CT findings and MRC grade in muscles with a low (<3) MRC grade. Abnormality on CT scan may precede the clinical symptoms.     

Short-term unilateral resistance training affects the agonist-antagonist but not the force-agonist activation relationship

In this study we investigated the contribution of neural adaptations to strength changes after 4 weeks of unilateral isometric resistance training. Maximal and submaximal isometric knee extension contractions were assessed before and after training. Surface electromyography (EMG) data were collected from the agonist and antagonist muscles and normalized to evoked maximal M-wave and maximal knee flexor EMG, respectively. The interpolated twitch technique (ITT) was also used to determine activation at maximum voluntary force (MVF). MVF increased in the trained (+20%) and untrained (+8%) legs. Agonist EMG at MVF increased in the trained leg (+26%), although activation determined via the ITT was unchanged. In both legs the position of the force-agonist EMG relationship was unchanged, but antagonist coactivation was lower for all levels of agonist activation. Strength gains in the trained leg were due to enhanced agonist activation, whereas decreased coactivation may have affected strength changes in both legs.