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Review article (meta-analysis)

Do Thermal Agents Affect Range of Movement and Mechanical Properties in Soft Tissues? A Systematic Review

Chris M. Bleakley PhD and Joseph T. Costello PhD

Faculty of Life and Health Sciences, Ulster Sports Academy, University of Ulster, Co Antrim, Ireland

Department of Physical Education and Sports Sciences, Centre for Physical Activity and Health Research, University of Limerick, Limerick, Ireland

https://doi.org/10.1016/j.apmr.2012.07.023

 

Abstract

Objectives

To examine the effect of thermal agents on the range of movement (ROM) and mechanical properties in soft tissue and to discuss their clinical relevance.

Data Sources

Electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE) were searched from their earliest available record up to May 2011 using Medical Subjects Headings and key words. We also undertook related articles searches and read reference lists of all incoming articles.

Study Selection

Studies involving human participants describing the effects of thermal interventions on ROM and/or mechanical properties in soft tissue. Two reviewers independently screened studies against eligibility criteria.

Data Extraction

Data were extracted independently by 2 review authors using a customized form. Methodologic quality was also assessed by 2 authors independently, using the Cochrane risk of bias tool.

Data Synthesis

Thirty-six studies, comprising a total of 1301 healthy participants, satisfied the inclusion criteria. There was a high risk of bias across all studies. Meta-analyses were not undertaken because of clinical heterogeneity; however, effect sizes were calculated. There were conflicting data on the effect of cold on joint ROM, accessory joint movement, and passive stiffness. There was limited evidence to determine whether acute cold applications enhance the effects of stretching, and further evidence is required. There was evidence that heat increases ROM, and a combination of heat and stretching is more effective than stretching alone.

Conclusions

Heat is an effective adjunct to developmental and therapeutic stretching techniques and should be the treatment of choice for enhancing ROM in a clinical or sporting setting. The effects of heat or ice on other important mechanical properties (eg, passive stiffness) remain equivocal and should be the focus of future study.

 

Keywords

Cold temperature

Hot temperature

Joint range of motion

Muscle stretching exercises

Rehabilitation

 

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Hi everyone,

Today's podcast is our second-to-last in this heat series. We hope you've enjoyed this small continuous series of the role of heat in muscle physiology and performance.

 

Passive hyperthermia reduces voluntary activation and isometric force production.

Morrison S, Sleivert GG, Cheung SS

Eur J Appl Physiol. 2004 May;91(5-6):729-36. Epub 2004 Mar 11.

 

Abstract

It has been suggested that a critically high body core temperature may impair central neuromuscular activation and cause fatigue. We investigated the effects of passive hyperthermia on maximal isometric force production (MVC) and voluntary activation (VA) to determine the relative roles of skin (T(sk)) and body core temperature ( T(c)) on these factors.

Twenty-two males [VO(2max)=64.2 (8.9) ml x kg(-1) min(-1), body fat=8.2 (3.9)%] were seated in a knee-extension myograph, then passively heated from 37.4 to 39.4 degrees C rectal temperature (T(re)) and then cooled back to 37.4(o)C using a liquid conditioning garment.

Voluntary strength and VA (interpolated twitch) were examined during an isometric 10-s MVC at 0.5 degrees C intervals during both heating and cooling.

Passive heating to a T(c) of 39.4(o)C reduced VA by 11 (11)% and MVC by 13 (18)% (P

Happy New Year everyone.

We hope this post finds you well.  Today's podcast continues our current theme on the role of heat with respect to all things sports science. This episode looks at the role of passive heat on muscle hypertrophy and neuromuscular performance outcomes. This is a review so it covers a wide breadth of quality academic articles.  We hope you enjoy it and look forward to bringing you more articles over the coming year.

 

Effects of Passive Heating Intervention on Muscle Hypertrophy and Neuromuscular Function: A Systematic Review with Meta-analysis

Objective: To synthesise the evidence on the effects of passive heating on muscle hypertrophy and neuromuscular function.


Methods: Seven databases were searched using combinations of the terms: passive heating, muscle hypertrophy and neuromuscular function. Eligible studies included original papers using healthy animals or human samples (≥ 18 years) that have used a control group or condition. Studies involving combined interventions or applied passive heating as a recovery strategy for exercise were excluded.

Results: After duplicates had been removed the search generated 1,747 references. Of these, the criteria were met by eight studies in the systematic review and four studies were used to perform the meta-analysis. The meta-analysis detected an increase in muscle mass in animal samples seven days after passive heating (I2= 65%, P= 0.00001). The systematic review showed some preliminary evidence, such as, muscle hypertrophy was reported after chronic passive heat intervention in animals and humans, augmented muscle strength was observed.

 

 

 

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The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis

Sports Medicine November 2016 Volume 46 Issue 11 pp 1699-1724

Christopher J. Tyler

Tom Reeve

Gary J. Hodges

Stephen S. Cheung

Systematic Review

First Online: 22 April 2016

 

Abstract

 

Background

Exercise performance and capacity are impaired in hot, compared to temperate, conditions. Heat adaptation (HA) is one intervention commonly adopted to reduce this impairment because it may induce beneficial exercise performance and physiological and perceptual adaptations. A number of investigations have been conducted on HA but, due to large methodological differences, the effectiveness of different HA regimens remain unclear.

 

Objectives

(1) To quantify the effect of different HA regimens on exercise performance and the physiological and perceptual responses to subsequent heat exposure. (2) To offer practical HA recommendations and suggestions for future HA research based upon a systematic and quantitative synthesis of the literature.

 

Data Source

PubMed was searched for original research articles published up to, and including, 16 February 2016 using appropriate first- and second-order search terms.

 

Study Selection

English-language, peer-reviewed, full-text original articles using human participants were reviewed using the four-stage process identified in the PRISMA statement.

 

Data Extraction

Data for the following variables were obtained from the manuscripts by at least two of the authors: participant sex, maximal oxygen consumption and age; HA duration, frequency, modality, temperature and humidity; exercise performance and capacity; core and skin temperature; heart rate, stroke volume, cardiac output, skin blood flow, sweat onset temperature, body mass loss, sweat rate, perception of thirst, volitional fluid consumption, plasma volume changes; sweat concentrations of sodium, chloride and potassium; aldosterone, arginine vasopressin, heat shock proteins (Hsp), ratings of perceived exertion (RPE) and thermal sensation.

 

Data Grouping

Data were divided into three groups based upon the frequency of the HA regimen. Performance and capacity data were also divided into groups based upon the type of HA used.

 

Data Analyses

Hedges’ g effect sizes and 95 % confidence intervals were calculated. Correlations were run where appropriate.

 

Results

Ninety-six articles were reviewed. The most common duration was 7–14 days and the most common method of HA was the controlled work-rate approach. HA had a moderately beneficial effect on exercise capacity and performance in the heat irrespective of regimen; however, longer regimens were more effective than shorter approaches. HA had a moderate-to-large beneficial effect on lowering core body temperature before and during exercise, maintaining cardiovascular stability, and improving heat-loss pathways. Data are limited but HA may reduce oxygen consumption during subsequent exercise, improve glycogen sparing, increase the power output at lactate threshold, reduce lactate concentrations during exercise, have a trivial effect on increasing extracellular concentrations of Hsp, and improve perceived ratings of exertion and thermal sensation.

 

Conclusion

HA regimens lasting

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The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis

Sports Medicine November 2016 Volume 46 Issue 11 pp 1699-1724

Christopher J. Tyler

Tom Reeve

Gary J. Hodges

Stephen S. Cheung

Systematic Review

First Online: 22 April 2016

 

Abstract

 

Background

Exercise performance and capacity are impaired in hot, compared to temperate, conditions. Heat adaptation (HA) is one intervention commonly adopted to reduce this impairment because it may induce beneficial exercise performance and physiological and perceptual adaptations. A number of investigations have been conducted on HA but, due to large methodological differences, the effectiveness of different HA regimens remain unclear.

 

Objectives

(1) To quantify the effect of different HA regimens on exercise performance and the physiological and perceptual responses to subsequent heat exposure. (2) To offer practical HA recommendations and suggestions for future HA research based upon a systematic and quantitative synthesis of the literature.

 

Data Source

PubMed was searched for original research articles published up to, and including, 16 February 2016 using appropriate first- and second-order search terms.

 

Study Selection

English-language, peer-reviewed, full-text original articles using human participants were reviewed using the four-stage process identified in the PRISMA statement.

 

Data Extraction

Data for the following variables were obtained from the manuscripts by at least two of the authors: participant sex, maximal oxygen consumption and age; HA duration, frequency, modality, temperature and humidity; exercise performance and capacity; core and skin temperature; heart rate, stroke volume, cardiac output, skin blood flow, sweat onset temperature, body mass loss, sweat rate, perception of thirst, volitional fluid consumption, plasma volume changes; sweat concentrations of sodium, chloride and potassium; aldosterone, arginine vasopressin, heat shock proteins (Hsp), ratings of perceived exertion (RPE) and thermal sensation.

 

Data Grouping

Data were divided into three groups based upon the frequency of the HA regimen. Performance and capacity data were also divided into groups based upon the type of HA used.

 

Data Analyses

Hedges’ g effect sizes and 95 % confidence intervals were calculated. Correlations were run where appropriate.

 

Results

Ninety-six articles were reviewed. The most common duration was 7–14 days and the most common method of HA was the controlled work-rate approach. HA had a moderately beneficial effect on exercise capacity and performance in the heat irrespective of regimen; however, longer regimens were more effective than shorter approaches. HA had a moderate-to-large beneficial effect on lowering core body temperature before and during exercise, maintaining cardiovascular stability, and improving heat-loss pathways. Data are limited but HA may reduce oxygen consumption during subsequent exercise, improve glycogen sparing, increase the power output at lactate threshold, reduce lactate concentrations during exercise, have a trivial effect on increasing extracellular concentrations of Hsp, and improve perceived ratings of exertion and thermal sensation.

 

Conclusion

HA regimens lasting

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The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis

Sports Medicine November 2016 Volume 46 Issue 11 pp 1699-1724

Christopher J. Tyler

Tom Reeve

Gary J. Hodges

Stephen S. Cheung

Systematic Review

First Online: 22 April 2016

 

Abstract

 

Background

Exercise performance and capacity are impaired in hot, compared to temperate, conditions. Heat adaptation (HA) is one intervention commonly adopted to reduce this impairment because it may induce beneficial exercise performance and physiological and perceptual adaptations. A number of investigations have been conducted on HA but, due to large methodological differences, the effectiveness of different HA regimens remain unclear.

 

Objectives

(1) To quantify the effect of different HA regimens on exercise performance and the physiological and perceptual responses to subsequent heat exposure. (2) To offer practical HA recommendations and suggestions for future HA research based upon a systematic and quantitative synthesis of the literature.

 

Data Source

PubMed was searched for original research articles published up to, and including, 16 February 2016 using appropriate first- and second-order search terms.

 

Study Selection

English-language, peer-reviewed, full-text original articles using human participants were reviewed using the four-stage process identified in the PRISMA statement.

 

Data Extraction

Data for the following variables were obtained from the manuscripts by at least two of the authors: participant sex, maximal oxygen consumption and age; HA duration, frequency, modality, temperature and humidity; exercise performance and capacity; core and skin temperature; heart rate, stroke volume, cardiac output, skin blood flow, sweat onset temperature, body mass loss, sweat rate, perception of thirst, volitional fluid consumption, plasma volume changes; sweat concentrations of sodium, chloride and potassium; aldosterone, arginine vasopressin, heat shock proteins (Hsp), ratings of perceived exertion (RPE) and thermal sensation.

 

Data Grouping

Data were divided into three groups based upon the frequency of the HA regimen. Performance and capacity data were also divided into groups based upon the type of HA used.

 

Data Analyses

Hedges’ g effect sizes and 95 % confidence intervals were calculated. Correlations were run where appropriate.

 

Results

Ninety-six articles were reviewed. The most common duration was 7–14 days and the most common method of HA was the controlled work-rate approach. HA had a moderately beneficial effect on exercise capacity and performance in the heat irrespective of regimen; however, longer regimens were more effective than shorter approaches. HA had a moderate-to-large beneficial effect on lowering core body temperature before and during exercise, maintaining cardiovascular stability, and improving heat-loss pathways. Data are limited but HA may reduce oxygen consumption during subsequent exercise, improve glycogen sparing, increase the power output at lactate threshold, reduce lactate concentrations during exercise, have a trivial effect on increasing extracellular concentrations of Hsp, and improve perceived ratings of exertion and thermal sensation.

 

Conclusion

HA regimens lasting

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Hi everyone,

This episode builds on the last one which started to look at the role that EMS can assist with strength and muscle gains.  The addition of Blood Flow Restriction with EMS prior to this paper hadn't been investigated so this was a novel investigation.

As always we appreciate the support of Eliteform (www.eliteform.com) so if you are into velocity based training make sure you check them out as I am sure you'll be excited with their product. 

The Effects of Blood Flow Restricted Electrostimulation on Strength and Hypertrophy.

Slysz JT, Burr JF.

J Sport Rehabil.2018 May 1;27(3):257-262. doi: 10.1123/jsr.2017-0002. Epub 2018 May 22.

Abstract

CONTEXT:

The combined effect of neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) on muscle mass and strength has not been thoroughly investigated.

OBJECTIVE:

To examine the effects of combined and independent BFR and a low-intensity NMES on skeletal muscle adaptation.

 

MAIN OUTCOME MEASURES:

Subjects had each leg randomly allocated to 1 of 4 possible intervention groups: (1) cyclic BFR alone, (2) NMES alone, (3) BFR + NMES, or (4) control. Each leg was stimulated in its respective intervention group for 32 minutes, 4 days per week for 6 weeks. Mean differences in size (in grams) and isometric strength (in kilograms), between week 0 and week 6, were calculated for each group.

Again, thank you to our podcast sponsor EliteForm, which brings together cutting edge sports science technologies.  Please visit https://eliteform.com and check out their products, StrengthPlanner and PowerTracker.

Thanks again for listening.  Please check out some of our other content below.

 

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Hi everyone,

Thanks for you continued support. Today's article looks into the plethora of information that surround protein consumption for improved muscle building:

 

How much protein can the body use in a single meal for muscle-building? Implications for daily protein distribution

Brad Jon Schoenfeld &

Alan Albert Aragon 

Journal of the International Society of Sports Nutrition volume 15, Article number: 10 (2018)

Abstract

Controversy exists about the maximum amount of protein that can be utilized for lean tissue-building purposes in a single meal for those involved in regimented resistance training. It has been proposed that muscle protein synthesis is maximized in young adults with an intake of ~ 20–25 g of a high-quality protein; anything above this amount is believed to be oxidized for energy or transaminated to form urea and other organic acids. However, these findings are specific to the provision of fast-digesting proteins without the addition of other macronutrients. Consumption of slower-acting protein sources, particularly when consumed in combination with other macronutrients, would delay absorption and thus conceivably enhance the utilization of the constituent amino acids. The purpose of this paper was twofold: 1) to objectively review the literature in an effort to determine an upper anabolic threshold for per-meal protein intake; 2) draw relevant conclusions based on the current data so as to elucidate guidelines for per-meal daily protein distribution to optimize lean tissue accretion. Both acute and long-term studies on the topic were evaluated and their findings placed into context with respect to per-meal utilization of protein and the associated implications to distribution of protein feedings across the course of a day. The preponderance of data indicate that while consumption of higher protein doses (> 20 g) results in greater AA oxidation, this is not the fate for all the additional ingested AAs as some are utilized for tissue-building purposes. Based on the current evidence, we conclude that to maximize anabolism one should consume protein at a target intake of 0.4 g/kg/meal across a minimum of four meals in order to reach a minimumof 1.6 g/kg/day. Using the upper daily intake of 2.2 g/kg/day reported in the literature spread out over the same four meals would necessitate a maximum of 0.55 g/kg/meal.

 

Again, thank you to our podcast sponsor EliteForm, which brings together cutting edge sports science technologies.  Please visit https://eliteform.com and check out their products, StrengthPlanner and PowerTracker.

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Hi there,

We are finally back - Jared and I have finally synced our schedules to do an episode together.  We are trying some new software called SquadCast to try and improve the quality of the internet recording - I think the audio is much better on this episode.

We are quite busy at the moment so we have decided in the short term to push our podcast release to every 2 weeks. Jared in particular is in the back-end of his thesis writing so it is great he is able to take a little bit of his valuable time out to come onto the podcast. 

As always we are grateful to our sponsor EliteForm who have integrated Velocity Based Training through the use of 3D camera system with an online Strength planner so please give them a visit at Eliteform.com (Also we forgot to acknowledge them in the introduction so hence our extra shout out here.)

Today's episode from a practical standpoint helps to understand the optimisation of Blood Flow Restriction pressures when doing aerobic (stationary-based) exercise. I personally have found that dropping my pre-determined BFR pressure by around 20mmHg works best and that if I stayed at this  pressure (I usually do my strength training at) it is just doesn't feel right and is too high. The debate of BFR pressures is an ongoing on and this article helps shed some light as to some great evidence.

 

Effects of Different Percentages of Blood Flow Restriction on Energy Expenditure.

Pfeiffer PS, Cirilo-Sousa MS, Santos HHD

Int J Sports Med. 2019 Mar;40(3):186-190. doi: 10.1055/a-0828-8295. Epub 2019 Jan 31.

 

Abstract

The study aimed to analyze the effect of different levels of blood flow restriction (BFR) on energy expenditure (EE) and subjective perceptions of discomfort (SPD) during aerobic exercises.

A sample group of 24 young men was required to walk on a treadmill for 14 min at 40% of their maximum speed, with 4 different percentages of BFR (0, 50, 80 and 100%) applied in the lower limbs (LL) once a week with a 7-day interval between the 4 evaluations. EE data were collected during the exercise periods; SPD data were collected after the exercises.

There was a significant increase in EE at 50, 80 and 100% BFR compared to the condition without BFR, and between 50 and 100% BFR; however, there were no differences between 50 and 80% and 80 and 100% BFR. Discomfort showed a significant increase according to the increase in BFR. During the walking exercises with BFR, the EE strongly increased until 50% of BFR; after this level the additional increases slowed.

It can be concluded that when performing aerobic exercises with BFR, there is no need to use BFR levels above 50% to reach satisfying level of EE with only a moderate level of discomfort to the practitioner.

 

Again, thank you to our podcast sponsor EliteForm, which brings together cutting edge sports science technologies.  Please visit https://eliteform.com and check out their products, StrengthPlanner and PowerTracker.

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Hi there,

Both Jared and I are currently in a very busy time period of work. In particular Jared is in the thick of his PhD writing so we've decided to push our podcast release to a fortnight format.  Once things settle down we'll get back to our weekly format.

Today's article review in my opinion is a really practical paper. It reviews the mechanism of hamstring injuries in sprinting and then highlights a few different exercises that would be of benefit to include into a strengthening program.  The paper has pictures so do yourself a favour and download it.

Hamstring exercises for track and field athletes: injury and exercise biomechanics, and possible implications for exercise selection and primary prevention.

Malliaropoulos N1, Mendiguchia J, Pehlivanidis H, Papadopoulou S, Valle X, Malliaras P, Maffulli N.

 

Br J Sports Med. 2012 Sep;46(12):846-51. doi: 10.1136/bjsports-2011-090474. Epub 2012 Jun 9.

 

Abstract

Hamstring strain injuries are the most prevalent muscle injuries in track and field (TF). These injuries often cause prolonged symptoms and a high risk of re-injury. Strengthening of the hamstring muscles has been recommended for injury prevention. The authors review the possible role of eccentric training in TF hamstring injury prevention and introduce exercise classification criteria to guide clinicians in designing strengthening programmes adapted to TF. The principles exposed may serve as a foundation for future development and application of new eccentric programmes to decrease the high incidence of this type of injury in other sports.

 

Also, thank you to our podcast sponsor EliteForm, which brings together cutting edge sports science technologies.  Please visit https://eliteform.com and check out their products, StrengthPlanner and PowerTracker.

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