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The aim was to compare the acute effects of work matched high intensity (75% peak aerobic capacity) aerobic exercise to low intensity (40% peak aerobic capacity) aerobic exercise with different degrees of blood flow restriction (BFR) [40% estimated arterial occlusion (40 BFR) and 60% estimated arterial occlusion (60 BFR)] on variables previously hypothesized to be important for muscle adaptation. There were no meaningful changes in torque. Anterior thigh muscle thickness was increased from baseline with high intensity cycling and 40 BFR (~2 mm increase, p ≤ 0.008). A significant increase in lactate occurred in all exercise conditions but was greatest with high intensity cycling (~5.4 mmol/L increase). Muscle activation was significantly higher with high intensity cycling compared to low intensity cycling with BFR, regardless of pressure (~25% vs. ~12% MVC). Mean power frequency was not different between conditions but did increase from the first 5 minutes of exercise to the last 5 minutes (93% vs. 101%, p < 0.001). Ratings of perceived exertion (RPE) were higher with high intensity cycling but discomfort was similar between conditions. We wish to suggest that high intensity cycling produces greater muscular stress than that observed with work matched low intensity cycling in combination with BFR.

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To investigate the relationships between site-specific muscle loss in the thigh, muscle quality and zigzag walking performance, 40 men and 41 women aged 65–79 years had muscle thickness (MTH) measured by ultrasound at nine sites on the anterior and posterior aspects of the body. Skeletal muscle mass (SM) was estimated from an ultrasoundderived prediction equation. Site-specific thigh sarcopenia was calculated using ultrasound-measured MTH at the anterior/posterior aspects of the thigh (AP-MTH ratio). Zigzag walking time (ZWT) and maximum isometric knee extension (KE) and flexion (KF) torques were measured. Muscle quality (torque/thigh SM) and knee joint strength index (torque/body mass) were calculated. There were no significant correlations between SM index and ZWT. However, AP-MTH ratio was inversely correlated (P < 0.05) to ZWT in men (r = −0.335) and women (r = −0.309). ZWT was also inversely correlated (P < 0.05) to KE-strength index in both sexes (men, r = −0.328; women, r = −0.372). Similarly, ZWT was correlated to KF-strength index (r = −0.497) and muscle quality (r = −0.322) in women, but not in men. After adjusting for age, height and body mass, AP-MTH ratio was inversely correlated to ZWT in men (r = −0.325) and tended to be correlated to ZWT in women (r = −0.263). Zigzag walking performance may be associated with site-specific thigh sarcopenia in older men and women.

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Authors: SJ Dankel, MB Jessee, SL Buckner, JG Mouser, KT Mattocks and JP Loenneke

The application of blood flow restriction during low-load resistance exercise has been shown to induce muscle growth with high or low restriction pressures, however, loads lower than 20% one-repetition maximum (1RM) remain unexplored. Fourteen trained individuals completed six elbow flexion protocols involving three different loads (10%, 15%, and 20% 1RM) each of which was performed with either a low (40% arterial occlusion) or high (80% arterial occlusion) pressure. Pre- and post-measurements of surface electromyography (sEMG), isometric torque, and muscle thickness were analyzed. An interaction was present for torque (p < 0.001) and muscle thickness (p < 0.001) illustrating that all increases in pressure and/or load resulted in a greater fatigue and muscle thickness. There was no interaction for sEMG (p = 0.832); however, there were main effects of condition (p = 0.002) and time (p = 0.019) illustrating greater sEMG in the 20% 1RM conditions. Higher blood flow restriction pressures may be more beneficial for muscle growth when very low loads are used.

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Authors: SL Buckner, SJ Dankel, KT Mattocks, MB Jessee, JG Mouser and JP Loenneke


A training program consisting of only one-repetition maximum (1RM) training results in similar strength adaptations as traditional resistance exercise. However, little is known regarding the affective or behavioral responses to this type of training.


To examine the affective and behavioral response to either a traditional resistance exercise program or a biweekly 1RM-training program.


Participants were trained for 8 weeks (2× per week). The HYPER group completed four sets of 8–12 repetitions; the 1RM group (TEST) worked up to a single maximal repetition.


The TEST group felt more revitalized and had an increase in positive engagement during their first visit, whereas the HYPER group showed an increase in feelings of physical exhaustion during their first and last visits. There were no pre to post differences for the change in behavior or self-efficacy between groups.


1RM training appears to elicit a more favorable affective response, compared with HYPER training, which may ultimately improve adherence to resistance-type exercise.

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The purpose of this study was to compare the acute muscular response with resistance exercise between the following conditions [labeled (% one-repetition maximum/% arterial occlusion pressure)]: high-load (70/0), very low-load (15/0), very low-load with moderate (15/40), and high (15/80) blood flow restriction pressures. Twenty-three participants completed four sets of unilateral knee extension to failure (up to 90 repetitions) with each condition, one condition per leg, each day. Muscle thickness and maximal voluntary contraction (MVC) were measured before (Pre), immediately after (Post-0), and 15 min after (Post-15) exercise and electromyography (EMG) amplitude during exercise. Pre to Post-0 muscle thickness changes in cm [95% CI] were greater with 15/40 [0.57 (0.41, 0.73)] and 15/80 [0.49 (0.35, 0.62)] compared to 70/0 [0.33 (0.25, 0.40)]. Pre to Post-0 MVC changes in Nm [95% CI] were higher with 15/40 [−127.0 (−162.1, −91.9)] and 15/80 [−133.6 (−162.8, −104.4)] compared to 70/0 [−48.4 (−70.1, −26.6)] and 15/0 [−98.4 (−121.9, −74.9)], which were also different. Over the first three repetitions, EMG increased across sets, whereas in the last three repetitions it did not. EMG was also different between conditions and was generally greater during 70/0. Repetitions decreased across sets reaching the lowest for 70/0, and for very low loads decreased with increased pressure. In trained participants exercising to failure, lower load and the application of restriction pressure augment changes in muscle thickness and torque. The EMG amplitude was augmented by load. Training studies should compare these conditions, as the results herein suggest some muscular adaptations may differ.

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Authors: Robert Thiebaud, J.P. Loenneke, C.A. Fahs, D. Kim, X. Ye, T. Abe, K. Nosaka and M.G. Bemben

Discrepancies exist whether blood flow restriction (BFR) exacerbates exercise-induced muscle damage (EIMD). This study compared low-intensity eccentric contractions of the elbow flexors with and without BFR for changes in indirect markers of muscle damage. Nine untrained young men (18–26 y) performed low-intensity (30% 1RM) eccentric contractions (2-s) of the elbow flexors with one arm assigned to BFR and the other arm without BFR. EIMD markers of maximum voluntary isometric contraction (MVC) torque, range of motion (ROM), upper arm circumference, muscle thickness and muscle soreness were measured before, immediately after, 1, 2, 3, and 4 days after exercise. Electromyography (EMG) amplitude of the biceps brachii and brachioradialis were recorded during exercise. EMG amplitude was not significantly different between arms and did not significantly change from set 1 to set 4 for the biceps brachii but increased for the brachioradialis (p ≤ 0.05, 12.0% to 14.5%) when the conditions were combined. No significant differences in the changes in any variables were found between arms. MVC torque decreased 7% immediately post-exercise (p ≤ 0.05), but no significant changes in ROM, circumference, muscle thickness and muscle soreness were found. These results show that BFR does not affect EIMD by low-intensity eccentric contractions.

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Authors: SJ Dankel, SL Buckner, BR Counts, MB Jessee, JG Mouser, KT Mattocks, GC Laurentino, T Abe and JP Loenneke

The purpose of this study was to determine acute physiological and perceptual responses to two commonly implemented blood flow restriction protocols. Using a within-subject design, 15 participants (age ∼25) performed four sets of unilateral elbow flexion with each arm. One arm exercised using a 3-cm elastic cuff inflated to 160 mmHg, whereas the other arm exercised using a 5-cm nylon cuff inflated to 40% of the individual’s arterial occlusion pressure. While both protocols elicited increases in acute muscle thickness [pre: 4.5 (0.2) cm, post: 5.0 (0.2) cm; p < 0.001] and electromyography amplitude [first 3 reps: 55 () %MVC; last 3 reps: 87 () %MVC], there were no differences between conditions. Both protocols produced decreases in post-exercise strength (pre: 70 Nm, post: 51 Nm; p < 0.001) with no difference between conditions. The nylon protocol resulted in more repetitions during sets 2 [13 () vs. 9 (); p = 0.001] and 3 [10 () vs. 7 (); p = 0.05], while producing lower levels of discomfort following each set (average 3 vs. 4; p < 0.05). In conclusion, both protocols produced similar acute responses thought to be important for promoting muscle growth. However, the use of arbitrary pressures may place some individuals under complete arterial occlusion which may increase the potential risk of an adverse event.

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Authors: T Abe, JP Loenneke, KC Young, VK Nahar, KM Hollaway, CD Stover, MA Ford, MA Bass, SG Owens and M Loftin

It is unknown whether age-related site-specific muscle loss is associated with areal bone mineral density (aBMD) in older adults. To examine the relationships between aBMD and whole-body muscle thickness distribution, 97 healthy adults (46 women and 51 men) aged 50–78 years volunteered. Total and appendicular lean soft tissue mass, aBMD of the lumbar spine (LS-aBMD) and femoral neck (FN-aBMD) were determined using dual-energy X-ray absorptiometry. Muscle thickness (MT) was measured by ultrasound at nine sites of the body (forearm, upper arm, trunk, upper leg, and lower leg). Relationships of each co-variate with aBMD were tested partialling out the effect of age. aBMD was not correlated with either MT of the trunk or anterior lower leg in either sex. In men, significant and relatively strong correlations were observed between anterior and posterior upper arms, posterior lower leg, and anterior upper leg MT and LS-aBMD or FN-aBMD. In women, significant correlations were observed between anterior and posterior upper legs, posterior lower leg, and anterior upper arm MT and FN-aBMD. LS-aBMD was only correlated with forearm and posterior upper leg MT in women. In conclusion, the site-specific association of MT and aBMD differs between sexes and may be associated with the participants’ daily physical activity profile.

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