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This case study describes the collaboration between a self-insured employee benefits team and a national health insurance provider to control costs while maintaining program quality and promoting population health. In 2015, Quest Diagnostics well exceeded the full-year expense target for their ∼60,000-life Group Health Insurance (GHI) program. Through proactive changes, physician executive leadership, health plan collaboration, disease-specific population health initiatives, and plan design, Quest GHI annual employer health care cost trend subsequently improved from a year-over-year trend of 5.7% for 2014 to 2015, to 4.6% for 2015 to 2016, to −1.0% for 2016 to 2017, and most recently, 0.3% for 2017 to 2018. The actuarial value of the GHI plan did not decline, and employee cost share also remained unchanged in 2017 and 2018 versus 2016 for the high-performance network option. There was a 3% premium increase for the Preferred Provider Organization option in 2018. A third-party analysis for full year 2017 showed Quest GHI to be 11% more efficient than the mean GHI for programs with a comparable benefit and employee contribution. Early results in 2018 show improvements in the health status of the health plan membership. This article describes an approach for self-insured employers to proactively collaborate with a health plan and pharmacy benefits manager to practice the Triple Aim of improving the patient health care experience and population health while reducing per capita health care spending.

Huggins, RA, Fortunati, AR, Curtis, RM, Looney, DP, West, CA, Lee, EC, Fragala, MS, Hall, ML, and Casa, DJ. Monitoring blood biomarkers and training load throughout a collegiate soccer season. J Strength Cond Res 33(11): 3065-3077, 2019-This observational study aimed to characterize the responses of a comprehensive panel of biomarkers, observed ranges, training load (TL) metrics, and performance throughout the collegiate soccer season (August-November). Biomarkers (n = 92) were collected before the start of pre-season (PS), in-season weeks (W)1, W4, W8, and W12 in NCAA Division I male soccer players (n = 20, mean ± SD; age = 21 ± 1 years, height = 180 ± 6 cm, body mass = 78.19 ± 6.3 kg, body fat = 12.0 ± 2.6%, VO2max 51.5 ± 5.1 ml·kg·min). Fitness tests were measured at PS, and W12 and TL was monitored daily. Changes in biomarkers and performance were calculated via separate repeated-measures analysis of variance. Despite similar fitness (p0.05), endocrine, muscle, inflammatory, and immune markers changed over time (p0.05). Total and free testosterone was lower in W1 vs. PS, whereas free cortisol remained unchanged at PS, W1, and W4 (0.94 mg·dL). Oxygen transport and iron metabolism markers remained unchanged except for HCT (W1 vs. PS) and total iron binding capacity (W8-W12 vs. W1). Hepatic markers albumin, globulin, albumin:globulin, and total protein levels were elevated (p0.05) at W12 vs. W1, whereas aspartate aminotransferase and alanine aminotransferase levels were elevated at W1-W12 and W8-W12 vs. PS, respectively. Vitamin E, zinc, selenium, and calcium levels were elevated (p0.05) at W12 vs. W1, whereas Vitamin D was decreased (p0.05). Fatty acids and cardiovascular markers (omega-3 index, cholesterol:high-density lipoprotein [HDL], docosahexenoic acid, low-density lipoprotein [LDL], direct LDL, non-HDL, ApoB) were reduced at W1 vs. PS (p ≤ 0.05). Immune, lipid, and muscle damage biomarkers were frequently outside clinical reference ranges. Routine biomarker monitoring revealed subclinical and clinical changes, suggesting soccer-specific reference ranges. Biomarker monitoring may augment positive adaptation and reduce injuries from stressors incurred during soccer.

Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

Background Androgen deprivation therapy (ADT) contributes to lean mass loss and adiposity increases in prostate cancer patients. Radiotherapy during ADT might act synergistically and further worsen body composition. Previous investigations have shown that resistance training is an effective method of preserving body composition during ADT, however, most have not accounted for direct or indirect effects of other therapies, such as radiotherapy. Therefore, the purpose of this study was to examine training adaptations of the tissue composition in patients receiving radiation therapy (RT) prior or during ADT. Methods Analyses were performed by combining data from two previous trials for a total of 131 prostate cancer patients who underwent a combination of resistance and aerobic exercise training (N = 70, age: 68.9 ± 6.6y, RT-before: 13%, RT-during: 14%) or usual care (N = 61, age: 67.5 ± 7.9y, RT-before: 16%, RT-during: 20%) for 3 months upon ADT onset. Whole-body lean mass (LM), fat percentage and appendicular LM were determined by dual energy x-ray absorptiometry, and lower-leg muscle area and density by peripheral computed tomography at baseline (onset of ADT) and at 3 months post-intervention. Covariates included RT prior and during the intervention, demographic characteristics, physical symptoms, and chronic conditions. Results Radiotherapy before or during the intervention did not affect body composition. Only the usual care group experienced a significant decrease in whole-body LM (−994 ± 150 g, P

Early detection of disease enables prompt treatment that can prevent disease progression and costly health outcomes. We report incidence of previously unrecognized disease and investigate the expected effect of early detection and care on health outcomes.Population health study based on laboratory evidence.Laboratory evidence of prediabetes, diabetes, chronic kidney disease, and colorectal cancer was evaluated in an employee and spouse population (65% women; mean [SD] age = 46 [12] years). Expected disease progression was assessed.Annual screening found laboratory evidence for 1185 previously unrecognized cases of prediabetes, 287 cases of diabetes, 73 cases of chronic kidney disease, and 669 positive colorectal screens per 10,000 people.Early identification and appropriate medical care may delay 34 cases of end-stage kidney disease and prevent diabetes-related complications, 210 cases of diabetes, and 3 cases of late-stage colorectal cancer over 5 years per 1000 cases identified.

Short-term unilateral resistance training results in cross education of strength without changes in muscle size, activation, or endocrine response. J Strength Cond Res 30(5): 1213-1223, 2016-The purpose of this study was to assess the cross education of strength and changes in the underlying mechanisms (muscle size, activation, and hormonal response) after a 4-week unilateral resistance training (URT) program. A group of 9 untrained men completed a 4-week URT program on the dominant leg (DOM), whereas cross education was measured in the nondominant leg (NON); and were compared with a control group (n = 8, CON). Unilateral isometric force (PKF), leg press (LP) and leg extension (LE) strength, muscle size (by ultrasonography) and activation (by electromyography) of the rectus femoris and vastus lateralis, and the hormonal response (testosterone, growth hormone, insulin, and insulin-like growth factor-1) were tested pretraining and posttraining. Group × time interactions were present for PKF, LP, LE, and muscle size in DOM and for LP in NON. In all interactions, the URT group improved significantly better than CON. There was a significant acute hormonal response to URT, but no chronic adaptation after the 4-week training program. Four weeks of URT resulted in an increase in strength and size of the trained musculature, and cross education of strength in the untrained musculature, which may occur without detectable changes in muscle size, activation, or the acute hormonal response.

This study examined the influence of recovery time on fatigue indices, performance (total work [TW], peak power [PP], and mean power [MP]), and oxygen consumption during repeated sprint ability (RSA) on a cycle ergometer. Eight recreationally-trained men performed 3 RSA protocols consisting of 10 × 6 s sprints with 12 s, 18 s, and 24 s rest intervals between each sprint. Fatigue indices were determined as percent decrement (%Dec) and rate of decline using either a log transform method or standard slope approach for TW, PP, and MP during respective RSA protocols. The maximal VO2 value in response to given sprint intervals and the minimal VO2 value in response to given rest periods (VO2 work and VO2 rest, respectively) were recorded. A repeated measures analysis of variance was used to analyze all variables. Average VO2 work was not different among rest interval trials. Average VO2 rest with 12 s rest was greater than 18 s and 24 s (2.16 ± 0.17 L · min(-1), 1.91 ± 0.18 L · min(-1), 1.72 ± 0.15 L · min(-1), respectively), while 18 s was greater than 24 s. Average TW and MP were greater with 24 s rest than 12 s (4,604.44 ± 915.98 J vs. 4,305.46 ± 727.17 J, respectively), with no differences between RSA protocols for PP. No differences in %Dec were observed. Both methods of calculating rates of decline per sprint for PP and TW were greater during 12 s than 18 s or 24 s. Since changes were only noted between the 12 s and 24 s protocols, a 6 s differential in rest intervals may not be enough to elicit alterations in TW, PP, MP, or %Dec in RSA performance. Rate of decline may be a more sensitive measure of fatigue than %Dec.

AB Introduction: The fine aspiration microbiopsy is a relatively new biopsy technique, which allows muscle physiologists to sample skeletal muscle less invasively. However, the small sample size obtained is often deemed insufficient for certain analyses. The aim of the current study was to develop procedures for muscle fiber morphology and immunohistological analysis from a microbiopsy technique. Methods: Microbiopsies of the vastus lateralis were taken with a 14-gauge microbiopsy needle from four healthy men on two separate occasions. The tissue was oriented in a cryomold, embedded in Tissue-Tek(R) then frozen in liquid nitrogen cooled isopentane. The muscle sections were stained with hematoxylin and eosin, laminin, MHCI, MHCIIa, and Pax7 for fiber number, mean fiber area, muscle fiber typing, and satellite cell observation. Results: The mean +/- SD (range) microbiopsy sample weight was 18.3 +/- 2.9 mg (14-22 mg). The mean fiber number within the microbiopsy specimens was 150.4 +/- 120.6 (64-366). All viable fibers were measured in each sample, and the mean fiber area was 4385.1 +/- 1265.8 [mu]m2 (977.0-10,132.93 [mu]m2). There was no significant time difference (P = 0.69) in mean fiber area. Discussion: Results suggest the potential use of a "minimally invasive" muscle biopsy technique for immunohistological and morphological analysis. This could provide clinicians and investigators additional data in future research. Further investigations are needed to determine the usefulness and potential limiting factors of this technique.

Fragala, MS, Goldman, SM, Goldman, MM, Bi, C, Colletti, JD, Arent, SM, Walker, AJ, and Clarke, NJ. Measurement of cortisol and testosterone in athletes: Accuracy of LC-MS/MS assays for cortisol and testosterone measurement in whole-blood microspecimens. J Strength Cond Res 32(9): 2425-2434, 2018-Biomarker monitoring provides insight into athletes' training tolerance but is limited by the need for office-based specimen collection. To facilitate self-collection during training, we developed liquid chromatography-tandem mass spectrometry-based tests that measure circulating total cortisol and testosterone using a finger stick volumetric absorptive microsampler. Here, we describe the analytical validation of these tests. Forty-six Division I athletes (18-22 years, 30 women, 16 men) provided a 20-µL finger stick microspecimen and a 5-ml venous blood specimen from the forearm; the venous blood sample was analyzed using both normal volume serum analysis and analysis of dried whole blood (from the microsampler). Liquid chromatography-tandem mass spectrometry on standard serum specimens obtained by venipuncture yielded total cortisol levels of 26.2 ± 11.6 µg·dl (women and men), and total testosterone levels of 37 ± 17 ng·dl in women and 564 ± 171 ng·dl in men. Analytical measurement ranges of the microspecimen assay were 0.3-440 µg·dl (CV

The purpose of this study was to investigate the effects of short term resistance exercise on neuromuscular fatigue threshold (PWCFT), strength, functional performance, and body composition in older adults. Twenty-three participants (71.2 ± 6.0 yr) were randomly assigned to 6 weeks of resistance exercise (EXE) or control (CONT). A submaximal cycle ergometer test, physical working capacity at fatigue threshold, was used to determine PWCFT. Strength was assessed with predicted leg extension 1-RM and functional performance with time to complete 5 chair rises (CHAIR) and walk an 8-ft course (WALK). PWCFT, 1-RM and CHAIR significantly (p

To examine the efficacy of l-alanyl-l-glutamine ingestion with a commercially available sports drink compared to the sports drink only on time to exhaustion and physiological measures during prolonged endurance exercise.Twelve endurance-trained men (23.5 ± 3.7 years; 175.5 ± 5.4 cm; 70.7 ± 7.6 kg) performed 4 trials, each consisting of a 1-hour treadmill run at 75% VO2peak followed by a run to exhaustion at 90% VO2peak. One trial consisted of no hydration (NHY), another required ingestion of only a sports drink (ED), and 2 trials required ingestion of a low dose (LD; 300 mg·500 ml(-1)) and high dose (HD) of l-alanyl-l-glutamine (1 g·500 ml(-1)) added to the sports drink. During the fluid ingestion trials, 250 ml was consumed every 15 minutes. Plasma glutamine, glucose, electrolytes, and osmolality were measured prior to the run (PRE) and at 30, 45, and 60 minutes. VO2, respiratory quotient (RQ), and heart rate (HR) were measured every 15 minutes.Time to exhaustion was significantly longer during the LD and HD trials compared to NHY. No differences were noted in time to exhaustion between ED and NHY. Plasma glutamine concentrations were significantly elevated at 45 minutes in LD and HD trials and remained elevated at 60 minutes during HD. Sodium concentrations increased from the beginning of exercise and remained stable for the duration of the 1-hour run. At 60 minutes, plasma sodium was significantly lower in all trials compared to NHY.Results indicated that ingestion of the alanine-glutamine dipeptide at either the low or high dose significantly improved time to exhaustion during high-intensity exercise compared to a no-hydration trial.

Context:Resistance training is a common form of exercise for competitive and recreational athletes. Enhancing recovery from resistance training may improve the muscle-remodeling processes, stimulating a faster return to peak performance.Objective:To examine the effects of 2 different recovery modalities, neuromuscular electrical stimulation (NMES) and cold-water immersion (CWI), on performance and biochemical and ultrasonographic measures.Participants:Thirty resistance-trained men (23.1 ± 2.9 y, 175.2 ± 7.1 cm, 82.1 ± 8.4 kg) were randomly assigned to NMES, CWI, or control (CON).Design and Setting:All participants completed a high-volume lower-body resistance-training workout on d 1 and returned to the human performance laboratory 24 (24H) and 48 h (48H) postexercise for follow-up testing.Measures:Blood samples were obtained preexercise (PRE) and immediately (IP), 30 min (30P), 24 h (24H), and 48 h (48H) post. Subjects were examined for performance changes in the squat exercise (total repetitions and average power per repetition), biomarkers of inflammation, and changes in cross-sectional area and echo intensity (EI) of the rectus femoris (RF) and vastus lateralis muscles.Results:No differences between groups were observed in the number of repetitions (P = .250; power: P = .663). Inferential-based analysis indicated that increases in C-reactive protein concentrations were likely increased by a greater magnitude after CWI compared with CON, while NMES possibly decreased more than CON from IP to 24H. Increases in interleukin-10 concentrations between IP and 30P were likely greater in CWI than NMES but not different from CON. Inferential-based analysis of RF EI indicated a likely decrease for CWI between IP and 48H. No other differences between groups were noted in any other muscle-architecture measures.Conclusions:Results indicated that CWI induced greater increases in pro- and anti-inflammatory markers, while decreasing RF EI, suggesting that CWI may be effective in enhancing short-term muscle recovery after high-volume bouts of resistance exercise.

To determine if exercise training alters the pattern and magnitude of plasma concentrations of proenkephalin Peptide F and epinephrine, plasma proenkephalin [107–140] Peptide Fir and catecholamines were examined pre-training (T-1), and after 4- (T-2), 8- (T-3), and 12-weeks (T-4) of training. 26 healthy men were matched and randomly assigned to one of three groups: heavy resistance strength training (Strength, n = 9), high intensity endurance training (Endurance, n = 8), or both training modalities combined (Combined, n = 9). Blood was collected using a syringe with a cannula inserted into a superficial arm vein with samples collected at rest, after each 7 min stage and 5 and 15 min into recovery. With training, all groups observed shifted plasma Peptide F responses to graded exercise, where significant increases were observed at lower exercise intensities. Increases in plasma epinephrine with exercise were observed in all groups. The Combined group saw increases at 25% at T-3 and for 50% at T-2, T-3, and T-4 which was higher than T-1. The Endurance group demonstrated increases for 50% at T-1, T-2, T-3 but not at T-4. The plasma epinephrine response to graded exercise was reduced in the Strength group. Increases in plasma norepinephrine above rest were observed starting at 50% . The Strength group demonstrated a significant reduction in norepinephrine observed at 100% at T-3 and T-4. Peptide F and catecholamines responses to graded exercise can be altered by different types of physical exercise training. Simultaneous high intensity training may produce adrenal medulla exhaustion when compared to single mode training.

Objectives Physical exercise may affect levels of blood-based biomarkers. However, exercise status is seldom considered in the interpretation of laboratory results. This study reports the associations between habitual exercise participation and clinical laboratory test results. Methods The effects of days per week of aerobic and strength exercise participation on laboratory test results for 26 biomarkers in young adults aged 18 to 34 years (n = 80,111) were evaluated using percentile distribution analyses and multivariate regression. Results In both men and women, more days per week of either aerobic or strength exercise were significantly associated with lower levels of glucose, hemoglobin A1c, LDL cholesterol, total cholesterol, triglycerides, estimated glomerular filtration rate, globulin, and C-reactive protein, and significantly higher levels of HDL cholesterol, creatinine, iron, and percent saturation (all p < .05). Type of exercise or gender influenced the observed relationships with exercise frequency for total cholesterol, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, uric acid, bilirubin, and iron binding capacity. Conclusions Physical exercise shifted the distribution of results into the direction suggestive of better health. Reported relationships may help clinicians and patients to better understand and interpret laboratory results in athletic populations and possibly re-evaluate interpretation of reference intervals for physically active populations.

Objective The consequences of age-related decline in the somatotropic axis of humans are complex and remain largely unresolved. We tested the hypothesis that hGH measurements of plasma by bioassay vs immunoassay from samples obtained from free-living, elderly individuals would reveal a dichotomy in GH activities that are correlated with the functional status of the donors, i.e. their healthspan. Design Forty-one men and women of advanced age (men: N = 16, age, 80.5 ± 6.5 years; height, 173.1 ± 6.9 cm; body mass, 81.8 ± 13.0 kg) and (women: N = 25, age, 80.7 ± 7.2 years; height, 157.7 ± 6.0 cm; body mass, 68.8 ± 17 kg), were recruited for a cross-sectional study. Participants filled out PROMIS (Patient-Reported Outcomes Measurement Information System, U. S. Department of Health and Human Services) scales, undertook physical performance tests and had fasted blood samples obtained at rest for measurement of hormonal and immunology biomarkers. Results When measured by the well-established rat tibial line GH bioassay, one half of the plasma samples (n = 20) contained bioassayable GH (bGH), but the other half (n = 21) failed to mount increases in tibial plate width above saline injected controls. This difference did not correlate with the age, sex or physical functionality of the plasma donor. It also did not correlate with hGH concentrations measured by immunoassay. In those cases in which bGH was detected, various hierarchical regression models predicted that GHRH, c-peptide, VEGF, NPY, IL-4 and T-regulatory lymphocytes were associated with the difference and predicted bGH. Conclusion Results from this study suggest that the actions of bGH at the cellular level may be modified by other factors and that this may explain the lack of correlations observed in this study.

To determine if unilateral measures of muscle architecture in the rectus femoris (RF) and vastus lateralis (VL) were related to (and predictive of) sprinting speed and unilateral (and bilateral) force (FRC) and power (POW) during a 30 s maximal sprint on the Woodway Curve 3.0 non-motorized treadmill. Twenty-eight healthy, physically active men (n = 14) and women (n = 14) (age = 22.9 ± 2.4 years; body mass = 77.1 ± 16.2 kg; height = 171.6 ± 11.2 cm; body-fa t = 19.4 ± 8.1%) completed one familiarization and one 30-s maximal sprint on the TM to obtain maximal sprinting speed, POW and FRC. Muscle thickness (MT), cross-sectional area (CSA) and echo intensity (ECHO) of the RF and VL in the dominant (DOM; determined by unilateral sprinting power) and non-dominant (ND) legs were measured via ultrasound. Pearson correlations indicated several significant (p < 0.05) relationships between sprinting performance [POW (peak, DOM and ND), FRC (peak, DOM, ND) and sprinting time] and muscle architecture. Stepwise regression indicated that POW(DOM) was predictive of ipsilateral RF (MT and CSA) and VL (CSA and ECHO), while POW(ND) was predictive of ipsilateral RF (MT and CSA) and VL (CSA); sprinting power/force asymmetry was not predictive of architecture asymmetry. Sprinting time was best predicted by peak power and peak force, though muscle quality (ECHO) and the bilateral percent difference in VL (CSA) were strong architectural predictors. Muscle architecture is related to (and predictive of) TM sprinting performance, while unilateral POW is predictive of ipsilateral architecture. However, the extent to which architecture and other factors (i.e. neuromuscular control and sprinting technique) affect TM performance remains unknown.

The purpose of this study was to examine the effect of the L-Alanyl-L-Glutamine dipeptide (AG) on cognitive function and reaction time (RT) following endurance exercise. Twelve male endurance athletes (23.5 ± 3.7 y; 175.5 ± 5.4 cm; 70.7 ± 7.6 kg) performed four trials, each consisting of running on a treadmill at 70% of VO2max for 1h, then at 90% of VO2max until exhaustion. One trial consisted of no hydration (DHY), another required ingestion of only a sports electrolyte drink (ED) and two trials required ingestion of a low dose (LD; 300 mg·500 ml(-1)) and high dose (HD) of AG (1 g·500ml(-1)) added to the ED. Cognitive function and reaction tests were administered pre- and post-exercise. Magnitude based inferences were used to analyze ∆ cognitive function and ∆ reaction test data. Results indicated that DHY had a possible negative effect on number of hits in a 60-sec reaction test compared to LD and HD, while ED appeared to have a negative effect compared to HD. Analysis of lower body quickness indicated that LD and HD were likely improved in comparison to DHY. Performance on the serial subtraction test appeared to be possibly better in ED than DHY, while other comparisons between groups regarding cognitive function were unclear. In conclusion, rehydrating with AG during submaximal exercise may maintain or enhance subsequent RT in upper and lower body activities compared to DHY. These same effects were not apparent when participants consumed ED.

The purpose of this study was to determine the relationship between visual tracking speed (VTS) and reaction time (RT) on basketball-specific measures of performance. Twelve professional basketball players were tested before the 2012-13 season. Visual tracking speed was obtained from 1 core session (20 trials) of the multiple object tracking test, whereas RT was measured by fixed- and variable-region choice reaction tests, using a light-based testing device. Performance in VTS and RT was compared with basketball-specific measures of performance (assists [AST]; turnovers [TO]; assist-to-turnover ratio [AST/TO]; steals [STL]) during the regular basketball season. All performance measures were reported per 100 minutes played. Performance differences between backcourt (guards; n = 5) and frontcourt (forward/centers; n = 7) positions were also examined. Relationships were most likely present between VTS and AST (r = 0.78; p < 0.003), STL (r = 0.77; p < 0.003), and AST/TO (r = 0.78; p < 0.003), whereas a likely relationship was also observed with TO (r = 0.49; p < 0.109). Reaction time was not related to any of the basketball-specific performance measures. Backcourt players were most likely to outperform frontcourt players in AST and very likely to do so for VTS, TO, and AST/TO. In conclusion, VTS seems to be related to a basketball player's ability to see and respond to various stimuli on the basketball court that results in more positive plays as reflected by greater number of AST and STL and lower turnovers.

The relationship between PWCFT and common measures used to assess sarcopenia in older adults were examined. Fifty-eight older adults [age: 71.1 ± 6.2 years; body mass index (BMI): 28.0 ± 5.4 kg/m2] completed the testing procedures. Sarcopenia-related body composition was measured by dual-energy X-ray absorptiometry and participants performed a discontinuous cycle ergometry test to determine PWCFT. Functionality assessments included maximal isometric grip strength (GRIP) and sit-to-stand (STS) repetitions in 30 s. Muscle quality (MQ) was defined as GRIP relative to appendicular lean soft tissue (ALM), while skeletal muscle index (SMI) was defined as ALM/height2. Pearson correlations were used to examine the relationships among dependent variables. PWCFT showed significant relationships with ALM (r = 0.57), SMI (r = 0.47), body fat percentage (BF%) (r = −0.50), GRIP (r = 0.49), and STS (r = 0.44). For follow-up analyses, study participants were categorized into low sarcopenia risk (n = 31) or high sarcopenia risk (n = 27) groups by SMI. Sarcopenia risk was associated with PWCFT [odds ratio (OR): 1.051, 95% confidence interval (CI): 1.016–1.087] and STS (OR: 1.305, CI: 1.060–1.607), but not GRIP (OR: 1.098, CI: 0.989–1.218). Using receiver–operator characteristic curve analysis, both PWCFT [area under the curve (AUC): 0.737, CI: 0.608–0.866, optimal cutoff: 37.5 W] and STS (AUC: 0.749, CI: 0.623–0.874, optimal cutoff: 12.5 repetitions) showed discriminative ability with regard to sarcopenia risk. The current data suggest that the neuromuscular fatigue threshold, as measured by PWCFT, is related to measures of body composition and function in older adults.

Introduction Sarcopenia is currently best described as an age-related decline in skeletal muscle mass and function. However, no consensus exists as to how to best quantify muscle function in older adults. The muscle quality index (MQI) was recently recommended as an ideal evidence-based assessment of functional status in older adults. Nevertheless, the usefulness of MQI to assess physical function is limited by whether it is reflective of muscle qualitative changes to an intervention. Thus, the purpose of this investigation was to determine whether MQI changes in response to resistance exercise training and detraining and how such changes correspond to other recommended measures of physical function proposed by suggested definitions of sarcopenia. Methods Twenty-five older adults (70.6 ± 6.1 y; BMI = 28.1 ± 5.4 kg · m− 2) completed a 6-week resistance training program in a wait-list controlled, cross-over design. MQI was determined as power output from timed sit to stand (STS), body mass, and leg length. Gait speed, hand grip strength, get-up-and-go and lean body mass (LBM) were evaluated before and after exercise training and detraining. MQI and functional changes to training and detraining were evaluated with repeated measures ANOVA and clinical interpretations of magnitude based inferences. Results Short term resistance training significantly and clinically improved MQI (203.4 ± 64.31 to 244.3 ± 82.92 W), gait time (1.85 ± 0.36 to 1.66 ± 0.27 s) and sit to stand performance (13.21 ± 2.51 to 11.05 ± 1.58 s). Changes in LBM and hand grip strength were not significant or clinically meaningful. De-training for 6-weeks did not result in significant changes in any measure from post-training performance.

Background. Weakness is common and contributes to disability, but no consensus exists regarding a strength cutpoint to identify persons at high risk. This analysis, conducted as part of the Foundation for the National Institutes of Health Sarcopenia Project, sought to identify cutpoints that distinguish weakness associated with mobility impairment, defined as gait speed less than 0.8 m/s. Methods. In pooled cross-sectional data (9,897 men and 10,950 women), Classification and Regression Tree analysis was used to derive cutpoints for grip strength associated with mobility impairment. Results. In men, a grip strength of 26–32 kg was classified as “intermediate” and less than 26 kg as “weak”; 11% of men were intermediate and 5% were weak. Compared with men with normal strength, odds ratios for mobility impairment were 3.63 (95% CI: 3.01–4.38) and 7.62 (95% CI 6.13–9.49), respectively. In women, a grip strength of 16–20 kg was classified as “intermediate” and less than 16 kg as “weak”; 25% of women were intermediate and 18% were weak. Compared with women with normal strength, odds ratios for mobility impairment were 2.44 (95% CI 2.20–2.71) and 4.42 (95% CI 3.94–4.97), respectively. Weakness based on these cutpoints was associated with mobility impairment across subgroups based on age, body mass index, height, and disease status. Notably, in women, grip strength divided by body mass index provided better fit relative to grip strength alone, but fit was not sufficiently improved to merit different measures by gender and use of a more complex measure. Conclusions. Cutpoints for weakness derived from this large, diverse sample of older adults may be useful to identify populations who may benefit from interventions to improve muscle strength and function.

Early efforts to create an operational definition of sarcopenia (including the creation of cutpoints) have relied on distributional definitions of lean mass (1), with sarcopenia defined as a value of appendicular lean mass (ALM)/height2 (derived from whole-body dual-energy x-ray absorptiometry [DXA]) below the young adult mean level of lean mass or was based on definitions that further account for body size or fatness (2–4). More recent efforts have added functional and/or strength measures to lean mass to define sarcopenia (5,6), but no approaches thus far have proposed and validated cutpoints and definitions based on discriminative and predictive ability using a data-driven approach from a variety of cohort studies. The overarching goal of this set of concurrent reports from the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project was to determine preliminary data-driven criteria for clinically relevant weakness and low lean mass. The conceptual framework was based on a clinician making a “differential diagnosis” of mobility impairment, defined as slow gait speed. The clinician understands that there are many causes of slow walking, one of which is weakness. Similarly, low lean mass may be considered a potential contributing factor to the development of weakness (7). Data from multiple large cohort studies of aging were pooled for this effort (7). The first stage of analyses identified sex-specific cutpoints for weakness that discriminated slow participants (walking speed

The inflammatory response to muscle-damaging exercise requires monocyte mobilization and adhesion. Complement receptor type 3 (CR3) and macrophage inflammatory protein (MIP)-1β enables monocyte recruitment, adhesion, and subsequent infiltration into damaged muscle tissue. The purpose of this study was to examine the effects of cold water immersion (CWI) and/or β-hydroxy-β-methylbutyrate free acid (HMB-FA) on CR3 expression and MIP-1β concentration after four sets of up to 10 repetitions of squat, dead lift, and split squat exercises at 70–80% 1-repetition maximum. Thirty-nine resistance-trained men (22.2 ± 2.5 yr) were randomly divided into four groups: 1) placebo (PL), 2) HMB-FA, 3) HMB-FA-CWI, and 4) PL-CWI. The HMB-FA groups ingested 3 g/day, and CWI groups were submersed into 10–12°C water for 10 min after exercise. Blood was sampled at baseline (PRE), immediately post- (IP), 30 min post- (30P), 24 h post- (24P), and 48 h post (48P)-exercise. Circulating MIP-1β was assayed and CR3 expression on CD14+ monocytes was measured by flow cytometry. Without treatment, CR3 expression significantly elevated at 30P compared with other time points ( P = 0.030–0.047). HMB-FA significantly elevated the percentage of monocytes expressing CR3 between IP and 24P ( P = 0.046) and between IP and 48P ( P = 0.046). No time effect was observed for MIP-1β concentration. The recovery modalities showed to attenuate the rise in CR3 following exercise. Additionally, supplementation with HMB-FA significantly elevated the percentage of monocytes expressing CR3 during recovery. Although the time course that inflammatory responses are most beneficial remains to be determined, recovery modalities may alter immune cell mobilization and adhesion mechanisms during tissue recovery.

Background. Several consensus groups have previously published operational criteria for sarcopenia, incorporating lean mass with strength and/or physical performance. The purpose of this manuscript is to describe the prevalence, agreement, and discrepancies between the Foundation for the National Institutes of Health (FNIH) criteria with other operational definitions for sarcopenia. Methods. The FNIH Sarcopenia Project used data from nine studies including: Age, Gene and Environment Susceptibility-Reykjavik Study; Boston Puerto Rican Health Study; a series of six clinical trials from the University of Connecticut; Framingham Heart Study; Health, Aging, and Body Composition Study; Invecchiare in Chianti; Osteoporotic Fractures in Men Study; Rancho Bernardo Study; and Study of Osteoporotic Fractures. Participants included in these analyses were aged 65 and older and had measures of body mass index, appendicular lean mass, grip strength, and gait speed. Results. The prevalence of sarcopenia and agreement proportions was higher in women than men. The lowest prevalence was observed with the FNIH criteria (1.3% men and 2.3% women) compared with the International Working Group and the European Working Group for Sarcopenia in Older Persons (5.1% and 5.3% in men and 11.8% and 13.3% in women, respectively). The positive percent agreements between the FNIH criteria and other criteria were low, ranging from 7% to 32% in men and 5% to 19% in women. However, the negative percent agreement were high (all >95%). Conclusions. The FNIH criteria result in a more conservative operational definition of sarcopenia, and the prevalence was lower compared with other proposed criteria. Agreement for diagnosing sarcopenia was low, but agreement for ruling out sarcopenia was very high. Consensus on the operational criteria for the diagnosis of sarcopenia is much needed to characterize populations for study and to identify adults for treatment.

Background. This analysis sought to determine the associations of the Foundation for the National Institutes of Health Sarcopenia Project criteria for weakness and low lean mass with likelihood for mobility impairment (gait speed ≤ 0.8 m/s) and mortality. Providing validity for these criteria is essential for research and clinical evaluation. Methods. Among 4,411 men and 1,869 women pooled from 6 cohort studies, 3-year likelihood for incident mobility impairment and mortality over 10 years were determined for individuals with weakness, low lean mass, and for those having both. Weakness was defined as low grip strength (

Background. Low muscle mass and weakness are common and potentially disabling in older adults, but in order to become recognized as a clinical condition, criteria for diagnosis should be based on clinically relevant thresholds and independently validated. The Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project used an evidence-based approach to develop these criteria. Initial findings were presented at a conference in May 2012, which generated recommendations that guided additional analyses to determine final recommended criteria. Details of the Project and its findings are presented in four accompanying manuscripts. Methods. The Foundation for the National Institutes of Health Sarcopenia Project used data from nine sources of community-dwelling older persons: Age, Gene/Environment Susceptibility-Reykjavik Study, Boston Puerto Rican Health Study, a series of six clinical trials, Framingham Heart Study, Health, Aging, and Body Composition, Invecchiare in Chianti, Osteoporotic Fractures in Men Study, Rancho Bernardo Study, and Study of Osteoporotic Fractures. Feedback from conference attendees was obtained via surveys and breakout groups. Results. The pooled sample included 26,625 participants (57% women, mean age in men 75.2 [±6.1 SD] and in women 78.6 [±5.9] years). Conference attendees emphasized the importance of evaluating the influence of body mass on cutpoints. Based on the analyses presented in this series, the final recommended cutpoints for weakness are grip strength

Purpose The purpose of this study was to examine the effects of resistance exercise on the hypothalamic–pituitary–adrenal axis (HPA) response to mental challenge, withdrawal symptoms, urge to smoke, and cognitive stress during 24-hour smoking abstinence. Methods 8 sedentary smokers (mean ± SD age: 20.1 ± 1.7 y; height: 171.6 ± 10.8 cm; body mass: 70.4 ± 12.0 kg; smoking history: 2.9 ± 0.8 y) completed a 24-hour ad libitum smoking trial (SMO) followed by two 24-hour smoking abstinence trials. During abstinence trials, participants performed six whole body resistance exercises (EX) or a control condition (CON) in the morning, followed by mental challenge tasks in the afternoon. Plasma adrenocorticotropin hormone (ACTH), and salivary and serum cortisol were measured during each visit at rest (REST), and then before (PRE-EX), immediately after (IP-EX), and 30 min after exercise (30-EX); and before (PRE-MC), immediately after (IP-MC), and 30 min after mental challenge (30-MC). Results Resistance exercise significantly (p ≤ 0.05) elevated plasma ACTH and serum cortisol at IP-EX during EX compared with SMO and CON trials. Resting ACTH, salivary and serum cortisol concentrations at Pre-MC did not differ between EX and CON trials. The HPA axis response to mental challenge was similar after EX and CON trials. Finally, resistance exercise did not reduce withdrawal symptoms, urge to smoke, or stress. Conclusion Resistance exercise did not substantially alter resting HPA hormones or the HPA response to mental challenge tasks during 24 h of smoking abstinence.

The purpose of this study was to examine the effect of β-hydroxy-β-methylbutyrate-free acid (HMB-FA) and cold-water immersion (CWI) on circulating concentrations of TNF-α and monocyte TNF-α receptor 1 (TNFR1) expression. Forty resistance-trained men (22.3 ± 2.4 yr) were randomized into four groups [placebo (PL), HMB-FA, CWI, and HMB-FA-CWI] and performed an acute, intense exercise protocol (four sets of up to 10 repetitions of the squat, dead lift, and split squat). Participants also performed four sets of up to 10 repetitions of the squat at 24 and 48 h following the initial exercise bout. Blood was sampled before exercise (PRE), immediately postexercise (IP), and 30 min, 24 h, and 48 h postexercise (30P, 24P, and 48P, respectively). Circulating TNF-α was assayed, and TNFR1 expression on CD14+ monocytes was measured by flow cytometry. The exercise protocol significantly elevated TNF-α in only PL ( P = 0.006) and CWI ( P = 0.045) IP. Mean percent changes show that TNF-α significantly increased from PRE to IP for only PL and CWI groups ( P < 0.05), whereas the percent change of TNF-α for HMB-FA and HMB-FA-CWI was not significant. TNFR1 expression was elevated in PL ( P = 0.023) and CWI ( P = 0.02) at 30P compared with PRE, whereas both HMB-FA-treated groups did not increase significantly. In conclusion, HMB-FA attenuated circulating TNF-α IP and TNFR1 expression during recovery compared with PL and CWI. HMB-FA supplementation may attenuate the initial immune response to intense exercise, which may reduce recovery time following intense exercise.

Compared to soy, whey protein is higher in leucine, absorbed quicker and results in a more pronounced increase in muscle protein synthesis.To determine whether supplementation with whey promotes greater increases in muscle mass compared to soy or carbohydrate, we randomized non-resistance-trained men and women into groups who consumed daily isocaloric supplements containing carbohydrate (carb; n = 22), whey protein (whey; n = 19), or soy protein (soy; n = 22).All subjects completed a supervised, whole-body periodized resistance training program consisting of 96 workouts (~9 months). Body composition was determined at baseline and after 3, 6, and 9 months. Plasma amino acid responses to resistance exercise followed by supplement ingestion were determined at baseline and 9 months.Daily protein intake (including the supplement) for carb, whey, and soy was 1.1, 1.4, and 1.4 g·kg body mass⁻¹, respectively. Lean body mass gains were significantly (p0.05) greater in whey (3.3 ± 1.5 kg) than carb (2.3 ± 1.7 kg) and soy (1.8 ± 1.6 kg). Fat mass decreased slightly but there were no differences between groups. Fasting concentrations of leucine were significantly elevated (20%) and postexercise plasma leucine increased more than 2-fold in whey. Fasting leucine concentrations were positively correlated with lean body mass responses.Despite consuming similar calories and protein during resistance training, daily supplementation with whey was more effective than soy protein or isocaloric carbohydrate control treatment conditions in promoting gains in lean body mass. These results highlight the importance of protein quality as an important determinant of lean body mass responses to resistance training.

The purpose of this study was to compare starters (S) with nonstarters (NS), on their ability to maintain strength, power, and quickness during a competitive National Basketball Association (NBA) season. Twelve NBA players were assessed at the beginning and end of the competitive season. However, because of trades and injury, only 7 (S = 4, NS = 3) players (28.2 ± 3.4 years; 200.9 ± 9.4 cm; 104.7 ± 13.9 kg; 7.2 ± 1.9% body fat) participated in both testing sessions and underwent analysis. Anthropometric performance (repetitive vertical jump power [VJP], squat power [SQT power], and reaction time) and subjective feelings of energy, focus, alertness, and fatigue were recorded during each testing session. Results were interpreted using magnitude-based statistics to make inferences on true differences between starters and nonstarters using the unequal variances t-statistic. Starters played an average of 27.8 ± 6.9 minutes per game and nonstarters played an average of 11.3 ± 7.0 minutes per game. During the course of the season, changes in VJP indicated that starters were likely to increase VJP ([INCREMENT] = 77.3 ± 78.1 W) compared to nonstarters ([INCREMENT] = -160.0 ± 151.0 W). There also appeared to be a possible beneficial effect on maintaining reaction time in starters ([INCREMENT] = 0.005 ± 0.074 seconds) compared with nonstarters ([INCREMENT] = 0.047 ± 0.073 seconds). In addition, no clear differences in [DELTA]SQT power were seen between starters ([INCREMENT] = 110.8 ± 141.4 W) and nonstarters ([INCREMENT] = 143.5 ± 24.7 W). Changes in subjective feelings of energy indicated that starters were very likely to maintain their energy over the course of a season. It also appeared possible that starters were able to have a more positive response to subjective measures of fatigue and alertness than nonstarters, with only trivial differences between starters and nonstarters in regards to maintaining focus. Results of this study suggest that NBA players may enhance lower-body power, repetitive jump ability, and reaction during a competitive season, which appear to be enhanced with the stimulus of playing time.

The purpose of this study was to investigate age-related changes in anthropometric and performance variables in professional baseball players. Baseball players (n = 1,157) from several professional baseball organizations were categorized into 7 cohorts based upon age. All adolescent athletes were categorized as age group 1 (AG1), whereas the next 5 groups (AG2-AG6) consisted of players 20-22, 23-25, 26-28, 29-31, and 31-34 years, respectively. The final group (AG7) comprised athletes ≥35 years. All performance assessments were part of the athlete's normal preseason training camp testing routine. Field assessments were used to analyze lower-body power, speed, agility, grip strength, and body composition. The players were heaviest between the ages of 29 and 31 (AG5), and their body mass in that age group was 10.1% (p = 0.004) greater than that of AG1. A 7.0% increase (p = 0.000) in lean body mass occurred between AG1 and AG5. No differences in 10-yd sprint times or agility were seen across any age group or position. A 2.0 seconds (p = 0.001) slower run time for the 300-yd shuttle was seen between AG4 and AG5 for all positions combined. Elevations in grip strength were seen at AG4 compared with AG1 (p = 0.001) and AG2 (p = 0.007) for all positions combined. No other differences were noted. Lower-body power was increased for all positions combined from AG1 to AG3 (p = 0.007). This pattern was similar to that observed in position players, but a 12.4% decrease (p = 0.024) in VJMP was seen between AG7 and AG5 in pitchers. Results of this study indicate that lower-body power is maintained in baseball players until the age of 29-31, whereas speed, agility, and grip strength are maintained in players able to play past the age of 35 years. Age-related differences observed in this study suggest that athletes focus on their strength and conditioning programs to extend the length of their professional careers.

Objectives To compare the relative predictive power of handgrip and leg extension strength in predicting slow walking. Design Report of correlative analysis from two epidemiological cohort studies. Setting Foundation of the National Institutes of Health Sarcopenia Project. Participants Men and women aged 67 to 93 (N = 6,766). Measurements Leg strength, handgrip strength, and gait speed were measured. Strength cutpoints associated with slow gait speed were developed using classification and regression tree analyses and compared using ordinary least squares regression models. Results The cutpoints of lower extremity strength associated with slow gait speed were 154.6 N-m in men and 89.9 N-m in women for isometric leg extension strength and 94.5 N-m in men and 62.3 N-m in women for isokinetic leg extension strength. Weakness defined according to handgrip strength (odds ratios (OR) = 1.99 to 4.33, c-statistics = 0.53 to 0.67) or leg strength (ORs = 2.52 to 5.77; c-statistics = 0.61 to 0.66) was strongly related to odds of slow gait speed. Lower extremity strength contributed 1% to 16% of the variance and handgrip strength contributed 3% to 17% of the variance in the prediction of gait speed depending on sex and mode of strength assessment. Conclusion Muscle weakness of the leg extensors and forearm flexors is related to slow gait speed. Leg extension strength is only a slightly better predictor of slow gait speed. Thus, handgrip and leg extension strength appear to be suitable for screening for muscle weakness in older adults.

Previous research has shown reduced tissue disruption and inflammatory responses in women as compared to men following acute strenuous exercise. While the mechanism of this action is not known, estrogen may reduce the inflammatory response through its interaction with granulocytes. The purpose of this study was to determine if estrogen receptor β expression on granulocytes is related to sex differences in tissue disruption in response to an acute heavy resistance exercise protocol. Seven healthy, resistance-trained, eumenorrheic women (23 ± 3 years, 169 ± 9.1 cm, 66.4 ± 10.5 kg) and 8 healthy, resistance-trained men (25 ± 5 years, 178 ± 6.7 cm, 82.3 ± 9.33 kg) volunteered to participate in the study. Subjects performed an acute resistance exercise test consisting of six sets of five squats at 90% of the subject's one repetition maximum. Blood samples were obtained pre-, mid-, post-, and 1-, 6-, and 24-h postexercise. Blood samples were analyzed for 17-β-estradiol by ELISA, creatine kinase by colorimetric enzyme immunoassay, and estradiol receptors on circulating granulocytes through flow cytometry. Men had higher CK concentrations than women at baseline/control. Men had significantly higher CK concentrations at 24-h postexercise than women. No significant changes in estradiol β receptors were expressed on granulocytes after exercise or between sexes. While sex differences occur in CK activity in response to strenuous eccentric exercise, they may not be related to estradiol receptor β expression on granulocytes. Thus, although there are sex differences in CK expression following acute resistance exercise, the differences may not be attributable to estrogen receptor β expression on granulocytes.

Purpose: Epinephrine and norepinephrine mediate interactions between the neuroendocrine and the immune systems to alter immune cell activity. Although both systems respond to exercise stress, less is known about how they interact in response to such stress. The purpose of this investigation was to examine s2-adrenergic receptor (s2-ADR) expression on circulating leukocytes to an acute bout of resistance exercise in men and women. Methods: Resistance-trained men (n = 8; mean ± SD age = 24.63 ± 5.07 yr, body mass index = 26.09 ± 2.21 kg·m-2) and women (n = 7; age = 22.13 ± 3.09 yr, body mass index = 22.63 ± 2.03 kg·m-2) performed an acute resistance exercise protocol (six sets of five-repetition maximum heavy squats) and a control test (i.e., identical conditions with no exercise) in a balanced, randomized order. Using a within-subject design, s2-ADR expressions on circulating leukocytes were evaluated with flow cytometry, and plasma epinephrine and norepinephrine were evaluated with high-performance liquid chromatography. Results: Plasma epinephrine and norepinephrine increased during the exercise bout and returned to baseline during recovery. s2-ADR expression on monocytes was elevated in anticipation of the exercise protocol. s2-ADR expression on monocytes and granulocytes decreased during the exercise. s2-ADR expression on lymphocytes was elevated during the recovery time points. Conclusions: In conclusion, s2-ADR expression on leukocyte subpopulations changes in response to acute heavy resistance exercise protocol. The present findings provide insights into the potential temporal interactions between the neuroendocrine and the immune systems in response to the physiological stress of acute heavy resistance exercise in men and women.

The purpose of this study was to verify the concurrent validity of a bar-mounted Myotest® instrument in measuring the force and power production in the squat and bench press exercises when compared to the gold standard of a computerized linear transducer and force platform system. Fifty-four men (bench press: 39-171 kg; squat: 75-221 kg) and 43 women (bench press: 18-80 kg; squat: 30-115 kg) (age range 18-30 years) performed a 1 repetition maximum (1RM) strength test in bench press and squat exercises. Power testing consisted of the jump squat and the bench throw at 30% of each subject's 1RM. During each measurement, both the Myotest® instrument and the Celesco linear transducer of the directly interfaced BMS system (Ballistic Measurement System [BMS] Innervations Inc, Fitness Technology force plate, Skye, South Australia, Australia) were mounted to the weight bar. A strong, positive correlation (r) between the Myotest and BMS systems and a high correlation of determination (R2) was demonstrated for bench throw force (r = 0.95, p < 0.05) (R2 = 0.92); bench throw power (r = 0.96, p < 0.05) (R2 = 0.93); squat jump force (r = 0.98, p < 0.05) (R2 = 0.97); and squat jump power (r = 0.91, p < 0.05) (R2 = 0.82). In conclusion, when fixed on the bar in the vertical axis, the Myotest is a valid field instrument for measuring force and power in commonly used exercise movements.

The purpose of this study was to examine the influence of a cold treatment and a dynamic warm-up on lower body power in the form of a countermovement vertical jump (CMVJ). Nine physically active men, who were either current or ex-National Collegiate Athletic Association (NCAA) Division 1 athletes, consented to participate in the study. Using a balanced, randomized presentation and a within-subject design, each subject performed 4 environmental and warm-up protocols (i.e., ambient temperature without warm-up, ambient temperature with warm-up, cold without warm-up, or cold with warm-up). Two sets of 3 maximal effort CMVJs were performed on a force plate at each testing time point. For each protocol, the subjects completed a pretest set of CMVJ (pretreatment [PRE]), were then exposed to 1 of the 2 temperature treatments, completed another set of CMVJ (initial [IT]), then either went through a 15-minute warm-up, or were asked to sit in place. Then a final set of CMVJs was completed (posttreatment [PT]). The primary finding in this study was that warm-up was effective in offsetting the negative effects of cold exposure on CMVJ power. There was a significant main effect for Time (PRE > PT > IT), and there was a significant (p ≤ 0.05) main effect for Trial (AMB = AMBWU > COLDWU > COLD). Because athletic competitions happen in various colder climates, it is important to make sure that a proper warm-up be completed to maximize the athlete's power output. The results of this study demonstrate that when athletes are exposed to cold conditions, it is recommended that before practice or play, a dynamic warm-up be employed to optimize performance.

The aim of this study was to determine the effect of a 16-week intrahospital supervised, conditioning program including both resistance and aerobic type training on insulin-like growth factors 1 and 2 (IGF-1, IGF-2), several IGF-binding proteins (IGFBPs), and growth hormone (GH) in children receiving treatment against acute lymphoblastic leukemia (ALL). We also analyzed the effects of a 20-week detraining period on these hormones. Seven children (3 girls and 4 boys) aged 4-7 years in the maintenance phase of treatment against ALL performed 3 training sessions per week for 16 weeks of resistance (1 set of 8-15 repetitions of 11 exercises) and aerobic training (30 minutes at >or=50% heart rate max) followed by 20 weeks of detraining where no structured exercise program was performed. Levels of IFG-1 and IFG-2 did not significantly change after the intervention period or after the detraining phase. Likewise, levels of GH, IGFBP-2, and IGFBP-3 remained stable pre and posttraining and after the detraining period. IGFBP-1 levels significantly decreased after training (-43.8%, p = 0.014), whereas there were no significant differences between pretraining vs. detraining (-17.8%, p = 0.108) nor between posttraining vs. detraining (17.7%, p = 0.251). Exercise training did not have major effects on the IGFs, IGFBPs, and GH in children with ALL. Although the importance of these findings to long-term cancer prognosis and/or recurrence remains to be determined, the present data (particularly those on IGF-1 and IGFBP-3) support the idea that exercise training can be safely undergone during treatment against ALL with no major adverse effect. 1.848 JCR (2010) Q2, 33/80 Sport sciences UEM

The primary purpose of this investigation was to evaluate the influence of a whole body compression garment on recovery from a typical heavy resistance training workout in resistance-trained men and women. Eleven men (mean +/- SD: age, 23.0 +/- 2.9 years) and 9 women (mean +/- SD: age 23.1 +/- 2.2 years) who were highly resistance trained gave informed consent to participate in the study. A within-group (each subject acted as their own control), balanced, and randomized treatment design was used. Nutritional intakes, activity, and behavioral patterns (e.g., no pain medications, ice, or long showers over the 24 hours) were replicated 2 days before each test separated by 72 hours. An 8-exercise whole body heavy resistance exercise protocol using barbells (3 sets of 8-10 repetition maximum, 2.0- to 2.5-minute rest) was performed after which the subject showered and put on a specific whole body compression garment one designed for women and one for men (CG) or just wore his/her normal noncompression clothing (CON). Subjects were then tested after 24 hours. Dependent measures included sleep quality, vitality rating, resting fatigue rating, muscle soreness, muscle swelling via ultrasound, reaction movement times, bench throw power, countermovement vertical jump power, and serum concentrations of creatine kinase (CK) measured from a blood sample obtained via venipuncture of an arm vein. We observed significant (por = 0.05) differences between CG and CON conditions in both men and women for vitality (CGCON), resting fatigue ratings (CGCON), muscle soreness (CGCON), ultrasound measure swelling (CGCON), bench press throw (CGCON), and CK (CGCON). A whole body compression garment worn during the 24-hour recovery period after an intense heavy resistance training workout enhances various psychological, physiological, and a few performance markers of recovery compared with noncompressive control garment conditions. The use of compression appears to help in the recovery process after an intense heavy resistance training workout in men and women.

Rehabilitation programs and research experiments use single-arm protocols in which the contralateral arm is not functional or used as a control limb. This study was interested in determining the hormonal signal impacts of such one- versus two-arm exercise responses that might have an impact on adaptational changes with training. The purpose was to examine the acute hormonal responses to a unilateral and a bilateral upper-body resistance exercise (RE) protocol. A balanced randomized treatment intervention with series time frame for blood collections before and after exercise was used as the basic experimental design. Ten recreationally resistance trained men (18-25 years, 20.4 +/- 1.2 years, 175.6 +/- 4.5 cm, 81.7 +/- 9.3 kg) gave informed consent to participate in the investigation. Each subject performed unilateral (dominant arm only) and bilateral upper-body RE protocol separated by 1 week in a balanced randomized fashion. The RE protocol consisted of 3 sets of 10 repetitions of 5 different dumbbell upper-body exercises at 80% of 1-repetition maximum, and blood samples were obtained before and 5, 15, and 30 minutes immediately postexercise (IP). Blood was obtained and analyzed for lactate, immunoreactive growth hormone (iGH), cortisol (C), total testosterone (T), and insulin concentrations. Total volume of work also was determined for the 2 exercise sessions. Total volume of work performed during the unilateral protocol was 52.1% of that for the bilateral protocol. Both RE protocols elicited a significant (p < or = 0.05) increase in lactate and iGH, but the increase for the bilateral condition was significantly greater. Cortisol decreased significantly during recovery for the unilateral condition. Testosterone was not affected by either protocol. Insulin was significantly increased at IP and 5 minutes postexercise for both conditions.These results indicate that the hormonal responses to dominant-arm unilateral RE is blunted compared to that for bilateral RE. This differential endocrine response is likely a result of the difference in volume between the protocols. It is important to pay attention to the amount of muscle mass utilized in a resistance exercise protocol to optimize endocrine signaling.

The purpose of this study was to examine the acute effect of resistance exercise (RE) on muscle androgen receptor (AR) and glucocorticoid receptor (GR) protein content. Fifteen resistance-trained men (n=8; 21+/-1 years, 175.3+/-6.7 cm, 90.8+/-11.6 kg) and women (n=7; 24+/-5 years, 164.6+/-6.7 cm, 76.4+/-15.6 kg) completed 6 sets of 10 repetitions of heavy squats. Blood samples were obtained before RE, after 3 and 6 sets of squats, and 5, 15, 30 and 70 min after RE. Muscle biopsies from the vastus lateralis were obtained before RE, and 10 min and 70 min after RE. Blood samples were analyzed for total and free testosterone concentrations and muscle samples were analyzed for AR and GR protein content. Circulating total testosterone increased significantly (p< or =0.05) in men and free testosterone increased in men and women with exercise. AR was significantly reduced at 70 min post-exercise in men and at 10 min post-exercise in women compared to pre-exercise. There were no changes in GR following RE, but GR was significantly higher in women compared to men. These findings support a current paradigm for stabilization followed by a reduction and then a rebound in the acute AR response to RE but demonstrate that gender differences exist in the timeline of the AR response.

Circulating testosterone is elevated acutely following resistance exercise (RE) and is an important anabolic hormone for muscle adaptations to resistance training. The purpose of this study was to examine the acute effect of heavy RE on intracrine muscle testosterone production in young resistance-trained men and women. Fifteen young, highly resistance-trained men (n = 8; 21 +/- 1 yr, 175.3 +/- 6.7 cm, 90.8 +/- 11.6 kg) and women (n = 7; 24 +/- 5 yr, 164.6 +/- 6.7 cm, 76.4 +/- 15.6 kg) completed 6 sets of 10 repetitions of Smith machine squats with 80% of their 1-repetition maximum. Before RE and 10 and 70 min after RE, muscle biopsies were obtained from the vastus lateralis. Before RE, after 3 and 6 sets of squats, and 5, 15, 30, and 70 min into recovery from RE, blood samples were obtained using venipuncture from an antecubital vein. Muscle samples were analyzed for testosterone, 17beta-hydroxysteroid dehydrogenase (HSD) type 3, and 3beta-HSD type 1 and 2 content. Blood samples were analyzed for glucose and lactate concentrations. No changes were found for muscle testosterone, 3beta-HSD type 1 and 2, and 17beta-HSD type 3 concentrations. However, a change in protein migration in the Bis-Tris gel was observed for 17beta-HSD type 3 postexercise; this change in migration indicated an approximately 2.8 kDa increase in molecular mass. These findings indicate that species differences in muscle testosterone production may exist between rats and humans. In humans, muscle testosterone concentrations do not appear to be affected by RE. This study expands on the current knowledge obtained from animal studies by examining resting and postexercise concentrations of muscle testosterone and steroidogenic enzymes in humans.

The purpose of this investigation was to examine the influence of upper-body static stretching and dynamic stretching on upper-body muscular performance. Eleven healthy men, who were National Collegiate Athletic Association Division I track and field athletes (age, 19.6 +/- 1.7 years; body mass, 93.7 +/- 13.8 kg; height, 183.6 +/- 4.6 cm; bench press 1 repetition maximum [1RM], 106.2 +/- 23.0 kg), participated in this study. Over 4 sessions, subjects participated in 4 different stretching protocols (i.e., no stretching, static stretching, dynamic stretching, and combined static and dynamic stretching) in a balanced randomized order followed by 4 tests: 30% of 1 RM bench throw, isometric bench press, overhead medicine ball throw, and lateral medicine ball throw. Depending on the exercise, test peak power (Pmax), peak force (Fmax), peak acceleration (Amax), peak velocity (Vmax), and peak displacement (Dmax) were measured. There were no differences among stretch trials for Pmax, Fmax, Amax, Vmax, or Dmax for the bench throw or for Fmax for the isometric bench press. For the overhead medicine ball throw, there were no differences among stretch trials for Vmax or Dmax. For the lateral medicine ball throw, there was no difference in Vmax among stretch trials; however, Dmax was significantly larger (p

Previous research has shown that L-carnitine L-tartrate (LCLT) supplementation beneficially affects markers of hypoxic stress following resistance exercise. However, the mechanism of this response is unclear. Therefore, the primary purpose of this study was to determine the effects of LCLT supplementation on muscle tissue oxygenation during and after multiple sets of squat exercise. Nine healthy, previously resistance-trained men (25.2 +/- 6.years, 91.2 +/- 10.2 kg, 180.2 +/- 6.3 cm) ingested 2 g.d of LCLT or an identical placebo for 23 days in a randomized, balanced, crossover, double-blind, placebo-controlled, repeated-measures study design. On day 21, forearm muscle oxygenation was measured during and after an upper arm occlusion protocol using near infrared spectroscopy (NIRS), which measures the balance of oxygen delivery in relation to oxygen consumption. On day 22, subjects performed 5 sets of 15 to 20 repetitions of squat exercise with corresponding measures of thigh muscle oxygenation, via NIRS, and serial blood draws. Compared to the placebo trial, muscle oxygenation was reduced in the LCLT trial during upper arm occlusion and following each set of resistance exercise. Despite reduced oxygenation, plasma malondealdehyde, a marker of membrane damage, was attenuated during the LCLT trial. There were no differences between trials in the vasoactive substance prostacyclin. In conclusion, because oxygen delivery was occluded during the forearm protocol, it is proposed that enhanced oxygen consumption mediated the reduced muscle oxygenation during the LCLT trial. Enhanced oxygen consumption would explain why hypoxic stress was attenuated with LCLT supplementation.

Purpose: Hormones and muscle contraction alter protein kinase B (Akt) signaling via distinct mechanisms. Therefore, the purpose of this study was to determine whether physiologically elevated circulating hormones modulate resistance exercise (RE)-induced signaling of Akt and its downstream targets. We hypothesized that elevated circulating hormones would potentiate the signaling response. Methods: Seven healthy men (mean +/- SD age, 27 +/- 4 yr; body mass, 79.1 +/- 13.6 kg; body fat, 16% +/- 7%) performed two identical lower-body RE protocols (five sets of five maximal repetitions of knee extensions) in a randomized order and separated by 1-3 wk: one protocol was preceded by rest [low-circulating hormonal concentration (LHC) trial], and the other was preceded by a bout of high-volume upper-body RE using short rest periods designed to elicit a large increase in circulating hormones [high-circulating hormonal concentration (HHC) trial]. Results: The HHC trial invoked significantly (P 2.5-fold) circulating GH concentrations; this was potentially due to cortisol-induced inhibition of p70 S6K Thr 389 phosphorylation

Objective To examine associations between use of school vending machines and fast-food restaurants and youth intake of sugar-sweetened beverages. Design A cross-sectional observational study. Subjects/setting From a group randomized obesity intervention, we analyzed baseline data from 1,474 students in 10 Massachusetts middle schools with vending machines that sold soda and/or other sweetened drinks. Main Outcome Measures Daily sugar-sweetened beverage consumption (regular soda, fruit drinks, and iced tea), purchases from school vending machines, and visits to fast-food restaurants in the preceding 7 days were estimated by self-report. Statistical Analyses Performed χ 2 and nonparametric tests were performed on unadjusted data; multivariable models adjusted for sex, grade, body mass index, and race/ethnicity, and accounted for clustering within schools. Results Among 646 students who reported using school vending machines, 456 (71%) reported purchasing sugar-sweetened beverages. Overall, 977 students (66%) reported eating at a fast-food restaurant. Sugar-sweetened beverage intakes averaged 1.2 servings per day. In adjusted models, relative to no vending machine purchases, servings per day increased by 0.21 for one to three purchases per week ( P =0.0057), and 0.71 with four or more purchases ( P P =0.07), 0.49 with two to three visits ( P =0.0013), and by 1.64 with four or more visits ( P =0.0016). Conclusions Among students who use school vending machines, more report buying sugar-sweetened beverages than any other product category examined. Both school vending machine and fast-food restaurant use are associated with overall sugar-sweetened beverage intake. Reduction in added dietary sugars may be attainable by reducing use of these sources or changing product availability.

To better understand how developmental differences impact performance on a broad selection of common physical fitness measures, we examined changes in boys and girls from fourth to fifth grade. Subjects included 273 boys (age, 9.5 ± 0.6 years; height, 139.86 ± 7.52 cm; mass, 38.00 ± 9.55 kg) and 295 girls (age, 9.6 ± 0.5 years; height, 139.30 ± 7.19 cm; weight, 37.44 ± 9.35 kg). We compared anthropometrics, cardiorespiratory and local muscular endurance, flexibility, power, and strength. A mixed-method analysis of variance was used to compare boys and girls at the 2 time points. Pearson correlation coefficients were used to examine relationships between anthropometric and fitness measurements. Significance was set at p ≤ 0.05. Weight increased significantly (>10%) in both sexes, and girls became significantly taller than boys after growing 4.9% by fifth grade (vs. 3.5%). Both groups improved cardiorespiratory endurance and power, although boys performed better than girls at both time points. Boys were stronger in fourth grade, but girls improved more, leading to similar fifth-grade values. Girls were more flexible in fourth grade, but their significant decreases (∼32.4%) coupled with large improvements in boys (∼105%) resulted in similar fifth-grade scores. Body mass index (BMI) was positively correlated with run time regardless of grade or sex. Power was negatively correlated with BMI and run time in fourth grade. In conclusion, sex-specific differences in physical fitness are apparent before pubescence. Furthermore, this selection of measures reveals sexually dimorphic changes, which likely reflect the onset of puberty in girls. Coaches and teachers should account these developmental differences and their effects on anthropometrics and fitness in boys and girls.

The relationships between 30-m sprint time and performance on a nonmotorized treadmill (TM) test and a vertical jump test were determined in this investigation. Seventy-eight physically active men and women (22.9 ± 2.7 years; 73.0 ± 14.7 kg; 170.7 ± 10.4 cm) performed a 30-second maximal sprint on the curve nonmotorized TM after 1 familiarization trial. Pearson product-moment correlation coefficients produced significant (p ≤ 0.05) moderate to very strong relationships between 30-m sprint time and body mass (r = -0.37), %fat (r = 0.79), peak power (PP) (r = -0.59), relative PP (r = -0.42), time to peak velocity (r = -0.23) and TM sprint times at 10 m (r = 0.48), 20 m (r = 0.59), 30 m (r = 0.67), 40 m (r = 0.71), and 50 m (r = 0.75). Strong relationships between 30-m sprint time and peak (r = -0.479) and mean vertical jump power (r = -0.559) were also observed. Subsequently, stepwise regression was used to produce two 30-m sprint time prediction models from TM performance (TM1: body mass + TM data and TM2: body composition + TM data) in a validation group (n = 39), and then crossvalidated against another group (n = 39). As no significant differences were observed between these groups, data were combined (n = 72) and used to create the final prediction models (TM1: r = 0.75, standard error of the estimate (SEE) = 0.27 seconds; TM2: r = 0.84, SEE = 0.22 seconds). These final movement-specific models seem to be more accurate in predicting 30-m sprint time than derived peak (r = 0.23, SEE = 0.48 seconds) and mean vertical jump power (r = 0.31, SEE = 0.45 seconds) equations. Consequently, sprinting performance on the TM can significantly predict short-distance sprint time. It, therefore, may be used to obtain movement-specific measures of sprinting force, velocity, and power in a controlled environment from a single 30-second maximal sprinting test.

AB Introduction: The insulin-like growth factor 1 (IGF-1) system plays a central role in anabolic cellular processes. Recently, a regulatory role of IGF-1 in the immune response for muscle repair has been suggested, but how it modulates the inflammatory process is largely unknown. We evaluated changes in leukocyte expression of IGF-1 receptors (IGF-1R) during recovery from resistance exercise to determine whether changes in the potential for IGF-1 interactions with leukocytes may mediate the role of IGF-1 in muscle repair. Methods: Twenty resistance-trained men (18-35 yr) performed resistance exercise followed by cold water immersion (CWI) or control treatment (CON) on three consecutive days. Blood was sampled at baseline (PRE), immediately (IP), 30 min (30P), 24 h (24H), and 48 h after (48H) exercise. Circulating IGF-1 was assayed, and IGF-1 receptor expression (CD221) on gated circulating leukocytes (monocytes, granulocytes, and lymphocytes) was measured by flow cytometry. Time and treatment effects were analyzed with ANCOVA. Results: Circulating IGF-1 significantly increased from PRE to IP as a result of resistance exercise, but no differences between CON and CWI were observed. Mean fluorescence intensity of CD221 on monocytes and granulocytes and percent of CD221+ granulocytes significantly increased at 30P (P < 0.000) and returned to preexercise levels by 24H. No treatment effects on monocytes or granulocytes were observed. On lymphocytes, mean fluorescence intensity of CD221+ significantly increased from PRE to 30P in CWI. Conclusions: Changes in IGF-1 and its receptor on monocytes and granulocytes seem to be part of the mechanism that facilitates recovery from resistance exercise during earlier stages of muscle recovery. In addition, CWI seems to alter IGF-mediated responses on slower-acting lymphocytes, suggesting that its effects may be seen in later stages of muscle repair.

Fragala, MS, Beyer, KS, Jajtner, AR, Townsend, JR, Pruna, GJ, Boone, CH, Bohner, JD, Fukuda, DH, Stout, JR, and Hoffman, JR. Resistance exercise may improve spatial awareness and visual reaction in older adults. JS trength Cond Res28(8): 2079–2087, 2014—Aerobic exercise has been shown to counteract age-related neurological decrements that are associated with cognitive and physical impairments. However, the effects of resistance exercise on cognition, reaction, and neurotrophins are largely unknown. We examined changes in spatial awareness, visual and motor reaction, and circulating brain-derived neurotrophic factor (BDNF) in response to a resistance exercise intervention in older adults (aged 70.6 6 6.1 years). Spatial awareness was evaluated before and after training with a Neurotracker perceptual 3-dimensional objecttracking device. Peripheral, visual, motor, and physical reaction times were evaluated using a Dynavision visuomotor device. Circulating BDNF was assayed. Data were analyzed for clinical significance using magnitude-based inferences calculated from independent t-tests. Clinical interpretations of the analyses revealed that resistance exercise training was “likely beneficial” for improving spatial awareness and visual and physical reaction times. Each improved by 40.0, 14.6, and 14.0%, respectively. Circulating BDNF and motor reaction time displayed no apparent meaningful changes. Thus, resistance exercise training may be an effective means to preserve or improve spatial awareness and reaction with aging.

Mediators of monocyte migration, complement receptor-3 (CR3), and chemokine ligand-4 (CCL4) were measured in response to recovery modalities following resistance exercise. Thirty resistance-trained men (23.1±2.9 y;175.2±7.1 cm;82.1±8.4 kg) were given neuromuscular electric stimulation (NMES), cold water immersion (CWI), or control (CON) treatments immediately following resistance exercise. Blood samples were obtained preexercise (PRE), immediately (IP), 30 minutes (30 P), 24 hours (24 H), and 48 hours (48 H) after exercise for measurement of circulating CCL4 and CR3 expression on CD14+ monocytes, by assay and flow cytometry. Circulating CCL4 showed no consistent changes. Inferential analysis indicated that CR3 expression was likely greater in CON at 30 P than NMES (90.0%) or CWI (86.8%). NMES was likely lower than CON at 24 H (92.9%) and very likely lower at 48 H (98.7%). Expression of CR3 following CWI was very likely greater than CON (96.5%) at 24 H. The proportion of CR3+ monocytes was likely greater following CWI than NMES (85.8%) or CON (85.2%) at 24 H. The change in proportion of CR3+ monocytes was likely (86.4%) greater following NMES than CON from IP to 30 P. The increased expression of CR3 and increased proportion of CR3+ monocytes following CWI at 24 H indicate a potentially improved ability for monocyte adhesion to the endothelium, possibly improving phagocytosis of damaged tissues.