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Our previous study showed that relatively low-intensity (approximately 50% one-repetition maximum [1RM]) resistance training (knee extension) with slow movement and tonic force generation (LST) caused as significant an increase in muscular size and strength as high-intensity (approximately 80% 1RM) resistance training with normal speed (HN). However, that study examined only local effects of one type of exercise (knee extension) on knee extensor muscles. The present study was performed to examine whether a whole-body LST resistance training regimen is as effective on muscular hypertrophy and strength gain as HN resistance training. Thirty-six healthy young men without experience of regular resistance training were assigned into three groups (each n = 12) and performed whole-body resistance training regimens comprising five types of exercise (vertical squat, chest press, latissimus dorsi pull-down, abdominal bend, and back extension: three sets each) with LST (approximately 55-60% 1RM, 3 seconds for eccentric and concentric actions, and no relaxing phase); HN (approximately 80-90% 1RM, 1 second for concentric and eccentric actions, 1 second for relaxing); and a sedentary control group (CON). The mean repetition maximum was eight-repetition maximum in LST and HN. The training session was performed twice a week for 13 weeks. The LST training caused significant (p < 0.05) increases in whole-body muscle thickness (6.8 +/- 3.4% in a sum of six sites) and 1RM strength (33.0 +/- 8.8% in a sum of five exercises) comparable with those induced by HN training (9.1 +/- 4.2%, 41.2 +/- 7.6% in each measurement item). There were no such changes in the CON group. The results suggest that a whole-body LST resistance training regimen is as effective for muscular hypertrophy and strength gain as HN resistance training.

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EFFECTS OF WHOLE-BODY L OW-INTENSITY

RESISTANCE TRAINING WITH S LOW MOVEMENT AND

TONIC FORCE GENERATION ON MUSCULAR SIZE AND

STRENGTH IN YOUNG MEN

MICHIYA TANIMOTO ,

KIYOSHI SANADA ,

KENTA YAMAMOTO ,

HIROSHI KAWANO ,

YUKO G ANDO ,

IZUMI TABATA ,

NAOKATA ISHII ,

AND M OTOHIKO MIYACHI

Division of Health Promotion and Exercise, National Institute of Health and Nutrition, Tokyo, Japan;

Consolidated Research

Institute for Advanced Science and Medical Care, Waseda University, Tokyo, Japan;

Faculty of Sports Sciences, Waseda

University, Tokorozawa, Japan; and

Department of Life Sciences Graduate School of Arts and Sciences, University of Tokyo,

Tokyo, Japan

ABSTRACT

Tanimoto, M, Sanada, K, Yamamoto, K, Kawano, H, Gando,

Y, Tabata, I, Ishii, N, and Miyachi, M. Effects of whole-body

low-intensity resistance training with slow movement and tonic

force generation on muscular size and strength in young men.

J Strength Cond Res 22(6): 1926–1938, 2008—Our previous

study showed that relatively low-intensity (~50% one-repetition

maximum [1RM]) resistance training (knee extension) with slow

movement and tonic force generation (LST) caused as

signiﬁcant an increase in muscular size and strength as high-

intensity (~80% 1RM) resistance training with normal speed

(HN). However, that study examined only local effects of one

type of exercise (knee extension) on knee extensor muscles.

The present study was performed to examine whether a whole-

body LST resistance training regimen is as effective on

muscular hypertrophy and strength gain as HN resistance

training. Thirty-six healthy young men without experience of

regular resistance training were assigned into three groups

(each n = 12) and performed whole-body resistance training

regimens comprising ﬁve types of exercise (vertical squat, chest

press, latissimus dorsi pull-down, abdominal bend, and back

extension: three sets each) with LST (~55–60% 1RM,

3 seconds for eccentric and concentric actions, and no relaxing

phase); HN (~80–90% 1RM, 1 second for concentric and

eccentric actions, 1 second for relaxing); and a sedentary

control group (CON). The mean repetition maximum was eight-

repetition maximum in LST and HN. The training session was

performed twice a week for 13 weeks. The LST training caused

signiﬁcant (p, 0.05) increases in whole-body muscle

thickness (6.8 6 3.4% in a sum of six sites) and 1RM strength

(33.0 6 8.8% in a sum of ﬁve exercises) comparable with those

induced by HN training (9.1 6 4.2%, 41.2 6 7.6% in each

measurement item). There were no such changes in the CON

group. The results suggest that a whole-body LST resistance

training regimen is as effective for muscular hypertrophy and

strength gain as HN resistance training.

KEY WORDS resistance training regimens, muscular

hypertrophy, continuous muscular activity, intramuscular hypoxic

environment

INTRODUCTION

Resistance training at medium-to-high intensity

(~80% one-repetition maximum [1RM]) is gen-

erally regarded as optimal for increasing muscular

size and strength (21,23,32). It has been reported

that resistance training at intensities lower than 65% 1RM is

virtually ineffective for increasing muscular size and strength

(6). Therefore, large mechanical stress has often been con-

sidered essential for increasing muscular size and strength.

However, the concept of enhancing exercise movement

variation was not explored in these studies. When exercise

movement is devised to place muscles under continuous

tension throughout the exercise movement, resistance train-

ing, even with low-intensity loads of less than 65% 1RM, may

cause muscular hypertrophy and increase strength.

The results of our previous study indicated that a 12-week

program of relatively low-intensity (~50% 1RM) resistance

training with slow movement and tonic force generation

(3 seconds for eccentric and concentric actions, 1-second

pause and no relaxing phase; designated as LST) for knee

extensor muscles caused signiﬁcant increases in muscular size

(~5% gain in cross-sectional area) and strength (~10% gain in

Address correspondence to Michiya Tanimoto, tanimoto@nih.go.jp.

22(6)/1926–1938

Journal of Strength and Conditioning Research

Ó2008 National Strength and Conditioning Association

1926

Journal of Strength and Conditioning Research

the

maximum voluntary contraction [MVC], 30% gain in 1RM)

in young men. The effects of muscular size and strength gains

in LST were comparable with those seen in traditional high-

intensity (~80% 1RM) resistance training with normal speed

(1 second for concentric and eccentric actions, and 1 second

for relaxing: HN) (37). The LST exercise movement was

conﬁgured to achieve continuous force generation through-

out the exercise movement. Continuous force generation

at . 40% MVC has been shown to suppress both blood

inﬂow to and outﬂow from the muscle because of an increase

in intramuscular pressure (5,19). Therefore, LST training is

expected to restrict muscular blood ﬂow during exercise

movement. Resistance training regimens with restricted

muscular blood ﬂow were considered to induce increases

in muscular size and strength likely mediated by the

following processes attributable to oxygen insufﬁciency in

muscle: (a) stimulated secretion of growth hormone (GH) by

intramuscular accumulation of metabolic byproducts, such as

lactate (33); (b) moderate production of reactive oxygen

species (ROS) promoting tissue growth (18,35); and (c)

additional recruitment of fast-twitch ﬁbers in a hypoxic

condition (30,36).

However, our previous study examined only local effects (in

knee extensor muscles) in one type of exercise (knee

extension) training using LST. We had no information

regarding the systemic effects of whole-body resistance

training using LST. Single-joint exercises with exercise

machines, such as knee extension and biceps curl, are

considered more appropriate for LST to place speciﬁc

muscles under continuous tension throughout the exercise

movement than multijoint exercises, such as squat and chest

press. Most single-joint exercise machines are designed to

maintain almost-constant joint torque at any joint position.

Therefore, we adopted knee extension exercise with a knee

extension machine for the experimental exercise in our

previous study (37). However, a whole-body resistance

training program consisting of only single-joint exercises may

not be realistic or appropriate. Multijoint exercises usually

recruit one or more large muscle area as agonist muscles and

some other muscles as coacting muscles, whereas single-joint

exercises usually isolate a speciﬁc muscle or muscle group.

Also, most sport and daily performance movements consist

of multijoint movements. The more similar the training

activity is to the actual sport and daily performance

movements, the greater the likelihood that there will be

a positive transfer to these movements (i.e., the speciﬁcity

concept) (9,24). Therefore, multijoint exercises are consid-

ered more important for improving sport and daily

performance than single-joint exercise.

In the present study, we investigated systemic effects,

including changes in whole-body fat-free mass (FFTM) and

percent body fat, of a long-term (13 weeks) whole-body LST

training program consisting mainly of multijoint exercises on

muscular size and strength. The results show that a whole-

body LST training program caused increases in muscular

size and strength as effectively as normal high-intensity

training.

METHODS

Experimental Approach to the Problem

This study was designed to examine whether a whole-body

resistance training regimen with the LST method (using

a relatively low-intensity load with slow movement and tonic

force generation—3 seconds for concentric and eccentric

actions and no relaxing phase), as a training prescription

program for the real ﬁeld, is as effective on muscular

hypertrophy and strength gain as resistance training with

the HN method (a traditional method using a relatively high-

intensity load with normal speed—1 second for concentric and

eccentric actions and 1 second for relaxing). After providing

informed consent, subjects were assigned to three experi-

mental groups (LST training group, HN training group, and

CON [no-training control group], n = 12 for each group) for

this study. Subjects in the training groups (LST and HN)

performed whole-body resistance training regimens consist-

ing of ﬁve types of exercise by each resistance training

method. Subjects performed each type of exercise with eight-

repetition maximum (8RM) intensity. Exercise intensities on

LSTand HN were adjusted to the 8RM intensity. Mechanical

load in LST training was much lower than that in HN

training (~55–60% 1RM in LST vs. ~80–90% 1RM in

HN).The difference of mechanical load between the two

groups with the same 8RM intensities may be attributable to

the difference in the type of movement. The training sessions

were performed twice a week for 13 weeks.

We compared measurements of acute and chronic changes

in LSTand HN to investigate the physiological characteristics

and evaluate the effects of muscular hypertrophy and strength

gain of whole-body resistance training with the LST method.

As acute changes in physiological parameters during exercise,

we measured electromyographic (EMG) signals, peripheral

muscle oxygenation level, blood lactate concentration, and

blood pressure. As chronic changes after the training, we

measured muscle thickness (MT) and subcutaneous fat

thickness (SFT) using B-mode ultrasound, lean soft-tissue

mass (LSTM: body mass minus bone mass minus fat mass),

fat mass, and bone mineral density (BMD) using dual-energy

X-ray absorptiometry (DXA), and 1RM strength in the ﬁve

types of exercise used in the training regimen. These were

measured before and after the training period.

Subjects

Thirty-six healthy young men who did not have experience of

regular resistance training volunteered as subjects. The

subjects were randomly assigned into three experimental

groups (n = 12 for each group: LST, HN, and CON,

described below), which were matched for physical

parameters, such as height, weight, and age (Table 1). All

subjects were advised to maintain their usual dietary habits

and not to make any intentional changes such as protein

VOLUME 22 | NUMBER 6 | NOVEMBER 2008 | 1927

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supplement intake or increasing the amount of intake or

number of meals a day, to avoid nutritional inﬂuence. All

subjects were fully informed about the experimental

procedures to be used as well as the purpose of the study,

and they gave their written informed consent before

participating in the study. The study was approved by the

ethics committee for human experiments at the National

Institute of Health and Nutrition.

Resistance Training Regimens

The subjects in each training group performed whole-body

resistance training regimens consisting of ﬁve types of

exercise: vertical squat, chest press, latissimus dorsi pull-

down, abdominal bend, and back extension. All of these

exercises were performed using resistance exercise machines

(Cybex Corp. USA for vertical squat; Nautilus Corp. USA for

chest press, abdominal bend, and back extension; and Senoh

Corp. Japan for latissimus dorsi pull-down); these machine

exercises were considered easier to perform than free weight

resistance exercises because of balance and coordination

recruitment. The subjects performed their whole-body resis-

tance training according to the following training regimens.

The LST group exercised at low intensity (~55–60% of

1RM), with slow movement and tonic force generation

(3 seconds for concentric [lifting phase] and eccentric [low-

ering phase] actions, and no relaxing phase). In the vertical

squat, chest press, and latissimus dorsi pull-down, the subjects

did not extend their legs or arms fully, to maintain continuous

tension in the muscles throughout the exercise movement.

The HN group exercised at high intensity (~80–90%

1RM), with normal speed (1 second for concentric and

eccentric actions, and 1 second for relaxing).

The CON group served as the no-training control. The

training session consisted of the ﬁve types of exercise

described above, and each subject performed one warm-up

set and three regular sets for each type of exercise, with an

interset rest period of 60 seconds. A 3-minute rest period was

taken between exercise events. The training session was

performed twice a week for 13 weeks. The ﬁrst 2 weeks were

a preparation period, during which the subjects gradually

increased the training volume and intensity, and in 2 weeks

they reached regular volume and intensity. Subjects in both

training groups (LST and HN) repeated the movement at

approximately constant speed and frequency with the aid of

a metronome. The subjects repeated the movement until

exhaustion (repetition maximum [RM]) at each exercise set.

The exercise intensity was determined at 8RM for each set but

not at % 1RM, because the former method is more commonly

used in actual exercise training. The intensity was adjusted in

all training sessions based on the record of the previous

training session. The intensities used in the LST and HN

groups (8RM) in the ﬁrst set corresponded to about 55–60%

1RM and about 85–90% 1RM, respectively (Table 2). In the

HN group, the subjects performed the same RM (8RM) as in

the LST group: that is, the same RM-based intensity. The

difference in % 1RM intensities between the LST and HN

groups may have been attributable to the difference in type of

exercise movement. The exercise intensities actually used in

both training groups are summarized in Table 2.

Procedures

Acute Changes in Physiological Parameters During Exercise.

Electromyographic signals, peripheral muscle oxygenation

level, blood lactate concentration, and blood pressure were

measured during and after exercise to investigate the

characteristics of these trainings. Electromyographic signals

were measured to conﬁrm muscle continuous activity in LST,

because muscle continuous activity may lead to a decrease in

peripheral muscle oxygenation level, and decreases in muscle

oxygenation level during exercise movement may lead to

increases in blood lactate concentration. Muscle oxygenation,

which was the primary measurement element, could be

measured only in limb muscles. Of the ﬁve types of exercise,

only vertical squat limb muscles were mobilized as agonist

muscles. Blood pressure was measured from the radial artery

with the upper-body muscles kept relaxed. Of the ﬁve types

of exercise, only vertical squat was performed with the

upper-body muscles kept relaxed. Thus, EMG signal,

muscle oxygenation, and blood pressure were measured

during and after vertical squats, and the results were used as

TABLE 1. Physical characteristics of the subjects.

LST HN CON

Pretraining Posttraining Pretraining Posttraining Pretraining Posttraining

Age (y) 19.0 6 0.6 19.5 6 0.5 19.8 60.7

Height (cm) 174.1 6 5.5 174.8 6 4.3 174.3 67.2

Body mass (kg) 62.5 6 4.8 64.1 6 5.2 63.8 6 4.0 65.3 6 4.3 64.2 6 4.0 64.7 63.9

Values are mean 6 SD ;n = 12 for each group.

LST = low-intensity resistance training with slow movement and tonic force generation; HN = high-intensity resistance training with

normal speed; CON = sedentary controls.

1928

Journal of Strength and Conditioning Research

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Effects of Whole-Body LST Training

TABLE 2. One-repetition maximum and exercise intensity during the experimental period.

Pretraining LST 7th week 13th week Pretraining HN 7th week 13th week Pretraining

CON 7th

week 13th week

Vertical squat

1RM (kg) 106.5 6 22.8 122.1 6 22.9* 136.4 6 20.5†‡ 105.1 6 16.1 125.2 6 17.4* 136.5 6 20.4† § 113.7 6 16.3 112.9 617.8

Intensity/ﬁrst

set (kg)

70.9 6 22.8 82.4 6 8.5 111.3 6 17.4 121.9 618.8

% 1RM 59.0 6 5.8 60.8 6 5.8 88.7 6 4.1 89.4 64.2

Chest press

1RM (kg) 46.1 6 10.4 56.1 6 11.3* 62.0 6 12.3†‡ 41.3 6 5.4 49.7 6 8.5* 55.1 6 9.1† § 46.1 6 10.0 47.3 611.1

Intensity/ﬁrst

set (kg)

30.8 6 5.7 35.3 6 6.3 40.5 6 6.1 46.9 67.3

% 1RM 55.3 6 5.6 57.3 6 5.9 81.9 6 5.4 85.2 63.5

Lat pull-down

1RM (kg) 42.7 6 6.7 56.3 6 7.4* 62.0 6 8.2†‡ 39.6 6 7.2 50.4 6 6.9* 55.7 6 9.0† § 47.7 6 6.9 48.9 67.3

Intensity/ﬁrst

set (kg)

32.9 6 3.3 35.3 6 6.3 41.7 6 5.8 46.7 67.3

% 1RM 59.0 6 5.9 57.3 6 5.9 82.7 6 3.9 83.9 64.2

Abdominal bend

1RM (kg) 57.8 6 8.1 74.5 6 11.9* 82.0 6 13.7†‡ 59.3 6 8.8 78.5 6 10.6* 90.4 6 13.4† § 66.4 6 7.9 67.1 68.5

Intensity/ﬁrst

set (kg)

40.1 6 5.2 45.4 6 5.2 69.8 6 9.3 79.9 69.8

% 1RM 54.4 6 5.6 56.0 6 6.4 89.0 6 3.4 88.8 64.7

Back extension

1RM (kg) 63.8 6 6.9 81.7 6 11.1* 98.4 6 14.1†‡ 61.5 6 10.0 94.7 6 20.9* 113.0 6 13.5† §k 70.0 6 16.4 72.4 616.2

Intensity/ﬁrst

set (kg)

48.8 6 7.9 58.9 6 9.5 79.5 6 18.9 96.6 611.9

% 1RM 59.7 6 5.1 60.0 6 6.8 83.7 6 3.7 85.5 61.7

Values are mean 6 SD ;n = 12 for each group. One-repetition maximum in the 13th week was measured after completion of the 13-week training period (posttraining).

LST = low-intensity resistance training with slow movement and tonic force generation; HN = high-intensity resistance training with normal speed; CON = sedentary controls;

1RM = one-repetition maximum.

*Signiﬁcant difference (p, 0.05) between pretraining and 7th week.

†Signiﬁcant difference (p, 0.05) between 7th week and 13th week.

‡Signiﬁcant increase from pretraining to 13th week in LST (p, 0.05) as compared with CON.

§Signiﬁcant increase from pretraining to 13th week in HN (p, 0.05) as compared with CON.

kSigniﬁcant increase from pretraining to 13th week in HN (p, 0.05) as compared with LST.

VOLUME 22 | NUMBER 6 | NOVEMBER 2008 | 1929

Journal of Strength and Conditioning Research

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representative for all ﬁve types of exercise. Each measurement

was taken between weeks 7 and 9, when the participants had

become sufﬁciently accustomed to the training routine.

Electromyographic Recording. Electromyographic signals dur-

ing squat exercise were recorded from the left vastus lateralis

(VL) muscle and long head of the biceps femoris (BF) muscle.

Bipolar surface electrodes (Vitrode F; Nihon Kohden Corp.,

Japan) were placed over the belly of the muscle with

a constant interelectrode distance of 30 mm. The EMG

signals were ampliﬁed, fed into a full-wave rectiﬁer through

both low (30 Hz) and high (1 kHz) cut ﬁlters, and stored using

a data-acquisition system (Power Lab/16SP; AD Instruments,

Australia).

Measurement of Peripheral Muscle Oxygenation by a Near-

Infrared Continuous-Wave Spectroscopic Monitor. A near-infrared

continuous-wave spectroscopic (NIRcws) monitor

(BOML1TR; Omegawave, Inc., Japan) was used to measure

the peripheral muscle oxygenation in the left VL muscle during

and after vertical squat exercise. The wavelengths of emission

light were 780, 810, and 830 nm, and the relative concen-

trations of oxygenated hemoglobin/myoglobin (Oxy-Hb/Mb)

in tissues were quantiﬁed according to the Beer-Lambert law

(7). Because the NIRcws signals registered during exercise do

not always reﬂect the absolute levels of oxygenation, the

changes in oxygenation in working skeletal muscles are

expressed as values relative to the overall changes in the signal

monitored according to the arterial occlusion method (7,14).

In the present study, the resting level of Oxy-Hb/Mb was

deﬁned as 100% (baseline), and the minimum plateau level of

Oxy-Hb/Mb obtained by arterial occlusion was deﬁned as 0%.

A pressure cuff was placed around the proximal portion of the

thigh and was inﬂated manually up to 300 mm Hg until

the minimum plateau level of Oxy-Hb/Mb was attained (4).

The distance between the incident point and the detector was

30 mm. The laser emitter and detector were ﬁxed with tape

after shielding with a rubber sheet. The NIRcws signals were

stored on a personal computer.

Measurement of Blood Lactate Concentration. Blood samples

were collected during the exercise sessions. Samples were

collected before and immediately after each type of exercise.

Blood samples of approximately 5 m l were taken from the

ﬁngertip using a needle and were analyzed immediately for

blood lactate concentration using a lactate analyzer (Lactate

Pro; Kyoto Primary Science, Japan).

Measurement of Blood Pressure. Blood pressure from the left

radial artery was measured continuously during exercise with

an arterial tonometry during the vertical squat exercise

(JENTOW-7700; Colin, Japan). During measurements, the

arm was supported with an adjustable board. To minimize the

mechanical effects of the contraction of upper-body muscles

and changes in posture, the upper body was kept relaxed and

was immobilized on the machine during exercise. Blood

pressure signals were stored on a personal computer.

Chronic Effects of Resistance Training. Muscle thickness and

SFT using B-mode ultrasound, LSTM (body mass minus

bone mass minus fat mass), fat mass, and BMD using DXA,

and maximal muscular strength by 1RM test with the ﬁve

types of exercise used in the training regimen were measured

before and after the experimental period to evaluate the

chronic effects of these training regimens.

Muscle and Subcutaneous Fat Thickness by B-Mode Ultrasound

Imaging. The MT and SFT were measured by B-mode

ultrasound (5-MHz scanning head) at six sites from the

anterior and posterior surfaces of the body, in principle

following the standard method described by Abe et al. (1).

The sites were the chest, anterior and posterior upper arm,

abdomen, subscapula, and anterior and posterior thigh. Six

anatomic landmarks for the sites are noted below.

Chest: At a distance of 8 cm, directly above the mamilla.

Anterior and posterior upper arm: On the anterior and

posterior surface, 60% distal between the lateral epicondyle of

the humerus and the acromial process of the scapula.

Abdomen: At a distance 2–3 cm to the right of the

umbilicus.

Subscapula: At a distance of 5 cm, directly below the

inferior angle of the scapula.

Anterior and posterior thigh: On the anterior and posterior

surface, midway between the lateral condyle of the femur and

the greater trochanter.

Muscle thickness and SFT were scanned using a real-time

linear electronic scanner with a 5-MHz scanning head

(SSD-500; Aloka, Japan). The scanning head was prepared

with water-soluble transmission gel that provided acoustic

contact without depression of the skin surface. The scanner

was placed perpendicular to the tissue interface at the

marked sites.

Whole-Body Composition in Dual-Energy X-Ray Absorptiometry.

Lean soft-tissue mass (body mass minus bone mass minus fat

mass), fat mass, and BMD were determined for the whole

body using DXA (Hologic QDR-4500A scanner; Hologic,

USA). Subjects were positioned for whole-body scans

according to the manufacturer's protocol. Participants lay

in the supine position on the DXA table with the limbs close

to the body. Fat-free body mass (FFM) was the sum of LSTM

and bone mineral content (BMC). The bone densitometer

delivers a very low dose of radiation (1.5 mR for the whole

body) using quantitative digital radiography. To minimize

interobserver variation, all scans and analyses were carried out

by the same investigator, and the day-to-day coefﬁcients of

variation (CVs) of the observations were , 0.8 whole-body

BMD. The whole-body was divided into several regions:

arms, legs, trunk, and head. The body compositions were

analyzed using manual DXA analysis software (version

11.2.3). The arm region was deﬁned as the region extending

1930

Journal of Strength and Conditioning Research

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Effects of Whole-Body LST Training

from the head of the humerus to the distal tip of the ﬁngers.

The reference point between the head of the humerus and the

scapula was positioned at the glenoid fossa. The leg region

was deﬁned as the region extending from the inferior border

of the ischial tuberosity to the distal tip of the toes. The whole

body was deﬁned as the region extending from the shoulders

to the distal tip of the toes. We selected a reference point that

could be visualized clearly on the DXA system terminal.

Measurements of Muscle Strength. Maximal muscular strength

was tested with the ﬁve types of exercise used in the training

regimen: vertical squat, chest press, latissimus dorsi pull-

down, abdominal bend, and back extension. Values were

obtained for 1RM according to the established guidelines

(39). The 1RM strength test using resistance exercise

machines was considered better suited to eliminate the

inﬂuence of coordination recruitment skills than a test using

free weights, such as barbells.

In this 1RM test, subjects lifted the load on a resistance

exercise machine from a bottom position without preliminary

(eccentric) muscle contractions, because preliminary muscle

contraction enhances muscle force (41). In this study, 1RM

has been underestimated compared with 1RM as tested with

preliminary muscle contractions such as free weight bench

press and squat lifting after eccentric movement. This means

that the exercise loads (% 1RM) used in LST and HN might

be overestimated.

Statistical Analyses

All values are expressed as mean 6SD . One-way analysis of

variance (ANOVA) with a Fisher protected least signiﬁcant

difference test was used to determine the signiﬁcance of any

differences among the initial parameters of the three groups,

such as body weight and muscle strength. One-way ANOVA

with a Fisher protected least signiﬁcant difference test was

used to examine differences in peripheral muscle oxygena-

tion and blood lactate concentration between groups.

Two-way ANOVA with repeated measures (group 3period)

with the Newman-Keuls method was used to examine

differences in changes in MT and SFT, body weight, LSTM,

fat mass, percent body fat, BMD, and 1RM among groups.

For all statistical tests, p# 0.05 was considered signiﬁcant.

Power calculations (statistical power) were performed using

G*power computer software. Statistical power of . 80%

was obtained in the main signiﬁcant changes, such as MT,

LSTM, and 1RM strength after the LST and HN training

terms. Intraclass correlation coefﬁcient and CV were

calculated to examine the test-retest reliability for variables

in MT and SFT measured by B-mode ultrasound and 1RM

strength test, because these variables may be affected by

manual handling technique. Intraclass correlation coefﬁcient

and the mean CV value for measurement values by B-mode

ultrasound in our laboratory were 0.999 and 3.2%, re-

spectively. Intraclass correlation coefﬁcient and the mean CV

value for measurement values of 1RM strength test were 0.995

and 2.8%, respectively.

RESULTS

Acute Effects of Exercises

Typical Examples of Muscle Electric Activity During Exercise.

Figure 1 shows typical examples of changes in EMG signals

from VL during vertical squat exercise. In LST, the EMG

from VL showed almost continuous activity throughout the

entire movement. In HN, EMG signals from VL exhibited

intermittent activity. Data from two subjects, whose 1RM

values were about the same, are shown. The measurements

of EMG from VL were made for all subjects in the training

groups (n = 24). All subjects showed essentially the same

patterns.

Peripheral Muscle Oxygenation

Figure 2 shows minimum and maximum oxygenation levels

in the left VL during and after vertical squat exercise in

Figure 1. Typical electromyographic (EMG) signals from the vastus lateralis (VL) during vertical squat exercise. The signals were recorded during (A) low-intensity

resistance training with slow movement and tonic force generation (LST) with a load of 75 kg (~57% one-repetition maximum [1RM]) and (B) high-intensity

resistance training with normal speed (HN) with a load of 102 kg (~89% 1RM) in the vertical squat. Records were from the ﬁrst to second lifting movements in the

ﬁrst set for LST and from the ﬁrst to fourth lifting movements for HN. Data from two subjects, whose 1RM strengths were about the same, are shown.

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LST and HN. In both LST and HN, the oxygenation level

decreased immediately when the exercise repetitions started,

and it recovered rapidly and was followed by a hyper-

compensation after the end of the exercise repetitions. The

mean value of minimum oxygenation level during LST

vertical squat exercise was signiﬁcantly lower than that

during HN exercise (Figure 2A). The large decrease in

muscle oxygenation level during LST exercise was likely

attributable to continuous activity of the knee extensor

muscles (see Figure 1A). There were no signiﬁcant differ-

ences in the mean values of maximum oxygenation level after

LST and HN exercise (Figure 2B).

Blood Lactate Concentration

Figure 3 shows changes in blood lactate concentration

measured at rest and immediately after each type of exercise

in LST and HN. There were no signiﬁcant differences in

blood lactate concentration at rest between LST and HN

groups. Both LST and HN exercise caused marked increases

in blood lactate concentration after each type of exercise. No

signiﬁcant differences were observed between blood lactate

concentrations after any of the exercise types in LSTand HN.

Changes in blood lactate concentration during exercise were

similar in LSTand HN, despite the much lower intensity and

smaller amount of work in LST than in HN. The large

increase in the concentration of blood lactate (which is an

anaerobic energy metabolite) during LST exercise was likely

attributable to the lower muscle oxygenation level in LST

(see Figure 2A).

Blood Pressure During Exercise

Figure 4 shows peak blood diastolic pressure during LSTand

HN vertical squat exercise in the ﬁrst set and at rest. In both

LST and HN training groups, the diastolic pressure reached

a peak at the last repetition or the second- or third-from-last

repetition in the exercise set, and it exhibited signiﬁcant

increases from that at rest. The peak diastolic pressure during

HN vertical squat exercise (183.4 6 33.0 mm Hg) was

signiﬁcantly higher than that during LST exercise (124.4 6

29.4 mm Hg). Peak blood systolic pressure during vertical

exercise exceeded the measurement range of the equipment

(300 mm Hg) in some subjects in the HN group. Therefore,

we evaluated the elevation of blood pressure during vertical

squat exercise with peak blood diastolic pressure during

exercise.

Chronic Effects of Resistance Training

Changes in Muscle and Subcutaneous Fat Thickness. Figure 5

shows changes in total MT, deﬁned as the sum of the values

for all six measurement sites, in the three groups after the

experimental period. There were no signiﬁcant differences

among groups in MT at each measurement site before the

experimental period. In both LST and HN groups, MT

increased signiﬁcantly after the experimental period, whereas

no such change was observed in the CON group. The

percent changes in total MT after the experimental period

were +6.8 6 3.4% in LST, +9.1 6 4.2% in HN, and +1.3 6

2.2% in CON. These changes in LST and HN were

signiﬁcantly greater than those in CON, and there were no

signiﬁcant differences between the changes in LST and in

HN (Figure 5). In LST and HN, the MT of all measurement

sites except the anterior upper arm increased signiﬁcantly

after the experimental period. There were no changes at any

of the sites in CON. Increases in MT at all measurement sites

(except the anterior upper arm) in LST and in HN were

signiﬁcantly greater than those in CON, and there were no

signiﬁcant differences between the changes in LST and HN

Figure 2. A) Mean values of minimum oxygenation level during low-intensity resistance training with slow movement and tonic force generation (LST) and

high-intensity resistance training with normal speed (HN) in the vertical squat. Mean values 6SD (n = 12 for each group) are shown. *Signiﬁcant differences

(p, 0.05) between groups. B) Mean values of maximum oxygenation level after LST and HN exercises in the vertical squat. Mean values 6 SD (n = 12 for each

group) are shown.

1932

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Effects of Whole-Body LST Training

at any of the measurement sites. The values of MT at each

measurement site before and after the experimental period

are summarized in Table 3. Figure 6 shows changes in total

SFT, deﬁned as the sum of the values for all six measurement

sites, in the three groups after the experimental period. No

signiﬁcant differences were observed among groups in SFT at

each measurement site before the experimental period. In

the HN group, total SFT decreased signiﬁcantly after the

experimental period, whereas there were no such changes in

the LST or CON groups. The percent changes in total SFT

after the experimental period

were 2 2.1 6 1.22% in LST,

210.2 6 9.4% in HN, and +1.5

610.2% in CON. This decrease

in HN was signiﬁcantly greater

than those in the LST and

CON groups (Figure 6). In

HN, SFT in the posterior upper

arm was signiﬁcantly decreased

after the experimental period.

In LST and CON, the SFT in

the subscapula increased signif-

icantly after the experimental

period. The decrease in HN in

the posterior upper arm was

signiﬁcantly greater than that in

CON. The SFT decrease in the

subscapula was signiﬁcantly

greater in HN than in LST

and CON. All values of SFT at each measurement site before

and after the experimental period are summarized in Table 3.

Changes in Lean Soft-Tissue Mass, Fat Mass, Percent Body

Fat, and Bone Mineral Density in Dual-Energy X-Ray

Absorptiometry

Table 4 shows all values measured by DXA, such as LSTM,

fat mass, percent body fat, and BMD, before and after

the experimental period. No signiﬁcant differences were

observed among groups before the experimental period.

Whole-body LSTM in all groups, even in the CON group,

increased signiﬁcantly after the experimental period. The

Figure 4. Peak blood diastolic pressure during low-intensity resistance

training with slow movement and tonic force generation (LST) and

high-intensity resistance training with normal speed (HN) vertical squat

exercises (ﬁlled bars) and at rest (open bars). Mean values 6SD (n =12

for each group) are shown. *Signiﬁcant differences (p, 0.05) between

groups. The values for both types of exercise showed signiﬁcant changes

as compared with the resting level (p, 0.05).

Figure 3. Changes in blood lactate concentrations before and immediately after low-intensity resistance training

with slow movement and tonic force generation (LST;  ) and high-intensity resistance training with normal speed

(HN; s ). Mean values 6 SD (n = 12 for each group) are shown. SQ = vertical squat; CP = chest press;

LP = latissimus dorsi pull-down; BE = back extension.

Figure 5. Sum of whole-body muscle thickness of six sites before (open

bars) and after (ﬁlled bars) the experimental period. Mean values 6SD

(n = 12 for each group) are shown. *Signiﬁcant differences between

pre- and posttraining values (p, 0.05). † Signiﬁcant differences between

groups (p, 0.05).

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TABLE 3. Muscle and subcutaneous fat thickness before and after the experimental period.

LST HN CON

Pretraining Posttraining Pretraining Posttraining Pretraining Posttraining

Muscle thickness, mm

Chest 1.75 6 0.34 2.03 6 0.41*† 1.67 6 0.44 2.02 6 0.51*‡ 1.62 6 0.22 1.64 60.23

Anterior upper arm 2.70 6 0.21 2.76 6 0.25 2.53 6 0.21 2.66 6 0.22 2.69 6 0.24 2.70 60.25

Posterior upper arm 2.87 6 0.38 3.15 6 0.41*† 2.84 6 0.49 3.09 6 0.38*‡ 2.95 6 0.55 2.96 60.55

Abdomen 1.44 6 0.19 1.56 6 0.20*† 1.29 6 0.13 1.45 6 0.14*‡ 1.30 6 0.23 1.28 60.23

Subscapula 2.42 6 0.41 2.58 6 0.47*† 2.31 6 0.33 2.61 6 0.44*‡ 2.35 6 0.35 2.23 60.28

Anterior thigh 5.12 6 0.59 5.45 6 0.66*† 4.94 6 0.36 5.49 6 0.42*‡ 5.16 6 0.55 5.29 60.50

Posterior thigh 5.72 6 0.52 5.96 6 0.37*† 5.82 6 0.45 6.00 6 0.49*‡ 5.69 6 0.35 5.76 60.38

Subcutaneous fat thickness, mm

Chest 0.52 6 0.18 0.50 6 0.18 0.82 6 0.51 0.62 6 0.31 0.67 6 0.36 0.65 60.34

Anterior upper arm 0.21 6 0.06 0.22 6 0.06 0.25 6 0.07 0.26 6 0.06 0.22 6 0.06 0.25 60.07

Posterior upper arm 0.54 6 0.18 0.52 6 0.22 0.69 6 0.17 0.61 6 0.14*§ 0.59 6 0.15 0.58 60.13

Abdomen 0.85 6 0.88 0.74 6 0.70 1.03 6 0.43 0.90 6 0.36 1.07 6 0.65 1.05 60.56

Subscapula 0.57 6 0.12 0.63 6 0.15* 0.65 6 0.16 0.63 60.12

0.59 6 0.13 0.68 60.12*

Anterior thigh 0.50 6 0.12 0.48 6 0.19 0.62 6 0.19 0.55 6 0.17 0.56 6 0.11 0.53 60.13

Posterior thigh 0.63 6 0.27 0.61 6 0.27 0.71 6 0.20 0.64 6 0.15 0.71 6 0.18 0.69 60.18

Values are mean 6 SD ;n = 12 for each group.

LST = low-intensity resistance training with slow movement and tonic force generation; HN = high-intensity resistance training with

normal speed; CON = sedentary controls.

*Signiﬁcant difference (p, 0.05) between pretraining and posttraining.

†Signiﬁcant increase in muscle thickness in LST (p, 0.05) as compared with CON.

‡Signiﬁcant increase in muscle thickness in HN (p, 0.05) as compared with CON.

§Signiﬁcant decrease in subcutaneous fat thickness in HN (p, 0.05) as compared with CON.

Signiﬁcant decrease in subcutaneous fat thickness in HN (p, 0.05) as compared with LST and CON.

TABLE 4. Body composition in DXA before and after the experimental period.

LST HN CON

Pretraining Posttraining Pretraining Posttraining Pretraining Posttraining

Whole body

LSTM (kg) 53.86 6 3.86 55.23 6 3.68*† 53.74 6 3.04 55.57 6 3.41*‡ 54.56 6 2.71 55.19 62.57*

Fat mass (kg) 8.66 6 2.75 58.86 6 3.11 10.08 6 2.35 9.75 6 2.20 9.60 6 2.70 9.55 62.68

% Fat (%) 13.75 6 3.63 11.68 6 3.79 15.73 6 3.21 14.85 6 2.89* 14.83 6 3.56 14.63 63.54

BMD (gcm

) 1.19 6 0.10 1.10 6 0.10 1.17 6 0.10 1.17 6 0.10 1.21 6 0.07 1.21 60.07

Arms

LSTM (kg) 5.35 6 0.52 5.52 6 0.59*† 5.10 6 0.51 5.38 6 0.51*‡ 5.18 6 0.46 5.24 60.50

Fat mass (kg) 0.84 6 0.30 0.86 6 0.28 1.01 6 0.29 0.99 6 0.26 0.99 6 0.34 0.94 60.30

Legs

LSTM (kg) 17.80 6 1.45 18.26 6 1.34*† 17.73 6 1.43 18.55 6 1.57*‡ 17.91 6 1.07 18.22 61.35

Fat mass (kg) 3.30 6 1.17 3.36 6 1.24 3.96 6 1.06 3.78 6 0.86 3.55 6 1.04 3.52 61.04

Values are mean 6 SD ;n = 12 for each group.

DXA = dual-energy X-ray absorptiometry; LST = low-intensity resistance training with slow movement and tonic force generation;

HN = high-intensity resistance training with normal speed; CON = sedentary controls; LSTM = lean soft-tissue mass; BMD = bone mass

density; % fat = percent body fat.

*Signiﬁcant difference (p, 0.05) between pretraining and posttraining.

†Signiﬁcant increase in LST (p, 0.05) as compared with CON.

‡Signiﬁcant increase in HN (p, 0.05) as compared with CON.

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Journal of Strength and Conditioning Research

the

Effects of Whole-Body LST Training

absolute changes in LSTM were 1.4 6 1.4 kg in LST, 1.8 6

1.3 kg in HN, and 0.6 6 0.7 kg in CON. These changes in

LST and in HN were signiﬁcantly greater than those in

CON, and there were no signiﬁcant differences between the

changes in LST and in HN. The LSTM increase observed in

the CON group may have been attributable to weight gain

associated with seasonal variations and growth. Whole-body

percent body fat in the HN group decreased signiﬁcantly

after the experimental period. This decrease in HN was

signiﬁcantly greater than those in LST and CON, and there

were no signiﬁcant differences between the changes in LST

and in CON. No signiﬁcant changes occurred in body mass,

fat mass, or BMD in any of the groups. All values measured

by DXA before and after the experimental period are

summarized in Table 4. Changes in FFM and fat mass in

DXA were similar to those in MTH and SFT as determined

by ultrasound imaging. Ultrasound imaging was used for

direct assessment in regions involved in training, so

ultrasound imaging may have higher detection sensitivity

for detecting signiﬁcant changes than DXA.

Changes in Muscular Strength

Figure 7 shows changes in total 1RM strength, deﬁned as the

sum of values for all ﬁve types of exercise used in the training

regimen, in the three groups after the experimental period.

No signiﬁcant differences were observed among groups in

1RM strength in each type of training before the exper-

imental period. In the LST group and the HN group, total

1RM strength increased signiﬁcantly after the experimental

period (Table 4), whereas there was no such change in the

CON group (Figure 7). The percent changes in total 1RM

strength were +33.0 6 8.8% in LST, +41.2 6 7.8% in HN, and

+1.3 6 2.4% in CON. These increases in LSTand in HN after

the experimental period were signiﬁcantly greater than the

value in CON, and there were no signiﬁcant differences

between the changes in LST and HN. In both LST and HN,

1RM strength in all ﬁve exercises increased signiﬁcantly after

the experimental period. There were no such changes in

CON. The increases in LST and HN in 1RM strength in all

ﬁve types of exercise were signiﬁcantly larger than the values

in CON, and there were no signiﬁcant differences between

the changes in LSTand in HN except in back extension. The

increase in 1RM strength on back extension in HN was

signiﬁcantly greater than that in LST. The values of 1RM

strength in each type of exercise before and after the

experimental period are summarized in Table 2.

DISCUSSION

The results of the present study indicate a signiﬁcant increase

in muscular size and concomitant increase in muscular

strength after a 13-week whole-body LST training program

consisting of the ﬁve following exercises: vertical squat, chest

press, latissimus dorsi pull-down, abdominal bend, and back

extension. The term LST refers to a low-intensity (~55–60%

1RM) resistance training program with slow movement and

tonic force generation. The gains in muscular size and

strength were similar to those after the same whole-body

training program using a high-intensity load (~80–90%

1RM) with normal speed (HN). Previously, we reported that

a 12-week LST training program with one type of exercise

(knee extension) caused signiﬁcant increases in muscular size

and strength to the same degree as HN. This previous study

investigated only local effects and provided no information

about systemic effects of LST whole-body resistance training.

Figure 6. Sum of whole-body subcutaneous fat thickness of six sites

before (open bars) and after (ﬁlled bars) the experimental period. Mean

values 6SD (n = 12 for each group) are shown. *Signiﬁcant differences

between pre- and posttraining values (p, 0.05). † Signiﬁcant differences

between groups (p, 0.05).

Figure 7. Sum of one-repetition maximum (1RM) strength of ﬁve

exercises before (open bars) and after (ﬁlled bars) the experimental

period. Mean values 6SD (n = 12 for each group) are shown.

*Signiﬁcant differences between pre- and posttraining values (p, 0.05).

†Signiﬁcant differences between groups (p, 0.05).

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Single-joint exercises with exercise machines, such as knee

extensions, are considered more appropriate for LST to

achieve strict continuous force generation throughout the

exercise movement than multijoint exercises. However,

whole-body resistance training programs usually consist

mainly of multijoint exercises. Multijoint exercises usually

recruit more large muscle areas than single-joint exercises. In

addition, the movements in most multijoint exercises are

considered more similar to sport and daily performance

movements. The signiﬁcance of the present study lies in the

demonstration that a whole-body LST training program

consisting mainly of multijoint exercises, as a prescription

program for actual training, was effective for muscular

hypertrophy and strength gain as systemic effects.

In the previous study, the increase in muscular size after

a 12-week knee extension LST training program tended to be

higher than that after HN training. On the other hand, the

increase in systemic muscular size after 13 weeks of whole-

body LST training mainly consisting of multijoint exercises

tended to be lower than that after HN in this study (no sig-

niﬁcant difference). The difference between the results in

these two studies may be related to the fact that knee exten-

sion exercise, which is a single-joint exercise, is considered to

be better suited for continuous muscle contraction in LST.

Multijoint LST exercise (vertical squat) has the following

physiological characteristics: a) continuous muscle activity is

kept constant throughout the entire exercise movement

(Figure 1A); b) lowered peripheral muscle oxygenation level

during exercise (Figure 2A); c) elevated peripheral muscle

oxygenation level immediately after exercise (Figure 2B); and

d) increased blood lactate concentration (Figure 3). These

characteristics in multijoint LST exercise are similar to those

of single-joint LST exercise with a knee extension exercise

machine examined in the previous study (37). The lowered

muscle oxygenation level and increased blood lactate

concentration during LST exercise were likely attributable

to the restriction of muscular blood ﬂow by continuous

muscle activity. It has been speculated that local accumula-

tion of anaerobic energy metabolites, such as lactate,

stimulates the hypophyseal secretion of GH (22,33) and

the local secretion of growth factors, such as insulin-like

growth factor 1 (28). It has also been shown that plasma GH

stimulates synthesis and secretion of insulin-like growth

factor 1 within muscle, which may then act on the muscle

itself and promote growth (8,17). The production of ROS

may play an important role in muscular hypertrophy. The

activity of ROS within the muscle has been shown to be

enhanced in hypoxic environments (20). A considerable

amount of ROS could be produced when the muscle is kept

hypoxic and subsequently exposed to reperfusion (31).

Among the ROS, nitric oxide, which is the strongest

vasodilator characterized to date, has also been shown to

mediate the activation and proliferation of muscle satellite

cells, which are muscle ﬁber stem cells (3). Therefore, both

lowered and elevated muscle oxygenation levels during and

after exercise may cause enhanced production of ROS,

thereby stimulating muscle growth. Additional recruitment

of fast-twitch ﬁbers under a hypoxic condition is likely to

mediate muscle hypertrophy (30,36). Almost all of the motor

units were considered to be recruited at the ﬁnal repetition in

all sets in LST as well as in HN exercise, because subjects in

both HN and LST repeated the movement until exhaustion

(27). The physiological characteristics of LST differ signif-

icantly from those of HN using a high-intensity load.

However, 13 weeks of whole-body resistance training using

both LST and HN caused comparable increases in muscular

size and strength.

Some recent studies have indicated that low-intensity

resistance training combined with moderate vascular occlu-

sion using artiﬁcial occlusive pressure causes marked

increases in muscular size and strength (2,29,34,36). These

studies suggest that large mechanical stress is not indispens-

able for muscular hypertrophy and strength gain. They also

suggest that the muscle-trophic effect of resistance training

involves not only large mechanical stress but also metabolic,

hormonal, and neuronal factors. However, resistance training

with vascular occlusion is so specialized that it should not be

widely used without careful monitoring of occlusive pressure

and blood ﬂow. Its application is limited to upper-limb and

lower-limb muscles, because it can be applied only to distal

muscles from occlusive pressure belts. Usually, resistance

training combined with moderate vascular occlusion is

performed using occlusive pressure belts at the roots of the

limbs. This is often associated with pain attributable

to artiﬁcial occlusive pressure. The LST training, which sus-

tains continuous force generation at . 40% MVC to restrict

muscle blood ﬂow, would also be effective to make the

intramuscular environment hypoxic even without artiﬁcial

occlusive pressure. This can be applied not only to limb

muscles but also to trunk muscles, and it is free from the pain

associated with artiﬁcial occlusive pressure. Therefore, this

represents a good alternative to resistance training with

vascular occlusion.

The movement speed of LST in this study (3 seconds for

concentric and eccentric actions) was conﬁgured so that all

subjects could easily maintain continuous force generation

throughout the exercise movement. In the exercise move-

ment consisting of 2 seconds for concentric and eccentric

actions, it seemed to be difﬁcult for the subjects to maintain

constant tension, whereas in the exercise movement consist-

ing of 4 seconds for concentric and eccentric actions, the

subjects could maintain constant tension easily, but it was

almost impossible for them to perform several repetitions at

sufﬁcient intensity (. 40% MVC) to restrict muscle blood

ﬂow. Thus, the movement speed of LST was determined

based on the requirements described below.

1. Continuous force generation could be easily achieved

even by beginners without previous experience of resis-

tance training.

1936

Journal of Strength and Conditioning Research

the

Effects of Whole-Body LST Training

2. Continuous force generation throughout the exercise

movement with more than 40% MVC load to restrict

muscle blood ﬂow.

The prime point of LST is slow movement to achieve tonic

force generation, and not to slow movement itself. In this

point, LST is different from SuperSlow (10-second lifting

and 4-second lowering movement), a registered trademark

of Ken Hutchins (42).

Fat mass measured by DXA decreased signiﬁcantly,

although not markedly, after HN training, whereas no

signiﬁcant decrease was observed after LST. Acute increase

in plasma catecholamine concentration during exercise may

be one of the reasons for fat loss in HN. We also have shown

previously that LST and HN leg extension exercise

immediately increased plasma norepinephrine concentration.

The amount of increase in HN tended to be higher than that

in LST (38). Acute increases in plasma catecholamine

concentration during and immediately after exercise enhance

fat oxidation for energy expenditure (12,25). In addition, the

larger amount of mechanical work may cause fat loss in HN.

The amount of work in HN was about 1.5 times that in LST.

Bone mass density (see Table 4) and bone mass component

(BMC data not shown) were not increased after the

experimental period in any groups. This result is perhaps

related to the length of the experimental period. It is

considered that the experimental period in this study was

short, and therefore no changes were observed in BMD or

BMC. Bone adapts to high mechanical stress by changing its

size and density, and the heavier the magnitude of load, the

greater the stimulus for bone growth (40). Thus, BMD and

BMC increases from long-term resistance training would be

more effective in HN than in LST.

High-intensity resistance training does not necessarily

increase the risk of injury. High-intensity resistance training

does not cause orthopedic or cardiovascular problems when

performed or supervised appropriately (13). However, it has

also been reported that approximately 20% of the elderly

(aged 70–79 years) showed some symptoms of orthopedic

injury after training at 1RM (26). In addition, a marked

increase in systolic blood pressure (up to 250 mm Hg) has

been reported to occur during high-intensity resistance

training (~8RM) for large muscle groups (10). Some studies

have reported large numbers of cases in which vascular

events, such as aortic dissection, occurred during high-

intensity resistance training (15,16). Thus, high-intensity

resistance training can increase the risk of injury and vascular

events during exercise. Therefore, the development of

a resistance training regimen that can cause substantial gains

in strength with much lower mechanical stress would be

advantageous for the development of safer and effective

methods of promoting muscle hypertrophy for a wider range

of people, including older people and those with cardiovas-

cular problems.

In conclusion, low-intensity whole-body resistance training

with slow movement and tonic force generation consisting

mainly of multijoint exercises was as effective for increasing

muscular size and strength as high-intensity resistance

training. This training method was not associated with the

generation of large force or with any considerable elevation of

blood pressure. Therefore, it would be useful for promoting

muscular hypertrophy and strength increases in a larger

population, including the elderly and those at higher risk of

cardiovascular adverse events. In this regard, however, LST is

anything but easy for subjects to carry out despite the use of

a relatively low-intensity load. Subjects repeat movement

until exhaustion in LST as in HN.

PRACTICAL APPLICATIONS

The guideline of ''load and repetition assignments based on

the training goal'' based on Fleck and Kraemer's systematic

review of resistance training (11) and other studies (39) has

been widely used in the ﬁeld of physical ﬁtness. This

guideline recommends resistance training with 6–12 repeti-

tions using a 67–85% 1RM load for muscle hypertrophy. This

guideline seems like an appropriate assignment in voluntary

movement, but it does not include the concept of enhancing

exercise movement variation. When exercise movement is

devised to place muscles under continuous tension through-

out the exercise movement as in the LST method, resistance

training, even with low-intensity loads of less than 65% 1RM,

can cause muscular hypertrophy and increase strength. The

results of this study indicate that whole-body LST training is

an effective method for gaining muscular size and strength in

actual training. A regimen of LST training with a relatively

low-intensity load can be chosen as a safe resistance training

method with relatively low risk for orthopedic injury and

cardiac event during exercise. The LST training should be

performed with a speed that easily enables continuous force

generation throughout the exercise movement. In actual

training, LST does not have to be performed with the speed

used in this study (3 seconds for concentric and eccentric

actions). However, if the movement is too slow (e.g., more

than 5 seconds for concentric and eccentric actions), it may

be difﬁcult to perform several repetitions at an intensity

sufﬁcient to restrict muscle blood (. 40% MVC). Also, the

mechanical work may not be sufﬁcient to enhance local

accumulation of metabolic byproducts such as lactate and

proton. We recommend that the movement speed should be

as fast as possible within the limits in which continuous force

generation can be maintained. We regard tonic force

generation rather than slow movement to be the primary

point of LST training.

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Journal of Strength and Conditioning Research

the

Effects of Whole-Body LST Training

... Previous studies have provided partial support for Delorme's hypothesis, underpinning what is currently accepted as theory [11,12]. Although some guidelines suggest the use of high and moderate loads to development maximal strength and muscle hypertrophy, several studies showed increases in maximal strength and muscle hypertrophy after resistance training with low loads (i.e., <60% 1RM) [13][14][15][16][17]. These studies are in line with recent guidelines indicating that the athletic population may achieve comparable muscle hypertrophy across a wide spectrum of loading zones [18]. ...

... Reports not retrieved (n = 0) Table 2 shows the characteristics of the participants in the 23 studies that were selected for systematic review regarding the sample size, age, height, weight, and training status (mean ± SD) of the 563 participants, where 454 were untrained (80.6%) [11,[14][15][16][17][21][22][23]26,28,29,[38][39][40][41][42][43][44][45] and 109 were recreationally trained (19.4%) [13,46,47] in resistance training. Table 3 shows the characteristics of the studies that were selected for the systematic review regarding the study design, time of analysis, resistance exercise(s), prescription, weekly frequency, movement tempo, volume, and findings. ...

... Table 3 shows the characteristics of the studies that were selected for the systematic review regarding the study design, time of analysis, resistance exercise(s), prescription, weekly frequency, movement tempo, volume, and findings. Regarding the assessment of maximal strength development, 13 studies assessed dynamic strength using 1RM (56.5%) [11,[13][14][15]17,[21][22][23]29,44,[46][47][48] and another four studies assessed the isometric strength (17.4%) [26,38,39,45]. In addition, five studies simultaneously assessed dynamic strength using 1RM and isometric strength using a maximal voluntary isometric contraction (MVIC) (21.7%) [16,28,[41][42][43], and, finally, one study assessed isometric strength using maximal isometric voluntary torque (4.4%) [40]. ...

The load in resistance training is considered to be a critical variable for neuromuscular adaptations. Therefore, it is important to assess the effects of applying different loads on the development of maximal strength and muscular hypertrophy. The aim of this study was to systematically review the literature and compare the effects of resistance training that was performed with low loads versus moderate and high loads in untrained and trained healthy adult males on the development of maximal strength and muscle hypertrophy during randomized experimental designs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (2021) were followed with the eligibility criteria defined according to participants, interventions, comparators, outcomes, and study design (PICOS): (P) healthy males between 18 and 40 years old, (I) interventions performed with low loads, (C) interventions performed with moderate or high loads, (O) development of maximal strength and muscle hypertrophy, and (S) randomized experimental studies with between-or within-subject parallel designs. The literature search strategy was performed in three electronic databases (Embase, PubMed, and Web of Science) on 22 August 2021. Results: Twenty-three studies with a total of 563 participants (80.6% untrained and 19.4% trained) were selected. The studies included both relative and absolute loads. All studies were classified as being moderate-to-high methodological quality, although only two studies had a score higher than six points. The main findings indicated that the load magnitude that was used during resistance training influenced the dynamic strength and isometric strength gains. In general, comparisons between the groups (i.e., low, moderate, and high loads) showed higher gains in 1RM and maximal voluntary isometric contraction when moderate and high loads were used. In contrast, regarding muscle hypertrophy, most studies showed that when resistance training was performed to muscle failure, the load used had less influence on muscle hypertrophy. The current literature shows that gains in maximal strength are more pronounced with high and moderate loads compared to low loads in healthy adult male populations. However, for muscle hypertrophy, studies indicate that a wide spectrum of loads (i.e., 30 to 90% 1RM) may be used for healthy adult male populations. Citation: Lacio, M.; Vieira, J.G.; Trybulski, R.; Campos, Y.; Santana, D.; Filho, J.E.; Novaes, J.; Vianna, J.; Wilk, M. Effects of Resistance Training

... Previous studies have reported that long-term intervention of LRE with slow movement and tonic force generation (ST-LRE) increases skeletal muscle size and strength effectively in healthy young and older individuals [18][19][20][21][22]. Furthermore, Takenami et al. [23] reported that long-term ST-LRE was effective to increasing these muscle size and strength adaptations in patients with type 2 diabetes, which is a well-known risk of various cognitive diseases (e.g., mild cognitive impairment and Alzheimer's disease) [24]. ...

... All subjects completed both ST-LRE and HRE in a randomized and counterbalanced order (see Fig. 1A). The ST-LRE and HRE were set at 50% and 80% of 1-RM, respectively, according to previous studies [19,20,22]. Both protocols were programmed with bilateral knee extension for six sets with eight repetitions per set using a leg extension machine (Life Fitness; Schiller Park, IL, USA). ...

... Rest intervals between sets for both protocols lasted 1 min. These resistance exercise variables were the basis of the methods employed in previous studies [19][20][21][22][23]. The two experimental sessions were performed at approximately the same time (± 1 h) in the morning, as separated by 1 week. ...

This study compared the effects of low-intensity resistance exercise with slow movement and tonic force generation (ST-LRE) and high-intensity resistance exercise (HRE) on post-exercise improvements in cognitive inhibitory control (IC). Sixteen young males completed ST-LRE and HRE sessions in a crossover design. Bilateral knee extensor ST-LRE and HRE (8 repetitions/set, 6 sets) were performed with 50% of one-repetition maximum with slow contractile speed and 80% of one-repetition maximum with normal contractile speed, respectively. The IC was assessed using the color–word Stroop task at six time points: baseline, pre-exercise, immediate post-exercise, and every 10 min during the 30-min post-exercise recovery period. The blood lactate response throughout the experimental session did not differ between ST-LRE and HRE (condition × time interaction P = 0.396: e.g., mean ± standard error of the mean; 8.1 ± 0.5 vs. 8.1 ± 0.5 mM, respectively, immediately after exercise, P = 0.983, d = 0.00). Large-sized decreases in the reverse-Stroop interference scores, which represent improved IC, compared to those before exercise (i.e., baseline and pre-exercise) were observed throughout the 30 min post-exercise recovery period for both ST-LRE and HRE (decreasing rate ≥ 38.8 and 41.4%, respectively, all d s ≥ 0.95). The degree of post-exercise IC improvements was similar between the two protocols (condition × time interaction P = 0.998). These findings suggest that despite the application of a lower exercise load, ST-LRE improves post-exercise IC similarly to HRE, which may be due to the equivalent blood lactate response between the two protocols, in healthy young adults.

... However, this study compared the effect of a single resistance exercise, which may not necessarily translate into a whole-body training program. To determine the effects of movement tempo during a whole-body resistancetraining program (squat, chest press, latissimus dorsi pulldown, abdominal crunches, and back extensions), Tanimoto et al. [40] investigated MED (3/0/3/0; 55-60%1RM) and FAS (1/0/1/1; 80-90%1RM) tempos over 13 weeks using 3 sets of repetitions performed to muscular fatigue and 60-s rest intervals. They showed that despite using a lighter load with a MED tempo, similar hypertrophic effects were observed compared to the FAS tempo with a heavier load, which is consistent with the single-joint individual exercise results presented previously [18]. ...

... 20 trained men 10/2 Leg press, knee extension, knee flexion, bench press, seated row, elbow extension, elbow flexion 3 sets × 8-10 repetitions 1RM in leg press, bench press ↑ Muscle strength in leg press and bench press between pre and post for X/0/X/0 ↑ Muscle strength in leg press and bench press between pre and post for 2-3/0/2-3/0 ↔ Muscle strength in leg press and bench press between X/0/X/0 and 2-3/0/2-3/0 Leg press, knee extension 3 sets × 8 repetitions 1RM in leg press, knee extension ↑ Muscle strength in leg press and knee extension between pre and post for 2/1/X/0 ↑ Muscle strength in leg press and knee extension between pre and post for 2/1/2/0 ↔ Muscle strength in leg press and knee exten- Although the load, or the mechanical stimulus, has been suggested to be of critical importance for inducing hypertrophic adaptations [36,41,42], most studies use different external loads for the faster and slower tempos [18,25,40,43], which results in different mechanical stimuli. Furthermore, the meta-analysis made by Schoenfeld et al. [2] showed that not only the external load but also the point of muscle failure during the set is an important factor affecting hypertrophy. ...

... Furthermore, the meta-analysis made by Schoenfeld et al. [2] showed that not only the external load but also the point of muscle failure during the set is an important factor affecting hypertrophy. Therefore, the results of the two previously described studies [18,40] indicate that movement tempo is an important variable that also plays a significant role in the anabolic process, and slower movements can be useful to compensate for any decreases in the load used as long as the exercises are performed to muscular failure. Although the data of Tanimoto and Ishii [18] and Tanimoto et al. [40] indicate that hypertrophy can be similar, or greater, with a MED movement tempo at 50-60%1RM compared to a FAS one at (80-90%1RM), not only differences in the load used, but also the volume of exercise should also be considered. ...

Hypertrophy and strength are two common long-term goals of resistance training that are mediated by the manipulation of numerous variables. One training variable that is often neglected but is essential to consider for achieving strength and hypertrophy gains is the movement tempo of particular repetitions. Although research has extensively investigated the effects of different intensities, volumes, and rest intervals on muscle growth, many of the present hypertrophy guidelines do not account for different movement tempos, likely only applying to volitional movement tempos. Changing the movement tempo during the eccentric and concentric phases can influence acute exercise variables, which form the basis for chronic adaptive changes to resistance training. To further elaborate on the already unclear anecdotal evidence of different movement tempos on muscle hypertrophy and strength development, one must acknowledge that the related scientific research does not provide equivocal evidence. Furthermore, there has been no assessment of the impact of duration of particular movement phases (eccentric vs. concentric) on chronic adaptations, making it difficult to draw definitive conclusions in terms of resistance-training recommendations. Therefore, the purpose of this review is to explain how variations in movement tempo can affect chronic adaptive changes. This article provides an overview of the available scientific data describing the impact of movement tempo on hypertrophy and strength development with a thorough analysis of changes in duration of particular phases of movement. Additionally, the review provides movement tempo-specific recommendations as well real training solutions for strength and conditioning coaches and athletes, depending on their goals.

... A total of eight studies measured muscle thickness via ultrasound at multiple measurement sites including the upper thigh, lower arm, upper arm and chest. Seven (Ikezoe et al., 2020;Jenkins et al., 2017;Jessee et al., 2018;Schoenfeld et al., 2015Schoenfeld et al., , 2020Stefanaki et al., 2019;Tanimoto et al., 2008) of the eight studies identified equivalent increases in muscle thickness between high-load and low-load RT, and one study (Lasevicius et al., 2018) found greater improvements for highload RT. ...

... A total of 10 studies used either DXA (Franco et al., 2019;Morton et al., 2016;Ribeiro et al., 2020;Taaffe et al., 1996;Tanimoto et al., 2008;Vargas et al., 2019), BodPod (Au et al., 2017;Rana et al., 2008), bioelectrical impedance analysis (Richardson et al., 2019) or skinfolds (Schuenke et al., 2012) to measure changes in lean body mass (LBM) or fat-free mass. Six (Au et al., 2017;Morton et al., 2016;Rana et al., 2008;Ribeiro et al., 2020;Schuenke et al., 2012;Tanimoto et al., 2008) of the 10 studies found no differences between loading conditions, one study (Vargas et al., 2019) demonstrated an advantage for high-load RT, while another (Franco et al., 2019) showed the opposite effect. ...

This systematic review and meta-analysis determined resistance training (RT) load effects on various muscle hypertrophy, strength, and neuromuscular performance task [e.g., countermovement jump (CMJ)] outcomes. Relevent studies comparing higher-load [>60% 1-repetition maximum (RM) or <15-RM] and lower-load (≤60% 1-RM or ≥ 15-RM) RT were identified, with 45 studies (from 4713 total) included in the meta-analysis. Higher- and lower-load RT induced similar muscle hypertrophy at the whole-body (lean/fat-free mass; [ES (95% CI) = 0.05 (−0.20 to 0.29), P = 0.70]), whole-muscle [ES = 0.06 (−0.11 to 0.24), P = 0.47], and muscle fibre [ES = 0.29 (−0.09 to 0.66), P = 0.13] levels. Higher-load RT further improved 1-RM [ES = 0.34 (0.15 to 0.52), P = 0.0003] and isometric [ES = 0.41 (0.07 to 0.76), P = 0.02] strength. The superiority of higher-load RT on 1-RM strength was greater in younger [ES = 0.34 (0.12 to 0.55), P = 0.002] versus older [ES = 0.20 (−0.00 to 0.41), P = 0.05] participants. Higher- and lower-load RT therefore induce similar muscle hypertrophy (at multiple physiological levels), while higher-load RT elicits superior 1-RM and isometric strength. The influence of RT loads on neuromuscular task performance is however unclear.

... The exercise intensity involved in performing resistance exercise is a major variable for determining muscle size and strength adaptations induced by long-term resistance exercise [1,17,18]. Additionally, movement velocity when resistance exercise is performed is an important variable for these muscle adaptations [19,20,21,22,23,24]. Movement velocities during normal resistance exercise are generally prescribed by performing concentric and eccentric actions for 1-2 s [1]. ...

... Movement velocities during normal resistance exercise are generally prescribed by performing concentric and eccentric actions for 1-2 s [1]. Compared to this normal protocol, specific movement velocity protocols are performed with faster or slower velocities during concentric and eccentric actions [19,20,21,22,23,24]. Of those, a typical protocol of slow movement and tonic force generation (ST) is prescribed by performing 3-sec concentric, 3-sec eccentric, and 1-sec isometric actions with no rest between each repetition [20,21,22,23,24]. ...

... Compared to this normal protocol, specific movement velocity protocols are performed with faster or slower velocities during concentric and eccentric actions [19,20,21,22,23,24]. Of those, a typical protocol of slow movement and tonic force generation (ST) is prescribed by performing 3-sec concentric, 3-sec eccentric, and 1-sec isometric actions with no rest between each repetition [20,21,22,23,24]. ...

Background The extremely low loads (e.g., <30% of one-repetition maximum) involved in performing resistance exercise are effective in preventing musculoskeletal injury and enhancing exercise adherence in various populations, especially older individuals and patients with chronic diseases. Nevertheless, long-term intervention using this type of protocol is known to have little effects on muscle size and strength adaptations. Despite this knowledge, very low-intensity resistance exercise (VLRE) with slow movement and tonic force generation (ST) significantly increases muscle size and strength. To further explore efficacy of ST-VLRE in the clinical setting, this study examined the effect of ST-VLRE on post-exercise inhibitory control (IC). Methods Twenty healthy, young males (age: 21 ± 0 years, body height: 173.4 ± 1.2 cm, body weight: 67.4 ± 2.2 kg) performed both ST-VLRE and normal VLRE in a crossover design. The load for both protocols was set at 30% of one-repetition maximum. Both protocols were programmed with bilateral knee extension for six sets with ten repetitions per set. The ST-VLRE and VLRE were performed with slow (3-sec concentric, 3-sec eccentric, and 1-sec isometric actions with no rest between each repetition) and normal contractile speeds (1-sec concentric and 1-sec eccentric actions and 1-sec rests between each repetition), respectively. IC was assessed using the color-word Stroop task at six time points: baseline, pre-exercise, immediate post-exercise, and every 10 min during the 30-min post-exercise recovery period. Results The reverse-Stroop interference score, a parameter of IC, significantly decreased immediately after both ST-VLRE and VLRE compared to that before each exercise (decreasing rate >32 and 25%, respectively, vs. baseline and/or pre-exercise for both protocols; all Ps < 0.05). The improved IC following ST-VLRE, but not following VLRE, remained significant until the 20-min post-exercise recovery period (decreasing rate >48% vs. baseline and pre-exercise; both Ps < 0.001). The degree of post-exercise IC improvements was significantly higher for ST-VLRE than for VLRE (P = 0.010 for condition × time interaction effect). Conclusions These findings suggest that ST-VLRE can improve post-exercise IC effectively. Therefore, ST-VLRE may be an effective resistance exercise protocol for improving cognitive function.

... A similar relationship between the external load used and time under tension was observed for hypertrophy responses. The greater (Tanimoto et al., 2008) or comparable (Tanimoto and Ishii, 2006) hypertrophy effect was observed after resistance exercise with slower movement tempo, but a lighter load compared to a faster tempo and heavier loads which partly can be related to the greater total time under tension (Burd et al., 2010(Burd et al., , 2012Schoenfeld et al., 2015;Wilk et al., 2020a). ...

The goal of the present study was to evaluate the effect of contrast tempo movement on bar velocity changes during a multi-set bench press exercise. In randomized and counterbalanced order, participants performed three sets of the bench press exercise at 60%1RM under two testing conditions: E-E where all repetitions were performed with explosive (X/0/X/0) movement tempo; and S-E where the first two repetitions were performed with a slow tempo (5/0/X/0) while the third repetition was performed with explosive movement tempo (slow, slow, explosive). Twelve healthy men volunteered for the study (age = 30 ± 5 years; body mass = 88 ± 10 kg; bench press 1RM = 145 ± 24 kg). The three-way repeated measures ANOVA (tempo × set × repetition) showed statistically significant multi-interaction effect for peak bar velocity (p < 0.01; η2 = 0.23), yet not for mean bar velocity (p = 0.09; η2 = 0.14). The post hoc results for multi-interaction revealed that peak bar velocity in the 3 rd repetition was significantly higher for E-E compared to S-E only during set 1 (p < 0.001). Therefore, the distribution of movement tempo had a significant impact on peak bar velocity, but not on mean bar velocity. The decrease in peak bar velocity in the 3 rd repetition during the S-E condition was observed only in the first set, while such a tendency was not observed in the second and third set.

... If prescriptive parameters were unclear, we imputed the mean value from other studies: number of exercises = 8 (required for four studies [34][35][36]); number of sets = 2.6 (required for one study [37]). We excluded two studies [38,39] (three comparisons) from this meta-regression because both studies completed as many repetitions as possible in each set. ...

Background Resistance training is the gold standard exercise mode for accrual of lean muscle mass, but the isolated effect of resistance training on body fat is unknown.Objectives This systematic review and meta-analysis evaluated resistance training for body composition outcomes in healthy adults. Our primary outcome was body fat percentage; secondary outcomes were body fat mass and visceral fat.DesignSystematic review with meta-analysis.Data SourcesWe searched five electronic databases up to January 2021.Eligibility CriteriaWe included randomised trials that compared full-body resistance training for at least 4 weeks to no-exercise control in healthy adults.AnalysisWe assessed study quality with the TESTEX tool and conducted a random-effects meta-analysis, with a subgroup analysis based on measurement type (scan or non-scan) and sex (male or female), and a meta-regression for volume of resistance training and training components.ResultsFrom 11,981 records, we included 58 studies in the review, with 54 providing data for a meta-analysis. Mean study quality was 9/15 (range 6–15). Compared to the control, resistance training reduced body fat percentage by − 1.46% (95% confidence interval − 1.78 to − 1.14, p < 0.0001), body fat mass by − 0.55 kg (95% confidence interval − 0.75 to − 0.34, p < 0.0001) and visceral fat by a standardised mean difference of − 0.49 (95% confidence interval − 0.87 to − 0.11, p = 0.0114). Measurement type was a significant moderator in body fat percentage and body fat mass, but sex was not. Training volume and training components were not associated with effect size.Summary/Conclusions Resistance training reduces body fat percentage, body fat mass and visceral fat in healthy adults.Study Registrationosf.io/hsk32.

... The intensity was determined in a pilot study, so that all volunteers could perform, at the beginning of the study, 3 sets of the protocols with the highest possible weight (external resistance) while maintaining the other variables as described above. A previous study using bench press exercise, with similar configurations adopted in this study, made it possible to increase the muscle thickness of the pectoralis major and brachial triceps (37), reinforcing the applicability of training protocols for obtaining hypertrophic responses. ...

The aim of this study was to investigate the effects of 2 training protocols equalized by tension (TUT) on maximal strength (1 repetition maximum [RM]), regional cross-sectional areas (proximal, middle, and distal), and total cross-sectional areas (sum of the regional cross-sectional areas) of the pectoralis major and triceps brachii muscles. Thirty-eight men untrained in resistance training participated in the study and were allocated under 3 conditions: Protocol 3s (n 5 11; 12 repetitions; 3s repetition duration), Protocol 6s (n 5 11; 6 repetitions; 6s repetition duration), and Control (n 5 11; no training). Training protocols (10 weeks; bench press exercise) were equated for TUT (36 seconds per set), number of sets (3-4), intensity (50-55% of 1RM), and rest between sets (3 minutes). Analysis of variance was used to examine a percentage change in variables of interest across the 3 groups with an alpha level of 0.05 used to establish statistical significance. Protocols 3s and 6s showed no differences in the increase of total and regional muscle cross-sectional areas. There were no differences in regional hypertrophy of the pectoralis major muscle. In the triceps brachii muscle, the increase in distal cross-sectional area was greater when compared with the middle and proximal regions. Both experimental groups had similar increases in the 1RM test. In conclusion, training protocols with the same TUT promote similar strength gains and muscle hypertrophy. Moreover, considering that the protocols used different numbers of repetitions, the results indicate that training volumes cannot be considered separately from TUT when evaluating neuromuscular adaptations.

Jonathan Dropkin
Asha Roy
Jaime Szeinuk
Robert Baker

Background: Among work-related conditions in the United States, musculoskeletal disorders (MSDs) account for about thirty-four percent of work absences. Primary care physicians (PCPs) play an essential role in the management of work-related MSDs; for conditions diagnosed as work-related, up to seventeen percent of cases are PCP managed; within these conditions, up to fifty-nine percent are diagnosed as musculoskeletal. Negative factors in treatment success confronting PCPs include time constraints and unfamiliarity with work-related MSDs. A multidimensional team approach to secondary prevention, where PCPs can leverage the expertise of allied health professionals, might provide a useful alternative to current PCP practices for the treatment of work-related MSDs. Objective: Provide the structure of and rationale for an "extended care team" within primary care for the management of work-related MSDs. Methods: A systematic literature search, combining medical subject headings and keywords, were used to examine eight peer-reviewed literature databases. Gray literature, such as government documents, were also used. Results: An extended care team would likely consist of at least nine stakeholders within primary care. Among these stakeholders, advanced practice orthopedic physical therapists can offer particularly focused guidance to PCPs on the evaluation and treatment of work-related MSDs. Conclusions: A multidimensional approach has the potential to accelerate access and improve quality of work-related outcomes, while maintaining patient safety.

Loading recommendations for resistance training are typically prescribed along what has come to be known as the "repetition continuum", which proposes that the number of repetitions performed at a given magnitude of load will result in specific adaptations. Specifically, the theory postulates that heavy load training optimizes increases maximal strength, moderate load training optimizes increases muscle hypertrophy, and low-load training optimizes increases local muscular endurance. However, despite the widespread acceptance of this theory, current research fails to support some of its underlying presumptions. Based on the emerging evidence, we propose a new paradigm whereby muscular adaptations can be obtained, and in some cases optimized, across a wide spectrum of loading zones. The nuances and implications of this paradigm are discussed herein.

M. Tanimoto
H. Madarame
N. Ishii

We investigated the acute effects of "Kaatsu" resistance exercise and other types of exercise on muscle oxygenation and plasma growth hormone. Six young male bodybuilders performed leg extension exercise according to four exercise regimens: low-intensity [∼30% of one repetition maximum (1RM)] exercise with moderate occlusion (LO-Kaatsu), low-intensity (∼50% 1RM) exercise with slow movement and tonic force generation (3 s for lowering and 3 s for lifting actions, 1-s pause, and no relaxing phase; LST), low-intensity (same as LST) isometric exercise at 45° knee angle (ISO), and high-intensity (∼80% 1RM) exercise with normal movement speed (HN), commonly used for gaining muscular size and strength. The muscle oxygenation level measured with near-infrared continuous-wave spectroscopy (NIRcws) showed the largest changes during and after LO-Kaatsu among all regimens. The minimum oxygenation level during LO-Kaatsu was the lowest among the four exercise regimens. On the other hand, the increases in muscle oxygenation after LO-Kaatsu were the largest among the four regimens. Plasma GH and blood lactate concentrations after LO-Kaatsu, LST and HN were significantly (P < 0.05) higher than those after ISO, but there were no significant differences among those after LO-Kaatsu, LST and HN. The results indicate that "Kaatsu" resistance exercise causes marked changes in muscle oxygenation level and circulating growth hormone, both of which may be related to muscular hypertrophy.

A total of 117 Japanese subjects (62 men and 55 women) volunteered for the study. Subcutaneous adipose tissue (AT) and muscle thicknesses were measured by B-mode ultrasonography at nine sites of the body. Body density (BD) was determined the hydrodensitometry. Reproducibility of thickness measurements by ultrasonography was high (r = 0.96–0.99). Correlations between AT thickness and BD ranged from −0.46 (gastrocnemius) to −0.87 (abdomen) for males and −0.46 (gastrocnemius) to −0.84 (abdomen) for females. A higher negative correlation (r = −0.89) was observed for the sum of AT thicknesses (forearm, biceps, triceps, abdomen, subscapula, quadriceps, hamstrings, gastrocnemius, and tibialis anterior) both in males and in females. Slightly lower coefficients were observed between muscle thickness and LBM (r = 0.36 to r = 0.70 for males and r = 0.44 to r = 0.55 for females). Prediction equations for BD and LBM from AT and muscle thickness were obtained by multiple regression analysis. Cross-validation on a separate sample (33 men and 44 women) showed an accurate prediction for BD. The present findings suggest that B-mode ultrasonography can be applied in clinical assessment and field surveys. © 1994 Wiley-Liss, Inc.

Four hundred M-mode echocardiographic surveys were distributed to determine interobserver variability in M-mode echocardiographic measurements. This was done with a view toward examining the need and determining the criteria for standardization of measurement. Each survey consisted of five M-mode echocardiograms with a calibration marker, measured by the survey participants anonymously. The echoes were judged of adequate quality for measurement of structures. Seventy-six of the 400 (19%) were returned, allowing comparison of interobserver variability as well as examination of the measurement criteria which were used. Mean measurements and percent uncertainty were derived for each structure for each criterion of measurement. For example, for the aorta, 33% of examiners measured the aorta as an outer/inner or leading edge dimension, and 20% measured it as an outer/outer dimension. The percent uncertainty for the measurement (1.97 SD divided by the mean) showed a mean of 13.8% for the 25 packets of five echoes measured using the former criteria and 24.2% using the latter criteria. For ventricular chamber and cavity measurements, almost one-half of the examiners used the peak of the QRS and one-half of the examiners used the onset of the QRS for determining end-diastole. Estimates of the percent of measurement uncertainty for the septum, posterior wall and left ventricular cavity dimension in this study were 10--25%. They were much higher (40--70%) for the right ventricular cavity and right ventricular anterior wall. The survey shows significant interobserver and interlaboratory variation in measurement when examining the same echoes and indicates a need for ongoing education, quality control and standardization of measurement criteria. Recommendations for new criteria for measurement of M-mode echocardiograms are offered.

J D MacDougall
G R Ward
D G Sale
J R Sutton

Nine healthy subjects were studied under control conditions and following 5 mo of heavy resistance training and 5 wk of immobilization in elbow casts. Needle biopsies were taken from triceps brachii and analyzed for adenosine triphosphate (ATP), adenosine diphosphate (ADP), creatine (C), creatine phosphate (CP, and glycogen concentrations. Training resulted in an 11% increase in arm circumference and a 28% increase in maximal elbow extension strength. Immobilization resulted in decreases in arm circumference and elbow extension strength of 5% and 35%, respectively. Training also resulted in significant increases in resting concentrations of muscle creatine (by 39%), CP (by 22%), ATP (by 18%), and glycogen (by 66%). Conversely, immobilization significantly reduced CP concentration by 25% and glycogen concentration by 40%. It was concluded that heavy-resistance training results in increases in muscle energy reserves which may be reversed by a period of immobilization-induced disuse.

F Bonde-Petersen
A L Mork
E Nielsen

The endurance during sustained contraction of elbow, flexors, elbow extensors, and back extensors was tested in 3 human subjects. The force level used was varied between ca. 15 and ca. 75% of maximal isometric strength (IS). The clearance of 133Xe from contracting muscles was registered during and after the endurance test. In this way it was possible to determine whether muscle blood flow (MBF) was increased or had stopped during the contraction. Experiments with artificial ischaemia of the upper arm together with MBF measurements showed that MBF was of no importance for continuing sustained contractions above a certain force level, which was 50,25, and 40% of IS for elbow flexors, elbow extensors and back extensors, respectively. However, the level, where longer lasting ( greater than 15 min) sustained contraction is possible is directly related to MBF. These levels were 22, 15, and 20% IS for elbow flexors, elbow extensors, and back extensors, respectively.

B Chance
M. T. Dait
Cheng-Duo Zhang
FF Hagerman

A simple muscle tissue spectrophotometer is adapted to measure the recovery time (TR) for hemoglobin/myoglobin (Hb/Mb) desaturation in the capillary bed of exercising muscle, termed a deoxygenation meter. The use of the instrument for measuring the extent of deoxygenation is presented, but the use of TR avoids difficulties of quantifying Hb/Mb saturation changes. The TR reflects the balance of oxygen delivery and oxygen demand in the localized muscles of the quadriceps following work near maximum voluntary contraction (MVC) in elite male and female rowers (a total of 22) on two occasions, 1 yr apart. TR ranged from 10 to 80 s and was interpreted as a measure of the time for repayment of oxygen and energy deficits accumulated during intense exercise by tissue respiration under ADP control. The Hb/Mb resaturation times provide a noninvasive localized indication of the degree of O2 delivery stress as evoked by rowing ergometry and may provide directions for localized muscle power output improvement for particular individuals in rowing competitions.

In order to examine the contribution of neuromuscular activity to the slow increase in VO2 during heavy exercise, integrated electromyogram (iEMG) of dominant working muscle and VO2 was compared in seven subjects during constant-load cycling exercise at the intensity of 10% below and 30% above ventilatory threshold (VT) for seven minutes. VO2 and iEMG after 4th min in above VT test was significantly correlated (r = 0.53, p less than 0.01) and VO2/iEMG was constant after 4th min, indicating coupling of iEMG with VO2. The results suggested that the slow increase in VO2 during heavy exercise may result from the changes in the recruitment pattern of motor units.

M. L. Pollock
Joan F. Carroll
J. E. Graves
James M Hagberg

To evaluate the effects of 26 wk of aerobic and resistance training on the incidence of injury and program adherence in 70- to 79-yr-old men and women, 57 healthy volunteers (25 males, 32 females) were randomly assigned to a walk/jog (W/J, N = 21), strength (STREN, N = 23), or control (CONT, N = 13) group. Walk/jog training was for 30-45 min, 3 d.wk-1 with intensity equal to 40-70% heart rate max reserve (HRmax reserve) during the first 13 wk, and 75-85% HRmax reserve for weeks 14-26. STREN training consisted of one set (10-12 repetitions) each of 10 variable resistance exercises performed to volitional fatigue. Forty-nine of the original participants completed the training program. Walk/jog training increased VO2max from 22.5 to 27.1 ml.kg-1.min-1 (P less than or equal to 0.05) while STREN and CONT showed no change. STREN improved significantly in chest press and leg extension strength (P less than or equal to 0.05) while W/J and CONT showed no change. Adherence to training was 20/23 (87%) and 17/21 (81%) in STREN and W/J, respectively. One repetition maximum (1-RM) strength testing resulted in 11 injuries in the 57 subjects (19.3%) while STREN training resulted in only two injuries in 23 subjects (8.7%). Walk training during weeks 1-13 resulted in one injury in 21 subjects (4.8%). Eight of 14 subjects (57%) who began jogging intervals at week 14 incurred an injury: two of eight (25%) of the men and all of the women (6 of 6). All W/J training injuries were to the lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)

Source: https://www.researchgate.net/publication/23446054_Effects_of_Whole-Body_Low-Intensity_Resistance_Training_With_Slow_Movement_and_Tonic_Force_Generation_on_Muscular_Size_and_Strength_in_Young_Men

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