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Effects of Eccentric vs. Concentric Exercise in Stimulating Muscle Hypertrophy. Strength Gains & Enhanced.. Kirk, Gregory; Maudie, Bob; McKinnon, Patrick; Murray, Ryan; Stewart, Sarah; Reid, Darlene 2007

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Systematic Review: Effects of eccentric versus concentric exercise in stimulating gains in strength, hypertrophy, or performance in healthy adults.Presented by Gregory Kirk, Bob Maudie, Pat McKinnon, Ryan Murray, & Sarah StewartIntroduction||Resistance training is widely utilized by many facets of the population as a method of inducing gains in muscular strength zzathletic performancezzpreventing injurieszzimproving functional capacityzzmaintaining a healthy lifestyle Introduction:Dynamic muscle activations||Eccentric= Dynamic muscle action which occurs when external resistance exceeds muscle force and the muscle lengthens while developing tension.||Concentric= Dynamic muscle action which occurs when muscle shortens, and joint movement occurs as tension develops.Introduction:Eccentric vs. concentric activations||??d ability to produce greater amounts of tension [3-5] ||??dconsumption of O2and ATP for a comparable workload [6-9]||??dEMG activation (ie. recruitment of a smaller motor unit pool) for a given tension [10]||Smaller decreases in strength following repeated muscle contractions [2,11,12] ||Greater cross education [13]||??dmuscle damage and delayed onset muscle soreness (DOMS) [14,15]Introduction:Potential benefits of eccentric activations||Potential for the development of greater strength gains, because the muscle can be overloaded to a greater extent [13,16,17]zzAthletic performance, prevention of injuries, and a primary outcome measure ||Superior adaptations in muscular conditioning because of metabolic efficiency & decreased fatigabilityzzImplications for older adults and clinical populations that have limited energy reserveSystematic Review Question||Is eccentric training superior to concentric training in stimulating gains in muscular strength, hypertrophy, and performancein healthy adults?MethodsMethods:Inclusion criteria||Healthy adult subjects (18 ?65 years)||Resistance training program of at least 4 weeks in duration, minimum of 2x/week||Testing and training completed on an isokinetic dynamometer||Comparison of eccentric and concentric training programs||Measurement of at least one of the following outcome measures: strength, hypertrophy, performance||RCTsor CCTsin peer reviewed journalsMethods:Exclusion criteria||Participants with any known existing pathological conditions||Explored only one comparison variable (e.g. only eccentric training) orcombined other interventions with eccentric and concentric programs||Cross over design with insufficient washout period ( ?6 months)||Non-English studiesMethods:Search Strategy||Electronic searches were performed on the following databases: SPORTDiscus, EMBASE, MEDLINE, CINAHL, PEDro, and Cochrane Controlled Trial Register.||Grey literature searches were conducted using Proquest, PapersFirst, and ProceedingsFirst.||Hand searches were performed for the following journals from January 1997 to April 2007: Journal of Applied Physiology, British Journal of Sports Medicine, Sports Medicine, American Journal of Sports Medicine, and the Medicine Science of Sport and Exercise.||Reference lists of included articles were screened using the same criteria as applied to the initial citation search.Potentially relevant publications identified and screened for retrieval.                                          N =1933Publication abstracts retrieved for more detailed evaluation.                                 N = 208Publications (full text) articles retrieved.                                               N = 33Publications included in the systematic review.                                N = 11 FULL TEXTPapers excluded by abstract -unsuitable based on outlined criteria. N = 175Papers excluded by title -unsuitable based on outlined criteria. N = 1726Publications excluded: N = 22 Not age appropriate:2Did not meet minimum training duration/frequency: 2No isokinetic dynamometer:7Not an appropriate comparative outcome measures: 7Insufficient washout period: 4Study selectionMethods: Quality and Evidence assessment||Quality assessmentzzModified Van Tulder ~ 11 point scalezzSackett?smodel was used to describe the level of evidence for each included studyzzBest evidence synthesis was used to describe the overall grade of evidenceMethods:Data extraction||Data extraction zzA data extraction form was developed to improve standardization and ease of the extraction process zzData extraction was completed by 2 reviewers independently for each full text publicationzzDisagreements were resolved during a consensus meeting.Methods:Data analysis||Data was analyzed qualitatively for the following comparisons:1.Effectiveness of eccentric versus concentric training on eccentric, concentric, and isometric strength  2.Effectiveness of eccentric versus concentric training on selected hypertrophy measures3.Effectiveness of eccentric versus concentric training on selected performance measuresResults & DiscussionResults:Study descriptionStudyQuality score (Modified Van Tulder)Study designLevel of Evidence    Duncan et al.[32]3RCT2BHigbie et al.[33]6RCT1BHortobagyi, Barrier, et al.[34]4RCT2BKomi et al.[16]3RCT2BMayhew et al.[35] 5CCT1BMiller et al.[36]7CCT1BMont et al.[40]7RCT1BSeger et al.[37]4CCT2BTomberlin et al.[38]4RCT2BHortobagyi, Hill et al.[2]5RCT1BEllenbecker et al.[39]4CCT2BResults:Study participants||Training status:Untrained (8), Moderately trained (1), Trained tennis players (2)||Sex:Female only (3), Male only (5), Male and female (3)||Age:Mean age = 24.0 years; Range 19.6 ?33 years||Dropout rate:Reported by 7 studies                       ~ Mean = 1.4 subjects; Range 0 ?6 subjectsResults:Training intervention||Exercise: Knee extension (7); Knee flexion and extension (1); Shoulder internal and external rotation (2); Elbow flexion (1)||Frequency: Ranged from 2 ?4 days/week||Duration: Ranged from 4 ?20 weeks, with 8/11 studies lasting between 6 ?10 weeks in length||Volume: Ranged from 12 ?60 total exercise sessions; 1 ?8 sets of 6 ?12 repetitions (6 ?72 contractions per session)||Intensity: Absolute (8) ~ MVC for both ETG and CTG; Relative (2) ~ ETG exercised at the same relative load as the CTG (90 ?100 % of the concentric MVC); ?Submaximal?(1) ~ intensity not specified||Progression: Periodization design (3), Constant number of sets and repetitions (8)||Contraction speed: Varied from 60 ?210 deg/s; Single speed for all contractions (9); Pyramid of speed (2)  StrengthResultsEffectiveness of eccentric and concentric training  on eccentric, concentric, and isometric strengthResults: Strength||Eccentric strength ~10/11 studies  measured eccentric strength in ETG and CTGzz9/10 studies found significant ??s with ETzz8/10 studies found significant ??s with CTzzOf the 7 studies that compared the significance of the ET vsCT in producing gains in eccentric strength, all 7 found that ET improved eccentric strength significantly more than CT.Results: Strength||Concentric strength ~10/11 studies measured concentric strength in ETG and CTGzz6/10 studies found significant ??s with ETzz9/10 studies found significant ??s with CTzzOf the 7 studies that compared the significance of the ET vsCT in producing gains in concentric strength, 2 found that CT improved concentric strength significantly more than ET. No studies found that the ET was significantly more effective than the CT in ??inggains in concentric strength.Results: Strength||Isometric strength ~ 4/11 studies measured isometric strength in the ETG and CTGszz2 studies found that isometric strength ??d significant with ET; 1 study found that isometric strength ??d significant with CT zz2/4 studies did not report significance levelszz3 studies compared the significance of the ET vsCT in producing gains in isometric strength; mixed results were reportedResults: Strength||Total strength~2/11 studies calculated total strength gains by the ETG and CTG, averaging over all contraction types and velocitieszzNo significant differences were reportedzzThree studies reported that the ETG ??deccentric strength more than the CTG ??dconcentric strengthDiscussionEffectiveness of eccentric and concentric training on eccentric, concentric, and isometric strengthDiscussion:Strength||Eccentric strengthzzStrong evidence that both ET and CT programs can produce gains in eccentric strength zzStrong evidence that ET is superior to CT in developing eccentric strength ?Suggests a strong mode specific relationship between ET and eccentric strength developmentDiscussion:Strength||Concentric strengthzzStrong evidence that CT and ET programs are effective in producing gains in concentric strength zzNo evidence that CT is superiorto ET in promoting concentric strength gains Discussion:Strength||Isometric strengthzzIndicative findings that both ET and CT are effective in producing gains in isometric strengthzzNo evidence that either contraction type is superiorDiscussion:Strength||Total StrengthzzNo evidence that either contraction type is superior in producing gains in total average strengthzzStrong evidence that ET increases eccentric strength more than CT increases concentric strengthDiscussion:Strength||Eccentric vsConcentriczzResults clearly show that eccentric and concentric training are both effective methods of inducing strength gains in the healthy adult populationzzHowever, eccentric training appears to elicit a more substantial effect on mode specific strengthening ?All studies that reported a statistical comparison of the ETG and CTG found that the ETG produced superior eccentric gains with respect to the CTG, but only two out of seven found that the CTG produced superior concentric gains in comparison to the ETGEccentric vsConcentric Cont. ||Eccentric vsConcentriczzThe distinct outcomes generated by the eccentric and concentric training groups suggest that different mechanisms are responsible for increases in strength?Eccentric muscle actions have been shown to generate significantly higher levels of maximal tension [3-5], it is possible that the greater increases in strength are due to the higher absolute loads?Two studies included addressed this issue by having the ETG and CTG exercise at equal absolute loads; the results were mixedEccentric vsConcentric Cont. ||Further research necessary, but results suggest that ET is potentially able to produce significantly greater eccentric gains than CT when exercising at equalized loads||Suggests other adaptive mechanisms:zzCombination of neurological factors and hypertrophy [2,32-34,38,42-45] HypertrophyResults Effectiveness of eccentric versus concentric training on selected hypertrophy measuresResults: Hypertrophy||5/11 studies included a hypertrophy outcome measure||3 of which used measures of CSAzzDuncan et al. reported no significant change in girth for eccentric or  concentric training using a thigh circumference measure.zzKomiet al. found a significant ?in upper arm circumference in the trained arm of the ETG compared to pre-test values and the CTG zzHigbieet al., using MRI showed a significant ?in CSA in both  ETG and CTGswith a significantly greater ?in the ETG compared to the CTG. Results:Hypertrophy||Two studies used muscle biopsies to explore changes fibre type and area. zzHortobagyiet al. showed no significant change in the percentage of type I fibres, a significant ?in type IIbfibres, and a significant ?in type IIafibres in both the ETG and CTGs. They also showed a significant ten times greater ?in type IIafibre area when comparing ETG to CTG. zzMayhew et al. showed no significant change in type I or  type II fibres pre/post, but a significant ?in type II fibre area in the CTG compared to the ETG.DiscussionEffectiveness of eccentric versus concentric  training on selected hypertrophy measuresDiscussion:Hypertrophy||Moderate evidence that eccentric muscle training ??sskeletal muscle hypertrophy more than concentric training by measure of CSA||Moderate evidence that eccentric training ??stype II fibre area greater than concentric trainingPerformanceResultsEffectiveness of eccentric versus concentric training on selected performance measuresResults:Performance ||3/11 studies included performance measureszzTwo studies explored the effect of ET and CT on serve velocity.?Ellenbecker et al. ?CT significantly ??dserve velocity compared to pre-test values. No significant change was seen in the ETG. ?Mont et al. ?ET and CT significantly ??dserve velocity compared to the CG. ~  Also explored % drop off of serve velocity ?both training groups maintained serve velocity better than the CG. No difference between ETG and CTG. Results:PerformancezzMiller et al. included 2 performance measures:?Acceleration time ?The CTG improved acceleration time, compared to pre-test values, for concentricknee extension only. ?ETG had significant improvements in acceleration time for concentric and eccentricmovements compared to the pre-test values. Improvements in acceleration time with eccentric movements were greater in the ETG compared to the CTG.?Time to peak torque?The CTG improved time to peak torque in concentricknee flexion and knee extension compared to pre-test values. ?The ETG showed significant improvements for concentric and eccentricmovements compared to the pre-test and also showed significant improvements in eccentric movements compared to the CTG.DiscussionEffectiveness of eccentric versus concentric  training on selected performance measuresDiscussion:Performance||Serve velocity and endurance zzLimited evidence that both ET and CT improved serve velocityzzLimited evidence that the ET and CT groups tended to maintain their serve velocity to a significantly greater extent than the CGzzET and CT ?equally beneficial in improving serve velocity and endurance compared to a training regimen that does not include strength trainingDiscussion:Performance||Acceleration time zzIndicative finding ?CT improved acceleration time, compared to pre-test values, for concentricknee extension onlyzzIndicative finding ?ET resulted in significant improvements in acceleration time for concentric and eccentric movements compared to the pre-test values ||Time to peak torque zzIndicative finding ?CT significantly improved time to peak torque in concentricknee flexion and extension compared to pre-test valueszzIndicative finding ?ET resulted in significant improvements in concentric and eccentric movements compared to the pre-test and showed significant improvements in eccentric movements compared to the CTG  ||Based on this single study, concentric training appears to be more mode specific compared to eccentric training in regards to these selected performance measures ConclusionConclusion||Eccentric and concentric strength training are effective means of producing gains in muscular strength in a population of healthy adults ||Eccentric training:zzMore effective than concentric strength training in stimulating gains in eccentric strengthzz??s eccentric strength to a greater degree than concentric training ??s concentric strength||Concentric training: zzNo evidence to support the superiority of concentric training in stimulating gains in concentric strengthConclusion||Hypertrophy: zzEccentric training ??d muscle fiber CSA more than concentric training and induced greater ??s in type II fiber area.   ||Performance: zzNo significance difference in serve velocityzzIndicative findings that both ET and CT improved acceleration time and concentric time to peak torque zzIndicative evidence that ET was more effective at improving eccentric time to peak torque Clinical implications||Specificity: Target a specific muscle action to prevent injury of an athlete and enhance performancezzEccentric: Nordic hamstring curls in the training program of a sprinter ||Both modes should be considered when performance and injury prevention is the primary goal ||Eccentric training with energetically compromised populations may be warrantedStrengths ||Review limited to RCTs and CCTs||Homogenous populations||All training and testing completed on isokinetic dynamometersLimitations||Reviewers were not blinded to authors or journal publication ||Methodological weaknesseszzSix studies of low quality (<5 mod VanTulder)zzFour studies failed to report dropout ratezzNo allocation concealment or assessor blinding ||Restricted to studies written in English ||Main outcome measure focused on body structure and function level of ICF, minimal involvement on an activity or participation level ||Population of healthy adults: lacks external validity to the clinical population ||Isokinetic dynamometer not commonly used in clinical rehabilitationFuture Recommendations ||ReviewszzComparison of eccentric and concentric training at the same absolute loadzzDifferences with fatigue and activation patterns using EMG between ETG and CTG zzIsotonic actions as this contraction type relates more to the general populationzzExamining the effect of the combination of modes versus a single mode is warranted ||ResearchzzMore primary research is needed on the effects of resistance training and its application to performanceAcknowledgements ||The research was not funded by grants or sponsorship, and no relevant conflicts of interest existed for any of the authors ||Thanks to:zzDarlene Reid: SupervisorzzAngela Busch: RSPT 532 instructorzzCharlotte Beck: assistance with research strategieszzSusan Harris: RSPT 572 coordinatorFinal cost of systematic review...998 credits (RSPT 526, 532, and 572)         $5920.0099Transportation to meetings$376.0599Phone calls$478.1299Photocopying$126.5699Printing$267.8999Cutting edge Filing Device$11.0299Surprise99Additional Administration Fees $400 x 5Completion of a Systematic Review ..........PRICELESS!References1.McCaffertyWB, Horvath SM. 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J OrthopSports Phys Ther2003; 33: 557-571Search strategy: EMBASESearch #Search termResultsLimiters1Eccentric.mp47382Concentric.mp619031 & 214584MeSH term "muscle strength"136945MeSH term "hypertrophy"21116MeSH term "muscle fatigue"47307MeSH term "muscle contraction"187368MeSH term "muscle training"19009MeSH term "muscle mass"402410MeSH term "refractory period"166711MeSH term "relaxation time"1692124 or 5 or 6 or 7 or 8 or 9 or 1043500133 & 12475Search was limited to human, English language, and adult (18 - 64 years) at search # 13.Search strategy: SPORTDiscusSearch #Search termResultsLimiters1Eccentric.mp14722Concentric.mp114831 & 27574MeSH term "strength"114355MeSH term "power"21776MeSH term "strength training"33757MeSH term "hypertrophy"6568MeSH term "muscle contraction"510594 or 5 or 6 or 7 or 820319109 & 3 547All searches were limited to "English"Search strategy: SPORTDiscusSearch #Search termResultsLimiters1Eccentric.mp14722Concentric.mp114831 & 27574MeSH term "strength"114355MeSH term "power"21776MeSH term "strength training"33757MeSH term "hypertrophy"6568MeSH term "muscle contraction"510594 or 5 or 6 or 7 or 820319109 & 3 547All searches were limited to "English"Search strategy: EMBASESearch #Search termResultsLimiters1Eccentric.mp47382Concentric.mp619031 & 214584MeSH term "muscle strength"136945MeSH term "hypertrophy"21116MeSH term "muscle fatigue"47307MeSH term "muscle contraction"187368MeSH term "muscle training"19009MeSH term "muscle mass"402410MeSH term "refractory period"166711MeSH term "relaxation time"1692124 or 5 or 6 or 7 or 8 or 9 or 1043500133 & 12475Search was limited to human, English language, and adult (18 - 64 years) at search # 13.

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