Accelerated Muscular Development Programs

Physique Zero

The name of the author is Alain Gonzalez who is a fitness coach and a long time author. This guy wants to help millions of people all over the world especially those that don't have enough time to train at the GYM. On his prior work, this man wanted to help skinny guys but later noticed that people of all ages, and body sizes needed help to build muscles too. With a busy family life, he believes that you can as well use the little time you have to build muscles and at the same time become fit. With this program, you will eliminate some of the things that you thought mattered the most to build muscles. As a matter of fact, the author dedicated some time to conduct research and later develop a powerful system that is easy to follow and that will help you build muscles without 'GYMing''. Upon purchasing, you will get the main product in form of a downloadable PDF formats. The author has also included some videos to show you exactly what you are supposed to do. This program is for anyone that wants to get leaner, stronger and get more energy with ease regardless of their social status, age and race. Continue reading...

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Changes in maximal muscle strength in response to strength training

The influence of strength training on the maximal contraction strength of human muscle in vivo has been extensively investigated for the concentric part of the moment-velocity curve 10,20,23,26,30,39,40 - Also, data exist for the training-induced change in maximal eccentric muscle strength 26,39-46 . Following concentric strength training, maximal muscle strength and power have been reported to increase at the specific velocity employed during training 4,6,7,10,30 . These and similar observations have been taken to indicate a specificity of training velocity and training load. However, it is questionable whether a generalized concept of training specificity should exist, since muscle strength has been reported to increase also at velocities lower than the actual velocity of training 20,23,47,48 as well as at higher velocity 6,39,48 . The conflicting findings of specific as well as non-specific training adaptations probably arise, at least partly, due to a varying influence of learning...

Cardio and Weight Training The Perfect Combination

Some people ask, Which is more important, cardio or weight work The answer is both. You need the combination of aerobic and weight training for overall fitness. As one of my clients once said, Weights make it hard cardio gets rid of the lard. If you want to do cardio and weights on the same day, that's fine. It's also fine to alternate days, whichever you fancy. There is not, as of yet, a definite rule on which you should do first merely personal preference. Some folks like to be good and sweaty before they hit the weights, whereas others prefer to get the weight training out of the way and then loosen up with cardio afterwards. The choice is yours.

The Relationship of Physical Attractiveness to Occupational Success

In their meta-analysis, Langlois et al. (2000) calculated an average weighted effect size (d) of .76 (p .05) that showed that attractive persons were more successful than unattractive persons. This was the largest effect found for adults with the only larger effect found for popularity ratings of children (d .77). It is instructive to examine in more detail two of the studies in the Langlois et al. (2000) meta-analysis that examined physical attractiveness as a predictor of career success. In a survey of 3,692 persons, Umberson and Hughes (1987) found that ratings of attractiveness were positively related to education, occupational status, and life satisfaction. Roszell, Kennedy, and Grabb (1989) examined the relationship of attractiveness to income attainment for 1,062 Canadians. In the 1979 wave of interviews, the physical attractiveness of the respondents was measured on a 5-point scale that ranged from strikingly handsome or beautiful, to homely. A statistically significant effect...

Physical Attractiveness in Performance Appraisal and Promotions

Another unresolved issue is whether the target person's sex moderates the effects of attractiveness. Contrary to the common belief that physical attractiveness is unimportant for men, attractive men are consistently preferred over unattractive men. A possible manifestation of the importance of looks to men is the increasing frequency with which men are undergoing cosmetic surgery to enhance their careers ( Men try to put a new face on careers, Wall Street Journal, August 28,1991 Workplace edge plastic surgery. Journal of Commerce, August 23, 1999 Leaders The right to be beautiful, The Economist May 24, 2003). The effect of attractiveness for women is much less clear. Although most studies seem to show that attractive women are preferred over unattractive women, a few studies show that attractive women are disadvantaged in traditionally male jobs (Heilman & Saruwatari, 1979 Heilman & Stopeck, 1985a, 1985b). However, this beauty is beastly effect is possibly the result of the...

Physical Attractiveness as a Factor in Selection Judgments

More recently, Rynes and Gerhart (1990) examined evaluations of MBA graduates by recruiters. Recruiters rated the applicants on three kinds of measures (a) trait scales (e.g., general knowledge, leadership), (b) overall employability, and (c) employability in your firm. Two placement officials independently rated each applicant's physical attractiveness and height on a 3-point scale (average, significantly above, significantly below average).

Neuromuscular adaptations evoked by strength training

The adaptive changes observed in the neuromuscular system in response to specific types of strength training may be differentiated into neural and muscular factors. Thus, it is well known that changes in contractile properties, i.e. increases in maximal contraction force Neural adaptation mechanisms may involve changes in motoneuron recruitment and or rate coding, more synchronized motoneuron firing patterns within the muscle itself as well as between muscle synergists, changes in spinal motoneuron excitability, and altered coactivation of antagonist muscles 54-57 . Early evidence, indicating neural mechanisms to play a significant role, was based on the findings that muscle strength increased more than could be accounted for by increases in muscle size alone 58 and that strength gains were observed with no detectable muscle hypertrophy 20,59-62 . More direct evidence has been provided with the use of electromyography (EMG), although inherent methodologic limitations may exist with...

Strength Training

To achieve an increase in muscle strength and volume, progression in training may be guided by the Repetition Maximum (RM) method. One RM is the maximum resistance the athlete can manage once, in a controlled manner or specific movement. If the movement can be performed up to, but not more than, 10 times it is called 10RM. A 10RM movement will result in increase in muscle strength and volume if performed for six weeks or more. Before initiating heavy resistance training such as this, the instructor must emphasise the importance of warming up and learning the correct techniques for the method and apparatus used for each muscle group. The initial increase in performance after this kind of training is neuromuscular the athlete learns how to use existing muscle fibres. To achieve a true increase in muscle volume and muscle hypertrophy, at least three months of regular training is required. Training with lighter resistance and more repetitions will improve muscle strength and endurance....

The Functionally Normal Bicuspid Aortic Valve

Normal systolic murmurs in young persons, with the exception of a systolic mammary souffle, are not heard maximally at the right base.52 A midsystolic murmur that is most prominent in the second right intercostal space in children or young adults arouses suspicion of a functionally normal bicuspid aortic valve, especially in males (relative male prevalence is 70 to 75 ).56 Auscultation should then seek the confirmatory evidence of an aortic ejection sound that is most prominent at the apex, where it is readily mistaken for the second component of a split first heart sound.37,52 The initial component of a normally split first heart sound is louder at the apex, and the second component is louder at the lower left sternal border.52 Additional evidence of a functionally normal bicuspid aortic valve is the soft high-frequency early diastolic murmur of bicuspid aortic regurgitation that adds materially to the diagnosis. The murmur is heard best when firm...

Nonpharmacologic Interventions

Exercise, while discouraged when the patient is acutely decompensated to ease cardiac workload, is recommended when patients are stable. The heart is a muscle that requires activity to prevent atrophy. In addition, exercise improves peripheral muscle conditioning and efficiency, which may contribute to better exercise tolerance despite the low CO state. Regular, low-intensity aerobic exercise that includes walking, swimming, or riding a bike is encouraged, while heavy weight training is discouraged. The prescribed exercise regimen needs to be tailored to the individual's functional ability, and thus it is suggested that patients participate in cardiac rehabilitation programs, at least initially. It is important that patients not overexert themselves to fatigue or exertional dyspnea.

Hand And Foot Activations

Another experiment points to the contribution of parallel, cortical networks in a distributed motor system. Muscle strength increased by having individuals practice at imagining they were contracting a particular muscle.211 Indeed, when the abductor digiti quinti was exercised to increase its strength and when subjects only imagined that they practiced abduction against resistance, the abductor of the untrained hand also increased in strength. This neural, as opposed to muscular, origin for strengthening also seems to occur during physical exercise before any muscle hypertrophy is evident. Mental exercise that improves muscle strength is associated with an increase in elec-troencephalographic-derived cortical potentials.212 Positron emission tomography and other techniques suggest that this strengthening derives from the activation of central motor planning areas outside of M1. These areas increase the coordination and strength of outputs to spinal motoneurons.213 The transfer of the...

Steroids Anabolicandrogenic

There are more than 100 different types of anabolic-androgenic steroids, synthetic substances related to male sex hormones (androgens). Anabolic refers to increased muscle building, and androgenic refers to increased masculine characteristics. Steroids refers to the class of drugs. These drugs are available legally only by prescription to treat conditions that occur when the body produces abnormally low amounts of testosterone, such as delayed puberty and some types of impotence. They are also used to treat body wasting in patients with AIDS and other diseases that result in loss of lean muscle mass. Abuse of anabolic steroids, however, can lead to serious health problems, some irreversible.

General Characteristics

General status characteristics such as gender, race, age, physical attractiveness, or socioeconomic status affect performance expectations for a group of people. A high level of competence is expected from people with certain characteristics even if there is no previous evidence for the relationship between the specific characteristics and task performance. For instance, articles with females as first author sometimes receive lower ratings than articles with males as first author. The results were more dramatic if the female author was not previously known in the This situation is also related to dying young. If a successful creator dies at an early age, he or she becomes more eminent in the future. This is mostly because people remember them at their most attractive ages. Eminent people, like all of us, lose their physical attractiveness and popularity as they become older. Thus, if they die before their success wanes, people remember them as more creative, not because they are...

Muscle fiber plasticity

The mechanisms behind mechanical loading resulting in altered gene expression and thus altered protein content are not clear. Several potential messengers generated within contracting skeletal myofibers are illustrated in Table 1.3.2. The acetylcholine released from the motor nerve binding to its receptor, and the subsequent release of Ca2+ from the SR and resulting myofiber contraction can either itself or by generating other intracellular messengers activate signals for altered gene expression in response to mechanical loading. These additional messengers can either be linked to receptor-linked pathways or stretch-dependent pathways, or be a part of the metabolic changes associated with the contraction. What has been shown so far is that resistance training decreases the Ca2+ concentration needed to elicit 50 of maximal tension, decreases MHC IIx gene expression, and increases contractile proteins in parallel, all of which together allows greater absolute workloads to be moved 29,30...

Classical reference

Heavy-resistance strength training generally results in both neural and muscular adaptations. Muscle hypertrophy was already recognized in the late 1800s and has since then been extensively documented at whole-muscle, muscle-fiber and muscle subcellular levels. About the same time it was observed that substantial gains in muscle strength could occur without any detectable changes in the muscle itself, particularly in the early stages of the training regime. (Recent methodologic developments have, however, demonstrated early changes to occur in RNA translation and transcription.) The logical conclusion was that the improvements in strength had to be accounted for by neural adaptations. This assumption required there to be a margin, or force reserve, in the muscle that would not be accessible with a normal maximal voluntary effort due to neural inhibitory mechanisms. Another assumption would be that these mechanisms could be overcome, disinhibited, by adaptations in the nervous system...

Motoneuron synchronization

That the synchronization of motoneuron firing can be altered by learning ioi , which suggests that changes in synchronization may also occur as an adaptive response to strength training. Even though an increased incidence of synchronization between the firing patterns of different motor units within the muscle may occur with strength training io3 , the advantage of such intramuscular synchronization, if any, remains unsolved 56 . Studies using artificial nerve stimulation have shown that at submaximal contraction intensity, muscle force is greater with asynchronous than synchronous stimulation i04,i05 . In addition, RFD in brief maximal contractions was higher during voluntary (i.e. asynchronous) contractions as compared to evoked tetanic (i.e. synchronous) contractions 9i . However, synchronous stimulation may not adequately mimic in vivo muscle contraction, where the occurrence of discharge doublets at the onset of contraction may yield a marked increase in RFD (see above)....

Training for optimal neural and morphologic adaptation

From the findings presented in this chapter strength training appears effective for evoking significant adap tive changes within the nervous system as well as in the muscle itself (Fig. 1.4.21). Training with heavy loads (1-8 RM) seems to emphasize various aspects of neural adaptation, in turn causing significant increases in contractile RFD 247 and maximal eccentric strength 50 . The use of moderate to heavy training loads (6-12 RM) may be more optimal for the development of muscle hypertrophy 247 and may also prove more effective for inducing alterations in muscle Fig. 1.4.21 Diagram summarizing neural and morphological effects evoked by resistance training. *T Muscle cross-sectional area (CSA) T CSA type II muscle fibers (type II MHC isoforms). Changes in muscle architecture (T fiber pennation angle). ** T Neural drive to muscle fibers (T iEMG) T motoneuron excitability 0 motoneuron inhibition. architecture. It should be noted, however, that the adaptation evoked by resistance...

Multiple choice questions

2 Which of the following neural adaptations is least likely to occur after heavy-resistance strength training 3 Which of the following muscular adaptations is the least likely to occur after heavy-resistance strength training c The effect of slow vs. fast movement velocity on maximal voluntary muscle strength is smaller in eccentric than in concentric muscle contractions. d Combining eccentric and concentric contractions in strength training gives a larger strength gain than concentric training alone. 5 Which of the following statements about neural adaptations to strength training is false d The intention and effort to develop force quickly during heavy-resistance strength training can lead to an increased ability to produce force at high speeds. e Strength training of agonist muscles does not necessarily result in a decreased coactivation of antagonist muscles.

The effects of physical inactivity and activity on bone mass and bone mineral density in humans

Observational studies can be suggestive as to the effect of different kinds of activities on bone mass. However, the study groups are independent samples and therefore a causal relationship between the different variables of interest cannot be established. In addition, the subjects investigated in these studies are highly selected. Individuals with a high muscle mass (and thereby bone mass) are more prone to engage in activities involving resistance training such as weight-lifting, while individuals with a low muscle mass might preferentially choose to participate in endurance training activities like long-distance running.

Specific muscle training

A brief description of muscle strength training is given below. Further information about strength training can be obtained in Chapter i .4. Strength training In many sports there are activities which are forceful and explosive, e.g. high jumping, hiding in boxing and turning in ice hockey. The power output during such activities is related to the strength of the muscles involved in the movements. Thus, it is beneficial for an athlete in such sports to have a high level of muscular strength, which can be obtained by strength training. Strength training can result in hypertrophy of the muscle, partly through an enlargement of muscle fibers. In addition, training with high resistance can alter the fiber type distribution in favor of fast-twitch fibers 66 . There is also a neuromotor effect of strength training and part of the increase in muscle strength can be attributed to changes in the nervous system. Improvements in muscular strength during isolated movements seem closely related to...

The physical and motor development of the child is an ongoing process Discuss

This essay allows you to write an opening introduction which generally defines the process of maturation and the nature-nurture debate within this context. You then need to outline the stages of development that occur and the kinds of physical and motor changes a child might experience throughout its lifespan, including the key areas such as developments in height and weight, skeletal and muscular development, the changes that occur to the brain and nervous system

Leisure activities and sports

There is limited evidence that certain strenuous sports such as weightlifting and gymnastics may carry an increased risk of disk degeneration and vertebral damage (Sward et al 1990,1991 Videman et al 1995). Some high-level and competitive sports may also be associated with an increased prevalence of back pain. That link could, however, involve both physical and psychosocial factors.

Political Approaches To Ethics

Multicultural feminists generally affirm socialist feminist thought, but they believe it is inattentive to issues of race and ethnicity. They note, for example, that U.S. ''white'' culture does not praise the physical attractiveness of African-American women in a way that validates the natural arrangement of black facial features and bodies, but only insofar as they look white with straightened hair, very light brown skin, and thin figures. Thus, African-American women are doubly oppressed. Not only are they subject to gender discrimination in its many forms, but racial discrimination as well.

Historical aspects of the anabolic steroid controversy

Although the use of performance-enhancing products dates back to antiquity, anabolic steroids have emerged as the most prevalent drugs of abuse among athletes in recent decades (Dawson 2001). Although the Russian power lifters were perhaps the first to abuse anabolic steroids in the early 1950s, this practice spread quickly to athletes in other countries. The systematic use of anabolic steroids by athletes in the former German Democratic Republic was an extreme example of state-sponsored malpractice however, the abuse of performance-enhancing drugs is not limited to any one nation. Athletes and recreational bodybuilders who abuse androgenic steroids believe that these compounds increase muscle mass and performance and that higher doses of androgens produce greater effects on the muscle than lower doses (Wilson 1988). Hence, they take large doses and abuse multiple steroids simultaneously in a practice called stacking (Dawson 2001 Wilson 1988). Until a few years ago, the academic...

Anabolic androgen steroids

These substances, especially the hormone testosterone, are the doping substances most widely used for improving muscle mass and strength in association with regular training. Initially evidence for its effect was minor, due to the use of very small doses, but later studies have confirmed a significant effect. Body composition changes, with increased fat-free mass and reduced body fat. Some of this effect can be seen even without training, but is relatively more pronounced when added to resistance training 5-7 . Doses used

The role of 5areduction and aromatization of testosterone in the muscle

Although the enzyme 5a-reductase is expressed at low concentrations within the muscle (Bartsch etal. 1983), we do not knowwhether conversion of testosterone to dihydrotestosterone (DHT) is required for mediating androgen effects on the muscle. Men with benign prostatic hypertrophy who are treated with a 5a-reductase inhibitor do not experience muscle loss. Similarly, individuals with congenital 5a-reductase deficiency have normal muscle development at puberty. These data suggest that 5a-reduction of testosterone is not obligatory for mediating its effects on the muscle.

Associated Neurological Findings

The autonomic nervous system can be evaluated in a noninvasive manner at the bedside with the following assessments blood pressure and heart rate response to standing, isometric exercise, heart rate variation with respiration, Valsalva ratio, and plasma norepinephrine levels with standing.y

Workingout And Gym Training

Working-out, aerobics and similar activities are excellent, and often essential, rehabilitation methods and useful alternatives during rehabilitation of many injuries. Gym training, with a variety of fixed stations for weight training, has become popular recreational exercise. It is also used for basic pre-season training in almost every sport. There is no better way to learn functional anatomy than to work-out the muscle groups step by step in a gym. No equipment is better than the skills of the instructor. Working-out with weights is technically difficult and there are lots of pitfalls that need to be considered in close collaboration with a licensed instructor and access to appropriate training equipment. Training should start with an objective function test, so a reasonable measure of progress can be made. Beginners usually start with an individual training programme based on six to ten exercises. After working-out a few times at low resistance and learning the specific movements,...

Androgen excess from anabolic steroid abuse

A formal case-control study of anabolic-androgenic steroid abuse in younger men presenting with acute myocardial infarction has not been performed. Nevertheless, a review of the literature covering a 12-year period from 1987 to 1998 (Sullivan etal. 1998) identified 17 case reports of cardiovascular events (11 acute myocardial infarction, 4 cardiomyopathy, 2 stroke) in young male bodybuilders using extremely high suprapharmacological doses of anabolic androgens. However, although the number of current and former anabolic androgen users has greatly increased since the 1960s to over 1 million in the USA alone, there does not seem to have been any increase in the frequency of reported vascular events amongst likely and ex-users of anabolic-androgenic steroids.

The Focus Of Rehabilitation

A conservative approach is usually warranted, considering the patient population's comorbidities. Any form of aerobic activity should be structured to provide adequate rest and minimal imposition of joint stress.2 Initiating resistance training under close supervision with the least amount of resistance can provide significant benefit in the aging population.3 As with younger individuals, functional range of motion is extremely important and all aspects of physical therapy should be preceded by appropriate stretching and warm-up to prevent further injury.

Longitudinal perspective

In the last decade a number of trials have been undertaken in which traditional strength training programs have been undertaken by older people. The findings of these studies suggest that the muscles of older people are able to adapt to progressive resistance exercise training and that this is true for both men and women. The adaptations to strength training can be considered at a number of different levels. For example the gains in the amount of weight that can be lifted once (1RM) may increase some 174 in even very frail elderly people 2 , similar relative gains to those achieved in young adults (see also 'Classical reference'). With strength training it is clear that the gains in isometric strength are lower than that of the 1 RM. However, in older people the gains in isometric strength are also similar in percentage terms to young people. Skelton et al. 57 , for example, reported a 23 increase in isometric knee extensor strength in older women aged 75-80 years of age following 12...

Ability or performance

There was a small improvement in the range of lumbar motion following treatment, but this only correlated weakly with improved pain and disability. Isometric strength and EMG activity increased after treatment, though the correlation between them was weak. Fifty-five percent of patients had loss of the normal flexion-relaxation response at baseline, but this did not improve following treatment. Endurance in the Biering-Sorensen test improved after treatment, but there was no corresponding improvement in EMG measures of fatigability. At baseline, the cross-sectional area of the paraspinal muscles and the fiber types correlated with isometric strength. Following treatment, there was little change in muscle size or fiber type. Improvement in strength did not correlate with any changes in muscle size. Altogether, physical changes in the muscles were insufficient to account for the observed improvement in muscle performance. Burton A K, Tillotson K M, Edwards V A, Sykes D A1990 Lumbar...

Neuromuscular disorders

The neuromuscular disorders include a variety of myopathies, i.e. muscular dystrophy and other disorders originating in the nervous system, e.g. motoneuron diseases. Due to the difficulty in recruiting participants, only few larger studies exist on the effect of endurance and strength training in these individuals. In a study of six myopathy patients in a 12-week cycle ergometer training program improvements were found in their maximal oxygen uptake from approximately 13 to 47 , and a reduction in their heart rate at submaximal exercise. These changes were comparable to those in matched control subjects. Although these results are encouraging, two of the participants, one with limb-girdle and one with congenital dystrophy had 30 increases in plasma creatinine kinase and myoglobulin, which may indicate muscle damage induced by the training 42 . In a recent study of six myotonic dystrophy ambulatory persons, who completed a 12-week progressive high-resistance training program for their...

Aortic Valve Regurgitation

The surgical treatment of AR is indicated in symptomatic patients with dyspnea, angina, or CHF (Bonow, 2000). Asymptomatic patients should undergo surgery if LVEF is 55 or less, or left ventricular end-systolic dimension approaches 5.5 cm. Patients with moderate to severe AR should avoid competitive sports, heavy workloads, and weightlifting. Patients with severe AR may benefit from long-acting vasodilators such as nifedipine XL. This treatment

Hit the Weights and Pump Some Iron

Let's clear something up Weight training is not the same as body building. Weight training is about improving muscle strength and muscle tone. For men, who have naturally higher levels of testosterone, it usually does mean an increase in muscle size, hypertrophy. On the other hand, women tend to increase the tone without significantly increasing the muscle size. Typically, muscle v conditioning uses dumbbells and barbells dSSii H What can weight training do for you Weight training helps to tone, lift, firm, and shape your body. Weight training can help prevent osteoporosis. Weight training can help to reshape problem areas such as your sagging arms and your butt. Unfortunately, there is no such thing as spot reducing zapping off fat from specific body parts. But don't fret because the combination of a low-fat diet and aerobic activity burns total fat from all over your body, and chances are it will eventually come off your personal pudge. Weight training can increase your lean body...

Top Five Exercise Myths

Bogus statement It is true that both weight training and cardiovascular exercise usually involve some type of minor discomfort, such as feelings of slight burning or fatigue and moderate to heavy breathing. However, pain is entirely different. If you feel pain when you work out (particularly joint pain), you're doing something wrong. Stop exercising immediately, and have it checked by your physician. Pushing through agony can lead to serious trouble. If it checks out okay, seek the assistance of a qualified trainer something is probably wrong with your exercise program or technique. 2. Eating extra protein builds muscle. We already went over this one in the protein chapter, but allow me to drive the point home. The increase in muscle size, known as hypertrophy, has nothing to do with eating a lot of protein. Muscles get bigger when you overload them via weight training not kilos of tuna. The recommended daily amounts for protein remains about 15 percent of total...

Become Familiar with the Weight Training Tools

Weight-training equipment can be super high-tech (multi-muscle machinery) or super low-tech (a pair of dumbbells and a box). Don't be fooled into thinking that something more complicated means a better workout. That's not the case at all Weight-training machines In general, machines are a good starting point for beginners. They remove a lot of the guess work you just move from machine to machine. (Adjust your seat, stick in a pin, and you're ready for action.) Several machine variations include weight stacks with pulleys and cords (such as Universal and Cybex), metal rod systems (such as Cybex and Med-X), cams and chains (such as Nautilus), or air pumps (such as Kaiser). Just name the nut and bolt, and there's a machine out there that has it. Test them all and find the one you're most comfortable with. Free weights These, on the other hand, require a fair amount of coordination, strength, and skill because they heavily depend on your balance and body control. Although weight training...

Metabolic responses to infections and effects on performance

Quired 'clinical bed rest' resulted in a decrease in the isometric strength of 5-15 35 , and in the isometric endurance of 13-18 36 in various major muscle groups tested shortly after the disappearance of clinical symptoms of disease, as compared to subsequent repeated individual baseline results when the patients were healthy. Furthermore, in both young male and young female adults, such infections caused a decrease in the aerobic exercise capacity, as determined from the heart rate response during submaximal exercise, by approximately 25 37 . The aerobic exercise capacity is dependent on central factors, such as the plasma volume, the total hemoglobin and the myocardial function, as well as on peripheral factors, i.e. the state of the skeletal muscles 38 . Potentially, all these factors may be negatively influenced by either the infection or the clinical bed rest that is part of the treatment, or both. In a group of healthy young adult males who served as controls in the studies...

Integrity of an Intervention

In another scenario, a drug is given to test its rehabilitative effect without any added therapy. For example, -adrenergic agonists may exert anabolic effects on muscle. In a study of patients with facioscapulohumeral dystrophy, the agent albuterol increased lean muscle mass, but did not improve strength.250 In retrospect, a reader may ask whether it is reasonable to expect an anabolic drug to improve muscle strength without an accompanying resistance exercise program. In the same vein, a study of an antispasticity drug to improve ADLs or walking speed may fail to do so if the drug is not augmented with therapy for the chosen endpoint and then compared to therapy alone. Subjects in a study that does not add therapy may not attempt to increase their skills when left on their own, so they do not improve functionally. The reader is left to wonder whether the drug may have had a positive effect on motor control that could have been manifested by task-oriented practice. Investigators must...

Nonpharmacologic Therapy

Lifestyle modification should be employed in all patients at risk for OA and in those with established disease. Aerobic exercise and strength-training programs improve functional capacity in older adults with OA. Stretching and strengthening exercises should target affected and vulnerable joints. Isometric exercises performed three to four times weekly improve physicalfunctioning and decrease disability, pain, and analgesic use. Some patients have the misconception that increased activity will exacerbate joint symptoms, but controlled clinical trials have invalidated this belief.10 The American Geriatrics Society issued guidelines on the implementation of exercise in OA patients.11 In general, it is advisable to recommend performing low-impact exercise routinely.

Personal Protein Requirements

Athletes do need protein for that competitive edge. You learned the vital roles of protein in Chapter 3, but let's get sport-specific for a minute. Protein is essential for building and maintaining muscle tissue, as well as repairing the muscle damage you endure during hard workouts. Remember, dietary protein does not automatically build bigger muscles You build bigger muscles through regular exercise and training. Dietary protein simply allows all your hard work to pay off. Go ahead and take the credit it had nothing to do with all the protein powder you shoveled in each day. A 200-pound bodybuilder needs between 120 and 160 grams of protein daily. Notice that even though the growing gymnast might require more protein per pound than the bodybuilder, bodybuilders usually weigh a lot more and therefore tend to have greater protein requirements.

Basal contractile activity

(MEF2, NFAT, and PGC-1) controlled by these pathways. However, many other signaling proteins also have been implicated in the generation of cardiac or skeletal muscle hypertrophy, and in the control of specialized programs of gene expression. It will be of paramount impor-

JS Davis S Hassanzadeh S Winitsky H Wen A Aletras and ND Epstein

In general, although morphologic changes associated with HCM are variable both within and between families, papillary muscle does not typically thicken to the extent of the septal and or free wall hypertrophy. Since mid-cavity HCM is partly the result of an unusually large amount of papillary muscle hypertrophy, only a small fraction of HCM is characterized by mid-cavity obstruction. As rare as this phenotype is, it is even more rare in children. Toward this end, a telling experiment evaluated the role of the two homologous serines in the context of striated Drosophila flight muscle (Tohtong et al. 1995). An embryonic lethal transgenic fly, missing the RLC, was rescued with an RLC in which the homologous serines were substituted with alanines, prohibiting phosphoryla-tion. The flies were born with morphologically normal flight muscle capable of producing normal isometric tension, yet the flies were incapable of flight. The property of stretch-activation was missing from the flight...

Trials of Schools of Therapy

Another trial gave all 75 patients functional training and stretching, then randomized the patients into 3 groups. One group continued this training, another performed additional active exercises, and the third performed additional resistive exercises.212 The latter group was more independent at 1 month, but no difference was apparent by 2 months. Strength increased in the resistive-exercise group. Although selective muscle strengthening has not been a focus of most schools of therapy, this trial alone warrants further exploration of potential links between the rate of early recovery and methods for selective muscle strengthening. An increasing variety of studies point to the feasibility and functional benefit of using general exercise and resistance training to increase strength in hemiparetic subjects.120,213,214

Medial and Lateral Meniscus

Lateral meniscal injuries are seen with less frequency than medial meniscal injuries. The lateral meniscus permits greater anatomic mobility and is thus less susceptible to tears. Damage to the lateral meniscus can occur when both rotational and compressive forces are applied to the knee while it is fully flexed with the foot fixed on the ground. These injuries can be seen in sports such as wrestling and in weightlifting when an athlete performs improper squatting. Patients should be treated conservatively in all but the most severe cases. Initial treatment consists of RICE, NSAIDs, and analgesics. Physical therapy is recommended for a partial-thickness tear with minimal displacement. Rehabilitation programs should incorporate ROM exercises, progressive strengthening beginning with isometric exercises and transitioning to closed kinetic chain exercises, and sports-specific agility training as the patient progresses. Arthroscopy should be considered in competitive athletes or patients...

Do androgens have physiologic relevance in women

It is well established that androgens are not simply reproductive hormones. While they do have multiple reproductive effects both in the fetus and in postnatal life, acting to direct the development of sexual dimorphism and for maintenance of secondary sexual characteristics, they also are multi-system hormones with protean effects on multiple organ systems. Androgens act to enhance bone mass, potentiate certain cognitive behaviors, and enhance erythropoesis. They also modify hepatic protein secretion, stimulate kidney and muscle hypertrophy, and modify patterns of adipose tissue deposition. They are clearly related to skin and appendage function and finally, may have certain immune-enhancing effects.

Sign Up for a Prenatal Exercise Class

Generally, these specialty classes focus on thorough warm-ups, cool-downs, aerobic workouts, and stretching. In some instances, they might also include strength training and yoga. All exercises are carefully choreographed to keep you energized, but in a comfortable and appropriate fashion. Furthermore, you won't feel self-conscious because everyone in the class is in the same boat give or take a few inches (or yards) around the waist. In other words, it's highly unlikely that the woman standing next to you will be wearing a thong leotard (and if she is, more power to her). It's also a nice place to bond, swap pregnancy war stories, and meet other women who are soon to have kids the same age as your own.

Yesr MomstoBe Can Lift Weights

Being pregnant doesn't necessarily mean passing up the weight room. In fact, some light weight training might cut back on some of the back and shoulder pain associated with enlarged breasts, extra weight, and a growing uterus. It might also reduce the leg cramps and neck strain that some women experience toward the last trimester. Personally, my favorite benefit from prenatal lifting is that your muscles will be primed for the baby aftermathThat is, you'll be ready to lug around your pocket-book, diaper bag, and stroller on one arm, while carrying your baby on the other. To this day, I still amaze my sister Debra with the amount of equipment I can juggle with just two arms Regroup your weight-training goals. Instead of focusing on intense workouts that will increase strength and define your muscles, relax, take it easy, and simply concentrate on strength maintenance.

Diverse Functions Of Igf1 In Vivo

Distinct components of the IGF system in vivo have been studied by gene targeting experiments (for review, see D'Ercole 1999), showing that IGF-1 (Liu et al. 1993 Powell-Braxton et al. 1993), as well as the IGF-1 receptor (Liu et al. 1993), is necessary for normal embryonic and postnatal growth, and that the development of many tissues and organs is regulated to some degree by components of the IGF system. Although obviously also affecting other tissues, like brain, skin, and bone (for review, see Stewart and Rotwein 1996), as well as the immune and reproductive system (for review, see Clark 1997 van Buul-Offers Kooijman 1998 Bartke 1999), IGF-1 plays a central role in the control of muscle development,

Igf1 Isoform Diversity In Skeletal Muscle

In the different muscles correlates with the amount of mIGF-1 transgene expressed (Musaro et al. 2001). Thus, the transgenic IGF-1 product initiates a cascade of events that ultimately lead to up-regulation of endogenous IGF-1 gene products. The present findings also raise the possibility that the phenotype seen in the transgenic mIGF-1 mice is due not only to the overexpression of the exogenous mIGF-1 isoform, but also to increases in all endogenous IGF-1 isoforms, which then act synergistically to stimulate muscle hypertrophy, to maintain muscle functionality, and to promote regeneration in these animals.

Well Known Techniques and Packages

Many other procedures for training creativity have also been marketed. These may consist of specific, discrete activities such as 'attribute listing,' 'idea matrix,' and 'creativity toolbox,' that sometimes take the form of games such as 'bridge building,' 'idea production,' or 'creative productions.' Sometimes a series of activities are combined to form creativity facilitating packages or programs which are meant to be used regularly for creativity training, according to a schedule. It has become common to refer to such materials (both the discrete activities and the packages) as involving the technology of creativity training, in much the same way as the machines in a gymnasium constitute the technology of bodybuilding. The idea is that it is possible, with the help of this technology, to do mental workouts, just as athletes do physical workouts.

Igf1 And Muscle Regeneration

This argument is supported by a recent study, in which mIGF-1 transgenic mice, which show pronounced muscle hypertrophy, escape age-related muscle atrophy, and retain the regenerative capacity in response to injury characteristic for younger animals (Musaro et al. 2001), were crossed with mdx mice (Barton et al. 2002). This study demonstrated the complete rescue of the dystrophic phenotype, suggesting that supplementary levels of the mIGF-1 isoform are sufficient to stimulate a regenerative response, which overcomes the degeneration of muscle fibers and is capable of maintaining the functionality of the muscle in these animals. Although up-regulation of endogenous IGF-1 isoforms in mdx muscles is clearly not sufficient to maintain the hypertrophic muscle phenotype seen in the mdx mIGF-1 muscles, these results highlight the potential therapeutic value of at least the mIGF-1 isoform in the maintenance of muscle function and stimulation of regeneration.

Carpal tunnel syndrome

Carpal tunnel syndrome is the most common com-pressive neuropathy at the wrist and may be associated with sporting activities secondary to flexor tenosyn-ovitis or lumbrical muscle hypertrophy as well as an extension injury 3,7 . The signs and symptoms of carpal tunnel have been well described the patient presents

The assessment of maximal muscle strength

Concentric isokinetic quadriceps peak moment occurs at gradually more extended knee joint positions with increasing joint angular velocity 12,14,29 . Accordingly, the corresponding moment-velocity relationship consists of moment values obtained at different parts of the quadriceps length-tension curve. Nevertheless, the momentvelocity pattern based on angle-specific moment appears to deviate most markedly from a hyperbolic curvature at least when obtained in untrained subjects, as reflected by a levelling-off ('plateauing') of moment at low angular velocities 11,14,19,25,26,28,30-32 (see Fig. 1.4.3). A similar plateauing of moment of force during slow concentric contraction has been reported for other muscle groups than the quadriceps, e.g. the arm flexors 9,33 . Interestingly, maximal arm flexor and extensor moments plateaued in subjects of low maximal muscle strength, whereas no plateauing could be demonstrated in subjects of high strength 33 suggesting...

Chronic myotendinous groin injuries

Iliopsoas Muscle Inflammation

Could be that this muscle is 'hidden' to the athlete's knowledge and is difficult to examine clinically. Knowledge of the preventive measures usually practiced for other muscles at risk such as strength training and stretching is thus sparse, and both strains and overuse injuries in the iliopsoas muscle might develop into a chronic problem. The exercise program consisted of two modules. The first module was a period of 2 weeks with careful static and dynamic exercises to teach the patient to reactivate the adductor muscles (Fig. 6.3.11). In most cases the athlete with adductor-related groin pain has difficulties activating these muscles, probably as a result of negative feedback caused by the pain. In the second module the exercises were gradually more demanding heavier resistance training as well as challenging balance and coordination exercises were added (Fig. 6.3.12). The groin exercise program was performed three times a week and the exercises from module 1 were done on the days...

Eccentric muscle contraction

Muscle Contraction Sport

Eccentric contraction strength was higher than isometric strength during contractions evoked by electrical stimulation, but not during maximal voluntary muscle contractions 34,36,130,131 (Fig. 1.4.2). Moreover, with artificial activation the normalized momentvelocity relationship of human muscle in situ appears to have a more similar shape to that of isolated muscle in vitro, during both eccentric and concentric contractions 34,130,131 (Fig. 1.4.2). Quadriceps muscle strength is elevated during eccentric but not concentric contractions when electrical transcutaneous stimulation is superimposed onto maximal voluntary contractions 131,132 (see Fig. 1.4.2). Interestingly, this evoked increase in eccentric contraction strength is seen only in sedentary subjects and not in strength-trained athletes I32 , suggesting that the apparent deficit in eccentric muscle strength disappears as an adaptive response to strength training. Recent results suggest that the apparent suppression in...

Attractiveness Bias as a Behavioral Effect

As part of the efforts to make employees more open to diversity, workshops and seminars on the topic should attempt to increase awareness of attractiveness bias and its effect on judgments and behavior. Such efforts may not succeed, however, unless there are also changes in personnel policies and procedures. In particular, appearance should be deempha-sized as a factor in selection and appraisal systems except for those aspects of appearance that are clearly shown to be related to performance of the job. Explicit appearance ratings are frequently used in the evaluation of applicants and employees, but can serve as a surrogate for all sorts of biases. If appearance is shown to be job-related, then behaviorally specific scales should be developed to conduct appearance ratings. A careful study is likely to reveal that some appearance standards are justifiable, such as a prohibition against beards for employees who must wear safety masks. In other cases, appearance standards are unrelated...

Emotional Intensity Emotional Valence and Visual Perspective

Although emotional experience has long been described as comprised of two dimensions, valence and intensity (e.g., Duffy, 1934,1941 Dunlap, 1932), it is unclear which of these properties produces the observed effects within the perspective literature. Strongman and Kemp (1991) cued memories with 12 emotional words that varied in both valence and intensity and found that, regardless of valence or intensity, individuals predominantly used first-person perspectives. In fact, of the 912 memories recalled in the entire study, 908 were recalled from a first-person perspective. Given that some of the cued events were likely high in both emotional intensity and self-awareness (e.g., shame), which Nigro and Neisser (1983) found were likely to produce third-person perspectives, it is unclear why so few memories were recalled using a third-person perspective. But certainly, these findings suggest that remembering emotional events produces first-person perspective memories.

Human physique and sexual attractiveness

Somatotypes Figures

A number of studies have produced evidence that women find certain types of masculine physique more attractive sexually. A broad chest and shoulders, narrow hips, and a muscular torso are important traits which influence female assessments of masculine physical attractiveness (Lynch and Zellner 1999 Dixson et al. 2003). In order to quantify these preferences, some studies have made use of Sheldon's (1940) system of somatotyp-ing. This classifies human physique according its degree of mesomorphy (muscular and powerful build), ectomorphy (slim and lean build), and endo-morphy (heavy-set and fatter build). Examples of pronounced mesomorphic, ectomorphic, and endo-morphic somatotypes are shown in Figure 7.6, along with an intermediate, or average, type of physique. Images of this kind, back-posed to avoid the distraction of facial cues and standardized for height and posture, have been used in cross-cultural studies to measure female preferences for masculine physique (Dixson et al. 2003...

Sarcopenia associated with chronic illnesses

In two placebo-controlled, double-blind, clinical trials, we have demonstrated that testosterone replacement in HIV-infected men with low testosterone levels is associated with significant gains in fat-free mass (Bhasin et al. 1998 2000). There were no significant changes in liver enzymes, plasma HIV-RNA copy number, and CD4 and CD8+ T cell counts with testosterone administration in either of the two trials. In one study (Bhasin et al. 2000), we determined the effects of testosterone replacement, with or without a program of resistance exercise, on muscle strength and body composition in androgen-deficient, HIV-infected men with weight loss and low testosterone levels. This was a placebo-controlled, doubleblind, randomized, clinical trial in HIV-infected men with serum testosterone less than 350 ng dl, and weight loss of 5 or more in the previous six months. Participants were randomly assigned to one of four groups placebo, no exercise testosterone, no exercise placebo plus exercise...

Iiiiiiiii 2 4 6 8 10 12 14 16 18 Vaginal length

Does the thickness of the human penis have any significance as regards sexual selection during human evolution If human penile morphology evolved to promote pleasurable stimulation of the female partner, there might be at least two avenues of selective advantage. Firstly, if enduring relationships between the sexes with long-term reproductive benefit in terms of offspring survival are facilitated by pleasurable sexual activity, then penile morphology might be adaptive in this context. However, it will be recalled that in the monogamous and polygynous non-human primates, males tend to have the least specialized penile morphologies, despite the occurrence of long-term sexual relationships in such species. There is some evidence that women rate the thickness and length of a partner's penis as significant factors in their sexual satisfaction (Stulhofer 2006). Human mate choice and long-term relationship decisions are immensely complicated, however. Cross-cultural studies indicate that...

The Use of Bedside Maneuvers and Vasoactive Agents Bedside Maneuvers

Postures such as standing and squatting, and finally the effect of sustained handgrip or isometric exercise (1-4). Isometric exercise can also be applied. This exercise must be done for at least 60-90 s to achieve changes in sympathetic tone with increase in heart rate, cardiac output, and blood pressure (16). These effects are best seen in the supine position. As opposed to aerobic exercise, such as walking on a treadmill, isometric exercise will result in marked increase in the systemic arterial resistance. The filling pressure will rise in the left ventricle, augmenting events related to ventricular filling such as left-sided filling sounds (S3 and the S4) (17). The elevated left atrial pressure will cause the OS, if present, to occur earlier. The mitral diastolic murmur of mitral stenosis will become augmented. The effect in hypertrophic obstructive cardiomyopathy will be variable because of the opposing effects of the increased heart rate and the increased blood pressure on the...

Median Neuropathy Carpal Tunnel Syndrome

Other risk factors include any tasks that require repeated or sustained stress over the base of the palm. Low-frequency vibration exposure is another well-recognized risk factor for CTS. Repetitive wrist and hand movements such as knitting, typing, painting, woodworking, and weightlifting are also implicated as high-risk factors.

Self Awareness Self Concept and Visual Perspective

There are a few problems with this model as it is described. Primarily, it does not account for some of the existing data. For example, it does not explain data suggesting that emotional memories, regardless of valence, produce more first-person perspectives (e.g., D'Argembeau, Comblain, & Van der Linden, 2003 Nigro & Neisser, 1983 Strongman & Kemp, 1991), nor does it explain the cultural differences found by Cohen and Gunz (2002). As described, it also does not account for some of the other differences observed across first- and third-person perspective memories, such as differences in vividness and other phenomenological variables. This model is an important step in trying to integrate literatures. However, there is still work to be done to describe the relationship between perspective, self-related processes, and emotion.

Antagonist muscle coactivation

It is not well known whether strength training per se may induce altered patterns of antagonist coactiva-tion. Intuitively, a decrease in antagonist coactivation would seem desirable, as this would cause net joint moment (agonist joint moment minus antagonist joint moment) to increase. However, as implied above a decrease antagonist muscle coactivation may not be optimal for the integrity of the joint. Antagonist coactivation has been reported to decrease 77a, 158 , increase 151 or remain unchanged 43,5o,76a,77a,i35,i57,i59, 160 in response to strength training. H kkinen and coworkers 77a found that coactivation of the lateral hamstring muscle during maximal isometric contraction of the quadriceps femoris was elevated in old subjects (70 years) compared to middle-aged subjects (40 years). However, after 6 months of heavy resistance-training coactivation decreased in the old subjects to reach a level similar to that recorded for the middle-aged subjects, which in turn did not change...

Muscle crosssectional area and volume

Raphy to address the alteration in macroscopic muscle dimensions evoked by resistance training (Fig. i .4. i6). Fig. 1.4.16 (a) Coronal MRI scan of m. quadriceps femoris. (b) The relationship between quadriceps muscle CSA and total quadriceps volume. Pre- and post-training values are shown by closed and open symbols, respectively. (c) Axial MRI images of the thigh obtained at 50 femur length (proximal site) and 30 femur length (distal site) before and after i4 weeks of heavy-resistance strength training. Data adapted from 207 and 229 . Fig. 1.4.16 (a) Coronal MRI scan of m. quadriceps femoris. (b) The relationship between quadriceps muscle CSA and total quadriceps volume. Pre- and post-training values are shown by closed and open symbols, respectively. (c) Axial MRI images of the thigh obtained at 50 femur length (proximal site) and 30 femur length (distal site) before and after i4 weeks of heavy-resistance strength training. Data adapted from 207 and 229 . The determination of muscle...

Fearavoidance beliefs

Fear Avoidance Model

Patients who believe that physical activity may aggravate their pain, whether from their past experience or because of their understanding of the pain, will expect and fear more pain if they are active. Note that this is all a matter of fears and expectations about what might happen. Schmidt (1985) showed that patients with chronic low back pain do not do as much on a treadmill task and have lower pain tolerance when they immerse their forearm in ice water. However, it is not simply a question of the intensity of pain during the task. They found that treadmill performance depended more on previous reports of pain than on pain at the time. Cold tolerance depended more on beliefs about how well they could cope. Al-Obaidi et al (2000) again showed that physical performance on lumbar isometric strength testing depended on anticipation of pain and fear-avoidance beliefs, rather than on actual pain during testing or beliefs about disability.

Functional Rehabilitation Protocol

Continue isometric exercise as outlined in week 3 increase resistive band exercise at three sets of 20 repetitions hamstring curls with light resistance at three sets of 20 repetitions Stationary bike without boot with increased resistance continued isotonic and isometric exercises weight shifting and unilateral balance exercise seated on therapeutic ball closed chain Partial Weight Bearing (PWB) strengthening of plantar flexors (0 degrees to full plantarflex-ion) seated heel raises, and hamstring curl with light resistance open chain strengthening with medium resistive band begin stair stepper with involved limb only

Special Autonomic Function Testing

Other tests used to assess sympathetic cardiovascular outflow include the hemodynamic response to physical or emotional perturbations such as immersion of a hand in cold water for 1 minute (cold pressor test), isometric exercise (e.g., the sustained handgrip maneuver), or emotional stress (e.g., mental arithmetic). In normal subjects these maneuvers produce increases in diastolic pressure of more than 15 mm Hg and in heart rate of more than 10 beats per minute. y The venoarteriolar reflex is an axon reflex mediated by sympathetic C fibers. This reflex is provoked by distention of the veins of a dependent limb that produces local arteriolar constriction the reflex can be detected by a decrease in skin blood flow. y

Functional Electrical Stimulation

Muscular contractions evoked solely by electrical stimulation or superimposed on contractions by paretic muscles can increase muscle bulk and strength.176 For example, FES training of the quadriceps, by stimulating full knee extension in sets of 5-15 repetitions against an increasing load resistance of 1 kg-15 kg, increases muscle bulk, improves strength, and reduces fatigability for the FES activity by 12 weeks.175 In another study, cross-sectional area of most of the exercised leg muscles increased by approximately 30 over the course of 1 year of a gradual buildup of exercise tolerance 3 days a week for 30 minutes.177 A 2-week trial of a beta2-adrenergic agent such as salbutamol may increase muscle mass more when combined with FES-cycling compared to training alone,178 but much more study of drug-induced muscle hypertrophy is needed (see Chapter 2). Functional electrical stimulation has also reduced the rate of loss of trabecular bone from the proximal tibia.179

Congenital Aortic Regurgitation

Aorta Fistula

Ejection is rapid and the pre-ejection period is shortened. With isotonic exercise' systemic systolic pressure rises but peripheral resistance falls' diastole shortens as heart rate increases' and regurgitant fraction per beat decreases. An appropriate increment in effective cardiac output is achieved without an increase in end-diastolic volume or end-diastolic pressure.19 Despite these favorable adaptations' left ventricular response to isotonic or isometric exercise is not necessarily normal even in young asymptomatic patients.19'20'85'93'95'210

Ulnar nerve cubital tunnel syndrome and compression

Entrapment at the arcade of Struthers in the upper arm or the flexor carpi ulnaris muscle in the forearm is seen with muscular hypertrophy. The primary treatment is conservative rest and reduction of the activities which stress the nerve, e.g. throwing or body-building (muscular hypertrophy). With persisting symptoms, surgical treatment is necessary. The nerve is decompressed at the site of entrapment. In the cubital tunnel this can be achieved by either in situ decompression or transposition of the nerve anterior to the epicondyle. Osteophytes are removed. If the nerve entrapment is an element of thrower's elbow (medial instability, posterior impingement, lateral cartilagenous degeneration and ulnar nerve entrapment), the medial instability should be addressed, as decompression alone rarely reduces medial pain 38 .

Treatment Options Nonoperative Care

Osteophytes Elbow Posteromedial Thrower

Lumbar spine injuries in athletes are a category that often demands prevention of atrophy and stiffness and restoration to maximum function as early as possible. Also, it follows that if this restoration can be achieved in athletes, it can function just as effectively in steelworkers, secretaries, weekend athletes, and housewives. The key to the program, obviously, lies in safety and effectiveness. If you could summarize an overall basis to our preferred rehabilitation program, it would lie in the concept of neutralposition isometric strengthening for the spine. This program is derived from work by Jeff Saal, MD, Arthur White, MD, and others, including Celeste Randolph, Ann Robinson, and Clive Brewster at the Kerlan Jobe Orthopedic Clinic, Inglewood, CA. It certainly appears that the place to begin the rehabilitation program in an injured lumbar spine, with or without neurologic deficit, should be with neutral-position isometric strengthening. The basis of the trunk stability program...

Painful Conditions Of The Upper Back

Pectoralis Minor Length Test

Thoracic kyphosis is a primary deformity in osteoporosis, usually accompanied by compensatory extension of the cervical spine. Complaints of upper middle and low back pain are common and can best be treated by gentle efforts to reduce the postural deformity and prevent further progression before the faulty posture becomes a fixed structural fault. If a support can be tolerated, encourage the patient to use one to help maintain the best possible alignment. As tolerated, exercises should be done to help maintain functional range of motion and develop strength.

Training Of The Lower Leg Muscles

Talar Dome Cartilaginous Injuries

Injuries to the lower leg or immobilisation of the ankle joint often lead to atrophy of the lower leg muscles and reduced power output in ankle plantar flexion with straight knee (m gastrocnemius) and with flexed knee (m soleus, m tibialis posterior, m flexor hallucis longus, m flexor digitorum longus) and in dorsi-flexion (m tibialis anterior and m extensor digitorum). The lower leg muscles are of vital importance for activities like jumping, running on hard surfaces and most ball sports. Strength training of the calf muscles can be performed with toe raises in standing or sitting positions, with both straight and flexed knees.

Neural inhibitory mechanisms

Numerous pathways in the nervous system could be responsible for exerting an inhibitory synaptic drive onto the spinal pool of a-motoneurons. As an important feature, these pathways allow for an integration of spinal and supraspinal inputs. It appears therefore that changes in the spinal neural circuitry induced by training, including alterations in synaptic gating, may emerge as a result of adaptive changes at both spinal and supraspinal levels. Consequently, considerable plasticity can be expected for the neural adaptation to specific types of activity and training. For example, inhibition of various inhibitory pathways as a result of strength training would yield an increase in the net excitatory drive to the motoneuron pool. resistance strength training (Fig. 1.4.10) is the result of a down-regulation in spinal Ib inhibitory interneuron activity (i.e. 'disinhibition') mediated via central descending pathways. In the spinal cord Renshaw cells may serve as a variable gain regulator...

Motoneuron firing frequency

Two basic questions can be raised is motoneuron firing frequency influenced by strength training and if that is the case, what is the functional significance To address the latter question first, motor unit discharge rates have been recorded at much higher frequencies than needed to achieve full tetanic fusion in force. Thus, transient firing frequencies of 60-200 Hz were reported in brief bursts of activity during maximal voluntary contraction of human muscles in vivo 83-86 . Muscle innervation frequency influences not only the magnitude of contractile tension but also the rate of tension rise (i.e. rate of force development RFD Aforce Atime), as observed for whole muscle in situ 87 , single muscle fibers 88,89 and human muscle in vivo 90-92 . When individual motor units were examined in the neonatal rat 93 it was noticed that RFD continued to increase at stimulation rates higher than the stimulation rate at which maximum tetanic tension was achieved 92 (Fig. 1.4.5). Similar findings...

Epidemiology of exercise health and aging

Resistance training with equipment, calisthenics and other types of resistive activities Resistance training as above to maintain or increase bone strength and dynamic balance and to prevent osteoporotic fractures Aerobic and resistance training as above to strengthen the tendons, ligaments, and other connective tissue structures static and or dynamic stretching of major muscle groups included in the exercise programs to increase and maintain range of motion

Table 305 Glycogenoses

Numerous episodes of supraventricular tachycardia occurred in an infant with Thomson's disease. The baby developed normally until he was about 18 months old, when he began to walk on his toes. Examination revealed mild weakness and poor muscle development. Calf muscles were bulky and firm, and the Achilles' tendons

Key theoriesstages of physical development

Physical development skeletal and muscular development Skeletal development varies, with skull and hands maturing first and most structures in place by the age of 18. According to Tanner (1978) neonates are born with all the muscle cells they will ever have, with muscular development occurring in a cephalocaudal direction, that is, from top to toes. The key areas of physical development that undergo change involve those in height and weight, skeletal and muscular development, those to the brain and nervous system and the changes that occur at the time of puberty.

Systematizing the Consensual Assessment Technique in Creativity Research

It overcomes the difficulty of attempting to specify 'ultimate' objective criteria for identifying products as creative. Indeed it may be impossible to articulate such ultimate criteria. Just as the judgment of attitude statements as more or less favorable or the identification of individuals as 'physically attractive' depends on social context, so too does the judgment of creativity. Certainly, there must be particular characteristics of attitude statements or persons or products that observers systematically look to in rating them on scales of favorability or physical attractiveness or creativity, but in the end the choice of these characteristics is a subjective one. Important writings by Gardner, Csiksentmihalyi, and others argue that creativity arises from a combination of three sources a cultural historical context that imposes specific symbolic rules on the creator, the creator who introduces novelty into that symbolic domain, and a field of experts who point out and validate...

Distal Biceps Tendon Rupture

It takes months for the tendon to form a strong attachment to the bone, so the recovery phase is long. During recovery, heavy use of the arm, especially for pulling and lifting, should be avoided. A gradual increase in motion and strength training is required. This should progress over many months to full return to sport.

Open Achilles Tendon Debridement with Repair

Postoperative day 1 elevation, nonsteroidal antiinflammatory drugs (NSAIDs), protected weight bearing (WB), isometric strength training with active dorsiflexion and plantarflexion Postoperative day 2 weight bearing as tolerated (WBAT) with crutches, continue isometric strength training Week 1 full weight bearing (FWB), continue isometric strength training Week 2 swimming, water running

Frequency of steroid hormone misuse

Data concerning the most commonly misused AAS in non-controlled sports are only available via recommendations in magazines for bodybuilders, via underground handbooks (Taylor 1982 Duchaine 1989 Grundig and Bachmann 1995), the internet and via confiscated, smuggled substances and those obtained from black market sources. Frequently recommended AAS include boldenone unde-cylenate, drostanolone propionate, fluoxymesterone, mesterolone, metandienone, methandriol dipropionate, methenolone enanthate, methyltestosterone, nortestos-terone decanoate and other esters (cypionate, hexylphanylpropionate, laurate), oxandrolone, oxymetholone, stanozolol, testosterone in the form of different esters (cypionate, decanoate, enanthate, isocaproate, hexanoate, isohexanoate, phenyl-propionate, propionate and undecanoate) and trenbolone, trenbolone acetate.

Androstenedione administration in clinical studies

Effects of oral androstenedione have not been studied in women and have been largely disappointing in men. Short-term (5 days) androstenedione (100 mg day) had no anabolic effect on muscle protein metabolism in eugonadal young men (Rasmussen etal. 2000). In 30-56 year-old men androstenedione (3 x 100 mg day) for 28 days slightly reduced HDL-cholesterol without affecting prostate specific antigen (PSA), suggesting some androgenic activity (Brown et al. 2000). Serum HDL-cholesterol was also reduced in an eight-week randomized trial in 20 young men receiving oral androstenedione (300 mg day) (King etal. 1999). Androstene-dione failed to enhance muscle adaptation to resistance training in this population (King etal. 1999).

Patient Care and Monitoring

Stress lifestyle modifications for rehabilitation and prevention. Recommend strength training, range-of-motion exercises, and a warm-up period before exercise. In repetitive-motion injury, recommend methods to correct biomechanical abnormalities and vary work tasks as applicable. Refer to a physical therapist or sports trainer as needed.

Clinical Implications

Our survival porcine study demonstrates that progressive, incremental ureteral tissue overexpansion can be carried out safely and reliably with a percutaneously placed expansion balloon. This ureteral expansion is well tolerated and can be performed over a 3- to 4-week period to create a sizeable reservoir for bladder augmentation. The expanded ureter is thick and vascular and reveals histologic and electron microscopic features of durable ureteral smooth-muscle hypertrophy and hyperplasia. This expanded tissue can be used laparoscopically to augment the bladder. Such augmented bladders possess good urodynamic properties over a three-month follow-up period.

Future Of The Preparticipation Examination

Explanation Those with significant essential (unexplained) hypertension should avoid weight and power lifting, body building, and strength training. Those with secondary hypertension (hypertension caused by a previously identified disease) or severe essential hypertension need evaluation. The National High Blood Pressure Education Working group defined significant and severe hypertension. Explanation Athlete needs individual assessment for collision, contact, or limited-contact sports. The following noncontact sports should be avoided archery, riflery, swimming, weight or power lifting, strength training, or sports involving heights. In these sports, occurrence of a seizure may pose a risk to self or others.

Treatment of type 2 diabetes

Data on effects of aerobic and resistance training on glycemic control in established type 2 diabetes are summarized in Tables 4.4.1 and 4.4.2. Many studies lacked an appropriate sedentary control group. This limitation is a concern as intensified patient-doctor interaction may itself improve glycemic control and other metabolic parameters. In many studies, the patients lost weight, which may or may not be a consequence of physical activity and confounds, as does small sample size, interpretation of effects of exercise as compared to weight loss per se on metabolic control. Overall effects of physical training on glycemic control have been modest and in roughly half of the studies non-significant. There are several potential explanations for the failure of exercise to be an effective antihyperglycemic therapy. First, physical training primarily improves insulin sensitivity in skeletal muscle (see below) rather than in the liver, which is the ultimate target of any antihyperglycemic...

Human growth hormone hGH and insulinlike growth factor IGFI

Intake of growth hormone (GH) has been used for years in the belief that it has an anabolic effect on skeletal muscle. It has been demonstrated that GH administration in GH-deficient individuals can improve fat-free body mass and thus muscle, and animal studies have documented a GH-mediated stimulation of muscle hypertrophy. In spite of this, there have been no studies robustly documenting any muscle mass-increasing effect of GH in addition to strength training

Risk Factors For Overuse Injury

The etiology of overuse is often multifactorial, including repetitive mechanical load, anatomic malalignment, training errors, and equipment problems (Table 21-1). A resulting muscle imbalance may lead to abnormal kinematics or repetitive tensile failure. Overuse injuries can be insidious and difficult to diagnose. Acute injuries often force an athlete out of play and demand immediate attention. Continued slow accumulation of microinjury may be easily overlooked by both athlete and physician. Early diagnosis and prevention remain paramount. When overuse injuries are caught early in their course, the athlete will most often respond favorably to conservative treatment with minimal time out of play. When diagnosed late, the injury complex may have progressed to the point of requiring significant time off for rest, rehabilitation, and possibly surgery. Recognition of poor technique or inadequate stretching, proper strength training, and reduction of excessive play are all key to...

Postoperative Rehabilitation

Postoperatively, the repair should be braced for 4 to 6 weeks. Harness suspension devices that maintain the knee in flexion during crutch ambulation31 and braces that prevent simultaneous hip flexion and knee extension30 have been advocated during this period. Passive range of motion exercises can be initiated as well as gait training with the goal of full weight bearing and normal gait being attained by 6 to 12 weeks. Strength training may then be initiated as tolerated by the patient.

Postoperative Rehabilation

Active motion begins during the next phase, from weeks 6 to 12, with a gradual increase in the range of motion. During this intermediate phase, gentle stretching is permitted at the end of motion ranges. Although active motion is allowed, no strengthening or resisted motion is allowed. At 8 weeks, isometric exercise with the arm at the side in a neutral position is allowed.

Cervical Disk Herniations

Sports Hernia Mri Sagittal Coverage

Between an acute herniation and symptomatic hard disk disease in patients with significant spondylosis. Regardless, initial treatment is generally nonoperative with few exceptions. Treatment includes rest, short-term immobilization, activity modifications, anti-inflammatory medications, cervical traction, and possibly selective nerve root injections and is successful in the majority of patients.17 Once initial symptoms improve, a three-phase rehabilitation program of stretching, range of motion, and isometric strengthening is performed. The athlete should be allowed to return to play once symptoms have resolved, the neurologic examination is normal, and painless full range of motion has been restored.44


Beta-hydroxy-beta-methylbutyrate (HMB) is a relatively new product marketed as an anti-catabolic compound. Use of HMB has been associated with increased lean muscle mass and decreased CPK levels after exercise, but the mechanism of these effects is unclear.72 In a separate study, brief use of HMB did not prevent common effects of exercise such as muscle soreness or swelling.88 Other studies have shown HMB does not have an androgenic effect nor does it have a significant impact beyond resistance training alone on strength and body composition among athletes.89-91 Used either alone or with creatine, HMB has not shown ergogenic effects on either aerobic or anaerobic exercise, although one isolated study did demonstrate an increased time to peak lactate production with its use.92,93 Again, no clear mechanism exists to explain this effect. No major risks have been associated with HMB use. In fact, HMB may impart favorable cardiovascular effects via lipid metabolism.94 In summary, no clear...

Special tests range of motion and strength

The history, observation and palpation of the athlete provide a rough idea of the type and severity of the injury. In order to eliminate or confirm a specific diagnosis a range of special tests must be performed. These tests should allow the investigator to stress the structures sufficiently to distinguish between injured or non-injured structures without aggravating the injury. As for palpation of the extremities, the specific tests should first be performed on the non-injured side. The sum of the results from the tests performed should help in narrowing the possibilities of the diagnosis. When testing the range of motion (ROM) it is recommended to start by allowing the athlete to actively move the injured joint, observing the quantity and quality of the movement. Based on the result further information can be obtained by passively moving the injured joint, making an assessment of the end-feel of the joint possible. Following the determination of ROM, strength testing can provide...

Physical activity and prevention of osteoporotic fractures

Physical activity may influence the risk of fall and its consequences through several mechanisms. The most likely effects are mediated through musculoskeletal and neuromuscular systems and can be measured by performance in strength, balance, coordination, postural stability, gait and mobility. Review of the currently published studies 47 revealed that randomized controlled exercise trials aiming at decreasing the risk of falls have produced inconclusive results. No exercise modalities have shown to be consistently effective in reducing risk for falls, but balance and strength training exercise programs have shown promising results in recent studies. Most case-control studies of physical activity and hip fracture have shown a 20-60 reduction in odds of fracture among women engaging in moderate physical activity vs. control. Most prospective studies on the topic have found 30-50 smaller risk in physically active as compared with sedentary subjects. The consistency, magnitude of effect...

Physical activity and bone mass

Mass at the loaded sites has been found to be high as compared with sports with weak loading characteristics and with referents (Fig. 3.2.6) 26 . Quantitative analyses of results of clinical trials agree well with these cross-sectional observations and strongly support the notion that only high-intensity activity significantly influences bone mass except possibly in osteoporotic subjects. Both endurance or aerobic and dynamic strength or progressive resistance training as well as impact and non-impact exercises have been found effective and thus far no definite differences in the effectiveness between the types of training have been found in quantitative analyses, possibly due to small number of studies in some categories. Static exercises and slow movements do not influence bone

Peripheral vessel diseases

A treadmill training program improves functional status during daily activities, 24 weeks of training being more effective than 12 weeks. Treadmill training (walking) alone is more effective in improving functional status in patients with intermittent claudication than strength training or combinations of the training modalities 32 . In one study comparing angioplasty to exercise training in the treatment of stable claudication the exercise training group had the greatest improvement in terms of improved walking performance

Legal substances or procedures

One of the most debated substances lately has been creatine (Cr), and its performance-enhancing effects. Research indicates that Cr supplementation (initially 20 g day followed by 3-4 g day) can increase muscle PCr content in some individuals. Exercise performance involving short periods of extremely powerful activity can be enhanced, especially during repeated bouts of activity 15 , whereas performance in aerobic exercise is not influenced. Furthermore, it has been demonstrated that Cr results in increased improvement of muscle strength with strength training but the mechanism behind this has not been discovered 16 . So far there are no documented gastrointestinal, renal or muscle side-effects associated with Cr intake.

Effects of mechanical strain on bone turnover and bone remodeling

In another study the training group subjected to weight training (three times weekly) displayed significant increases in serum osteocalcin and serum bone-specific AP activity within the first month, and persisting throughout the training period, while there was no significant change in plasma procollagen type I C-terminal concentration. Urinary deoxypyridinoline excretion was transiently suppressed and returned to the initial value but was never stimulated during the 4 months.

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