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Cardiovascular and Muscular Consequences of Work-Matched Interval-Type of Concentric and Eccentric Pedaling Exercise on a Soft Robot.

ABSTRACT: Eccentric types of endurance exercise are an acknowledged alternative to conventional concentric types of exercise rehabilitation for the cardiac patient, because they reduce cardiorespiratory strain due to a lower metabolic cost of producing an equivalent mechanical output. The former contention has not been tested in a power- and work-matched situation of interval-type exercise under identical conditions because concentric and eccentric types of exercise pose specific demands on the exercise machinery, which are not fulfilled in current practice. Here we tested cardiovascular and muscular consequences of work-matched interval-type of leg exercise (target workload of 15 sets of 1-min bipedal cycles of knee extension and flexion at 30 rpm with 17% of maximal concentric power) on a soft robotic device in healthy subjects by concomitantly monitoring respiration, blood glucose and lactate, and power during exercise and recovery. We hypothesized that interval-type of eccentric exercise lowers strain on glucose-related aerobic metabolism compared to work-matched concentric exercise, and reduces cardiorespiratory strain to levels being acceptable for the cardiac patient. Eight physically active male subjects (24.0 years, 74.7 kg, 3.4 L O2 min^-1), which power and endurance performance was extensively characterized, completed the study, finalizing 12 sets on average. Average performance was similar during concentric and eccentric exercise (p = 0.75) but lower than during constant load endurance exercise on a cycle ergometer at 75% of peak aerobic power output (126 vs. 188 Watt) that is recommended for improving endurance capacity. Peak oxygen uptake (-17%), peak ventilation (-23%), peak cardiac output (-16%), and blood lactate (-37%) during soft robotic exercise were lower during eccentric than concentric exercise. Glucose was 8% increased after eccentric exercise when peak RER was 12% lower than during concentric exercise. Muscle power and RFD were similarly reduced after eccentric and concentric exercise. The results highlight that the deployed interval-type of eccentric leg exercise reduces metabolic strain of the cardiovasculature and muscle compared to concentric exercise, to recommended levels for cardio-rehabilitation (i.e., 50-70% of peak heart rate). Increases in blood glucose concentration indicate that resistance to contraction-induced glucose uptake after the deployed eccentric protocol is unrelated to muscle fatigue.

SUBMITTER: Fluck M

PROVIDER: S-EPMC5583980 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. OBJECTIVE:We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO2peak), peak aerobic power output (Ppeak), and parameters of muscle oxygen saturation (SmO2) during exercise, and anaerobic muscle power. METHODS:We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO2. Moreover, the aerobic skeletal muscle power (Ppeak) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. RESULTS:The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO2peak (+26% vs -6%), and Ppeak (+20% vs 0%), and exaggerated muscle deoxygenation during the ramp test (248% vs 49%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (-9% vs +20%) and peak SmO2 (+7% vs -7%). Anaerobic muscle power only improved after the CON protocol (+18% vs -15%). CONCLUSIONS:This study indicates the potential of the implemented CON and ECC protocols of pedaling-type interval exercise to improve oxygen metabolism of exercised muscle groups while maintaining or even increasing the Ppeak. The ECC training protocol seemingly provided a lower cardiovascular stimulus in patients with CAD while specifically enhancing the reoxygenation and blood lactate clearance in recruited muscle groups during recovery from exercise. TRIAL REGISTRATION:ClinicalTrials.gov NCT02845063; https://clinicaltrials.gov/ct2/show/NCT02845063.

Project description:BACKGROUND:Single bouts of muscle damaging eccentric exercise (EE) affect glucose metabolism negatively while single bouts of concentric (CE) and not muscle damaging eccentric exercise have positive acute short-term effects on glucose metabolism. It has been proposed that long-term endurance EE might be more effective in improving glucose metabolism than long-term CE when adjusted for energy expenditure. This would imply that adaptations of glucose metabolism are dependent on the type of exercise. Interleukin-6 (IL-6) released from the exercising muscles may be involved in and could therefore explain acute adaptations on glucose metabolism. The aim of the study was to investigate the effects of a single bout of CE and a single bout of EE inducing no or just mild muscle damage, matched for energy expenditure, on glucose metabolism. METHODS:7 healthy but sedentary female participants (age 20.7 ± 2.9 years; BMI 22.45 ± 1.66 kg m(-2); VO2peak 39.0 ± 4.5 ml kg(-1) min(-1)) took part in a randomized cross over trial consisting of 1 h uphill (CE) respectively downhill (EE) walking on a treadmill. Venous blood samples were drawn before, directly after and 24 h after exercise. An oral glucose tolerance test (OGTT) was performed before and 24 h after exercise. RESULTS:CE and EE lead to comparable changes of glucose tolerance (area under the curve of the OGTT) (-16.0 ± 25.81 vs. -6.3 ± 45.26 mg dl(-1) h(-1), p = 1.000) and HOMA insulin resistance (-0.16 ± 1.53 vs. -0.08 ± 0.75, p = 0.753). Compared to baseline, IL-6 concentration increased significantly immediately after EE (1.07 ± 0.67 vs. 1.32 ± 0.60 pg ml(-1), p = 0.028) and tended to increase immediately after CE (0.75 ± 0.29 vs. 1.03 ± 0.21 pg ml(-1), p = 0.058). TNF-? concentration decreased significantly immediately after EE (1.47 ± 0.19 vs. 1.06 ± 0.29 pg ml(-1), p = 0.046) but not after CE (1.27 ± 0.43 vs. 1.24 ± 0.43 pg ml(-1), p = 0.686) compared to baseline. CONCLUSIONS:Acute effects of a single bout of exercise inducing no or just mild muscle damage on glucose tolerance and insulin resistance seem to be primarily energy expenditure dependent whereas acute anti-inflammatory activity induced by a single bout of exercise appears to be rather exercise type dependent. TRIAL REGISTRATION:NCT01890876, clinicaltrials.gov, https://clinicaltrials.gov/.

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Cardiovascular and Muscular Consequences of Work-Matched Interval-Type of Concentric and Eccentric Pedaling Exercise on a Soft Robot.

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