Forces in Joints, Skeletal Biology, Analysis of Bone Remodeling, Mechanical Properties of Bone, Fatigue and Fracture Resistance of Bone, Mechanical Adaptation of the Skeleton, Synovial Joint Mechanics, Mechanical Properties of Ligament and Tendon

Skeletal Tissue Mechanics

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

Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association.

Worldwide estimates predict 2 billion people will be aged over 65 years by 2050. A major current challenge is maintaining mobility and quality of life into old age. Impaired mobility is often a precursor of functional decline, disability and loss of independence. Sarcopenia which represents the age-related decline in muscle mass is a well-established factor associated with mobility limitations in older adults. However, there is now evidence that not only changes in muscle mass but other factors underpinning muscle quality including composition, metabolism, aerobic capacity, insulin resistance, fat infiltration, fibrosis and neural activation may also play a role in the decline in muscle function and impaired mobility associated with ageing. Importantly, changes in muscle quality may precede loss of muscle mass and therefore provide new opportunities for the assessment of muscle quality particularly in middle-aged adults who could benefit from interventions to improve muscle function. This review will discuss the accumulating evidence that in addition to muscle mass, factors underpinning muscle quality influence muscle function and mobility with age. Further development of tools to assess muscle quality in community settings is needed. Preventative diet, exercise or treatment interventions particularly in middle-aged adults at the low end of the spectrum of muscle function may help preserve mobility in later years and improve healthspan.

/pdf/it-is-not-just-muscle-mass-a-review-of-muscle-quality-3wll7gufs5.pdf

It is not just muscle mass: a review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life

We present the design and evaluation of a multi-articular soft exosuit that is portable, fully autonomous, and provides assistive torques to the wearer at the ankle and hip during walking. Traditional rigid exoskeletons can be challenging to perfectly align with a wearer's biological joints and can have large inertias, which can lead to the wearer altering their natural motion patterns. Exosuits, in comparison, use textiles to create tensile forces over the body in parallel with the muscles, enabling them to be light and not restrict the wearer's kinematics. We describe the biologically inspired design and function of our exosuit, including a simplified model of the suit's architecture and its interaction with the body. A key feature of the exosuit is that it can generate forces passively due to the body's motion, similar to the body's ligaments and tendons. These passively generated forces can be supplemented by actively contracting Bowden cables using geared electric motors, to create peak forces in the suit of up to 200 N. We define the suit-human series stiffness as an important parameter in the design of the exosuit and measure it on several subjects, and we perform human subjects testing to determine the biomechanical and physiological effects of the suit. Results from a five-subject study showed a minimal effect on gait kinematics and an average best-case metabolic reduction of 6.4%, comparing suit worn unpowered versus powered, during loaded walking with 34.6 kg of carried mass including the exosuit and actuators 2.0 kg on both legs, 10.1 kg total.

A biologically inspired soft exosuit for walking assistance

The present article systematically reviews recent literature on the in vivo adaptation of asymptomatic human tendons following increased chronic mechanical loading, and meta-analyzes the loading conditions, intervention outcomes, as well as methodological aspects. The search was performed in the databases PubMed, Web of Knowledge, and Scopus as well as in the reference lists of the eligible articles. A study was included if it conducted (a) a longitudinal exercise intervention (≥8 weeks) on (b) healthy humans (18 to 50 years), (c) investigating the effects on mechanical (i.e., stiffness), material (i.e., Young’s modulus) and/or morphological properties (i.e., cross-sectional area (CSA)) of tendons in vivo, and was reported (d) in English language. Weighted average effect sizes (SMD, random-effects) and heterogeneity (Q and I
 2
 statistics) of the intervention-induced changes of tendon stiffness, Young’s modulus, and CSA were calculated. A subgroup analysis was conducted regarding the applied loading intensity, muscle contraction type, and intervention duration. Further, the methodological study quality and the risk of bias were assessed. The review process yielded 27 studies with 37 separate interventions on either the Achilles or patellar tendon (264 participants). SMD was 0.70 (confidence interval: 0.51, 0.88) for tendon stiffness (N=37), 0.69 (0.36, 1.03) for Young’s modulus (N=17), and 0.24 (0.07, 0.42) for CSA (N=33), with significant overall intervention effects (p<0.05). The heterogeneity analysis (stiffness: I
 2
 =30%; Young’s modulus: I
 2
 =57%; CSA: I
 2
 =21%) indicated that differences in the loading conditions may affect the adaptive responses. The subgroup analysis confirmed that stiffness adaptation significantly (p<0.05) depends on loading intensity (I
 2
 =0%), but not on muscle contraction type. Although not significantly different, SMD was higher for interventions with longer duration (≥12 weeks). The average score of 71±9% in methodological quality assessment indicated an appropriate quality of most studies. The present meta-analysis provides elaborate statistical evidence that tendons are highly responsive to diverse loading regimens. However, the data strongly suggests that loading magnitude in particular plays a key role for tendon adaptation in contrast to muscle contraction type. Furthermore, intervention-induced changes in tendon stiffness seem to be more attributed to adaptations of the material rather than morphological properties.

/pdf/human-tendon-adaptation-in-response-to-mechanical-loading-a-18uz7oc08u.pdf

Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults

This study examined the concurrent age-related differences in muscle and tendon structure and properties. Achilles tendon morphology and mechanical properties and triceps surae muscle architecture ...

/pdf/age-related-differences-in-achilles-tendon-properties-and-2ixy85hopm.pdf

Age-related differences in Achilles tendon properties and triceps surae muscle architecture in vivo.

The functional roles of individual lower limb muscles during human walking may differ depending on walking speed or duration. In this study, 11 volunteers walked on a treadmill for 60 min at speeds corresponding to both optimal and 20% above optimal energetic cost of transport whilst oxygen consumption and medial gastrocnemius (MG) and soleus fascicle lengths were measured. Although energetic cost of transport was ∼12% higher at the faster speed, it remained constant over 60 min at both speeds, suggesting that humans can walk for prolonged periods at a range of speeds without compromising energetic efficiency. The fascicles of both muscles exhibited rather ‘isometric’ behaviour during the early to mid stance phase of walking, which appears to be independent of walking speed or movement efficiency. However, several functional differences were observed between muscles. MG exhibited time- and speed-dependent decreases in operating length, and shortened faster during the pushoff phase at the faster walking speed. Conversely, soleus exhibited consistent contractile behaviour regardless of walking speed or duration, and always shortened slower than MG during pushoff. Soleus appears to play a more important functional role than MG during walking. This may be especially true when walking for prolonged periods or at speeds above the most energetically efficient, where the force potential and thus the functional importance of MG appears to decline.

* COT
 : cost of transport
 GG
 : Geisser-Greenhouse
 MG
 : medial gastrocnemius
 RQ
 : respiratory quotient
 V max
 : maximal shortening velocity

/pdf/differences-in-contractile-behaviour-between-the-soleus-and-3gfm3shdpx.pdf

Differences in contractile behaviour between the soleus and medial gastrocnemius muscles during human walking.

It has been postulated that human tendons are viscoelastic and their mechanical properties time-dependent. Although Achilles tendon (AT) mechanics are widely reported, there is no consensus about AT viscoelastic properties such as loading rate dependency or hysteresis, in vivo. AT force-elongation characteristics were determined from 14 subjects in an ankle dynamometer at different loading rates using motion capture assisted ultrasonography. AT stiffness and elongation were determined between 10 – 80% of maximum voluntary contraction (MVC) force at fast and slow loading rates. As subjects were unable to consistently match the target unloading rate in the slow condition, AT hysteresis was only calculated for the fast rate. There was a significant difference between the fast and the slow loading rates: 120 ± 6 vs. 21 ± 1% of MVC s-1 (mean ± standard error), respectively. However, neither stiffness (193 ± 18 N mm-1 vs. 207 ± 22 N mm-1) nor elongation at any force level (13.0 ± 1.2 mm vs. 14.3 ± 0.9 mm at 80% of MVC) were significantly different between the fast and slow loading rates. Tendon hysteresis at the fast rate was 5 ± 2%. As stiffness was not sensitive to loading rate and hysteresis was small, it was concluded that elastic properties prevail over viscous properties in the human AT. The current results support the idea that AT stiffness is independent of loading rate.

/pdf/viscoelastic-properties-of-the-achilles-tendon-in-vivo-41fpj5spqy.pdf

Viscoelastic properties of the Achilles tendon in vivo

This viewpoint was stimulated by two observations: 1) the statistical skewness whereby numerous articles have reported tendon stiffness and Young9s modulus, but far fewer have reported tendon hysteresis; 2) in vivo human studies seem very often to report hysteresis values greater than 10%, suggesting either that there are methodological differences between human and animal studies, or that human tendons have a much poorer capacity to store and reutilize elastic energy. In this article we focus on the healthy human Achilles/gastrocnemius tendon (AT) since it has an important locomotor function and clearly a low AT hysteresis would allow elastic recoil for efficient locomotion. We discuss that both the measurement of tendon length and force and their correct synchronization can contribute to the variability of measures of tendon properties. Within the large variability the lower values are likely to be more valid, being consistent with animal studies.

/pdf/viewpoint-on-the-hysteresis-in-the-human-achilles-tendon-4ll7c4jdoc.pdf

Viewpoint: On the hysteresis in the human Achilles tendon.

In this study, we examined the effects of time-of-day-specific strength training on maximum strength and electromyography (EMG) of the knee extensors in men. After a 10-week preparatory training period (training times 17:00–19:00 h), 27 participants were randomized into a morning (07:00–09:00 h, n = 14) and an evening group (17:00–19.00 h, n = 13). Both groups then underwent 10 weeks of time-of-day-specific training. A matched control group (n = 7) completed all testing but did not train. Unilateral isometric knee extension peak torque (MVC) and one-repetition maximum half-squat were assessed before and after the preparatory training and after the time-of-day-specific training at times that were not training-specific (between 09:00 and 16:00 h). During training-specific hours, peak torque and EMG during MVC and submaximum isometric contraction at 40% MVC were assessed before and after the time-of-day-specific training. The main finding was that a significant diurnal difference (P < 0.01) in peak ...

Jussi Peltonen

Papers

Age-related differences in Achilles tendon properties and triceps surae muscle architecture in vivo.

Differences in contractile behaviour between the soleus and medial gastrocnemius muscles during human walking.

Viscoelastic properties of the Achilles tendon in vivo

Viewpoint: On the hysteresis in the human Achilles tendon.

Effect of time-of-day-specific strength training on maximum strength and EMG activity of the leg extensors in men.