Key points Exercise is considered medicine; however, the individual degree of responsiveness to a standardized dose of exercise is idiosyncratic. Individual responsiveness between distinct exercise modalities and the genetic/environmental contributions to exercise response are not well understood. In this novel randomized cross‐over design study, monozygotic and dizygotic twins, as pairs, underwent 3 months of resistance and endurance training, separated by a 3 month washout period, aiming to assess training responses in strength and fitness outcomes to dichotomous training modalities, as well as the genetic/environmental contributions to exercise response. Our findings indicate that (i) individual responsiveness differs between exercise modalities; (ii) low‐responders to one mode may be ‘rescued’ by switching to an alternate mode of exercise; and (iii) genes may not play as large a role, as previously estimated from cross‐sectional data, for exercise training adaptation. The present study has implications for those charged with optimizing the benefits of exercise by means of individualizing the exercise prescription. Abstract Exercise response is idiosyncratic, although the degree of responsiveness, concordance in response between modalities and genetic contribution to responsiveness are not well understood. We investigated this using a novel randomized cross‐over design of dichotomous exercise interventions in mono‐(MZ) and di‐zygotic (DZ) twin pairs. We studied strength (1RM) and fitness (V̇O2max) responses in 84 same‐sex untrained twins (30 MZ, 12 DZ pairs; 24.9 ± 5.4 years). Twins, as pairs, underwent 3 months of resistance (RES) and endurance (END) training, separated by a 3 month washout period. Training responses and genetic/environmental contributions to responses were assessed. Leg strength 1RM increased following RES but not END (△47 ± 29 vs. 3 ± 26 kg; P < 0.001), whereas V̇O2max increased following END but not RES (△0.25 ± 0.26 vs. 0.04 ± 0.25 L min−1; P < 0.001). A higher percentage of individuals responded to RES for strength and to END for V̇O2max (P < 0.0001). Within‐individual responses to each mode were not correlated (P > 0.05). Cross‐sectional intraclass correlations were higher for MZ than DZ pairs for all variables, largely as a result of shared environment. Following training, MZ, but not DZ pairs, were significantly correlated for strength change to RES (rMZ = 0.62, P = 0.002) and END (rMZ = 0.36, P = 0.04), and for V̇O2max change to END (L min−1, rMZ = 0.45, P = 0.02) with a mixture of unshared/shared environmental contributions. Our findings indicate that individual responsiveness differs between modalities and low‐responders to one mode may be ‘rescued’ by switching to an alternate mode. Additionally, genes may not play as large a role as previously estimated from cross‐sectional data for training adaptation, and/or cross‐sectional data do not reflect longitudinal training effects. The present study has implications for optimizing the individualization of exercise prescription.

Introduction: Blood flow restriction (BFR) during low-load resistance exercise increases muscle size similarly to high-load training, and may be an alternative to lifting heavy weights for older people at risk of sarcopenia. However, few studies have addressed the safety of such exercise in older people, or whether this is impacted by the actual exercises performed during training. This study aimed to compare the acute hemodynamic and perceptual responses during low-load BFR exercise to unrestricted low-load and high-load exercise in older women, and to determine whether these responses depend on the type of exercise performed.Methods: Fifteen older women (63–75 year) were assessed for maximal strength (1RM) in the leg press and leg extension. Participants then completed three protocols using these exercises in a randomized order: (1) low-load exercise (LL); (2) low-load exercise with BFR (LLBFR), and; (3) high-load exercise (HL). Blood pressure was assessed at baseline and after each set, and impedance cardiography measured cardiovascular function during trials. Rating of perceived exertion (RPE) and muscle soreness scores were obtained throughout trials.Results: Baseline hemodynamic values were consistent between trials. Systolic, diastolic, and mean arterial pressures were higher in LLBFR compared with HL and LL (p ≤ 0.021). The LL condition resulted in lower heart rate (p ≤ 0.002) and rate-pressure product (p ≤ 0.011) responses compared with LLBFR and HL. The leg press generally conferred greater hemodynamic and perceptual demands than the leg extension for all conditions (p ≤ 0.002). RPE was lower during LL compared with LLBFR and HL (p ≤ 0.008), and there were no between-condition differences in perceived muscle soreness.Conclusion: The blood pressure data indicate that LLBFR causes greater stress on the vasculature than LL and HL exercise, and that the leg press was generally more demanding than the leg extension. While additional cardiovascular measures were similar between LLBFR and HL conditions, caution should be advised when prescribing BFR exercise for individuals with compromised cardiac or vascular function. Nevertheless, LLBFR and HL exercise were perceived similarly, indicating that BFR training may be viable for healthy older people.

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There is acknowledged variability in the Circle of Willis in the general population, yet the structure and function relationship of the cerebrovasculature is poorly understood. We aimed to demonstrate the feasibility of combining high resolution imaging techniques and computational fluid dynamics (CFD) to describe cerebrovascular structure and function in vivo. We examined the null hypothesis that monozygotic (MZ) twins (18-30yrs) would exhibit similar CoW structure and function. Six twin pairs underwent 3T magnetic resonance angiography of the head and neck and B-mode Doppler ultrasound for velocity and diameter recordings in the vertebral and internal carotid arteries under three conditions (rest, hypercapnia and exercise). Artery diameter, length, tortuosity and bifurcation angle were assessed in regions of interest of the CoW. CFD simulated hemodynamics to determine the cardiac-cycle time averaged wall shear stress (TAWSS), oscillatory shear index (OSI) and relative residence time (RRT). We observed low and insignificant intra-class correlations (ICC) between twins in all regions for diameter (ICC range 0.000-0.657, P>0.05), two of four regions for length (ICC range 0.355-0.368, P>0.05), all regions for tortuosity (ICC range 0.270-0.505, P>0.05), and all bifurcation angles (ICC range 0.000-0.547, P> 0.05). Similarly, no significant correlations were apparent for cerebral blood flow or CFD-derived measures of TAWSS, OSI and RRT, at rest or in response to hypercapnia or exercise. Therefore differences exist in CoW structure and associated shear stress in response to physiological stimulation. These data suggest that the structure, function and health of cerebrovascular arteries are not primarily genetically dependent.

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