The present study investigated neuromuscular adaptations between same-session combined strength and endurance training with 2 loading orders and different day combined training over 24 weeks. 56 subjects were divided into different day (DD) combined strength and endurance training (4-6 d·wk(-1)) and same-session combined training: endurance preceding strength (E+S) or vice versa (S+E) (2-3 d·wk(-1)). Dynamic and isometric strength, EMG, voluntary activation, muscle cross-sectional area and endurance performance were measured. All groups increased dynamic one-repetition maximum (p<0.001; DD 13±7%, E+S 12±9% and S+E 17±12%) and isometric force (p<0.05-0.01), muscle cross-sectional area (p<0.001) and maximal power output during cycling (p<0.001). DD and S+E increased voluntary activation during training (p<0.05-0.01). In E+S no increase in voluntary activation was detected after 12 or 24 weeks. E+S also showed unchanged and S+E increased maximum EMG after 24 weeks during maximal isometric muscle actions. A high correlation (p<0.001, r=0.83) between the individual changes in voluntary activation and maximal knee extension force was found for E+S during weeks 13-24. Neural adaptations showed indications of being compromised and highly individual relating to changes in isometric strength when E+S-training was performed, while gains in one-repetition maximum, endurance performance and hypertrophy did not differ between the training modes.

Neurophysiological changes that involve activity-dependent neuroplasticity mechanisms via repeated stimulation and locomotor training are not commonly employed in research even though combination of interventions is a common clinical practice. In this randomized clinical trial, we established neurophysiological changes when transcranial magnetic stimulation (TMS) of the motor cortex was paired with transcutaneous thoracolumbar spinal (transspinal) stimulation in human spinal cord injury (SCI) delivered during locomotor training. We hypothesized that TMS delivered before transspinal (TMS-transspinal) stimulation promotes functional reorganization of spinal networks during stepping. In this protocol, TMS-induced corticospinal volleys arrive at the spinal cord at a sufficient time to interact with transspinal stimulation induced depolarization of alpha motoneurons over multiple spinal segments. We further hypothesized that TMS delivered after transspinal (transspinal-TMS) stimulation induces less pronounced effects. In this protocol, transspinal stimulation is delivered at time that allows transspinal stimulation induced action potentials to arrive at the motor cortex and affect descending motor volleys at the site of their origin. Fourteen individuals with motor incomplete and complete SCI participated in at least 25 sessions. Both stimulation protocols were delivered during the stance phase of the less impaired leg. Each training session consisted of 240 paired stimuli delivered over 10-min blocks. In transspinal-TMS, the left soleus H-reflex increased during the stance-phase and the right soleus H-reflex decreased at mid-swing. In TMS-transspinal no significant changes were found. When soleus H-reflexes were grouped based on the TMS-targeted limb, transspinal-TMS and locomotor training promoted H-reflex depression at swing phase, while TMS-transspinal and locomotor training resulted in facilitation of the soleus H-reflex at stance phase of the step cycle. Furthermore, both transspinal-TMS and TMS-transspinal paired-associative stimulation (PAS) and locomotor training promoted a more physiological modulation of motor activity and thus depolarization of motoneurons during assisted stepping. Our findings support that targeted non-invasive stimulation of corticospinal and spinal neuronal pathways coupled with locomotor training produce neurophysiological changes beneficial to stepping in humans with varying deficits of sensorimotor function after SCI.

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This study is the first to specifically examine potential sites underlying the decreases in neural activation of muscle and force production after a bout of muscle stretching. However, no changes were found in either the H-reflex or motor-evoked potential amplitude during submaximal contractions.