Diaphragm atrophy developing during mechanical ventilation strongly impacts clinical outcomes. Targeting an inspiratory effort level similar to that of healthy subjects at rest might accelerate liberation from ventilation.

The aim of this systematic review was to determine if eccentric exercise is superior to concentric exercise in stimulating gains in muscle strength and mass. Meta-analyses were performed for comparisons between eccentric and concentric training as means to improve muscle strength and mass. In order to determine the importance of different parameters of training, subgroup analyses of intensity of exercise, velocity of movement and mode of contraction were also performed. Twenty randomised controlled trials studies met the inclusion criteria. Meta-analyses showed that when eccentric exercise was performed at higher intensities compared with concentric training, total strength and eccentric strength increased more significantly. However, compared with concentric training, strength gains after eccentric training appeared more specific in terms of velocity and mode of contraction. Eccentric training performed at high intensities was shown to be more effective in promoting increases in muscle mass measured as muscle girth. In addition, eccentric training also showed a trend towards increased muscle cross-sectional area measured with magnetic resonance imaging or computerised tomography. Subgroup analyses suggest that the superiority of eccentric training to increase muscle strength and mass appears to be related to the higher loads developed during eccentric contractions. The specialised neural pattern of eccentric actions possibly explains the high specificity of strength gains after eccentric training. Further research is required to investigate the underlying mechanisms of this specificity and its functional significance in terms of transferability of strength gains to more complex human movements.

The purposes of this study were to assess the presence of 99mTc-labeled white blood cells (WBC) in exercised muscle compared with nonexercised muscle over time and to determine the time course of delayed onset muscle soreness (DOMS) and eccentric torque in 10 female subjects. A pretest was followed by 300 eccentric repetitions of the right quadriceps. DOMS and eccentric torque were measured at 2, 4, 20, 24, 48, and 72 h postexercise. Eccentric torque was also tested at 0 h. Radionuclide images of both quadriceps were taken at 2, 4, 20, and 24 h postexercise. The presence of 99mTc-WBC in the exercised muscle was significantly greater (P < 0.001) than in the nonexercised muscle. Eccentric torque declined at 0 and 24 h postexercise. DOMS peaked at 24 h postexercise. The presence of 99mTc-WBC in the exercised muscle in the first 24 h suggests that acute inflammation occurs as a result of exercise-induced muscle injury. The bimodal pattern of eccentric torque supports the hypothesis that more than one mechanism is involved.

Overall reductions in muscle strength typically accompany the aging process. However, older adults show a relatively preserved capacity of producing eccentric strength. The preservation of eccentric strength in older adults is a well-established phenomenon, occurring indiscriminately across different muscle groups, independent of age-related architectural changes in muscle structure and velocity of movement.The mechanisms for the preservation of eccentric strength appear to be mechanical and cellular in origin and include both passive and active elements regulating muscle stiffness. The age-related accumulation of non-contractile material in the muscle-tendon unit increases passive stiffness, which might offer mechanical advantage during eccentric contractions. In addition, the preserved muscle tension and increased instantaneous stiffness of old muscle fibers during stretch increase active stiffness, which might enhance eccentric strength.The fact that the preservation of eccentric strength is present in people with chronic conditions when compared to age-matched healthy controls indicates that the aging process per se does not exclusively mediate the preservation of eccentric strength. Physical inactivity, which is common in elderly and people with chronic conditions, is a potential factor regulating the preservation of eccentric strength.When compared to concentric strength, the magnitude of the preservation of eccentric strength in older adults ranges from 2% to 48% with a mean value from all studies of 21.6%. This functional reserve of eccentric strength might be clinically relevant, especially to initiate resistance training and rehabilitation programs in individuals with low levels of strength.

No abstract