<scp>A</scp>lpine <scp>S</scp>kiing <scp>W</scp>ith total knee <scp>A</scp>rthro<scp>P</scp>lasty (<scp>ASWAP</scp>): metabolism, inflammation, and skeletal muscle fiber characteristics

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This study investigated the effectiveness of recreational skiing as an intervention to improve quadriceps muscle architecture, strength, and antagonistic co-activation in patients with unilateral total knee arthroplasty (TKA). Hence, patients with TKA were assigned to either an intervention group (IG) or control group (CG). The IG completed a 12-week guided skiing program whereas the CG was instructed not to change their daily routines for the same period and was not allowed to ski. Before, after the intervention/after an 8-week retention period m. rectus femoris (RF) cross-sectional area (CSA), m. vastus lateralis muscle thickness, fascicle length, and pennation angle were measured with ultrasonography, while isometric (90° knee angle) knee extension, flexion torque and m. biceps femoris co-activation were assessed on an isokinetic dynamometer in 26 patients. There were significant and stable increases in RF CSA for the operated (10%; P < 0.05) and non-operated leg (12%; P < 0.01) after the training period in the IG whereas no changes were observed for the CG (all P > 0.05). There were no significant effects for other parameters (all P > 0.05). Overall, the skiing intervention was successful in increasing muscle mass in TKA older patients.

Section: Discussionsupporting

confidence: 82%

Alpine Skiing With total knee ArthroPlasty (ASWAP): muscular adaptations

Rieder

Kösters

Wiesinger

et al. 2015

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“…Consequently, muscle contraction forces in alpine skiing seem adequate and effective to increase leg muscle strength in the weaker OP leg. The strength improvements in the present study seem to be mainly based on hypertrophy of the rectus femoris as shown by Rieder et al () while no change could be observed in the vastus lateralis (Kristensen et al., ; Rieder et al., ).…”

Section: Discussionsupporting

confidence: 65%

Alpine Skiing With total knee ArthroPlasty (ASWAP): effects on strength and cardiorespiratory fitness

Pötzelsberger

Stöggl

Lindinger

et al. 2015

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This study investigated the effect of a 12-week recreational skiing intervention on lower limb muscle strength and cardiorespiratory fitness in participants with unilateral total knee arthroplasty (TKA). Twenty-seven older adults (70 ± 5 years) were assigned to the intervention (n = 13) or control group (n = 14) after surgery (2.5 ± 1 years). Leg muscle strength was measured using an IsoMed 2000 dynamometer and cardiorespiratory fitness was determined by cycle ergometry before and after the intervention as well as after an 8-week retention period. The skiing intervention led to increased muscle strength in the operated leg during unilateral single joint isometric extension (maximal force: 11%; P < 0.05; rate of torque development: 24%; P < 0.05) and during the unilateral multi-joint isokinetic single leg strength test (8%; P < 0.05). This resulted in a decreased asymmetry index in the isokinetic test (13% to 5%; P < 0.05). These adaptations remained unchanged toward the retention test. No effect was observed for cardiorespiratory fitness. The results demonstrate that muscle contraction forces required during recreational skiing in individuals with TKA seem adequate and effective to increase quadriceps and hamstrings muscle strength in the initially weaker operated leg and to reduce an augmented post-operative asymmetry index.

“…Activation of the inflammatory pathway can indeed lead to a reduction in protein synthesis through inhibition of the AKT‐mTOR‐p70s6K pathway but also stimulate protein breakdown through the NF‐κΒ‐mediated release of inflammatory cytokines leading to activation of the MURF1 and MAFbx (Kumar et al., ). Although systemic inflammation in these patients was found to be within the normal range (see Kristensen et al., ) both before and after training, the possibility of raised local muscle inflammation cannot be excluded. In fact it has been reported that aging is associated with muscle inflammation susceptibility (Merritt et al., ) and we recently hypothesized that local inflammation is more important than the systemic one for the inflamm‐aging effects to occur (Salvioli et al., ).…”

Section: Discussionmentioning

confidence: 77%

Alpine Skiing With total knee ArthroPlasty (ASWAP): impact on molecular and architectural features of musculo‐skeletal ageing

Narici

Conte

Salvioli

et al. 2015

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This study investigated features of skeletal muscle ageing in elderly individuals having previously undergone unilateral total knee arthroplasty (TKA) and whether markers of sarcopenia could be mitigated by a 12-week alpine skiing intervention. Novel biomarkers agrin, indicative of neuromuscular junction (NMJ) degeneration, tumor suppressor protein p53, associated with muscle atrophy, and a new ultrasound-based muscle architecture biomarker were used to characterize sarcopenia. Participant details and study design are presented by Kösters et al. (2015). The results of this study show that NMJ degeneration is widespread among active septuagenarians previously subjected to TKA: all participants showed elevated agrin levels upon recruitment. At least 50% of individuals were identified as sarcopenic based on their muscle architecture, supporting the hypothesis that NMJ alterations precede sarcopenia. Notably, sarcopenia was strongly associated with the expression of p53, which seems to confirm its validity as a biomarker of muscle atrophy. Training did not significantly modify any of these biomarkers. In view of the lack of accretion of muscle mass in response to the alpine skiing intervention, we hypothesize that local muscle inflammation and oxidative stress may have blunted the anabolic response to training and promoted muscle breakdown in this elderly post-TKA population.