Resistance Training vs Immobilization for Muscle Changes

Overseen By Kristine Boileau

Age: 18 - 65

Sex: Female

Trial Phase: Academic

Sponsor: Queen's University

Must not be taking: Fish oils, Steroids, Anticoagulants, others

Disqualifiers: Muscular, Neurological, Metabolic, Cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 7

14 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial requires that you stop taking fish oils and steroids if you have used them within the last 6 months and 3 months, respectively. If you are on antiplatelet or anticoagulation therapy, you cannot participate. Other medications are not specifically mentioned, so it's best to discuss with the trial team.

What data supports the effectiveness of this treatment?

Research shows that resistance training, even at low volumes, can help maintain muscle strength and size during periods of immobilization. Additionally, resistance training in the early postoperative phase can lead to muscle growth and reduce hospital stays in elderly patients after hip surgery. ^{1 2 3 4 5}

Is resistance training generally safe for humans?

Resistance training is generally considered safe for humans, with serious adverse events being uncommon. Proper guidance, trained personnel, and standardized guidelines can enhance safety during resistance training. ^{6 7 8 9 10}

How does resistance training differ from other treatments for muscle changes?

Resistance training is unique because it involves physical exercises that improve muscle strength and size by applying mechanical stress, unlike immobilization which restricts movement. It can lead to specific neuromuscular adaptations and muscle growth, even at low loads, making it effective for increasing muscle strength and size. ^{11 12 13 14 15}

What is the purpose of this trial?

Skeletal muscle plays a critical role in supporting human health. Beyond its role in providing the force to move, skeletal muscle accounts for a large proportion of metabolic rate, glucose disposal, and amino acid storage. Skeletal muscle is dynamically regulated by environmental stimuli, such as loading (i.e., resistance training\]) and unloading (i.e., disuse atrophy) as well as the intake of essential amino acids (EAAs). However, the precise mechanisms that regulate skeletal muscle mass in response to various conditions (e.g., EAA supplementation, resistance training, and unloading) are not completely understood. Therefore, concerted efforts to better understand the mechanisms regulating skeletal muscle size are needed that aid in the development of therapeutic interventions to combat age, disease, and disuse related muscular atrophy.

Eligibility Criteria

This trial is for healthy individuals interested in how muscles change with exercise and rest. Participants should be willing to undergo resistance training and have one leg immobilized temporarily. Specific eligibility details are not provided, but typically, participants must meet certain health standards.

Inclusion Criteria

Generally healthy as assessed by medical and physical activity questionnaires

Participants not currently pregnant

≥2 days per week of structured exercise

Exclusion Criteria

Any concurrent medical, psychiatric, or orthopedic condition that, subject to investigators' discernment, would negatively affect the subject's ability to comply with the study requirements

I have had cancer within the last 5 years.

I am currently ill.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Immobilization

Participants undergo 10 days of unilateral leg immobilization with a brace

10 days

1 visit (in-person) for brace fitting and instructions

Resistance Training

Participants undergo 4 sessions of unilateral resistance training over a 10-day period

10 days

4 visits (in-person) for resistance training sessions

Follow-up

Participants are monitored for changes in muscle protein synthesis and dynamic proteome

10 days

2 visits (in-person) for assessments at day 0 and day 10

Treatment Details

Interventions

• Immobilization
• Resistance training

Trial Overview The study looks at the effects of resistance exercise on muscle proteins compared to the effects of not using a muscle (immobilization). It aims to understand how muscles grow stronger with exercise and weaken when they're not used.

Participant Groups

Group I: Resistance Training Experimental Treatment 1 Intervention

Participants will undergo 4 sessions of unilateral resistance training over a 10 day period (the resistance training protocol will include 3 sets of 8-12 reps of leg press and leg extension). All participants will complete this protocol. On day 0, participants will be asked to undergo a bout of unilateral resistance exercise, and the investigators will assess the acute response to exercise + protein feeding (via EAA supplement).

Group II: Immobilization Experimental Treatment 1 Intervention

Participants will undergo 10 days of unilateral immobilization whereby a leg will remain in 60 degrees of flexion with the use of a brace. All participants will complete this protocol.

Who Is Running the Clinical Trial?

Queen's University

Lead Sponsor

Trials

382

Recruited

122,000+

Kingston Health Sciences Centre

Lead Sponsor

Trials

312

Recruited

112,000+

Queen's University

Lead Sponsor

Findings from Research

Resistance training at moderate intensities (40% and 60% of maximum contraction strength) is effective for promoting recovery from muscle atrophy in mice, as shown by improvements in muscle strength and myofiber size.

Training at very low (10%) or very high (90%) intensities did not support recovery, highlighting the importance of optimal training intensity for muscle regeneration and the role of myogenic satellite cells in muscle repair.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training at non-damaging intensities facilitates recovery from muscle atrophy. Itoh, Y., Murakami, T., Mori, T., et al.[2018]

A study involving 17 participants (5 men and 12 women) showed that low-volume resistance exercise (140 contractions over 14 days) effectively prevented muscle mass and strength loss in the quadriceps during 14 days of leg immobilization.

While the exercise helped maintain quadriceps strength, it was only partially effective in preventing atrophy of the triceps surae muscle, indicating that targeted resistance training may be necessary for different muscle groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low-volume resistance exercise attenuates the decline in strength and muscle mass associated with immobilization. Oates, BR., Glover, EI., West, DW., et al.[2022]

Maintaining skeletal muscle mass is crucial for health and independence, and inactivity can lead to negative effects on muscle, bone, and overall health.

Blood flow restriction (BFR) combined with low-load resistance training can effectively increase muscle size and strength, making it a safer alternative for at-risk populations like the elderly or those in rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blood flow restriction: an evidence based progressive model (Review). Loenneke, JP., Abe, T., Wilson, JM., et al.[2022]

Blood flow restriction (BFR) without exercise can help reduce strength loss and muscle atrophy in the thigh muscles of individuals who are immobilized, based on a review of 3 studies with a total of 38 participants.

However, the studies had a high risk of bias, which raises concerns about the reliability of these findings and limits the recommendation of BFR as a definitive treatment for preventing muscle loss during immobilization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of blood flow restriction without additional exercise on strength reductions and muscular atrophy following immobilization: A systematic review. Cerqueira, MS., Do Nascimento, JDS., Maciel, DG., et al.[2021]

In a study of 36 elderly patients undergoing hip replacement, resistance training after surgery significantly improved muscle size (12% increase in quadriceps cross-sectional area) and strength (22-28% increase) compared to standard rehabilitation.

Patients who engaged in resistance training also had a shorter hospital stay (10 days) compared to those receiving standard rehabilitation (16 days), highlighting the effectiveness of this training regime in enhancing recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients--a controlled, randomized study. Suetta, C., Magnusson, SP., Rosted, A., et al.[2008]

In a review of 121 trials involving 6700 older adults, most adverse events related to progressive resistance strength training were musculoskeletal issues like muscle strains and joint pain, particularly in participants with pre-existing health conditions or those engaging in high-intensity training.

Adverse events were often underreported, highlighting the need for clearer definitions and consistent reporting in future studies to better inform practitioners about the risks and benefits of strength training in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin. Liu, CJ., Latham, N.[2010]

Resistance training (RT) significantly reduces all-cause mortality and the incidence of cardiovascular disease while improving physical functioning in adults, based on an analysis of 11 systematic reviews involving over 382,000 participants.

Although adverse events were not consistently reported, serious adverse events related to RT were uncommon, suggesting that the benefits of resistance training outweigh the potential harms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance training and health in adults: an overview of systematic reviews. El-Kotob, R., Ponzano, M., Chaput, JP., et al.[2021]

Researchers in resistance training studies often lack clear guidance and motivation for thorough adverse event (AE) reporting, which can lead to inconsistent practices.

There is a need for exercise-specific guidelines for AE reporting, as current standards are perceived as not applicable to exercise trials, highlighting the importance of tailored strategies to improve reporting consistency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Researchers' perspectives on adverse event reporting in resistance training trials: a qualitative study. El-Kotob, R., Pagcanlungan, JR., Craven, BC., et al.[2022]

Resistance exercise training significantly benefits the musculoskeletal system and helps prevent conditions like osteoporosis, sarcopenia, and lower-back pain, making it essential for maintaining functional abilities.

Just two 15- to 20-minute sessions of resistance training per week can effectively improve various health risk factors, including insulin resistance and blood pressure, suggesting it should be a key focus in public health promotion alongside aerobic exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Potential health-related benefits of resistance training. Winett, RA., Carpinelli, RN.[2022]

Resistance training is a safe and effective method for improving muscle strength and aerobic endurance, particularly beneficial for healthy adults, the elderly, and patients with cardiac and pulmonary conditions.

Proper assessment and tailored exercise programs enhance the safety and long-term effectiveness of resistance training, contributing to better health outcomes and reduced risk factors for cardiovascular and metabolic diseases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Resistance (strength) training in health promotion and rehabilitation]. Kostka, T.[2006]

Resistance training (RT) at a longer range of motion (LR) leads to significantly greater improvements in muscle strength and size compared to a shorter range of motion (SR), as shown in a study with 16 recreationally active participants over 8 weeks.

During a 4-week detraining period, the SR group experienced a faster decline in strength compared to the LR group, indicating that longer range training may provide more lasting benefits in muscle adaptations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of range of motion during ecologically valid resistance training protocols on muscle size, subcutaneous fat, and strength. McMahon, GE., Morse, CI., Burden, A., et al.[2022]

Resistance training leads to different adaptations in the body, primarily categorized as neural or anabolic, with neural adaptations occurring early in the training process, allowing for strength improvements even before muscle growth happens.

As training progresses, there is an increase in myofibrillar proteins and changes in muscle fiber types, which are crucial for enhancing strength and performance, highlighting the importance of tailored resistance training methods for specific goals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Molecular, cellular and physiological responses to resistance training]. Treff, G., Steinacker, JM.[2009]

In a study involving 50 resistance-trained men, performing the bench press through a full range of motion (BPFULL) resulted in significantly greater neuromuscular adaptations compared to partial range variations (BP2/3 and BP1/3) after 10 weeks of training.

The BPFULL group showed the highest improvements in strength and mean propulsive velocity, with effect sizes ranging from 0.52 to 1.96, while partial range exercises yielded smaller gains, indicating that full range training is more effective for enhancing performance in resistance training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bench Press at Full Range of Motion Produces Greater Neuromuscular Adaptations Than Partial Executions After Prolonged Resistance Training. Martínez-Cava, A., Hernández-Belmonte, A., Courel-Ibáñez, J., et al.[2021]

After 6 weeks of training, both moderate load (ML) and low-load blood flow restricted (BFR) resistance exercises improved strength and muscle size in young adults, with ML showing greater effectiveness.

Isometric peak torque and neuromuscular function did not significantly change in any group, suggesting that while strength and hypertrophy were achieved, further research is needed to understand the underlying neuromuscular adaptations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuromuscular Adaptations to Low-Load Blood Flow Restricted Resistance Training. Cook, SB., Scott, BR., Hayes, KL., et al.[2019]

In a study involving 16 recreationally active young men, drop set resistance training (DS) led to greater increases in muscle thickness of the rectus femoris (RF) at certain muscle lengths compared to traditional resistance training (TRAD) after eight weeks of training.

Both training methods resulted in similar improvements in overall muscle strength, as measured by one repetition maximum and peak torque, indicating that while DS may enhance specific muscle hypertrophy, it does not provide a significant advantage in overall strength gains compared to TRAD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Drop-Set Training Elicits Differential Increases in Non-Uniform Hypertrophy of the Quadriceps in Leg Extension Exercise. Varović, D., Žganjer, K., Vuk, S., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Training at non-damaging intensities facilitates recovery from muscle atrophy. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Low-volume resistance exercise attenuates the decline in strength and muscle mass associated with immobilization. [2022]

3. Hungary pubmed.ncbi.nlm.nih.gov

Blood flow restriction: an evidence based progressive model (Review). [2022]

4. China pubmed.ncbi.nlm.nih.gov

Effects of blood flow restriction without additional exercise on strength reductions and muscular atrophy following immobilization: A systematic review. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients--a controlled, randomized study. [2008]

6. United States pubmed.ncbi.nlm.nih.gov

Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin. [2010]

7. Canada pubmed.ncbi.nlm.nih.gov

Resistance training and health in adults: an overview of systematic reviews. [2021]

8. Canada pubmed.ncbi.nlm.nih.gov

Researchers' perspectives on adverse event reporting in resistance training trials: a qualitative study. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Potential health-related benefits of resistance training. [2022]

10. Poland pubmed.ncbi.nlm.nih.gov

[Resistance (strength) training in health promotion and rehabilitation]. [2006]

11. United States pubmed.ncbi.nlm.nih.gov

Impact of range of motion during ecologically valid resistance training protocols on muscle size, subcutaneous fat, and strength. [2022]

12. Germany pubmed.ncbi.nlm.nih.gov

[Molecular, cellular and physiological responses to resistance training]. [2009]

13. United States pubmed.ncbi.nlm.nih.gov

Bench Press at Full Range of Motion Produces Greater Neuromuscular Adaptations Than Partial Executions After Prolonged Resistance Training. [2021]

14. Turkey pubmed.ncbi.nlm.nih.gov

Neuromuscular Adaptations to Low-Load Blood Flow Restricted Resistance Training. [2019]

15. Switzerland pubmed.ncbi.nlm.nih.gov

Drop-Set Training Elicits Differential Increases in Non-Uniform Hypertrophy of the Quadriceps in Leg Extension Exercise. [2021]