This study examined the effects of carbohydrate supplementation on resistance exercise performance, cortisol levels, and creatine kinase levels in trained males undergoing energy restriction. Sixteen experimental subjects were randomly assigned to a carbohydrate (C, n=8) or placebo group (P, n=8). The remaining six subjects served as controls (N). Performance tests were done before (Trials 1 and 2) and after (Trial 3) energy restriction. Experimental subjects consumed a low calorie formula diet for three days (18 kcal-1 kg-1 d-1). They had blood drawn before and after T2 and T3. For T3, they consumed either a carbohydrate (1g kg-1) or a placebo beverage 30 minutes before exercise. There was a significant increase in resting cortisol levels following energy restriction. CK levels were significantly elevated after exercise, suggestion muscle damage. Carbohydrate supplementation had no effect on blood glucose, cortisol, creatine kinase, or RPE. The number of repetitions performed during the final set of bench press showed significant interaction between groups and time. P and N increased the number of repetitions performed from T2 to T3 (15.0 + 1.4 to 17.3 + 0.8 for P, 15.0 + 2.7 to 16.7 + 2.3 for N). C decreased the number of repetitions performed 17.6 + 0.7 to 17.3 + 1.0). The number of repetitions performed during the final set of leg extensions showed no interaction between groups and time (p=0.801). This study did not support a benefit of consuming carbohydrate prior to resistance exercise for dieting athletes but illustrates that energy restriction increases a catabolic hormone. / Master of Science

Bakgrund: Generaliserat ångestsyndrom (GAD) är en vanlig diagnos med negativa konsekvenser såväl på individ- som samhällsnivå. För att som fysioterapeuter kunna fånga upp den här typen av patienter och då ha god kunskap om olika träningsformer som tillförlitlig behandling ansågs det fördelaktigt att undersöka det vetenskapliga underlaget för styrketräning som behandlingsmetod. Syfte: Syftet med denna litteraturstudie var att undersöka det vetenskapliga underlaget för effekten av styrketräning, i jämförelse med annan eller ingen intervention, som behandlingsmetod för att minska oros- och ångestsymtom hos vuxna mellan 18-64 år med GAD. Metod: En litteraturstudie av randomiserade kontrollerade studier där populationen var vuxna mellan 18-64 år med GAD. Sökningar genomfördes i databaserna PubMed, Cochrane, PEDro och Psycinfo. Fyra studier inkluderades och granskades sedan med PEDro. Den sammanvägda tillförlitligheten av resultatet av tre studier bedömdes med hjälp av GRADEstud. Resultat: Det vetenskapliga underlaget för styrketräning som behandling för personer med GAD är för begränsat för att kunna dra några starka slutsatser. Alla inkluderade studier visade dock på reducering av oros- och ångestsymtom, som båda är kännetecknande symtom för GAD. Konklusion: Det sammanvägda resultatet indikerar på att styrketräning skulle kunna vara en alternativ behandlingsmetod för denna patientgrupp. Mer forskning behövs dock för att kunna utvärdera effekten av styrketräning som behandling för personer med GAD. / Background: Generalized anxiety disorder (GAD) is a common diagnosis with negative consequences both on an individual and societal level. In order for physiotherapists to be able to catch these patients and then have good knowledge of different forms of exercise as reliable treatment, it was considered beneficial to investigate the scientific basis for resistance exercise training as a treatment method. Objective: The aim of this literature review was to investigate the scientific basis for the effect of resistance exercise training, in comparison with other or no intervention, as a treatment method to reduce worry and anxiety symptoms in adults aged 18-64 with GAD. Method: A literature review of randomized controlled trials where the population was adults between 18-64 years old with GAD. Searches were conducted in the databases PubMed, Cochrane, PEDro and Psycinfo. Four studies were included and reviewed with PEDro. The combined reliability of the results of three studies was assessed using GRADEstud. Results: The scientific basis for resistance exercise training as a treatment for people with GAD is too limited to be able to draw any strong conclusions. However, all included studies showed a reduction in worry and anxiety symptoms, both of which are characteristic symptoms of GAD. Conclusion: The combined results indicate that strength training could be an alternative treatment method for this patient group. However, more research is needed to be able to evaluate the effect of strength training as a treatment for people with GAD.

Introduction Weight loss practices are commonly used by athletes who perceive lower levels of body fat and higher fat-free mass (FFM) as advantageous for physical performance. High protein diets have been associated with greater fat loss and greater retention of lean mass during periods of energy restriction (ER) in individuals with obesity. However, less is known about the effects of high protein diets in trained individuals during ER. It has been proposed that leaner individuals are more at risk of losing FFM during ER than individuals with overweight. The current ACSM recommendation for protein intake in active individuals is 1.2-1.7g/kg. However, it is unclear whether higher intakes are necessary to maximize FFM retention and maximize physical performance in athletes undergoing periods of ER. Objective Our primary objective was to determine whether high protein intakes could maximize FFM retention in trained individuals during periods of ER. We also aimed to determine whether higher protein intakes are superior at maintaining physical performance. Lastly, we aimed to determine whether high protein intakes could mitigate adaptive thermogenesis (AT) in response to ER. Methods Twelve college aged athletes (6 women and 6 men) from various sports were analyzed in this study. They underwent a 6-week 25% reduction in energy intake along side a 3-day full body resistance training program. Participants were randomly assigned to a low (~1.2g/kg), moderate (~1.6g/kg) or high (~2.2g/kg) protein group. Baseline and post-intervention measures were obtained via Dual X-ray absorptiometry (DXA), isotopic water dilution, indirect calorimetry, dietary records and strength based physical testing. Results Our results indicate a main effect of the intervention on fat mass reductions (19.66 ± 9.05 kg vs 18.02 ± 8.07 kg) (p = 0.016) despite non-significant reductions in body weight (p = 0.059). No significant changes in FFM were observed (p = 0.307). Significant increases in chest press 5RM strength (43.18 ± 14.95 kg vs 48.86 ± 17.46 kg) and chin-up maximal repetition (4.75 ± 5.64 vs 6.08 ± 6.56) were observed across all groups from baseline to post-intervention (p < 0.05). No significant increases in strength were noted on lower body movements. Resting energy expenditure (REE) was significantly reduced after the 6-week intervention (1743.52 ± 295.74 kcal vs 1655.18 ± 263.23 kcal) (p = 0.006). What is more, post-intervention measured and predicted REE were also significantly different (1655.18 ± 263.23 kcal vs 1747.92 ± 263.20) (p = 0.012). No significant effects of protein were noted on any of the outcomes. Conclusion Our preliminary results indicate that the ACSM recommendation of 1.2-1.7g/kg is sufficient for most athletes even during periods of ER to maintain FFM and physical performance. We also found the possibility of early AT in that population independently of protein intake. In fact, REE was reduced by ~100 kcal/day more than predicted despite minimal weight loss and relative preservation of FFM.

Recent recommendations are that older adults increase their dietary protein intake to intakes higher than are currently recommended to mitigate sarcopenia-induced muscle loss caused in part by anabolic resistance. Protein supplementation may serve as an effective strategy to meet protein intake goals; however, protein supplements vary in their quality, which may impact muscle protein turnover. Protein quality is determined by the digestibility and content of essential amino acids in a protein source and may play an important role in mitigating the loss of muscle mass and muscle protein synthesis (MPS) during energy restriction (ER), acute reductions in physical activity, which we modeled using enforced step reduction (SR), and during recovery from SR. We aimed to determine whether the quality of a protein supplement – whey protein (higher quality) versus collagen peptides (lower quality) – would impact the reduction in fat-free bone-free mass (FBFM) and MPS (Study 1), and also to compare differences in functional variables: strength loss in men and women, and single fibre function with SR in men (Study 2). In Studies 1 and 2 we compared supplementation with whey protein (WP) and collagen peptides (CP), higher and lower quality proteins respectively, as part of a higher protein diet provided to older adults during one week of ER (-500 kcal/d), two weeks of step reduction (< 750 steps/d) (ER+SR) and one week of recovery (RC). Two weeks of ER+SR significantly reduced FBFM in both the WP and CP groups with greater FBFM recovery with WP. MPS was significantly reduced following ER in both groups and did not decrease further during ER+SR. MPS was increased above ER+SR following 1 week of RC in the WP group only. ER+SR significantly reduced maximum voluntary contraction (MVC) in both men and women; however, following RC men fully recovered their strength and women did not. In Study 3, we aimed to determine the impact of WP and CP supplementation combined with unilateral resistance exercise (RE) to augment the acute and longer term MPS response in healthy older women. Acutely, rates of MPS were elevated following WP+RE and with WP alone while MPS was elevated only in CP+RE. Six days of supplementation increased MPS in WP and WP+RE with no increase in MPS with CP or CP+RE. Collectively, these studies demonstrate that protein quality is an important variable to consider in selecting a protein supplement for older adults and for recovering from inactivity. / Thesis / Doctor of Science (PhD) / At the end of the 5th decade of life, adults will have lost an appreciable amount of muscle mass and strength versus what they had in their 3rd decade of life. This age-related loss of muscle mass and strength is known as sarcopenia. Additionally, as they age, adults will experience brief periods of reduced physical activity due to illness, injury, or recovery from surgery. Such periods are associated with a rapid loss of muscle and strength creating a brief period of ‘accelerated sarcopenia’. Strategies to combat the loss of muscle and strength in these periods include increasing protein intake and even periodic exercise which may help to reduce the negative impact of physical inactivity. In particular, higher quality protein sources (protein derived from animal sources or soy) and weightlifting may better help muscles recover from inactivity. Our main findings were that consuming high quality protein (whey protein) stimulated the process of muscle building that is normally reduced with inactivity. Importantly, when combined with resistance exercise, we were able to increase the rate at which healthy older women built muscle with whey protein in comparison to a lower quality protein source (collagen peptides). These findings provide novel and insightful information for the recommendations of protein supplement types to older adults to increase daily protein intake to preserve muscle mass with age.

Bakgrund: Det finns rekommendationer för fysisk aktivitet under graviditet där styrketräning av kroppens stora muskelgrupper två ggr/vecka ingår. Styrketräning på låg och måttlig intensitet betraktas som säker under en medicinskt okomplicerad graviditet. Forskning gällande tyngre styrketräning under graviditet är dock nästintill obefintlig och kvinnor som söker vägledning saknar riktlinjer att förhålla sig till. På grund utav det etiska dilemmat med att utsätta gravida kvinnor för risk kan ett första steg därför vara att kartlägga hur gravida kvinnor väljer att styrketräna idag.   Syfte: Att undersöka hur gravida kvinnor styrketränar idag samt vad eventuella modifieringar beror på. Syftet var även att undersöka om styrketräning på självvald intensitet korrelerar med förekomsten av vanliga fysiska besvär under graviditeten.  Metod: Studien var utformad som en explorativ tvärsnittsstudie där gravida kvinnor fick besvara en online-enkät vid ett tillfälle. Enkäten behandlade frågor rörande deltagarnas bakgrund och träningsvana, nuvarande träningsvanor och graviditetsrelaterade besvär. Inklusionskriterier var pågående medicinskt okomplicerad graviditet, att styrketräna minst två ggr/vecka och att ha styrketränat minst en ggr/vecka under minst tre månader innan graviditet. Exklusionskriterier var att vänta fler än ett barn.  Resultat: Samtliga deltagare (n=20) hade gjort någon form av anpassning av sin styrketräning under graviditet. En minskning av antal styrketräningspass/vecka kunde ses (p=0.04) och en majoritet av deltagarna hade valt bort övningar i sin träning samt minskat intensiteten i träningen. Inga statistiskt signifikanta samband (p&gt;0.05) kunde identifieras mellan om man upplevde besvär och graviditetsvecka, träningsmängd eller intensitet i träningen. Andelen deltagare med ryggsmärta var 10 %, bäckensmärta 45 %, ansträngningsinkontinens 20 %, högt blodtryck 5 % och ingen hade graviditetsdiabetes.  Konklusion: Prevalensen av besvär var inte större än hos den genomsnittliga gravida populationen vilket skulle kunna vara ett tecken på att styrketräning på självvald intensitet inte ökar risken för graviditetsrelaterade besvär. Generaliserbarheten är dock låg på grund utav det låga deltagarantalet. Fler studier behövs och fortsatta prospektiva träningsstudier rekommenderas där betydelsen av intensitet och besvär undersöks såväl under graviditet som efter förlossning. / Background: There are recommendations regarding physical activity that involve resistance exercise twice a week. Resistance exercise on low or moderate intensity are considered safe during a medically uncomplicated pregnancy. Research regarding heavier resistance exercise is almost nonexistent and women who seek direction lack guidelines to relate to. Because of the ethical dilemma of exposing pregnant women at risk, a first step could be to investigate how pregnant women choose to engage in resistance exercise today.  Objective: To examine how pregnant women are resistance exercising and what possible modifications depend on. The aim was also to examine if resistance exercise on self-elected intensity correlate with the prevalence of common physical complications during pregnancy.  Method: The study was conducted as an explorative cross-sectional study where pregnant women responded to an online survey at one single occation. The survey contained items regarding the participants background and experience from resistance exercise, current exercise habits and pregnancy related complications. Criteria of inclusion were having an ongoing medically uncomplicated pregnancy, engaging in resistance exercise at least twice a week and to have engaged in resistance exercise at least once a week for at least three months before pregnancy. Exclusion criteria were to expect more than one child.  Results: All of the participants (n=20) modified their resistance exercise in some way during pregnancy. A reduction of sessions per week was shown (p=0.04) and a majority of the participants cut out some movements in their exercise regime and lowered the intensity. No statistically significant correlations (p&gt;0.05) were identified between experiencing complications and week of pregnancy, amount of training or intensity in training. The proportion of participants experiencing back pain were 10%, pelvic girdle pain 45 %, stress urianary incontinence 20 %, hypertension 5 % and none suffered from gestational diabetes.  Conclusion: The prevalence of complications were not larger than in the general pregnant population which could be a sign of resistance exercise on self-elected intensity not increasing the risk of pregnancy complications. The generalizability of the results is however limited because of the low number of participants. Further studies are needed and prospective exercise studies are recommended where the significance of intensity and complications are examined during pregnancy as well as after delivery.

Yes / Maintenance of skeletal muscle mass and function is critical to health and wellbeing throughout the lifespan. However, disuse through reduced physical activity (e.g., sedentarism), immobilisation, bed rest or microgravity has significant adverse effects on skeletal muscle health. Conversely, resistance exercise training (RET) induces positive muscle mass and strength adaptations. Several studies have employed microarray technology to understand the transcriptional basis of muscle atrophy and hypertrophy after disuse and RET, respectively, to devise fully effective therapeutic interventions. More recently, rapidly falling costs have seen RNA-sequencing (RNA-seq) increasingly applied in exploring muscle adaptations to RET and disuse. The aim of this review is to summarise the transcriptional responses to RET or disuse measured via RNA-seq in young and older adults. We also highlight analytical considerations to maximise the utility of RNA-seq in the context of skeletal muscle research. The limited number of muscle transcriptional signatures obtained thus far with RNA-seq are generally consistent with those obtained with microarrays. However, RNA-seq may provide additional molecular insight, particularly when combined with data-driven approaches such as correlation network analyses. In this context, it is essential to consider the most appropriate study design parameters as well as bioinformatic and statistical approaches. This will facilitate the use of RNA-seq to better understand the transcriptional regulators of skeletal muscle plasticity in response to increased or decreased use.

Skeletal muscle adapts differently to specific modes of exercise, where resistance training results in muscle growth and endurance training induces mitochondrial biogenesis. These are results of molecular events that occur after each exercise session, increasing the expression of specific genes and the rate of both synthesis and breakdown of protein. The rate of protein synthesis is controlled by the mTORC1 signaling pathway, which is potently stimulated by resistance exercise and amino acid, and their combined effect is needed for muscle growth. The essential amino acids (EAA) are responsible for the stimulation of protein synthesis and here leucine has been attributed specific attention, but its particular role among the EAA, and the involvement of the other branched-chain amino acids (BCAA) is unclear. Endurance exercise activates the protein AMPK which, in animal models, has been shown to inhibit mTORC1 signaling and protein synthesis.  Suggesting that concurrent endurance and resistance exercise could restrain muscle growth, but it is unknown if this mechanism is relevant in exercising human muscle. Little is known about the regulation of protein breakdown and although much attention has been given the proteins MuRF-1 and MAFbx which target proteins for degradation, their role requires further investigation. The aim of thesis was to address the mentioned uncertainties by examining how different modes of exercise and amino acids affect mTORC1 signaling, protein synthesis and markers of protein breakdown in human muscle. In study I, the influence of high intensity endurance exercise on subsequent resistance exercised induced mTORC1 signaling was examined. Despite robust activation of AMPK by the endurance exercise there was no inhibition of mTORC1 signaling or protein synthesis during recovery from resistance exercise. Study II utilized a similar set up, but with the difference that resistance exercise was performed with the triceps. The cycling exercise reduced the resistance exercise stimulated mTORC1 signaling immediately after the exercise, but during the recovery period mTORC1 signaling and protein synthesis was similar between trials. Concurrent exercise induced the mRNA expression of MuRF-1 and that of PGC-1α, the master regulator of mitochondrial biogenesis, in both studies, despite that the exercise modes in study II were separated between legs and arms. In study III, the effect of an EAA supplement with or without leucine, in the stimulation of mTORC1 signaling in connection with resistance exercise was examined. Intake of EAA robustly stimulated mTORC1 signaling after exercise, but this was only minor when leucine was excluded from the supplement. In study IV, subjects were supplied with leucine, BCAA, EAA or placebo in a randomized fashion during four sessions of resistance exercise. Leucine alone stimulated mTORC1 signaling after the exercise, but both the amplitude and extent of stimulation was substantially greater with EAA, an effect that was largely mediated by the BCAA as a group. In conclusion, endurance exercise prior to resistance exercise using the leg or arm muscles does not affect mTORC1 signaling or protein synthesis during the three hour recovery period from exercise, supporting compatibility between resistance- and endurance exercise induced signaling. Concurrent exercise increases the expression of the proteolytic marker MuRF-1 compared to resistance exercise only, which could indicate both and increased demand of cellular adaptive remodeling or a more direct detrimental proteolytic effect. Leucine is crucial among the EAA in the stimulation of mTORC1 signaling after exercise, its effect is however potentiated by intake of the remaining EAA. As a supplement a mixture of EAA must be regarded preferable, although the effect is largely mediated by the BCAA as a group.

Distortion to hemodynamic, ischemic and metabolic stimuli during low load resistance exercise with blood flow restriction (BFR) may influence regional vascular adaptation. This thesis investigated the acute response and chronic adaptations of the peripheral vasculature to low load resistance exercise with BFR. The methodology utilised Doppler ultrasound, strain gauge plethysmography and muscle biopsy for insightful measures of the vasculature at different regions of the arterial tree. Short term (4-6 weeks) localised low load (30-40% 1RM) resistance exercise with BFR increased brachial (3.1%) and popliteal (3.3%) artery maximal diameter (in response to ischemic exercise), forearm (29%) and calf (24%) post-occlusive blood flow, and calf filtration capacity (14%). These findings indicate potential vascular remodelling at the conduit (chapters 3, 4) resistance (chapter 4) and capillary (chapter 4) level of the vascular tree. Regional, rather than systemic, factors are responsible for these adaptations as evidenced by an absent response in the contralateral control limb. Transient improvements in popliteal artery FMD% occurred at week 2 before increased maximal diameter at week 6, suggesting functional changes precede structural remodelling (chapter 4). Maximal brachial artery diameter and forearm post-occlusive blood flow returned to baseline values after a 2 week detraining period, signifying rapid structural normalisation after stimulus removal (chapter 3). Enhanced capillarity, despite low training loads, could be explained by augmentation of VEGF (~7 fold), PGC-1α (~6 fold) and eNOS (~5 fold) mRNA, and upregulation VEGFR-2 (~5 fold) and HIF-1α (~2.5 fold) mRNA with BFR (chapter 5). This indicates a targeted angiogenic response potentially mediated through enhanced metabolic, ischemic and shear stress stimuli. Large between subject variability in the level of BFR was observed during upper and lower limb cuff inflation protocols. Adipose tissue thickness and mean arterial pressure were the largest independent determinants of upper and lower limb BFR, respectively (Chapter 6). In conclusion, this thesis demonstrates that low load resistance exercise with BFR induces adaptation in the conduit, resistance and capillary vessels. The mediators of this response are likely to be the hemodynamic and chemical signals elicited by repeated bouts of BFR resistance exercise, although confirmation of these mechanisms is required. The functional significance of these adaptations is unknown and warrants further investigation.

The aim of this research was to develop a novel multi-function exercise system for use in a broad range of applications. Market research indicates that the demand for aerobic and anaerobic exercise devices will continue to grow with the introduction of government physical activity guidelines and increased social pressure regarding health related issues. A detailed investigation of the basic exercise science fundamentals and training methodologies was conducted in order to develop a system which would provide efficient and effective training related stimuli for improving fitness. The generation, storage and utilisation of actual and virtual load and velocity profiles for use in the development of original training modes was identified as an important area of the research. The proposed solution utilises an electromechanical programmable motion control system which provides all of the necessary exercise modalities defined in the system specification. This system combines existing industrial servo drive technology with proprietary software and database facilities to provide a step change in functionality, ease of use and safety for all users. Development of these hardware and software elements was supported by the creation of a series of system models at the initial stages of the research using the computer integrated manufacturing open systems architecture (CIMOSA) modelling approach. These diagrams were an invaluable resource during the concept generation and refinement processes and have clearly demonstrated the cross-discipline applications of such formalised modelling techniques. Validation and reliability data collected during prototype testing indicated that the exercise motion generation capabilities and performance measurement facilities were comparable to existing isokinetic dynamometer equipment. Additional subject testing produced results with peak output values and parameter trends which correlated closely to those determined during clinical and academic research. These experimental results suggest that the modular exercise system could be a valuable tool for the collection of research data to be used in support of current and future training theories.

Bakgrund: Regelbunden fysisk aktivitet leder till positiva hälsoeffekter och är därmed viktig som primär- och sekundärprevention för flera olika sjukdomar och för tidig död. Primärprevention ges dock begränsat utrymme inom sjukvården och därmed kan ett samarbete med andra hälsofrämjande aktörer i samhället vara motiverat. Syfte: Att undersöka om deltagare skattar högre upplevd livskvalitet och fysisk aktivitetsnivå efter Friskis&amp;Svettis (F&amp;S) tio veckor långa ”Börja träna”-kurs samt undersöka om det fanns en korrelation mellan livskvalitet och fysisk aktivitetsnivå. Metod: 95 deltagare (81 kvinnor, 14 män) med en medelålder på 50 år fyllde i två enkäter, en före och en efter interventionen. En inomgruppsjämförelse samt en korrelationsanalys gällande livskvalitet och fysisk aktivitetsnivå gjordes. Resultat: Medianen för livskvalitet var 7 före interventionen och 8 efter vilket var en signifikant ökning (p=0,022). Även för fysisk aktivitet var ökningen signifikant med en median på 3 före interventionen och 4 efter (p&lt;0,001). I studien sågs ett mycket svagt samband mellan livskvalitet och fysisk aktivitetsnivå före interventionen (r=-0,172, p=0,122). Konklusion: Efter deltagande i F&amp;S ”Börja träna”-kurs skattade deltagarna högre livskvalitet och fysisk aktivitetsnivå. På grund av ett stort bortfall och flera metodologiska felkällor bör resultatet användas med försiktighet och vidare studier är därmed nödvändiga.