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Resistance training (RT) is a popular exercise mode and is considered an essential part of an exercise program. In current pandemic times due to the coronavirus (i.e. COVID-19) outbreak, RT practice has been strongly threatened. However, such threat might not be an inherent problem to RT, but rather to misconceptions related to RT. In the current opinion article, we provide insights to better understand RT. When analyzing current scientific evidence, it seems that RT can be performed in a safe, time-efficient and uncomplicated manner, in many different places and with few resources, which makes it fully feasible within measures adopted to control coronavirus dissemination. RT should not be sacrificed due to consequences of the coronavirus pandemic. However, it might be necessary to sacrifice some old-fashioned thoughts, rooted in beliefs that have already been overturned by science. It would be counter-productive for population health (and countries economy) to avoid RT due to the misconception that specialized equipment, fashioned programs, or resources are needed for effective programs implementation. Therefore, RT can be easily adapted to the new time and logistical challenges brought by the coronavirus outbreak. From a practical standpoint, RT could be performed using body weight, accessible materials (e.g. elastic bands, lights dumbbells and barbell) or even without external load at home or at public spaces and still result in important health benefits.
published: 07 July 2020
doi: 10.3389/fphys.2020.00859
Frontiers in Physiology | 1July 2020 | Volume 11 | Article 859
Edited by:
Hassane Zouhal,
University of Rennes 2 - Upper
Brittany, France
Reviewed by:
Antonio Dello Iacono,
University of the West of Scotland,
United Kingdom
Pantelis Theodoros Nikolaidis,
University of West Attica, Greece
Paulo Gentil
Specialty section:
This article was submitted to
Exercise Physiology,
a section of the journal
Frontiers in Physiology
Received: 24 May 2020
Accepted: 26 June 2020
Published: 07 July 2020
Gentil P, Ramirez-Campillo R and
Souza D (2020) Resistance Training in
Face of the Coronavirus Outbreak:
Time to Think Outside the Box.
Front. Physiol. 11:859.
doi: 10.3389/fphys.2020.00859
Resistance Training in Face of the
Coronavirus Outbreak: Time to Think
Outside the Box
Paulo Gentil 1,2
*, Rodrigo Ramirez-Campillo 3and Daniel Souza 1
1College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil, 2Hypertension League, Federal
University of Goias, Goiânia, Brazil, 3Laboratory of Human Performance, Quality of Life and Wellness Research Group,
Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
Keywords: COVID19, human physical conditioning, virus infection, exercise is medicine, barbell, dumbbell, muscle
strength, weightlifting
Resistance training (RT) is an exercise type commonly associated with the performance of
muscle contractions against external resistance. This training model is very popular and has been
recommended as an essential part of an exercise program by several important associations (ACSM,
2009; Garber et al., 2011). Its benefits are commonly associated with muscle strength and mass gains
and expand to several areas such as blood pressure control (MacDonald et al., 2016), improved
bone mineral density (Zhao et al., 2015), depression management (Gordon et al., 2018), cancer
treatment (Fuller et al., 2018), controlling blood glucose (Codella et al., 2018), weight management
(Paoli et al., 2014), among others. Such benefits, largely mediated by strength gains, culminate in
reductions in mortality rates in different populations (Ruiz et al., 2008; Artero et al., 2011; Ortega
et al., 2012; Hardee et al., 2014; Dankel et al., 2016). Many of the problems that RT has been
shown to counteract are related to increased mortality and morbidity associated with COVID,
like hypertension, diabetes, coronary diseases, overweight (Muniyappa and Gubbi, 2020; Salerno
et al., 2020; Shahid et al., 2020; Singh et al., 2020; Zhou et al., 2020). Although it is not possible to
attribute a direct cause-effect relationship between RT and mortality risk during COVID, it might
be important to perform RT to improve general health and help in a better prognostic in case
of contamination.
Notwithstanding, in the face of the coronavirus or COVID-19 outbreak, the practice of
RT has been strongly threatened. Considering that this virus is highly contagious and may
be transmitted by close contact among people and by sharing subjects, public health policies
generally recommend distance from other people, avoidance of tight spaces and agglomeration
as preventive measures (Adhikari et al., 2020). Therefore, RT practice faces new challenges and
these should be addressed in the near future, for practical and logistical reasons. However,
this might not be an inherent problem to RT, but rather in the way that it is commonly
understood and applied. Although it originally involved exercises with body weight or objects
obtained from the nature itself, RT began to be increasingly associated with sophisticated
equipment and facilities, and with time-consuming, and complicated routines. As a result,
RT is being mainly performed in facilities such as gyms, health clubs, fitness centers, and
with high-cost specialized machines. Such conceptions regarding RT imposes a barrier for its
implementation in the current scenario, since its performance would involve agglomeration,
climatized environments, sharing of materials, and other characteristics that may favor an increased
risk of infection. However, is it important to note that RT does not necessarily involve the
need of conventional equipment and facilities which allows it to be performed in a range of
alternative situations.
Gentil et al. Resistance Training and the Coronavirus Outbreak
When analyzing current scientific evidence, it seems that
RT can safely, time-efficient and easily be implemented, in
almost anywhere and with minimal resources, which makes it
fully feasible within measures adopted to control coronavirus
dissemination. Therefore, this opinion aimed to discuss practical
and uncomplicated evidence-based RT alternatives to overcome
the restrictions measures adopted during COVID-19 outbreak.
Most conventional approaches suggest that RT should be
performed with moderate to high loads, with specific number of
repetitions and using specific equipment, like machines and free
weights (Kraemer et al., 2002; ACSM, 2009). However, according
to the muscle effort principle (i.e., effort-based paradigm; Steele
et al., 2017a), when effort is high, RT performed in different ways,
such as using different loads, different types of equipment and in
different environments, can bring gains in muscle size and fitness
similar to the most conventional approaches (Fisher et al., 2017b;
Steele et al., 2017b, 2019).
With regard to load, it is commonly recommended that, for
optimal gains in strength and muscle mass, it is necessary to
use moderate- to high-loads [60% of one repetition maximum
(1RM)] (McDonagh and Davies, 1984; ACSM, 2009), which
would make it difficult to perform RT without specialized
equipment. However, studies have shown that, regardless of
training level, gains in muscle strength, and mass may be related
to muscle effort (i.e., physiological stimulus), and not necessarily
to the load being used (Fisher et al., 2017b).
Studies in untrained (Mitchell et al., 2012; Assunção et al.,
2016) and trained people (Morton et al., 2016) reveal that
training with low-external loads (LEL) promote similar gains
in muscle mass and strength compared to high-external loads,
especially when the strength tests are not specific (Fisher et al.,
2017b). In fact, relevant gains in strength and muscle mass are
feasible with LEL (40% of 1RM) and a high number (>100) of
repetitions (Farup et al., 2015), something that was previously
unimaginable for RT. Although the studies with LEL involved the
precise quantification of the load, which might not be feasible
during the social distance measures, the results suggested that
RT benefits might be associated with effort and not with the
number of repetitions or loads used. Therefore, it brought the
insight that muscles do not “see” the load being lifted or count
repetitions performed, but it seems to interpret physiological
signaling associated with effort (Steele et al., 2017a, 2019). With
this in mind, it might be expected that training with affordable
implements (elastic bands, light dumbbells, and barbells) without
the need of specialized resources or facilities could be a feasible
option for RT.
Indeed, similar physiological stimulus can be induced with
elastic bands when compared to traditional methods, including
muscle activation and micro-structural damage (Aboodarda
et al., 2011, 2016), strength gains (Martins et al., 2013), and
functional improvements (Colado et al., 2010; Souza et al., 2019).
Moreover, some training models traditionally associated with
aerobic activities such as stationary cycling may promote muscle
hypertrophy and strength gains (Ozaki et al., 2015, 2016; Steele
et al., 2019). Such a proposal has already been presented and
tested, with promising results (Steele et al., 2019). Therefore,
effective RT programs can be performed using implements easily
obtained in standard commercial facilities at low cost, and that
might be stored at home.
Moreover, significant peripheral physiological stimulus can be
induced even without external-load (NEL), involving maximal
or near-maximal voluntary muscle contraction. For example,
acute studies verified high levels of motor units recruitment
when performing NEL muscle contractions with the intention
to maximally contract the muscles (Gentil et al., 2017a). Some
studies showed muscle strength and mass gains after NEL-RT
programs (Counts et al., 2016; Barbalho et al., 2019). In young
men and women, after a contralateral training design, equivalent
gains in the arm muscle size was observed after traditional RT
and NEL-RT (Counts et al., 2016). This hypothesis was also
confirmed in rehabilitation setting, with positive outcomes in
terms of hypertrophy and functionality (Barbalho et al., 2019).
Therefore, evidence points toward the need of inducing
significant muscle physiological stimulus and this can be
achieved with LEL, or even with NEL. Therefore, the need for
equipment and implements should not be viewed as a barrier to
implement RT programs during current pandemic times. On the
other hand, due the high levels of perceived effort and discomfort
during NEL and LEL (Fisher and Steele, 2017; Gentil et al.,
2017a), as well as the high cardiovascular stress induced by LEL
(Vale et al., 2018), is reasonable to suggest that these training
methods might not be suitable for special population, such as
sedentary aging people and heart disease patients.
Finally, RT has been usually monitored by external load
parameters, which might not be feasible in absence of specialized
equipment. However, it has been suggested that that monitoring
internal load might be also important to understand exercise
response (Impellizzeri et al., 2019). In this regard, session rate
of perceived effort and training impulse (repetitions x session
rate of perceived exertion) might be useful tools for this purpose
(Martorelli et al., 2020). According to (Martorelli et al., 2020),
session rating of perceived exertion might be more indicated
when training to or close to muscle failure, while training impulse
might be indicated when avoiding muscle failure.
A practical issue that raised with social isolation was the
reduction of free time. Although social isolation may presume
more time available it is also possible that greater involvement
in household activities, family care and children’s education,
for example, might make time more scarce. Thus, the need
for time-efficient RT approaches has become promising and
attractive (Fisher et al., 2017a). If we consider a minimum dose
approach, workouts that last a few minutes can be efficient in
promoting muscle strength and size gains (Souza et al., 2020).
Another important aspect is about exercise selection. It is
commonly believed that a complete routine would require a
Frontiers in Physiology | 2July 2020 | Volume 11 | Article 859
Gentil et al. Resistance Training and the Coronavirus Outbreak
wide variety of exercises, including many isolated exercises
for specific muscles, like gluteus, biceps, and triceps brachii.
However, current evidence shows that the use of basic and
multi-joint exercises is sufficient to promote gains in muscle
strength and size in most muscles involved in movement
(Gentil et al., 2015, 2017b; Paoli et al., 2017; Barbalho et al.,
2020a,b) and the addition of isolated exercises, in general, does
not seem to bring additional benefits (Gentil et al., 2013; de
França et al., 2015; Barbalho et al., 2020b). Furthermore, RT
using body weight promotes similar gains in muscle strength
and thickness in comparison with traditional training, even in
young trained practitioners (Calatayud et al., 2015; Kikuchi and
Nakazato, 2017), as: provides benefits to middle-aged people
with non-alcoholic fat liver disease (Takahashi et al., 2015, 2017)
and improvements on muscle strength and body composition
in elderly people (Tsuzuku et al., 2017). Although the study of
Kikuchi and Nakazato (2017) had a limited sample size and a high
variability in the results, it is possible that body-weight exercises
(such as jumps, dips, push-ups, chin-ups, squats, and lunges)
performed at home, requiring no extra equipment, in a relatively
reduced space, with a low-volume time-efficient approach can be
capable of inducing significant health benefits and increases in
muscle strength, power, and hypertrophy.
A common belief related to RT is the need of constant exercise
variation to guarantee continued results over medium and long-
term. This might lead to the misconception that it would not be
possible to obtain positive results unless several different types
of equipment and loads are available, as in traditional facilities.
However, variation of external load, methods and exercises
do not necessarily translates into greater muscle strength and
hypertrophy gains (Loturco and Nakamura, 2016; Loturco et al.,
2016; De Souza et al., 2018; Baz-Valle et al., 2019; Damas et al.,
2019). In this sense, proper adjustment of RT intensity and
volume in order to provide an adequate muscle physiological
stimulus might be more beneficial to achieve optimum gains in
muscle strength and size, than to vary the RT program per se.
The repercussions of the current pandemic on the health of
economy is a major concern for most countries around the
globe. With people at home, sedentary behavior, and physical
inactivity may increase, posing an even greater burden to the
economy (Ding et al., 2016) and increasing the prevalence
of problems associated with greater mortality and morbidity
associated with COVID-19. Home-based (or public open spaces)
RT programs in the context of current pandemic times are highly
feasible, with an enormous potential impact in counteracting the
detrimental effects of sedentary behavior and physical inactivity
on population health and economic burden.
Several effective, safe, low-cost, time-efficient, and practical
RT approaches can be considered, such as programs with
LEL, NEL, body-weight load, jump-based, elastic bands, among
others. Complicated, highly specialized exercises are not an
essential part of RT programs for most people. RT programs
should be promoted during current pandemic times in order
to promote better health and quality of life (Tasiopoulos et al.,
2018; Nikolaidis et al., 2019). However, it might be necessary
to sacrifice some old-fashioned thoughts rooted in beliefs that
have already been overturned by science. Analyzing the new
perspectives brought in this opinion article, we see that it is
possible to perform RT in a practical and uncomplicated manner,
avoiding the exposure to a potentially infectious environment
and adapting training programs to the new time and logistical
challenges brought by the coronavirus outbreak. These strategies
might allow obtaining continued results in terms of mental and
physical health. These seems be the returning message of to what
Leonardo Da Vinci told us more than 500 years ago: “simplicity
is the ultimate sophistication.”
PG, RR-C, and DS contributed to the conception, drafting the
article, revising it critically, and final approval of the version to
be published. All authors contributed to the article and approved
the submitted version.
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors. PG
receives a Research Grand from CNPq (304435/2018-0).
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Conflict of Interest: The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be construed as a
potential conflict of interest.
Copyright © 2020 Gentil, Ramirez-Campillo and Souza. This is an open-access
article distributed under the terms of the Creative Commons Attribution License (CC
BY). The use, distribution or reproduction in other forums is permitted, provided
the original author(s) and the copyright owner(s) are credited and that the original
publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these
Frontiers in Physiology | 5July 2020 | Volume 11 | Article 859
... Although it is not possible to attribute a direct cause-effect relationship between RT practice and the mortality risk during the COVID-19 pandemic, current evidence suggests that it might be important to perform RT to improve general health and promote a better prognosis in cases of contamination [11][12][13][14][15][16][17][18]37 58] usually have a better immunological profile than people who perform long-duration aerobic activities [59], which might be a positive point for RT [60,61]. Strategies for RT prescription for improving or maintaining immune function involve using a low exercise volume (4-6 exercises, with 1-2 sets per exercise), avoiding metabolic stress (perform ≤ 6 repetitions and ≥2 min of rest between sets and exercises) and preferring exercising during the afternoon/evening [60]. ...
... If one decides to avoid exercise facilities, RT can be adapted to be performed in many different situations, even with limited space and equipment, and it can easily be adapted to an individual's characteristics and health status [61]. For example, previous studies have shown that bodyweight exercises [66][67][68], stationary bike training [69], plyometric training [70], elastic band training [71][72][73], and even exercises with no external load [74][75][76] promote similar responses to traditional RT. ...
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By the end of 2019 a severe acute respiratory syndrome caused by the SARS-CoV-2 started a pandemic, leading to millions of deaths and many important political and social changes. Even in the absence of contamination, the mobility reduction, social distancing and closing of exercise facilities negatively affected physical activity and conditioning, which is associated to muscle atrophy, loss of muscle strength and reductions in functional capacity. In case of infection, it has been shown that increased physical capacity is associated with decreased hospitalization and mortality risk. Although millions of people died from COVID-19, most contaminated individu-als survived from the infection, but carried different sequelae, like severe loss of physical func-tion and reduced quality of life. Among different physical exercise models that might help to prevent and treat COVID-19 outcomes, resistance training (RT) might be particularly relevant. Among its benefits, RT can be adapted to be performed in many different situations, even with limited space and equipment, and it is easily adapted to individual characteristics and health status. The current narrative review aims to provide insights on how RT can be used in different scenarios to counteract the negative effects of COVID-19. By this, the authors expect to provide insights do deal with the current pandemic and also in case the World has to deal with similar events in the future.
... Furthermore, PJT may be inexpensive compared to other resistance training methods, requiring little or no equipment, usually involving drills with the body mass used as resistance [10]. Additionally, PJT may be conducted in a relatively small physical space, which may be an essential advantage during specific scenarios (e.g., encountering pandemic restrictions) where participants may be forced to train at their homes [11]. Moreover, PJT may be considered more fun than other training methods (e.g., flexibility, endurance), particularly among youths [12]. ...
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Background: Plyometric jump training (PJT) encompasses a range of different exercises that may offer advantages over other training methods to improve human physical capabilities (HPC). However, no systematic scoping review has analyzed either the role of the type of PJT exercise as an independent prescription variable or the gaps in the literature regarding PJT exercises to maximize HPC. Objective: This systematic scoping review aims to summarize the published scientific literature and its gaps related to HPC adaptations (e.g., jumping) to PJT, focusing on the role of the type of PJT exercise as an independent prescription variable. Methods: Computerized literature searches were conducted in the PubMed, Web of Science, and SCOPUS electronic databases. Design (PICOS) framework: (P) Healthy participants of any age, sex, fitness level, or sports background; (I) Chronic interventions exclusively using any form of PJT exercise type (e.g., vertical, unilateral). Multimodal interventions (e.g., PJT + heavy load resistance training) will be considered only if studies included two experimental groups under the same multimodal intervention, with the only difference between groups being the type of PJT exercise. (C) Comparators include PJT exercises with different modes (e.g., vertical vs. horizontal; vertical vs. horizontal combined with vertical); (O) Considered outcomes (but not limited to): physiological, biomechanical, biochemical, psychological, performance-related outcomes/adaptations, or data on injury risk (from prevention-focused studies); (S) Single- or multi-arm, randomized (parallel, crossover, cluster, other) or non-randomized. Results: Through database searching, 10,546 records were initially identified, and 69 studies (154 study groups) were included in the qualitative synthesis. The DJ (counter, bounce, weighted, and modified) was the most studied type of jump, included in 43 study groups, followed by the CMJ (standard CMJ or modified) in 19 study groups, and the SJ (standard SJ or modified) in 17 study groups. Strength and vertical jump were the most analyzed HPC outcomes in 38 and 54 studies, respectively. The effects of vertical PJT versus horizontal PJT on different HPC were compared in 21 studies. The effects of bounce DJ versus counter DJ (or DJ from different box heights) on different HPC were compared in 26 studies. Conclusions: Although 69 studies analyzed the effects of PJT exercise type on different HPC, several gaps were identified in the literature. Indeed, the potential effect of the PJT exercise type on a considerable number of HPC outcomes (e.g., aerobic capacity, flexibility, asymmetries) are virtually unexplored. Future studies are needed, including greater number of participants, particularly in groups of females, senior athletes, and youths according to maturity. Moreover, long-term (e.g., >12 weeks) PJT interventions are needed.
... Along with fitness, health conditions can be improved through planned, structured and repetitive form of physical activity (Caspersen et al., 1985) which in turn, could provide school aged participants (SAP) with a competitive edge during sporting activities (Faigenbaum & Myer, 2010;Zwolski et al., 2017). For example, a study by Arnason et al. (2004) showed that football teams with higher heights during countermovement jumps (CMJ) were most IJKSS 11(1): [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] limited physical area, and are often viewed as funnier (Chu & Myer, 2013;Gentil et al., 2020;Ward et al., 2007). ...
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Background: Altering moderator variables during a jump rope training (JRT) program can provide a novel training modification that can be used to modify the specific training outcomes. JRT is commonly implemented as a traditional game activity in many countries as an old culture of physical activity in school-age participants (SAP). However, strength and conditioning professionals need to know how JRT moderator variables affect these health- and physical fitness outcomes. Thus, an evidence-gap map (EGM) could provides a clearer picture of the design of an appropriate JRT based on scientific evidence. Objective: the purpose of this systematic review secondary analysis was to assess the moderator variables related to JRT effectiveness for health and physical fitness-related outcomes in SAP. Method: literature searches were conducted in the following electronic databases: PubMed, Web of Science and SCOPUS. The PICOS (participants, intervention, comparators, outcomes, and study design) approach was used to rate studies for eligibility. An EGM will be constructed to graphically represent the body of evidence and the current research gaps. Results: 10,546 records were initially identified and finally, 8 studies were considered. A total of 186 participants were analysed in the intervention groups (16 groups). Five of seven studies measured health-related parameters and five of eight included fitness-related parameters. Conclusion: rope weight (e.g., weighted rope i.e. 695 g), adequate post-exercise recovery strategies (e.g., dark chocolate supplementation), type of jump (e.g., freestyle), and total number of jumps, can be manipulated into JRT programs to optimise health and physical related capacities among SAP.
... One such method is jump training which offers distinct benefits for the player. For example, jump training may be conducted in a relatively small physical space, which may be an important advantage during certain scenarios where athletes may be forced to train at their homes (9), as was the case during the recent Covid 19 pandemic. Moreover, jump training may be considered more fun and engaging than other training methods (e.g., flexibility, endurance), particularly among younger soccer athletes (10). ...
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Background Youth female soccer players require high muscular power to overcome their opponents. Jump training can facilitate improvements in muscular power as has been demonstrated in youth male soccer players. However, studies in female players are comparatively scarce. Objective The aim of this study was to assess the effects of a jump-training program, as compared to soccer training alone, on the physical fitness of youth female soccer players. Methods Fourteen physically active youth female soccer players (age: 16.0±2.2 years) were randomly divided into a jump-training group (n=8) or control group (n=6). Before and after a 4-week intervention period, the players were assessed with a countermovement jump (CMJ) test, multiple 4-bounds test (4BT), a 20-m sprint, maximal kicking velocity (MKV) and the Yo-Yo intermittent recovery test (level 1; Yo-Yo IR1). Results No significant changes in any of the dependent variables were noted in the control group, although small effect sizes were observed in CMJ (ES=0.33) and 4BT (ES=0.27). In contrast, the jump training group achieved significant improvements in CMJ (p=0.001; ES=0.85), 4BT (p=0.002; ES=1.01) and MKV (p=0.027; ES=0.77), with small to medium effect sizes observed in the 20-m sprint (p=0.069; ES=0.59) and Yo-Yo IR1 (p=0.299; ES=0.20) tests. Conclusion Compared to regular soccer training that induced only small improvements in CMJ and 4BT, a jump training intervention resulted in small to large improvements in the physical fitness of youth female soccer players with changes seen in CMJ, 4BT, 20-m sprint, MKV, and Yo-Yo IR1.
... Third, the implementation of PJT is inexpensive compared to other training methods, requiring little or no equipment, usually involving drills with the body mass used as load (Ramírez-Campillo et al., 2020b). Additionally, PJT may be conducted in a relatively small space, which may be an important advantage during certain scenarios (e.g., encountering pandemic restrictions) where athletes may be forced to train at home (Gentil et al., 2020). Moreover, PJT is a highly variable exercise type compared with other training methods (e.g., flexibility, endurance). ...
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Postural balance represents a fundamental movement skill for the successful performance of everyday and sport-related activities. There is ample evidence on the effectiveness of balance training on balance performance in athletic and non-athletic population. However, less is known on potential transfer effects of other training types, such as plyometric jump training (PJT) on measures of balance. Given that PJT is a highly dynamic exercise mode with various forms of jump-landing tasks, high levels of postural control are needed to successfully perform PJT exercises. Accordingly, PJT has the potential to not only improve measures of muscle strength and power but also balance. To systematically review and synthetize evidence from randomized and non-randomized controlled trials regarding the effects of PJT on measures of balance in apparently healthy participants. Systematic literature searches were performed in the electronic databases PubMed, Web of Science, and SCOPUS. A PICOS approach was applied to define inclusion criteria, (i) apparently healthy participants, with no restrictions on their fitness level, sex, or age, (ii) a PJT program, (iii) active controls (any sport-related activity) or specific active controls (a specific exercise type such as balance training), (iv) assessment of dynamic, static balance pre- and post-PJT, (v) randomized controlled trials and controlled trials. The methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. This meta-analysis was computed using the inverse variance random-effects model. The significance level was set at p <0.05. The initial search retrieved 8,251 plus 23 records identified through other sources. Forty-two articles met our inclusion criteria for qualitative and 38 for quantitative analysis (1,806 participants [990 males, 816 females], age range 9–63 years). PJT interventions lasted between 4 and 36 weeks. The median PEDro score was 6 and no study had low methodological quality (≤3). The analysis revealed significant small effects of PJT on overall (dynamic and static) balance (ES = 0.46; 95% CI = 0.32–0.61; p < 0.001), dynamic (e.g., Y-balance test) balance (ES = 0.50; 95% CI = 0.30–0.71; p < 0.001), and static (e.g., flamingo balance test) balance (ES = 0.49; 95% CI = 0.31–0.67; p < 0.001). The moderator analyses revealed that sex and/or age did not moderate balance performance outcomes. When PJT was compared to specific active controls (i.e., participants undergoing balance training, whole body vibration training, resistance training), both PJT and alternative training methods showed similar effects on overall (dynamic and static) balance (p = 0.534). Specifically, when PJT was compared to balance training, both training types showed similar effects on overall (dynamic and static) balance (p = 0.514). Conclusion: Compared to active controls, PJT showed small effects on overall balance, dynamic and static balance. Additionally, PJT produced similar balance improvements compared to other training types (i.e., balance training). Although PJT is widely used in athletic and recreational sport settings to improve athletes' physical fitness (e.g., jumping; sprinting), our systematic review with meta-analysis is novel in as much as it indicates that PJT also improves balance performance. The observed PJT-related balance enhancements were irrespective of sex and participants' age. Therefore, PJT appears to be an adequate training regime to improve balance in both, athletic and recreational settings.
... Additionally, jump training may be conducted in a relatively small physical space, which may be an important advantage during certain scenarios (e.g. encountering pandemic restrictions) where athletes may be forced to train at their homes (31). Moreover, jump training may be considered more fun compared to other training methods (e.g., flexibility, endurance), particularly among younger athletes (32). ...
The authors explore jump training exercises as a mean to maximize vertical force production and related physical fitness traits. Jump training may enhance muscular force, the rate of force devel¬opment, muscular power, muscle contraction velocity, cross-sectional area, muscle stiffness, among other biological and biomechanical factors associated with enhanced physical function and athletic performance. Jump training exercises are characterized by the stretch-shortening cycle of the muscle-tendon complex, usually involving a preactivation, stretching, and a shortening phase. Athletes have used jumps as a training method at least in the last 3,000 years. From a scientific perspective, the number of scientific publications increased tremendously in recent years, with a 25-fold increase between 2000 and 2017. Scientific evidence support the role of jump training for the improvement of physical performance in male and female athletes, from pre-pubertal to adult and senior age. However, evidence also support the role of modified jump training exercises for several health-related outcomes (e.g., fat mass; muscle hypertrophy; bone density). In this chapter, the reader will found a summary of current scientific evidence regarding the biological foundations for jump training exercises, the scientifically proved methodological principles and practical guidelines regarding the programming of jump training exercises.
... Additionally, jump training may be conducted in a relatively small physical space, which may be an important advantage during certain scenarios (e.g. encountering pandemic restrictions) where athletes may be forced to train at their homes (31). Moreover, jump training may be considered more fun compared to other training methods (e.g., flexibility, endurance), particularly among younger athletes (32). ...
In this chapter, the authors explore jump training exercises as a mean to maximise vertical force production and related physical fitness traits. Jump training may enhance muscular force, the rate of force development, muscular power, muscle contraction velocity, cross-sectional area, muscle stiffness, among other biological and biomechanical factors associated with enhanced physical function and athletic performance. Jump training exercises are characterised by the stretch–shortening cycle of the muscle–tendon complex, usually involving a pre-activation, stretching, and a shortening phase. Athletes have used jumps as a training method at least in the last 3000 years. From a scientific perspective, the number of scientific publications increased tremendously in recent years, with a 25-fold increase between 2000 and 2017. Scientific evidence supports the role of jump training for the improvement of physical performance in male and female athletes, from pre-pubertal to adult and senior age. However, evidence also supports the role of modified jump training exercises for several health-related outcomes (e.g., fat mass; muscle hypertrophy; bone density). In this chapter, the reader will find a summary of current scientific evidence regarding the biological foundations for jump training exercises, the scientifically proven methodological principles and practical guidelines regarding the programming of jump training exercises.
The COVID-19 (coronavirus disease 2019) pandemic forces athletes to perform their workout at home with alternative training methods. Exercise resistance bands, often used for this purpose, can cause damage when they recoil or tear. Potentially resulting injuries include bruises, head injuries, lacerations, facial fractures and eye injuries. The following article presents two case reports including accident mechanism, injuries, diagnostic evaluation and treatment. The first patient presented with an open depressed skull fracture caused by a recoiling exercise resistance band, while the second patient sustained a complex ocular trauma caused by a tearing exercise resistance band when performing supported chin-ups.
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Background and purpose: This meta-analysis review aimed to investigate the effect of resistance training on functional performance and physiological factors in patients with ischemic stroke. Materials and methods: The search was conducted in PubMed, Web of Science, and Scopus using related keywords. All articles were reviewed, but 22 studies that met the inclusion criteria were included after screening. Results: Based on findings, resistance training had a significant effect on the Six-minute Walk Test (difference in means= -32.04, P= 0.028), the Berg Balance Scale (difference in means= -2.37, P= 0.018), handgrip strength test (Difference in means= -2.05, P= 0.001), and Gait Speed (difference in means= -0.089, P= 0.101) in patients with ischemic stroke. However, resistance training did not significantly affect the Up and Go Test (difference in means= -2.27, P= 0.192) in these patients. On the other hand, according to several physiological indicators in different subgroups, including body mass index, TC, HDL-C, and LDL-C, resistance training did not have a significant effect (difference in means=0.02, P= 0.642) in patients with ischemic stroke. Conclusion: Resistance training improves the performance of patients with ischemic stroke. This improvement occurs in both the upper and lower body, but resistance training did not improve physiological parameters in ischemic stroke patients.
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The aim of this study was to compare two different maximal intensity exercise modality training protocols of similar durations on muscle strength, cardiorespiratory fitness, and lower limb composition in recreationally trained men. Twenty-five trained men (28.9 ± 5.6 years) were randomly divided into Cycle ergometer (4 sets of 30 seconds sprints) and Leg press (4 sets of 10–12 repetitions to momentary failure). Both groups trained three times a week for 5 weeks. Before and after the training period, the participants performed a 10-repetition maximum (10RM) test for knee extension, an incremental exercise test on a treadmill for time to exhaustion (TTE) and peak oxygen consumption (V˙O2peak) and underwent dual energy X-ray absorptiometry to assess lower limb composition. Knee extension 10RM and TTE increased in both groups with no statistically significant between group (p = 0.614 and p = 0.210). Only cycle ergometer group increased V˙O2peak (p = 0,012). For all lower limb composition outcomes, changes were minimal. The results suggest that 5 weeks of effort and duration matched exercise protocols using cycle ergometer training or leg press may produce similar strength adaptations.
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Purpose. To conduct a narrative review of relevant studies comparing the impact of different resistance training (RT) volumes on muscle hypertrophy and lean body mass. Methods. Studies were eligible for inclusion if they were clinical trials comparing the effects of different RT volumes on muscle hypertrophy and body composition. Overall, 22 articles were considered relevant and included in this review after an extensive literature hand search of the following databases: SciELO, PubMed/MEDLINE, Scopus, SPORTDiscus, LILACS, and Web of Science. Results. Of the 22 studies, 6 showed greater effects of high-volume, 1 showed greater effects of low-volume, and the remaining studies showed no difference between high- and low-volume RT. Five studies that revealed better results for higher volume were performed in untrained people, 1 concerned trained people, and the study that presented better results for lower volume referred to trained subjects. High heterogeneity was observed in the studies’ methodology regarding training protocols, population characteristics, length of intervention, supervision status, and measures of muscle size and body composition. Conclusions. Our findings suggest that muscle size and lean body mass are not mainly affected by RT volume and that other variables, especially the intensity of effort, should be considered in RT prescription. In this sense, increased volume could be beneficial, especially when training with low effort or when effort is not well controlled. However, it is important to note that there seems to be a ceiling effect and the use of higher volumes might be detrimental to muscle hypertrophy over a long term.
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Background: The current outbreak of COVID-19 infection, which started in Wuhan, Hubei province, China, in December 2019, is an ongoing challenge and a significant threat to public health requiring surveillance, prompt diagnosis, and research efforts to understand a new, emergent, and unknown pathogen and to develop effective therapies. Despite the increasing number of published studies on COVID-19, in all the examined studies the lack of a well-defined pathophysiology of death among patients who died following COVID-19 infection is evident. Autopsy should be considered mandatory to define the exact cause of death, thus providing useful clinical and epidemiologic information as well as pathophysiological insights to further provide therapeutic tools. Methods: A literature review was performed on PubMed database, using the key terms: "COVID-19", "nCov 19", and "Sars Cov 2". 9709 articles were retrieved; by excluding all duplicated articles, additional criteria were then applied: articles or abstracts in English and articles containing one of the following words: "death", "died", "comorbidity", "cause of death", "biopsy", "autopsy", or "pathological". Results: A total of 50 articles met the inclusion criteria. However, only 7 of these studies reported autopsy-based data. Discussion: The analysis of the main data from the selected studies concerns the complete analysis of 12,954 patients, of whom 2269 died (with a mortality rate of 17.52%). Laboratory confirmation of COVID-19 infection was obtained in all cases and comorbidities were fully reported in 46 studies. The most common comorbidities were: cardiovascular diseases (hypertension and coronary artery disease), metabolic disorders (diabetes, overweight, or obesity), respiratory disorders (chronic obstructive pulmonary disease), and cancer. The most common reported complications were: acute respiratory distress syndrome (ARDS), acute kidney injury, cardiac injury, liver insufficiency, and septic shock. Only 7 papers reported histological investigations. Nevertheless, only two complete autopsies are described and the cause of death was listed as COVID-19 in only one of them. The lack of postmortem investigation did not allow a definition of the exact cause of death to determine the pathways of this infection. Based on the few histopathological findings reported in the analyzed studies, it seems to be a clear alteration of the coagulation system: frequently prothrombotic activity with consequent thromboembolism was described in COVID-19 patients. As a scientific community, we are called on to face this global threat, and to defeat it with all the available tools necessary. Despite the improvement and reinforcement of any method of study in every field of medicine and science, encouraging the autopsy practice as a tool of investigation could also therefore, help physicians to define an effective treatment to reduce mortality.
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Background and aims COVID-19 is already a pandemic. Emerging data suggest an increased association and a heightened mortality in patients of COVID-19 with comorbidities. We aimed to evaluate the outcome in hypertensive patients with COVID-19 and its relation to the use of renin-angiotensin system blockers (RASB). Methods We have systematically searched the medical database up to March 27, 2020 and retrieved all the published articles in English language related to our topic using MeSH key words. Results From the pooled data of all ten available Chinese studies (n = 2,209) that have reported the characteristics of comorbidities in patients with COVID-19, hypertension was present in nearly 21%, followed by diabetes in nearly 11%, and established cardiovascular disease (CVD) in approximately 7% of patients. Although the emerging data hints to an increase in mortality in COVID-19 patients with known hypertension, diabetes and CVD, it should be noted that it was not adjusted for multiple confounding factors. Harm or benefit in COVID-19 patients receiving RASB has not been typically assessed in these studies yet, although mechanistically and plausibly both benefit and harm is possible with these agents, given that COVID-19 expresses to tissues through the receptor of angiotensin converting enzyme-2. Conclusion Special attention is definitely required in patients with COVID-19 with associated comorbidities including hypertension, diabetes and established CVD. Although the role of RASB has mechanistic equipoise, patients with COVID-19 should not stop these drugs at this point of time, as recommended by various world organizations and without the advice of health care provider.
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SARS-CoV-2, a novel virus that causes COVID-19 infection, has recently emerged and caused a deadly pandemic. Studies have shown that this virus causes worse outcomes and a higher mortality rate in older adults and those with comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease. A significant percentage of older American adults have these diseases, putting them at a higher risk of infection. Additionally, many adults with hypertension, diabetes, and chronic kidney disease are placed on angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Studies have shown that these medications upregulate the ACE-2 receptor, the very receptor which the SARS-CoV-2 virus uses to enter host cells, which puts older adults at a further increased risk of infection. In this review, we discuss the transmission, symptomatology, mortality, and possible treatments for this infection, as they relate to older adults.
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Background The coronavirus disease (COVID-19) has been identified as the cause of an outbreak of respiratory illness in Wuhan, Hubei Province, China beginning in December 2019. As of 31 January 2020, this epidemic had spread to 19 countries with 11 791 confirmed cases, including 213 deaths. The World Health Organization has declared it a Public Health Emergency of International Concern. Methods A scoping review was conducted following the methodological framework suggested by Arksey and O’Malley. In this scoping review, 65 research articles published before 31 January 2020 were analyzed and discussed to better understand the epidemiology, causes, clinical diagnosis, prevention and control of this virus. The research domains, dates of publication, journal language, authors’ affiliations, and methodological characteristics were included in the analysis. All the findings and statements in this review regarding the outbreak are based on published information as listed in the references. Results Most of the publications were written using the English language (89.2%). The largest proportion of published articles were related to causes (38.5%) and a majority (67.7%) were published by Chinese scholars. Research articles initially focused on causes, but over time there was an increase of the articles related to prevention and control. Studies thus far have shown that the virus’ origination is in connection to a seafood market in Wuhan, but specific animal associations have not been confirmed. Reported symptoms include fever, cough, fatigue, pneumonia, headache, diarrhea, hemoptysis, and dyspnea. Preventive measures such as masks, hand hygiene practices, avoidance of public contact, case detection, contact tracing, and quarantines have been discussed as ways to reduce transmission. To date, no specific antiviral treatment has proven effective; hence, infected people primarily rely on symptomatic treatment and supportive care. Conclusions There has been a rapid surge in research in response to the outbreak of COVID-19. During this early period, published research primarily explored the epidemiology, causes, clinical manifestation and diagnosis, as well as prevention and control of the novel coronavirus. Although these studies are relevant to control the current public emergency, more high-quality research is needed to provide valid and reliable ways to manage this kind of public health emergency in both the short- and long-term.
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External load influences internal load in resistance training (RT). The purpose of the present study was to compare the total volume-load, perceptual and stress responses during three different RT protocols. Twelve resistance-trained men completed three different RT protocols with the back squat and bench press exercises: 1) power (POW) (5 sets of 6 repetitions at 50%1RM, 2-min of rest), 2) hypertrophy (HYP) (5 sets-to-failure at 75%1RM, 2-min of rest), and 3) strength (STR) (5 sets-to-failure at 90%1RM, 3-min of rest). Volume-load (kg × reps.), session rating of perceived exertion (sRPE), training impulse (TRIMP; reps. × sRPE), cortisol, immunoglobulin A (IgA), lactate, and creatine kinase (CK) were assessed before and/or after the sessions. HYP was the most demanding session in terms of volume-load (p < 0.001), TRIMP (p < 0.001), cortisol (p = 0.001), lactate (p < 0.001), and CK (p = 0.001). Despite POW exhibited a greater volume-load than STR (p = 0.016), the latter exhibiting a greater sRPE (p < 0.001), and a greater post-session CK (p = 0.05). However, the TRIMP of STR and POW were not statistically different (152 vs. 260 AU; p = 0.089). These specific responses could be meditated by the presence of muscular failure. When pooling all the sessions, significant correlations were revealed among external and internal stress markers (r = 0.35-0.80; p ≤ 0.05). The use of TRIMP could be recommended as a simple and valid monitoring tool which integrates into a single parameter the internal and the external loads of RT sessions.
The study compared the effects of resistance training programs composed by multi-joint (MJ), single-joint (SJ) and the combination of multi- and single-joint (MJ+SJ) exercises on muscle strength and hypertrophy in trained women. Thirty participants were divided into groups that performed only MJ exercises, SJ exercises and MJ+SJ exercises for six months. Participants were tested for 1-repetition maximum (RM) and muscle thickness (MT) before and after the intervention. All groups showed significant gains on 1RM tests from pre- to post-training (P<0.01). However, MJ and MJ+SJ groups obtained greater gains in 1RM for the MJ exercises in comparison with the SJ group. Increases in 1RM for the SJ exercises were similar among groups, with the exception of leg curl, where the SJ group obtained greater gains than MJ and MJ+SJ. All groups obtained significant increases in MT from pre- to post-training for all muscle groups. However, MJ and MJ+SJ groups presented greater increases in gluteus maximus, quadriceps femoris and pectoralis major in comparison with the SJ group. Therefore, our results suggest that, in general, performing MJ exercises seems to be necessary to obtain optimal results from a resistance training program; however SJ might be necessary to provide optimal strength gains in knee flexion.
The pandemic of COVID-19, a disease caused by a novel coronavirus (CoV), SARS-CoV-2, is causing substantial morbidity and mortality. Older age and presence of diabetes mellitus, hypertension, and obesity significantly increases the risk for hospitalization and death in COVID-19 patients. In this Perspective, informed by the studies on severe acute respiratory syndrome, SARS-CoV, and Middle East respiratory syndrome, MERS-CoV, and the current literature on SARS-CoV-2, we discuss potential mechanisms by which diabetes modulates the host-viral interactions and host-immune responses. We hope to highlight gaps in knowledge that require further studies pertinent to COVID-19 in patients with diabetes.
Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/L (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/L could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
The study compared the effects of back squat (BS) and hip thrust (HT) exercises on muscle strength and hypertrophy in well-trained women. Twenty-two participants were divided in two groups: BS group (n=12, 26.4±1.32 years, 171.8±3.79 cm, and 69.5±4.9 kg) performed the BS exercise and HT group (n=10, 27.5±1.42 years, 170.8±4.4 cm, 67.5±4.7 kg) performed the HT exercise. Training was performed for 12 weeks. Before and after the training period, participants were assessed for quadriceps femoris and gluteus maximus muscle thickness (MT) and 1 repetition maximum (1RM) test on the BS and HT. Both groups significantly increased hip extensors MT and HT 1RM; however, the improvements in BS group were higher than in HT group on quadriceps femoris (12.2% for BS and 2% for HT, P<0.001) and gluteus maximus MT (9.4% for BS and 3.7% for HT, P=0.001) and BS 1 RM (35.9% for BS and 4.3% for HT, P<0.001). BS was more efficient than HT, since it resulted in greater muscle hypertrophy of the quadriceps femoris and gluteus maximus, increases in BS 1RM and similar increases in HT.