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PubMed1995

Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute.

This Quick Reference Guide for Clinicians highlights the conclusions and recommendations from Cardiac Rehabilitation, Clinical Practice Guideline No. 17, which was formulated by a panel representing the major health care disciplines involved in cardiac rehabilitation. The conclusions and recommendations were derived from an extensive and critical review of the scientific literature pertaining to cardiac rehabilitation, as well as from the expert opinion of the panel. This guide addresses the role of cardiac rehabilitation and the potential benefits to be derived in the comprehensive care of the 13.5 million patients with heart disease in the United States, as well as the 4.7 million patients with heart failure and the several thousand patients undergoing heart transplantation. This Quick Reference Guide for Clinicians highlights the major effects of multifactorial cardiac rehabilitation services: medical evaluation; prescribed exercise; cardiac risk factor modification; and education, counseling, and behavioral interventions. The outcomes of and recommendations for cardiac rehabilitation services are categorized as to their effects on exercise tolerance, strength training, exercise habits, symptoms, smoking, lipids, body weight, blood pressure, psychological well-being, social adjustment and functioning, return to work, morbidity and safety issues, mortality and safety issues, and pathophysiologic measures. Patients with heart failure and after cardiac transplantation, as well as elderly patients, are specifically addressed. Alternate approaches to the delivery of cardiac rehabilitation services are presented.

Aged↗
PubMed1996

COPD: using nutrition to prevent respiratory function decline.

Close to three-fourths of patients with chronic obstructive pulmonary disease (COPD) suffer from weight loss. Identifying a single cause for this is difficult, as several factors-including chronic mouth breathing, dyspnea, aerophagia, certain medications, and depression-often act in concert. Malnutrition can exacerbate symptoms of COPD by decreasing ventilatory muscle strength, exercise tolerance, and immunocompetence, and by increasing the risk of depression and anxiety. Goals of nutrition intervention are to prevent or reverse malnutrition without worsening the disease process and to improve respiratory function, thereby reducing morbidity and delaying mortality. Recommendations for intake of fats, carbohydrates, protein, and water must be individualized.

Aged↗
PubMed1998

Longitudinal trends and gender differences in physical fitness and lifestyle factors in career U.S. Navy personnel (1983-1994)

This study examines long-term health and physical readiness trends in the U.S. Navy. We mailed lifestyle questionnaires to all participants in baseline studies between 1983 and 1989 who were still on active duty in 1994. Commands provided body composition and physical readiness test scores for the participants. Two longitudinal cohorts were created: an 8-year sample (N = 640) with matched data from 1986, 1989, and 1994; and an 11-year sample (N = 1,576), with data from 1983 and 1994. Analyses of both cohorts revealed significant improvements in cardiovascular fitness, muscle strength, exercise, lean body mass, dietary habits, and sleep, as well as significant decreases in tobacco and alcohol use and job stress. However, hypertension rates, percentage of body fat, and body mass index increased over time. Women's scores were significantly better than men's on a number of factors. Overall, these findings suggest that the Navy's health promotion efforts have had a significant positive effect on the fitness and health behaviors of career Navy men and women.

Adult↗
PubMed2002

[Exercise increases muscle strength and probably prevents hip fractures].

No hypothesis-testing studies (blinded, randomized, controlled, prospective) with fracture as endpoint have been published so far. Instead we have to rely on observational cohort and case-control studies, from which available data imply that physical activity reduces the risk of hip fracture in women and perhaps also in men. This could be the case, but repeated sampling bias could present the same outcome. Whether or not exercise reduces the number of vertebral fractures and other fragility fractures is less often evaluated. Fracture rate seems not to be reduced with cessation of exercise. The evidence that exercise modifies the risk of falling is compelling. Exercise is associated with improved muscle strength, coordination and balance. Exercise increases muscle strength even in octogenarians by 20-200 per cent, but these benefits are lost if activity is reduced. Exercise reduces the risk of falling and perhaps also the number of falls. Whether or not the number of injurious falls is reduced by exercise is even more hotly debated.

Accidental Falls↗
PubMed1999

Reliability and validity of a new device to measure isometric strength in polyarticular exercises.

BACKGROUND: The purpose of this study was to assess the validity of a new device to evaluate isometric strength during multi-joint exercise such as the squat or bench press. METHODS: The device used an electric motor-driven bar to simultaneously generate and measure forces during weight lifting exercises. This new device and a force platform measured the forces generated by either the motor on a fixed telescopic steel girder (passive condition) or a subject pushing vertically against the bar from three squat positions (active condition). In the passive condition, 252 measurements were made, with 3 trials for 6 bar heights and 14 bar loads. In the active condition, 8 young physically active students (age, height and body mass were 25.1 +/- 2.6 years, 179.3 +/- 7.2 cm and 82.0 +/- 9.9 kg, respectively) performed 3 maximal isometric strength (MIS) trials in each of the 3 squat exercise positions (parallel, half and quarter squat), and 3 additional MIS trials in one position randomly assigned two weeks later to test inter-day reliability. RESULTS: In the passive condition, no differences were observed between the forces measured by the force platform and the new device. The coefficient of linear regression (r) and the coefficient of variation (CV) were 1 and below 0.23%, respectively. In the active condition, the peak MIS measured was 2828 N and the values of r and CV were above 0.982 and below 5.96%, respectively. The assessment of inter-day reliability showed an r value of 0.984 and a CV of 3.98%. CONCLUSIONS: This study demonstrated that the new electric motor-driven exerciser provides valid and reliable data when used to generate forces and measure isometric strength throughout the load and motion ranges commonly used in squat exercise.

Adult↗
PubMed2005

Strength training and aerobic exercise training for muscle disease.

BACKGROUND: Strength training or aerobic exercise programmes might maximise muscle and cardiorespiratory function and prevent additional disuse atrophy in patients with muscle disease. However, over-exerting might cause more rapid disease progression. OBJECTIVES: To examine the efficacy and safety of strength training and aerobic exercise training in patients with muscle diseases. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group register (October 2002 and May 2004), the Cochrane Collaboration Rehabilitation and Related Therapies Field register (October 2002), MEDLINE (January 1966 to December 2002), EMBASE (January 1973 to October 2002), and CINAHL (January 1982 to August 2002) for randomised trials. We reviewed the bibliographies of trials identified and reviews covering the subject. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing strength training and/or aerobic exercise programmes lasting at least 10 weeks. Types of outcome measures: FOR STRENGTH TRAINING. Primary: static or dynamic muscle strength. Secondary: muscle strength (endurance or fatigue), functional assessments, quality of life, muscle membrane permeability, pain, and fatigue. FOR AEROBIC EXERCISE TRAINING. Primary: aerobic capacity expressed as work capacity. Secondary: aerobic capacity (oxygen consumption, parameters of cardiac or respiratory function), functional assessments, quality of life, muscle membrane permeability, pain, and fatigue. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted the data. MAIN RESULTS: We identified two randomised trials fulfilling all inclusion criteria. The first trial compared the effect of strength training versus no training in 36 patients with myotonic dystrophy. The other trial compared strength training versus no training combined with albuterol or placebo in 65 patients with facioscapulohumeral muscular dystrophy. Methodological quality and training programmes were graded adequate. In the myotonic dystrophy trial there were no significant differences between training and non-training groups for the primary outcome measure. In the facioscapulohumeral muscular dystrophy trial static muscle strength did not show significant differences between training and non-training groups. Only a +1.2 kg difference (95% confidence interval 0.2 to 2.1) in dynamic strength of elbow flexors in favour of the training group, reached statistical significance. For both trials there were no significant differences between groups for most of the secondary outcome measures, including those covering adverse effects. AUTHORS' CONCLUSIONS: In myotonic dystrophy and facioscapulohumeral muscular dystrophy moderate-intensity strength training appears not to do harm but there is insufficient evidence to establish that it offers benefit. Limitations in the design of studies in other muscle diseases prevent general conclusions in these disorders.

Exercise↗
PubMed2004

Running exercises improve the strength of a partially ruptured Achilles tendon.

OBJECTIVES: To examine the effects of running and swimming exercises on the functional performance and mechanical strength of a recovering Achilles tendon. METHODS: 30 Sprague-Dawley rats had surgical transection of their right medial Achilles tendon. The rats were divided into running (n = 11), swimming (n = 10), and control (n = 9) groups. The running and swimming groups were given daily exercise training, starting from the fifth day after the injury; the control group did not exercise throughout the period of the experiment. An Achilles functional index (AFI) was recorded before the operation and on the third, 10th, and 30th days after the operation. On the 30th day, the rats were killed and their Achilles tendons harvested for biomechanical testing of load relaxation properties, stiffness, and ultimate tensile strength (UTS). The AFI data were analysed by two way analysis of variance; load relaxation, stiffness, and UTS data were analysed by multivariate analysis, with alpha at 0.05. RESULTS: The UTS of the running group was higher than in the control group (p = 0.015), while there was no significant difference between the swimming and control groups (p = 0.228). Differences in stiffness and load relaxation were non-significant (p = 0.823 and 0.633, respectively). The AFI results did not differ among the three groups (p = 0.242). CONCLUSIONS: Running exercises can improve the strength of partially ruptured Achilles tendons at 30 days after injury.

Achilles Tendon↗
PubMed2006

Hormonal responses after a strength endurance resistance exercise protocol in young and elderly males.

This study examined testosterone, cortisol and growth hormone responses in elderly and young men after a strength endurance protocol. Eight elderly (age: 69 +/- 5 yrs) and nine young (age: 23 +/- 1 yrs) males with recreational experience in resistance training performed a strength endurance protocol, which included six exercises. At each exercise, the subjects performed 3 sets of 15 reps at 60 % of 1-RM with a 90 s rest interval between sets. The subjects also participated in a control session. Hormonal and blood lactate concentrations were measured before exercise, immediately after exercise and 15 min after the end of exercise. Blood lactate increased (p<0.05) with resistance exercise in both age groups with the highest increases observed in the young males. Testosterone and cortisol concentrations were higher (p<0.05) immediately and 15 min after exercise as compared to the respective control session values in both young and elderly subjects, whereas no differences were observed between groups (p>0.05). Growth hormone concentration increased (p<0.05) after resistance exercise compared to the control session in both age groups. This increase was higher (p<0.05) in the young as compared to the elderly group. The above results show that a moderate intensity - high repetition resistance exercise protocol for the improvement of strength endurance, seems to be a sufficient stimulus that increases testosterone, growth hormone and cortisol concentrations in elderly males. These hormonal responses may create an optimal metabolic environment, which improves muscular function after a strength endurance program although the elderly subjects present an attenuated growth hormone response compared to younger ones.

Adult↗
PubMed2001

Exercise and eating disorders: a 3-year inpatient hospital record analysis.

The purpose of this study was to describe the exercise behavior across the DSM-IV eating disorder diagnosis (anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS)) and determine if differences exist among exercise category (high level and low level), type of exercise (aerobic, strength, and total), Eating Attitudes Test (EAT), Eating Disorders Inventory (EDI-2), and the length of inpatient hospitalization. This study was a retrospective analysis of 199 inpatient hospital records of female patients (age M=20.6, S.D.=7.03) in the following diagnostic categories: AN (n=115, 58%), BN (n=38, 19%), and EDNOS (n=46, 23%). Patients were also grouped by a median split into low- and high-level exercise categories based on their total amount of weekly exercise. No significant relationship was found between diagnosis and exercise category (high and low) or diagnosis and exercise type (total, aerobic, and strength exercise). This is valuable because exercise specialist may be a worthwhile addition to treatment teams working with all eating disorder diagnostic groups. The high-level exercisers showed significantly greater scores on the EAT [F(2,1,110)=5.117, P<.05] and weight preoccupation [F(1,1010)=4.861, P<.05] than the low-level exercise groups. There were significant relationships between total exercise and EAT (r=.354, P<.01), drive for thinness (r=.262, P<.01), and body dissatisfaction (r=.312, P<.001). Total aerobic exercise was significantly related to EAT (r=.352, P<.001), drive for thinness (r=.272, P<.01), and body dissatisfaction (r=.268, P<.01). Finally, total strength exercise was related to body dissatisfaction (r=.249, P<.05). A significant difference was found among exercise group and length of hospitalization [F(1,155)=14.384, P<.000]. The high-level exercisers were in treatment for 3 weeks longer than their low-level exercisers. A forced stepwise multiple linear regression was calculated to predict the length of hospitalization. At Step 1, diagnosis and Body Mass Index (BMI) on admission explained 27% of the variance in length of inpatient hospitalization [F(4,154)=18.08, P<.004, r(2)=.273]. When two exercise variables were included, aerobic activity explained an additional 5% of variance, whereas strength activity explained an additional 0.3% of the variance. Three-fourths of the predictors explained significant components of the total 32% variance. The present study demonstrates that patients with greater total exercise and a greater total aerobic exercise show a significantly greater drive for thinness and require a longer length of hospitalization. This association was not present with total strength exercise levels. Effective clinical methods to modify total aerobic exercise levels need to be determined with inpatient populations.

Journal Article↗
PubMed2002

[Physical activity can influence the course of early arthritis. Both strength training and aerobic exercise provide pain relief and functional improvement].

There is no causal treatment for osteoarthritis. Instead treatment is aimed at decreasing pain and improving function. The base of osteoarthritis treatment is education and exercise. Exercise, both aerobic exercise and muscular strength training, have positive effects on pain and function. The minimum recommendations of exercise are equivalent to the recommendations of physical activity to obtain or maintain a good general health. Acupuncture is a safe and effective treatment for osteoarthritis pain. However, function is not automatically improved when pain is relieved.

Europe↗
PubMed2007

Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee.

AIM: This paper reports a study of the effects of aquatic exercise on physical fitness (flexibility, strength and aerobic fitness), self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee. BACKGROUND: Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement. Exercise is important for preventing and/or managing the functional limitations associated with joint disease. Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis; however, few studies have examined the effects on people with osteoarthritis, and these have yielded inconsistent results. METHODS: A two-group randomized controlled trial with a convenience sample was used. Participants were recruited from community sources and randomly assigned to a 12-week aquatic programme or a non-exercise control condition. Data for 38 participants were collected at baseline, week 6, and week 12 during 2003 and 2004. Instruments were a standard plastic goniometer, a handheld dynamometer, the 6-minute walk test, the multidimensional Health Assessment Questionnaire, and a visual analogue scale for pain. RESULTS: Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility, strength and aerobic fitness, but had no effect on self-reported physical functioning and pain. The exercise adherence rate was 81.7%, and no exercise-related adverse effect was observed or reported. CONCLUSIONS: Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee. Although the programme may not offer pain relief or self-reported improvements in physical functioning, results suggest that aquatic exercise does not worsen the joint condition or result in injury. Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients.

Activities of Daily Living↗
PubMed1999

Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults.

OBJECTIVE: To determine the effect of frequency of resistive training on gain in muscle strength and neuromuscular performance in healthy older adults. DESIGN: A randomized controlled trial with subjects assigned either to high-intensity resistance training 1 (EX1), 2 (EX2), or 3 (EX3) days per week for 24 weeks or to a control group (CO). SETTING: An exercise facility at an academic medical center. SUBJECTS: Forty-six community-dwelling healthy men (n = 29) and women (n = 17) aged 65 to 79 years. INTERVENTION: Progressive resistance training consisting of three sets of eight exercises targeting major muscle groups of the upper and lower body, at 80% of one-repetition maximum (1-RM) for eight repetitions, either 1, 2, or 3 days per week. MEASURES: Dynamic muscle strength (1-RM) using isotonic equipment every 4 weeks, bone mineral density and body composition by dual energy X-ray absorptiometry (DXA), and neuromuscular performance by timed chair rise and 6-meter backward tandem walk. RESULTS: For each of the eight exercises, muscle strength increased in the exercise groups relative to CO (P < .01), with no difference among EX1, EX2 and EX3 groups at any measurement interval. Percent change averaged 3.9 +/- 2.4 (CO), 37.0 +/- 15.2 (EX1), 41.9 +/- 18.2 (EX2), and 39.7 +/- 9.8 (EX3). The time to rise successfully from the chair 5 times decreased significantly (P < .01) at 24 weeks, whereas improvement in the 6-meter backward tandem walk approached significance (P = .10) in the three exercise groups compared with CO. Changes in chair rise ability were correlated to percent changes in quadriceps strength (r = -0.40, P < .01) and lean mass (r = -0.40, P < .01). CONCLUSIONS: A program of once or twice weekly resistance exercise achieves muscle strength gains similar to 3 days per week training in older adults and is associated with improved neuromuscular performance. Such improvement could potentially reduce the risk of falls and fracture in older adults.

Absorptiometry, Photon↗
PubMed2004

Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up.

OBJECTIVE: To investigate at 5 years whether an initial 2 year home based strength training period imposes sustained effects on muscle strength, bone mineral density (BMD), structural joint damage, and on disease activity in patients with early rheumatoid arthritis (RA). METHODS: Seventy patients were randomised either to perform home based strength training with loads of 50-70% of repetition maximum (EG) or range of motion exercises (CG). Both groups were encouraged to take part in aerobic activities 2-3 times a week. Maximal muscle strength of different muscle groups was measured by dynamometers, and BMD at the femoral neck and lumbar spine by dual x ray densitometry. Disease activity was assessed by the 28 joint disease activity score, and joint damage by x ray findings. RESULTS: 62 patients completed 2 years' training and 59 patients attended check up at 5 years. Mean (SD) maximum muscle strength indices increased from baseline to 2 years-in EG from 212 (78) kg by a mean (95% CI) of 68 (55 to 80) and in CG from 195 (72) kg by 35 (13 to 60) kg-and remained at that level for the next 3 years. Development of BMD in EG tended to be more favourable than that in CG. Muscle strength training was not detrimental to joint structures or disease activity. CONCLUSION: The patients' exercise induced muscle strength gains during a 2 year training period were maintained throughout a subsequent self monitored training period of 3 years. Despite substantial training effects in muscle strength, BMD values remained relatively constant. Radiographic damage remained low even at 5 years.

Adult↗
PubMed2005

The effects of aerobic exercise on endurance, strength, function and self-perception in adolescents with spastic cerebral palsy: a report of three case studies.

PURPOSE: The purpose of this study was to investigate changes in endurance, strength, function, and self-perception before, during, and after aerobic exercise intervention in three ambulatory adolescents with spastic cerebral palsy. METHODS: Three individuals (17-20 years of age) with spastic cerebral palsy participated. An A1B1A2B2 design was employed. Data obtained during the different phases included energy expenditure index (EEI), lower extremity muscle strength using a handheld dynamometer, the Gross Motor Function Measure (GMFM), and the Self-Perception Profile for College Students (SPPCS). RESULTS: All participants had a significant improvement in at least one of the components of the EEI. Combined mean strength of quadriceps, hamstrings, and ankle plantarflexors and dorsiflexors increased bilaterally for all participants. Gross motor function improved for all participants in at least one phase of the study. The self-perception of appearance improved for all participants. CONCLUSIONS: Aerobic exercise may help increase strength of the lower extremity muscles, decrease energy required to ambulate, and improve gross motor function and self-perception for some adolescents with spastic cerebral palsy.

Adolescent↗
PubMed1992

Effect of one-legged exercise on the strength, power and endurance of the contralateral leg. A randomized, controlled study using isometric and concentric isokinetic training.

The purpose of this investigation was to study the effect of one-legged exercise on the strength, power and endurance of the contralateral leg. The performance of the knee extensor and flexor muscle of 20 healthy young adults (10 men and 10 women) was first tested by Cybex II+ and 340 dynamometers. Then 10 subjects were chosen at random to train using one leg three times a week for 7 weeks whilst the other 10 served as controls. During the 8th week, the tests were repeated. Both quadriceps and hamstring muscles of the trained subjects showed a cross-transfer effect from the trained limb to the untrained side. This concerned the strength and power, as well as endurance characteristics of these muscles. The average change in peak torque of the quadriceps muscle was +19% (P less than 0.001) in the trained limb, +11% (P less than 0.01) in the untrained limb and 0% in the control limbs. In hamstring muscles the changes were +14% (P less than 0.01), +5% and -1%, respectively. Concerning muscle endurance (work performed during the last 5 contractions in the 25-repetition test) the corresponding changes were +15% (P less than 0.01), +7% (P less than 0.01), and -1% in quadriceps muscle, and +17% (P less than 0.05), +7%, and -3% in hamstring muscles. The average strength benefit in the untrained limb was +36% (hamstring muscles) and +58% (quadriceps muscle) of that achieved in the trained limb. Untrained hamstring muscle showed better benefits in the endurance parameters than in strength or power parameters, while in the quadriceps muscle this effect was reversed. A positive relationship was observed between the changes (greater improvement in the trained limb resulted in greater improvement in the untrained limb) (hamstring muscles: r = 0.83, P less than 0.001, quadriceps muscle: r = 0.53, P less than 0.001). In endurance parameters, this relationship was almost linear while in the strength and power parameters the results were more in favour of a curvilinear relationship with limited benefit.

Adult↗
PubMed1997

Effect of cryotherapy on muscle soreness and strength following eccentric exercise.

The purpose of this study was to determine whether a post-exercise cryotherapy protocol could facilitate recovery of elbow flexor strength and reduce the severity of delayed onset muscle soreness following eccentric exercise. Eight resistance-trained males (23 +/- 3 yr) performed 64 eccentric elbow flexions with each arm. One arm was subjected to five, 20 minute immersions in a 5 +/- 1 degree C ice-water bath interspersed by 60 minute rest periods. The non-immersed arm served as the control. A main effect for time was observed for all dependent variables (p < 0.05). Isometric torque (mean SE) decreased from a pre-exercise value of 87.9 +/- 4.5 Nm to 65.2 +/- 4.5 Nm immediately post-exercise. Isokinetic torque at 60 and 300 degrees x s(-1) decreased from 71.0 +/- 3.5 NM and 48.4 +/- 2.8 Nm to 55.8 +/- 3.3 Nm and 39.8 +/- 3.1 Nm, respectively. All torque measures returned to pre-test levels by 72 h. Muscle soreness peaked 48 h post-exercise and was evident until 120 h. Limb volume increased by 200 +/- 18 ml immediately post-exercise (p < 0.05) but was not significantly elevated thereafter. No significant difference between the immersed and control arms were observed for any variable. The result suggest that the use of cryotherapy immediately following damaging eccentric exercise may not provide the same therapeutic benefits commonly attributed to cryotherapy following traumatic muscle injury.

Adult↗
PubMed2005

Training with unilateral resistance exercise increases contralateral strength.

Evidence that unilateral training increases contralateral strength is inconsistent, possibly because existing studies have design limitations such as lack of control groups, lack of randomization, and insufficient statistical power. This study sought to determine whether unilateral resistance training increases contralateral strength. Subjects (n = 115) were randomly assigned to a control group or one of the following four training groups that performed supervised elbow flexion contractions: 1) one set at high speed, 2) one set at low speed, 3) three sets at high speed, or 4) three sets at low speed. Training was 3 times/wk for 6 wk with a six- to eight-repetition maximum load. Control subjects attended sessions but did not exercise. Elbow flexor strength was measured with a one-repetition maximum arm curl before and after training. Training with one set at slow speed did not produce an increase in contralateral strength (mean effect of -1% or -0.07 kg; 95% confidence interval: -0.42-0.28 kg; P = 0.68). However, three sets increased strength of the untrained arm by a mean of 7% of initial strength (additional mean effect of 0.41 kg; 95% confidence interval: 0.06-0.75 kg; P = 0.022). There was a tendency for training with fast contractions to produce a greater increase in contralateral strength than slow training (additional mean effect of 5% or 0.31 kg; 95% confidence interval: -0.03-0.66 kg; P = 0.08), but there was no interaction between the number of sets and training speed. We conclude that three sets of unilateral resistance exercise produce small contralateral increases in strength.

Adolescent↗