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Rate of Torque Development Scaling Factor Decreased following a 6-Week Unilateral Isometric Training Using Electrostimulation or Voluntary Contractions

Knezevic, Olivera M.,Šarabon, Nejc,García Ramos, Amador,Majstorović, Nikola,Milanović, Sladjan D.,Filipović, Saša R.,Mirkov, Dragan M.

Abstract

Ministry of Education, Science, and Technological Development of the Republic of Serbia under the contract no. 451-03-68/2022-14/200154 (O.M.K. and D.M.M.) and under the contract no. 451-03-9/2022-14/200015 (S.R.F. and S.D.M.)

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Ci a ion: Kneže i´c, O.M.; Ša abon, N.; Ga cia-Ramos, A.; Majs o o i´c, N.; Milano i´c, S.D.; Filipo i´c, S.R.; Mi ko , D.M. Ra e o To que De elopmen Scaling Fac o Dec eased ollowing a 6-Week Unila e al Isome ic T aining Using Elec os imula ion o Volun a y Con ac ions. Appl. Sci. 2024,14, 6485. h ps://doi.o g/10.3390/ app14156485 Academic Edi o s: Rui Mendes, O lando Fe nandes and Ma ia An ónio Cas o Recei ed: 30 June 2024 Re ised: 19 July 2024 Accep ed: 23 July 2024 Published: 25 July 2024 Copy igh : © 2024 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion (CC BY) license (h ps:// c ea i ecommons.o g/licenses/by/ 4.0/). applied sciences A icle Ra e o To que De elopmen Scaling Fac o Dec eased ollowing a 6-Week Unila e al Isome ic T aining Using Elec os imula ion o Volun a y Con ac ions Oli e a M. Kneže i´c 1,2,* , Nejc Ša abon 3,4,5,6 , Amado Ga cia-Ramos 7,8 , Nikola Majs o o i´c 1, Sladjan D. Milano i´c 2, Saša R. Filipo i´c 2and D agan M. Mi ko 1 1Facul y o Spo and Physical Educa ion, Uni e si y o Belg ade, 11000 Belg ade, Se bia; nikola.majs o o ic@ s .bg.ac. s (N.M.); d agan.mi ko @ s .bg.ac. s (D.M.M.) 2Ins i u e o Medical Resea ch, Uni e si y o Belg ade, Na ional Ins i u e o he Republic o Se bia, 11000 Belg ade, Se bia; [email p o ec ed] (S.D.M.); [email p o ec ed] (S.R.F.) 3Facul y o Heal h Sciences, Uni e si y o P imo ska, 6000 Kope , Slo enia; [email p o ec ed].si 4And ej Ma ušiˇc Ins i u e, Uni e si y o P imo ska, 6000 Kope , Slo enia 5Human Heal h Depa men , InnoRenew CoE, 6310 Izola, Slo enia 6Labo a o y o Mo o Con ol and Mo o Beha io , S2P, Science o P ac ice, L d., 13244 Ljubljana, Slo enia 7Depa men o Physical Educa ion and Spo , Facul y o Spo Sciences, Uni e si y o G anada, 18071 G anada, Spain; amag @ug .es 8Depa men o Spo s Sciences and Physical Condi ioning, Facul y o Educa ion, Uni e sidad Ca ólica de la San ísima Concepción, Concepción 4030136, Chile *Co espondence: oli e a.kneze ic@ s .bg.ac. s Fea u ed Applica ion: Ra e o To que De elopmen Scaling Fac o (RTD-SF) is sensi i e enough o de ec changes ollowing aining p og ams based on elec os imula ion o olun a y con ac ions. Abs ac : This s udy explo ed he changes in he a e o o que de elopmen scaling ac o (RTD-SF) and maximum olun a y isome ic con ac ion (MVC) a iables ollowing six weeks o unila e al isome ic elec omyos imula ion (EMS) and olun a y (VOL) exe cises. Twen y-six physically ac i e pa icipan s we e andomly assigned o EMS (n = 13) o a VOL g oup. MVC and RTD-SF o he quad iceps emo is o bo h legs we e assessed be o e and a e aining. EMS and VOL exe cises had iden ical equency ( h ee sessions/week), in ensi y (60% MVC), olume (40 con ac ions), and wo k- o- es a io (18 min: 6.25 s o wo k/20 s o es ). The e we e no be ween-g oup di e ences o he ained leg wi h o e all inc eases in maximal o que (Tmax) o ~29% (d = 2.11–2.12), ~13% o RTDmax ( d = 0.92–1.10 ); ~23% o In e cep (d = 0.72–0.78), and educ ion in RTD-SF by ~15% ( d = 1.01–1.10 ). In he non- ained leg, signi ican mode a e change was only obse ed a e EMS o RTD-SF which dec eased by 12.5% (d = 0.76). Bo h EMS and VOL aining applied a equi alen wo kloads posi i ely impac on Tmax, RTDmax, and In e cep , bu hey nega i ely a ec he quickness wi h which muscle con ac s ac oss a wide ange o submaximal o ces. Using a mode a e aining in ensi y in egula ly physically ac i e pa icipan s could explain he absence o c oss-educa ion in he VOL g oup. Keywo ds: quad iceps; s eng h; RTD-SF; RFD-SF; EMS 1. In oduc ion When apid isome ic con ac ions o di e en submaximal in ensi ies a e pe o med, a s ong linea ela ionship is obse ed be ween peak o ce/ o que and peak a e o o ce/ o que de elopmen . The slope o his ela ionship, named he a e o o ce de- elopmen scaling ac o (RFD-SF) o a e o o que de elopmen ac o (RTD-SF), has been p oposed as a measu e o neu omuscula quickness o submaximal con ac ions [ 1 , 2 ]. Some claim ha RTD a iables may be mo e e ec i e o e alua e aining- ela ed adap a- ions, o ollow up eco e y om an inju y, o o dis inguish be ween a ious popula ions Appl. Sci. 2024,14, 6485. h ps://doi.o g/10.3390/app14156485 h ps://www.mdpi.com/jou nal/applsci Appl. Sci. 2024,14, 6485 2 o 13 han he maximal o que (Tmax) exe ed du ing maximal olun a y isome ic con ac ion (MVC) [ 3 – 6 ]. Thus i is no su p ising ha he RTD-SF has been la ely pe o med mo e equen ly and epo ed as an indica o o apid o que gene a ion [ 1 , 6 – 8 ]. Since being e i ied as eliable [ 1 , 9 – 11 ], he RTD-SF p o ocol has been used o isome ic neu omuscula assessmen o uppe and lowe limb muscle g oups [ 6 , 7 , 9 , 10 , 12 ], o explo e he e ec s o sex [ 13 ], aging [ 13 , 14 ], a igue [ 15 ], and heal h condi ions such as os eopo osis o mul iple scle osis [ 6 , 8 , 14 ], as well as in s udies explo ing in e -limb asymme ies [ 7 , 11 , 15 ]. In addi- ion, Bellumo i e al. [ 12 ] in es iga ed he e ec s o high-speed cycling on a e-dependen mobili y in ac i e olde adul s. Al hough Jacque e al. [ 16 ] ecen ly s udied he e ec o cogni i e ask-induced men al a igue on hand o ce p oduc ion capaci ies including RTD-SF, he s udy o Bellumo i e al. [ 12 ] emains he only one ha explo ed he sensi i i y o he RTD-SF p o ocol o an exe cise in e en ion. Thus, i would be o in e es o s udy how o he ypes o aining, o example, isome ic, a ec RTD-SF a iables. Knee muscle s eng h is o pa amoun impo ance o daily li e ac i i ies and a hle ic pe o mance. I has been shown ha quad iceps emo is (QF) s eng h has signi ican im- plica ions o all and inju y p e en ion as well as o desi able ou comes o ehabili a ion ollowing inju ies and su gical in e en ions [ 3 , 17 ]. Bo h olun a y isome ic con ac ion (VOL) and elec omyos imula ion (EMS) ha e been used in s eng h aining o imp o ing muscula s eng h [ 18 – 20 ] and/o igh ing de ici s in muscula ac i a ion and o imp o e s eng h (Tmax and RTD) [ 17 , 21 ]. In line wi h he speci ici y o aining e ec s, speci ic iso- me ic s eng h imp o emen s ha e been obse ed [ 22 – 24 ]. Many au ho s ha e a emp ed o de e mine whe he EMS o VOL exe cise p o ides a mo e e icien s imulus o imp o e muscle s eng h [ 22 , 24 – 26 ]. Howe e , he aining e ec s we e g ea ly dependen on ain- ing in ensi y, ype o muscle ac ion, o pa icipan s’ aining his o y. In addi ion o gains in maximum s eng h, esis ance aining can e oke signi ican inc eases in RTD pa icula ly when exe cises a e pe o med wi h in en ion o p oduce apid o que i espec i e o ac ual mo emen speed, while he simila i y be ween aining and es ing mo emen pa e ns e okes he g ea es imp o emen s [ 5 ]. Howe e , inc eases in RTD ha e also been obse ed in s udies using high load esis ance (i.e., s eng h) aining wi hou he in en ion o as mo emen speeds [ 5 , 27 , 28 ]. E en so, s udies ha in es iga ed he in luence o EMS aiming a maximum s eng h de elopmen o apid o que p oduc ion a e sca ce and less clea . In line wi h ha , he e ec s o he s eng h aining modali y on he de elopmen o RTD-SF (i.e., neu omuscula quickness) ha e no been in es iga ed so a . I he e o e emains unclea how s eng h aining ha includes EMS and VOL exe cises a ec s apid s eng h p oduc ion unde isome ic condi ions. Unde ce ain ci cums ances, neu al adap a ion o unila e al aining goes beyond he muscles di ec ly in ol ed in he exe cise and esul s in inc eased olun a y ac i a ion and s eng h gains in he con ala e al homologous muscle, i.e., non- ained limbs [ 29 ]. This c oss-educa ion phenomenon in ol es adap a ions o he cen al ne ous sys em a sup aspinal and spinal le els [ 19 , 29 – 31 ] a he han muscle o mo phological ac o s, and ha is why i is widely u ilized in spo s o clinical ehabili a ion ollowing a unila e al inju y [ 31 – 33 ]. Rega ding he e ec i eness o a ious aining modali ies o induce he c oss-educa ion e ec , G een and Gab iel [ 34 ] concluded ha in young pa icipan s he c oss-educa ion e ec (i.e., gains in he non- ained limb) was simila among isome ic, isokine ic, o isoine ial exe cises and ha EMS esul ed in subs an ially g ea e gains (27% o EMS s. 18% o o he aining modali ies). Howe e , Oakman e al. [ 26 ] and la e Zhou e al. [ 20 ] epo ed simila c oss-educa ion e ec s in he non- ained leg a e EMS and VOL aining. C oss-educa ion e ec s we e obse able e en ollowing an 8-week low-in ensi y aining in e en ion (20% MVC) [ 32 ]. None heless, i is ob ious ha bo h ypes o aining modali ies (VOL and EMS) could esul in signi ican c oss-educa ion, and his is some hing ha is independen o age [ 35 ]. Howe e , conclusions a e mos ly based on gains in Tmax while da a on changes in isome ic RTD a iables a e limi ed. Conside ing he ea lie s a ed impo ance o apid o que p oduc ion, i would be o in e es o explo e po en ial Appl. Sci. 2024,14, 6485 3 o 13 c oss-educa ion changes in he non- ained leg muscle’s capaci ies o quickly gene a e o ques o submaximal and maximal in ensi y ollowing an isome ic exe cise in e en ion. The e o e, his s udy in es iga ed he changes in RTD-SF o quad iceps emo is muscle o he ained and non- ained legs ollowing a 6-week mode a e-in ensi y unila e al isome ic aining p og am using EMS o VOL exe cises. In line wi h a p e ious s udy in es iga ing changes in RTD-SF ollowing an exe cise in e en ion [ 12 ], he planned in e en ion was expec ed o change RTD-SF along wi h Tmax and RTDmax. In addi ion, we hypo hesized ha bo h aining modali ies would esul in a c oss-educa ion e ec on he non- ained leg [20,32]. 2. Ma e ials and Me hods 2.1. S udy Design This s udy is an in e en ional clinical ial wi h ac o ial assignmen ( egis e ed wi hin ClinicalT ials.go , iden i ie : NCT04624438). Fo he sake o simplici y, a p e–pos design wi h wo andom pa allel g oups (bo h expe imen al) was used. Quad iceps emo is (QF) unc ion was assessed by MVC and RTD-SF on h ee occasions: p io o he in e en ion (p e- es ), a e 3 weeks o aining (which se ed as he adjus men o exe cise h eshold; mid- es ), and a e 6 weeks o aining (pos - es ; Figu e 1). Isome ic aining in ol ed ei he elec omyos imula ion (EMS) o he olun a y (VOL) exe cises o QF. One week p io o in e en ion, all subjec s pa icipa ed in one p ac ice session o amilia ize hemsel es wi h s imula ion pa ame e s and aining p o ocols and o de e mine he in ensi y o EMS needed o achie e 60% o MVC. P io o he p e- es , body mass and pe cen o body a we e assessed using a bioelec ic impedance me hod (In Body 720; InBody Co., L d. InBody Bldg, 625, Eonju- o, Gangnam-gu, Seoul, 06106 Ko ea) and body heigh wi h a s anda d s adiome e . A e he p e- es , he pa icipan s we e andomly assigned in o ei he an EMS o VOL g oup. Nei he pa icipan s no e alua o s we e blinded o he in e en ion o he assessmen . Appl. Sci. 2024, 14, x FOR PEER REVIEW 3 o 13 is some hing ha is independen o age [35]. Howe e , conclusions a e mos ly based on gains in Tmax while da a on changes in isome ic RTD a iables a e limi ed. Conside ing he ea lie s a ed impo ance o apid o que p oduc ion, i would be o in e es o explo e po en ial c oss-educa ion changes in he non- ained leg muscle’s capaci ies o quickly gene a e o ques o submaximal and maximal in ensi y ollowing an isome ic exe cise in e en ion. The e o e, his s udy in es iga ed he changes in RTD-SF o quad iceps emo is mus- cle o he ained and non- ained legs ollowing a 6-week mode a e-in ensi y unila e al isome ic aining p og am using EMS o VOL exe cises. In line wi h a p e ious s udy in es iga ing changes in RTD-SF ollowing an exe cise in e en ion [12], he planned in- e en ion was expec ed o change RTD-SF along wi h Tmax and RTDmax. In addi ion, we hypo hesized ha bo h aining modali ies would esul in a c oss-educa ion effec on he non- ained leg [20,32]. 2. Ma e ials and Me hods 2.1. S udy Design This s udy is an in e en ional clinical ial wi h ac o ial assignmen ( egis e ed wi hin ClinicalT ials.go , iden i ie : NCT04624438). Fo he sake o simplici y, a p e–pos design wi h wo andom pa allel g oups (bo h expe imen al) was used. Quad iceps em- o is (QF) unc ion was assessed by MVC and RTD-SF on h ee occasions: p io o he in- e en ion (p e- es ), a e 3 weeks o aining (which se ed as he adjus men o exe cise h eshold; mid- es ), and a e 6 weeks o aining (pos - es ; Figu e 1). Isome ic aining in ol ed ei he elec omyos imula ion (EMS) o he olun a y (VOL) exe cises o QF. One week p io o in e en ion, all subjec s pa icipa ed in one p ac ice session o amilia ize hemsel es wi h s imula ion pa ame e s and aining p o ocols and o de e mine he in- ensi y o EMS needed o achie e 60% o MVC. P io o he p e- es , body mass and pe - cen o body a we e assessed using a bioelec ic impedance me hod (In Body 720; InBody Co., L d. InBody Bldg, 625, Eonju- o, Gangnam-gu, Seoul, 06106 Ko ea) and body heigh wi h a s anda d s adiome e . A e he p e- es , he pa icipan s we e andomly assigned in o ei he an EMS o VOL g oup. Nei he pa icipan s no e alua o s we e blinded o he in e en ion o he assessmen . Bo h g oups o pa icipan s pe o med unila e al isome ic s eng h aining h ee imes pe week o six weeks. T aining densi y and in ensi y we e selec ed in line wi h p e ious ecommenda ions and knowing he limi a ions o EMS [24,25,36]. Pa icipan s we e ad ised o e ain om any ype o esis ance aining a ge ing he leg muscles o he du a ion o he s udy. All sessions we e pe o med a he same ime o he day o each subjec (always be ween 8 a.m. and 2 p.m.) and unde simila en i onmen al condi ions (~22 °C and ~60% humidi y). Figu e 1. An o e iew o he s udy. Bo h g oups o pa icipan s pe o med unila e al isome ic s eng h aining h ee imes pe week o six weeks. T aining densi y and in ensi y we e selec ed in line wi h p e ious ecommenda ions and knowing he limi a ions o EMS [ 24 , 25 , 36 ]. Pa icipan s we e ad ised o e ain om any ype o esis ance aining a ge ing he leg muscles o he du a ion o he s udy. All sessions we e pe o med a he same ime o he day o each subjec (always be ween 8 a.m. and 2 p.m.) and unde simila en i onmen al condi ions (~22 ◦C and ~60% humidi y). Appl. Sci. 2024,14, 6485 4 o 13 2.2. Subjec s The subjec s we e ec ui ed by wo d-o -mou h. Twen y-six physical educa ion s u- den s (14 males and 12 emales) we e andomly assigned o ei he he EMS o VOL g oup (7 males and 6 emales in each g oup; mean ± SD: age: 21 ± 1.5 yea s ( ange: 20–25 yea s); body mass: 75 ± 12 kg, body a : 18.4 ± 5.5%; body heigh : 175 ± 14 cm in EMS g oup, and mean ± SD: age: 21 ± 2.5 yea s ( ange: 20–25 yea s); body mass: 77 ± 12 kg, body a : 16.9 ± 6.1%; body heigh : 177 ± 12 cm in VOL g oup). The e we e no signi ican be ween-g oup di e ences in any o subjec s’ cha ac e is ics be o e and a e he in e en- ion (all p> 0.41). All pa icipan s we e egula ly physically ac i e h ough hei s anda d academic cu iculum ha included 6 o 8 h o physical ac i i y pe week (bo h mode a e and high in ensi y). Besides being physically ac i e, he pa icipan s we e equi ed o be ee o muscle–skele al o neu ological disease o medica ion in ake and o e ain om changing daily ou ines wi h espec o aining and sleeping. All pa icipan s ga e w i en in o med consen ha was in acco dance wi h he Decla a ion o Helsinki and app o ed by he Uni e si y Ins i u ional Re iew Boa d (02-672-2/09-04-2015). 2.3. Tes ing P ocedu es All sessions we e conduc ed on wo kdays and began wi h a s anda dized wa m-up consis ing o s a iona y cycling o 5 min and 5 min o ac i e s e ching. Following he wa m-up, he pa icipan s we e sea ed in a cus om-made chai wi h knee and hip angles ixed a 120 ◦ and 100 ◦ , espec i ely (Figu e 2, uppe le panel). The chai was adjus ed o e e y pa icipan wi h espec o hei body size. The pa icipan ’s unk, wais , and highs we e i mly s apped o he chai and he dis al pa s o hei legs we e a ixed o s ain gauge o ce ansduce s (Dongguan Sou h China Sea Elec onic Co., L d., Dongguan, China; load cell S-Type CZL302; ange 2 kN) using igid cu s. The cu s we e secu ed wi h hook and loop as ene s 2 cm abo e he malleolus la e alis. Appl. Sci. 2024, 14, x FOR PEER REVIEW 4 o 13 Figu e 1. An o e iew o he s udy. 2.2. Subjec s The subjec s we e ec ui ed by wo d-o -mou h. Twen y-six physical educa ion s u- den s (14 males and 12 emales) we e andomly assigned o ei he he EMS o VOL g oup (7 males and 6 emales in each g oup; mean ± SD: age: 21 ± 1.5 yea s ( ange: 20–25 yea s); body mass: 75 ± 12 kg, body a : 18.4 ± 5.5%; body heigh : 175 ± 14 cm in EMS g oup, and mean ± SD: age: 21 ± 2.5 yea s ( ange: 20–25 yea s); body mass: 77 ± 12 kg, body a : 16.9 ± 6.1%; body heigh : 177 ± 12 cm in VOL g oup). The e we e no signi ican be ween-g oup diffe ences in any o subjec s’ cha ac e is ics be o e and a e he in e en ion (all p > 0.41). All pa icipan s we e egula ly physically ac i e h ough hei s anda d academic cu ic- ulum ha included 6 o 8 h o physical ac i i y pe week (bo h mode a e and high in en- si y). Besides being physically ac i e, he pa icipan s we e equi ed o be ee o muscle– skele al o neu ological disease o medica ion in ake and o e ain om changing daily ou ines wi h espec o aining and sleeping. All pa icipan s ga e w i en in o med con- sen ha was in acco dance wi h he Decla a ion o Helsinki and app o ed by he Uni e - si y Ins i u ional Re iew Boa d (02-672-2/09-04-2015). 2.3. Tes ing P ocedu es All sessions we e conduc ed on wo kdays and began wi h a s anda dized wa m-up consis ing o s a iona y cycling o 5 min and 5 min o ac i e s e ching. Following he wa m-up, he pa icipan s we e sea ed in a cus om-made chai wi h knee and hip angles ixed a 120° and 100°, espec i ely (Figu e 2, uppe le panel). The chai was adjus ed o e e y pa icipan wi h espec o hei body size. The pa icipan ’s unk, wais , and highs we e i mly s apped o he chai and he dis al pa s o hei legs we e affixed o s ain gauge o ce ansduce s (Dongguan Sou h China Sea Elec onic Co., L d., Dongguan, China; load cell S-Type CZL302; ange 2 kN) using igid cuffs. The cuffs we e secu ed wi h hook and loop as ene s 2 cm abo e he malleolus la e alis. Figu e 2. Tes ing and aining se -up (uppe le panel; 1: o ce ansduce ; 2: shanks; 3: igid s aps; 4: acquisi ion and analog- o-digi al con e sion uni ; 5: moni o wi h isual eedback). No e ha only ained legs we e affixed o o ce ansduce du ing he aining sessions. Lowe le panel shows posi ioning o EMS elec odes and subjec inc easing he cu en o main ain a ge ed aining in- ensi y. Uppe and lowe igh panels depic aining p ocedu e ac oss weeks and isual eedback gi en du ing he aining sessions ( i s wo con ac ions ou o 40 a e ma ked as “1” and “2”). All es ing p ocedu es we e pe o med sepa a ely o each leg. Maximal olun a y con ac ion (MVC) was always pe o med p io o RTD-SF es ing o de e mine he g ea - es alue o o que du ing he pe o med ask [1]. Pa icipan s we e ins uc ed o ex end Figu e 2. Tes ing and aining se -up (uppe le panel; 1: o ce ansduce ; 2: shanks; 3: igid s aps; 4: acquisi ion and analog- o-digi al con e sion uni ; 5: moni o wi h isual eedback). No e ha only ained legs we e a ixed o o ce ansduce du ing he aining sessions. Lowe le panel shows posi ioning o EMS elec odes and subjec inc easing he cu en o main ain a ge ed aining in ensi y. Uppe and lowe igh panels depic aining p ocedu e ac oss weeks and isual eedback gi en du ing he aining sessions ( i s wo con ac ions ou o 40 a e ma ked as “1” and “2”). All es ing p ocedu es we e pe o med sepa a ely o each leg. Maximal olun a y con ac ion (MVC) was always pe o med p io o RTD-SF es ing o de e mine he g ea es alue o o que du ing he pe o med ask [ 1 ]. Pa icipan s we e ins uc ed o ex end he knee ‘as as and as ha d as possible’ and each maximal con ac ion was sus ained o app oxima ely 3 s [28]. Th ee MVCs we e comple ed o each leg wi h a 60 s es be ween successi e ials [ 3 , 4 ]. The MVC wi h he highes alue o o que (Tmax) o e he h ee Appl. Sci. 2024,14, 6485 5 o 13 consecu i e ials was used o u he analysis as well as o p esc ibe he subsequen submaximal as con ac ions ha we e exp essed as a pe cen age o Tmax. Following a 5 min es , he RTD-SF es ing p o ocol was conduc ed. Subjec s comple ed ~15 submaximal apid con ac ions o amilia iza ion pu poses. They we e ins uc ed o con ac hei QF muscle as quickly as possible and o elax ins an ly. Th ee se s o ≥ 20 con ac ions we e comple ed o expe imen al pu poses. In each se , he e we e 5 consecu i e con ac ions a 4 di e en in ensi ies p esen ed in ascending o de (20%, 40%, 60%, 80% o Tmax, i.e., MVC) [ 7 , 8 ]. The es ime be ween he se s was 60 s [ 1 ]. The expe imen e ga e a oice command o pe o m a new ial e e y 4–5 s. Visual eedback o o que as a a ge line was p o ided o he subjec s on a compu e moni o , bu subjec s we e ad ised no o pay a en ion o accu acy. Da a we e collec ed and sampled a 1000 Hz using he comme cially a ailable so - wa e Isome ics ( e sion 4.0.0, ‘Spo s Medical Solu ions’, Belg ade, Se bia). Signals we e il e ed wi h a low-pass (5 Hz), second-o de Bu e wo h il e . The so wa e au oma ically calcula ed he Tmax (peak alue on he o que– ime ace a e eaching he pla eau) and RTDmax (peak o i s de i a i e o he o que– ime signal o e lapping 0.1 s in e als). The peak o que and peak RTD om he isome ic o que pulses we e also au oma ically calcula ed as he maximal alue du ing he 1 s in e al o each epe i ion and as a maximum o he i s de i a i e o he o que– ime cu e, espec i ely. Each eco ding was inspec ed o ensu e ha no coun e mo emen was p esen as his would in luence RFD. Peak o que and peak RTD we e exp essed as a pe cen age o Tmax and plo ed o ob ain a eg ession line (slope and in e cep ) and R 2 alues o each pa icipan , espec i ely. The slope o he eg ession line p o ides he RTD-SF ( o mo e de ails, please see Figu e 2). The R2 ep esen s consis ency in he pe o mance apid muscula con ac ions [1,12]. 2.4. T aining P ocedu es The aining p ocedu es we e applied unila e ally o e he QF wi h lowe MVC o que a he p e- es , ega dless o leg dominance. As a no e, he e was a signi ican be ween-leg di e ence in Tmax in bo h g oups (10 ± 7%; p< 0.01 in EMS, and 12.5 ± 5%; p< 0.01 in VOL g oup). Pa icipan s’ posi ioning du ing aining sessions was iden ical o ha du ing es ing p ocedu es. The pa icipan ’s unk, wais , and highs we e i mly s apped o he chai wi h knee and hip angles ixed a 120 ◦ and 100 ◦ , espec i ely. The dis al pa o he ained leg was a ixed o a s ain gauge o ce ansduce (Figu e 2, uppe le panel). Each EMS and VOL aining session consis ed o 40 con ac ions each las ing 6.25 s and sepa a ed by 20 s in e -con ac ion in e als. The numbe o con ac ions and con ac ion- o- es a io (6.25/20 s) we e in acco dance wi h he wo k- o- es pa e n p oduced by he muscle s imula ion de ice (Figu es 1and 2—uppe and lowe igh panels). The s imula ion in ensi y was de e mined du ing he amilia iza ion when EMS was deli e ed a he indi idually maximal ole able dose and was kep close o iden ical among he session, a e aging in o al ~60% MVC pe subjec [ 24 ]. Speci ically, EMS in ensi y a ied be ween 58% and 63% ac oss sessions and subjec s, depending on hei daily pain ole ance. Due o an icipa ed posi i e exe cise e ec s on Tmax, pa icipan s we e e- es ed a e he hi d week o in e en ion (mid- es ), and hese da a se ed o adjus he exe cise h eshold (please see Figu e 2, uppe igh panel). The subjec s we e ins uc ed o s ay elaxed du ing EMS sessions, hus s imula ion was no supe imposed on o olun a y con ac ions. A po able ba e y-powe ed comme cially a ailable s imula o (Compex SP2.0, Medicompex SA, Ecublens, Swi ze land) was used in he EMS g oup. The mo o poin s we e iden i ied by s imula ing he skin su ace wi h a pen elec ode and a la ge e e ence elec ode placed o e he skin. S imula o y cu en was g adually inc eased un il a clea muscle wi ch was obse ed. The posi ions o he mo o poin s we e ma ked wi h wa e - esis an ma ke s, so he elec odes we e applied a he same si es h oughou he in e en ion pe iod. The posi i e elec odes, measu ing 25 cm 2 (5 cm × 5 cm), which had memb ane-depola izing p ope ies, we e placed as close as possible o mo o poin s o as us medialis and as us la e alis muscles. The nega i e Appl. Sci. 2024,14, 6485 6 o 13 elec ode, measu ing 50 cm 2 (10 cm × 5 cm), was placed nea he p oximal inse ion o ec us emo is muscle. The s imula o discha ged biphasic ec angula pulses las ing 400 µ s. The s imula ion equency and du y cycle we e 75 Hz and 6.25 s o s imula ion ollowed by a pause las ing 20 s (du y cycle, 24%) [ 25 , 37 ]. The selec ed s imula ion pa ame e s co espond o a maximum s eng h de elopmen p og am. The s imula ion in ensi y was moni o ed on-line and de e mined by he subjec a he s a o each EMS session acco ding o hei pain h eshold and o p oduce a o que co esponding o a leas 60% o he p e- es Tmax sco e [24]. Rega ding he VOL g oup, pa icipan s we e equi ed o each he p esc ibed o que le el only h ough olun a y ac i a ion o QF. To a ain he same numbe o con ac ions and con ac ion- o- es a io as in EMS, au oma ed audible signals we e deli e ed in acco dance wi h he con ac ion– es pa e n p oduced by he muscle s imula ion de ice. Depending on he ype o exe cise, he subjec s we e asked o inc ease he cu en (please see Figu e 2, lowe le panel) o olun a y ac i a ion in ensi y h oughou he ain- ing session o main ain a ge o que le el o ~60% MVC. The exe ed o que du ing each con ac ion was measu ed wi h he same o ce ansduce and so wa e as desc ibed o es ing p ocedu es, and eal- ime eedback along wi h he indi idual 60% MVC h eshold was p o ided on a compu e sc een. All aining sessions we e supe ised by a leas one o he esea che s who conduc ed he expe imen . 2.5. S a is ical Analyses P io o s a is ical analyses, Tmax and RTDmax da a we e no malized wi h pa ici- pan s’ indi idual body mass. No mali y o he dependen a iables was con i med using a Shapi o–Wilk es (p> 0.05). Desc ip i e s a is ics (mean and s anda d de ia ion) we e calcula ed o all a iables (Tmax, RTDmax, RTD-SF, and In e cep ). A 2 × 2 analysis o a iance (ANOVA) wi h ime (p e- es and pos - es ) as wi hin-subjec ac o and g oup (EMS and VOL) as be ween-subjec ac o was applied o each dependen a iable sepa- a ely o he ained and non- ained leg, ollowed by he Bon e oni pos hoc es . The Cohen’s e ec size (d) was used o quan i y he wi hin-g oup di e ences as d < 0.2 ( i ial o no e ec ), d = 0.2–0.5 (small), d = 0.5–0.8 (mode a e), d = 0.8–1.3 (la ge), and d > 1.3 ( e y la ge). Cohen’s d e ec size (ES) and 90% con idence in e al (CI) we e compu ed using he ha monic mean o he SD o he compa ed condi ions and an ES o 0.20 was conside ed as he minimal alue o p ac ical impo ance. When he 90% CI o e lapped subs an ial posi i e and nega i e alues, he e ec was deemed unclea ; o he wise, e ec s we e deemed clea [ 38 ]. p- alues < 0.05 we e conside ed s a is ically signi ican . The mag- ni ude compa ison analysis was pe o med using a cus om Excel sp eadshee (a ailable om: h ps://www.spo sci.o g/jou /03/wgh ials.h m, accessed on 18 Sep embe 2023), while o he s a is ical analyses we e pe o med using he so wa e package SPSS (IBM SPSS e sion 20.0, Chicago, IL, USA). 3. Resul s Consis ency in he pe o mance o apid muscula con ac ions ep esen ed by he coe icien o de e mina ion o he RTD-SF eg ession line emained high, om p e- es o pos - es (median R 2 = 0.951, ange 0.936–0.959). Figu e 3depic s he ela ionship o peak o que ela i e o Tmax and he espec i e peak RTD (%Tmax) o ained and non- ained legs in EMS and VOL g oups, espec i ely. Table 1depic s he changes in he dependen a iables om p e- es and pos - es . Rega ding he ained leg, ANOVA e ealed signi ican main e ec o ime o all dependen a iables, wi h gene ally la ge e ec sizes obse ed bo h wi hin EMS and VOL g oups (0.78–2.2). The la ges change was obse ed o Tmax (29%), ollowed by RTDmax (~13%), RTD-SF (~ − 15%), and In e cep . The main e ec o g oup ac o and in e ac ion o ac o s we e no signi ican , indica ing ha EMS and VOL exe cises induced simila changes o e a six-week pe iod, as suppo ed by he analysis o he s anda dized di e ences (Figu e 3; lowe panel), since he ES always anged om −0.20 o 0.20 (i.e., i ial di e ences). Appl. Sci. 2024,14, 6485 7 o 13 Appl. Sci. 2024, 14, x FOR PEER REVIEW 7 o 13 Figu e 3. P e- es and pos - es g oup ela ionships be ween peak o ce ela i e o Tmax and he espec i e peak RTD (%Tmax/s) o EMS and VOL, as well as o ained and non- ained leg, e- spec i ely. Table 1 depic s he changes in he dependen a iables om p e- es and pos - es . Rega ding he ained leg, ANOVA e ealed signi ican main effec o ime o all depend- en a iables, wi h gene ally la ge effec sizes obse ed bo h wi hin EMS and VOL g oups (0.78–2.2). The la ges change was obse ed o Tmax (29%), ollowed by RTDmax (~13%), RTD-SF (~−15%), and In e cep . The main effec o g oup ac o and in e ac ion o ac o s we e no signi ican , indica ing ha EMS and VOL exe cises induced simila changes o e a six-week pe iod, as suppo ed by he analysis o he s anda dized diffe ences (Figu e 3; lowe panel), since he ES always anged om −0.20 o 0.20 (i.e., i ial diffe ences). Table 1. Desc ip i e da a o dependen a iables shown as mean ± s anda d de ia ion. Mean ela- i e changes be ween p e- es and pos - es (% change) a e gi en as aw alues. Wi hin-g oup effec size is p esen ed wi h Cohen’s d. EMS VOL ANOVA P e-Tes Pos -Tes % Change Cohen’s d P e-Tes Pos -Tes % Change Cohen’s d F-Value Time F-Value G oup F-Value Time × G oup T ained leg Tmax (Nm/kg) 15.7 ± 2 20.2 ± 3.5 29.3 2.12 16.6 ± 2.2 21.4 ± 3.4 28.8 2.11 82.0 ** 0.9 0.0 RTD (Nm/kg/s) 83 ± 13 93 ± 17 12.3 0.92 85 ± 18 97 ± 15 16.6 1.10 16.4 ** 0.1 0.2 RTD-SF 6.0 ± 0.6 5.1 ± 0.7 −14.6 1.10 5.9 ± 0.8 5.0 ± 0.6 −14.9 1.01 25.1 ** 0.1 0.0 In e cep 0.9 ± 0.18 1.07 ± 0.21 22.5 0.78 0.86 ± 0.29 1.08 ± 0.17 24.9 0.72 12.5 ** 0.0 0.1 Non- ained leg Tmax (Nm/kg) 17 ± 1.9 19 ± 3.6 11.9 0.76 19.2 ± 2.8 19.4 ± 2.9 2.2 0.20 3.28 1.4 2.1 RTD (Nm/kg/s) 87 ± 16 89 ± 20 2 0.34 96 ± 18 94 ± 18 −0.6 0.01 0.04 0.9 0.4 RTD-SF 5.9 ± 0.6 5.1 ± 0.5 † −12.6 0.76 5.5 ± 0.6 5.4 ± 0.7 −0.1 0.20 6.35 * 0.0 5.5 * In e cep 0.94 ± 0.25 1.10 ± 0.17 16.6 0.60 1.02 ± 0.17 0.99 ± 0.24 −2.2 0.25 1.13 0.0 2.7 * Main effec o ac o in e ac ion signi ican a p < 0.05; ** main effec o ac o in e ac ion signi ican a p < 0.01; † pos hoc signi ican a p < 0.01. Fo he non- ained leg (Table 1), ime ac o and g oup× ime in e ac ion we e signi - ican only o RTD-SF, whe eas a subsequen pos hoc es e ealed ha signi ican change was obse ed only wi hin EMS g oup. Howe e , no e ha al hough diffe ences be ween aining modali ies eached signi icance only o RTD-SF, Figu e 4 (uppe panel) indica es ha diffe ences o RTD-SF, In e cep , and Tmax a e subs an ially g ea e o he EMS han VOL g oup (ES < −0.20). This is also suppo ed by mode a e wi hin-g oup effec sizes (0.60–0.76), whe eas Cohen’s d was i ial ac oss he VOL g oup. Figu e 3. P e- es and pos - es g oup ela ionships be ween peak o ce ela i e o Tmax and he espec i e peak RTD (%Tmax/s) o EMS and VOL, as well as o ained and non- ained leg, espec i ely. Table 1. Desc ip i e da a o dependen a iables shown as mean ± s anda d de ia ion. Mean ela i e changes be ween p e- es and pos - es (% change) a e gi en as aw alues. Wi hin-g oup e ec size is p esen ed wi h Cohen’s d. EMS VOL ANOVA P e-Tes Pos -Tes % Change Cohen’s dP e-Tes Pos -Tes % Change Cohen’s dF-Value Time F-Value G oup F-Value Time × G oup T ained leg Tmax (Nm/kg) 15.7 ±2 20.2 ±3.5 29.3 2.12 16.6 ±2.2 21.4 ±3.4 28.8 2.11 82.0 ** 0.9 0.0 RTD (Nm/kg/s) 83 ±13 93 ±17 12.3 0.92 85 ±18 97 ±15 16.6 1.10 16.4 ** 0.1 0.2 RTD-SF 6.0 ±0.6 5.1 ±0.7 −14.6 1.10 5.9 ±0.8 5.0 ±0.6 −14.9 1.01 25.1 ** 0.1 0.0 In e cep 0.9 ±0.18 1.07 ±0.21 22.5 0.78 0.86 ±0.29 1.08 ±0.17 24.9 0.72 12.5 ** 0.0 0.1 Non- ained leg Tmax (Nm/kg) 17 ±1.9 19 ±3.6 11.9 0.76 19.2 ±2.8 19.4 ±2.9 2.2 0.20 3.28 1.4 2.1 RTD (Nm/kg/s) 87 ±16 89 ±20 2 0.34 96 ±18 94 ±18 −0.6 0.01 0.04 0.9 0.4 RTD-SF 5.9 ±0.6 5.1 ±0.5 †−12.6 0.76 5.5 ±0.6 5.4 ±0.7 −0.1 0.20 6.35 * 0.0 5.5 * In e cep 0.94 ±0.25 1.10 ±0.17 16.6 0.60 1.02 ±0.17 0.99 ±0.24 −2.2 0.25 1.13 0.0 2.7 * Main e ec o ac o in e ac ion signi ican a p< 0.05; ** main e ec o ac o in e ac ion signi ican a p< 0.01; †pos hoc signi ican a p< 0.01. Fo he non- ained leg (Table 1), ime ac o and g oup × ime in e ac ion we e signi i- can only o RTD-SF, whe eas a subsequen pos hoc es e ealed ha signi ican change was obse ed only wi hin EMS g oup. Howe e , no e ha al hough di e ences be ween aining modali ies eached signi icance only o RTD-SF, Figu e 4(uppe panel) indica es ha di e ences o RTD-SF, In e cep , and Tmax a e subs an ially g ea e o he EMS han VOL g oup (ES < − 0.20). This is also suppo ed by mode a e wi hin-g oup e ec sizes (0.60–0.76), whe eas Cohen’s d was i ial ac oss he VOL g oup. Appl. Sci. 2024,14, 6485 8 o 13 Appl. Sci. 2024, 14, x FOR PEER REVIEW 8 o 13 Figu e 4. S anda dized mean diffe ences (90% con idence in e als) o all dependen a iables be- ween he EMS and VOL g oup (ES = EMS mean - VOL mean/SD bo h). The shaded a ea ep esen s a i ial diffe ence (ES om -0.20 o 0.20). Tmax—maximum o que; RTDmax—maximum a e o o que de elopmen ; RTD-SF— a e o o que de elopmen scaling ac o . 4. Discussion The aim o his s udy was o in es iga e he changes in he quad iceps emo is muscle a e o o que de elopmen scaling ac o (RTD-SF) ollowing unila e al isome ic ain- ing. The aining in e en ion included ei he elec os imula ion o olun a y exe cises (EMS and VOL, espec i ely). The main indings ega ding ou i s hypo hesis a e as ol- lows: (1) bo h in e en ions induced simila dec emen s in RTD-SF (app oxima ely 15%); (2) In e cep was inc eased ollowing bo h aining modali ies (22 and 17% o EMS and VOL, espec i ely) bu due o he high a iabili y he change was signi ican only ollow- ing EMS; (3) bo h in e en ions inc eased Tmax by ~30%; and (4) compa able inc emen s, al hough o lowe magni ude (14%), we e obse ed o RTDmax. Ou second hypo hesis was no con i med because he c oss-educa ion effec o he non- ained leg was obse ed only o he EMS g oup. As was hypo hesized, he applied aining in e en ions had a signi ican effec on he RTD-SF. In ac , o ou su p ise, bo h EMS and VOL induced a dec ease in RTD-SF, which could be pa ly explained by a highe ela i e inc ease in Tmax han in RTDmax. Al hough p e ious s udies e ealed ha he RTD-SF p o ocol could be used o disc imi- na e be ween pa icipan s o diffe en ages [14], sexes [13], a igue o physical ac i i y le els [11,15], o in e -limb asymme ies [7,39], cu en ly no published da a a e a ailable ega ding how s eng h aining in e en ions affec he RTD-SF. The s udy ha in es i- ga ed changes in RTD-SF ollowing exe cise in e en ion was conduc ed on ac i e olde adul s and i in ol ed a 6-week high-in ensi y in e al cycling in e en ion [12]. Hence, Figu e 4. S anda dized mean di e ences (90% con idence in e als) o all dependen a iables be ween he EMS and VOL g oup (ES = EMS mean - VOL mean/SD bo h). The shaded a ea ep esen s a i ial di e ence (ES om -0.20 o 0.20). Tmax—maximum o que; RTDmax—maximum a e o o que de elopmen ; RTD-SF— a e o o que de elopmen scaling ac o . 4. Discussion The aim o his s udy was o in es iga e he changes in he quad iceps emo is muscle a e o o que de elopmen scaling ac o (RTD-SF) ollowing unila e al isome ic ain- ing. The aining in e en ion included ei he elec os imula ion o olun a y exe cises (EMS and VOL, espec i ely). The main indings ega ding ou i s hypo hesis a e as ollows: (1) bo h in e en ions induced simila dec emen s in RTD-SF (app oxima ely 15%); (2) In e cep was inc eased ollowing bo h aining modali ies (22 and 17% o EMS and VOL, espec i ely) bu due o he high a iabili y he change was signi ican only ollowing EMS; (3) bo h in e en ions inc eased Tmax by ~30%; and (4) compa able inc emen s, al hough o lowe magni ude (14%), we e obse ed o RTDmax. Ou second hypo hesis was no con i med because he c oss-educa ion e ec o he non- ained leg was obse ed only o he EMS g oup. As was hypo hesized, he applied aining in e en ions had a signi ican e ec on he RTD-SF. In ac , o ou su p ise, bo h EMS and VOL induced a dec ease in RTD-SF, which could be pa ly explained by a highe ela i e inc ease in Tmax han in RTDmax. Al hough p e ious s udies e ealed ha he RTD-SF p o ocol could be used o disc imina e be ween pa icipan s o di e en ages [ 14 ], sexes [ 13 ], a igue o physical ac i i y le els [ 11 , 15 ], o in e -limb asymme ies [ 7 , 39 ], cu en ly no published da a a e a ailable ega ding how s eng h aining in e en ions a ec he RTD-SF. The s udy ha in es iga ed changes in RTD-SF ollowing exe cise in e en ion was conduc ed on ac i e olde adul s and i in ol ed a 6-week high-in ensi y in e al cycling in e en ion [ 12 ]. Hence, he au ho s epo ed a 34% imp o emen in RTD-SF (i.e., a highe slope) o QF in he exe cise g oup Appl. Sci. 2024,14, 6485 9 o 13 bu no in con ols. This is no su p ising since obus imp o emen s in explosi e capaci ies a e expec ed ollowing bo h high- and low-speed dynamic exe cises and ballis ic isome ic exe cises pe o med agains lowe load (e.g., <60% o maximum o que) and wi h he in en o apid o que p oduc ion [ 5 ]. In he cu en s udy, i seems ha apid o que gene a ion was una ec ed by aining in e en ion o in ensi ies < 50% MVC (Figu e 2). Howe e , a isible dec ease in apid p oduc ion can be obse ed o highe in ensi ies (50–80% MVC) ha we suspec esul ed in lowe RTD-SF when compa ed o p e- es alues. Conside ing ha isome ic exe cises used in his s udy we e no as ballis ic as in he RFD-SF assessmen p o ocol, he applied aining modali ies had a signi ican nega i e impac on neu omuscula quickness assessed h ough RTD-SF. This inding could be o impo ance o esea che s in es iga ing muscle unc ion and o coaches wo king wi h speed- ained a hle es who may conside using mode a e-in ensi y isome ic con ac ions in hei aining o ehabili a ion ou ines as well. In e cep is he a iable ha has mos ly s ayed un epo ed o no discussed as i was conside ed o p o ide no addi ional in o ma ion [ 1 , 2 , 6 , 12 ]. A s udy ha in es iga ed how cogni i e a igue a ec s RFD-SF p esen ed a ely epo ed esul s on In e cep ha emained una ec ed [ 16 ]. Kozinc e al. [ 2 ] specula ed ha a highe In e cep oge he wi h he same RFD-SF could indica e supe io quickness ac oss he ange o con ac ion in ensi ies, which is only pa ly he case in ou s udy since In e cep inc eased while he slope, i.e., RFD-SF, declined. Ne e heless, mo e s udies a e needed o answe he ques ion on he physiological and po en ially clinical ele ance o he In e cep . Rega ding maximal s eng h and RTD gains, i should be no ed ha he le el o he elec ically e oked o que achie ed in his s udy anged be ween 58% and 63% MVC ( he a e age in ensi y ac oss pa icipan s was 60% MVC). The in ensi y was selec ed ollowing p e ious ecommenda ions and knowing he limi a ions o EMS [ 24 , 25 , 36 ]. Speci ically, o p omo e s eng h gains, EMS was p e iously mos commonly applied a in ensi ies o ~60% MVC [ 24 ]. To ensu e a compa able aining olume be ween he wo aining modali ies we ma ched he con ac ion in ensi y and du a ion o he EMS and VOL g oups. Al hough highe olun a y exe cise loads a e ecommended o p omo e muscle hype ophy and s eng h gains [ 40 ], signi ican s eng h gains could be achie ed e en when using medium loads (50–60% MVC) [ 25 , 41 – 44 ]. In ac , Sze o e al. [ 44 ] demons a ed a 31% inc ease in MVC ollowing isome ic VOL aining a 50% MVC, while Filipo ic e al. [ 24 ] epo ed gains in maximum s eng h o 32.6 ± 17.6% in ained subjec s and o 32 ± 15.6% in eli e a hle es ollowing isome ic EMS. None heless, he esul s ob ained in he cu en s udy a e in line wi h hose epo ed p e iously [ 24 , 25 , 42 – 44 ] and show no subs an ial di e ence in MVC o que gains be ween VOL and EMS aining modali ies. While MVC Tmax was among he mos in es iga ed a iables in EMS s udies [23,24] , changes in RTDmax ha e been sca cely epo ed. Fo example, Speiche e al. [ 45 ] demon- s a ed signi ican inc eases o up o 16% in he QF muscle du ing he ea ly ime sec ions o RTD (100–200 ms om he con ac ion onse ) bu no in maximal RTD a e dynamic whole-body combina ion EMS aining [ 24 ]. Tha is no su p ising since i is well known ha pe o ming isome ic exe cises in a ballis ic manne can maximize he imp o emen o RTD [ 40 ]. Ne e heless, as shown in he cu en s udy, an inc ease in RTD max (15% o bo h aining modali ies) is wa an ed e en when isome ic exe cises a e pe o med on a single muscle g oup and in a non-ballis ic manne . Ou second hypo hesis and ou inal indings conce n he c oss-educa ion o he non- ained leg. A signi ican change in RTD-SF o he non- ained leg was ob ained only ollowing EMS aining, sugges ing po en ial cen al adap a ions. Mode a e, non- signi ican change was also obse ed o he In e cep . Al hough he c oss-educa ion e ec is well desc ibed in he li e a u e [ 18 , 19 , 26 , 32 ], his is he i s s udy o in es iga e his phenomenon conce ning RTD-SF and s eng h aining. In he a o emen ioned s udy o Bellumo i e al. [ 12 ], he au ho s epo ed ha hei lowe limb speed-cycling aining p og am had a posi i e c oss-educa ion e ec on RFD-SF o non- ained uppe limbs. Those who compa ed he e ec s o olun a y and s imula ed isome ic exe cises on he