PURPOSE To compare biceps femoris long-head (BFlh) fascicle lengths (Lfs) obtained with different ultrasound-based approaches: 1) single ultrasound images and linear Lf extrapolation; 2) single ultrasound images and one of two different trigonometric equations (termed equations A and B); and 3) extended field of view (EFOV) ultrasound images. METHODS Thirty-seven elite alpine skiers (21.7±2.8 yrs) without a previous history of hamstring strain injury were tested. Single ultrasound images were collected with a 5 cm linear transducer from BFlh at 50% femur length and were compared with whole muscle scans acquired by EFOV ultrasound. RESULTS The intra-session reliability (ICC3,k = intraclass correlation coefficient) of Lf measurements was very high for both single ultrasound images (i.e., Lf estimated by linear extrapolation; ICC3,k = 0.96-0.99, SEM = 0.18 cm) and EFOV scans (ICC3,k = 0.91-0.98, SEM = 0.19 cm). Although extrapolation methods showed cases of overestimation and underestimation of Lf when compared with EFOV scans, mean Lf measured from EFOV scans (8.07±1.36 cm) was significantly shorter than Lf estimated by trigonometric equations A (9.98±2.12 cm, P<0.01) and B (8.57±1.59 cm, P=0.03), but not significantly different from Lf estimated with manual linear extrapolation (MLE) (8.40±1.68 cm, p=0.13). Bland-Altman analyses revealed mean differences in Lfs obtained from EFOV scans and those estimated from equation A, equation B and MLE of 1.91±2.1 cm, 0.50±1.0 cm and 0.33±1.0 cm, respectively. CONCLUSIONS The typical extrapolation methods used for estimating Lf from single ultrasound images are reliable within the same session, but not accurate for estimating BFlh Lf at rest with a 5-cm FOV. We recommend that EFOV scans are implemented to accurately determine intervention-related Lf changes in BFlh.

Ultrasound (US) imaging has been widely used in both research and clinical settings to evaluate the morphological and mechanical properties of muscle and tendon. In elite sports scenarios, a regular assessment of such properties has great potential, namely for testing the response to training, detecting athletes at higher risks of injury, screening athletes for structural abnormalities related to current or future musculoskeletal complaints, and monitoring their return to sport after a musculoskeletal injury. However, several practical and methodological aspects of US techniques should be considered when applying this technology in the elite sports context. Therefore, this narrative review aims to (1) present the principal US measures and field of applications in the context of elite sports; (2) to discuss, from a methodological perspective, the strengths and shortcomings of US imaging for the assessment of muscle and tendon properties; and (3) to provide future directions for research and application.

Introduction Gene polymorphisms are associated with athletic phenotypes relying on maximal or continued power production and affect the specialization of skeletal muscle composition with endurance or strength training of untrained subjects. We tested whether prominent polymorphisms in genes for angiotensin converting enzyme (ACE), tenascin-C (TNC), and actinin-3 (ACTN3) are associated with the differentiation of cellular hallmarks of muscle metabolism and contraction in high level athletes. Methods Muscle biopsies were collected from m. vastus lateralis of three distinct phenotypes; endurance athletes ( n = 29), power athletes ( n = 17), and untrained non-athletes ( n = 63). Metabolism-, and contraction-related cellular parameters (such as capillary-to-fiber ratio, capillary length density, volume densities of mitochondria and intramyocellular lipid, fiber mean cross sectional area (MCSA) and volume densities of myofibrils) and the volume densities of sarcoplasma were analyzed by quantitative electron microscopy of the biopsies. Gene polymorphisms of ACE (I/D (insertion/deletion), rs1799752), TNC (A/T, rs2104772), and ACTN3 (C/T, rs1815739) were determined using high-resolution melting polymerase chain reaction (HRM-PCR). Genotype distribution was assessed using Chi 2 tests. Genotype and phenotype effects were analyzed by univariate or multivariate analysis of variance and post hoc test of Fisher. P -values below 0.05 were considered statistically significant. Results The athletes demonstrated the specialization of metabolism- and contraction-related cellular parameters. Differences in cellular parameters could be identified for genotypes rs1799752 and rs2104772, and localized post hoc when taking the interaction with the phenotype into account. Between endurance and power athletes these concerned effects on capillary length density for rs1799752 and rs2104772, fiber type distribution and volume densities of myofibrils (rs1799752), and MSCA (rs2104772). Endurance athletes carrying the I-allele of rs1799752 demonstrated 50%-higher volume densities of mitochondria and sarcoplasma, when power athletes that carried only the D-allele showed the highest fiber MCSAs and a lower percentage of slow type muscle fibers. Discussion ACE and tenascin-C gene polymorphisms are associated with differences in cellular aspects of muscle metabolism and contraction in specifically-trained high level athletes. Quantitative differences in muscle fiber type distribution and composition, and capillarization in knee extensor muscle explain, in part, identified associations of the insertion/deletion genotypes of ACE (rs1799752) with endurance- and power-type Sports.

We investigated the validity of panoramic ultrasound (US) compared to magnetic resonance imaging (MRI) for the assessment of hamstrings cross-sectional area (CSA) and volume. Hamstrings CSA were acquired with US (by an expert operator) at four different sites of femur length (FL) in 85 youth competitive alpine skiers (14.8 ± 0.5 years), and successively compared to corresponding scans obtained by MRI, analyzed by a trained vs. a novice rater. The agreement between techniques was assessed by Bland-Altman analyses. Statistical analysis was carried out using Pearson's product moment correlation coefficient (r). US-derived CSA showed a very good agreement compared to MRIbased ones. The best sites were 40% FL (0 = mid patellar point) for biceps femoris long head (r = 0.9), 50% for semitendinosus (r = 0.9), and 30% for semimembranosus (r = 0.86) and biceps femoris short head (BFsh, r = 0.8). US-based vs. MRI-based hamstrings volume showed an r of 0.96. Poorer r values were observed for the novice compared to the trained rater, with the biggest difference observed for BFsh at 50% (r = 0.001 vs. r = 0.50, respectively) and semimembranosus at 60% (r = 0.23 vs. r = 0.42, respectively). Panoramic US provides valid CSA values and volume estimations compared to MRI. To ensure optimal US-vs.-MRI agreement, raters should preferably possess previous experience in imaging-based analyses. The assessment of skeletal muscle size is central within many athletic performance and clinical scenarios. Monitoring changes in muscle size allows to gain more specific insights into the actual status of athletes within their long-term athletic development process or their return-to-sport journeys, when recovering from injuries 1. The most commonly used measures of muscle size are muscle cross-sectional area (CSA) and muscle volume. Muscle CSA has been widely used in research and sport medicine contexts being strongly related to joint torque production in both quadriceps and hamstrings muscle groups 2,3. Furthermore, muscle CSA assessment has been recently shown to be useful in hospital settings for predicting survival and risk of treatment failure 4 as well as for improving the prognosis process when evaluated overtime 5. Similarly, muscle volume is regarded as one of the best predictors of joint torque in humans for both upper and lower limbs of healthy males and sport athletes 6,7. The quantification of muscle CSA and volume is usually obtained by imaging techniques, such as computer tomography (CT) and magnetic resonance imaging (MRI). The latter is recognized as the gold standard for clinical and research imaging, providing accurate estimations of muscle size and involving minimal radiation exposure compared to CT scans 8. However, MRI is not cheap and not always accessible as other imaging techniques 9 , especially in athletic-related settings, when many measures should be acquired over time (and preferably independently of fixed imaging facilities) in order to meticulously monitor the athletic development process or the successfulness of ...

Background Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. Objective We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO 2peak ), peak aerobic power output (P peak ), and parameters of muscle oxygen saturation (SmO 2 ) during exercise, and anaerobic muscle power. Methods We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO 2 . Moreover, the aerobic skeletal muscle power (P peak ) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. Results The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO 2peak (+26% vs −6%), and P peak (+20% vs 0%), and exaggerated muscle deoxygenation during the ramp test (248% vs 49%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (−9% vs +20%) and peak SmO 2 (+...