What Helps Prevent Muscle Atrophy During Immobilization

Which leg was immobilized?

We see many patients with muscle atrophy on their affected limb. This definitely happens after surgery where whole body or single limb immobilization may be necessary. This leads to decreased muscle size and strength.

What strategies are there to mitigate this? You may be very surpised.

20 male participants (average age 33) took part in this study (Labidi et al, 2024). All were former competitive athletes, primarily in athletics, now working as fitness coaches. 

The participants were split into 2 groups. They had 2 weeks of single lower leg immobilization with a orthopaedic walking boot . They were taught to use crutches and instructed not to weight bear on that leg. This was followed by 2 weeks of supervised rehabilitation before return to sport (RTS). 

The participants underwent 4 weeks of a standardized training program to ensure a common training base before the immobilization procedure. There were 5 sessions (3 resistance, 2 endurance) of training each week. They also received 4 nutritional sessions inclusive of face-to-face consults with a nutritionist and educational videos to standardized daily energy and protein intake throughout training, immobilization and rehabilitation phases.

Picture from SIU Med

The participants then underwent 4 weeks of supervised training. The 1st group had whole body heat therapy (HEAT) while the 2nd group had sham treatment (SHAM) throughout the immobilization and rehabilitation periods.

During the immobilization period, the participants received 11 passive interventions of 60 minutes. The HEAT group sat in a heat chamber at 48 to 50 degree celcius at 50% relative humidity (at 0 m altitude). 

During the rehabilitation period, the participants received 5 active interventions (conditioning) of 60 minutes. The HEAT group performed the sessions in the heat chamber at 35 degrees Celcius and 60 degress relative humidity at 0 m altitude. 

The SHAM group sat in an altitude chamber, set at only 200 m (to create a placebo effect while avoiding any effect of altitude). The temperature was at 24 degree celcius and 40% relative humidity.

Ready for the results? All of the following were measured pre-immobilization, post-immobilization and at RTS. Muscle strength (isometric and isokinetic) were measured. Muscle volume was measured by MRI and ultrasound while muscle biopsies were also obtained. Maximal isometric strength for the calf muscles (plantarflexion) was lower at RTS compared to pre-immobilization in SHAM. 

Isokinetic strength during a fatigue test was higher at RTS compared with pre-immobilization in HEAT but not SHAM. 

Shape of muscle and muscle thickness were lower at post-immobilization compared with pre-immobilization only in SHAM. Cross sectional area of the soleus and the medial, lateral gastrocnemius were decreased in SHAM. Only the medial gastrocnemius was smaller in cross sectional area in HEAT.

The results indicate that using heat therapy during immobilization and rehabilitation reduces muscle atrophy and maintains calf strength in healthy humans. Repeated heat exposures should be considered to counteract muscle atrophy during immobilization.

I'm not sure that it's practical to get in a sauna with a cast on but maybe with a boot or back slab that can be removed temporarily? I would do it if I wanted to return to sport badly enough or maybe if I'm old and wanted to prevent muscle bulk and strength while awaiting healing to happen. For those with with an aversion to heat, definitely no go.

Reference

Labidi M, AlhammoudM, Mtibaa K et al (2024). The Effects Of Heat Therapy During Immobilization And Rehabilitation On Muscle Atrophy And Strength Loss At Return To Sports In Healthy Humans. Orth J Sp Med. 12(10). DOI: 10.1177/23259671241281727

Are Cold Drinks Better When You Exercise?

A question I received from one of our blog's readers is whether one can drink cold water or beverage during exercise? He said that he was advised by friends that he should drink room temperature or even warm water/ beverage after exercise as cold drinks are 'too cooling' for the body.

Well, what does research and science tell us? Exercise authorities such as American College of Sports Medicine (ACSM) and the International Society of Sports Nutrition (ISSN) both recommend water and other hydrating drinks be cold when used during exercise (Kerksick et al, 2018). 

There are a few reasons for their suggestions. Our core temperature rises when we exercise and to keep cool, we lose fluids through sweating. Remember a lot of energy is spent regulating and keeping our temperature down when we exercise. Drinking ice water or ice slushie helps keep our core temperature from rising (Hosseinlou et al, 2013). This also prevents excessive water loss through sweating while exercising.

Moreover, cold drinks are definitely more palatable compared to a warm drink and one tends to drink more when cold drinks are available. A meta-analysis found that subjects consumed 50% more cold (0-10 degrees Celsius) or cool (<22 degrees) beverages than a control group (>22 degrees) during exercise (Burdun et al, 2012).

Researchers also found that drinking cold water improved performances in 49% of participants in the broad jump and 51% of participants in a cycling to exhaustion test (LaFata el, 2012).

I don't know about you, I definitely prefer an ice cold drink during and after exercise. However, if you prefer room temperature or even warm water, don't fret. Drinking whatever appeals to you during and after exercise to get adequate hydration is most important.

References

Burdon CA, Johnson NA, Chapman PG et al (2012). Influence Of Beverage Temperature On Palatability And Fluid Ingestion During Endurance Exercise: A Systematic Review. Int J Sp Nutr Ex Metab. 22(3): 199-211. DOI: 10.1123/ijsnem.22.3.199

Kerksick CM, Wilborn CD, Roberts MD et al (2018). ISSN Exercise & Sports Nutrition Review update: Research & Recommendations. J Int Soc Sp Nutr. 15(1): 38. DOI: 10.1186/s12970-018-0242-y

LaFata D, Carlson- Phillips A, Sims ST et al (2012). The Effect Of A Cold Beverage During An Exercise Session Combining Both Strength And Energy Systems Development Training On Core Temperature And Markers Of Performance. J Int Soc Sp Nutr. 9: 44. DOI: 10.1186/1150-2783-9-44