Management strategies and contributory factors for resistance exercise-induced muscle damage: an exploration of dietary protein, exercise load, and sex

Abstract

The World Health Organisation recommends that resistance exercise be performed at least twice per week to benefit general health and wellbeing. However, resistance exercise is associated with acute muscle damage that potentially can dampen muscle adaptations promoted by chronic resistance training. The extent to which muscle is damaged by exercise is influenced by various factors, including age, training status, exercise type, and – notable to this thesis – sex. To this end, establishing sex-specific management strategies for exercise-induced muscle damage (EIMD) is important to optimise the benefits of exercise. Two EIMD management strategies were focussed on in this thesis: dietary protein supplementation and exercise load manipulation.
It was identified in this thesis that research into the impact both of protein supplementation and exercise load on EIMD heavily underrepresent female populations (chapters 3 and 5), despite well-documented sex differences in EIMD responses. Therefore, future research priority should be placed on bridging the sex data gap by conducting high-quality studies centralising around female-focussed and sex-comparative methodological designs.
Both peri-exercise protein supplementation and exercise load manipulation in favour of lighter loads were revealed to be effective management strategies for resistance EIMD in males through systematic and scoping review of the current literature (chapters 3 and 5, respectively). Due to a lack of data from females, it is only appropriate for these strategies to be recommended for males at present. To decipher whether protein supplementation and lower exercise loads are beneficial for managing EIMD in females, a randomised controlled trial (RCT) (chapter 4) and a protocol for an RCT (chapter 6) involving male and female participants are presented in this thesis.
The incorporation of ecologically-valid resistance exercise in the RCT in chapter 4 highlighted that even mild muscle damage is attenuated in females, reflected in diminished increases in post-exercise creatine kinase concentration and muscle soreness compared with males; however, the reason for this difference requires further investigation. This study, while supporting sex differences, contrasted previous studies, as neither males nor females experienced an attenuation of EIMD during milk protein supplementation. This difference likely owed to the lower severity of muscle damage induced in the current study relative to previous studies, and accordingly, future research should seek to discover alternative management strategies for mild EIMD. A protocol for an RCT examining the impact of exercise load on EIMD in untrained males and females is described in Chapter 6 of this thesis and may be used as guidance for researchers developing similar, sex-comparative studies. It was hypothesised that females will experience attenuated muscle damage relative to males and low-load exercise will induce less muscle damage than high-load exercise in both sexes.
A lack of methodological consistency among EIMD studies was a recurring finding throughout this thesis, which posed an issue when attempting to compare between-study outcomes and reach a consensus. Achieving greater uniformity in study designs by adopting comparable methods relating to EIMD markers and time-points of assessment would help improve understanding of the factors influencing the magnitude of EIMD and effective management strategies. While there are limitations with several EIMD markers – for example the variability of biomarkers and subjectivity of perceptual assessments – once the optimal markers are determined, these should be consistently used moving forward.
Overall, this thesis has contributed to the current body of knowledge by demonstrating that milk protein ingestion is not an effective management strategy for muscle damage following ecologically-valid resistance exercise; therefore, alternative strategies to mitigate mild muscle damage should be investigated. Further, this work supported previous reports of sex differences in EIMD and indicated that the attenuation of EIMD in females relative to males was not attributed to sex differences in body composition; thus, the aetiology of such differences necessitates further exploration by means of high-quality sex comparative research. Finally, this thesis reached the consensus recommendation that lower exercise loads can be utilised to reduce muscle damage in males; nonetheless, supporting evidence for the application of this recommendation to females is required.