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A Systematic Review Examining the Exercise Parameters Required to Induce the Repeated Bout Effect

Implications for Acute Care Physical Therapists

VanWye, William R.; Goldberg, Melissa D.; Green, Anna E.; Harrold, Timothy J.; Dick, Sonya C.

Journal of Acute Care Physical Therapy : October 2019 - Volume 10 - Issue 4 - p 139–150
doi: 10.1097/JAT.0000000000000105
Review Article
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Background: Acute care physical therapists regularly use therapeutic exercise to target body structures and functions as a supplement to or even replacing activity-based interventions. Interestingly, little is known regarding the mechanism of action explaining how exercise enables future activity and participation. One potential mechanism of action is the repeated bout effect (RBE), which is the phenomenon that a single bout of exercise provides protective adaptations for future exercise/physical activity.

Purpose: To perform a systematic review examining the exercise parameters required to induce the RBE and explore how the results apply to acute care physical therapists.

Data Sources: Academic Search Complete, CINAHL, MasterFILE Premier, MEDLINE, PsycINFO, and SPORTDiscus.

Study Selection: The search included articles appearing before January 1, 2017. The following were the inclusion criteria: human subjects, randomized controlled trial design, published in English, treatment and control group engaged in exercise, lower extremity exercise intervention, and pre- and postintervention creatine kinase blood marker measurement.

Data Extraction and Quality Assessment: Three reviewers extracted data and then assessed the methodological quality of the included articles.

Results: Of the 1780 potential studies, seven were included. The RBE can be induced with exercise that includes an eccentric component, as well as with maximal voluntary isometric contractions at elongated muscle lengths. Concentric-only exercise does not induce the RBE and could instead blunt it. Stretching does not induce the RBE; however, it does not blunt it.

Conclusion: The RBE enhances a person's tolerance for future exercise/physical activity. Consequently, the use of exercise to induce the RBE would be advantageous during initial and subsequent acute care physical therapist interventions. Future research is needed to specifically address the precise dose needed to induce the RBE in middle-aged and older adults, those with acute and chronic diseases, and women of all ages.

William R. VanWye, PT, DPT, CCS Physical Therapy Program, Gannon University, 105 Commercial Center Dr, Ruskin, FL 33573 (USA). vanwye002@gannon.edu.

Melissa D. Goldberg, SPT Department of Physical Therapy, Western Kentucky University, Bowling Green, KY.

Anna E. Green, SPT Department of Physical Therapy, Western Kentucky University, Bowling Green, KY.

Timothy J. Harrold, SPT Department of Physical Therapy, Western Kentucky University, Bowling Green, KY.

Sonya C. Dick, PT, DPT, CWS College of Medicine, University of Kentucky, Bowling Green, KY.

The abstract was accepted to the 2017 APTA Combined Sections Meeting in New Orleans, Louisiana.

The authors have no conflicts of interest and no source of funding to declare.

© 2019 by Lippincott Williams & Wilkins, Inc.
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