Effects of Eccentric Training at Long Muscle Length on Functional Capacities of Elderly Adults (EMULE)

April 23, 2025 updated by: Robin Souron

Effects of Home-Based Eccentric Training at Long Muscle Length on Functional Capacity and Neuromechanical Function in Healthy Older Adults

As aging leads to a decline in muscle function and overall physical performance, interventions targeting muscle strength and neuromechanical properties are critical for maintaining functional independence in older adults. Long-length eccentric training has shown promise in enhancing muscle performance, but its effects in older adults, particularly in a home-based setting, remain underexplored.

The aim of this trial is to assess whether a targeted home-based training intervention incorporating long-length eccentric contractions can enhance functional capacity and neuromechanical properties in healthy older adults. Participants will be semi-randomly allocated to one of two groups: an experimental group incorporating long-length eccentric contractions (Group 1) or a conventional resistance training group (Group 2), with group assignment stratified to ensure an equal number of men and women in each group. Each participant will complete three laboratory-based experimental sessions (i.e., two Pre-training sessions and one Post-training session) , during which five key evaluations will be conducted: (i) the 5-Time Sit to Stand test, serving as the primary outcome measure; (ii) the Timed Up and Go test; (iii) assessments of isometric and dynamic muscle strength in the knee extensors and plantar flexors; (iv) measurements of the cross-sectional areas of the vastus lateralis, rectus femoris, gastrocnemius medialis, and soleus muscles; and (v) evaluation of tendon stiffness.

Following the pre-evaluation, each participant will engage in a 24-session, semi-supervised, home-based training protocol over a period of 8 to 11 weeks. The training program will include eight exercises, with four targeting the upper limbs and four focused on the lower limbs. Group 1 will perform the lower limb exercises at long muscle lengths, while Group 2 will perform the same exercises in a conventional manner (i.e., at neutral or shorter muscle lengths). The total training volume (calculated as repetitions × sets, in arbitrary units) will be matched across both groups, ensuring that any observed differences in outcomes are attributable to the specific training modality rather than differences in workload.

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

Home-based resistance training has emerged as a practical alternative for individuals who lack access to traditional, facility-based exercise programs. This is particularly relevant for older adults, who often face multiple barriers to participating in supervised center-based training-the current gold standard-including reduced mobility, transportation difficulties, and financial constraints. As a result, home-based programs can offer a more accessible option to support engagement in resistance training. Evidence suggests that home-based resistance training can lead to improvements in strength and functional capacity among healthy older individuals; however, these gains tend to be modest. One key limitation is that exercise intensity in home settings may not progress adequately over time, often due to the absence of supervision or limited motivation to increase effort.

Besides training localization and level of supervision, the modality of contraction appears to be of importance. Previous evidences in young but also elderly adults suggest that eccentric training should be performed at long muscle length to obtain the greatest improvements in neuromuscular and physical functions. At the muscle level, the force-length relationship indicates that muscle tension is greater at long vs short muscle length. This is an obvious but important point since mechanical tension during training exercises is a key parameter for muscle plasticity and strength gains. It has been reported positive effects of a short-term (i.e. 3-week) eccentric training performed in a lengthened position on architectural and functional characteristics of the hamstrings in young adults. However, they found no difference between long and short muscle lengths, likely because of the short training duration. It has also been reported significant neuromuscular (e.g. fascicle length, pennation angle, voluntary activation level) and functional (e.g. muscle force) improvements after a 6-week eccentric training at long muscle length in the hamstrings of young adults. Resistance training interventions focusing on eccentric contractions seem particularly interesting for older individuals, as they are less metabolically demanding than concentric contractions for comparable workloads.

Although home-based resistance training programs emphasizing eccentric contractions have been shown to be more effective than those focusing on concentric contractions for improving lower limb strength, mobility, and postural stability in healthy older adults, the integration of eccentric exercises performed at long muscle lengths within home-based protocols has yet to be explored. This represents a significant challenge, as both contraction intensity and muscle length are difficult to monitor and control in real-world, home-based settings compared to tightly controlled laboratory environments.

The aim of this trial is to assess whether a home-based resistance training program incorporating long-length eccentric contractions of the lower limbs can lead to greater improvements in functional capacities and neuromechanical properties in healthy older adults compared to a conventional resistance training program. Participants will be randomly assigned to one of two groups: (i) a control group performing a conventional home-based resistance training program, (ii) an experimental group following the same program, with the addition of specific long-length eccentric contractions integrated into lower limb exercises.

This trial is designed to address two primary research questions:

(i) Does the integration of long-length eccentric contractions enhance the functional benefits of a conventional resistance training program?

(ii) Are any observed functional improvements associated with specific neuromechanical adaptations?

The corresponding hypotheses are:

  1. A home-based resistance training incorporating specific long-length eccentric contractions is more effective to improve functional abilities of healthy old adults.
  2. These greater functional improvements result from specific neuromechanical adaptations.

Thirty healthy older adults will be recruited to participate in the study. Initial screening will be conducted via telephone to assess eligibility based on inclusion and exclusion criteria. If concerns arise during this call-specifically, if the participant answers "yes" to any item from the ICOPE Step 1 questionnaire-they will undergo further evaluation by a geriatrist to confirm eligibility. Written informed consent will be obtained from all participants prior to enrollment. Participants will then be semi-randomly allocated to one of two groups: a conventional resistance training group or an experimental group incorporating long-length eccentric contractions, with group assignment stratified to ensure an equal number of men and women in each group. Each participant will complete three laboratory-based experimental sessions and 24 semi-supervised, home-based training sessions over a period of 8 to 11 weeks.

Three experimental sessions will be conducted in the laboratory at the following time points: (i) four weeks prior to training (Pre1), (ii) one week before training (Pre2), and (iii) within one week following the final training session (Post). The two pre-training sessions (Pre1 and Pre2) will establish baseline values for all outcome measures and allow assessment of natural variability in the absence of an intervention. These baseline variations will be compared between groups to ensure initial comparability and to serve as internal controls.

To evaluate training effectiveness, post-training outcomes will be compared between groups using ANCOVA, with Pre2 values as covariates. This approach will directly address the primary research question: Does the addition of long-length eccentric contractions to a conventional training program enhance functional improvements in older adults?

The sessions will consist of 5 evaluations/tests:

5 Time Sit to Stand test, which is the main outcome Timed Up and Go test Measurements of isometric and dynamic muscle strength of the knee extensors and plantar flexors Measurement of cross-sectional areas of vastus lateralis and rectus femoris, as well as gastrocnemius medialis and soleus muscles Measurement of tendon stiffness

At the end of the second experimental session (Pre2), immediately prior to the start of the training intervention, each participant will complete a familiarization session with a researcher, during which they will be guided through the exercises specific to their assigned group (conventional or long-length eccentric program). This session ensures that participants can perform the exercises safely and correctly at home.

Participants will be provided with a training logbook to document their sessions throughout the intervention. They will also receive all necessary equipment, including a weighted vest and a lifting strap, and for those in the long-length eccentric group, an adjustable step platform. To further support autonomy and adherence, participants will be given instructional materials, including video demonstrations and a printed exercise manual.

The intervention will consist of 24 training sessions over a period of 8 to 11 weeks. Of these, 20 sessions will be performed independently at home, while 4 sessions will take place in the laboratory in small groups, supervised by a qualified adapted physical activity instructor and/or physiotherapist.

To maintain engagement and provide support, a researcher will conduct weekly follow-up phone calls to monitor progress, address any questions, and ensure adherence to the training protocol.

Eight different exercises will be included in the training program of both groups, 4 centered around the upper limbs and 4 for the lower limbs:

biceps curls military press triceps extension rowing heel drop: performed on the floor for the conventional group, and performed on the edge of a step for the other group chair squat drop: performed on the floor for the conventional group, and performed with the feet propped up on a step for the other group band dorsiflexion stair descent

Each training session will start with a warm-up and end with a cool-down consisting of stretching and active mobilization (neck, shoulders, elbows, wrists, hips, knee and ankles). The four lower limbs exercises and two upper limbs exercises will be performed each training session, the lower limbs exercises alternating each session between the four given exercises. The intensity of the exercises will be progressively increased by either modifying the execution of the movement (e.g., adjusting step height to alter muscle length) or adding weights, up to a maximum of 20% of the participant' bodyweight. This progression in intensity will be carefully controlled and managed using the CR10 Rating of Perceived Exertion scale. Training volume (calculated as the number of repetitions × number of sets per exercise, in arbitrary units) will gradually increase throughout the training protocol.

During the protocol, participants will be asked not to alter their usual daily activities.

Study Type

Interventional

Enrollment (Estimated)

30

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • France
      • Nantes, France, 44300
        • MIP Laboratory, Nantes University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Men or women 60 years and older
  • Individuals eligible for social security coverage
  • Individuals without health issues (e.g., musculoskeletal injuries, chronic conditions)
  • Individuals who have given their informed consent

Exclusion Criteria:

  • Accustomed to resistance exercise (i.e., no participation in a resistance training program within the 6 months prior to enrollment, or not engaging in lower-limb resistance training more than once per week as part of their current routine).
  • Pathologies affecting muscle strength in the lower limbs (e.g., neurological or neuromuscular conditions, history of ankle or knee trauma)
  • Individuals residing in a healthcare or social institution
  • Individuals receiving psychiatric care
  • Individuals deprived of their liberty
  • Adults under legal protection (guardianship, curatorship, or legal safeguard)
  • Participation in another ongoing biomedical research study
  • Individuals in an emergency situation
  • Individuals not covered by social security
  • BMI over 30
  • Minimal Mental State Examination (MMSE) score of 25 or lower
  • Significant visual impairment

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Long muscle length eccentric training program

Participants assigned to this arm will complete a home-based training program consisting of 24 sessions, including 20 sessions performed independently at home and 4 sessions conducted in small groups at the laboratory. The laboratory-based sessions will be scheduled in coordination with each participant to ensure regular spacing-approximately one supervised session every five home-based sessions-while accommodating individual availability. Group sizes will be maintained between 2 and 5 participants per session to foster motivation and promote adherence.

The training program will include conventional resistance exercises, with progressive increases in intensity and volume tailored to each participant's capabilities. In this intervention group, four specific exercises targeting the knee extensors and plantar flexors will be performed at long muscle lengths, distinguishing it from Group #2, where these exercises will be performed in a conventional manner (i.e., at neutral or shorter mus
Other: Home-based eccentric training at long muscle length
The training program will include conventional resistance exercises, with progressive increases in intensity and volume tailored to each participant's capabilities. In this condition, specific to the Arm #1, four specific exercises targeting the knee extensors and plantar flexors will be performed at long muscle lengths.
Other Names:
  • Physical training
Active Comparator: Conventional training program

Participants in this arm will follow a home-based resistance training program consisting of 24 sessions, including 20 sessions performed independently at home and 4 sessions conducted in small groups at the laboratory, as previously described. The training will involve conventional resistance exercises, with progressive adjustments in intensity and volume based on each participant's physical capacity and progression.

Note: the total training volume (i.e., number of repetitions × number of sets, in arbitrary units) will be matched between groups, ensuring that any differences in outcomes can be attributed to the specific training modality rather than differences in workload.
Other: Conventional home-based training
The training program will include conventional resistance exercises, with progressive increases in intensity and volume tailored to each participant's capabilities. In this condition, specific to the Arm#2, four specific exercises targeting the knee extensors and plantar flexors will be performed in a conventional manner (i.e., at neutral or shorter muscle lengths).
Other Names:
  • Physical training

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
5 times Sit to Stand
Time Frame: At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session
The subjects will complete five times STS repetitions on a standardized armless chair. After the cue "ready, set, go!", the subjects will start performing STS repetitions as rapidly as possible from the sitting position with their buttocks touching the chair to the full standing position, with their arms crossed over the chest. Verbal encouragement will be given during the test. The STS test will finish when the subjects sit on the chair after the fifth STS repetition, and the time needed to complete the task will be recorded with a stopwatch to the nearest 0.01 s.
At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Isometric and dynamic muscle strength
Time Frame: At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session

Participants will be seated on an isokinetic ergometer with hips at 70° and knees at 80° flexion (0° = full extension). They will perform a warm-up of 5 knee extensions at increasing effort (50-90%). Then, they will perform two isometric and two eccentric maximal voluntary contractions (MVCs) from 0° to 120° of knee flexion at 60°/s.

Next, in a supine position with knee fully extended and ankle neutral (0°), the same warm-up will be performed for plantar flexion, followed by two isometric MVCs. Ankle passive range of motion will be assessed by moving the foot until stretch-related pain occurs; the maximal dorsiflexion angle will define the range limit. The starting position will be set to ensure a constant 60° range. Then, participants will perform two eccentric MVCs across the full ankle range at 30°/s.

Strong verbal encouragement will be given throughout. All measurements will be taken on the right side only.
At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session
Timed Up and Go Test
Time Frame: At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session
Participants will start seated in a chair with their back against the backrest. At the signal, they will stand up, walk 3 meters as quickly and safely as possible, cross the marked line, turn around, walk back to the chair, and sit down. The timer will start when they begin to rise from the chair and stop when they are seated again.
At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session
Cross sectional areas of vastus lateralis (VL), rectus femoris (RF), soleus (SOL) and gastrocnemius medialis (GM) muscles.
Time Frame: At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session

All ultrasound assessments will be conducted by an experienced operator using the Aixplorer Ultimate system (SuperSonic Imagine, France).

For VL and RF muscles, participants will lie supine, knees extended, feet at bed edge, ankles neutral. Femur length will be defined as the distance between the greater trochanter and lateral femoral condyle. Skin will be marked at 30%, 50%, and 70% of this length. In panoramic mode, transverse images will be recorded at each mark, with the probe moving slowly from RF medial to VL lateral border.

For MG and SOL muscles, participants will lie prone in the same foot/knee position. Muscle-tendon junctions and femoral condyles will be located to define muscle length. Skin will be marked at 30%, 50%, and 70% of MG and SOL lengths. Panoramic transverse images will be taken at each mark, with the probe moving from medial to lateral border in a slow, controlled, low-pressure sweep.
At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session
Stiffness of VL and Achilles tendons
Time Frame: At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session

MG and VL myotendinous junctions displacement will be determined during the isometric contractions using B-mode ultrasound. An echo-absorptive marker will be placed on the skin under the probe to act as a fixed reference from which relative measures of displacement will be calculated with a Matlab script.

Achilles and VL tendon force will be calculated from the knee and ankle joint moments measured with the isokinetic ergometer and the respective moment arm length taken from MRI studies.

The tendon force-elongation relationships will be fitted with second-order polynomial functions forced through zero. Tendon stiffness (in N/mm) will be calculated from the slope of a linear fit between 60 and 100 % MVC.
At baseline (i.e., prior to the start of training) and at study completion (i.e., within one week following the final training session
Training metrics
Time Frame: Participants will complete the questions after each training session, resulting in 24 recordings.
Each participant will receive a training booklet in which they will be asked to report information regarding the adherence, feasibility, and acceptability of the training program, with higher score representing better outcomes. Each parameter will be evaluated through a "yes/no" question or a visual analog scale.
Participants will complete the questions after each training session, resulting in 24 recordings.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Robin Souron

Collaborators

Pole Hospitalo-Universitaire de Gérontologie Clinique, CHU de Nantes
Agence nationale de la recherche (ANR)see www.agence-nationale-recherche.fr

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 1, 2025

Primary Completion (Estimated)

September 1, 2026

Study Completion (Estimated)

March 1, 2027

Study Registration Dates

First Submitted

April 16, 2025

First Submitted That Met QC Criteria

April 23, 2025

First Posted (Actual)

May 1, 2025

Study Record Updates

Last Update Posted (Actual)

May 1, 2025

Last Update Submitted That Met QC Criteria

April 23, 2025

Last Verified

April 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • EMULE 24.03657.000456

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The Individual Participant Data (IPD) will be made available to other researchers upon request, under specific conditions. A data-sharing plan will be developed in accordance with the relevant ethical guidelines, ensuring participant confidentiality and data protection. We will collaborate with other researchers interested in neuromechanical adaptations and aging-related functional capacities, sharing anonymized data via a secure platform. Access to the IPD will be granted only to those who meet the criteria for research use and will be subject to institutional review board approval. Our intention is to promote transparency and foster further exploration in this field while respecting participant privacy and the integrity of the data.

We are committed to making the following data available: Study Protocol, Statistical Analysis Plan, Informed Consent Form, and Analytic Code. This will ensure transparency, reproducibility, and facilitate further research in the field

IPD Sharing Time Frame

At the end of study completion.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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