Profiles in excellence.

Paul LaStayo, PT, PhD, CHT, Associate Professor, University of Utah, is an example of a Foundation recipient who has made the most of his Foundation funding. LaStayo has turned his $15,000, 1999 PODS II scholarship and $30,000, 2000 NIFTI fellowship into an NIH R21 exploratory/developmental research grant, eight published manuscripts in five different peer-reviewed journals, several abstracts, and national/international invited presentations. A recent editorial (Hortobagyi T. The positives of negatives: clinical implications of eccentric resistance exercise in old adults. J Gerontol A Biol Sci Med Sci. 2003;58:M417-M418), stated that the results of the research by LaStayo and his colleagues should encourage geriatrics practices and geriatrics fitness program directors to consider adding eccentric training as an exercise modality to their programs. His most recent publication demonstrating the benefits of chronic eccentric exercise for the frail elderly was highlighted last month in the Foundation pages in Physical Therapy.

The first publication by LaStayo on the benefits of chronic eccentric exercise appeared in 1999 in the American Journal of Physiology (LaStayo PC, Reich TE, Urquhart M, Hoppeler H, Lindstedt SL. Chronic eccentric exercise: improvements in muscle strength can occur with little demand for oxygen. Am J Physiol Regul Integr Comp Physiol. 1999;276:R611-R615) and the second in 2000 (LaStayo PC, Pierotti DJ, Pifer J, Hoppeler H, Lindstedt SL. Eccentric ergometry: increases in locomotor muscle size and strength at low training intensities. Am J Physiol Regul Integr Comp Physiol. 2000;278:R1282-R1288). His research demonstrated that improved muscle structure and function could result from chronic eccentric exercise training without muscle damage. Supported by the Foundation at that time, LaStayo speculated that this method of exercise could have tremendous potential for elderly people. "Initially, there was a sense of trepidation about using high force negative work, as the linkage to damage was so strong," says LaStayo, "but the Foundation took a chance with my research, and now the potential clinical application is vast."

Utilizing animal models for research, LaStayo and his colleagues had three additional manuscripts published between 2000 and 2002. The first explored the effects of eccentric exercise (Reich TE, Lindstedt SL, LaStayo PC, Pierotti D. Are muscle springs plastic? Am J physiol Regul Integr Comp Physiol. 2000;278:R1661-R1666). Using a rat downhill-running model, they described how eccentric contractions can change the spring quality of muscle. LaStayo's team of collaborators followed this with another publication in 2001 (Lindstedt SL, LaStayo PC, Reich TE. When active muscles lengthen: properties and consequences of eccentric contractions. News Physiol Sci. 2001;16:256-261). This paper integrated the various results that LaStayo and his fellow researchers' studies had produced about eccentric exercise, and extended their findings to show how spring changes in both human and non-human muscle following eccentric training or negative work can increase power output.

In another study, LaStayo et al examined titin, the cytoskeletal protein believed to play a critical role in muscle spring stiffness, and explored underlying mechanisms of locomotor muscle changes following chronic exposure to eccentric exercise (Lindstedt SL, Reich TE, Keim P, LaStayo PC. Do muscles function as adaptable locomotor springs? J Exp Biol. 2002;205: 2211-2216). "The Foundation's support allowed me to extend my collaborations to investigators outside the clinical realm; this fertile environment constantly kept my creative juices flowing," notes LaStayo.

In 2003, LaStayo published a clinical commentary that explores the ability of the muscle-tendon system to adapt to progressively increasing eccentric muscle forces and the resultant structural outcomes and functional outcomes. It also explores the nature of the structural changes and how these adaptations may help prevent musculoskeletal injury, improve sport performance, and overcome musculoskeletal impairments (LaStayo PC, Woolf JM, Lewek MD, Snyder-Mackler L, Reich T, Lindstedt SL. Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport. J Orthop Sports Phys Ther. 2003;33:557-5711.

LaStayo's most recent article (LaStayo PC, Ewy GA, Pierotti DD, Johns RK, Lindstedt S. The positive effects of negative work: increased muscle strength and decreased fall risk in a frail elderly population. J Gerontol A Biol Sci Med Sci. 2003;58:M419-M424) examined the effects of lower-extremity resistance training on frail elderly subjects. The research tested an experimental eccentric exercise group and a control group and found that subjects who received the eccentric exercise intervention performed better in balance, stair descent, and fall risk than those who received the traditional resistance exercise intervention. In his editorial, Hortobagyi noted, "LaStayo and colleagues made it evident that the 'high-load-low-cost' approach to exercise can be clinically exploited to combat the epidemic levels of sarcopenia in our aging society."

Previous to LaStayo's line of research, there had been relatively few studies documenting the clinical effectiveness of eccentric exercise for increasing muscle strength and size. Much of his research is in collaboration with the renowned comparative physiologist, Stan Lindstedt, PhD, and was completed during LaStayo's postdoctoral fellowship at the Sarver Heart Center, University of Arizona, Tucson. LaStayo's work continues in his current position at the University of Utah. LaStayo comments that "fledgling concepts develop with Foundation dollars, but they mature long after those original monies have been spent."

LaStayo believes that his findings are important for clinicians because the findings challenge long-held notions that although eccentric exercise can cause muscle damage and injury, chronic exercise has the ability to increase the size and strength of muscle. The low energy input required to complete high-force eccentric exercise shows promise in battling sarcopenia in elderly people and also may be useful for other patient populations that may be unable to achieve high muscle forces through traditional resistance exercise.