Exercise physiology

514 Pages·2011·28.252 MB·English

by  Kraemer W., Fleck S., Deschenes M.

Exercise
Physiology
Integrating Theory and Application
William J. Kraemer, PhD
Professor
Department of Kinesiology
Neag School of Education
Department of Physiology and Neurobiology
University of Connecticut
Storrs, Connecticut
Steven J. Fleck, PhD
Professor and Chair
Department of Sport Science
Colorado College
Colorado Springs, Colorado
Michael R. Deschenes, PhD
Professor and Chair
Department of Kinesiology and Health Sciences
The College of William & Mary
Williamsburg, Virginia
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Library of Congress Cataloging-in-Publication Data
Kraemer, William J., 1953–
Exercise physiology : integrating theory and application / William J. Kraemer, Steven
J. Fleck, Michael R. Deschenes.—1st ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-7817-8351-4 (alk. paper)
1. Exercise—Physiological aspects—Textbooks. 2. Clinical exercise physiology—Textbooks. I. Fleck, Steven J.,
1951– II. Deschenes, Michael R. III. Title.
QP301.K654 2012
612'.044—dc22
2010043274
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9 8 7 6 5 4 3 2 1
DISCLAIMER
Care has been taken to confi rm the accuracy of the information present and to describe generally accepted practices.
However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from
application of the information in this book and make no warranty, expressed or implied, with respect to the currency,
completeness, or accuracy of the contents of the publication. Application of this information in a particular situation
remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not
be considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text
are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing
research, changes in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions,
the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings
and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for
limited use in restricted research settings. It is the responsibility of the health care providers to ascertain the FDA status
of each drug or device planned for use in their clinical practice.
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[phone]. International customers should call [phone].
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service representatives are available from 8:30 am to 6:00 pm, EST.
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To my mother, Jewell; my late father, Ray; and my sister, Judy:
I thank you for the love and nurturing in my life.
To my children, Daniel, Anna, and Maria: your love
and support, and your very lives, have given meaning to
my own. To my wife Joan for her love and support when taking
on all of life’s challenges.
—WILLIAM J. KRAEMER
To my mother, Elda; father, Marv; brothers, Marv and Glenn;
sisters, Sue and Lisa; and their families for their support in all
aspects of my career and life. To my wife, Maelu, for her
support and understanding throughout our life together,
but especially during the time necessary
to complete a textbook.
—STEVEN J. FLECK
To my mother for showing me unconditional love. To my father
for always having faith in me. To Jennifer and Gabrielle, my
two beautiful girls whom that I love so very much and who make
me so anxious to come home at the end of each day.
—MICHAEL R. DESCHENES
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Preface
The vision for this textbook is a bit different from oth- acute responses to exercise stress, building on this with
ers in the fi eld today. It is directed toward undergradu- an understanding of how the body adapts to exercise and
ate students, many of whom will not go immediately on environmental stresses. We integrate how these concepts
to graduate school but will be taking positions as personal relate to the array of practical job outcomes in which
trainers, strength and conditioning specialists, fi tness in- students will quickly fi nd themselves; they need to be
structors, exercise technicians, physical therapy assistants, able to understand exercise physiology from a practical
athletic trainers, wellness educators, recreational fi tness perspective so that they can apply it to their various
specialists, or health and physical education teachers. Our working environments. With this professional preparation,
goal is to capture the interest and excitement of students. it is our hope that students will be better able to take on
We want students to become fascinated with how the body the challenges and solve the problems they will face as
works and its responses to exercise. We want students to young professionals.
understand how one can train to improve performance and The approach of this text will allow for a linked
we want them to be interested in the basic physiological understanding of central concepts that exercise professionals
mechanisms that allow these training adaptations to occur need to know. Although chapters have domains of content,
in different structures and their specifi c functions. With we cross-reference information and do not corral content in
the popularity of sports we want students to understand only one area. Adaptations to exercise weave throughout the
the physiological basis of sport performance and condi- book as standard feature, rather than limiting adaptations to
tioning. Furthermore, we want them to understand the a single chapter. We take advantage of the interest students
vital health benefi ts of exercise and physical activity during have in nutrition, improved training, or losing weight, and
the life span and for special populations. use a number of examples in each area to integrate topics
It is our experience that textbooks in the fi eld today across the different chapters. Utilizing the student’s long-
are too overwhelming for many undergraduate students term memory by connecting the physiology to an example
to deal with or for the professor to cover in one semester. or an overall context is vital in this process. We used our
Almost every topic in exercise physiology has had a host experiences as a diverse group of authors to give examples
of scientifi c papers and books written about them, and of practical applications to help the students in their study
the real temptation we wanted to avoid was growing this of exercise physiology.
text into a graduate-level book with deep dimensions of This textbook is for undergraduate courses in exercise
detail. In many scenarios, students cannot connect these science, including exercise physiology, but it may well be
concepts to the practical applications when called upon adapted for other courses in which this type of information
to do so in their jobs. For example, a high school high is important for student’s professional preparation. Having
jumper may ask, How should I stretch before an attempt all taught exercise physiology at the college level for many
in a meet? Or, a client may ask his or her personal trainer, years, we wanted to make it as easy as possible for the
Can I really get a six pack set of abs in 6 weeks like I saw professors to use this text as a pivot point from which to
on this infomercial last night? Explanations and choices expand upon with their own style and expertise. We hope
made in these scenarios and many others refl ect the that it will facilitate inquiry and interest in the fi eld and
level of educational experiences and training. In Exercise enhance professional preparation and knowledge-based
Physiology: Integrating Theory and Application we emphasize practice for students.
a fundamental understanding of the exercise physiology
that surrounds such practical questions. Our aim is to
integrate basic exercise physiology as key elements to FEATURES
help the students understand what the answers may be
to various questions and understand how to fi nd these Exercise Physiology: Integrating Theory and Application
answers using a research-based perspective to help the contains many pedagogical features that will help stu-
students fi nd the facts and evaluate information in today’s dents remember and apply the material presented
society. We want our students to understand the body’s to them. At the beginning of each chapter, Chapter
v
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vi Preface
Objectives highlight the main points of the chapter ADDITIONAL RESOURCES
and what important information the students should fo-
cus on as they read through the content presented. The Exercise Physiology: Integrating Theory and Application in-
Introduction gives a brief overview of the topic discussed cludes additional resources for both instructors and stu-
in and the point of the chapter. dents that are available on the book’s companion Web site at
Within each chapter there are various boxes meant http://thepoint.lww.com/KraemerExPhys.
to help students bridge the gap between learning,
understanding, and application. Quick Review boxes Instructors
use brief, bulleted topic points to highlight important Approved adopting instructors will be given access to the
material. Did You Know? boxes provide more detailed following additional resources:
information about a topic that may be above and beyond
● Brownstone test generator
the scope of the chapter to help students expand their
● Answers to the in-text Review Questions
knowledge base. Applying Research boxes describe
● PowerPoint lecture outlines
in-depth how research findings can be applied in
● Image bank
real-life situations that students may encounter in
● WebCT and Blackboard cartridge
practice. Practical Questions from Students boxes
provide answers to popular questions, giving detailed Students
explanations about topics or issues that students may fi nd Students who have purchased Exercise Physiology: Integrating
diffi cult. An Expert View boxes give fi rsthand opinions Theory and Application have access to the following addi-
and perspectives of experts in the fi eld related to content tional resources:
presented in the chapter. Finally, Case Studies provide
● Interactive Quiz Bank
scenarios and questions, along with options of how you
● Animations
might respond to those scenarios, along with rationale.
These are meant to provoke discussion and expand In addition, purchasers of the text can access the search-
students’ critical thinking. able Full Text by going to the book’s Web site at http://
At the end of each chapter, an extensive list of Review thePoint.lww.com. See the inside front cover of this text
Questions provides the students with a chance to apply for more details, including the passcode you will need to
what they have learned and assess their knowledge through gain access to the Web site.
fi ll-in-the-blank, multiple choice, true/false, short answer,
and critical thinking questions. A Key Terms list at the WILLIAM J. KRAEMER, PHD
end of each chapter provides defi nitions of important STEVEN J. FLECK, PHD
terminology with which students should become familiar. MICHAEL R. DESCHENES, PHD
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User’s Guide
Exercise Physiology: Integrating Theory and Application was aims to help students comprehend the vital health ben-
created and developed to explain how one can train to im- efi ts of exercise and physical activity during the life span
prove performance, the knowledge of which builds off of and for special populations. Please take a few moments to
an understanding of the basic physiological mechanisms look through this User’s Guide, which will introduce you
that allow these training adaptations to occur in differ- to the tools and features that will enhance your learning
ent structures and their specifi c functions. The book also experience.
7
Chapter
Endocrine System
Chapter Objectives highlight the main
points of the chapter and what important
After reading this chapter, you should be able to:
information the students should focus on as
they read through the content presented. 1. Defi ne and describe the function of a hormone 8. Describe and distinguish peptide and steroid
2. Explain the organization of the endocrine system interactions with receptors
3. Describe hormone structure and synthesis, 9 Describe the interactions of the hypothalamus
release, transport, and degradation and pituitary gland
4. Describe the use and side effects of anabolic 10. Discuss the other forms of growth hormone and
drugs used by athletes their responses to exercise
5. Explain the differences between the different 11. Describe the exercise roles, regulation,
hormonal feedback loops responses, interactions, and adaptations of
6. Describe endocrine, autocrine, and paracrine the hormones presented in this chapter
actions and their signifi cance in hormonal 12. Explain the impact of competition on endocrine
responses to exercise responses
7. Explain circadian rhythms and seasonal changes
in hormones and how they relates to training and
performance
The Introduction gives a brief overview
of the topic discussed in and the point of
he endocrine system and the nervous system are the two major systems of communica-
the chapter. tion in the body, sending out signals or messages to infl uence physiological responses and
adaptations. The endocrine system sends a signal in the form of a hormone, which is a chemical
substance released from a gland into the blood. A gland is an organized group of cells that func-
tions as an organ to secrete chemical substances. Each hormone that is released from a gland is
specifi cally targeted for a receptor on a specifi c cell. Thus, the term “targeted receptor” relates
to the concept of a hormone’s specifi c set of cellular destinations for the signal being sent from
the gland. A hormone can affect many different cells but only those cells that have its receptor.
The endocrine system modulates a wide range of activities in the body from cellular function to
metabolism, sexual and reproductive processes, tissue growth, fl uid regulation, protein synthesis
and degradation, and mood states.
Increases in hormonal concentrations with exercise are important for the modulation of physi-
ological functions as well as the repair and remodeling of body tissues. Figure 7-1 shows some of
the major endocrine glands and other organs that release hormones, which also may be consid-
ered endocrine glands.
197
LWBK760_c07_197-238.indd 197 12/30/10 9:09:22 PM
vii
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viii User’s Guide
182 Part II Exercise Physiology and Body Systems Quick Review boxes use brief, bulleted
Quick Review to Tissue” section in Chapter 5). Once oxygen has diffused topic points to highlight important mate-
into tissue, an oxygen carrier molecule (myoglobin) within
● The reversible binding of oxygen to hemoglobin accounts for muscle assists in its transport to the mitochondria. rial.
98% of the oxygen transported by blood. Myoglobin is an oxygen transport molecule similar to
● The sigmoidal shape of the oxyhemoglobin disassociation hemoglobin except that it is found within skeletal and cardiac
curve ensures near-maximal formation of oxyhemoglobin muscle. Myoglobin reversibly binds with oxygen, and its role
at the lungs even when the atmospheric partial pressure is to assist in the passive diffusion of oxygen from the cell
of oxygen decreases. It also ensures that small changes in membrane to the mitochondria. Because the rate of diffusion
partial pressure result in release of oxygen at active tissue. slows exponentially as distance is increased, myoglobin
● Changes in temperature and acidity shift the oxyhemoglobin located between the membrane and the mitochondria actually Did You Know? boxes provide more
disassociation curve, causing greater delivery of oxygen to results in two smaller diffusion distances rather than a single
muscle tissue during exercise. long one. As a result, the transit time of oxygen across the detailed information about a topic that
● Three methods are responsible for carbon dioxide transport, muscle fi ber to the mitochondria is signifi cantly reduced.
bbuicta 7r0b%on oaft ec.arbon dioxide is transported in the form of oneD iifrfoenre nmto flreocmul eh, ewmhoegrleoabsi nh, emmyoogglloobbiinn ccoonnttaaiinnss ofonulyr may be above and beyond the scope of
● The transport of oxygen and that of carbon dioxide is iron molecules. Muscle that appears reddish contains large
linked by the formation of carbaminohemoglobin and the amounts of myoglobin, whereas muscles that appear white the chapter to help students expand their
buffering of hydrogen ions by hemoglobin, which decrease contain small amounts of myoglobin. The concentration
hemoglobin’s affi nity for oxygen. of myoglobin within a muscle fi ber varies with the muscle knowledge base.
fi ber type (see Chapter 3). Myoglobin concentration is
high in type I muscle fi bers with a high aerobic capacity
bicarbonate ion for a chloride ion is termed the chloride (slowtwitch), whereas type IIa (fast-twitch) and type IIx
shift. (fast-twitch) muscle fi bers contain an intermediate and a
The hydrogen ion produced is bound to the globin part of limited amount of myoglobin, respectively. Chapter 6 Respiratory System 179
hemoglobin. So, hemoglobin acts as a buffer and helps maintain In addition to speeding up the diffusion of oxygen
nbuofrfmerailn agc oidf ihtyy d(proHg)e wn iitohnins rtehdeu rceeds ibtslo aoffid ncietyll .f oHr eomxyoggelonb. Sino’s, a“rcerosesrsv teh”e a mt tuhsec sleta fir tb oefr ,e mxeyrocigsleo. bEinve fnu nwcittiho nthse a asn atnic oipxaytgoerny Box 6-3 DID YOU KNOW?
the buffering of hydrogen ions triggers the Bohr effect or rise (see “Effects of Exercise on Pulmonary Ventilation,” Common Types of Anemia
moves the oxyhemoglobin disassociation curve to the right. below) in breathing rate prior to the beginning of exercise,
At the tissue level, this results in the release of oxygen from there is a lag in oxygen delivery to muscle. During this
hAdietom Ttxhiohdegee ll obdubiincfifgnausr ss,b oeows tn hohaeuatrtte e ior tePf i assCoc aOtlviu2oa tiinisloa clnboa,lnw ed p ifwsortroui tcmrhebieeinntd agt bih ntoeh le ieaist mlbhvaee.lroa lndici, rece aocrtfbi toohnne. ptUrheepper oilooenxnd yit,s ghtheehen ecd er oaesxsnqyadutg iieirosenn am b oseofmn uetanxsle dlo r cfcto oimsm emu,p symocolnyegeo ltnoghtbla ooitnb fi sithn hbe eoel pcxooysx gmyteogin nem ngm a aduicnestfitti a vcbieinet. Aottcwrafnap oneta hmsbfpeaiiliocairtt r ioitehs r seosa.m .x S dyAyoegmngfie elncpomit eboaininmanc d yrs c e osiosnofun alttctnehsaen enmi tn n,ai uafoa fm irend cbcaetel c urcerd eonoeamdf s puebrar eiliandlnno a brctt,eihl oeo eanoo sdr ay ob afcfiae eltitrltilhogyseb u otsieoecr, baopconllfao ndusoc mpdew n atedo tvior goa2ehlts0uit o%n mntor e.tda1 ,ii2usnn iTrgciinrnnhegigeafi, s ttceorhae tepnas atlufi lr aylratm slsclt eho islnuasen nvtagthe eroepa, f ldl ba hedsuecmatmr yedasoa u sgvoeelof o tiltonbur i mahtnihe newemi niiitonnghgcc.i rlrnToee btaahhssiineees
bicarbonate reaction and causing this reaction to proceed in (see Chapter 2). breathlessness with exertion, heart palpitations, and loss of in plasma volume, hemoglobin concentration decreases.
the direction of the production of carbon dioxide and water. Although myoglobin and hemoglobin are similar in appetite. Iron defi ciency can result in anemia and is the most After several weeks of training, hemoglobin concentrations
Additionally, oxygenation of hemoglobin causes it to lose chemical structure, one difference between these two common type of anemia. It most commonly occurs due to and hematocrit return toward normal. Thus, sports anemia
its affi nity for hydrogen ions. Thus, they are available for molecules is that myoglobin has a much steeper oxygen an insuffi cient intake of iron in the diet or impaired iron is normally a transient event and less prevalent than once
the production of carbonic acid, which because of the low disassociation curve and approaches 100% oxygen absorption. However, iron-defi cient anemia can also occur believed.3
rtooPrefxCal yeOncgaas2es,rp ebnod oariotsntfia o osodnsfxi o coyocaxgfiria ebdhtnoeee snmbb iydyon ighthoolexeo mimcbdaioeonr ggbb.lloyoon bbh iiednnmi oaaoxtt gi tdtlihoesse bau ilnneud ,ni asgw nlsdia nit stek hrel.eid n Sr kteooel,ed tta hhtsoeee 2molsoa fwmit tuto mhrlcaeeh tvsHioeeon lgnsfd. a orTcaiftta ho PauroO ssf,m,2 ,am mucwtcyyihhovoi egcgl lhloomo wbibusiei nsnric’ms l Perope,O xoltye2rh gat(ease3 ennP0st Odbimi2tse smacc saaos nuxoH sycbeggi eae)wt .nia io stBnh aelt ioccn wauv uter hvrsayeees bbdc1o4yue c nrSgtiachn.puedegosnL epprt− terr1o sareof ftg ofin hoarbaemnnlnmoseac omnoytd.crhi eriaahn to a wfgra peoep hfmpoeyrerrson siaci nacalcnht ortd er caamlisrineneeidnindc ,gu airr.cl eo Aesnapdln te hnecoemthiueveidgeamshl y, o ()p1s ghuc2layc oushabis cneiaanddsl R1. efmEDexaeelrreruecsi. sn as2nec0ad0eu 4f s;eK3m6C:a2,l e4Rs1o –pb2ee4rr8ftos. rLmMin,g K wuesihgnhitc kt rMainRi,n get eaxle. rIcriosne. sMtateuds Socfi ySopuontgs
GAS EXCHANGE AT THE MUSCLE a(4ll0o wmsQm i tuH tigoc) tfkroau nnRsdp eowrvitt hoiiexny wsgkeenle atat l tmheu slcolwe.er levels of PO2 thcrrueealnmilnsno,ii nngaglngo ddbs oippneoo srcs tsrasieub,s sluaeylnd tg e ibamnsy ti aari on siicmsnr taetelaylss pteliiodncs aasdll l eoybsf lt enirreuoodctnti ni coigannu wssoweiftde hr a ebtdd,y i l sobttaslhosne ocosdeef 23.. SiEaWrpcoxphreniaur gcrsmhe.t anta2t ct0uL h0speM 2hor;e f3,Y n 4aOKo:t8hml,6 leSee9itcnn–eh 8osmM 7ni5n i,id. nv NA aer,on iGoadukursear tsash npTwoceorDt hst,lr aaDenitnd, ee apdtl .e a arlStf.ho pHrloemertmteassn a.c taIoennsleo.t mgMJi icSaeap:dl o iaSnr ctdrsiei cSMaepls eo oodtrsf.
Gas exchange at the muscle or any tissue occurs due to factors. Physical training, including both aerobic training 1992;13:344–347.
ldairfyfe brelonocdes ( Finig P. 6O-27 a)n. dA lPl oCfO t2h bee ftawcetoerns tphree vtiiossuusely a dneds ccraibpeild- ● Gdiaffse erexnccheasn gine oaxty tgisesnu ea nodc ccuarrsb odnu ed itoox pidaer tbiaelt wpreeesns uthree tissue
cpoonrtc eorfn oixnygg epna ratniadl cparrebsosnu rdei odxiifdfeer aepnpcleys toan cda pbillloaoryd gtarsa nexs-- ● aMnydo tghloeb binlo, oad m.olecule similar to hemoglobin, transports g(Floigb.i n6 -8b)i.n Adst tohxey gluenng, s,f owrmheirneg thoexryeh iesm ao hgilgohb iPn,O 2a, nhde mboe-- or Thhase aonxy h“Sem” oshglaopbei.n Tdhisiass ssohcaiaptei oonf fceurrsv ea disv asnigtamgoeisd atlo,
change at the tissue level. The amount of oxygen delivered oxygen from the cell membrane to the mitochondria for use comes 100% saturated with oxygen. When hemoglobin hemoglobin becoming both oxyhemoglobin at the lungs and
taort teirsisaul-ev ceanno ubse coaxlycguelant eddi fufesrineng cteh e( sFeeic k“ Oprxiyngceipnl eD aenldiv tehrye in aerobic metabolism. iasm 1o0u0n%t osfa otuxryagteend pwoistshi bolxey. gAetn t,i sistu iess cwarhreyrien go xtyhgee nm iasx uimseadl fdreoomxy 9h0e mtoo g1l0o0b imn mat tHheg ,t iossxuyeg elenv esal.t uFrirasttio, ant ias PaOb2o rvaen 9g7in%g
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refl ex. Figure 4-6 shows the classical “knee-jerk” refl ex when0 veins arteries bound to hemoglobin, meaning 25% of the oxygen is
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enclosed and protected by vertebra making up the vertebral the consequences of placing a hand on a hot stove csoautuldra tbioen between the lungs and tissue is the amount of oxygen the oxyhemoglobin disassociation curve, help to ensure
column, and each level has nerves that come out of it to dif- severe if one had to take the time to consider the sdtiemlivuelrueds to the tissue. adequate oxygen delivery to tissue during exercise.
ferent target organs. Nerves related to muscle functions are and consciously devise a response before pulling it off.
shown in Figure 4-5. Information is passed from the higher The patellar refl ex is a bit different from other refl exes
brain centers to the peripheral target tissues, such as muscle. because it is mediated by what is called a monosynaptic
In addition, local circuits from a particular spinal cord level refl ex, and no interneuron connection is involved. Most
Box 4-2 APPLYING RESEARCH LWBK760_c06_167-196.indd 179 Applying Research boxes describ1e2/30 /10 9:08:51 PM
Neurological and Motor Function: Movement Behaviors in in-depth how research fi ndings can
Down Syndrome
be applied in real-life situations that
motor neuron function. In 1994, Latash’s research group
con“cTluhdies ds:tudy supports the idea that subjects with Down students may encounter in practice.
syndrome can use patterns of muscle activation that are
qualitatively indistinguishable from those used by individuals
who are neurologically normal. With appropriate training,
individuals with Down syndrome achieved similar levels of
motor performance to that described in the literature for
individuals who are neurologically normal.”
Much of the movement inhibition was due to protective
behaviors (e.g., limiting arm swing because such a movement
had resulted in pain from hitting something in everyday
movements) carefully reinforced to avoid injury. The
importance of practicing new exercise and sport skills to
reinforce the the idea that one could safely move in a new
range of motion without the fear of pain or injury cannot
be underestimated when working with people with Down
Dbcdcoheyomsr cwoprbmrniiben osseayesdtonni oimdctn erie on o.om f1I fd8te i6,afw fn6oea. rr s Tee txnrnhticasreeoma sc m oiecnndyh db r2aoio1tfdmit,oe yinor ss sihtaozh aemges a e benBn ederoe itsnntitci rsc uhtahhcl atteperu harr2acyett1s iedisorcetnii pza heecnduna umdwbsiyhnae ndoga sTtnbayeehsnhukidasrsrv o oaiilnolmos rogt eth i,ocm ea a spilh g rsoheedvmeti ensbeon we rta diivntnehedjrr u myarw tyai ma nwasynp o daiornt kreh t.n lafeTsantuctehr tsuie ni sans , u e “wlvreSvehapirravyentacd leia.aadpyl p Omperlaoyorvmeteedpmc iatceissvn .ea”t
upon the penetration of the third chromosome on the phenotypic Further Readings
cohccaIurnarct eetevrreeinsstt wiicni gtehxlyian,m pfioenroe pdyl.ee Ta wrhsitu hist , D aw owawsi dnte hs yoranundggrhoet m otfeh .daitf ftehreen ccaers ecfaunl AlmsTeiinhdgealr eG. -1jLo9,i9 nC4t;o 7er4lcb(o1os1w D) :1mM0o0,v 0Le–ma1ta0esn1h2t s.M inL i. nPdriavcitdiucea las nwdi tthra nDsofewrn e fsfyenctdsr doumrein. gP fhaysst
movement and rigidity of locomotion was a result of this Latash ML, Anson JG. Synergies in health and disease: Relations to adaptive
phenotypic penetration, or interference with normal changes in motor coordination. Phys Ther. 2006;86(8):1151–1160.
LWBK760_c04_103-134.indd 110 12/30/10 9:32:28 PM
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