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Review 905

Muscle Protein Turnover in Endurance Training:


a Review

Authors T. Seene1, P. Kaasik2, K. Alev2


1
Affiliations Institute of Exercise Biology and Physiotherapy, University of Tartu, Estonia
2
Department of Functional Morphology, University of Tartu, Estonia

Key words Abstract capacity of muscle fibres. The turnover rate of

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●▶ endurance training ▼ myofibrillar proteins in the same muscle is dif-
●▶ skeletal muscle
There has been much debate about skeletal mus- ferent and is also different within the myosin
●▶ oxidative capacity
cle capacity to adapt to long-lasting endurance molecule between myosin heavy and light chain
●▶ protein turnover
exercise. Exercise in the aerobic zone of metabo- isoforms. The turnover rate of muscle proteins
lism does not result in hypertrophy of skeletal in endurance training shows the adaptation
muscle fibres but increases their oxidative capac- of skeletal muscle to long-lasting exercise via
ity. The duration and intensity of an exercise ses- remodelling of muscle structures. Adaptational
sion determines the time period of depressed coordination between myofibrillar and mito-
muscle protein synthesis and increased degrada- chondrial compartments shows the physiologi-
tion rate during the recovery period after exer- cal role and adaptational capacity of skeletal
cise. Protein turnover characterizes the renewal muscle to endurance training. It is challenging
processes of muscle proteins and the functional to use muscle protein turnover for the purposes
capacity of muscle. The turnover rate of myofi- of monitoring the training process of endurance
brillar proteins is slow in comparison with mito- athletes, optimizing training programs and pre-
chondrial proteins and depends on the oxidative venting overtraining.

Introduction protein, is the regulator in the conversion of


▼ chemical energy into mechanical activity. There
Adaptation of skeletal muscle to exercise training is a clear relationship between myosin isoforms
depends on its character, oxidative capacity, and functional properties of the skeletal muscle.
accepted after revision
structural rearrangements of muscle fibres, the Maximal shortening velocity is higher in muscle
June 07, 2011
turnover rate of proteins of the contractile appa- fibres where myosin heavy chain (MyHC) fast
Bibliography ratus and fibre recovery from exercise-induced isoforms dominate as the rate of actomyosin
DOI http://dx.doi.org/ injury [9, 21, 40, 63, 87, 90]. interaction is greater, because the size of the step
10.1055/s-0031-1284339 Endurance training does not result in hypertro- generated by single interactions is larger [15]. It
Published online: phy of skeletal muscle fibres involved in the exer- has been demonstrated that MyHC slow (I) iso-
November 8, 2011 cise response because the level of force form propelled actin filaments at a lower speed
Int J Sports Med 2011; 32:
production is relatively small compared to their than fast (IIb) isoforms [43].
905–911 © Georg Thieme
Verlag KG Stuttgart · New York
maximal force-generation [10]. This type of exer- Currently, the role of initial oxidative capacity of
ISSN 0172-4622 cise training results in the regulation of the muscle fibres in the development of endurance of
enzyme system of the Krebs cycle, electron trans- athletes via the turnover rate of muscle proteins
Correspondence port chain, capillary supply, changes in key meta- is not fully understood. There are no definite
Prof. Teet Seene, PhD, DSci bolic enzymes involved in fatty acid activation, answers to the questions where the border of
Institute of Exercise Biology and and increased oxygen uptake [40, 41, 101]. If development of oxidative capacity of muscle
Physiotherapy exercise training occurs mainly in the aerobic fibres during endurance training is and what the
University of Tartu
zone of metabolism, it promotes a transition limiting factors are [23]. Putative mechanisms for
Ülikooli 18
Tartu
from type II to type I fibres in skeletal muscle, the increase of muscle fibre oxidative capacity
Estonia 50090 which occurs at the expense of type II fibre popu- and muscle protein turnover in parallel with
Tel.: +372/7/375 364 lation [100]. This process is related to the myofi- endurance development prove that there is no
Fax: +372/7/375 379 brillar apparatus as myosin, the main contractile 1:1 relationship between these indicators. On the
teet.seene@ut.ee

Seene T et al. Muscle Protein Turnover in … Int J Sports Med 2011; 32: 905–911
906 Review

whole, the initial oxidative capacity of muscle fibres determines muscle cells, only cardiocytes have high oxidative capacity,
the progress of endurance development in athletes but may not while skeletal muscle fibres have low (type IIB/X) and higher
guarantee the final result. The purpose of this review is to pro- oxidative capacity (type I and IIA) [76, 82, 87, 91].
vide an overview of literature published relating to endurance VO2max is proportional to succinate dehydrogenase (SDH)
training and muscle fibre oxidative capacity and its relation to activity [12] or oxoglutarate dehydrogenase activity [13] and
myofibrillar protein turnover rate. This article highlights the consequently to the number of mitochondria [44, 71]. Muscle
effects of endurance training on the renewal of the myofibrillar fibres with a relatively large cross-sectional area had low SDH
apparatus, the accompanying rearrangements in the contractile activities and vice versa [50, 73].
machinery and resulting skeletal muscle remodelling. It has been shown that muscle fibre can hypertrophy and
increase strength potential at the expense of endurance capacity
Effect of exercise intensity and duration on muscle [105]. Type I and IIA muscle fibres have a relatively large oxida-
metabolism tive capacity and small fibre size compared to type IIB/IIX fibres.
Both low and high intensity exercise are important components Muscle fibre size, not necessarily the fibre type, is related to its
for endurance athletes’ training programs [53]. Endurance train- oxidative capacity [105]. The same authors raised the question
ing programs, in a variety of forms, improve the energetic poten- why high oxidative muscle fibres remain relatively small com-
tial of muscle and result in the effective functioning of the pared to low oxidative muscle fibres.
muscle contractile apparatus for longer periods of time It is well known that physiological function of muscle fibre type
[35, 94, 109]. High intensity interval training supplemented into is an outcome of MyHC isoform expressed within fibre. Some
the already high training volumes elicits improvements in both fibres, the so-called hybrid fibres express a combination of 2 or
short-lasting intense and prolonged exercise performance [54]. more MyHC isoforms [17, 93]. Laboratory animal experiments

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It has been shown that low volume high intensity interval train- have shown that the relative proportions of hybrid fibres vary
ing maintains an athlete′s endurance performance and muscle significantly from muscle to muscle [17].
oxidative potential and increases intense exercise performance In human skeletal muscle, hybrid fibre types represent a signifi-
[46, 47]. cant population of fibres, but the stability of this fibre pheno-
Adaptation of skeletal muscle to exercise duration and intensity type is currently unclear. For example, electrical stimulation
changes muscle glycogen level [22] and protein synthesis rate increases the proportion of hybrid fibres [68] and mechanical
[72] within several hours after exercise. The post exercise load and thyroid hormone changes the proportion of hybrid
response is fundamentally more important to the state of pro- fibres in skeletal muscle [18]. It has been shown that running
tein metabolism changes that occur during exercise [102]. On exercise declines the hybrid fibres in human skeletal muscle
the other hand, the duration and intensity of an exercise session [51], whereas muscle hybrid fibres are relatively refractory to
determines the time period of depressed protein synthesis rate the effect of exercise in mice [32].
and the rate of degradation of muscle protein after exercise It is not clear yet what role hybrid fibres play in endurance train-
training, i. e. during the recovery period [49, 83, 87, 90]. It is well ing of athletes, particularly the role of these fibres in changes of
known that protein synthesis is an energy consuming process skeletal muscle oxidative capacity.
and as depicted in the context of sports performance and energy
metabolism, it is strongly related to implication recovery period. Protein synthesis and degradation in muscle fibres
Low cellular energy level induces in response to sustained con- It seems paradoxical that high oxidative fibres are relatively
tractile process activation of the 5′adenosine monophosphate- small, but have a larger capacity for protein synthesis compared
activated protein kinase (AMPK). AMPK reduces translational to low oxidative fibres [105]. These fibres contain higher quanti-
processes and a low energy status is associated with a high rate ties of satellite cells, myonuclei, mitochondria, mRNA, and total
of protein turnover, which limits the increase of fibre size [105]. ribosomal RNA content (i. e., components of the transcription
Lack of recovery also leads to changes in the skeletal muscle machinery). IGF-1 expression, a stimulator of myofibrillar pro-
myofibrillar apparatus, particularly the destruction of contrac- tein synthesis, is also higher in type I fibres [14, 96]. Myostatin,
tile proteins and decreased exercise performance [82, 83, 90]. expression inhibitor of muscle hypertrophy, is higher in type II
Several studies have shown that in addition to type I fibres, type fibres [55, 110]. At the same time, the components of the degra-
II fibres, particularly IIA fibres, are also recruited during endur- dation machinery of muscle proteins, such as ubiquitin ligases
ance training [45, 82, 83, 85, 87, 88]. Due to the diversity of MAFbx and MuRF, are about 2-fold higher in fibres with higher
molecular mechanisms in different fibre types, muscle functions oxidative capacity [105]. The higher rate of protein degradation
uniformly during intervention to exercise [5, 9, 31]. Changes in in muscle fibres with higher oxidative capacity is balanced by a
myosin isoform composition during endurance training may be high rate of synthesis. This may be an important factor limiting
qualified as qualitative remodelling of skeletal muscle by replac- the size of these fibres [105]. As a result of that steady state, pro-
ing isoforms, which better suit the energetic adaptation to pro- tein turnover rate is faster in muscle fibres with higher oxidative
longed force-generation activity [9]. capacity. In these fibres, the half-life of mitochondrial protein is
the shortest although the turnover of cytochrome C is higher in
Muscle fibre oxidative capacity the low oxidative fibres [39].
The maximum rate of oxygen consumption (VO2max) per vol- The concept of protein turnover was described about 7 decades
ume unit and the cross-sectional areas of striated myocytes ago [80]. All proteins are in a continous process of synthesis and
from different vertebrates vary across a 100-fold range [105]. degradation and characterize renewal processes in the subse-
Muscle fibres with high oxidative capacity are relatively small quent tissue (● ▶ Fig. 1). Amino acids that are released during

compared to fibres with low oxidative capacity pointing to an intracellular degradation of proteins are extensively reutilized
increase in relationships between fibre cross-sectional area and for protein synthesis within the cell or transported to other
VO2max [105]. It is necessary to mention that among striated organs where they enter intercellular recycling. The continuous

Seene T et al. Muscle Protein Turnover in … Int J Sports Med 2011; 32: 905–911
Review 907

turnover of muscle proteins determines how the myofibrillar or tive capacity at the same time, it shows that a competition exists
mitochondrial fractions balance change, and accordingly change between the turnover rate of myofibrillar and mitochondrial
muscle functional capacity [64]. Muscle fibres with higher oxi- proteins [105]. It has been demonstrated that the turnover rate
dative capacity contain a higher level of cathepsin suggesting of MyHC isoforms does not only show differences between the
that there is a higher potential for protein degradation in mus- muscles of different twitch characteristics, but also between
cles with high protein turnover [11]. fast-twitch (FT) muscles, and the turnover rate is faster in FT
The protein turnover rate in skeletal muscle fibres is very slow. muscles with a higher oxidative potential [82].
After an acute lesion or in chronic pathological conditions, satel- Faster myosin turnover rate supports qualitative remodelling FT
lite cells are induced to proliferate and may change the protein muscle with higher oxidative capacity so that the former pattern
turnover [33]. of MyHC and myosin light chain (MyLC) isoforms changes. This
Vertebrate skeletal muscle fibres are multinucleate cells [57] process shows that muscles with higher oxidative capacity adapt
with hundreds of thousands of myonuclei [34, 78]. Each myonu- faster to the new condition [30].
cleus regulates gene products within a finite volume called the In the light of recent findings, the expression of specific contrac-
myonuclear domain [3] or DNA unit [20] and has been defined tile, regulatory and minor protein isoforms is a relevant, though
as the theoretical volume of cytoplasm associated with a single not the only mechanism of regulation of heterogeneity and plas-
myonucleus [3, 4]. Cytoplasmic volume per myonucleus is ticity of skeletal muscle. The pattern of MyHC isoforms in skele-
smaller in fibres expressing slow as compared to fast MyHC tal muscle might change for several reasons.
[73, 103] or in fibres highly active in protein synthesis [29]. The
greater concentration of myonuclei in slow-twitch (ST) fibres Effect of endurance training on interaction between
has been shown to be related to a higher rate of protein turnover mitochondria and sarcomeres

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[103]. Skeletal muscle oxidative capacity increases with endurance
RNA and protein ratio called the RNA unit [58] and the protein training and the decline in oxidative capacity is related to the
synthesis per RNA unit has been defined as the “activity” of RNA reduction in fitness [74]. Endurance training stimulates mito-
[58] and shown as a stable indicator of protein synthesis or chondrial biogenesis and improves their functional parameters
effectiveness of the translation process in cell in physiological [42, 56]. Exhaustive endurance exercise produces undesired
conditions [61, 108]. effects and results in a marked decrease in cytochrome c/aa3
About 4 decades ago, it was shown that the protein turnover rate ratio by about 37 % in striated muscles with high oxidative
depends on the type of muscle [28] and even functionally related capacity (heart muscle), and the reason for the deficit of cyto-
proteins such as myofibrillar proteins have different speed of chrome C is the disruption of the outer membrane [48]. Studies
renewal [79]. It was shown that a relationship exists between in skeletal muscle have shown a potential role of mitochondrial
the turnover rate of myofibrillar protein and quantity of mito- impairment during exhaustive exercise and subsequent muscle
chondria in muscle [28, 98]. fibre damage [87, 89].
The concept of plasticity of skeletal muscle [30, 65] enables It has been shown in striated muscles with high oxidative poten-
fibres to adapt themselves to different genetic and environmen- tial that intracellular phosphotransfer systems constitute a
tal influences on the cellular and molecular level, which in turn major mechanism linking mitochondria and ATPases within
lead to the changes in metabolic functions [31]. According to specific structures − intracellular energetic units [76, 92]. Mito-
contemporary understanding, muscle protein turnover rate may chondria are precisely positioned between the myofilaments
be used for diagnostic purposes of muscle diseases and training throughout the whole muscle due to the fixed juxtaposition of
monitoring. mitochondria with sarcomeres [104]. The effectiveness of meta-
Changes in the turnover rate of myofibrillar proteins character- bolic signalling strongly depends on structural-functional rela-
ize the renewal processes in the contractile apparatus during tionships of the interaction between mitochondria and
adaptation to increased functional activity [66, 67]. As muscle sarcomeres [91]. Under conditions of hypoxia, the connections
fibres have limited capacity for hypertrophy and increase oxida- between mitochondria and sarcomeres are disturbed as sarcom-

Fig. 1 Protein turnover in muscle fibre. Protein


Increase in DNA Unit Number turnover is a continuous process determined by
Hypertrophy the ratio between protein synthesis and degrada-
tion rate. Protein turnover rate is faster in muscle
fibres with higher oxidative capacity. Protein
Increase in Protein Synthesis Rate Ratio turnover characterizes renewal processes in mus-
between cle fibres and, accordingly, changes in muscle func-
Protein tional capacity. Faster turnover of muscle proteins
Muscle Fibre Protein
Synthesis also provides faster regeneration of fibres and their
Oxidative Capacity Turnover
readiness for the next endurance training load.
Rate and Rate
Nucleus RNA Protein
Protein
Degradation
Rate

Increase in Protein Degradation Rate

Atrophy
Decrease of DNA Unit Numbers

Seene T et al. Muscle Protein Turnover in … Int J Sports Med 2011; 32: 905–911
908 Review

eric components disintegrate the muscle cell structure and Endurance exercise training increased the oxidative capacity in
cause cell injury and death [91]. The activation of apoptosis may Pla muscle by 16 % and in EDL muscle by 12 % [82]. How much of
be partly responsible for the initiation of protein degradation gene expression of MyHC isoforms is due to genetic predisposi-
and loss of muscle nuclei associated with local atrophy [27]. For tion and how much to the specificity of training is unresolved
example, the disruption of desmin impairs the linking of mito- [9]. Differences in MyHC isoforms turnover rate between FT
chondria to Z-disc and skeletal muscle exhibits impaired oxida- muscles show that the turnover rate is faster in muscles where
tive phosphorylation [75]. AMPK becomes activated in skeletal oxidative capacity is higher [82]. Changes in MyHC isoforms’
muscle during acute bouts of exercise [8]. AMPK′s main function turnover rate in FT muscles during endurance training also char-
is to monitor the energy status of muscle fibres and maintain acterize changes in myofibrillar apparatus through protein
muscle energy homeostasis [62]. metabolism. The latitude of changes (increase, decrease) in
Long-lasting endurance exercise may lead to the depletion of the myosin isoforms turnover rate also shows the significance of
energy system, neuromuscular fatigue and muscle damage [1]. MyHC isoforms in the process of adaptation to endurance train-
Children have less muscle mass than adults and generate lower ing. Although the exact role of MyLC isoforms in FT muscles dur-
absolute power during high-intensity exercise. Children′s mus- ing endurance training is not fully known, changes in MyLC
cles are better equipped for oxidative than glycolytic pathways isoforms’ relative content and their relation to the character of
during exercise and have a lower ability to activate their type II training show that they play an important role in the process of
muscle fibres [70]. Skeletal muscle oxidative capacity increases modulation of the contractile machinery during the increase of
with endurance training and an age-associated decline in oxida- oxidative capacity and degradation rate of contractile proteins
tive capacity is related to the reduction in fitness [74]. Aerobic [2]. There is still no answer to the question whether other myofi-
endurance training can positively influence structural changes brillar proteins can modulate the functional properties of

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in capillarity [36]. myosin during endurance training and if it is dependent on the
Type IIB muscles exhibit increased ADP concentrations in training volume. C-protein, which binds either myosin and actin
response to an increased workload, which conforms to the respi- or affects the mechanical properties of myosin cross-bridges by
ratory control theory in skeletal muscle [75]. linking the S2 segment of myosin to the backbone of the thick
filament [37], has shown to be very sensitive to high training
Exhaustive exercise and ROS volume [83]. C-protein together with MyHC isoforms plays the
Exhaustive exercise stimulates the generation of reactive oxygen key role in changes of functional properties of the contractile
species (ROS), which damage muscle cells, being side products of machinery during excessive increase in endurance training
oxidative phosphorylation, due to univalent reduction of molec- volume [83].
ular oxygen by electrons leaking from the respiratory chain
[26, 69] and induce damage of this chain [59]. Mitochondria are Role of MyHC and MyLC Isoforms in endurance training
the source and target of ROS because complexes I and III of the During the last 2 decades, it has been shown that among multi-
electron transport chain are the main sites of mitochondrial ple isoforms of muscle proteins MyHC and MyLC isoforms play
superoxide production [38, 60]. The magnitude of changes in an important role in muscle function. These 2 isoforms of the
exercise induced ROS depends on the type of muscle fibre [7] as myosin molecule have a different turnover rate. MyLC isoforms
cellular Ca2+ overload activates the degradation of muscle pro- turnover is faster than MyHC and their recovery dynamics from
teins and membrane phospholipids via Ca2+ dependent proteo- endurance exercise are also different [84]. Simultaneously with
lytic and phospholipolytic pathways [6]. Ca2+ overload results in increased contractile protein degradation, endurance training
the uptake of Ca2+ into mitochondria [99], reduces mitochon- also increased the degradation rate of MyHC isoforms [83, 87].
drial capacity to synthesize ATP and causes damage of mito- The degradation rate of MyHC isoforms increases in spite of the
chondrial membranes. increase of oxidative potential of FT skeletal muscle. The decrease
of expression of MyHC IIb isoform in FT muscles is caused by the
Effect of endurance training on contractile protein intensive degradation of the isoform during endurance training,
turnover which is probably the main reason for unchanged turnover rate
Changes in muscle protein turnover rate during endurance of MyHC IIb isoform in endurance trained rats [77]. During the
training may be regarded as an adaptation of a tissue or cells to adaptation to long-lasting endurance exercise, a decrease of
long-lasting low intensity functional activity. This adaptation MyHC IIb isoform in FT skeletal muscle shows the transforma-
provides a rapid means for the redistribution of amino acids into tion of muscle contractile apparatus in accordance with the
new proteins as they are required because amino acids are increase in muscle oxidative capacity and does not necessarily
derived from protein breakdown and incorporated into the show the decrease of muscle contraction speed.
newly synthesized protein. Aerobic exercise stimulates protein It has been claimed that in order to better understand the role of
turnover by increasing muscle protein degradation and synthe- MyLC in skeletal muscle, it is necessary to study changes in MyLC
sis in the recovery phase after exercise [19]. The turnover rate of in parallel with the quantification of MyHC under the same con-
MyHC and MyLC isoforms provides a mechanism by which the ditions [107]. During muscle atrophy of different genesis, it has
type and amount of protein can be changed in accordance with been shown that MyLC 1fast and 2fast isoforms increase in parallel
the needs of the contractile machinery during adaptation to with the increase in the relative content of MyHC IIb isoforms
endurance training [2, 82]. [25]. A decrease in the relative content of MyLC 1fast isoform is an
Activity patterns of muscle fibres where MyHC I and IIa isoforms indicator of the slowing of muscle contraction [37]. This stand-
are dominant have relatively high oxidative capacity and are point has been supported in rat skeletal muscle by decreasing
recruited during endurance exercise [85]. It has been shown that MyLC 1fast isoform in the following direction EDL→Pla→ dia-
in rat FT plantaris (Pla) and extensor digitorum longus (EDL) phragm (Dia) →soleus (Sol) muscle [2].
muscles, the difference in oxidative capacity is about 10 % [82].

Seene T et al. Muscle Protein Turnover in … Int J Sports Med 2011; 32: 905–911
Review 909

It has been demonstrated that a positive correlation exists Conclusion


between MyHC IIb isoforms, MyLC 3fast isoform relative content ▼
and muscle contraction speed [15]. In some studies, a positive Recent evidence suggests that a constant increase of endurance
correlation was also found between MyLC 3fast/MyLC 1fast iso- training volume is not the only way to improve athletes’ com-
forms ratio and contraction speed [16, 97], but others did not petitive results, but it is reasonable to assume that an increase of
support this standpoint [52] or it was shown that the above- muscle strength capacity is possible at the expense of endurance
mentioned relation only exists between ST and FT muscles but capacity. Endurance training stimulates mitochondrial biogen-
not between different FT muscles [2]. Higher apparent affinities esis and an increase of skeletal muscle oxidative capacity.
were found between the MyLC 3fast isoform and MyHC IIb and IId Exhaustive endurance exercise results in a marked decrease in
isoforms [95, 106]. cytochrome C/aa3 ratio in skeletal muscle with higher oxidative
The distribution of MyLC isoforms in different muscles has capacity. Disruption of minor muscle protein desmin impairs
shown that in ST muscle the distribution of dominating slow the linking between mitochondria and myofibrils and muscle
isoforms is wider than that of fast isoforms, and this shows the exhibits impaired oxidative phosphorylation. Muscle protein
physiological role and adaptational capacity of MyLC isoforms in turnover demonstrates the continuous process of protein syn-
skeletal muscle to everyday movement activity, and exercise thesis and degradation, characterizing renewal processes, and
since ST muscle mainly participate in the process of slow move- functional capacity of muscle. The turnover of contractile pro-
ments and keeping static position [2]. teins provides a mechanism by which the type and amount of
MyLC 3fast isoform has been shown to increase in rat Pla muscle protein can be changed in accordance with the needs of the con-
as well as in EDL muscle during endurance training. The MyLC tractile machinery during adaptation to endurance training. Aero-
alkali isoforms content as well as MyLC regulatory isoforms con- bic exercise stimulates protein turnover by increasing muscle

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tent does not change in FT muscles during endurance training protein degradation and synthesis in the recovery phase after
[82]. The decrease of slow isoforms, both in alkali and in regula- exercise, while exhaustive exercise conversely elicits slower turn-
tory MyLC, during endurance training and the increase of MyLC over rate of contractile proteins. The turnover rate of contractile
3fast isoform in FT muscle are at first glance not in agreement proteins depends on the oxidative capacity of muscle fibre.
with changes in MyHC isoforms pattern. However, the stoichom- Changes in myofibrillar protein turnover rate may be regarded as
etry of these subunits and their association with each other do the remodelling of contractile machinery during endurance train-
not change [2, 82] and this shows that there are no definite adap- ing supporting the energetic adaptation of muscle.
tational borders between MyHC and MyLC isoforms in FT mus- Muscle proteins turnover rate is applicable in monitoring the
cles to endurance exercise [2, 81]. training process of endurance athletes and enables to optimize
This adaptational process shows coordination between changes training programs and prevent overtraining.
in oxidative capacity and contractile machinery in skeletal mus-
cle during the adaptation to endurance exercise training mainly
in relation to muscle metabolism. Adaptational processes in FT Acknowledgements
muscles during endurance training show the high potential of ▼
recruiting these muscles in endurance training [82]. This study was supported by the funds of the Ministry of Educa-
tion and Research of the Republic of Estonia, research project
Effect of excessive volume of endurance training number SKKSB1787.
Excessive volume of endurance training leads to exercise intoler-
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