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CLINICAL SCIENCE
Acute strength exercise and the involvement of small or large muscle mass on plasma brain-derived neurotrophic factor levels
Paulo Roberto CorreiaI,
Corresponding author
paulo@nutriativo.com.br

Tel.: 55 11 5576-4513
, Aline PansaniII, Felipe MachadoI, Marilia AndradeI, Antonio Carlos da SilvaI, Fulvio Alexandre ScorzaII, Esper Abrão CavalheiroII, Ricardo Mario AridaI
I Universidade Federal de São Paulo, Departamento de Fisiologia, São Paulo, Brazil
II Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo, Brazil
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Plasma brain-derived neurotrophic factor &#40;BDNF&#41; at rest and after maximal arm and leg strength exercise sessions&#46; No significant differences were observed after either arm or leg protocols or between arm and leg exercise protocols&#46; Data are expressed as mean &#177; SD&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Brain-derived neurotrophic factor &#40;BDNF&#41; is a member of the neurotrophic factor family that plays key roles in regulating survival&#44; growth and maintenance of neurons&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> Animal and human research has shown that exercise increases neuronal survival and resistance to brain insult&#44;<a class="elsevierStyleCrossRefs" href="#bib2">2&#44;3</a> promotes brain vascularization&#44; stimulates neurogenesis&#44; enhances learning and contributes to maintenance of cognitive function&#44; all of which are modulated by BDNF&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> Exercise for several days enhances BDNF production in the hippocampus and other areas of the central nervous system in rats&#44; which suggests that exercise induces neurotrophin release &#40;please see<a class="elsevierStyleCrossRef" href="#bib4">4</a> for a review&#41;&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">Although it is well known that BDNF synthesis is centrally mediated and activity dependent and that exercise increases BDNF transcription in the brain&#44;<a class="elsevierStyleCrossRef" href="#bib5">5</a> recent findings have reported that physical exercise increases circulating BDNF levels in healthy humans&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6-8</a> The main source of circulating BDNF at rest and in response to exercise has not been defined&#46; Nevertheless&#44; Tang et al&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a> proposed that platelets provide the increased source of serum BDNF in response to exercise&#46; BDNF is also increased in plasma samples after exercise&#44; which suggests that BDNF might originate from several other cell sources&#46; Researchers have demonstrated that the brain and&#47;or vascular endothelium produce BDNF during prolonged endurance exercise&#46;<a class="elsevierStyleCrossRefs" href="#bib10">10&#44;11</a> An increase in BDNF during ramp tests to exhaustion has been observed&#44;<a class="elsevierStyleCrossRef" href="#bib8">8</a> and the magnitude of its increase is exercise intensity dependent&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a></p><p id="para30" class="elsevierStylePara elsevierViewall">While the effects of moderate &#40;aerobic&#41; and intense exercise on blood BDNF have been demonstrated&#44;<a class="elsevierStyleCrossRefs" href="#bib6">6-9</a> little information about the effect of strength exercise on BDNF has been reported&#46; A few studies on this topic have investigated the effects of strength exercise on blood plasma concentrations of BDNF and Insulin-like growth factor 1 in humans&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;13</a> Despite the functional adaptations that were induced by strength training in these studies&#44; a single strength session<a class="elsevierStyleCrossRefs" href="#bib13">13&#44;14</a> or strength training<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;13</a> was insufficient to induce adaptations in basal BDNF plasma concentrations&#46; In opposition to the above findings&#44; Yarrow et al&#46;<a class="elsevierStyleCrossRef" href="#bib14">14</a> reported increases in serum BDNF levels after resistance exercise&#46; Although a single strength session was not able to significantly alter BDNF levels&#44; we hypothesize that the response of BDNF to strength exercise may differ depending on the type of exercise&#46; A number of reports in healthy human subjects suggest that the magnitude of the circulatory responses to exercise is dependent on the size of the active muscle mass&#46;<a class="elsevierStyleCrossRefs" href="#bib15">15-19</a> Along these lines&#44; we investigated the effects of acute strength exercise &#40;isokinetic muscle contraction&#41; on plasma BDNF concentrations in healthy individuals and compared the involvement of small versus large muscle mass on blood BDNF concentrations&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">MATERIALS AND METHODS</span><p id="para40" class="elsevierStylePara elsevierViewall">Sixteen young&#44; healthy male subjects &#40;age&#58; 26&#46;4 &#177; 3&#46;7 yr&#59; height&#58; 176&#46;5 &#177; 7&#46;6 cm&#59; weight&#58; 79&#46;9 &#177; 13&#46;9 kg&#59; reported as the mean &#177; SD&#41; were recruited for the study&#44; which was approved by the ethics committee of the Universidade Federal de S&#227;o Paulo &#40;UNIFESP&#41;&#46; The volunteers were informed about the aims of the study and received written&#44; detailed explanations about the experiments&#44; the potential discomforts&#44; the risks and the procedures employed in the investigation&#46; Subjects with known cardiovascular or metabolic disorders or orthopedic limitations&#44; as established by the American College of Sports Medicine&#44; were excluded from the study&#46;<a class="elsevierStyleCrossRef" href="#bib20">20</a> Therefore&#44; all volunteers were in good health and free of any physical condition that would place them at risk during participation in the study&#46; The participants were not previously involved in regular physical activities&#46; All subjects signed an informed consent document&#46; After signing the consent form&#44; the Beck Depression Inventory and Trait and State of Anxiety &#40;IDATE&#41; were given to the volunteers to exclude subjects with signs of depression or anxiety&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">The muscular strengths of concentric knee and elbow flexor and extensor muscles for both dominant and non-dominant sides were measured on separate days &#40;knee muscles were tested on day 1&#44; and elbow muscles were tested on day 2&#41; using a Cybex 6000 isokinetic dynamometer &#40;Ronkonkoma&#44; NY&#41;&#46; The dynamometer was calibrated before testing each subject&#46; The Cybex 6000 was arranged according to the guidelines described in the user&#39;s manual for measurement of knee and elbow flexion&#47;extension actions&#46; The flexor and extensor muscles of the dominant and non-dominant knees were assessed in the seated position with the hips flexed at 85 degrees&#46; The range of motion was set at 110 degrees&#44; considering full extension as 0 degrees&#46; One week later&#44; flexor and extensor elbow muscles were tested in the supine position with the shoulder abducted at 45 degrees in the frontal plane and the forearm positioned in the neutral position&#46; The range of motion was set at 130 degrees&#44; considering full extension as 0 degrees&#46; Exercise protocols were the same for knee and elbow muscles&#46; Five series of ten repetitions at 60 deg&#47;s were performed after a 5-min warm-up on a stationary bicycle&#46; The dominant side was tested first in all subjects&#46; Successive series were separated by 40 sec of rest&#44; and the non-dominant knee was examined 2 min after the complete trial of the dominant side&#46; A gravity correction was performed in which the volunteers were asked to perform a series of maximal knee and elbow contractions&#46; Visual feedback from the computer screen was not allowed&#46; Heart rates &#40;HR&#41; were recorded for each subject both pre- and post-exercise&#46; The exercise duration for each knee and elbow was as follows&#58; the time duration of each set &#40;10 repetitions&#41; for one knee was approximately 30 sec&#46; The total duration of exercise&#44; including the rest period &#40;40 sec between sets&#41;&#44; was 5&#46;10 min&#46; The duration of each set &#40;10 repetitions&#41; for one elbow was 43 sec&#46; The total duration of each exercise&#44; including the rest period &#40;40 sec between sets&#41;&#44; was 6&#46;15 min&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">Blood draws were performed at 1 min post-exercise and after a 30-min rest period&#46; Blood samples were taken from antecubital veins&#44; placed into plasma venipuncture tubes&#44; separated by centrifugation &#40;3000 rpm for 10 min at 4 &#176;C&#41; and stored at &#8722;70 &#176;C until use&#46; Plasma BDNF concentrations were analyzed by enzyme immunoassay using ELISA &#40;Enzyme-linked immunosorbent assay&#41; kits by Millipore &#40;Temecula&#44; CA&#44; USA&#41; according to the manufacturer&#39;s description&#46; Statistical analyses were performed by employing ANOVA &#40;Analysis of Variance&#41; with a Tukey&#39;s post-hoc test&#46; A p-value &#60; 0&#46;05 was considered to indicate statistical significance&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">RESULTS</span><p id="para70" class="elsevierStylePara elsevierViewall">All volunteers completed the exercise protocols&#46; Plasma BDNF did not significantly increase after both arm and leg protocols &#40;legs&#58; from 2464&#177;1543 pg&#47;ml at rest to 2261&#177;1493 pg&#47;ml after exercise&#59; arms&#58; from 1925&#177;1417 pg&#47;ml at rest to 1870&#177;1131 pg&#47;ml after exercise&#59; all values are reported as the mean &#177; SD&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig1-cln_65p1123">Figure 1</a>&#41;&#46; No significant difference in the plasma concentration of BDNF was observed after arm and leg exercises&#46; Analysis of the HR response after strengthening exercises showed a significant increase immediately after exercise and at 1 min post-exercise compared to the values at rest &#40;p&#60;0&#46;001&#41;&#46; Individual BDNF values &#40;<a class="elsevierStyleCrossRef" href="#t1-cln_65p1123">Table 1</a>&#41; and variations in HR &#40;<a class="elsevierStyleCrossRef" href="#t2-cln_65p1123">Table 2</a>&#41; pre- and post-exercise are presented below&#46;</p><elsevierMultimedia ident="fig1-cln_65p1123"></elsevierMultimedia><elsevierMultimedia ident="t1-cln_65p1123"></elsevierMultimedia><elsevierMultimedia ident="t2-cln_65p1123"></elsevierMultimedia></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">DISCUSSION</span><p id="para80" class="elsevierStylePara elsevierViewall">The present results demonstrate that acute strength exercise does not induce significant alterations in BDNF plasma concentrations in healthy individuals&#46; Based on previous reports that showed elevated blood BDNF after moderate &#40;aerobic&#41; and intense exercise&#44;<a class="elsevierStyleCrossRefs" href="#bib6">6-9&#44;11</a> we would expect that strength exercise might also increase plasma BDNF levels&#46; However&#44; there were no significant differences in the levels of plasma BDNF during arm and leg exercises&#46; One study that used a strength training protocol to evaluate peripheral BDNF analyzed the effects of &#8220;strength training&#8221; with high loads on blood plasma concentrations of BDNF and IGF-1 &#40;insulin-like growth factor&#41; in humans&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a> Importantly&#44; these investigators evaluated basal plasma BDNF concentrations and not BDNF levels after intensive effort&#46; Subsequent studies demonstrated that a single strength session did not induce significant changes in blood BDNF levels&#46;<a class="elsevierStyleCrossRefs" href="#bib13">13&#44;14</a> To the best of our knowledge&#44; this is the first study that compares the influence of large or small muscle groups on BDNF plasma concentrations in sedentary&#44; healthy humans using a protocol of acute strength exercise&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">To justify our findings&#44; it is important to understand several factors that may affect peripheral BDNF levels&#46; Reports have shown that various features of exercise stimuli&#44; including intensity&#44; duration and mode of activity&#44; can affect BDNF levels&#46; Protocols of moderate or intense exercise have been shown to increase levels of BDNF in the blood&#46; For instance&#44; Gold and co-workers<a class="elsevierStyleCrossRef" href="#bib6">6</a> showed that their moderate exercise task &#40;30 min of bicycle ergometry at a maximum of 60&#37; VO<span class="elsevierStyleInf">2</span>&#41; caused a transient increase in serum BDNF levels&#46; Serum BDNF was not significantly induced after exercise performed at low intensity &#40;20&#37; below ventilatory threshold&#41;&#44; but it was enhanced after 30 min of intense exercise &#40;10&#37; above ventilatory threshold&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> Correspondingly&#44; results from Tang and collaborators<a class="elsevierStyleCrossRef" href="#bib9">9</a> showed a significant&#44; acute increase in serum BDNF levels after 25 min of step-exercise&#46; Interestingly&#44; short periods &#40;10 min&#41; of moderate exercise did not change serum BDNF levels&#44; but a very transient increase in serum BDNF levels was observed during a ramp test to exhaustion&#46;<a class="elsevierStyleCrossRef" href="#bib8">8</a></p><p id="para100" class="elsevierStylePara elsevierViewall">As mentioned above&#44; the degree of physical effort during the exercise protocol may be important for altering blood BDNF levels&#46; Along these lines&#44; HRs were monitored during and after exercise in our study&#46; HR increased significantly after exercise&#44; but it was not substantially different from the post-exercise HR values reported in the majority of studies<a class="elsevierStyleCrossRefs" href="#bib7">7-9&#44;12</a> Therefore&#44; at the moment of blood collection &#40;1 min post-exercise&#41;&#44; HRs were not greatly elevated compared to other reports&#46; In our work&#44; an intermittent strength protocol with a shorter duration of execution was used&#44; which does not permit comparison of our BDNF values with those in the literature&#46; Protocols of strength exercise with longer duration need to be tested to confirm whether exercise duration&#44; independent of the type of exercise&#44; is a determining factor in altering BDNF&#46; Additionally&#44; in light of the massive motor recruitment after strength exercise &#40;i&#46;e&#46;&#44; maximal muscle contractions&#41;&#44; we expect that plasma BDNF might be increased&#46; This idea is supported by reports in rodents that indicate that BDNF mRNA increases in skeletal muscle in response to contraction&#44;<a class="elsevierStyleCrossRefs" href="#bib21">21&#44;22</a> suggesting that the source of BDNF is neurons within the skeletal muscle beds&#46; On the other hand&#44; Matthews et al&#46;<a class="elsevierStyleCrossRef" href="#bib23">23</a> showed that although BDNF is produced by the muscle&#44; it is not transported into the circulation&#46; To this end&#44; we verified whether the type of exercise &#40;strength work using large versus small muscle mass&#41; in our study could activate both peripheral &#40;recruitment of great motor units&#41; and central &#40;motor cortex&#41; BDNF&#46; Neither strength exercise nor activation of large versus small muscle groups was able to alter peripheral BDNF levels &#40;although we cannot discriminate between peripheral and central blood BDNF concentrations in our study&#41;&#46; Contrary to the concept that a larger muscle mass could stimulate greater physiological and biochemical changes&#44; no significant variations were observed&#46;</p><p id="para110" class="elsevierStylePara elsevierViewall">These preliminary results should be interpreted with caution&#46; In humans&#44; the BDNF response to exercise differs depending on the type and intensity of exercise&#46; Thus&#44; strength exercise can induce a different metabolic response compared to aerobic exercise&#44; which is manifested by lower oxygen consumption despite higher levels of muscular exertion&#46; An alternative hypothesis is presented by Rasmussen and collaborators<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#44; who found that the brain is a major contributor of circulating BDNF following exercise&#46; In conclusion&#44; these findings suggest that the mode of the exercise program can be a decisive factor in altering peripheral BDNF&#46; Knowledge about the effects of exercise on concentrations of blood neurotrophins will therefore help to optimize the health benefits of exercise&#44; and further intervention studies using other strength exercise protocols are necessary&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:6 [
        0 => array:2 [
          "identificador" => "xpalclavsec1581412"
          "titulo" => "KEYWORDS"
        ]
        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
        ]
        2 => array:2 [
          "identificador" => "cesec20"
          "titulo" => "MATERIALS AND METHODS"
        ]
        3 => array:2 [
          "identificador" => "cesec30"
          "titulo" => "RESULTS"
        ]
        4 => array:2 [
          "identificador" => "cesec40"
          "titulo" => "DISCUSSION"
        ]
        5 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-07-15"
    "fechaAceptado" => "2010-08-19"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec1581412"
          "palabras" => array:5 [
            0 => "BDNF"
            1 => "Exercise"
            2 => "Strength exercise"
            3 => "Human"
            4 => "Blood"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVE&#58;</span><p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Blood neurotrophins&#44; such as the brain-derived neurotrophic factor&#44; are considered to be of great importance in mediating the benefits of physical exercise&#46; In this study&#44; the effect of acute strength exercise and the involvement of small versus large muscle mass on the levels of plasma brain-derived neurotrophic factor were evaluated in healthy individuals&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS&#58;</span><p id="spara50" class="elsevierStyleSimplePara elsevierViewall">The concentric strengths of knee &#40;large&#41; and elbow &#40;small&#41; flexor and extensor muscles were measured on two separate days&#46; Venous blood samples were obtained from 16 healthy subjects before and after exercise&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">The levels of brain-derived neurotrophic factor in the plasma did not significantly increase after both arm and leg exercise&#46; There was no significant difference in the plasma levels of the brain-derived neurotrophic factor in the arms and legs&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSION&#58;</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">The present results demonstrate that acute strength exercise does not induce significant alterations in the levels of brain-derived neurotrophic factor plasma concentrations in healthy individuals&#46; Considering that its levels may be affected by various factors&#44; such as exercise&#44; these findings suggest that the type of exercise program may be a decisive factor in altering peripheral brain-derived neurotrophic factor&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "ceabs10"
            "titulo" => "OBJECTIVE&#58;"
          ]
          1 => array:2 [
            "identificador" => "ceabs20"
            "titulo" => "METHODS&#58;"
          ]
          2 => array:2 [
            "identificador" => "ceabs30"
            "titulo" => "RESULTS&#58;"
          ]
          3 => array:2 [
            "identificador" => "ceabs40"
            "titulo" => "CONCLUSION&#58;"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig1-cln_65p1123"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Plasma brain-derived neurotrophic factor &#40;BDNF&#41; at rest and after maximal arm and leg strength exercise sessions&#46; No significant differences were observed after either arm or leg protocols or between arm and leg exercise protocols&#46; Data are expressed as mean &#177; SD&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "t1-cln_65p1123"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:1 [
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                  \t\t\t\t  " align="char" valign="top">955&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">855&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">710&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">2050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1690&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1841&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">870&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">2464&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">2261&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1925&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1870&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Plasma BDNF concentration &#40;pg&#47;ml&#41; pre- and post-isokinetic strength exercise&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "t2-cln_65p1123"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Legs</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Arms</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">Subject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Rest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">0 min post- exercise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">1 min post- exercise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Rest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">0 min post- exercise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">1 min post- exercise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">144&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">171&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">85&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">151&#46;8 <a class="elsevierStyleCrossRef" href="#tfn1-cln_65p1123">&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">119&#46;8 <a class="elsevierStyleCrossRef" href="#tfn2-cln_65p1123">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">81&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">134&#46;6 <a class="elsevierStyleCrossRef" href="#tfn1-cln_65p1123">&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">106&#46;3 <a class="elsevierStyleCrossRef" href="#tfn2-cln_65p1123">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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