Summary • Tendons show rather good ability to adapt to different states of loading and movement provided that the time frame for adaptation is sufficient and long enough -weeks, months and years instead of days. • Concerning training and physical activity, the lower the initial loading state, the faster and better the adaptation, and vice versa. • Concerning the opposite (disuse and inactivity), the higher the initial loading state, the faster and more severe the tissue atrophy, and vice versa (Figure 16.5). the tendon tissue. • Regular and versatile loading is vital for skeletal health; bones ability to adapt to loading is in general very good and clearly exercise-specific. • While loading consisting of high-magnitude impacts is the most osteogenic type of exercise (resulting in thick cortical bone), endurance training, especially running, has potential to improve the tibial bone strength through geometric adaptation. • Apparently, a large number of repeated moderate-magnitude impacts explains the influence of endurance training on bone structure (Figure 16.6). • On the other hand, at the more proximal sites of the skeleton (such as proximal femur and lumbar spine) the influence of habitual locomotion and related weightbearing may largely overdrive the influence of similarly-loading endurance training. • In the upper extremities, in which the weight-bearing component of loading is not present, clear benefits of endurance training (swimming) can be seen.
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