Contralateral Effects of Unilateral Strength and Skill Training: Modified Delphi Consensus to Establish Key Aspects of C
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CONSENSUS STATEMENT
Contralateral Effects of Unilateral Strength and Skill Training: Modified Delphi Consensus to Establish Key Aspects of Cross‑Education A. Manca1 · T. Hortobágyi2 · T. J. Carroll3 · R. M. Enoka4 · J. P. Farthing5 · S. C. Gandevia6 · D. J. Kidgell7 · J. L. Taylor8 · F. Deriu1
© The Author(s) 2020
Abstract Background Cross-education refers to increased motor output (i.e., force generation, skill) of the opposite, untrained limb following a period of unilateral exercise training. Despite extensive research, several aspects of the transfer phenomenon remain controversial. Methods A modified two-round Delphi online survey was conducted among international experts to reach consensus on terminology, methodology, mechanisms of action, and translational potential of cross-education, and to provide a framework for future research. Results Through purposive sampling of the literature, we identified 56 noted experts in the field, of whom 32 completed the survey, and reached consensus (75% threshold) on 17 out of 27 items. Conclusion Our consensus-based recommendations for future studies are that (1) the term ‘cross-education’ should be adopted to refer to the transfer phenomenon, also specifying if transfer of strength or skill is meant; (2) functional magnetic resonance imaging, short-interval intracortical inhibition and interhemispheric inhibition appear to be promising tools to study the mechanisms of transfer; (3) strategies which maximize cross-education, such as high-intensity training, eccentric contractions, and mirror illusion, seem worth being included in the intervention plan; (4) study protocols should be designed to include at least 13–18 sessions or 4–6 weeks to produce functionally meaningful transfer of strength, and (5) crosseducation could be considered as an adjuvant treatment particularly for unilateral orthopedic conditions and sports injuries. Additionally, a clear gap in views emerged between the research field and the purely clinical field. The present consensus statement clarifies relevant aspects of cross-education including neurophysiological, neuroanatomical, and methodological characteristics of the transfer phenomenon, and provides guidance on how to improve the quality and usability of future cross-education studies.
1 Introduction An imposing body of evidence obtained under a variety of experimental conditions has demonstrated that unilateral motor practice improves the motor output in both the exercised and the unexercised homologous muscles [1, 2]. A wide range of terms have been used to describe this phenomenon, such as cross-education, interlimb transfer, contralateral effect, contralateral transfer, cross-transfer, and bilateral Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40279-020-01377-7) contains supplementary material, which is available to authorized users. * F. Deriu [email protected] Extended author information available on the last page of the article
transfer, etc. The most frequently used term is cr
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