Cross education: possible mechanisms for the contralateral effects of unilateral resistance training

Resistance training can be defined as the act of repeated voluntary muscle contractions against a resistance greater than those normally encountered in activities of daily living. Training of this kind is known to increase strength via adaptations in both the muscular and nervous systems. While the physiology of muscular adaptations following resistance training is well understood, the nature of neural adaptations is less clear. One piece of indirect evidence to indicate that neural adaptations accompany resistance training comes from the phenomenon of 'cross education', which describes the strength gain in the opposite, untrained limb following unilateral resistance training. Since its discovery in 1894, subsequent studies have confirmed the existence of cross education in contexts involving voluntary, imagined and electrically stimulated contractions. The cross-education effect is specific to the contralateral homologous muscle but not restricted to particular muscle groups, ages or genders. A recent meta-analysis determined that the magnitude of cross education is approximately equal to 7.8% of the initial strength of the untrained limb. While many features of cross education have been established, the underlying mechanisms are unknown. This article provides an overview of cross education and presents plausible hypotheses for its mechanisms. Two hypotheses are outlined that represent the most viable explanations for cross education. These hypotheses are distinct but not necessarily mutually exclusive. They are derived from evidence that high-force, unilateral, voluntary contractions can have an acute and potent effect on the efficacy of neural elements controlling the opposite limb. It is possible that with training, long-lasting adaptations may be induced in neural circuits mediating these crossed effects. The first hypothesis suggests that unilateral resistance training may activate neural circuits that chronically modify the efficacy of motor pathways that project to the opposite untrained limb. This may subsequently lead to an increased capacity to drive the untrained muscles and thus result in increased strength. A number of spinal and cortical circuits that exhibit the potential for this type of adaptation are considered. The second hypothesis suggests that unilateral resistance training induces adaptations in motor areas that are primarily involved in the control of movements of the trained limb. The opposite untrained limb may access these modified neural circuits during maximal voluntary contractions in ways that are analogous to motor learning. A better understanding of the mechanisms underlying cross education may potentially contribute to more effective use of resistance training protocols that exploit these cross-limb effects to improve the recovery of patients with movement disorders that predominantly affect one side of the body.