tendon rehabilitation exercise — the "eccentric squat" exercise or the universal gym "leg extension/leg curl" — produced more recovery results in terms of recovery in the treatment of chronic patellar tendonitis. On the twelve-week exercise program, participants were tested for thigh circumference and quadriceps and hamstring moment of force. There was no significant difference between the groups in either quadriceps or hamstring moment of force and hamstring moment of force significantly increased in both groups, but the eccentric squat saw significantly lower pain ratings and produced twice as many "pain free" subjects at the end of the program than the other group. Cardiovascular changes Several recent studies have indicated that eccentric exercise as in walking down hill has greater beneficial effects on insulin sensitivity, lipid profiles and physical fitness than walking up hill. One study used stairs and elevators and the other a mountain and a cable car. In both cases the cardiovascular improvements were greater for being lifted up and walking down that for walking up and being lowered down. See also Flywheel training Negative repetition References Sources Howlett K., T. Keniston, A. Grassl, A. Olsson, C. Eidem, and D.J. McCann, January 2011 [AN INITIAL ASSESSMENT OF THE METABOLIC COST OF USING THE QUADMILL ] Department of Exercise Science, Gonzaga University, Spokane, WA. Strength training