Maximal Voluntary Contraction Research Articles

Legendre Polynomial Fitting-Based Permutation Entropy Offers New Insights into the Influence of Fatigue on Surface Electromyography (sEMG) Signal Complexity.

In a recently published work, we introduced local Legendre polynomial fitting-based permutation entropy (LPPE) as a new complexity measure for quantifying disorder or randomness in time series. LPPE benefits from the ordinal pattern (OP) concept and incorporates a natural, aliasing-free multiscaling effect by design. The current work extends our previous study by investigating LPPE's capability to assess fatigue levels using both synthetic and real surface electromyography (sEMG) signals. Real sEMG signals were recorded during biceps brachii fatiguing exercise maintained at 70% of maximal voluntary contraction (MVC) until exhaustion and were divided into four consecutive temporal segments reflecting sequential stages of exhaustion. As fatigue levels rise, LPPE values can increase or decrease significantly depending on the selection of embedding dimensions. Our analysis reveals two key insights. First, using LPPE with limited embedding dimensions shows consistency with the literature. Specifically, fatigue induces a decrease in sEMG complexity measures. This observation is supported by a comparison with the existing multiscale permutation entropy (MPE) variant, that is, the refined composite downsampling (rcDPE). Second, given a fixed OP length, higher embedding dimensions increase LPPE's sensitivity to low-frequency components, which are notably present under fatigue conditions. Consequently, specific higher embedding dimensions appear to enhance the discrimination of fatigue levels. Thus, LPPE, as the only MPE variant that allows a practical exploration of higher embedding dimensions, offers a new perspective on fatigue's impact on sEMG complexity, complementing existing MPE approaches.

The effects of exercise, heat-induced hypo-hydration and rehydration on blood-brain-barrier permeability, corticospinal and peripheral excitability.

The effects of low-intensity exercise, heat-induced hypo-hydration and rehydration on maximal strength and the underlying neurophysiological mechanisms are not well understood. To assess this, 12 participants took part in a randomised crossover study, in a prolonged (3h) submaximal (60W) cycling protocol under 3 conditions: (i) in 45°C (achieving ~ 5% body mass reduction), with post-exercise rehydration in 2h (RHY2), (ii) with rehydration across 24h (RHY24), and (iii) a euhydrated trial in 25°C (CON). Dependent variables included maximal voluntary contractions (MVC), maximum motor unit potential (MMAX), motor evoked potential (MEPRAW) amplitude and cortical silent period (cSP) duration. Blood-brain-barrier integrity was also assessed by serum Ubiquitin Carboxyl-terminal Hydrolase (UCH-L1) concentrations. All measures were obtained immediately pre, post, post 2h and 24h. During both dehydration trials, MVC (RHY2: p < 0.001, RHY24: p = 0.001) and MEPRAW (RHY2: p = 0.025, RHY24: p = 0.045) decreased from pre- to post-exercise. MEPRAW returned to baseline during RHY2 and CON, but not RHY24 (p = 0.020). MEP/MMAX ratio decreased across time for all trials (p = 0.009) and returned to baseline, except RHY24 (p < 0.026). Increased cSP (p = 0.011) was observed during CON post-exercise, but not during RHY2 and RHY24. Serum UCH-L1 increased across time for all conditions (p < 0.001) but was not significantly different between conditions. Our findings demonstrate an increase in corticospinal inhibition after exercise with fluid ingestion, but a decrease in corticospinal excitability after heat-induced hypo-hydration. In addition, low-intensity exercise increases peripheral markers of blood-brain-barrier permeability.Kindly check and confirm inserted city name correctly identified in affiliation 7This is correct.

Upper extremity neuromuscular function can distinguish between individuals with and without glenohumeral labral repair

The purpose of this study was to determine whether common measures of neuromuscular function could distinguish injury status indicated by group membership (glenohumeral labral repair, uninjured controls). 16 individuals with glenohumeral labral repair (24.1 ± 5.0 years, 36.7 ± 33.3 months after surgery) and 14 uninjured controls (23.8 ± 2.7 years) volunteered. We measured mass-normalized shoulder abduction and wrist flexion maximal voluntary isometric contraction torque (Nm/kg), motoneuron pool excitability of the flexor carpi radialis (Hoffmann reflex), corticospinal excitability of the upper trapezius, middle deltoid, and flexor carpi radialis (active motor threshold [%]) bilaterally. Receiver operator characteristic curve analyses were performed to determine if each outcome could distinguish injury status along with their outcome thresholds. Binary logistic regression was used to determine the accuracy of classification for each outcome. Our results suggest shoulder abduction torque symmetry (≤95.5 %) and corticospinal excitability for the upper trapezius (≥41.0 %) demonstrated excellent diagnostic utility. Shoulder abduction torque (≤0.71 Nm/kg) and motoneuron pool excitability (≤0.23) demonstrated acceptable diagnostic utility. Shoulder abduction torque symmetry alone was the strongest indicator, and classified injury status with 90.0 % accuracy (p < 0.01). Overall, symmetric shoulder abduction strength most accurately distinguished individuals’ injury status, suggesting the utility of bilateral assessment in this population.

The effect of caffeine chewing gum on muscle performance and fatigue after severe-intensity exercise: isometric vs. dynamic assessments in trained cyclists.

This study investigated the effect of caffeinated chewing gum (GUMCAF) on muscle fatigue (isometric vs. dynamic) after severe-intensity cycling bouts. Fifteen trained male cyclists participated in four visits. Each visit involved two severe-intensity cycling bouts (Δ1 and Δ2) lasting 6min, separated by a 5-min recovery period. Muscle fatigue was assessed by isometric maximal voluntary knee extension contraction (IMVC) with twitch interpolation technique and dynamically by 7s all-out cycling sprints. Assessments were performed before GUMCAF (Pre-GUM) and after the cycling bouts (Post-Exercise). GUMCAF and placebo gum (GUMPLA) were administered in a randomized double-blind procedure with participants receiving each gum type (GUMCAF and GUMPLA) during two separate visits. The results showed no significant interaction between gum types and time for the isometric and dynamic measurements (p > 0.05). The percentage change in performance from Pre-GUM to Post-Exercise showed no significant difference between GUMCAF and GUMPLA for either the dynamic-derived TMAX (~ -17.8% and -15.1%, respectively; p = 0.551) or isometric IMVC (~ -12.3% and -17.7%, respectively; p = 0.091) measurements. Moderate to large correlations (r = 0.31-0.51) were found between changes in sprint maximal torque and maximal power output measurements and isometric force, for both gum conditions. GUMCAF was not effective in attenuating muscle force decline triggered by severe-intensity cycling exercises, as measured by both isometric and dynamic methods. The correlations between IMVC and cycling maximal torque and power output suggest caution when interpreting isometric force as a direct measure of fatigue during dynamic cycling exercises.

Acute normobaric hypoxia causes a rightward shift in the torque-frequency relationship but has no effect on postactivation potentiation.

Low fractions of inspired oxygen ([Formula: see text]; i.e., hypoxia) affect aspects of skeletal muscle contractility in humans, but it remains unclear if postactivation potentiation (PAP) and the torque-frequency (T-F) relationship are altered. We investigated the effects of 2 (H2) and 4 (H4) h of normobaric hypoxia ([Formula: see text] = 0.11 ± 0.47) on the magnitude of PAP of the knee extensors and the T-F relationship of the dorsiflexors in 13 and 12 healthy participants, respectively. To assess PAP, a resting twitch was evoked via femoral nerve stimulation before and 2-300 s after a 10-s maximal voluntary contraction (MVC). A T-F relationship was obtained by stimulating the common fibular nerve with a single pulse and 1-s trains between 5 and 100 Hz. During hypoxia, peripheral oxygen saturation decreased by ∼18% from 98.0 ± 0.8% at baseline (P < 0.001). MVC force and voluntary activation (VA) of the knee extensors were lower than baseline throughout hypoxia (e.g., ∼8% and ∼5%, respectively, at H2; P ≤ 0.027); however, the magnitude of PAP was not altered by hypoxia (P ≥ 0.711). Surprisingly, PAP did increase with time across the control day (P ≤ 0.012). MVC torque and VA of the dorsiflexors were unaffected by hypoxia (P ≥ 0.127), but the estimated frequency required to evoke 50% of 100 Hz torque increased by ∼1.2 Hz at H2 (P ≤ 0.021). These results imply that 2 h of normobaric hypoxia were sufficient to 1) impair neural drive to the knee extensors but not the mechanism(s) responsible for PAP and 2) lead to a rightward shift of the T-F relationship for the dorsiflexors.NEW & NOTEWORTHY Postactivation potentiation of the knee extensors was unaffected by 4 h of normobaric hypoxia exposure but may be confounded by hypoxia-related impairments to the conditioning contraction. In the dorsiflexors, contractile rates increased in hypoxia, which led to a rightward shift of the torque-frequency relationship, such that a higher frequency was required to obtain 50% of maximal torque. These results expand our understanding of the acute effects of hypoxia on skeletal muscle function.

The effects of sex and contraction intensity on fatigability and muscle oxygenation in trained individuals.

Fatigability varies depending on sex and contraction intensity during sustained exercise. This study examined the responses of time to task failure (TTF), performance fatigability (PF), and muscle oxygenation (SmO2) in males and females during isometric handgrip holds to failure (HTF) at 30% and 60% maximum voluntary isometric contraction (MVIC). Males (n=12) and females (n=12) performed a pre-MVIC, handgrip HTF at randomly ordered percentages of MVIC (either 30% or 60%), followed by a post-MVIC on the dominant arm. During the HTF testing, the TTF and SmO2 responses were recorded, and PF was determined from the pre- to post-MVICs. TTF for 30% MVIC HTF was greater than 60% MVIC HTF (p<0.001), but was not different between males and females (p=0.117). PF exhibited an inverse relationship with intensity for each sex, while males demonstrated greater PF than females for both 30% and 60% MVIC HTF. For the 60% MVIC HTF, males demonstrated greater desaturation than females (CI95% = [-28.1, -2.6%], p=0.021, d=0.621), but not for the 30% MVIC HTF (CI95% = [-12.2, 7.9%], p=0.315, d=0.621). Sex differences in PF and SmO2 may be attributed to the differences in muscle mass, absolute strength, contractile properties, and muscle metabolism between males and females. However, these proposed differences between males and females may not fully inform exercise performance (e.g., TTF). Sex-specific fatigue responses may be affected by complex physio-psychological mechanisms, and therefore, additional investigations under diverse exercise conditions are required to better prescribe exercise for both males and females.

The Effects of High-Intensity, Short-Duration and Low-Intensity, Long-Duration Hamstrings Static Stretching on Contralateral Limb Performance.

Increases in contralateral range of motion (ROM) have been shown following acute high-intensity and high-duration static stretching (SS) with no significant change in contralateral force, power, and muscle activation. There are currently no studies comparing the effects of a high-intensity, short-duration (HISD) or low-intensity, long-duration (LILD) SS on contralateral performance. The aim of this study was to examine how HISD and LILD SS of the dominant leg hamstrings influence contralateral limb performance. Sixteen trained participants (eight females, eight males) completed three SS interventions of the dominant leg hamstrings; (1) HISD (6 × 10 s at maximal point of discomfort), (2) LILD (6 × 30 s at initial point of discomfort), and (3) control. Dominant and non-dominant ROM, maximal voluntary isometric contraction (MVIC) forces, muscle activation (electromyography (EMG)), and unilateral CMJ and DJ heights were recorded pre-test and 1 min post-test. There were no significant contralateral ROM or performance changes. Following the HISD condition, the post-test ROM for the stretched leg (110.6 ± 12.6°) exceeded the pre-test (106.0 ± 9.0°) by a small magnitude effect of 4.2% (p = 0.008, d = 0.42). With LILD, the stretched leg post-test (112.2 ± 16.5°) exceeded (2.6%, p = 0.06, d = 0.18) the pre-test ROM (109.3 ± 16.2°) by a non-significant, trivial magnitude. There were large magnitude impairments, evidenced by main effects for testing time for force, instantaneous strength, and associated EMG. A significant ROM interaction (p = 0.02) showed that with LILD, the stretched leg significantly (p = 0.05) exceeded the contralateral leg by 13.4% post-test. The results showing no significant increase in contralateral ROM with either HISD or LILD SS, suggesting the interventions may not have been effective in promoting crossover effects.

Full-Body Harness versus Waist Belt: An Examination of Force Production and Pain during an Isoinertial Device Maximal Voluntary Isometric Contraction.

This study examined the differences in participant force production and pain between a squat maximal voluntary isometric contraction (IMVIC) performed with either a waist belt (WB) or full-body harness (FBH) on the Desmotec D.EVO isoinertial device (D.EVO). Agreement between FBH IMVIC and a traditional force plate squat MVIC (TMVIC) was also assessed. Twenty adults completed FBH, WB, and TMVIC assessments on two separate occasions. Two-way treatment x time ANOVAs were conducted to compare force outputs and pain between treatments (FBH vs. WB) across time. Test-retest reliability was assessed using intraclass correlation coefficients. Associations between outcomes were determined using Pearson's r. Standard error of estimate, constant error, total error, and Bland-Altman plots were used to assess agreement between IMVIC and TMVIC. FBH and WB IMVIC exhibited good to excellent reliability (ICC2,1 = 0.889-0.994) and strong associations (r = 0.813 and 0.821, respectively) when compared to TMVIC. However, agreement between FBH and TMVIC was poor. No significant interaction or main effects were observed for pain. FBH maximum isometric force (MIF) was significantly higher than WB MIF. WB IMVIC was the only significant predictor of TMVIC (R2 = 0.674). Our findings indicate that the D.EVO should not be utilized as a replacement for a traditional MVIC setup.

Effect of the ACTN3 R577X Polymorphism on Serum Creatine Kinase and Interleukin-6 Levels after Maximal Eccentric Exercise.

This study explored the interaction among ACTN3 R577X polymorphism, muscle damage, and post-exercise inflammatory response by assessing changes over time in serum creatine kinase and interleukin-6 levels. Ninety-five active Japanese participants (50 men and 45 women: 22.2 ± 2.3 years) who did not perform daily upper limb strength exercises were enrolled. Participants executed five sets of six maximal eccentric elbow flexion exercises. The exercise duration was 9 min, including rest between sets (90 s). Maximum voluntary isometric contraction, range of motion, muscle soreness, and serum creatine kinase and interleukin-6 levels were assessed pre and post and 1, 2, 3, and 5 d after exercise. Genotype groups were classified as RR + RX and XX based on the absence of ACTN3 expression. A significant time and group interaction (p = 0.045) on creatine kinase levels was observed between the groups, indicating that the absence of ACTN3 significantly affects creatine kinase changes. Conversely, no significant interaction on change in interleukin-6, maximum voluntary isometric contraction, range of motion, and muscle soreness was observed between groups. The results highlight an interaction on creatine kinase activity post-exercise by ACTN3 R577X polymorphism, with elevated activity in the XX genotype.

Peripheral chemoreflex restrains skeletal muscle blood flow during exercise in participants with treated hypertension.

We tested the hypothesis that in human hypertension, an increased tonicity/sensitivity of the peripheral chemoreflex causes a sympathetically mediated restraint of nutritive blood flow to the exercising muscles. Fourteen patients with treated hypertension (age 69±11 years, 136±12/80±11mmHg; mean±SD) were studied under conditions of intravenous 0.9% saline (control) and low-dose dopamine (2µgkg-1min-1) to inhibit the peripheral chemoreflex, at baseline, during isocapnic hypoxic rebreathing and during rhythmic handgrip exercise (3min, 50% maximum voluntary contraction). At baseline, dopamine did not change mean blood pressure (95±10 vs. 98±10mmHg, P=0.155) but increased brachial artery blood flow (59±20 vs. 48±16mlmin-1, P=0.030) and vascular conductance (0.565±0.246 vs. 0.483±0.160mlmin-1mmHg-1; P=0.039). Dopamine attenuated the increase in mean blood pressure (∆3±4 vs. ∆8 ±6mmHg, P=0.007) to isocapnic hypoxic rebreathing and reduced peripheral chemoreflex sensitivity by 28±37% (P=0.044). Rhythmic handgrip exercise induced increases in brachial artery blood flow and vascular conductance (both P<0.05 vs. rest after 45s) that were greater with dopamine than saline (e.g. Δ76±54 vs. Δ60±43mlmin-1 and Δ0.730±0.440 vs. Δ0.570±0.424mlmin-1mmHg-1, respectively, at 60s; main effect of condition both P<0.0001). Our results indicate that the peripheral chemoreflex is tonically active at rest and restrains the blood flow and vascular conductance increases to exercise in treated human hypertension. KEY POINTS: It was hypothesised that in human hypertension, an increased tonicity/sensitivity of the peripheral chemoreflex causes a sympathetically mediated restraint of nutritive blood flow to the exercising muscles. Treated patients with hypertension (n=14) were studied under conditions of intravenous 0.9% saline (control) and low-dose dopamine (2 µgkg-1min-1) to inhibit the peripheral chemoreflex. Low-dose dopamine reduced resting ventilation and peripheral chemoreflex sensitivity, and while mean blood pressure was unchanged, brachial artery blood flow and vascular conductance were increased. Low-dose dopamine augmented the brachial artery blood flow and vascular conductance responses to rhythmic handgrip. These findings indicate that the peripheral chemoreflex is tonically active at rest and restrains the blood flow, and vascular conductance increases to exercise in treated human hypertension.

Adults born preterm have lower peripheral skeletal muscle area and strength

Prematurity is associated with lower exercise capacity, which relies on the integrity of the cardiovascular, pulmonary, and skeletal muscle systems. Our animal model mimicking prematurity-associated conditions showed altered muscle composition and atrophy in adulthood. This study aimed to compare muscle composition and strength in adults born preterm versus full-term controls. This observational cohort study recruited 55 adults born preterm, ≤ 29 weeks’ of gestation and 53 full-term controls who underwent musculoskeletal ultrasound imaging to assess morphology of the rectus femoris at rest and during a maximal voluntary contraction. Maximal voluntary contraction of the hands and legs were measured by manual dynamometry. In adults born preterm, there was lower muscle strength (handgrip: − 4.8 kg, 95% CI − 9.1, − 0.6; knee extensor: − 44.6 N/m, 95% CI − 63.4, − 25.8) and smaller muscle area (− 130 mm2, 95% CI − 207, − 53), which was more pronounced with a history of bronchopulmonary dysplasia. Muscle stiffness was increased in the preterm versus term group (0.4 m/s, 95% CI 0.04, 0.7). Prematurity is associated with alterations in skeletal muscle composition, area, and function in adulthood. These findings highlight the necessity to implement preventive and/or curative approaches to improve muscle development and function following preterm birth to enhance overall health in this population.

Developing a real-time hand exoskeleton system that controlled by a hand gesture recognition system via wireless sensors

Numerous studies have been conducted using wearable sensors on gesture recognition and classification methods for the control of robotic arms, prostheses, and exoskeleton systems. The primary goal of this study is to classify 32 different hand gestures in real-time using electromyography (EMG) signals. EMG signals obtained by measuring the electrical activity of the muscles were simulated wirelessly on a hand exoskeleton. A Myo Armband placed on the upper arm was used to generate these signals for evaluating and validating the system. The signals were normalized according to maximum voluntary contraction (MVC), and relevant features such as MAV, STD, VAR, RMS, IEMG, ZC, and WL were selected using the univariate feature selection. A support vector machine (SVM) was then used for classification. The 32 different hand gestures were classified to an accuracy level of 99.9%. In short, this proposed approach can be effectively used in real-time hand gesture recognition and generating real-time actions for the hand exoskeleton system.

Influence of stimulation parameters on torque development during the combined application of electrical nerve stimulation and muscle lengthening.

This study investigated the influence of stimulation parameters on torque production when combining a brief muscle lengthening with electrical stimulation. Fifteen volunteers participated in one experimental session where two distinct stimulation modalities were compared: wide-pulse high-frequency (WPHF, pulse duration: 1ms, frequency: 100Hz), favouring afferent pathways activation, and narrow-pulse low-frequency (NPLF, pulse duration: 0.05ms, frequency: 20Hz), favouring activation of the efferent pathway. Both stimulation modalities, were applied to evoke 5-10% of maximal voluntary contraction either in isometric conditions (WPHF and NPLF) or in combination with a muscle lengthening (lengthening condition: WPHF+LEN and NPLF+LEN). The torque-time integral (TTI) during the stimulation trains and the muscle activity after the cessation of the stimulation trains (sustained EMG activity, normalized to the maximal EMG activity) were assessed and compared between the stimulation modalities and the conditions (two-way ANOVA). An interaction effect was obtained, revealing significant differences in TTI and sustained EMG activity between the WPHF+LEN and the other tested conditions (P=0.048 and P=0.044, respectively). TTI and sustained EMG activity were higher for WPHF+LEN (228.4±105.3 Nm.s and 0.085±0.070, respectively) compared to WPHF (168.4±72.9 Nm.s; 0.052±0.026), NPLF+LEN (136.4±38.9 Nm.s; 0.031±0.016) and NPLF (125.2±36.1 Nm.s; 0.028±0.015). The increased TTI during the WPHF+LEN condition suggests that the contribution of afferent pathways to the evoked torque can be enhanced with the muscle lengthening superimposition. They highlight the importance of using WPHF stimulation that already solicits Ia afferents to benefit from the cumulative afferent activation induced by the muscle lengthening to further increase torque production.

Descending motor drive does not interact with muscle metaboreflex for ventilation regulation during rhythmic exercise in healthy humans.

The muscle metaboreflex effect on pulmonary ventilation (V̇E) regulation is more apparent during rhythmic exercise than rest, possibly because this reflex interacts with other mechanisms regulating V̇E during voluntary contractions, such as central command. Therefore, we tested whether one part of central command, the descending component of motor execution (i.e., descending motor drive), and the muscle metaboreflex interact synergistically to regulate V̇E. Thirteen healthy adults (9 men) completed four experiments in random order under isocapnia. The muscle metaboreflex was activated by rhythmic handgrip exercise at 60% maximal voluntary contraction (MVC) force with the dominant hand. Then, the muscle metaboreflex remained active during a 4-minute recovery period via post-exercise circulatory occlusion (PECO), or it was inactivated, maintaining free blood flow to the dominant upper limb. During the last 2-minutes of the handgrip exercise recovery, participants either performed rhythmic voluntary plantar flexion with the dominant leg at 30% MVC torque to generate descending motor drive or the dominant leg's calf muscles were involuntarily activated by electrical stimulation at a similar torque level (i.e., without descending motor drive). V̇E increased to a similar level during handgrip exercise in all conditions (≈22 L/min, P = 0.364). PECO maintained V̇E elevated above recovery with free blood flow (≈17 L/min vs. ≈13 L/min, P = 0.009). However, voluntary and involuntary plantar flexion with or without PECO evoked similar V̇E responses (∆ ≈ 4 L/min, P = 0.311). Therefore, an interaction between descending motor drive and muscle metaboreflex is not ubiquitous for V̇E regulation during rhythmic exercise.

The effects of low vs. high rating of perceived exertion clamp exercise on performance, neuromuscular, and muscle oxygen saturation responses in females.

This study examined the time course of changes in force, relative to critical force (CF), electromyographic amplitude (EMG AMP), neuromuscular efficiency (NE), and muscle oxygen saturation (SmO2), as well as time to task failure (TTF) and performance fatigability (PF) during isometric handgrip holds to failure (HTF) anchored to the rating of perceived exertion (RPE) at 3 and 7. Ten females completed pre-test maximal voluntary isometric contractions (MVICs), submaximal HTF at four percentages of MVIC, an HTF at RPE = 3 and 7, and post-test MVICs. Analyses included paired samples t-tests, repeated measures ANOVAs and planned comparisons. TTF was not different between RPE 3 (540.4 ± 262.1s) and 7 (592.2 ± 299.6s), but PF for RPE 7 (42.1 ± 19.1%) was greater than RPE 3 (33.5 ± 15.4%) (p < 0.05). There were RPE-dependent decreases in force, EMG AMP, and NE across three discernable phases during the HTF (p < 0.01), but there were no significant changes in SmO2 across time. Although there were overall similar patterns across time for force, neuromuscular, and muscle metabolic responses between the RPE holds, the greater PF at RPE 7 than RPE 3 may be explained by the longer sustained time above CF at RPE 7, resulting in greater accumulation of intramuscular metabolites and afferent feedback. Throughout each trial, it is possible that force was adjusted to avoid the sensory tolerance limit, and the task was ended when force could no longer be reduced to maintain the assigned RPE, resulting in a similar TTF for RPE 7 and RPE 3.

Suspension training improves bilateral isometric strength asymmetry of knee muscles in people with multiple sclerosis

IntroductionMost people with multiple sclerosis are diagnosed with bilateral strength asymmetry in the lower limbs. Strength asymmetry increases muscle metabolic cost, muscle fatigability, postural instability, gait disturbance, imbalance, and risk of falling, and negatively affects the quality of life in PwMS. So far, the effects of rehabilitation exercises on reducing the asymmetric index in this population has not been studied convincingly. The purpose of this study was to investigate the effect of suspension exercise on bilateral isometric strength asymmetry of knee muscles in patients with multiple sclerosis. Materials & methodsIn this randomized controlled trial, twenty-seven female patients were purposively selected as the statistical sample and randomly divided into the control (n = 13, age: 34.72 ± 5.01 years) and exercise (n = 14, age: 37.62 ± 4.58 years) groups. The control group received routine care while the exercise group received the suspension exercise protocol. Isometric muscle strength and bilateral asymmetry were measured at baseline and after 8 weeks. The Biodex isokinetic dynamometer was used to measure the maximal voluntary isometric contraction of the flexor and extensor muscles of the knee. The analysis of covariance was used to analyze the data. ResultsThe isometric strength of the knee extensor muscles in the weak leg at the angle of 20° and in both legs at the angle of 70° in the exercise group improved significantly. Furthermore, the strength of the knee flexor muscles in the exercise group was increased. The amount of bilateral strength asymmetry in the knee flexor and extensor muscles at the angle of 70° significantly decreased in the exercise group. Discussions & conclusionsThese data suggest that suspension training is a practical approach to manage bilateral asymmetry in knee flexor and extensor muscle strength in patients with an EDSS of less than four.

A personalized clinical assessment: multi-sensor approach for understanding musculoskeletal health in the frail population

BackgroundSarcopenia is a muscle disorder causing a progressive reduction of muscle mass and strength, but the mechanism of its manifestation is still partially unknown. The three main parameters to assess are: muscle strength, muscle volume or quality and low physical performance. There is not a definitive approach to assess the musculoskeletal condition of frail population and often the available tests to be performed in those clinical bedridden patients is reduced because of physical impairments. In this paper, we propose a novel instrumental multi-domain and non-invasive approach during a well-defined protocol of measurements for overcoming these limitations. A group of 28 bedridden elder people, subjected to surgery after hip fracture, was asked to perform voluntary isometric contractions at the 80% of their maximum voluntary contraction with the non-injured leg. The sensor employed before and/or during the exercise were: ultrasound to determine the muscle architecture (vastus lateralis); force acquisition with a load cell placed on the chair, giving an indication of the muscle strength; surface electromyography (EMG) for monitoring muscular electrical activity; time-domain (TD) near-infrared spectroscopy (NIRS) for evaluating muscle oxidative metabolism.ResultsA personalized “report card” for each subject was created. It includes: the force diagram (both instantaneous and cumulative, expected and measured); the EMG–force diagram for a comparison between EMG derived median frequency and measured force; two graphs related to the hemodynamic parameters for muscle oxidative metabolism evaluation, i.e., oxy-, deoxy-, total-hemoglobin and tissue oxygen saturation for the whole exercise period. A table with the absolute values of the previous hemodynamic parameters during the rest and the ultrasound related parameters are also included.ConclusionsIn this work, we present the union of protocols, multi-domain sensors and parameters for the evaluation of the musculoskeletal condition. The novelties are the use of sensors of different nature, i.e., force, electrical and optical, together with a new way to visualize and combine the results, by means of a concise, exhaustive and personalized medical report card for each patient. This assessment, totally non-invasive, is focused on a bedridden population, but can be extended to the monitoring of rehabilitation progresses or of the training of athletes.

Consideration of absolute intensity when examining sex differences in blood pressure responses during static exercise.

Low- to moderate-intensity submaximal static contractions are commonly used to study the effects of biological sex on the cardiovascular response to exercise. Under this paradigm, premenopausal females frequently demonstrate smaller blood pressure responses than age-matched males. These differences are preserved during postexercise circulatory occlusion, implicating the muscle metaboreflex as an important driver of sex differences in the blood pressure response to static exercise. The mechanisms responsible for these differences are incompletely understood but often attributed to innate sex differences in skeletal muscle fiber type distribution, muscle metabolism, and/or sympathetic control of the circulation. However, one potential confounding factor is that the majority of studies use relative intensity exercise (e.g., 30% of maximal voluntary contraction), such that on average, females are completing static contractions at a lower absolute intensity. In this review, we summarize human evidence showing that sex differences in blood pressure responses to static exercise are attenuated or abolished when controlling for absolute intensity and muscle strength, either by statistical methods or strength-matched cohorts. We highlight evidence that the effect of higher absolute contraction intensity on exercise blood pressure likely occurs through increased mechanical occlusion of skeletal muscle microvasculature, leading to greater activation of the muscle metaboreflex. These findings highlight an important need to account for absolute intensity when studying and interpreting sex differences in cardiovascular responses to exercise.

Effects of minute oscillation stretching training on muscle and tendon stiffness and walking capability in people with type 2 diabetes.

we investigated the effects of a 10week training program (i.e., minute oscillatory stretching; MOS) on the mechanical responses and walking capability in people with type 2 diabetes (T2D). seventeen T2D patients performed maximum voluntary contractions of the plantar flexor muscles during which Achilles tendon stiffness (kT) and muscle-tendon stiffness (kM) were evaluated at different percentages of the maximum voluntary force (MVC). In addition, each participant was requested to walk at different walking speeds (i.e. 2, 3, 4, 5, and 6kmh-1) while their net energy cost of walking (Cnet), cumulative EMG activity per distance travelled (CMAPD) and kinematic parameters (step length, step frequency, the ankle/knee range of motion) were evaluated. maximum tendon elongation increased after MOS training, and kT significantly decreased (between 0 and 20% of MVC). No differences were observed for muscle elongation or kM after training. Cnet decreased after training (at the slowest tested speeds) while no changes in CMAPD were observed. Step length and ankle ROM during walking increased after training at the slowest tested speeds, while step frequency decreased; no significant effects were observed for knee ROM. these results indicate the effectiveness of 10weeks of MOS training in reducing tendon stiffness and the energy cost during walking in people with T2D. This training protocol requires no specific instrumentation, can be easily performed at home, and has a high adherence (92 ± 9%). It could, thus, be useful to mitigate mechanical tendon deterioration and improve physical behaviour in this population.

Characterizing Mechanical Changes in the Biceps Brachii Muscle in Mild Facioscapulohumeral Muscular Dystrophy Using Shear Wave Elastography.

There is no general consensus on evaluating disease progression in facioscapulohumeral muscular dystrophy (FSHD). Recently, shear wave elastography (SWE) has been proposed as a noninvasive diagnostic tool to assess muscle stiffness in vivo. Therefore, this study aimed to characterize biceps brachii (BB) muscle mechanics in mild-FSHD patients using SWE. Eight patients with mild FSHD, the BB were assessed using SWE, surface electromyography (sEMG), elbow moment measurements during rest, maximum voluntary contraction (MVC), and isometric ramp contractions at 25%, 50%, and 75% MVC across five elbow positions (60°, 90°, 120°, 150°, and 180° flexion). The mean absolute percentage deviation (MAPD) was analyzed as a measure of force control during ramp contractions. The shear elastic modulus of the BB in FSHD patients increased from flexed to extended elbow positions (e.g., p < 0.001 at 25% MVC) and with increasing contraction intensity (e.g., p < 0.001 at 60°). MAPD was highly variable, indicating significant deviation from target values during ramp contractions. SWE in mild FSHD is influenced by contraction level and joint angle, similar to findings of previous studies in healthy subjects. Moreover, altered force control could relate to the subjective muscle weakness reported by patients with dystrophies.