Less indication of muscle damage in the second than initial electrical muscle stimulation bout consisting of isometric contractions of the knee extensors

Estimation of the muscle force by perineural intramuscular electrical stimulation in healthy volunteers

The present study aimed to evaluate the elbow flexor force induced by perineural intramuscular stimulation compared with surface electrical stimulation (ES) and maximal voluntary contraction. Thirty nondominant arms of healthy volunteers were evaluated. Isometric elbow flexion force was evaluated using a surface electrode stimulation at the biceps brachii muscle, a perineural intramuscular stimulation around the musculocutaneous nerve, and maximum voluntary contraction. The elbow flexion force was measured at the wrist volar area in a 90° elbow flexion posture, fixed with a rigid elbow orthosis. Pain and discomfort associated with ES were evaluated using a numeric rating scale. The mean maximum elbow flexion force was 16.6 ± 4.1 kgf via voluntary contraction. The mean elbow flexion force by ES was 2.9 ± 2.0 kgf, stimulation intensity was 24.8 ± 5.5 mA, and the numeric rating scale was 5.0 ± 2.5 via surface electrode stimulation and 3.1 ± 2.0 kgf, 5.0 mA, and 3.8 ± 1.9 via perineural stimulation, respectively. ES provides 16% to 18% of the maximal voluntary contraction force in elbow flexion, which corresponds to a fair grade of muscle force. Perineural intramuscular stimulation can generate an equivocal contraction force with less discomfort in elbow flexion than surface electrode stimulation.

Sex hormone-mediated change on muscle activation deactivation dynamics in young eumenorrheic women

The goal of the study was to characterize muscle activation/deactivation dynamics across the menstrual cycle in healthy young women. Twenty-two healthy eumenorrheic women (age: 27.0 ± 4.4 years; mean ± SD) were tested every other day for one menstrual cycle. Serum estradiol and progesterone were quantified at the time of testing. Peak torque (PT), time to peak torque (TPT), and half relaxation time (HRT) of soleus muscle twitch were measured. Muscle twitch was elicited by delivering 1 ms width electrical pulses to the tibial nerve at an intensity that generated a maximum motor response (S-100) and at supramaximal intensity (S-120; 1.2 × S-100). The analyses were performed for each menstrual cycle phase: 1) the follicular phase to analyze the effect of estradiol while the progesterone concentrations remained at low concentrations; 2) the luteal phase to analyze the effect of progesterone with background estradiol concentrations. In the follicular phase, there was no association of estradiol for PT, TPT, and HRT. In the luteal phase, while estradiol had no association on PT, TPT, and HRT, progesterone expressed a significant association with HRT reduction but no association on PT or TPT. Also, there was a significant estradiol and progesterone interaction for HRT. However, the regression parameters are nearly zero, suggesting that the change in HRT may not have an impact on muscle performance across the menstrual cycle but implications on other women's health conditions with elevated sex hormone concentrations, such as pregnancy, may prove critical.

The effects of blood flow restriction resistance training on indices of delayed onset muscle soreness and peak power

BACKGROUND: Low-load resistance training with blood flow restriction (LL + BFR) attenuated delayed onset muscle soreness (DOMS) under some conditions. OBJECTIVE: The purpose of this study examined the effects of reciprocal concentric-only elbow flexion-extension muscle actions at 30% of peak torque on indices of DOMS. METHODS: Thirty untrained women (mean ± SD; 22 ± 2.4 years) were randomly assigned to 6 training days of LL + BFR (n= 10), low-load non-BFR (LL) (n= 10), or control (n= 10). Participants completed 4 sets (1 × 30, 3 × 15) of submaximal (30% of peak torque), unilateral, isokinetic (120∘s-1) muscle actions. Indices of DOMS including peak power, resting elbow joint angle (ROM), perceived muscle soreness (VAS), and pain pressure threshold (PPT) were assessed. RESULTS: There were no changes in peak power, ROM, or VAS. There was a significant interaction for PPT. Follow-up analyses indicated PPT increased for the LL + BFR condition (Day 5 > Day 2), but did not decrease below baseline. The results of the present study indicated LL + BFR and LL did not induce DOMS for the elbow extensors in previously untrained women. CONCLUSION: These findings suggested LL + BFR and LL concentric-only resistance training could be an effective training modality to elicit muscular adaptation without inducing DOMS.

Scientific Basis for Eccentric Quasi-Isometric Resistance Training: A Narrative Review

Oranchuk, DJ, Storey, AG, Nelson, AR, and Cronin, JB. The scientific basis for eccentric quasi-isometric resistance training: A narrative review. J Strength Cond Res 33(10): 2846-2859, 2019-Eccentric quasi-isometric (EQI) resistance training involves holding a submaximal, yielding isometric contraction until fatigue causes muscle lengthening and then maximally resisting through a range of motion. Practitioners contend that EQI contractions are a powerful tool for the development of several physical qualities important to health and sports performance. In addition, several sports involve regular quasi-isometric contractions for optimal performance. Therefore, the primary objective of this review was to synthesize and critically analyze relevant biological, physiological, and biomechanical research and develop a rationale for the value of EQI training. In addition, this review offers potential practical applications and highlights future areas of research. Although there is a paucity of research investigating EQIs, the literature on responses to traditional contraction types is vast. Based on the relevant literature, EQIs may provide a practical means of increasing total volume, metabolite build-up, and hormonal signaling factors while safely enduring large quantities of mechanical tension with low levels of peak torque. Conversely, EQI contractions likely hold little neuromuscular specificity to high velocity or power movements. Therefore, EQI training seems to be effective for improving musculotendinous morphological and performance variables with low injury risk. Although speculative due to the limited specific literature, available evidence suggests a case for future experimentation.

The effect of low level laser irradiation on oxidative stress, muscle damage and function following neuromuscular electrical stimulation. A double blind, randomised, crossover trial

BACKGROUND

Low level laser therapy (LLLT) is among novel methods for preventing and treating muscle damage and soreness induced by volitional exercise, but little is known about using LLLT before neuromuscular electrical stimulation. The aim of this first randomised, double blind, crossover trial addressing this issue was to evaluate effects of LLLT on muscle damage and oxidative stress, as well as recovery of muscle function after a single session of isometric neuromuscular electrical stimulation(NMES).

METHODS

Twenty four moderately active, healthy men aged 21-22 years received 45 electrically evoked tetanic, isometric contractions of the quadriceps femoris, preceded by LLLT or sham-LLLT. Maximal isometric voluntary muscle torques, perceived soreness, and blood samples were analysed from baseline to 96 h post intervention. We measured plasma markers of muscle damage (the activity of creatine kinase), and inflammation (C-reactive protein), and evaluated redox state parameters.

RESULTS

NMES-evoked contractions induced oxidative stress, demonstrated by an increase in lipid peroxidation and impairments in enzymatic antioxidant system. LLLT irradiations had a protective effect on NMES-induced decrease in enzymatic antioxidant defence and shortened the duration of inflammation. This effect of irradiations on redox state and inflammation did not affect lipid peroxidation, muscle damage, and muscle torque.

CONCLUSIONS

LLLT may protect from impairments in enzymatic antioxidant system and may shorten inflammation induced by a single NMES session in moderately active, healthy men. However, the effects of LLLT on redox state and inflammatory processes do not seem to affect muscle damage and recovery of muscle function after NMES.

TRIAL REGISTRATION

The study was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR); The trial registration number: ACTRN12619000678190; date of registration: 6 May 2019.

Activation of protein synthesis, regeneration, and MAPK signaling pathways following repeated bouts of eccentric cycling

The aim of this study was to examine the activation of skeletal muscle signaling pathways related to protein synthesis and the gene expression of regeneration/degradation markers following repeated bouts of eccentric cycling. Nine untrained men (25.4 ± 1.9 yr) performed two 30-min eccentric cycling bouts (ECC1, ECC2) at 85% of maximal concentric workload, separated by 2 wk. Muscle biopsies were taken from the vastus lateralis before and 2 h after each bout. Indirect markers of muscle damage were assessed before and 24-48 h after exercise. Changes in the Akt/mammalian target of rapamycin (mTOR)/rbosomal protein S6 kinase 1 (S6K1)/ribosomal protein S6 (rpS6) and MAPK signaling pathways were measured by Western blot and changes in mRNA expression of IL-6 and IL-1β, and myogenic regulatory factors (MRFs) were measured by real-time PCR. ECC1 induced greater increases in indirect markers of muscle damage compared with ECC2. Phosphorylation of S6K1 and rpS6 increased after both exercise bouts (P < 0.05), whereas phosphorylation of mTOR increased after ECC2 only (P = 0.03). Atrogin-1 mRNA expression decreased after ECC1 and ECC2 (P < 0.05) without changes in muscle RING-finger protein-1 mRNA. Basal mRNA levels of myoblast determination protein-1 (MyoD), MRF4, and myogenin were higher 2 wk after ECC1 (P < 0.05). MRF4 mRNA increased after ECC1 and ECC2 (P < 0.05), whereas MyoD mRNA expression increased only after ECC1 (P = 0.03). Phosphorylation of JNK and p38 MAPK increased after both exercise bouts (P < 0.05), similar to IL-6 and IL-1β mRNA expression. All together, these results suggest that differential regulation of the mTOR pathway and MRF expression could mediate the repeated bout effect observed between an initial and secondary bout of eccentric exercise.

(Whole-Body) Electromyostimulation, Muscle Damage, and Immune System: A Mini Review

Exercise-induced muscular damage (EIMD) is a well-known phenomenon in exercise medicine that is closely related to the type and intensity of training, with especially eccentric training content providing various physiological irritations, including mechanical as well as metabolic. Besides the increase in markers of muscular damage, such as creatine kinase (CK) and myoglobin (Mb), several physiological shifts trigger a kind of stepwise repair chain reactions lasting over a time course from several hours to days. Subsequent inflammatory processes are closely related to muscular damage with decisive influence on physiological repair mechanisms, as indicated by an increased invasion of immune cells and typical patterns of pro- and anti-inflammatory cytokines. Previously, whole-body electromyostimulation (WB-EMS) showed significant, partly extreme distractions in markers of muscular damage lasting over several days. Because of the large area of stimulated muscle mass and a relatively high proportion of eccentric movements, initially too intense WB-EMS is predisposed to produce serious changes on several physiological levels due to its unfamiliar muscular strain. Therefore, it is the aim of this short review to focus on the possible immunological side effects of this aspiring training technology. As the number of original investigations in this field is rather small, we will include data from other studies about the relation of exercise-induced muscle damage and immune regulation.

Rating of Perceived Exertion During Concentric and Eccentric Cycling: Are We Measuring Effort or Exertion?

Despite the terms' often being used interchangeably, it has been suggested that perceptions of effort and perceptions of exertion may differ. Eccentric (ECC) cycling may provide a model of exercise by which differences between these perceptions can be examined.

PURPOSE

To examine and compare perceptions of effort and exertion during ECC and concentric (CONC) cycling at 4 intensities.

METHODS

Ten healthy male participants (mean [SD]: age = 29.8 [2.3] y) performed an incremental cycling test for the determination of maximal aerobic power output, followed in a randomized and crossover design, by four 5-min bouts (30%, 60%, 80%, and maximal) of either ECC or CONC cycling. Through each bout, participants were asked to report their perceived effort, exertion, and muscle pain. Heart rate and oxygen consumption were continuously recorded throughout each bout.

RESULTS

Perceived exertion was greater for CONC at 30% (8.5 [1.5] vs 7.1 [1.8]; P = .01), 60% (12.4 [1.4] vs 10.3 [2.0]; P = .01), 80% (15.8 [1.7] vs 12.4 [2.5]; P < .01), and maximal (17.2 [1.3] vs 15.6 [1.8]; P = .03) in comparison with ECC. Perceptions of effort and pain were similar between CONC and ECC. Heart rate and oxygen consumption were greater during CONC than ECC.

CONCLUSIONS

Perceived exertion was greater during CONC compared with ECC cycling, yet effort was similar between conditions despite different physiological stress. Such findings have implications for understanding the development of such perceptions during exercise.

Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study

Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the study. Results A significant improvement of exercise capacity (Δ peak oxygen uptake+15% in exercise training group and +14% in exercise training + electrical myostimulation group) and of quality of life was observed in both groups without statistically significant differences between the two groups. Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group. Conclusions This prospective multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant additional improvement in exercise capacity in cardiac heart failure patients.

Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on the decline and recovery of muscle force

BACKGROUND

Neuromuscular electrical stimulation (NMES) is commonly used to activate skeletal muscles and reverse muscle atrophy in clinical populations. Clinical recommendations for NMES suggest the use of short pulse widths (100-200 μs) and low-to-moderate pulse frequencies (30-50 Hz). However, this type of NMES causes rapid muscle fatigue due to the (non-physiological) high stimulation intensities and non-orderly recruitment of motor units. The use of both wide pulse widths (1000 μs) and tendon vibration might optimize motor unit activation through spinal reflex pathways and thus delay the onset of muscle fatigue, increasing muscle force and mass. Thus, the objective of this study was to examine the acute effects of patellar tendon vibration superimposed onto wide-pulse width (1000 μs) knee extensor electrical stimulation (NMES, 30 Hz) on peak muscle force, total impulse before "muscle fatigue", and the post-exercise recovery of muscle function.

METHODS

Tendon vibration (Vib), NMES (STIM) or NMES superimposed onto vibration (STIM + Vib) were applied in separate sessions to 16 healthy adults. Total torque-time integral (TTI), maximal voluntary contraction torque (MVIC) and indirect measures of muscle damage were tested before, immediately after, 1 h and 48 h after each stimulus.

RESULTS

TTI increased (145.0 ± 127.7%) in STIM only for "positive responders" to the tendon vibration (8/16 subjects), but decreased in "negative responders" (-43.5 ± 25.7%). MVIC (-8.7%) and rectus femoris electromyography (RF EMG) (-16.7%) decreased after STIM (group effect) for at least 1 h, but not after STIM + Vib. No changes were detected in indirect markers of muscle damage in any condition.

CONCLUSIONS

Tendon vibration superimposed onto wide-pulse width NMES increased TTI only in 8 of 16 subjects, but reduced voluntary force loss (fatigue) ubiquitously. Negative responders to tendon vibration may derive greater benefit from wide-pulse width NMES alone.

Motor adaptations to unilateral quadriceps fatigue during a bilateral pedaling task

This study was designed to investigate how motor coordination adapts to unilateral fatigue of the quadriceps during a constant-load bilateral pedaling task. We first hypothesized that this local fatigue would not be compensated within the fatigued muscles leading to a decreased knee extension power. Then, we aimed to determine whether this decrease would be compensated by between-joints compensations within the ipsilateral leg and/or an increased contribution of the contralateral leg. Fifteen healthy volunteers were tested during pedaling at 350 W before and after a fatigue protocol consisting of 15 minutes of electromyostimulation on the quadriceps muscle. Motor coordination was assessed from myoelectrical activity (22 muscles) and joint powers calculated through inverse dynamics. Maximal knee extension torque decreased by 28.3%±6.8% (P<.0005) immediately after electromyostimulation. A decreased knee extension power produced by the ipsilateral leg was observed during pedaling (-22.8±12.3 W, -17.0%±9.4%; P<.0005). To maintain the task goal, participants primarily increased the power produced by the non-fatigued contralateral leg during the flexion phase. This was achieved by an increase in hip flexion power confirmed by a higher activation of the tensor fascia latae. These results suggest no adjustment of neural drive to the fatigued muscles and demonstrate no concurrent ipsilateral compensation by the non-fatigued muscles involved in the extension pedaling phase. Although interindividual variability was observed, findings provide evidence that participants predominantly adapted by compensating with the contralateral leg during its flexion phase. Both neural (between legs) and mechanical (between pedals) couplings and the minimization of cost functions might explain these results.

Can the Use of Neuromuscular Electrical Stimulation Be Improved to Optimize Quadriceps Strengthening?

CONTEXT

Neuromuscular electrical stimulation (NMES) is a common modality used to retrain muscles and improve muscular strength after injury or surgery, particularly for the quadriceps muscle. There are parameter adjustments that can be made to maximize the effectiveness of NMES. While NMES is often used in clinical practice, there are some limitations that clinicians should be aware of, including patient discomfort, muscle fatigue, and muscle damage.

EVIDENCE ACQUISITION

PubMed was searched through August 2014 and all articles cross-referenced.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 3.

RESULTS

Clinicians can optimize torque production and decrease discomfort by altering parameter selection (pulse duration, pulse frequency, duty cycle, and amplitude). Pulse duration of 400 to 600 μs and a pulse frequency of 30 to 50 Hz appear to be the most effective parameters to optimize torque output while minimizing discomfort, muscle fatigue, or muscle damage. Optimal electrode placement, conditioning programs, and stimulus pattern modulation during long-term NMES use may improve results.

CONCLUSION

Torque production can be enhanced while decreasing patient discomfort and minimizing fatigue.

Time course of central and peripheral alterations after isometric neuromuscular electrical stimulation-induced muscle damage

Isometric contractions induced by neuromuscular electrostimulation (NMES) have been shown to result in a prolonged force decrease but the time course of the potential central and peripheral factors have never been investigated. This study examined the specific time course of central and peripheral factors after isometric NMES-induced muscle damage. Twenty-five young healthy men were subjected to an NMES exercise consisting of 40 contractions for both legs. Changes in maximal voluntary contraction force of the knee extensors (MVC), peak evoked force during double stimulations at 10 Hz (Db₁₀) and 100 Hz (Db₁₀₀), its ratio (10∶100), voluntary activation, muscle soreness and plasma creatine kinase activity were assessed before, immediately after and throughout four days after NMES session. Changes in knee extensors volume and T₂ relaxation time were also assessed at two (D2) and four (D4) days post-exercise. MVC decreased by 29% immediately after NMES session and was still 19% lower than the baseline value at D4. The decrease in Db₁₀ was higher than in Db₁₀₀ immediately and one day post-exercise resulting in a decrease (−12%) in the 10∶100 ratio. On the contrary, voluntary activation significantly decreased at D2 (−5%) and was still depressed at D4 (−5%). Muscle soreness and plasma creatine kinase activity increased after NMES and peaked at D2 and D4, respectively. T₂ was also increased at D2 (6%) and D4 (9%). Additionally, changes in MVC and peripheral factors (e.g., Db₁₀₀) were correlated on the full recovery period, while a significant correlation was found between changes in MVC and VA only from D2 to D4. The decrease in MVC recorded immediately after the NMES session was mainly due to peripheral changes while both central and peripheral contributions were involved in the prolonged force reduction. Interestingly, the chronological events differ from what has been reported so far for voluntary exercise-induced muscle damage.

Metabolic and muscle damage profiles of concentric versus repeated eccentric cycling

PURPOSE

Eccentric cycling is an exercise modality that could elicit multiple health benefits with low metabolic cost, but unaccustomed performance results in significant muscle damage. It is not known whether muscle damage is attenuated when eccentric cycling is repeated; thus, this study compared metabolic and muscle damage responses to concentric (CONC) and two consecutive eccentric (ECC1 and ECC2) cycling bouts.

METHODS

Ten men (28 ± 8 yr) performed each cycling bout for 30 min at 60% of the maximal concentric power output at 60 rpm, with 2 wk between bouts. HR, oxygen consumption (V˙O2), blood lactate (BLa), RPE, and muscle activity (EMG) data were collected during cycling. Maximal voluntary isometric knee extensor (MVC) strength, squat (SJ), countermovement jump (CMJ) height, muscle soreness indicators, and plasma creatine kinase (CK) activity were measured before, immediately after, and 1-4 d after exercise.

RESULTS

Average HR, V˙O2, BLa, and RPE were lower (P < 0.05) during ECC1 than CONC, and EMG amplitude was also lower during ECC1 than CONC. Decreases in MVC, CMJ, and SJ and the increase in muscle soreness were greater (P x0003C; 0.05) after ECC1 than CONC. Increases in creatine kinase were minimal after all bouts. When comparing ECC1 and ECC2, HR and BLa were lower (P < 0.05) during ECC2 than ECC1, and decreases in MVC, CMJ, and SJ and the increase in muscle soreness were greater (P < 0.05) after ECC1 than ECC2. After ECC2, MVC, CMJ, and SJ did not change and no muscle soreness was developed.

CONCLUSIONS

Eccentric cycling was less metabolically demanding than concentric cycling, and HR and BLa were further reduced during ECC2. Muscle damage is minimal after ECC2 and should not influence the choice to undertake eccentric cycling training.

Protection against muscle damage induced by electrical stimulation: efficiency of a preconditioning programme

PURPOSE

The aim of this study was to explore the efficiency of a preconditioning programme composed of neuromuscular electrical stimulation (NMES) in the protection against muscle damage induced by a subsequent bout of NMES.

METHODS

Sixteen male volunteers were split up into a control group (CG; n = 8) and a preconditioned group (PCG; n = 8). Both groups attended two NMES bouts (test 1 and test 2) spaced 5 weeks apart. Each one consisted in 100 quadriceps contractions and 100 hamstrings contractions. PCG attended five additional progressive NMES sessions between test 1 and test 2. The outcome measures were the changes in muscle soreness [0-10 pain score on visual analogue pain scale (VAS)], muscle flexibility and serum creatine kinase (CK) activity; they were assessed before (pre-T1) and after (post-T1) test 1 and before (pre-T2) and after (post-T2) test 2.

RESULTS

Damage markers increased similarly in both groups after test 1 (at post-T1, VAS scores = 4·18 ± 2 and 4·43 ± 1·56 cm in CG and PCG, respectively; CK activity = 2307 ± 3774 and 1671 ± 1790 IU l(-1) in CG and PCG, respectively). Compared with test 1, these damage markers were reduced after test 2 in CG (at post-T2, VAS score = 2·68 ± 1·27 cm and CK activity = 218 ± 72 IU l(-1) ). Muscle soreness was further reduced after test 2 in PCG (VAS score = 0·37 ± 0·74 cm).

CONCLUSIONS

A protective effect against muscle damage can be obtained after only one NMES bout, and an additional protective effect can be induced by a preconditioning programme.

Comparison in muscle damage between maximal voluntary and electrically evoked isometric contractions of the elbow flexors

This study compared between maximal voluntary (VOL) and electrically stimulated (ES) isometric contractions of the elbow flexors for changes in indirect markers of muscle damage to investigate whether ES would induce greater muscle damage than VOL. Twelve non-resistance-trained men (23-39 years) performed VOL with one arm and ES with the contralateral arm separated by 2 weeks in a randomised, counterbalanced order. Both VOL and ES (frequency 75 Hz, pulse duration 250 μs, maximally tolerated intensity) exercises consisted of 50 maximal isometric contractions (4-s on, 15-s off) of the elbow flexors at a long muscle length (160°). Changes in maximal voluntary isometric contraction torque (MVC), range of motion, muscle soreness, pressure pain threshold and serum creatine kinase (CK) activity were measured before, immediately after and 1, 24, 48, 72 and 96 h following exercise. The average peak torque over the 50 isometric contractions was greater (P < 0.05) for VOL (32.9 ± 9.8 N m) than ES (16.9 ± 6.3 N m). MVC decreased greater and recovered slower (P < 0.05) after ES (15% lower than baseline at 96 h) than VOL (full recovery). Serum CK activity increased (P < 0.05) only after ES, and the muscles became more sore and tender after ES than VOL (P < 0.05). These results showed that ES induced greater muscle damage than VOL despite the lower torque output during ES. It seems likely that higher mechanical stress imposed on the activated muscle fibres, due to the specificity of motor unit recruitment in ES, resulted in greater muscle damage.

Sequenced response of extracellular matrix deadhesion and fibrotic regulators after muscle damage is involved in protection against future injury in human skeletal muscle

The purpose of this study was to test the hypothesis that remodeling of skeletal muscle extracellular matrix (ECM) is involved in protecting human muscle against injury. Biopsies were obtained from medial gastrocnemius muscles after a single bout of electrical stimulation (B) or a repeated bout (RB) 30 d later, or 30 d after a single stimulation bout (RBc). A muscle biopsy was collected from the control leg for comparison with the stimulated leg. Satellite cell content, tenascin C, and muscle regeneration were assessed by immunohistochemistry; real-time PCR was used to measure mRNA levels of collagens, laminins, heat-shock proteins (HSPs), inflammation, and related growth factors. The large responses of HSPs, CCL2, and tenascin C detected 48 h after a single bout were attenuated in the RB trial, indicative of protection against injury. Satellite cell content and 12 target genes, including IGF-1, were elevated 30 d after a single bout. Among those displaying the greatest difference vs. control muscle, ECM laminin-β1 and collagen types I and III were elevated ∼6- to 9-fold (P<0.001). The findings indicate that the sequenced events of load-induced early deadhesion and later strengthening of skeletal muscle ECM play a role in protecting human muscle against future injury.

Effects of a single bout of isometric neuromuscular electrical stimulation on rat gastrocnemius muscle: a combined functional, biochemical and MRI investigation

While muscle damage resulting from electrically-induced muscle isometric contractions has been reported in humans, animal studies have failed to illustrate similar deleterious effects and it remains to be determined whether these conflicting results are related to differences regarding experimental procedures or to species. We have investigated in vivo, in rat gastrocnemius muscles, using experimental conditions as close as possible to those used in humans (i.e., muscle length, number of contractions, stimulated muscle), the effects of a single bout of neuromuscular electrical stimulation (NMES). Maximal tetanic force was measured before, immediately after and 1h and 1, 2, 3, 7 and 14 days after NMES. Magnetic resonance imaging measurements, including volume of gastrocnemius muscles and proton transverse relaxation time (T(2)) were performed at baseline and 3, 7, and 14 days after the NMES session. Control animals did not perform any exercise and measurements were recorded at the same time points. For both groups, blood creatine kinase (CK) activity was measured within the first 3 days that followed the initial evaluation. Maximal tetanic force decreased immediately after NMES whereas measurements performed 1h and the days afterwards were similar to the baseline values. CK activity, muscle volume and T(2) values were similar throughout the experimental protocol between the two groups. Under carefully controlled experimental conditions, isometric NMES per se did not induce muscle damage in rat gastrocnemius muscles on the contrary to what has been repeatedly reported in humans. Further experiments would then be warranted in order to clearly delineate these differences and to better understand the physiological events associated with muscle damage resulting from NMES-induced isometric contractions.

Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis

The aim of the present study was to define the chronic effects of neuromuscular electrical stimulation (NMES) on the neuromuscular properties of human skeletal muscle. Eight young healthy male subjects were subjected to 25 sessions of isometric NMES of the quadriceps muscle over an 8-wk period. Needle biopsies were taken from the vastus lateralis muscle before and after training. The training status, myosin heavy chain (MHC) isoform distribution, and global protein pattern, as assessed by proteomic analysis, widely varied among subjects at baseline and prompted the identification of two subgroups: an "active" (ACT) group, which performed regular exercise and had a slower MHC profile, and a sedentary (SED) group, which did not perform any exercise and had a faster MHC profile. Maximum voluntary force and neural activation significantly increased after NMES in both groups (+∼30% and +∼10%, respectively). Both type 1 and 2 fibers showed significant muscle hypertrophy. After NMES, both groups showed a significant shift from MHC-2X toward MHC-2A and MHC-1, i.e., a fast-to-slow transition. Proteomic maps showing ∼500 spots were obtained before and after training in both groups. Differentially expressed proteins were identified and grouped into functional categories. The most relevant changes regarded 1) myofibrillar proteins, whose changes were consistent with a fast-to-slow phenotype shift and with a strengthening of the cytoskeleton; 2) energy production systems, whose changes indicated a glycolytic-to-oxidative shift in the metabolic profile; and 3) antioxidant defense systems, whose changes indicated an enhancement of intracellular defenses against reactive oxygen species. The adaptations in the protein pattern of the ACT and SED groups were different but were, in both groups, typical of both resistance (i.e., strength gains and hypertrophy) and endurance (i.e., a fast-to-slow shift in MHC and metabolic profile) training. These training-induced adaptations can be ascribed to the peculiar motor unit recruitment pattern associated with NMES.

Comparison between alternating and pulsed current electrical muscle stimulation for muscle and systemic acute responses

This study compared alternating current and pulsed current electrical muscle stimulation (EMS) for torque output, skin temperature ( Tsk), blood lactate and hormonal responses, and skeletal muscle damage markers. Twelve healthy men (23–48 yr) received alternating current EMS (2.5 kHz delivered at 75 Hz, 400 μs) for the knee extensors of one leg and pulsed current (75 Hz, 400 μs) for the other leg to induce 40 isometric contractions (on-off ratio 5–15 s) at the knee joint angle of 100° (0°: full extension). The use of the legs for each condition was counterbalanced among subjects, and the two EMS bouts were separated by 2 wk. The current amplitude was consistently increased to maximally tolerable level, and the torque and perceived intensity were recorded over 40 isometric contractions. Tskof the stimulated and contralateral knee extensors were measured before, during, and for 30 min after EMS. Blood lactate, growth hormone, testosterone, insulin-like growth factor 1, testosterone, and cortisol were measured before, during, and for 45 min following EMS. Muscle damage markers included maximal voluntary isometric contraction torque, muscle soreness with a 100-mm visual analog scale, and plasma creatine kinase (CK) activity, which were measured before and 1, 24, 48, 72, and 96 h after EMS. No significant differences in the torque induced during stimulation (∼30% maximal voluntary isometric contraction) and perceived intensity were found, and changes in Tsk, blood lactate, and hormones were not significantly different between conditions. However, all of the measures showed significant ( P < 0.05) changes from baseline values. Skeletal muscle damage was evidenced by prolonged strength loss, development of muscle soreness, and increases in plasma CK activity; however, the changes in the variables were not significantly different between conditions. It is concluded that acute effects of alternating and pulsed current EMS on the stimulated muscles are similar.