Regional differences in blood flow, glucose uptake and fatty acid uptake within quadriceps femoris muscle during dynamic knee-extension exercise

In vivo imaging of glycogen in human muscle

Probing regional glycogen metabolism in humans non-invasively has been challenging due to a lack of sensitive approaches. Here we studied human muscle glycogen dynamics post-exercise with a spatial resolution of millimeters and temporal resolution of minutes, using relayed nuclear Overhauser effect (glycoNOE) MRI. Data at 5T showed a homogeneous distribution of glycogen in resting muscle, with an average concentration of 99 ± 13 mM. After plantar flexion exercise following fasting with recovery under fasting conditions, the calf muscle showed spatially heterogeneous glycogen depletion and repletion kinetics that correlated with the severity of this depletion. Three types of regional glycogen kinetics were observed: (i) single exponential repletion (type a); (ii) biphasic recovery of rapid repletion followed by additional depletion (type b); (iii) biphasic recovery where continued depletion is followed by an exponential recovery (type c). The study of the complex patterns of glycogen kinetics suggests that glycogen breakdown may be quantitatively important during the initial recovery.

Contribution of skeletal muscle and serum lipids to muscle contraction induced by neuromuscular electrical stimulation in older individuals

Intramyocellular lipids (IMCL) stored in droplets in muscle cells and free fatty acids (FFA) from fat cells in the blood are the main substrates of adenosine triphosphate during continuous muscle contractions of relatively lower intensity. Although it is known that the lipid oxidative capacity decreases with aging, the effect of IMCL and FFA on muscle contraction in older individuals remains unclear. The purpose of this study was to investigate the contribution of skeletal muscle lipids and blood lipids as energy sources for muscle contraction in older individuals. Eighteen older individuals (mean age: 70.4 ± 3.5 years) underwent muscle contraction intervention induced by intermittent neuromuscular electrical stimulation (NMES) to the vastus lateralis for 30 min. Fasting blood samples were obtained and proton magnetic resonance spectroscopy (1 H-MRS) was performed before and after NMES, and the parameters (including IMCL and extramyocellular lipid [EMCL]) from 1 H-MRS, along with FFA and adiponectin levels, were analyzed using the blood samples of all participants. Levels of IMCL and EMCL did not change (p > 0.05); however, FFA and adiponectin levels decreased from 1.1 ± 0.5 mEq/L to 0.8 ± 0.2 mEq/L and 12.0 ± 5.3 μg/ml to 11.4 ± 5.0 μg/ml, after NMES (p < 0.05), respectively. These findings indicate that serum lipids, but not skeletal muscle lipids, are the energy substrate utilized during involuntary muscle contraction in older individuals.

Muscle deoxygenation and neuromuscular activation in synergistic muscles during intermittent exercise under hypoxic conditions

The purpose of this study was to elucidate the effects of hypoxia on deoxygenation and neuromuscular activation in synergistic quadriceps femoris (QF) muscles (i.e., the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis) during submaximal intermittent knee extension. Ten healthy men performed isometric intermittent knee extension exercises with the right leg at 50% of maximal voluntary contraction for 3 min while inhaling a normoxic [inspired oxygen (O₂) fraction = 0.21] or hypoxic (inspired O₂ fraction = 0.10–0.12) gas mixture. Muscle deoxygenation was measured by tissue O₂ saturation (StO₂), and neuromuscular activation by root mean square (RMS) of the surface electromyographic signals, from individual muscles of the QF using near-infrared spectroscopy and surface electromyography. StO₂ was decreased more in hypoxia than normoxia during the exercises, and there was a greater increase in RMS during intermittent knee extension in hypoxia than normoxia in individual muscles of the QF. There were no differences in the ratios of StO₂ and RMS in hypoxia compared with normoxia between individual muscles of the QF. These findings suggest that submaximal, isometric, and intermittent exercises in hypoxic conditions enhanced muscle oxygen consumption and muscle activity similarly for synergistic muscles.

Symmetry and spatial distribution of muscle glucose uptake in the lower limbs during walking measured using FDG-PET

Purpose

This study aimed to elucidate whether muscle activity (in terms of glucose uptake) between the legs can be considered symmetrical during walking. Furthermore, we aimed to determine whether the [¹⁸F]-fluorodeoxyglucose was distributed heterogeneously throughout each muscle, and if so, whether areas of high uptake would be clustered.

Methods

Ten healthy participants walked on a treadmill at self-selected comfortable walking speed for a total of 90 minutes, 60 minutes before and 30 minutes after intravenous injection of 50 MBq [¹⁸F]-fluorodeoxyglucose. Thereafter, a positron emission tomography/computed tomography scan of the lower limb was acquired. Three-dimensional muscle contours of 78 (= 39x2) muscles of the left and right lower limb were semi-automatically determined from magnetic resonance imaging scans. After non-rigid registration, those muscle contours were used to extract [¹⁸F]-fluorodeoxyglucose uptake from the positron emission tomography scans.

Results

Large asymmetries were observed in the lower leg muscles (e.g. median absolute asymmetry index of 42% in the gastrocnemius medialis) and in the gluteus minimus (30% asymmetry) and gluteus medius (15% asymmetry), whereas the uptake in the thighs was relatively symmetrical between the limbs (<6% asymmetry). These were not related to limb-dominance nor to inter-limb differences in muscle volume. The [¹⁸F]-fluorodeoxyglucose distribution was not distributed normally; most voxels had a relatively low standardized uptake value, and a minority of voxels had a relatively high standardized uptake value. The voxels with higher [¹⁸F]-fluorodeoxyglucose uptake were distributed heterogeneously; they were clustered in virtually all muscles.

Conclusion

The findings in this study challenge the common assumption of symmetry in muscle activity between the limbs in healthy subjects. The clustering of voxels with high uptake suggests that even in this prolonged repetitive task, different spatial regions of muscles contribute differently to walking than others.

Methods for the determination of skeletal muscle blood flow: development, strengths and limitations

Since the first measurements of limb blood flow at rest and during nerve stimulation were conducted in the late 1800s, a number of methods have been developed for the determination of limb and skeletal muscle blood flow in humans. The methods, which have been applied in the study of aspects such as blood flow regulation, oxygen uptake and metabolism, differ in terms of strengths and degree of limitations but most have advantages for specific settings. The purpose of this review is to describe the origin and the basic principles of the methods, important aspects and requirements of the procedures. One of the earliest methods, venous occlusion plethysmography, is a noninvasive method which still is extensively used and which provides similar values as other more direct blood flow methods such as ultrasound Doppler. The constant infusion thermodilution method remains the most appropriate for the determination of blood flow during maximal exercise. For resting blood flow and light-to-moderate exercise, the non-invasive ultrasound Doppler methodology, if handled by a skilled operator, is recommendable. Positron emission tomography with radiolabeled water is an advanced method which requires highly sophisticated equipment and allows for the determination of muscle-specific blood flow, regional blood flows and estimate of blood flow heterogeneity within a muscle. Finally, the contrast-enhanced ultrasound method holds promise for assessment of muscle-specific blood flow, but the interpretation of the data obtained remains uncertain. Currently lacking is high-resolution methods for continuous visualization and monitoring of the skeletal muscle microcirculation in humans.

Near-infrared spectroscopy of superficial and deep rectus femoris reveals markedly different exercise response to superficial vastus lateralis

To date our knowledge of skeletal muscle deoxygenation as measured by near-infrared spectroscopy (NIRS) is predicated almost exclusively on sampling of superficial muscle(s), most commonly the vastus lateralis (VL-s). Recently developed high power NIRS facilitates simultaneous sampling of deep (i.e., rectus femoris, RF-d) and superficial muscles of RF (RF-s) and VL-s. Because deeper muscle is more oxidative with greater capillarity and sustains higher blood flows than superficial muscle, we used time-resolved NIRS to test the hypotheses that, following exercise onset, the RF-d has slower deoxy[Hb+Mb] kinetics with reduced amplitude than superficial muscles. Thirteen participants performed cycle exercise transitions from unloaded to heavy work rates. Within the same muscle (RF-s vs. RF-d) deoxy[Hb+Mb] kinetics (mean response time, MRT) and amplitudes were not different. However, compared with the kinetics of VL-s, deoxy[Hb+Mb] of RF-s and RF-d were slower (MRT: RF-s, 51 ± 23; RF-d, 55 ± 29; VL-s, 18 ± 6 s; P < 0.05). Moreover, the amplitude of total[Hb+Mb] was greater for VL-s than both RF-s and RF-d (P < 0.05). Whereas pulmonary V˙O2 kinetics (i.e., on vs. off) were symmetrical in heavy exercise, there was a marked on-off asymmetry of deoxy[Hb+Mb] for all three sites i.e., MRT-off > MRT-on (P < 0.05). Collectively these data reveal profoundly different O₂ transport strategies, with the RF-s and RF-d relying proportionately more on elevated perfusive and the VL-s on diffusive O₂ transport. These disparate O₂ transport strategies and their temporal profiles across muscles have previously been concealed within the "global" pulmonary V˙O2 response.

Does postexercise modelled capillary blood flow accurately reflect cardiovascular effects by different exercise intensities?

Blood flow (BF) in exercising muscles is an important factor for exercise capacity. Recently, a non-invasive method to estimate capillary BF (Q_cap ) was introduced. Using this method, the Fick principle is re-arranged by using relative differences in deoxygenated haemoglobin (ΔHHb) as a surrogate for arteriovenous O₂ difference and pulmonary oxygen uptake (VO₂ ) instead of muscular oxygen uptake. The aim of this study was to examine (I) the relationship between Q_cap and exercise intensity during and following exercise, and (II) to critically reflect the Q_cap approach. Seventeen male subjects completed six bouts of cycling exercise with different exercise intensities (40-90% peak oxygen uptake, VO_2peak ) in randomized order. VO₂ and ΔHHb were monitored continuously during the trail. Q_cap was modelled bi-exponentially, and mean response time (MRT) was calculated during recovery as well as the dissociation of modelled VO₂ and Q_cap recovery kinetics (MRT/τVO₂ ). End-exercise Q_cap increased continuously with exercise intensity. This also applied to MRT. Postexercise MRT/τVO₂ increased from 40 to 60% VO_2peak but remained stable thereafter. The results show that Q_cap response to exercise is linearly related to exercise intensity. This is presumably due to vasoactive factors like shear-stress or endothelial-mediated vasodilation. MRT/τVO₂ shows that postexercise Q_cap is elevated for a longer period than VO₂ , which is representative for metabolic demand following exercise ≥70% VO_2peak . This is a hint for prolonged local vasodilation. According to previous studies, Q_cap could not be modelled properly in some cases, which is a limitation to the method and therefore has to be interpreted with caution.

FDG-PET detects nonuniform muscle activity in the lower body during human gait

INTRODUCTION

Nonuniform muscle activity has been partially explained by anatomically defined neuromuscular compartments. The purpose of this study was to investigate the uniformity of skeletal muscle activity during walking.

METHODS

Eight participants walked at a self-selected speed, and muscle activity was quantified using [¹⁸ F]-fluorodeoxyglucose positron emission tomography imaging. Seventeen muscles were divided into 10 equal length sections, and within muscle activity was compared.

RESULTS

Nonuniform activity was detected in 12 of 17 muscles (ƒ > 4.074; P < 0.046), which included both uni- and multi-articular muscles. Greater proximal activity was detected in 6 muscles (P < 0.049), and greater distal versus medial activity was found in the iliopsoas (P < 0.042).

CONCLUSIONS

Nonuniform muscle activity is likely related to recruitment of motor units located within separate neuromuscular compartments. These findings indicate that neuromuscular compartments are recruited selectively to allow for efficient energy transfer, and these patterns may be task-dependent. Muscle Nerve 54: 959-966, 2016.

Relationship of post-exercise muscle oxygenation and duration of cycling exercise

BACKGROUND

Aerobic adaptations following interval training are supposed to be mediated by increased local blood supply. However, knowledge is scarce on the detailed relationship between exercise duration and local post-exercise blood supply and oxygen availability. This study aimed to examine the effect of five different exercise durations, ranging from 30 to 240 s, on post-exercise muscle oxygenation and relative changes in hemoglobin concentration.

METHODS

Healthy male subjects (N = 18) performed an experimental protocol of five exercise bouts (30, 60, 90, 120, and 240 s) at 80 % of peak oxygen uptake [Formula: see text] in a randomized order, separated by 5-min recovery periods. To examine the influence of aerobic fitness, we compared subjects with gas exchange thresholds (GET) above 60 % [Formula: see text] (GET60+) with subjects reaching GET below 60 % [Formula: see text] (GET60-). [Formula: see text] and relative changes in concentrations of oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin were continuously measured with near-infrared spectroscopy of the vastus lateralis muscle.

RESULTS

Post-exercise oxygen availability and local blood supply increased significantly until the 90-s exercise duration and reached a plateau thereafter. Considering aerobic fitness, the GET60+ group reached maximum post-exercise oxygen availability earlier (60 s) than the GET60- group (90 s).

CONCLUSIONS

Our results suggest that (1) 90 s has evolved as the minimum interval duration to enhance local oxygen availability and blood supply following cycling exercise at 80 % [Formula: see text]; whereas (2) 60 s is sufficient to trigger the same effects in subjects with GET60 + .

Heterogeneity of Muscle Blood Flow and Metabolism: Influence of Exercise, Aging, and Disease States

The systematic increase in V˙O2 uptake and O2 extraction with increasing work rates conceals a substantial heterogeneity of O2 delivery (Q˙O2)-to- V˙O2 matching across and within muscles and other organs. We hypothesize that whether increased/decreased Q˙O2/V˙O2 heterogeneity can be judged as "good" or "bad," for example, after exercise training or in aged individuals or with disease (heart failure, diabetes) depends on the resultant effects on O2 transport and contractile performance.

End-exercise ΔHHb/ΔVO2 and post-exercise local oxygen availability in relation to exercise intensity

Increased local blood supply is thought to be one of the mechanisms underlying oxidative adaptations to interval training regimes. The relationship of exercise intensity with local blood supply and oxygen availability has not been sufficiently evaluated yet. The aim of this study was to examine the effect of six different intensities (40-90% peak oxygen uptake, VO_2peak ) on relative changes in oxygenated, deoxygenated and total haemoglobin (ΔO₂ Hb, ΔHHb, ΔTHb) concentration after exercise as well as end-exercise ΔHHb/ΔVO₂ as a marker for microvascular O₂ distribution. Seventeen male subjects performed an experimental protocol consisting of 3 min cycling bouts at each exercise intensity in randomized order, separated by 5 min rests. ΔO₂ Hb and ΔHHb were monitored with near-infrared spectroscopy of the vastus lateralis muscle, and VO₂ was assessed. ΔHHb/ΔVO₂ increased significantly from 40% to 60% VO₂ peak and decreased from 60% to 90% VO₂ peak. Post-exercise ΔTHb and ΔO₂ Hb showed an overshoot in relation to pre-exercise values, which was equal after 40-60% VO_2peak and rose significantly thereafter. A plateau was reached following exercise at ≥80% VO_2peak . The results suggest that there is an increasing mismatch of local O₂ delivery and utilization during exercise up to 60% VO_2peak . This insufficient local O₂ distribution is progressively improved above that intensity. Further, exercise intensities of ≥80% VO_2peak induce highest local post-exercise O₂ availability. These effects are likely due to improved microvascular perfusion by enhanced vasodilation, which could be mediated by higher lactate production and the accompanying acidosis.

Organ-specific physiological responses to acute physical exercise and long-term training in humans

Virtually all tissues in the human body rely on aerobic metabolism for energy production and are therefore critically dependent on continuous supply of oxygen. Oxygen is provided by blood flow, and, in essence, changes in organ perfusion are also closely associated with alterations in tissue metabolism. In response to acute exercise, blood flow is markedly increased in contracting skeletal muscles and myocardium, but perfusion in other organs (brain and bone) is only slightly enhanced or is even reduced (visceral organs). Despite largely unchanged metabolism and perfusion, repeated exposures to altered hemodynamics and hormonal milieu produced by acute exercise, long-term exercise training appears to be capable of inducing effects also in tissues other than muscles that may yield health benefits. However, the physiological adaptations and driving-force mechanisms in organs such as brain, liver, pancreas, gut, bone, and adipose tissue, remain largely obscure in humans. Along these lines, this review integrates current information on physiological responses to acute exercise and to long-term physical training in major metabolically active human organs. Knowledge is mostly provided based on the state-of-the-art, noninvasive human imaging studies, and directions for future novel research are proposed throughout the review.

Validation of a high-power, time-resolved, near-infrared spectroscopy system for measurement of superficial and deep muscle deoxygenation during exercise

Near-infrared assessment of skeletal muscle is restricted to superficial tissues due to power limitations of spectroscopic systems. We reasoned that understanding of muscle deoxygenation may be improved by simultaneously interrogating deeper tissues. To achieve this, we modified a high-power (∼8 mW), time-resolved, near-infrared spectroscopy system to increase depth penetration. Precision was first validated using a homogenous optical phantom over a range of inter-optode spacings (OS). Coefficients of variation from 10 measurements were minimal (0.5-1.9%) for absorption (μa), reduced scattering, simulated total hemoglobin, and simulated O2 saturation. Second, a dual-layer phantom was constructed to assess depth sensitivity, and the thickness of the superficial layer was varied. With a superficial layer thickness of 1, 2, 3, and 4 cm (μa = 0.149 cm(-1)), the proportional contribution of the deep layer (μa = 0.250 cm(-1)) to total μa was 80.1, 26.9, 3.7, and 0.0%, respectively (at 6-cm OS), validating penetration to ∼3 cm. Implementation of an additional superficial phantom to simulate adipose tissue further reduced depth sensitivity. Finally, superficial and deep muscle spectroscopy was performed in six participants during heavy-intensity cycle exercise. Compared with the superficial rectus femoris, peak deoxygenation of the deep rectus femoris (including the superficial intermedius in some) was not significantly different (deoxyhemoglobin and deoxymyoglobin concentration: 81.3 ± 20.8 vs. 78.3 ± 13.6 μM, P > 0.05), but deoxygenation kinetics were significantly slower (mean response time: 37 ± 10 vs. 65 ± 9 s, P ≤ 0.05). These data validate a high-power, time-resolved, near-infrared spectroscopy system with large OS for measuring the deoxygenation of deep tissues and reveal temporal and spatial disparities in muscle deoxygenation responses to exercise.

[18F]-FDG positron emission tomography--an established clinical tool opening a new window into exercise physiology

Positron emission tomography (PET) with [(18)F]-fluorodeoxyglucose (FDG) is an established clinical tool primarily used to diagnose and evaluate disease status in patients with cancer. PET imaging using FDG can be a highly valuable tool to investigate normal human physiology by providing a noninvasive, quantitative measure of glucose uptake into various cell types. Over the past years it has also been increasingly used in exercise physiology studies to identify changes in glucose uptake, metabolism, and muscle activity during different exercise modalities. Metabolically active cells transport FDG, an (18)fluorine-labeled glucose analog tracer, from the blood into the cells where it is then phosphorylated but not further metabolized. This metabolic trapping process forms the basis of this method's use during exercise. The tracer is given to a participant during an exercise task, and the actual PET imaging is performed immediately after the exercise. Provided the uptake period is of sufficient duration, and the imaging is performed shortly after the exercise; the captured image strongly reflects the metabolic activity of the cells used during the task. When combined with repeated blood sampling to determine tracer blood concentration over time, also known as the input function, glucose uptake rate of the tissues can be quantitatively calculated. This synthesis provides an accounting of studies using FDG-PET to measure acute exercise-induced skeletal muscle activity, describes the advantages and limitations of this imaging technique, and discusses its applications to the field of exercise physiology.

Glucose uptake heterogeneity of the leg muscles is similar between patients with multiple sclerosis and healthy controls during walking

BACKGROUND

Difficulties in ambulation are one of the main problems reported by patients with multiple sclerosis. A previous study by our research group showed increased recruitment of muscle groups during walking, but the influence of skeletal muscle properties, such as muscle fiber activity, has not been fully elucidated. The purpose of this investigation was to use the novel method of calculating glucose uptake heterogeneity in the leg muscles of patients with multiple sclerosis and compare these results to healthy controls.

METHODS

Eight patients with multiple sclerosis (4 men) and 8 healthy controls (4 men) performed 15 min of treadmill walking at a comfortable self-selected speed following muscle strength tests. Participants were injected with ≈ 8 mCi of [(18)F]-fluorodeoxyglucose during walking after which positron emission tomography/computed tomography imaging was performed.

FINDINGS

No differences in muscle strength were detected between multiple sclerosis and control groups (P>0.27). Within the multiple sclerosis, group differences in muscle volume existed between the stronger and weaker legs in the vastus lateralis, semitendinosus, and semimembranosus (P<0.03). Glucose uptake heterogeneity between the groups was not different for any muscle group or individual muscle of the legs (P>0.16, P≥0.05).

INTERPRETATIONS

Patients with multiple sclerosis and healthy controls showed similar muscle fiber activity during walking. Interpretations of these results, with respect to our previous study, suggest that walking difficulties in patients with multiple sclerosis may be more associated with altered central nervous system motor patterns rather than alterations in skeletal muscle properties.

Muscle metabolism and activation heterogeneity by combined 31P chemical shift and T2 imaging, and pulmonary O2 uptake during incremental knee-extensor exercise

The integration of skeletal muscle substrate depletion, metabolite accumulation, and fatigue during large muscle-mass exercise is not well understood. Measurement of intramuscular energy store degradation and metabolite accumulation is confounded by muscle heterogeneity. Therefore, to characterize regional metabolic distribution in the locomotor muscles, we combined 31P magnetic resonance spectroscopy, chemical shift imaging, and T2-weighted imaging with pulmonary oxygen uptake during bilateral knee-extension exercise to intolerance. Six men completed incremental tests for the following: (1) unlocalized 31P magnetic resonance spectroscopy; and (2) spatial determination of 31P metabolism and activation. The relationship of pulmonary oxygen uptake to whole quadriceps phosphocreatine concentration ([PCr]) was inversely linear, and three of four knee-extensor muscles showed activation as assessed by change in T2. The largest changes in [PCr], [inorganic phosphate] ([Pi]) and pH occurred in rectus femoris, but no voxel (72 cm3) showed complete PCr depletion at exercise cessation. The most metabolically active voxel reached 11 ± 9 mM [PCr] (resting, 29 ± 1 mM), 23 ± 11 mM [Pi] (resting, 7 ± 1 mM), and a pH of 6.64 ± 0.29 (resting, 7.08 ± 0.03). However, the distribution of 31P metabolites and pH varied widely between voxels, and the intervoxel coefficient of variation increased between rest (∼10%) and exercise intolerance (∼30-60%). Therefore, the limit of tolerance was attained with wide heterogeneity in substrate depletion and fatigue-related metabolite accumulation, with extreme metabolic perturbation isolated to only a small volume of active muscle (<5%). Regional intramuscular disturbances are thus likely an important requisite for exercise intolerance. How these signals integrate to limit muscle power production, while regional "recruitable muscle" energy stores are presumably still available, remains uncertain.

Squeezing the muscle: compression clothing and muscle metabolism during recovery from high intensity exercise

The purpose of this experiment was to investigate skeletal muscle blood flow and glucose uptake in m. biceps (BF) and m. quadriceps femoris (QF) 1) during recovery from high intensity cycle exercise, and 2) while wearing a compression short applying ∼37 mmHg to the thigh muscles. Blood flow and glucose uptake were measured in the compressed and non-compressed leg of 6 healthy men by using positron emission tomography. At baseline blood flow in QF (P = 0.79) and BF (P = 0.90) did not differ between the compressed and the non-compressed leg. During recovery muscle blood flow was higher compared to baseline in both compressed (P<0.01) and non-compressed QF (P<0.001) but not in compressed (P = 0.41) and non-compressed BF (P = 0.05; effect size = 2.74). During recovery blood flow was lower in compressed QF (P<0.01) but not in BF (P = 0.26) compared to the non-compressed muscles. During baseline and recovery no differences in blood flow were detected between the superficial and deep parts of QF in both, compressed (baseline P = 0.79; recovery P = 0.68) and non-compressed leg (baseline P = 0.64; recovery P = 0.06). During recovery glucose uptake was higher in QF compared to BF in both conditions (P<0.01) with no difference between the compressed and non-compressed thigh. Glucose uptake was higher in the deep compared to the superficial parts of QF (compression leg P = 0.02). These results demonstrate that wearing compression shorts with ∼37 mmHg of external pressure reduces blood flow both in the deep and superficial regions of muscle tissue during recovery from high intensity exercise but does not affect glucose uptake in BF and QF.