Determinants, analysis and interpretation of the muscle compound action potential (M wave) in humans: implications for the study of muscle fatigue

Caffeine Attenuates Exacerbated Central Fatigue during Moderate-Intensity Cycling Exercise in Women with Fibromyalgia

PURPOSE

To compare the development of fatigability during a moderate-intensity cycling exercise between women with fibromyalgia (FM) and control women (CON) after acute ingestion of caffeine and placebo.

METHODS

Ten FM and 10 CON women performed a 30-min moderate-intensity cycling exercise 1 h after the ingestion of a capsule containing either caffeine or a placebo. Fatigability and its central and peripheral determinants were determined via changes from pre- to post-15 and post-30 min of exercise in maximal voluntary isometric contractions, voluntary activation (VA), and quadriceps potentiated twitch torque ( Qtw-pot ), respectively. Heart rate, muscle oxygen saturation, perceptive responses, mood state, localized and widespread pain, and sleepiness were also monitored during and after exercise.

RESULTS

There was a time versus group interaction for maximal voluntary isometric contraction and VA ( P < 0.001) but not for Qtw-pot ( P = 0.363), indicating a greater rate of fatigability development, mainly caused by central mechanisms, in the FM than in the CON group. There was also a main effect of condition for VA ( P = 0.011), indicating that caffeine attenuates central mechanisms of fatigability in both groups. Caffeine ingestion also increased muscle oxygenation, perceived vigor, and energy, and decreased leg muscle pain, sleepiness, and perceived fatigue in both groups. However, caffeine improved perceived pleasure/displeasure and exercise adherence likelihood only in the FM group.

CONCLUSIONS

Compared with CON, women with FM present a greater rate of fatigability during exercise, mainly of central origin. Caffeine seems to be a promising bioactive to counteract the central mechanisms of fatigability and improve the exercise experience among FM women.

The first and second phases of the muscle compound action potential in the thumb are differently affected by electrical stimulation trains

Sarcolemmal membrane excitability is often evaluated by considering the peak-to-peak amplitude of the compound muscle action potential (M wave). However, the first and second M-wave phases represent distinct properties of the muscle action potential, which are differentially affected by sarcolemma properties and other factors such as muscle architecture. Contrasting with previous studies in which voluntary contractions have been used to induce muscle fatigue, we used repeated electrically induced tetanic contractions of the adductor pollicis muscle and assessed the kinetics of M-wave properties during the course of the contractions. Eighteen participants (24 ± 6 yr; means ± SD) underwent 30 electrically evoked tetanic contractions delivered at 30 Hz, each lasting 3 s with 1 s intervals. We recorded the amplitudes of the first and second M-wave phases for each stimulation. During the initial stimulation train, the first and second M-wave phases exhibited distinct kinetics. The first phase amplitude showed a rapid decrease to reach ∼59% of its initial value (P < 0.001), whereas the second phase amplitude displayed an initial transient increase of ∼19% (P = 0.007). Within subsequent trains, both the first and second phase amplitudes consistently decreased as fatigue developed with a reduction during the last train reaching ∼47% of its initial value (P < 0.001). Analyzing the first M wave of each stimulation train unveiled different kinetics for the first and second phases during the initial trains, but these distinctions disappeared as fatigue progressed. These findings underscore the interplay of factors affecting the M wave and emphasize the significance of separately scrutinizing its first and second phases when assessing membrane excitability adjustments during muscle contractions.NEW & NOTEWORTHY Our understanding of how the first and second phases of the compound muscle action potential (M wave) behave during fatigue remains incomplete. Using electrically evoked repeated tetanic contractions of the adductor pollicis, we showed that the first and second phases of the M wave followed distinct kinetics only during the early stages of fatigue development. This suggests that the factors affecting the M-wave first and second phases may change as fatigue develops.

Corticospinal and spinal responses following a single session of lower limb motor skill and resistance training

Prior studies suggest resistance exercise as a potential form of motor learning due to task-specific corticospinal responses observed in single sessions of motor skill and resistance training. While existing literature primarily focuses on upper limb muscles, revealing a task-dependent nature in eliciting corticospinal responses, our aim was to investigate such responses after a single session of lower limb motor skill and resistance training. Twelve participants engaged in a visuomotor force tracking task, self-paced knee extensions, and a control task. Corticospinal, spinal, and neuromuscular responses were measured using transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). Assessments occurred at baseline, immediately post, and at 30-min intervals over two hours. Force steadiness significantly improved in the visuomotor task (P < 0.001). Significant fixed-effects emerged between conditions for corticospinal excitability, corticospinal inhibition, and spinal excitability (all P < 0.001). Lower limb motor skill training resulted in a greater corticospinal excitability compared to resistance training (mean difference [MD] = 35%, P < 0.001) and control (MD; 37%, P < 0.001). Motor skill training resulted in a lower corticospinal inhibition compared to control (MD; - 10%, P < 0.001) and resistance training (MD; - 9%, P < 0.001). Spinal excitability was lower following motor skill training compared to control (MD; - 28%, P < 0.001). No significant fixed effect of Time or Time*Condition interactions were observed. Our findings highlight task-dependent corticospinal responses in lower limb motor skill training, offering insights for neurorehabilitation program design.

Ischemic preconditioning increases spinal excitability and voluntary activation during maximal plantar flexion contractions in men

The enigmatic benefits of acute limb ischemic preconditioning (IP) in enhancing muscle force and exercise performance have intrigued researchers. This study sought to unravel the underlying mechanisms, focusing on increased neural drive and the role of spinal excitability while excluding peripheral factors. Soleus Hoffmann (H)-reflex /M-wave recruitment curves and unpotentiated supramaximal responses were recorded before and after IP or a low-pressure control intervention. Subsequently, the twitch interpolation technique was applied during maximal voluntary contractions to assess conventional parameters of neural output. Following IP, there was an increase in both maximum normalized force and voluntary activation (VA) for the plantar flexor group, with negligible peripheral alterations. Greater benefits were observed in participants with lower VA levels. Despite greater H-reflex gains, soleus volitional (V)-wave and sEMG amplitudes remained unchanged. In conclusion, IP improves muscle force via enhanced neural drive to the muscles. This effect appears associated, at least in part, to reduced presynaptic inhibition and/or increased motoneuron excitability. Furthermore, the magnitude of the benefit is inversely proportional to the skeletal muscle's functional reserve, making it particularly noticeable in under-recruited muscles. These findings have implications for the strategic application of the IP procedure across diverse populations.

Determining intracortical, corticospinal and alpha motoneurone excitability in athletes with patellar tendinopathy compared to asymptomatic controls

BACKGROUND

Lower capacity to generate knee extension maximal voluntary force (MVF) has been observed in individuals affected with patellar tendinopathy (PT) compared to asymptomatic controls. This MVF deficit is hypothesized to emanate from alterations in corticospinal excitability (CSE). The modulation of CSE is intricately linked to the excitability levels at multiple sites, encompassing neurones within the corticospinal tract (CST), intracortical neurones within the primary motor cortex (M1), and the alpha motoneurone. The aim of this investigation was to examine the excitability of intracortical neurones, CST neurones, and the alpha motoneurone, and compare these between volleyball and basketball athletes with PT and matched asymptomatic controls.

METHOD

Nineteen athletes with PT and 18 asymptomatic controls participated in this cross-sectional study. Transcranial magnetic stimulation was utilized to assess CST excitability, corticospinal inhibition (silent period, and short-interval cortical inhibition). Peripheral nerve stimulation was used to evaluate lumbar spine and alpha motoneurone excitability, including the evocation of lumbar-evoked potentials and maximal compound muscle action potential (MMAX ), and CSE with central activation ratio (CAR). Knee extension MVF was also assessed.

RESULTS

Athletes with PT exhibited longer silent period duration and greater electrical stimulator output for MMAX , as well as lower MVF, compared to asymptomatic controls (p < 0.05).

CONCLUSION

These findings indicate volleyball and basketball athletes with PT exhibit reduced excitability of the alpha motoneurone or the neuromuscular junction, which may be linked to lower MVF. Subtle alterations at specific sites may represent compensatory changes to excitability aiming to maintain efferent drive to the knee extensors.

Neural Adjustments during Repeated Braking and Throttle Actions on a Motorcycle Setup

The aim of the study was to assess neuromuscular changes during an intermittent fatiguing task designed to replicate fundamental actions and ergonomics of road race motorcycling. Twenty-eight participants repeated a sequence of submaximal brake-pulling and gas throttle actions, interspaced by one maximal brake-pulling, until failure. During the submaximal brake-pulling actions performed at 30% MVC, force fluctuations, surface EMG, maximal M-wave (Mmax) and H-reflex were measured in the flexor digitorum superficialis. At the end of the task, the MVC force and associated EMG activity decreased (P<0.001) by 46% and 26%, respectively. During the task, force fluctuation and EMG activity increased gradually (106% and 61%, respectively) with respect to the pre-fatigue state (P≤0.029). The Mmax first phase did not change (P≥0.524), whereas the H-reflex amplitude, normalized to Mmax, increased (149%; P≤0.039). Noteworthy, the relative increase in H-reflex amplitude was correlated with the increase in EMG activity during the task (r=0.63; P<0.001). During the 10-min recovery, MVC force and EMG activity remained depressed (P≤0.05) whereas H-reflex amplitude and force fluctuation returned to pre-fatigue values. In conclusion, contrarily to other studies, our results bring forward that when mimicking motorcycling brake-pulling and gas throttle actions, supraspinal neural mechanisms primarily limit the duration of the performance.

Within- and between-day reliability and repeatability of neuromuscular function assessment in females and males

The study evaluated the reliability and repeatability of the force and surface electromyography activity (EMG) outcomes obtained through voluntary and electrically evoked contractions of knee extensors in females (n = 18) and males (n = 20) and compared these data between sexes. Maximal isometric voluntary contractions (iMVCs) of knee extensors associated with electrical stimulation of the femoral nerve were performed over 4 days (48-h interval), with the first day involving familiarization procedures, the second involving three trials (1-h interval), and the third and fourth involving just one trial. The intraclass correlation coefficient (ICC), coefficient of variation (CV), and repeatability of outcomes from within- and between-day trials were determined for each sex. Females presented lower maximal voluntary force during iMVC (iMVCForce) and associated vastus lateralis EMG activity (root mean square, RMSVL), force evoked by potentiated doublet high-frequency (Db100Force) and single stimuli (Qtw), and M-wave amplitude than males (P ≤ 0.01, partial eta squared ≥0.94). Voluntary activation (VA) and RMSVL/M-wave amplitude did not differ between sexes. iMVCForce, VA, Db100Force, Qtw, and M-wave amplitude were the most reliable outcomes in within-day trials, with similar results between sexes (ICC > 0.62; CV < 6.4%; repeatability: 12.2%-22.6%). When investigating between-day trials, the iMVCForce, VA, Db100Force, and Qtw were the most reliable (ICC > 0.66; CV < 7.5%; repeatability: 13.2%-33.45%) with similar results between sexes. In conclusion, females presented lower iMVCForce and evoked response than males. Although reliability and repeatability statistics vary between trials, data (e.g., from EMG or force signal), and sexes, most of the outcomes obtained through this technique are reliable in females and males.NEW & NOTEWORTHY Although reliability and repeatability of knee extensors vary according to the type of neuromuscular function outcome (e.g., from force or EMG responses), the trial intervals (i.e., hours or days), and the sex of the participant, most force and EMG outcomes obtained through these neuromuscular assessment protocols present ICC > 0.75, very good CV (<10%), and repeatability <25% in within- and between-day trials in both sexes.

Immediate Reduction in Spasticity of Ankle Plantar Flexors in a Stroke Patient after Treatment with a Spinning Permanent Magnet Device

Background

Magnetic stimulation devices can be large because of the need for cooling systems. We developed a compact and lightweight Spinning Permanent Magnet (SPM) device that generates magnetic fields with intensities below the motor threshold. In this report, we present the case of a post-stroke patient in which an immediate reduction in spasticity of the ankle plantar flexors was achieved after SPM treatment.

Case

A 37-year-old man was admitted to our hospital with a right putamen hemorrhage. The patient underwent conservative therapy and exhibited residual left hemiplegia and spasticity. Three months after stroke onset, he was able to walk with supervision while using a left ankle-foot orthosis and a T-cane. The Modified Ashworth Scale (MAS) score of the left ankle plantar flexors was 1+. The plantar flexors were stimulated by SPM treatment. The outcomes were the Hmax/Mmax of the tibial nerve (soleus muscle) and the MAS score. On the first day, SPM stimulation was applied for 30 min. On the second day, a sham stimulation of the same duration was performed. On the third day, the SPM stimulation was repeated. Hmax/Mmax decreased from 41.5% to 37.7% on the first day, and from 46.9% to 31.6% on the third day after SPM stimulation. The MAS score decreased from 1+ to 1 on both days. In contrast, after sham stimulation, Hmax/Mmax increased from 39.2% to 44.2%, whereas the MAS score remained unchanged at 1+.

Discussion

Stimulation below the motor threshold using SPM treatment can effectively reduce spasticity.

Exercise and fatigue: integrating the role of K+, Na+ and Cl- in the regulation of sarcolemmal excitability of skeletal muscle

Perturbations in K+ have long been considered a key factor in skeletal muscle fatigue. However, the exercise-induced changes in K+ intra-to-extracellular gradient is by itself insufficiently large to be a major cause for the force decrease during fatigue unless combined to other ion gradient changes such as for Na+. Whilst several studies described K+-induced force depression at high extracellular [K+] ([K+]e), others reported that small increases in [K+]e induced potentiation during submaximal activation frequencies, a finding that has mostly been ignored. There is evidence for decreased Cl- ClC-1 channel activity at muscle activity onset, which may limit K+-induced force depression, and large increases in ClC-1 channel activity during metabolic stress that may enhance K+ induced force depression. The ATP-sensitive K+ channel (KATP channel) is also activated during metabolic stress to lower sarcolemmal excitability. Taking into account all these findings, we propose a revised concept in which K+ has two physiological roles: (1) K+-induced potentiation and (2) K+-induced force depression. During low-moderate intensity muscle contractions, the K+-induced force depression associated with increased [K+]e is prevented by concomitant decreased ClC-1 channel activity, allowing K+-induced potentiation of sub-maximal tetanic contractions to dominate, thereby optimizing muscle performance. When ATP demand exceeds supply, creating metabolic stress, both KATP and ClC-1 channels are activated. KATP channels contribute to force reductions by lowering sarcolemmal generation of action potentials, whilst ClC-1 channel enhances the force-depressing effects of K+, thereby triggering fatigue. The ultimate function of these changes is to preserve the remaining ATP to prevent damaging ATP depletion.

Hybrid Robotic and Electrical Stimulation Assistance Can Enhance Performance and Reduce Mental Demand

Combining functional electrical stimulation (FES) and robotics may enhance recovery after stroke, by providing neural feedback with the former while improving quality of motion and minimizing muscular fatigue with the latter. Here, we explored whether and how FES, robot assistance and their combination, affect users' performance, effort, fatigue and user experience. 15 healthy participants performed a wrist flexion/extension tracking task with FES and/or robotic assistance. Tracking performance improved during the hybrid FES-robot and the robot-only assistance conditions in comparison to no assistance, but no improvement is observed when only FES is used. Fatigue, muscular and voluntary effort are estimated from electromyographic recording. Total muscle contraction and volitional activity are lowest with robotic assistance, whereas fatigue level do not change between the conditions. The NASA-Task Load Index answers indicate that participants found the task less mentally demanding during the hybrid and robot conditions than the FES condition. The addition of robotic assistance to FES training might thus facilitate an increased user engagement compared to robot training and allow longer motor training session than with FES assistance.

Altitude-induced effects on neuromuscular, metabolic and perceptual responses before, during and after a high-intensity resistance training session

PURPOSE

We tested if an acute ascending to 2320 m above sea level (asl) affects corticospinal excitability (CSE) and intracortical inhibition (SICI) measured with transcranial magnetic stimulation (TMS) at rest, before, during and after a traditional hypertrophy-oriented resistance training (RT) session. We also explored whether blood lactate concentration (BLa), ratings of perceived exertion (RPE), perceived muscular pain and total training volume differed when the RT session was performed at hypoxia (H) or normoxia (N).

METHODS

Twelve resistance-trained men performed eight sets of 10 repetitions at 70% of one repetition maximum of a bar biceps curl at N (SpO2 = 98.0 ± 0.9%) and H (at 2320 asl, SpO2 = 94.0 ± 1.9%) in random order. Before each session, a subjective well-being questionnaire, the resting motor threshold (rMT) and a single pulse recruitment curve were measured. Before, during and after the RT session, BLa, RPE, muscle pain, CSE and SICI were measured.

RESULTS

Before the RT session only the rMT differed between H (- 5.3%) and N (ES = 0.38). RPE, muscle pain and BLa increased through the RT session and were greater at H than N (12%, 54% and 15%, respectively) despite a similar training volume (1618 ± 468 kg vs. 1638 ± 509 kg). CSE was reduced during the RT session (~ 27%) but recovered ten minutes after, regardless of the environmental condition. SICI did not change after any RT session.

CONCLUSIONS

The data suggest that acute exposure to moderate hypoxia slightly increased the excitability of the most excitable structures of the corticospinal tract but did not influence intracortical or corticospinal responses to a single RT session.

Corticospinal excitability and reflex modulation in a contralateral non-stretched muscle following unilateral stretching

PURPOSE

Muscle stretching effect on the range of motion (ROM) and force deficit in non-stretched muscle, and the underlying mechanisms, is an ongoing issue. This study aimed to investigate crossover stretching effects and mechanisms on the plantar flexor muscles.

METHODS

Fourteen recreationally active females (n = 5) and males (n = 9) performed six sets of 45-s static stretching (SS) (15-s recovery) to the point of discomfort of the dominant leg (DL) plantar flexors or control (345-s rest). Participants were tested for a single 5-s pre- and post-test maximal voluntary isometric contraction (MVIC) with each plantar flexor muscle and were tested for DL and non-DL ROM. They were tested pre- and post-test (immediate, 10-s, 30-s) for the Hoffman (H)-reflex and motor-evoked potentials (MEP) from transcranial magnetic stimulation in the contralateral, non-stretched muscle.

RESULTS

Both the DL and non-DL-MVIC force had large magnitude, significant (↓10.87%, p = 0.027, pƞ2 = 0.4) and non-significant (↓9.53%, p = 0.15, pƞ2 = 0.19) decreases respectively with SS. The SS also significantly improved the DL (6.5%, p < 0.001) and non-DL (5.35%, p = 0.002) ROM. The non-DL MEP/MMax and HMax/MMax ratio did not change significantly.

CONCLUSION

Prolonged static stretching improved the stretched muscle's ROM. However, the stretched limb's force was negatively affected following the stretching protocol. The ROM improvement and large magnitude force impairment (statistically non-significant) were transferred to the contralateral muscles. The lack of significant changes in spinal and corticospinal excitability confirms that the afferent excitability of the spinal motoneurons and corticospinal excitability may not play a substantial role in non-local muscle's ROM or force output responses.

Multisystem physiological perspective of human frailty and its modulation by physical activity

"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.

Muscle innervation zone estimation from monopolar high-density M-waves using principal component analysis and radon transform

This study examined methods for estimating the innervation zone (IZ) of a muscle using recorded monopolar high density M waves. Two IZ estimation methods based on principal component analysis (PCA) and Radon transform (RT) were examined. Experimental M waves, acquired from the biceps brachii muscles of nine healthy subjects were used as testing data sets. The performance of the two methods was evaluated by comparing their IZ estimations with manual IZ detection by experienced human operators. Compared with manual detection, the agreement rate of the estimated IZs was 83% and 63% for PCA and RT based methods, respectively, both using monopolar high density M waves. In contrast, the agreement rate was 56% for cross correlation analysis using bipolar high density M waves. The mean difference in estimated IZ location between manual detection and the tested method was 0.12 ± 0.28 inter-electrode-distance (IED) for PCA, 0.33 ± 0.41 IED for RT and 0.39 ± 0.74 IED for cross correlation-based methods. The results indicate that the PCA based method was able to automatically detect muscle IZs from monopolar M waves. Thus, PCA provides an alternative approach to estimate IZ location of voluntary or electrically-evoked muscle contractions, and may have particular value for IZ detection in patients with impaired voluntary muscle activation.

Corticospinal and spinal adaptations following lower limb motor skill training: a meta-analysis with best evidence synthesis

Motor skill training alters the human nervous system; however, lower limb motor tasks have been less researched compared to upper limb tasks. This meta-analysis with best evidence synthesis aimed to determine the cortical and subcortical responses that occur following lower limb motor skill training, and whether these responses are accompanied by improvements in motor performance. Following a literature search that adhered to the PRISMA guidelines, data were extracted and analysed from six studies (n = 172) for the meta-analysis, and 11 studies (n = 257) were assessed for the best evidence synthesis. Pooled data indicated that lower limb motor skill training increased motor performance, with a standardised mean difference (SMD) of 1.09 being observed. However, lower limb motor skill training had no effect on corticospinal excitability (CSE), Hoffmann's reflex (H-reflex) or muscle compound action potential (M_MAX) amplitude. The best evidence synthesis found strong evidence for improved motor performance and reduced short-interval cortical inhibition (SICI) following lower limb motor skill training, with conflicting evidence towards the modulation of CSE. Taken together, this review highlights the need for further investigation on how motor skill training performed with the lower limb musculature can modulate corticospinal responses. This will also help us to better understand whether these neuronal measures are underpinning mechanisms that support an improvement in motor performance.

UBC-Nepal Expedition: Motor Unit Characteristics in Lowlanders Acclimatized to High Altitude and Sherpa

INTRODUCTION

With acclimatization to high altitude (HA), adaptations occur throughout the nervous system and at the level of the muscle, which may affect motor unit (MU) characteristics. However, despite the importance of MUs as the final common pathway for the control of voluntary movement, little is known about their adaptations with acclimatization.

METHODS

Ten lowlanders and Sherpa participated in this study 7 to 14 d after arrival at HA (5050 m), with seven lowlanders repeating the experiment at sea level (SL), 6 months after the expedition. The maximal compound muscle action potential (M max ) was recorded from relaxed biceps brachii. During isometric elbow flexions at 10% of maximal torque, a needle electrode recorded the MU discharge rate (MUDR) and MU potential (MUP) characteristics of single biceps brachii MUs.

RESULTS

Compared with SL, acclimatized lowlanders had ~10% greater MUDR, ~11% longer MUP duration, as well as ~18% lower amplitude and ~6% greater duration of the first phase of the M max (all P < 0.05). No differences were noted between SL and HA for variables related to MUP shape (e.g., jitter, jiggle; P > 0.08). Apart from lower near-fiber MUP area for Sherpa than acclimatized lowlanders ( P < 0.05), no M max or MU data were different between groups ( P > 0.10).

CONCLUSIONS

Like other components of the body, MUs in lowlanders adapt with acclimatization to HA. The absence of differences between acclimatized lowlanders and Sherpa suggests that evolutionary adaptations to HA are smaller for MUs than components of the cardiovascular or respiratory systems.

Comparisons in muscle compound action potential parameters measured during standing, walking, and running

The muscle compound action potential (M-wave) has been used as an indicator of peripheral muscle conditions during rest or on isometric muscle contraction. The present study aimed to compare the M-wave parameters during standing, walking, and running. Seventeen young males performed four sets of repeated maximal isometric plantar flexion. Before, after, and between the repeated contraction tasks, M-waves in the soleus muscle were measured during standing, walking, and running. M-waves on walking and running were elicited at the beginning of the swing phase when the soleus muscle was not voluntarily activated. From the detected M-waves, the amplitude, area, and latency for first and second phases were calculated. Amplitudes for first and second phases were not significantly different between standing and walking/running. The area and latency for both phases during walking/running were significantly lower than those during standing (p < 0.05). Significant correlations in amplitude and area were found between standing and walking/running for the first phase (p < 0.05), but not for the second phase (p > 0.05). These results suggest that assessments of the M-wave amplitude for the first phase can be applied to walking and running in the same way as for standing in the soleus muscle.

Complementary combination of biomarkers for diagnosis of sarcopenia in C57BL/6J mice

AIMS

The objective of this study is to provide a reliable strategy for the diagnosis of sarcopenia based on a complementary combination of biomarkers from various approaches.

MATERIAL AND METHODS

A total of 30 C57BL/6J mice were used for the experiment, in which 15 young mice (YM) at 24 weeks old and 15 aged mice (AM) at 88 weeks old. Extracted features-based digital biomarkers from the electromyography activity of tibialis anterior muscles were evaluated by using receiver operating characteristic analysis. Extracted tissular proteins and circulating hormones based chemical biomarkers were investigated by using immunoblotting and enzyme-linked immunosorbent assay.

KEY FINDINGS

In terms of digital biomarkers, the feature-based classification of mice groups showed good performance (Feature A: AUC = 0.986, accuracy = 0.928) and (Feature B: AUC = 0.999, accuracy = 0.990). On the other hand, muscle-specific protein levels based chemical biomarkers (e.g. MuRF1, FoxO1, and perilipin2) were observed significantly increase with age. Pro-inflammatory cytokines based biomarkers extracted from muscle tissue and circulating plasma (e.g. TNF-α, IL-6, and IL-8) were significantly higher in case of AM group compared to YM group. Circulating hormone-based chemical biomarkers (e.g. cortisol/DHEA ratio and cathepsin D) presented a significant increase in concentrations with age. Circulating neurotransmitter based biomarkers (e.g. acetylcholine, serotonin, and histamine) also increased significantly in concentrations from YM to AM.

SIGNIFICANCE

A complementary combination of digital and chemical biomarkers covers multiple domains of sarcopenia to provide an effective strategy for the early diagnosis of sarcopenia.

Muscle electromyographic activity normalized to maximal muscle activity, not to Mmax, better represents voluntary activation

In human applied physiology studies, the amplitude of recorded muscle electromyographic activity (EMG) is often normalized to maximal EMG recorded during a maximal voluntary contraction. When maximal contractions cannot be reliably obtained (e.g. in people with muscle paralysis, anterior cruciate ligament injury, or arthritis), EMG is sometimes normalized to the maximal compound muscle action potiential evoked by stimulation, the Mmax. However, it is not known how these two methods of normalization affect the conclusions and comparability of studies. To address this limitation, we investigated the relationship between voluntary muscle activation and EMG normalized either to maximal EMG or to Mmax. Twenty-five able-bodied adults performed voluntary isometric ankle plantarflexion contractions to a range of percentages of maximal voluntary torque. Ankle torque, plantarflexor muscle EMG, and voluntary muscle activation measured by twitch interpolation were recorded. EMG recorded at each contraction intensity was normalized to maximal EMG or to Mmax for each plantarflexor muscle, and the relationship between the two normalization approaches quantified. A slope >1 indicated EMG amplitude normalized to maximal EMG (vertical axis) was greater than EMG normalized to Mmax (horizontal axis). Mean estimates of the slopes were large and had moderate precision: soleus 8.7 (95% CI 6.9 to 11.0), medial gastrocnemius 13.4 (10.5 to 17.0), lateral gastrocnemius 11.4 (9.4 to 14.0). This indicates EMG normalized to Mmax is approximately eleven times smaller than EMG normalized to maximal EMG. Normalization to maximal EMG gave closer approximations to the level of voluntary muscle activation assessed by twitch interpolation.

Mechanisms of Neuromuscular Fatigability in People with Cancer-Related Fatigue

INTRODUCTION

Cancer-related fatigue (CRF) is a debilitating symptom that affects around one-third of people for months or years after cancer treatment. In a recent study, we found that people with posttreatment CRF have greater neuromuscular fatigability. The aim of this secondary analysis was to examine the etiology of neuromuscular fatigability in people with posttreatment CRF.

METHODS

Ninety-six people who had completed cancer treatment were dichotomized into two groups (fatigued and nonfatigued) based on a clinical cut point for fatigue. Alterations in neuromuscular function (maximal voluntary contraction peak force, voluntary activation, potentiated twitch force, and EMG) in the knee extensors were assessed across three common stages of an incremental cycling test. Power outputs during the fatigability test were expressed relative to gas exchange thresholds to assess relative exercise intensity.

RESULTS

The fatigued group had a more pronounced reduction in maximal voluntary contraction peak force and potentiated twitch force throughout the common stages of the incremental cycling test (main effect of group: P < 0.001, ηp2 = 0.18 and P = 0.029, ηp2 = 0.06, respectively). EMG was higher during cycling in the fatigued group (main effect of group: P = 0.022, ηp2 = 0.07). Although the relative intensity of cycling was higher in the fatigued group at the final common stage of cycling, this was not the case during the initial two stages, despite the greater impairments in neuromuscular function.

CONCLUSIONS

Our results suggest that the rapid impairments in neuromuscular fatigability in people with CRF were primarily due to disturbances at the level of the muscle rather than the central nervous system. This could affect the ability to tolerate daily physical activities.

Neuromuscular fatigability during repeated sprints assessed with an innovative cycle ergometer

PURPOSE

Repeated sprint ability is an integral component of team sports. This study aimed to evaluate fatigability development and its aetiology during and immediately after a cycle repeated sprint exercise performed until a given fatigability threshold.

METHODS

On an innovative cycle ergometer, 16 healthy males completed an RSE (10-s sprint/28-s recovery) until task failure (TF): a 30% decrease in sprint mean power (Pmean). Isometric maximum voluntary contraction of the quadriceps (IMVC), central alterations [voluntary activation (VA)], and peripheral alterations [twitch (Pt)] were evaluated before (pre), immediately after each sprint (post), at TF and 3 min after. Sprints were expressed as a percentage of the total number of sprints to TF (TS_TF). Individual data were extrapolated at 20, 40, 60, and 80% TS_TF.

RESULTS

Participants completed 9.7 ± 4.2 sprints before reaching a 30% decrease in Pmean. Post-sprint IMVCs were decreased from pre to 60% TS_TF and then plateaued (pre: 345 ± 56 N, 60% 247 ± 55 N, TF: 233 ± 57 N, p < 0.001). Pt decreased from 20% and plateaued after 40% TS_TF (p < 0.001, pre-TF = - 45 ± 13%). VA was not significantly affected by repeated sprints until 60% TS_TF (pre-TF = - 6.5 ± 8.2%, p = 0.036). Unlike peripheral parameters, VA recovered within 3 min (p = 0.042).

CONCLUSION

During an RSE, Pmean and IMVC decreases were first concomitant to peripheral alterations up to 40% TS_TF and central alterations was only observed in the second part of the test, while peripheral alterations plateaued. The distinct recovery kinetics in central versus peripheral components of fatigability further confirm the necessity to reduce traditional delays in neuromuscular fatigue assessment post-exercise.

Sarcolemmal Excitability, M-Wave Changes, and Conduction Velocity During a Sustained Low-Force Contraction

This study was undertaken to investigate whether sarcolemmal excitability is impaired during a sustained low-force contraction [10% maximal voluntary contraction (MVC)] by assessing muscle conduction velocity and also by analyzing separately the first and second phases of the muscle compound action potential (M wave). Twenty-one participants sustained an isometric knee extension of 10% MVC for 3min. M waves were evoked by supramaximal single shocks to the femoral nerve given at 10-s intervals. The amplitude, duration, and area of the first and second M-wave phases were computed. Muscle fiber conduction velocity, voluntary surface electromyographic (EMG), perceived effort, MVC force, peak twitch force, and temperature were also recorded. The main findings were: (1) During the sustained contraction, conduction velocity remained unchanged. (2) The amplitude of the M-wave first phase decreased for the first ~30s (−7%, p<0.05) and stabilized thereafter, whereas the second phase amplitude increased for the initial ~30s (+7%, p<0.05), before stabilizing. (3) Both duration and area decreased steeply during the first ~30s, and then more gradually for the rest of the contraction. (4) During the sustained contraction, perceived effort increased fivefold, whereas knee extension EMG increased by ~10%. (5) Maximal voluntary force and peak twitch force decreased (respectively, −9% and −10%, p<0.05) after the low-force contraction. Collectively, the present results indicate that sarcolemmal excitability is well preserved during a sustained 10% MVC task. A depression of the M-wave first phase during a low-force contraction can occur even in the absence of changes in membrane excitability. The development of fatigue during a low-force contraction can occur without alteration of membrane excitability.

Increased short interval intracortical inhibition in participants with previous hamstring strain injury

PURPOSE

Cortical mechanisms may contribute to weakness in participants with previous hamstring strain injury. This study aims to examine intra-cortical inhibition (SICI) and corticospinal excitability in previously injured participants.

METHODS

In this cross-sectional study, TMS was used to examine SICI, silent period, silent period: MEP ratios and area under the stimulus response curve in the biceps femoris and medial hamstrings. Comparisons were made between participants with (n = 10) and without (n = 10) previous hamstring strain injury. Motor threshold and isometric knee flexor strength were also compared between participants and the relationship between strength and SICI in control and previously injured participants was examined.

RESULTS

Isometric knee flexor strength was lower in previously injured limbs compared with control limbs (mean difference = - 41 Nm (- 26%) [95% CI = - 80 to - 2 Nm], p = 0.04, Cohen's d = - 1.27) and contralateral uninjured limbs (mean difference = - 23 Nm (- 17%), [95% CI = - 40 to - 6 Nm], p = 0.01, Cohen's d = - 0.57). Previously injured limbs exhibited smaller responses to paired pulse stimulation (i.e. greater levels of SICI) in the biceps femoris compared with control limbs (mean difference = - 19%, [95% CI = - 34 to - 5%], p = 0.007, Cohen's d = - 1.33). Isometric knee flexor strength was associated with the level of SICI recorded in the biceps femoris in previously injured participants (coefficient = 23 Nm [95% CI = 7-40 Nm], adjusted R² = 0.31, p = 0.01). There were no differences in markers of corticospinal excitability between previously injured and control limbs (all p > 0.24, all Cohen's d < 0.40).

CONCLUSION

Athletes with previous injury in the biceps femoris exhibit increased SICI in this muscle compared with control participants. Increased SICI is related to lower levels of hamstring strength, and rehabilitation programs targeting the removal of intra-cortical inhibition should be considered.

Neuromuscular Correlates of the Contralateral Stretch-induced Strength Loss

PURPOSE

The current study investigated the effects of unilateral passive stretching on the neuromuscular mechanisms involved in the force-generating capacity of the contralateral muscle.

METHODS

Twenty-six healthy men underwent unilateral passive stretching of the plantarflexors (5 × 45 s on + 15 s off; total stretching time, 225 s). Before and after the stretching protocol, contralateral ankle range of motion, maximum voluntary contraction (MVC) of the plantarflexors, and surface electromyographic root-mean-square (sEMG RMS) of the soleus and the gastrocnemii muscles were determined. Concurrently, V-wave, maximum and superimposed H-reflex, and M-wave were elicited via nerve stimulation to estimate the supraspinal, spinal, and peripheral mechanisms, respectively. sEMG RMS, V-wave, and H-reflex were normalized to the M-wave.

RESULTS

After passive stretching, contralateral ankle range of motion was increased (+8% [1%/15%], effect size [ES] = 0.43 [0.02/0.84], P < 0.001), MVC of the plantarflexors was decreased (-9% [-21%/-2%], ES = -0.96 [-1.53/-0.38], P < 0.001), and the sEMG RMS/M-wave of the soleus and the gastrocnemii muscles was decreased (≈-9%, ES ≈ -0.33, P < 0.05). Concurrently, the V-wave/M-wave superimposed was decreased in all muscles (≈-13%, ES = -0.81 to -0.52, P < 0.05). No change in H-reflex/M-wave and M-wave was observed under both maximum and superimposed condition. The decrease in the MVC and the sEMG RMS of the contralateral muscle was accompanied by a decrease in the V-wave/M-wave but not the H-reflex/M-wave ratios and the M-wave.

CONCLUSIONS

The present outcomes suggest that only supraspinal mechanisms might be involved in the contralateral decrease in the maximum force-generating capacity.

Analytical Modelling of Surface EMG Signals Generated by Curvilinear Fibers with Approximate Conductivity Tensor

OBJECTIVE

Mathematical modelling of surface electromyographic (EMG) signals has been proven a valuable tool to interpret experimental data and to validate signal processing techniques. Most analytical EMG models only consider muscle fibers with specific and fixed arrangements. However, the fiber orientation and curvature may change along the fiber paths and may differ from fiber to fiber. Here we propose a subject-specific EMG model that simulates the fiber trajectories in muscles of the upper arm and analytically derives the action potentials assuming an approximate conductivity tensor.

METHODS

Magnetic Resonance (MR) images were acquired to identify and generate muscle fiber paths and to determine the muscle locations in a cylindrical volume conductor. While the propagation of the action potentials followed the identified curvilinear fiber paths, the conductivity tensor was not adapted to the fiber direction but approximated along the longitudinal axis of the cylindrical volume conductor. Single fiber action potentials (SFAPs) were computed by simulating the generation, propagation, and extinction of membrane current sources. To validate the assumption of the approximate conductivity tensor, two numerical models were implemented for comparison with the analytical solution. The first numerical model reproduced the analytical model and therefore included an approximation for the conductivity tensor. The second numerical model included the exact conductivity tensor derived from the fiber curvatures.

RESULTS

The motor unit action potentials generated by the proposed analytical model and the two numerical models were highly similar (cross-correlation >0.98, normalized root mean square error, nRMSE 0.04, relative error in the median frequency of the simulated waveforms of approximately 3%). The proposed analytical model was also evaluated by comparing simulated and experimentally recorded compound muscle action potentials (CMAPs). The CMAPs simulated with the proposed model better matched the experimental data (cross-correlation >0.90 and nRMSE <0.25 for the majority of the channels) than a model with straight fibers. Finally, the proposed model was representatively used to test the accuracy of an EMG decomposition algorithm, providing a realistic benchmark.

CONCLUSIONS AND SIGNIFICANCE

The proposed analytical model generates action potentials that reflect the spatial distributions of muscle fibers with curvilinear paths. The simulated signals are more realistic than signals generated by analytical models with straight fibers and can therefore be applied for testing EMG processing algorithms with a trade-off between simulation accuracy and computational speed.

Maximal results with minimal stimuli: the fewest high-frequency pulses needed to measure or model prolonged low-frequency force depression in the dorsiflexors

Quantifying prolonged low-frequency force depression (PLFFD) with the gold-standard 1-s trains presents challenges, so paired pulses have been used. Owing to greater impairment of high-frequency doublet than tetanic torque, paired pulses underestimate PLFFD. This study aimed to approximate the minimum number of high-frequency pulses needed to avoid such underestimation and assess the feasibility of modeling PLFFD from a limited number of experimental pulses. In 13 participants, a 1-s 10-Hz train and 100-Hz trains with 2, 4, 7, 12, 15, 25, 50, or 100 pulses were evoked before and after (15 min, 2, 4, and 7 days) eccentric exercise of the dorsiflexors. With ≤12 pulses, impairment of 100-Hz torque was greater than the 1-s train (P ≤ 0.05; e.g., 12 vs. 100 pulses at 4 days: 97.8 ± 8.5% vs. 100.5 ± 8.2% baseline). Consequently, with ≤12 pulses, PLFFD was underestimated compared with the gold-standard measure (P ≤ 0.05; e.g., 12 vs. 100 pulse 10:100-Hz torque ratio at 4 days: 86.8 ± 12.8% vs. 84.6 ± 13.5% baseline). Modeling reproduced 10:100-Hz ratios (PLFFD) with 95% limits of agreement of -13.6% to 16.7% of experimental values with ≥12 pulses. Our results indicate that a minimum of 13-25 pulses of 100 Hz are needed to accurately quantify PLFFD in the dorsiflexors. Although this may not be the minimum range for other muscles, a similar relationship with pulse number likely exists. Modeling may eventually provide an option to estimate PLFFD from experimental trains with relatively few pulses; however, further development is imperative to reduce variability.NEW & NOTEWORTHY Ideally, prolonged low-frequency force depression (PLFFD) is measured with 1-s trains of supramaximal stimuli; however, this induces considerable discomfort. We tested briefer trains to approximate the minimum number of high-frequency pulses needed to accurately determine PLFFD and the feasibility of modeling 1-s tetani with relatively few pulses. After eccentric exercise, 13-25 high-frequency pulses were needed to accurately measure PLFFD. Modeling reproduced mean experimental values but had considerable variability.

Muscle Ionic Shifts During Exercise: Implications for Fatigue and Exercise Performance

Exercise causes major shifts in multiple ions (e.g., K⁺ , Na⁺ , H⁺ , lactate^- , Ca²⁺ , and Cl^- ) during muscle activity that contributes to development of muscle fatigue. Sarcolemmal processes can be impaired by the trans-sarcolemmal rundown of ion gradients for K⁺ , Na⁺ , and Ca²⁺ during fatiguing exercise, while changes in gradients for Cl^- and Cl^- conductance may exert either protective or detrimental effects on fatigue. Myocellular H⁺ accumulation may also contribute to fatigue development by lowering glycolytic rate and has been shown to act synergistically with inorganic phosphate (Pi) to compromise cross-bridge function. In addition, sarcoplasmic reticulum Ca²⁺ release function is severely affected by fatiguing exercise. Skeletal muscle has a multitude of ion transport systems that counter exercise-related ionic shifts of which the Na⁺ /K⁺ -ATPase is of major importance. Metabolic perturbations occurring during exercise can exacerbate trans-sarcolemmal ionic shifts, in particular for K⁺ and Cl^- , respectively via metabolic regulation of the ATP-sensitive K⁺ channel (K_ATP ) and the chloride channel isoform 1 (ClC-1). Ion transport systems are highly adaptable to exercise training resulting in an enhanced ability to counter ionic disturbances to delay fatigue and improve exercise performance. In this article, we discuss (i) the ionic shifts occurring during exercise, (ii) the role of ion transport systems in skeletal muscle for ionic regulation, (iii) how ionic disturbances affect sarcolemmal processes and muscle fatigue, (iv) how metabolic perturbations exacerbate ionic shifts during exercise, and (v) how pharmacological manipulation and exercise training regulate ion transport systems to influence exercise performance in humans. © 2021 American Physiological Society. Compr Physiol 11:1895-1959, 2021.

Neural adaptations to long-term resistance training: evidence for the confounding effect of muscle size on the interpretation of surface electromyography

This study compared elbow flexor (EF; experiment 1) and knee extensor (KE; experiment 2) maximal compound action potential (M_max) amplitude between long-term resistance trained (LTRT; n = 15 and n = 14, 6 ± 3 and 4 ± 1 yr of training) and untrained (UT; n = 14 and n = 49) men, and examined the effect of normalizing electromyography (EMG) during maximal voluntary torque (MVT) production to M_max amplitude on differences between LTRT and UT. EMG was recorded from multiple sites and muscles of EF and KE, M_max was evoked with percutaneous nerve stimulation, and muscle size was assessed with ultrasonography (thickness, EF) and magnetic resonance imaging (cross-sectional area, KE). Muscle-electrode distance (MED) was measured to account for the effect of adipose tissue on EMG and M_max. LTRT displayed greater MVT (+66%-71%, P < 0.001), muscle size (+54%-56%, P < 0.001), and M_max amplitudes (+29%-60%, P ≤ 0.010) even when corrected for MED (P ≤ 0.045). M_max was associated with the size of both muscle groups (r ≥ 0.466, P ≤ 0.011). Compared with UT, LTRT had higher absolute voluntary EMG amplitude for the KE (P < 0.001), but not the EF (P = 0.195), and these differences/similarities were maintained after correction for MED; however, M_max normalization resulted in no differences between LTRT and UT for any muscle and/or muscle group (P ≥ 0.652). The positive association between M_max and muscle size, and no differences when accounting for peripheral electrophysiological properties (EMG/M_max), indicates the greater absolute voluntary EMG amplitude of LTRT might be confounded by muscle morphology, rather than providing a discrete measure of central neural activity. This study therefore suggests limited agonist neural adaptation after LTRT.NEW & NOTEWORTHY In a large sample of long-term resistance-trained individuals, we showed greater maximal M-wave amplitude of the elbow flexors and knee extensors compared with untrained individuals, which appears to be at least partially mediated by differences in muscle size. The lack of group differences in voluntary EMG amplitude when normalized to maximal M-wave suggests that differences in muscle morphology might impair interpretation of voluntary EMG as an index of central neural activity.

Moving forward: methodological considerations for assessing corticospinal excitability during rhythmic motor output in humans

The use of transcranial magnetic stimulation to assess the excitability of the central nervous system to further understand the neural control of human movement is expansive. The majority of the work performed to-date has assessed corticospinal excitability either at rest or during relatively simple isometric contractions. The results from this work are not easily extrapolated to rhythmic, dynamic motor outputs, given that corticospinal excitability is task-, phase-, intensity-, direction-, and muscle-dependent (Power KE, Lockyer EJ, Forman DA, Button DC. Appl Physiol Nutr Metab 43: 1176-1185, 2018). Assessing corticospinal excitability during rhythmic motor output, however, involves technical challenges that are to be overcome, or at the minimum considered, when attempting to design experiments and interpret the physiological relevance of the results. The purpose of this narrative review is to highlight the research examining corticospinal excitability during a rhythmic motor output and, importantly, to provide recommendations regarding the many factors that must be considered when designing and interpreting findings from studies that involve limb movement. To do so, the majority of work described herein refers to work performed using arm cycling (arm pedaling or arm cranking) as a model of a rhythmic motor output used to examine the neural control of human locomotion.

Chronic resistance training: is it time to rethink the time course of neural contributions to strength gain?

Resistance training enhances muscular force due to a combination of neural plasticity and muscle hypertrophy. It has been well documented that the increase in strength over the first few weeks of resistance training (i.e. acute) has a strong underlying neural component and further enhancement in strength with long-term (i.e. chronic) resistance training is due to muscle hypertrophy. For obvious reasons, collecting long-term data on how chronic-resistance training affects the nervous system not feasible. As a result, the effect of chronic-resistance training on neural plasticity is less understood and has not received systematic exploration. Thus, the aim of this review is to provide rationale for investigating neural plasticity beyond acute-resistance training. We use cross-sectional work to highlight neural plasticity that occurs with chronic-resistance training at sites from the brain to spinal cord. Specifically, intra-cortical circuitry and the spinal motoneuron seem to be key sites for this plasticity. We then urge the need to further investigate the differential effects of acute versus chronic-resistance training on neural plasticity, and the role of this plasticity in increased strength. Such investigations may help in providing a clearer definition of the continuum of acute and chronic-resistance training, how the nervous system is altered during this continuum and the causative role of neural plasticity in changes in strength over the continuum of resistance training.

The Effects of Inter-Set Recovery Time on Explosive Power, Electromyography Activity, and Tissue Oxygenation during Plyometric Training

Performing continuous sets to failure is fatiguing during the plyometric training. Cluster sets have been used to redistribute total rest time to create short frequent sets so that muscle fatigue can be avoided. The purpose of the study was to investigate the effects of inter-set recovery time on lower extremity explosive power, neuromuscular activity, and tissue oxygenation during plyometric exercise and recovery. An integrated assessment of explosive power, muscle electrical activity, and tissue oxygenation was adopted in the present study to help understand local muscle metabolism and fatigue during plyometric exercise and recovery. Ten university male basketball players participated in this study. Subjects performed 4 groups of exercise, each group comprised of 3 sets of jumps: 1, 2, 3, or 5 min. Surface electromyography (sEMG) signals were collected from 9 lower extremity muscles; near-infrared spectroscopy (NIRS) was recorded on vastus lateralis; mechanical data during plyometric exercise were collected from a force plate. No significant differences among sets and among groups were found regarding explosive power, jump height, EMG intensity, mean power frequency, the rate of tissue saturation index, and HbO2 changes between baseline and recovery. The current study has shown no muscular fatigue induced during the 4 groups of exercise. The results of this study may help inform recommendations concerning the recovery time during plyometric exercises at low loads (30% 1 RM).

Quantification of Neuromuscular Fatigue: What Do We Do Wrong and Why?

Neuromuscular fatigue (NMF) is usually assessed non-invasively in healthy, athletic or clinical populations with the combination of voluntary and evoked contractions. Although it might appear relatively straightforward to magnetically or electrically stimulate at different levels (cortical/spinal/muscle) and to measure mechanical and electromyographic responses to quantify neuromuscular adjustments due to sustained/repeated muscle contractions, there are drawbacks that researchers and clinicians need to bear in mind. The aim of this opinion paper is to highlight the pitfalls inevitably faced when NMF is quantified. The first problem might arise from the definition of fatigue itself and the parameter(s) used to measure it; for instance, measuring power vs. isometric torque may lead to different conclusions. Another potential limitation is the delay between exercise termination and the evaluation of neuromuscular function; the possible underestimation of exercise-induced neural and contractile impairment and misinterpretation of fatigue etiology will be discussed, as well as solutions recently proposed to overcome this problem. Quantification of NMF can also be biased (or not feasible) because of the techniques themselves (e.g. results may depend on stimulation intensity for transcranial magnetic stimulation) or the way data are analyzed (e.g. M wave peak-to-peak vs first phase amplitude). When available, alternatives recently suggested in the literature to overcome these pitfalls are considered and recommendations about the best practices to assess NMF (e.g. paying attention to the delay between exercise and testing, adapting the method to the characteristics of the population to be tested and considering the limitations associated with the techniques) are proposed.

Factors associated with electrical stimulation-induced performance fatigability are dependent upon stimulation location

NEW FINDINGS

What is the central question of this study? How does peripheral nerve stimulation (PNS) compare with neuromuscular electrical stimulation (NMES) used clinically to reduce muscle atrophy? What is the main finding and its importance? NMES resulted in progressive increases in M-wave duration and delay of muscle relaxation throughout a single stimulation protocol, findings not observed with PNS. This suggests PNS recruits from a wider pool of muscle fibres/motor units, providing a more favourable alternative to NMES for rehabilitation intervention.

ABSTRACT

Neuromuscular electrical stimulation (NMES) is increasingly viewed as a central tenet to minimise muscle loss during periods of disuse/illness - typically applied directly over a muscle belly. Peripheral nerve stimulation (PNS) is afforded less attention, despite providing a more global contractile stimulus to muscles. We investigated NMES versus PNS in relation to performance fatigability and peripheral contributions to voluntary force capacity. Two fatigue protocols were assessed separately: (1) over-quadriceps NMES and (2) peripheral (femoral) nerve stimulation (PNS). Before and after each session, a maximal voluntary contraction (MVC) was performed to assess force loss. Knee-extensor force was measured throughout to assess contractile function in response to submaximal electrical stimulation, and M-wave features quantified myoelectrical activity. NMES and PNS induced similar voluntary (MVC, NMES: -12 ± 9%, PNS: -10 ± 8%, both P < 0.001) and stimulated (NMES: -45 ± 12%, PNS -27 ± 27%, both P < 0.001) force reductions. Although distinct between protocols, myoelectrical indicators of muscle recruitment (M-wave area and amplitude) and nerve conduction time did not change throughout either protocol. Myoelectrical propagation speed, represented as M-wave duration, and the delay before muscle relaxation began both progressively increased during NMES only (P < 0.05 and P < 0.001, respectively). NMES myoelectrical changes suggested performance fatigability, indicating activation of superficial fibres only, which was not observed with PNS. This suggests PNS recruits a wider pool of muscle fibres and motor units and is a favourable alternative for rehabilitation. Future work should focus on implementing PNS interventions in clinically relevant scenarios such as immobilisation, care homes and critical illness.

The M waves of the biceps brachii have a stationary (shoulder-like) component in the first phase: implications and recommendations for M-wave analysis

OBJECTIVE

We recently documented that compound muscle action potentials (M waves) recorded over the 'pennate' vastus lateralis showed a sharp deflection (named as a shoulder) in the first phase. Here, we investigated whether such a shoulder was also present in M waves evoked in a muscle with different architecture, such as the biceps brachii, with the purpose of elucidating the electrical origin of such afeature.

APPROACH

M waves evoked by maximal single shocks to the brachial plexus were recorded in monopolar and bipolar configurations from 72 individuals using large (10 mm diameter) electrodes and from eight individuals using small (1 mm diameter) electrodes arranged in a linear array. The changes in M-wave features at different locations along the muscle fiber direction were examined.

MAIN RESULTS

The shoulder was recognizable in most (87%) monopolar M waves, whereas it was rarely observed (6%) in bipolar derivations. Recordings made along the fiber direction showed that the shoulder was a stationary (non-propagating) feature, with short duration (spiky), which had positive polarity at all locations along the fibers. The latency of the shoulder (9.5 ± 0.5 ms) was significantly shorter than the estimated time taken for the action potentials to reach the biceps tendon (12.8 ms).

SIGNIFICANCE

The shoulder must be generated by a dipole source, i.e. a source created at a fixed anatomical position, although the exact origin of this dipole is uncertain. Our results suggest that the shoulder may not be due to the end-of-fiber signals formed at the biceps brachii tendon. The shoulder is not related to any specific arrangement of muscle fibers, as it has been observed in both pennate and fusiform muscles. Being a stationary (non-propagating) component, the shoulder is not reliable for studying changes in sarcolemmal excitability, and thus should be excluded from the M-wave analysis.

Adaptive Stimulation Profiles Modulation for Foot Drop Correction Using Functional Electrical Stimulation: A Proof of Concept Study

Functional electrical stimulation (FES) provides an effective way for foot drop (FD) correction. To overcome the redundant and blind stimulation problems in the state-of-the-art methods, this study proposes a closed-loop scheme for an adaptive electromyography (EMG)-modulated stimulation profile. The developed method detects real-time angular velocity during walking. It provides feedbacks to a long short-term memory (LSTM) neural network for predicting synchronous tibialis anterior (TA) EMG. Based on the prediction, it modulates the stimulation intensity, taking into account of the subject-specific dead zone and saturation of the electrically evoked activation. The proposed method is tested on ten able-bodied participants and six FD subjects as proof of concept. The experimental results show that the proposed method can successfully induce the dorsiflexion of the ankle joint, and generate an activation pattern similar to a natural gait, with the mean Correlation Coefficient of 0.9021. Thus, the proposed method has the potential to help patients to retrieve normal gait.

Relationship of Anabolic Hormones With Motor Unit Characteristics in Quadriceps Muscle in Healthy and Frail Aging Men

CONTEXT

Anabolic hormones are important factors in maintaining muscle mass for aging men, but their role in overall motor unit structure and function is unclear.

OBJECTIVE

The objective of this work is to determine associations of anabolic and reproductive hormone levels with motor unit characteristics in quadriceps muscle in older healthy and frail men.

DESIGN

This work is an observational cohort study of community-dwelling men.

PARTICIPANTS

Participants included healthy and frail men younger than 65 years.

INTERVENTION

No intervention was performed.

OUTCOME MEASURE

Quantitative assessments of electromyography-derived motor unit potential size (MUP) and compound muscle action potential size (CMAP) of the vastus lateralis muscle.

RESULTS

We studied 98 men (mean ± SD: age 73 ± 6 years; body mass index [BMI] 25.7 ± 4.0 kg/m2; diabetes 11%) of whom 45% were prefrail and 18% frail. After adjusting for age, BMI, and prevalent diabetes, higher total and free testosterone levels were significantly related to larger CMAP (total testosterone: β [95% CI]: 0.3 [0.08-0.53]; free testosterone: 0.34 [0.13-0.56]). Exploratory analysis showed the relationship between free testosterone and CMAP was stronger in frail rather than robust men. In univariate analyses, estradiol was associated with CMAP size (0.37 [0.16-0.57]); and vitamin D was associated with MUP size (0.22 [0.01-0.43]) but these relationships were no longer significant after adjusting for potential confounders.

CONCLUSION

Our data highlight the associations between androgen levels and the electrophysiological characteristics of older men, particularly in the frail. Clinical trials involving administration of androgens will help to elucidate the potential benefits of intervention on neuromuscular function and/or frailty status.

Nerve conduction during acute blood-flow restriction with and without low-intensity exercise Nerve conduction and blood-flow restriction

Despite being apparently safe for most individuals, the impact of low intensity (LI) blood-flow restricted (BFR) exercise on nerve function and integrity is still obscure. We explored whether BFR (with and without exercise) alters the properties of nerve conduction measured at the level of the restricted limb. Thirteen healthy, young men (22.0 ± 1.7 years) were included in this study. Arterial occlusion pressure was taken at rest. Soleus M- and H-recruitment curves were constructed for all participants. H-wave latencies and amplitudes were obtained in three testing conditions (non-BFR vs. 60 vs. 80% BFR) at four different time points: [#1] non-restricted baseline, [#2] time control either with or without BFR, [#3] non-restricted pre-exercise, [#4] LI exercise either with or without BFR. Nerve conduction was estimated using the difference between the latency of H and M wave. BFR did not affect H-wave amplitude, either with or without exercise. The changes in the difference between H- and M-wave latency of over time were similar between all conditions (condition-by-time interaction: F = 0.7, p = 0.47). In conclusion, our data indicate that performing LI exercise with BFR, set at 60 or 80% BFR, does not exert a negative impact on sciatic-tibial nerve function. Thus, from a neurological standpoint, we provide preliminary evidence that LI BFR exercise may be regarded as a safe mode of resistance training in healthy young men.

Muscle fibre activation and fatigue with low-load blood flow restricted resistance exercise-An integrative physiology review

Blood flow-restricted resistance exercise (BFRRE) has been shown to induce increases in muscle size and strength, and continues to generate interest from both clinical and basic research points of view. The low loads employed, typically 20%-50% of the one repetition maximum, make BFRRE an attractive training modality for individuals who may not tolerate high musculoskeletal forces (eg, selected clinical patient groups such as frail old adults and patients recovering from sports injury) and/or for highly trained athletes who have reached a plateau in muscle mass and strength. It has been proposed that achieving a high degree of muscle fibre recruitment is important for inducing muscle hypertrophy with BFRRE, and the available evidence suggest that fatiguing low-load exercise during ischemic conditions can recruit both slow (type I) and fast (type II) muscle fibres. Nevertheless, closer scrutiny reveals that type II fibre activation in BFRRE has to date largely been inferred using indirect methods such as electromyography and magnetic resonance spectroscopy, while only rarely addressed using more direct methods such as measurements of glycogen stores and phosphocreatine levels in muscle fibres. Hence, considerable uncertainity exists about the specific pattern of muscle fibre activation during BFRRE. Therefore, the purpose of this narrative review was (1) to summarize the evidence on muscle fibre recruitment during BFRRE as revealed by various methods employed for determining muscle fibre usage during exercise, and (2) to discuss reported findings in light of the specific advantages and limitations associated with these methods.

Acute effects of bi-hemispheric transcranial direct current stimulation on the neuromuscular function of patients with chronic stroke: A randomized controlled study

BACKGROUND

Muscle weakness in patients with chronic stroke is due to neuromuscular disorders such as muscle atrophy, loss of voluntary activation or weak muscle contractile properties which are majored by the imbalance of interhemispheric inhibition following stroke. In patients with chronic stroke, unilateral transcranial direct current stimulation improved the maximal isometric strength of paretic knee extensors, but bilateral transcranial direct current stimulation failed to improve concentric strength. This study aimed to assess if a bilateral current stimulation improves isometric maximal strength, voluntary activation and contractile properties of knee extensors in patients with chronic stroke.

METHODS

Thirteen patients with chronic stroke and eight young healthy individuals participated in this randomized, simple-blinded, crossover study that included two experimental sessions: one with sham bilateral transcranial direct current stimulation and another with effective bilateral transcranial direct current stimulation (20 min, 2 mA). In the stroke patients, the anode was placed over the primary motor cortex of the affected hemisphere and the cathode over the contralateral primary motor cortex. In healthy participants, the brain side targeted by the anode and the cathode was randomly assigned. In each session, participants performed three assessments of strength, voluntary activation and contractile properties: before, during and after effective/sham bilateral transcranial direct current stimulation.

FINDINGS

Bilateral transcranial direct current stimulation had no effect on any neuromuscular assessments in both groups (All P values > 0.05, partial eta-squares varied from 0.02 to 0.06).

INTERPRETATION

A single session of bilateral transcranial direct current stimulation did not compensate muscular weakness of knee extensors in patients with chronic stroke.

Sex difference in fatigability of knee extensor muscles during sustained low-level contractions

This study investigated whether the sex difference in fatigability of the knee extensors (KE) is explained by the sex difference in fatigue-induced changes in the shear modulus of one or more muscles of KE in 18 young men and 23 young women. The shear moduli of the resting rectus femoris and medial and lateral vastus muscles (VL) were measured before and after a sustained contraction at 20% peak torque during a maximal voluntary isometric contraction of KE until the endurance limit, in addition to evoked torque and voluntary activation (VA%). The fatigue-induced decrease in maximal muscle strength was more prominent in men than in women. Only the VL shear modulus for men increased after the fatiguing task, and a sex difference was observed in the percentage change in the VL shear modulus before and after the fatiguing task. The fatigue-induced decreased ratio was greater for men than for women in evoked torque, but not in VA%. These results suggest that although peripheral and central fatigue both influenced the fatigue-induced decrease in maximal muscle strength regardless of sex, the sex difference in KE fatigability is explained by that in peripheral fatigue, particularly the degree of peripheral VL fatigue.

Passive muscle stretching impairs rapid force production and neuromuscular function in human plantar flexors

PURPOSE

We examined the effect of muscle stretching on the ability to produce rapid torque and the mechanisms underpinning the changes.

METHODS

Eighteen men performed three conditions: (1) continuous stretch (1 set of 5 min), (2) intermittent stretch (5 sets of 1 min with 15-s inter-stretch interval), and (3) control. Isometric plantar flexor rate of torque development was measured during explosive maximal voluntary contractions (MVC) in the intervals 0-100 ms (RTD_V100) and 0-200 ms (RTD_V200), and in electrically evoked 0.5-s tetanic contractions (20 Hz, 20 Hz preceded by a doublet and 80 Hz). The rate of EMG rise, electromechanical delay during MVC (EMD_V) and during a single twitch contraction (EMD_twitch) were assessed.

RESULTS

RTD_V200 was decreased (P < 0.05) immediately after continuous (- 15%) and intermittent stretch (- 30%) with no differences between protocols. The rate of torque development during tetanic stimulations was reduced (P < 0.05) immediately after continuous (- 8%) and intermittent stretch (- 10%), when averaged across stimulation frequencies. Lateral gastrocnemius rate of EMG rise was reduced after intermittent stretch (- 27%), and changes in triceps surae rate of EMG rise were correlated with changes in RTD_V200 after both continuous (r = 0.64) and intermittent stretch (r = 0.65). EMD_V increased immediately (31%) and 15 min (17%) after intermittent stretch and was correlated with changes in RTD_V200 (r = - 0.56). EMD_twitch increased immediately after continuous (4%), and immediately (5.4%), 15 min (6.3%), and 30 min after (6.4%) intermittent stretch (P < 0.05).

CONCLUSIONS

Reductions in the rate of torque development immediately after stretching were associated with both neural and mechanical mechanisms.

Contraction intensity-dependent variations in the responses to brain and corticospinal tract stimulation after a single session of resistance training in men

The aim of this study was to determine the effects of acute resistance training (RT) intensity on motor-evoked potentials (MEPs) generated by transcranial magnetic brain stimulation and on cervicomedullary motor-evoked potentials (CMEPs) produced by electrical stimulation of the corticospinal tract. In four experimental sessions, 14 healthy young men performed 12 sets of eight isometric contractions of the elbow flexors at 0 (Control session), 25, 50, and 75% of the maximal voluntary contraction (MVC). Before and after each session, MEPs, CMEPs, and the associated twitch forces were recorded at rest. MEPs increased by 39% (P < 0.05 versus 25% in the control condition, Effect size (ES) = 1.04 and 1.76, respectively) after the 50% session and by 70% (P < 0.05 vs. all other conditions, ES = 0.91-2.49) after the 75% session. In contrast, CMEPs increased similarly after the 25%, 50%, and 75% sessions with an overall increase of 27% (P < 0.05 vs. control condition, ES = 1.34). The amplitude of maximal compound muscle action potentials (M_max) was unchanged during the experiment. The MEP- and CMEP-associated twitch forces also increased after RT, but training intensity affected only the increases in MEP twitch forces. The data tentatively suggest that the intensity of muscle contraction used in acute bouts of RT affects cortical excitability.NEW & NOTEWORTHY Resistance training (RT) can acutely increase the efficacy of the corticospinal-motoneuronal synapse, motoneuron excitability and motor cortical excitability. We show that motor-evoked potential generated by transcranial magnetic stimulation but not cervicomedullary electrical stimulation increased in proportion to the intensity of training used during a single session of RT. The data suggest that the intensity of muscle contraction used in acute bouts of RT affects cortical excitability.

Potentiation of the first and second phases of the M wave after maximal voluntary contractions in the biceps brachii muscle

The study was undertaken to examine separately the potentiation of the first and second phases of the M wave in biceps brachii after conditioning maximal voluntary contractions (MVCs) of different durations. M waves were evoked in the biceps brachii muscle before and after isometric MVCs of 1, 3, 6, 10, 30, and 60 s. The amplitude, duration, and area of the first and second phases of monopolar M waves were measured during the 10-min period following each contraction. Our results indicated that the amplitude and area of the M-wave first phase increased after MVCs of long (≥ 30 s) duration (P < 0.05), while it decreased after MVCs of short (≤ 10 s) duration (P < 0.05). The enlargement after the long MVCs persisted for 5 min, whereas the depression after the short contractions lasted only for 15 s. The amplitude of the second phase increased immediately (1 s) after all MVCs tested (P < 0.05), regardless of their duration, and then returned rapidly (10 s) to control levels. Unexpectedly, the amplitude of the second phase decreased below control values between 15 s and 1 min after the MVCs lasting ≥ 6 s (P < 0.05). Our results reinforce the idea that the presence of fatigue is a necessary condition to induce an enlargement of the M-wave first phase and that this enlargement would be greater (and occur sooner) in muscles with a predominance of type II fibers (quadriceps and biceps brachii) compared to type-I predominant muscles (tibialis anterior). The unique findings observed for the M-wave second phase indicate that changes in this phase are highly muscle dependent. Graphical abstract Left panel-Representative examples of M waves recorded in one participant before (control) and at various times after conditioning maximal voluntary contractions (MVCs) of short (a1) and long (a2) duration. Left panel-Time course of recovery of the amplitude of the first (b1) and second (b2) phases of the M wave after conditioning MVCs of different durations.

A Method for Suppressing Electrical Stimulation Artifacts from Electromyography

When surface electromyography (EMG) signal is used in a real-time functional electrical stimulation (FES) system for feedback control, the artifact from electrical stimulation is a key challenge for EMG signal processing. To address this challenge, this study proposes a novel method to suppress stimulation artifacts in the EMG-driven closed-loop FES system. The proposed method is inspired by an experimental study that compares artifacts generated by electrical stimulations with different current intensities. It is found that (1) spikes of stimulation artifacts are susceptible to the current intensity and (2) tailing components are similar under different current intensities. Based on these observations, the proposed method combines the blanking and template subtracting strategies for suppressing stimulation artifact. The length of blanking window for suppressing the stimulation spike is adaptively determined by a spike detection algorithm and the first-order derivative analysis of signal. An autoregressive model is used to estimate the tailing part of stimulation artifact, which is an adaptive template for subtracting the artifact. The proposed method is evaluated on both semi-synthetic and experimental datasets. Verified on the semi-synthetic dataset, the proposed method achieves better performance than the classic blanking method. Validated on the experimental dataset, the proposed method substantially decreases the power of stimulation artifact in the EMG. These results indicate that the proposed method can effectively suppress the stimulation artifact while retains the useful EMG signal for an EMG-driven FES system.

Loss of mitochondrial protein CHCHD10 in skeletal muscle causes neuromuscular junction impairment

The neuromuscular junction (NMJ) is a synapse between motoneurons and skeletal muscles to control motor behavior. Acetylcholine receptors (AChRs) are restricted at the synaptic region for proper neurotransmission. Mutations in the mitochondrial CHCHD10 protein have been identified in multiple neuromuscular disorders; however, the physiological roles of CHCHD10 at NMJs remain elusive. Here, we report that CHCHD10 is highly expressed at the postsynapse of NMJs in skeletal muscles. Muscle conditional knockout CHCHD10 mice showed motor defects, abnormal neuromuscular transmission and NMJ structure. Mechanistically, we found that mitochondrial CHCHD10 is required for ATP production, which facilitates AChR expression and promotes agrin-induced AChR clustering. Importantly, ATP could effectively rescue the reduction of AChR clusters in the CHCHD10-ablated muscles. Our study elucidates a novel physiological role of CHCHD10 at the peripheral synapse. It suggests that mitochondria dysfunction contributes to neuromuscular pathogenesis.

The magnitude of neuromuscular fatigue is not intensity dependent when cycling above critical power but relates to aerobic and anaerobic capacities

NEW FINDINGS

What is the central question of this study? Is the magnitude of neuromuscular fatigue dependent upon exercise intensity above critical power (CP) when W' (the curvature constant of the power-duration relationship) is depleted? What is the main finding and its importance? The magnitude of neuromuscular fatigue is the same after two bouts of supra-CP cycling (3 versus 12 min) when controlling for W' depletion but is larger for individuals of greater anaerobic capacity after the shorter bout and smaller for individuals of greater aerobic capacity after the longer exercise bout. These findings provide new insight into the mechanisms underpinning exercise above CP.

ABSTRACT

The aim of the present study was to test whether the development of neuromuscular fatigue within the severe-intensity domain could be linked to the depletion of the curvature constant (W') of the power-duration relationship. Twelve recreationally active men completed tests to determine peak oxygen consumption, critical power (CP) and W', followed by two randomly assigned constant-load supra-CP trials set to deplete W' fully in 3 (P-3) and 12 min (P-12). Pre- to postexercise changes in maximal voluntary contraction, potentiated quadriceps twitch force evoked by single (Q_pot ) and paired high- (PS100) and low-frequency (PS10) stimulations and voluntary activation were determined. Cycling above CP reduced maximal voluntary contraction (P-3, -20 ± 10% versus P-12, -15 ± 7%), measures associated with peripheral fatigue (Q_pot , -35 ± 13 versus -31 ± 14%; PS10, -38 ± 13 versus -37 ± 17%; PS100, -18 ± 9 versus -13 ± 8% for P-3 and P-12, respectively) and voluntary activation (P-3, -12 ± 3% versus P-12, -13 ± 3%; P < 0.05), with no significant difference between trials (P > 0.05). Changes in maximal voluntary contraction and evoked twitch forces were inversely correlated with CP and peak oxygen consumption after P-12, whereas W' was significantly correlated with changes in Q_pot and PS10 after P-3 (P < 0.05). Therefore, the magnitude of neuromuscular fatigue does not depend on exercise intensity when W' is fully exhausted during severe-intensity exercise; nonetheless, exploration of inter-individual variations suggests that mechanisms underpinning exercise tolerance within this domain differ between short- and long-duration exercise.