Potential interests and limits of magnetic and electrical stimulation techniques to assess neuromuscular fatigue

Neuromuscular Fatigue During Brazilian Jiujitsu Matches: Analysis of Upper and Lower Limbs

PURPOSE

To determine the effects of repeated Brazilian jiujitsu (BJJ) matches on neuromuscular fatigue in forearm-flexor and knee-extensor muscles.

METHODS

Twelve BJJ athletes (8 men and 4 women) performed a simulated BJJ tournament composed of four 8-minute matches interspersed by 16-minute intervals. Neuromuscular fatigue was assessed via prematch to postmatch(es) reductions in maximal voluntary isometric contraction (MVIC), voluntary activation, and potentiated twitch force (Ptwpot) in the forearm-flexor and knee-extensor muscles.

RESULTS

The MVIC of the knee extensors and forearm flexors reduced from prematch 1 to postmatch 2 and remained suppressed until postmatch 4 (P < .034). The voluntary activation of the knee extensors declined only after match 4, whereas the voluntary activation of the forearm flexors did not change throughout the matches (P = .102). Ptwpot of knee extensors decreased from prematch 1 to postmatch 1 (P < .001) and remained reduced until postmatch 4 (P < .001). Ptwpot of the forearm flexors reduced after every match (P < .010), with complete recovery occurring only before the second match (P = .99). The magnitude of the prematch-to-postmatch reduction in Ptwpot was lower in knee extensors than in forearm flexors (P = .044).

CONCLUSIONS

Repeated BJJ matches induced neuromuscular fatigue, mainly due to impairments in muscle contractile function (ie, peripheral fatigue). The time between BJJ matches seems to be insufficient to allow complete recovery of neuromuscular function, which may influence performance during subsequent matches.

Neural and Muscular Determinants of Performance Fatigability Are Independent of Work and Recovery Durations During High-Intensity Interval Exercise in Males

The present study aimed to investigate the effect of two protocols of high-intensity interval exercise (HIIE) on performance fatigability and its neural and muscular determinants. On different days, 14 healthy males performed two HIIE protocols with different work and recovery durations (matched for total duration, work and recovery intensities, and density): 1) 4 × 4 min at 90% HRpeak,180-s recovery at 70% HRpeak; and 2) 16 × 1 min at 90% HRpeak, 45-s recovery at 70% HRpeak. Pre- to post-HIIE reduction in maximal voluntary isometric contraction (MVIC) was used as marker of performance fatigability, while voluntary activation (VA) and potentiated quadriceps twitch force (Qtw) as markers of the neural (i.e. central fatigue) and muscular (i.e. peripheral fatigue) determinants, respectively. In addition, pre- to post-HIIE reduction in twitch force stimulated at 100 Hz (Qtw100) and 10:100 Hz ratio (Qtw10:Qtw100) were used as markers of high- and low-frequency performance fatigability, respectively. The MVIC, VA, Tw, Qtw100, and Qtw10:Qtw100 ratio decreased similarly from pre- to post-HIIE in both HIIE protocols (p < .05). The rating of perceived effort, blood pH, and plasma lactate responses were similar between HIIE protocols (p > .05), but the heart rate was higher in the longer HIIE protocol (p < .05). In conclusion, performance fatigability and its neural and muscular determinants seemed to be independent of the work and recovery durations of the HIIE, at least when HIIE protocols were matched for total work duration, work and recovery intensities, and density. Further, HIIE with long work and recovery might be preferable when the intention is to stress the chronotropic response.

Effects of exhaustive whole-body exercise and caffeine ingestion on muscle contractile properties in healthy men

BACKGROUND

The influence of exhaustive whole-body exercise and caffeine ingestion on electromechanical delay (EMD) has been underexplored. This study investigated the effect of exhaustive cycling exercise on EMD and other parameters of muscle contractile properties and the potential ability of caffeine to attenuate the exercise-induced impairments in EMD and muscle contractile properties.

METHODS

Ten healthy men cycled until exhaustion (88±2% of V̇O2max) on two separate days after ingesting caffeine (5 mg.kg-1 of body mass) or cellulose (placebo). Parameters of muscle contractile properties of the quadriceps muscles were assessed via volitional and electrically evoked isometric contractions, performed before and 50 minutes after ingestion of the capsules, and after exercise. Muscle recruitment during volitional contractions was determined via surface electromyography.

RESULTS

Exhaustive cycling exercise did not affect volitional and relaxation EMD (P>0.05) but increased evoked EMD. In addition, the exhaustive cycling exercise also increased muscle recruitment at the beginning of volitional isometric muscle contraction (P<0.05). The peak twitch force, maximal rate of twitch force development, and twitch contraction time were all compromised after exhaustive cycling exercise (P<0.05). Acute caffeine ingestion had no effect on muscle contractile properties (P>0.05), except that caffeine increased twitch contraction time at postexercise (P<0.05).

CONCLUSIONS

Exercise-induced decline in peripheral components of the EMD might be compensated by an increase in the muscle recruitment. In addition, acute caffeine ingestion had minimal influence on exercise-induced changes in muscle contractile proprieties.

Effect of Neuromuscular Fatigue on the Countermovement Jump Characteristics: Basketball-Related High-Intensity Exercises

ABSTRACT

Yoshida, N, Hornsby, WG, Sole, CJ, Sato, K, and Stone, MH. Effect of neuromuscular fatigue on the countermovement jump characteristics: basketball related high-intensity exercises. J Strength Cond Res 38(1): 164-173, 2024-The purpose of this study was to investigate basketball specific neuromuscular (NM) fatigue effect on countermovement jump (CMJ) force-time (F-T) curve characteristics. Eleven male college-level basketball athletes performed 6 CMJ trials at 3 baseline (pre) and 6 postexercise time points. The fatiguing protocol consisted of high-intensity basketball related exercises commensurate with basketball game or practice. Typical CMJ (CMJ-TYP) and phase-specific CMJ variables were derived from the F-T curve. Meaningful differences in CMJ performance were examined using effect size (ES) compared with baseline and previous postexercise time point. Baseline with 3 separated measurements demonstrated suitable CMJ variables reproducibility (CV, coefficient of variation). Most CMJ-TYP output and performance variables displayed substantial alterations immediately postexercise (0 hour) and returned to baseline at 24 hours postexercise, whereas the time and rate-related CMJ-TYP and CMJ-phase variables tended to display delayed decline peaked at 2 hours and delayed recovery to baseline at 48 hours postexercise. In conjunction with the return of the time and rate-related variables, CMJ performance displayed supercompensation at 72 hours postexercise. The results indicate altered NM functions with desired CMJ performance, such as jump height, which imply an altered movement strategy at early stage of recovery process. Full recovery may take 48-72 hours. Practitioners are, therefore, advised to monitor variables reflecting NM functions for precise manipulation of the intensity and volume of exercise to avoid prolonging the recovery from NM fatigue.

Characterization of neuromuscular performances in adults with late-onset Pompe disease: A control case cross-sectional study

Adults with late-onset Pompe disease (aLOPD) are characterized by muscular contractile tissue deterioration. However, their neuromuscular performances are poorly known. We aimed to compare maximal muscle strength, activation, explosive strength and neuromuscular fatigue between aLOPD and controls. We studied 20 aLOPD and 20 matched controls. Isometric maximum voluntary contraction (MVC) torque was obtained for the hip, knee and ankle muscles. The voluntary activation level (VAL) during knee extensor MVC was assessed using interpolated twitch technique. Explosive strength was evaluated for knee and ankle muscles through the rate of torque development (RTD) during fast contractions. Neuromuscular fatigue was measured during a 30-second contraction of knee flexors and extensors. All muscle MVC torques were significantly lower in aLOPD than controls (p <0.05). The weakest muscles were the hip extensors followed by hip abductors and abductors. Raw value of RTD was lower in aLOPD for the majority of muscles (p <0.05). No intergroup differences were reported for normalized RTD, VAL and neuromuscular fatigue (p-values> 0.05). Our study shows that maximal strength was the only neuromuscular characteristic affected in aLOPD with a proximal-distal intensity gradient. This suggests that the surviving muscle tissue of aLOPD is as functionally efficient as that of control individuals.

Acute performance, physiological, and perceptual changes in response to repeated cycling sprint exercise combined with systemic and local hypoxia in young males

This study investigated the acute performance, physiological, and perceptual changes during repeated sprint exercise (RSE) under normobaric hypoxia and with blood flow restriction (BFR). Fourteen active males completed standardized RSE (6 × 10s cycling sprints with 30s passive rest) in three randomized conditions: under normobaric hypoxia (F_iO₂∼14.4%, HYP), normoxia (F_iO₂∼20.9%, SHAM), and with BFR (40% arterial occlusion pressure). The percentage decrement score of power output (S_dec) was used to quantify motor performance fatigue. During RSE, muscle oxygenation and activity of the right quadriceps were measured. Perceived motor fatigue, physical strain, affective valence, and arousal were queried after each sprint. Blood lactate concentration (BLC) and peripheral oxygenation (S_pO₂) were measured before and after RSE. S_dec was greater in HYP and BFR compared to SHAM (p≤0.008). BFR decreased mean power output (p<0.001) and muscle activity (p=0.027) compared to SHAM. Muscle oxygenation was lower in BFR during each rest (p≤0.005) and in HYP during rest 4 (p=0.006) compared to SHAM. HYP increased BLC and decreased S_pO₂ compared to BFR (p<0.001) and SHAM (p=0.002). There were no differences between conditions for any rating scale (p≥0.060). HYP and BFR increased motor performance fatigue but with different physiological responses, whereas perceptual responses were unaffected during RSE.

Clinical studies on the electric automatic massage therapy for recovery of acute sports fatigue

BACKGROUND

Acute sports fatigue impairs athletes' performance and causes other health issues; therefore, an effective method of relieving acute sports fatigue is being researched.

OBJECTIVE

The present study was envisaged to evaluate the effect of electric auto-massage therapy and proprioceptive neuromuscular facilitated (PNF) stretching method on the recovery of acute exercise fatigue using the heart rate variability-based multi-physiological index and RPE scale, and to explore the underlying principle and mechanism.

METHOD

Sixty volunteers were divided into the stretching group, massage group and control group (20 subjects each) using the complete randomization method. The massage group chose the kneading, pressing, tapping and patting techniques using the intelligent massage chair to intervene on the volunteers, the stretching group chose the PNF stretching method to intervene on the volunteers, while the control group did not adopt any of these techniques. The Rating Of Perceived Exertion (RPE) score, heart rate (HR), grip strength, skin electrical activity, heart rate variability (HRV) and blood oxygen saturation (SpO2) of the three groups were recorded before and after the intervention.

RESULTS

Before the intervention, there was no statistically significant difference between the values of heart rate variability (HRV) in the three groups (P> 0.05), while after the intervention, there was a statistically significant difference between the values of heart rate variability - low frequency/high frequency (HRV (LF/HF)) and HRV (HF) in the three groups as: HRV (HF): ηH2= 0.10; P= 0.022; HRV (LF/HF): ηH2= 0.44; P= 0.001. The results indicated that the different intervention methods presented substantial effects on the values of HRV (HF) and HRV (LF/HF) in the volunteers. The HRV (HF) values of massage group, stretching group and control group were compared, and the difference between the massage group and control group was statistically significant (P= 0.019). Further, the HRV (HF) values of massage group rose more significantly than control group after the intervention, and the difference between HRV (HF) values of massage group and stretching group was not statistically significant. When comparing the HRV (LF/HF) values of massage group, stretching group and control group, the differences between the massage group and stretching group and control group were statistically significant (P= 0.001, P< 0.05), and it was observed that the HRV (LF/HF) values of massage group decreased more significantly than those of stretching group and control group after the intervention. The difference in HRV (LF) values between the three groups after the intervention was not statistically significant (P> 0.05).

CONCLUSION

1. It was observed that the electric automatic massage therapy played a vital role in the rapid relief of exercise fatigue by soothing and regulating the human phototropic system, reducing vagal tone, and accelerating the excretion of metabolites; while PNF stretching relieved the exercise fatigue by providing physical and verbal communication to transfer the perception of fatigue, and by promoting the excretion of metabolites through muscle isometric contraction. 2. The effect of electric auto-massage therapy was marginally stronger than the commonly used PNF stretching exercise method.

Measuring objective fatigability and autonomic dysfunction in clinical populations: How and why?

Fatigue is a major symptom in many diseases, often among the most common and severe ones and may last for an extremely long period. Chronic fatigue impacts quality of life, reduces the capacity to perform activities of daily living, and has socioeconomical consequences such as impairing return to work. Despite the high prevalence and deleterious consequences of fatigue, little is known about its etiology. Numerous causes have been proposed to explain chronic fatigue. They encompass psychosocial and behavioral aspects (e.g., sleep disorders) and biological (e.g., inflammation), hematological (e.g., anemia) as well as physiological origins. Among the potential causes of chronic fatigue is the role of altered acute fatigue resistance, i.e. an increased fatigability for a given exercise, that is related to physical deconditioning. For instance, we and others have recently evidenced that relationships between chronic fatigue and increased objective fatigability, defined as an abnormal deterioration of functional capacity (maximal force or power), provided objective fatigability is appropriately measured. Indeed, in most studies in the field of chronic diseases, objective fatigability is measured during single-joint, isometric exercises. While those studies are valuable from a fundamental science point of view, they do not allow to test the patients in ecological situations when the purpose is to search for a link with chronic fatigue. As a complementary measure to the evaluation of neuromuscular function (i.e., fatigability), studying the dysfunction of the autonomic nervous system (ANS) is also of great interest in the context of fatigue. The challenge of evaluating objective fatigability and ANS dysfunction appropriately (i.e.,. how?) will be discussed in the first part of the present article. New tools recently developed to measure objective fatigability and muscle function will be presented. In the second part of the paper, we will discuss the interest of measuring objective fatigability and ANS (i.e. why?). Despite the beneficial effects of physical activity in attenuating chronic fatigue have been demonstrated, a better evaluation of fatigue etiology will allow to personalize the training intervention. We believe this is key in order to account for the complex, multifactorial nature of chronic fatigue.

The impact of submaximal fatiguing exercises on the ability to generate and sustain the maximal voluntary contraction

Neuromuscular fatigability is a failure to produce or maintain a required torque, and commonly quantified with the decrease of maximal torque production during a few seconds-long maximal voluntary contraction (MVC). The literature shows that the MVC reduction after exercises with different torque-time integral (TTI), is often similar. However, it was shown that after a fatiguing exercise, the decline in the capacity to sustain the maximal voluntary contraction for 1 min (MVC1-MIN) differs from the decrease in the capacity to perform a brief-MVC, suggesting that this latter can only partially assess neuromuscular fatigability. This study aims to highlight the relevance of using a sustained MVC to further explore the neuromuscular alterations induced by fatiguing exercises with different TTI. We used two contraction intensities (i.e., 20% and 40% MVC) to modulate the TTI, and two exercise modalities [i.e., voluntary (VOL) and electrical induced (NMES)], since the letter are known to be more fatiguing for a given TTI. Thirteen subjects performed a plantar-flexors MVC1-MIN before and after the fatiguing exercises. A similar MVC loss was obtained for the two exercise intensities despite a greater TTI at 40% MVC, regardless of the contraction modality. On the other hand, the torque loss during MVC1-MIN was significantly greater after the 40% compared to 20% MVC exercise. These findings are crucial because they demonstrate that maximal torque production and sustainability are two complementary features of neuromuscular fatigability. Hence, MVC1-MIN assessing simultaneously both capacities is essential to provide a more detailed description of neuromuscular fatigability.

Downhill running affects the late but not the early phase of the rate of force development

Purpose

This study aimed to evaluate the acute changes in the knee extensors maximum voluntary isometric contraction force (MVIC), rate of force development (RFD), and rate of EMG rise (RER) following a bout of downhill running.

Methods

MVIC and RFD at 0–50, 50–100, 100–200, and 0–200 ms were determined in thirteen men (22 ± 2 yr) before and after 30 min of downhill running (speed: 10 km h⁻¹; slope: − 20%). Vastus lateralis maximum EMG (EMG_max) and RER at 0–30, 0–50, and 0–75 ms were also recorded.

Results

MVIC, RFD_0–200, and EMG_max decreased by ~ 25% [Cohen’s d = − 1.09 (95% confidence interval: − 1.88/− 0.24)], ~ 15% [d = − 0.50 (− 1.26/0.30)], and ~ 22% [d = − 0.37 (− 1.13/0.42)] (all P < 0.05), respectively. RFD_100–200 was also reduced [− 25%; d = − 0.70 (− 1.47/0.11); P < 0.001]. No change was observed at 0–50 ms and 50–100 ms (P ≥ 0.05). RER values were similar at each time interval (all P > 0.05).

Conclusion

Downhill running impairs the muscle capacity to produce maximum force and the overall ability to rapidly develop force. No change was observed for the early phase of the RFD and the absolute RER, suggesting no alterations in the neural mechanisms underlying RFD. RFD_100–200 reduction suggests that impairments in the rapid force-generating capacity are located within the skeletal muscle, likely due to a reduction in muscle–tendon stiffness and/or impairments in the muscle contractile apparatus. These findings may help explain evidence of neuromuscular alterations in trail runners and following prolonged duration races wherein cumulative eccentric loading is high.

Concentric versus eccentric cycling at equal power output or effort perception: Neuromuscular alterations and muscle pain

This study aimed to compare neuromuscular alterations and perceptions of effort and muscle pain induced by concentric and eccentric cycling performed at the same power output or effort perception. Fifteen participants completed three 30-min sessions: one in concentric at 60% peak power output (CON) and two in eccentric, at the same power output (ECC_POWER ) or same perceived effort (ECC_EFFORT ). Muscle pain, perception of effort, oxygen uptake as well as rectus femoris and vastus lateralis electromyographic activities were collected when pedaling. The knee extensors maximal voluntary contraction (MVC) torque, the torque evoked by double stimulations at 100 Hz and 10 Hz (Dt100; Dt10), and the voluntary activation level (VAL) were evaluated before and after exercise. Power output was higher in ECC_EFFORT than CON (89.1 ± 23.3% peak power). Muscle pain and effort perception were greater in CON than ECC_POWER (p < 0.03) while muscle pain was similar in CON and ECC_EFFORT (p > 0.43). MVC torque, Dt100, and VAL dropped in all conditions (p < 0.04). MVC torque (p < 0.001) and the Dt10/ Dt100 ratio declined further in ECC_EFFORT (p < 0.001). Eccentric cycling perceived as difficult as concentric cycling caused similar muscle pain but more MVC torque decrease. A given power output induced lower perceptions of pain and effort in eccentric than in concentric yet similar MVC torque decline. While neural impairments were similar in all conditions, eccentric cycling seemed to alter excitation-contraction coupling. Clinicians should thus be cautious when setting eccentric cycling intensity based on effort perception.

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.

Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom

More than half of patients who recover from COVID-19 experience fatigue. We studied fatigue using neuropsychological and neurophysiological investigations in post-COVID-19 patients and healthy subjects. Neuropsychological assessment included: Fatigue Severity Scale (FSS), Fatigue Rating Scale, Beck Depression Inventory, Apathy Evaluation Scale, cognitive tests, and computerized tasks. Neurophysiological examination was assessed before (PRE) and 2 min after (POST) a 1-min fatiguing isometric pinching task and included: maximum compound muscle action potential (CMAP) amplitude in first dorsal interosseous muscle (FDI) following ulnar nerve stimulation, resting motor threshold, motor evoked potential (MEP) amplitude and silent period (SP) duration in right FDI following transcranial magnetic stimulation of the left motor cortex. Maximum pinch strength was measured. Perceived exertion was assessed with the Borg-Category-Ratio scale. Patients manifested fatigue, apathy, executive deficits, impaired cognitive control, and reduction in global cognition. Perceived exertion was higher in patients. CMAP and MEP were smaller in patients both PRE and POST. CMAP did not change in either group from PRE to POST, while MEP amplitudes declined in controls POST. SP duration did not differ between groups PRE, increased in controls but decreased in patients POST. Patients' change of SP duration from PRE to POST was negatively correlated to FSS. Abnormal SP shortening and lack of MEP depression concur with a reduction in post-exhaustion corticomotor inhibition, suggesting a possible GABA_B-ergic dysfunction. This impairment might be related to the neuropsychological alterations. COVID-19-associated inflammation might lead to GABAergic impairment, possibly representing the basis of fatigue and explaining apathy and executive deficits.

Neuromuscular function and fatigability in people diagnosed with head and neck cancer before versus after treatment

PURPOSE

Treatment for head and neck cancer is associated with multiple side effects, including loss of body mass, impaired physical function and reduced health-related quality of life. This study aimed to investigate the impact of treatment (radiation therapy ± concurrent chemotherapy) on (i) muscle strength, muscle cross-sectional area and patient-reported outcomes, and (ii) central and peripheral alterations during a whole-body exercise task.

METHODS

Ten people with head and neck cancer (4 female; 50 ± 9 years) completed a lab visit before and after (56 ± 30 days) completion of treatment. Participants performed a neuromuscular assessment (involving maximal isometric voluntary contractions in the knee extensors and electrical stimulation of the femoral nerve) before and during intermittent cycling to volitional exhaustion. Anthropometrics and patient-reported outcomes were also assessed.

RESULTS

From before to after treatment, maximal isometric muscle strength was reduced (P = 0.002, d = 0.73), as was potentiated twitch force (P < 0.001, d = 0.62), and muscle cross-sectional area (e.g., vastus lateralis: P = 0.010, d = 0.64). Exercise time was reduced (P = 0.008, d = 0.62) and peripheral processes contributed to a reduction in maximal force due to cycling. After treatment, the severity of self-reported fatigue increased (P = 0.041, r = - 0.65) and health-related quality of life decreased (P = 0.012, r = - 0.79).

CONCLUSION

Neuromuscular function was impaired in patients with head and neck cancer after treatment. Whole-body exercise tolerance was reduced and resulted in predominantly peripheral, rather than central, disturbances to the neuromuscular system. Future research should evaluate strength training after treatment for head and neck cancer, with the overall aim of reducing fatigue and improving health-related quality of life.

Routine monitoring of isometric knee extension strength in patients with muscle impairments using a new portable device: cross-validation against a standard isokinetic dynamometer

OBJECTIVE

Muscle strength is a critical clinical hallmark in both health and disease. The current study introduces a novel portable device prototype (MyoQuad) for assessing and monitoring maximal voluntary isometric knee extension torque (MVIT).

APPROACH

Fifty-six patients with inclusion body myositis were studied. Knee extension weakness is a key feature in this inflammatory muscle disease. Cross-validation with an isokinetic dynamometer (Biodex System 3 Pro) was performed. Between-day reproducibility and ability to monitor changes in muscle strength over time compared to the gold standard method as a reference, were also investigated.

MAIN RESULTS

The measurement was feasible even in the weakest patients. Agreement between methods was excellent (standard error of measurement (SEM) was 3.8 Nm and intra-class correlation coefficient (ICC) was 0.973). Least significant difference (LSD) was 4.9 and 5.3 Nm for the MyoQuad and the Biodex, respectively Measurements using the MyoQuad exhibited excellent between-day reproducibility (SEM was 2.4 Nm and ICC was 0.989 versus 2.6 Nm and 0.988 using the Biodex). Changes in MVIT at 6 and 12 months were similar between methods (timepoint  ×  method interaction was not significant; all p   >  0.19); strength changes classified according to LSD at 6 and 12 months were consistent between methods (>70% consistent classification)).

SIGNIFICANCE

The measurement of MVIT using the MyoQuad offers a cost-effective, portable and immediate alternative for the routine measurement of maximal voluntary isometric strength of the quadriceps. The MyoQuad offers a comfort and stability that cannot be provided by standard hand-held dynamometers. These results support quantitative muscle strength assessment using fixed yet flexible dynamometry within clinical routine and multicenter trials.

Resting Muscle Shear Modulus Measured With Ultrasound Shear-Wave Elastography as an Alternative Tool to Assess Muscle Fatigue in Humans

The aim of this study was to investigate the time course of the resting vastus lateralis (VL) muscle shear elastic modulus (μ) measured with ultrasound shear-wave elastography during repetition of isometric maximal voluntary contractions (MVCs) of the knee extensors (KE). Fifteen well-trained young males repeated 60 5-s isometric MVCs. Evoked electrical stimulations and the VLμ were measured every ten MVCs at rest. The resting VLμ significantly decreased (−34.7 ± 6.7%; P < 0.001) by the end of the fatigue protocol. There was also a 38.4 ± 12.6 % decrease in MVC after exercise (P < 0.001). The potentiated doublet and single twitch torque amplitudes and properties were significantly modified by the end of exercise (P < 0.001). This study shows the time course of the resting VLμ during the repetition of maximal voluntary fatiguing exercise of the KE muscles. The decrease of the resting VLμ could directly affect the force transmission capabilities accounting for peripheral fatigue.

The effects of Ramadan intermittent fasting on the underlying mechanisms of force production capacity during maximal isometric voluntary contraction

The aim of the present study was to investigate the effects of Ramadan intermittent fasting (RIF) on the underlying mechanisms of force production capacity during maximal voluntary isometric contraction (MVIC) using the superimposed twitch technique. Ten healthy male physical education students performed three MVIC of the knee extensor superimposed with nerve electrical stimulation during four testing phases: one week before Ramadan (BR), at the end of the first week of Ramadan (R-1), during the fourth week of Ramadan (R-4) and two weeks after Ramadan (AR). This study was performed during Ramadan 2016. MVIC values, voluntary activation level (VAL), potentiated resting twitch and electromyography signals were recorded during each MVIC. The French version of the Profile of Mood States questionnaire (POMS-f) was used to evaluate the subjective mood states in each testing session. The results showed that MVIC values (890.57 ± 67.90 vs. 816.46 ± 54.72 N) and VAL (87.73 ± 3.27 vs. 77.32 ± 7.87%) decreased at R-1 compared to BR (p < 0.001). However, the neuromuscular efficiency and the potentiated resting twitch remained unchanged during Ramadan (R). Results showed that depression (p < 0.01; 6.3 ± 1.57 vs. 4.7 ± 1.25), fatigue (p < 0.001; 9.2 ± 1.93 vs. 4.6 ± 2.01) and anxiety (p < 0.001; 6.4 ± 1.51 vs. 11.8 ± 1.23) scores of POMS-f were higher during R-1 compared to BR. In conclusion, RIF-related impairment of maximal muscle force seems to be related to nervous alterations of the VAL, whereas the RIF did not adversely affect peripheral mechanisms. Abbreviations' List: ANOVA: Analysis of variance; AR: After Ramadan; BMI: Body-mass index; BR: Before Ramadan; EMG: Electromyography; ER: End of Ramadan; MF: Mean frequency; M_max: Peak-to-peak M-wave amplitudes; MVIV: Maximal voluntary isometric contraction; NES: Nerve electrical stimulation; NME: Neuromuscular efficiency; POMS-f: French version of the Profile of Mood States questionnaire; R: Ramadan; R-1: First week of Ramadan; R-4: Fourth week of Ramadan; RF: Rectus femoris; RIF: Ramadan intermittent fasting; RMS: Root mean square; VAL: Voluntary activation level; VL: Vastus lateralis; VM: Vastus medialis.

Acute and Delayed Neuromuscular Alterations Induced by Downhill Running in Trained Trail Runners: Beneficial Effects of High-Pressure Compression Garments

Introduction: The aim of this study was to examine, from a crossover experimental design, whether wearing high-pressure compression garments (CGs) during downhill treadmill running affects soft-tissue vibrations, acute and delayed responses in running economy (RE), neuromuscular function, countermovement jump, and perceived muscle soreness. Methods: Thirteen male trail runners habituated to regular eccentric training performed two separate 40-min downhill running (DHR, -8.5°) sessions while wearing either CGs (15-20 mmHg for quadriceps and calves) or control garments (CON) at a velocity associated with ∼55% of VO2max , with a set of measurements before (Pre-), after (Post-DHR), and 1 day after (Post-1D). No CGs was used within the recovery phase. Perceived muscle soreness, countermovement jump, and neuromuscular function (central and peripheral components) of knee extensors (KE) and plantar flexors (PF) were assessed. Cardiorespiratory responses (e.g., heart rate, ventilation) and RE, as well as soft-tissue vibrations (root mean square of the resultant acceleration, RMS Ar ) for vastus lateralis and gastrocnemius medialis were evaluated during DHR and in Post-1D. Results: During DHR, mean values in RMS Ar significantly increased over time for the vastus lateralis only for the CON condition (+11.6%). RE and cardiorespiratory responses significantly increased (i.e., alteration) over time in both conditions. Post, small to very large central and peripheral alterations were found for KE and PF in both conditions. However, the deficit in voluntary activation (VA) was significantly lower for KE following CGs (-2.4%), compared to CON (-7.9%) conditions. No significant differences in perceived muscle soreness and countermovement jump were observed between conditions whatever the time period. Additionally, in Post-1D, the CGs condition showed reductions in neuromuscular peripheral alterations only for KE (from -4.4 to -7.7%) and perceived muscle soreness scores (-8.3%). No significant differences in cardiorespiratory and RE responses as well as countermovement jump were identified between conditions in Post-1D. Discussion: Wearing high-pressure CGs (notably on KE) during DHR was associated with beneficial effects on soft-tissue vibrations, acute and delayed neuromuscular function, and perceived muscle soreness. The use of CGs during DHR might contribute to the enhanced muscle recovery by exerting an exercise-induced "mechanical protective effect."

Tailored exercise interventions to reduce fatigue in cancer survivors: study protocol of a randomized controlled trial

Background

Cancer-related fatigue (CRF) is a common and distressing symptom of cancer and/or cancer treatment that persists for years after treatment completion in approximately one third of cancer survivors. Exercise is beneficial for the management of CRF, and general exercise guidelines for cancer survivors are available. There are multiple potential pathways by which exercise improves CRF, and cancer survivors with CRF are diverse with respect to cancer type, treatments and experienced side effects. While the general exercise guidelines are likely sufficient for most cancer survivors, tailoring of exercise interventions may be more effective in those with persistent fatigue. The primary aim of this research is to investigate the effect of a traditional vs. tailored exercise intervention on CRF severity in cancer survivors with persistent CRF.

Methods/design

Cancer survivors (≥ 3 months and ≤ 5 years since primary treatment) who score ≤ 34 on the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) will be randomly allocated to one of two parallel treatment arms: traditional (active control) and tailored exercise. Participants in the traditional exercise group will engage in aerobic and resistance exercise that is consistent with exercise guidelines for cancer survivors. The tailored exercise group will be prescribed an intervention designed to address individual deficits identified at baseline, such as loss of muscular strength, cardiorespiratory deconditioning or sleep disturbance. Participants will be assessed before and after the intervention for CRF severity and other patient-reported outcomes, neuromuscular function and fatigue in response to whole-body exercise, sleep quantity and quality, physical activity levels, cardiorespiratory fitness and blood biomarkers.

Discussion

To our knowledge, this will be the first study to compare the effects of a traditional vs. tailored exercise intervention on CRF severity in cancer survivors with persistent CRF. Using physiological, behavioural and patient-reported outcomes, this study will add to the current knowledge about both the factors contributing to CRF, and the potential reduction in CRF severity with an exercise intervention.

Trial registration

The study is registered at ClinicalTrials.gov (NCT03049384), February, 2017.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4668-z) contains supplementary material, which is available to authorized users.

Caffeine increases both total work performed above critical power and peripheral fatigue during a 4-km cycling time trial

The link between total work performed above critical power (CP) and peripheral muscle fatigue during self-paced exercise is unknown. We investigated the influence of caffeine on the total work done above CP during a 4-km cycling time trial (TT) and the subsequent consequence on the development of central and peripheral fatigue. Nine cyclists performed three constant-load exercise trials to determine CP and two 4-km TTs ~75 min after oral caffeine (5 mg/kg) or cellulose (placebo) ingestion. Neuromuscular functions were assessed before and 50 min after supplementation and 1 min after TT. Oral supplementation alone had no effect on neuromuscular function ( P > 0.05). Compared with placebo, caffeine increased mean power output (~4%, P = 0.01) and muscle recruitment (as inferred by EMG, ~17%, P = 0.01) and reduced the time to complete the TT (~2%, P = 0.01). Work performed above CP during the caffeine trial (16.7 ± 2.1 kJ) was significantly higher than during the placebo (14.7 ± 2.1 kJ, P = 0.01). End-exercise decline in quadriceps twitch force (pre- to postexercise decrease in twitch force at 1 and 10 Hz) was more pronounced after caffeine compared with placebo (121 ± 13 and 137 ± 14 N vs. 146 ± 13 and 156 ± 11 N; P < 0.05). There was no effect of caffeine on central fatigue. In conclusion, caffeine increases muscle recruitment, which enables greater work performed above CP and higher end-exercise peripheral locomotor muscle fatigue. NEW & NOTEWORTHY The link between total work done above critical power and peripheral fatigue during a self-paced, high-intensity exercise is unclear. This study revealed that caffeine ingestion increases muscle recruitment, which enables greater work done above critical power and a greater degree of end-exercise decline in quadriceps twitch force during a 4-km cycling time trial. These findings suggest that caffeine increases performance at the expense of greater locomotor muscle fatigue.

Neuromuscular fatigue during exercise: Methodological considerations, etiology and potential role in chronic fatigue

The term fatigue is used to describe a distressing and persistent symptom of physical and/or mental tiredness in certain clinical populations, with distinct but ultimately complex, multifactorial and heterogenous pathophysiology. Chronic fatigue impacts on quality of life, reduces the capacity to perform activities of daily living, and is typically measured using subjective self-report tools. Fatigue also refers to an acute reduction in the ability to produce maximal force or power due to exercise. The classical measurement of exercise-induced fatigue involves neuromuscular assessments before and after a fatiguing task. The limitations and alternatives to this approach are reviewed in this paper in relation to the lower limb and whole-body exercise, given the functional relevance to locomotion, rehabilitation and activities of daily living. It is suggested that under some circumstances, alterations in the central and/or peripheral mechanisms of fatigue during exercise may be related to the sensations of chronic fatigue. As such, the neurophysiological correlates of exercise-induced fatigue are briefly examined in two clinical examples where chronic fatigue is common: cancer survivors and people with multiple sclerosis. This review highlights the relationship between objective measures of fatigability with whole-body exercise and perceptions of fatigue as a priority for future research, given the importance of exercise in relieving symptoms of chronic fatigue and/or overall disease management. As chronic fatigue is likely to be specific to the individual and unlikely to be due to a simple biological or psychosocial explanation, tailored exercise programmes are a potential target for therapeutic intervention.

Anticipation of magnetic and electrical stimuli does not impair maximal voluntary force production

INTRODUCTION

Knowing electro-myostimulation (EMS) will be delivered during a maximal voluntary contraction (MVC) has been demonstrated to limit maximal force production in the knee extensors. Many recent studies instead deliver peripheral nerve stimulation (PNS) or transcranial magnetic stimulation (TMS) during MVCs to assess neuromuscular function. This study investigated the effects of EMS, PNS and TMS on maximal voluntary force production and muscle activation in the knee extensors.

METHODS

Nineteen healthy participants performed MVCs under 8 randomized conditions: no stimulation, TMS at 40% of maximal stimulator output, TMS at 70% of maximal stimulator output, single-pulse PNS, paired (100-Hz)-pulse PNS, single-pulse EMS and two conditions where subjects expected TMS at 70% of maximal stimulator output or paired-pulse PNS yet no stimulus was delivered. Knee extensor force, discomfort associated with the stimulus and vastus lateralis, rectus femoris and biceps femoris electromyography (EMG) were recorded.

RESULTS

There were no differences between MVC forces and maximal agonist and antagonist muscle activity between conditions. Discomfort was greatest for EMS and least for TMS.

CONCLUSION

This study demonstrates that in familiarized subjects, knowing a stimulus (EMS, PNS or TMS) will occur does not impair maximal force or EMG produced despite differences in discomfort associated with the stimulus modalities. These techniques can be used to investigate central drive and peripheral function, at least for intensities comparable to those employed in the present study.

Muscle Fatigue Affects the Interpolated Twitch Technique When Assessed Using Electrically-Induced Contractions in Human and Rat Muscles

The interpolated twitch technique (ITT) is the gold standard to assess voluntary activation and central fatigue. Yet, its validity has been questioned. Here we studied how peripheral fatigue can affect the ITT. Repeated contractions at submaximal frequencies were produced by supramaximal electrical stimulations of the human adductor pollicis muscle in vivo and of isolated rat soleus fiber bundles; an extra stimulation pulse was given during contractions to induce a superimposed twitch. Human muscles fatigued by repeated 30-Hz stimulation trains (3 s on–1 s off) showed an ~80% reduction in the superimposed twitch force accompanied by a severely reduced EMG response (M-wave amplitude), which implies action potential failure. Subsequent experiments combined a less intense stimulation protocol (1.5 s on–3 s off) with ischemia to cause muscle fatigue, but which preserved M-wave amplitude. However, the superimposed twitch force still decreased markedly more than the potentiated twitch force; with ITT this would reflect increased “voluntary activation.” In contrast, the superimposed twitch force was relatively spared when a similar protocol was performed in rat soleus bundles. Force relaxation was slowed by >150% in fatigued human muscles, whereas it was unchanged in rat soleus bundles. Accordingly, results similar to those in the human muscle were obtained when relaxation was slowed by cooling the rat soleus muscles. In conclusion, our data demonstrate that muscle fatigue can confound the quantification of central fatigue using the ITT.

Fatigue detection in strength training using three-dimensional accelerometry and principal component analysis

Detection of neuro-muscular fatigue in strength training is difficult, due to missing criterion measures and the complexity of fatigue. Thus, a variety of methods are used to determine fatigue. The aim of this study was to use a principal component analysis (PCA) on a multifactorial data-set based on kinematic measurements to determine fatigue. Twenty participants (strength training experienced, 60% male) executed 3 sets of 3 exercises with 50 (12 repetitions), 75 (12 repetitions) and 100%-12 RM (RM). Data were collected with a 3D accelerometer and analysed by a newly developed algorithm to evaluate parameters for each repetition. A PCA with six variables was carried out on the results. A fatigue factor was computed based on the loadings on the first component. One-way ANOVA with Bonferroni post hoc analysis was calculated to test for differences between the intensity levels. All six input variables had high loadings on the first component. The ANOVA showed a significant difference between intensities (p < 0.001). Post-hoc analysis revealed a difference between 100% and the lower intensities (p < 0.05) and no difference between 50 and 75%-12RM. Based on these results, it is possible to distinguish between fatigued and non-fatigued sets of strength training.

The neuromuscular fatigue induced by repeated scrums generates instability that can be limited by appropriate recovery

The aim of this study was to evaluate the influence of the fatigue on the machine scrum pushing sagittal forces during repeated scrums and to determine the origin of the knee extensor fatigue. Twelve elite U23 rugby union front row players performed six 6-s scrums every 30 s against a dynamic scrum machine with passive or active recovery. The peak, average, and the standard deviation of the force were measured. A neuromuscular testing procedure of the knee extensors was carried out before and immediately after the repeated scrum protocol including maximal voluntary force, evoked force, and voluntary activation. The average and peak forces did not decrease after six scrums with passive recovery. The standard deviation of the force increased by 70.2 ± 42.7% (P < 0.001). Maximal voluntary/evoked force and voluntary activation decreased (respectively 25.1 ± 7.0%, 14.6 ± 5.5%, and 24 ± 9.9%; P < 0.001). The standard deviation of the force did not increase with active recovery and was associated with lower decrease of maximal voluntary/evoked force and voluntary activation (respectively 12.8 ± 7.9%, 4.9 ± 6.5%, and 7.6 ± 4.1%; all P < 0.01). As a conclusion repeated scrummaging induced an increased machine scrum pushing instability associated with central and peripheral fatigue of the knee extensors. Active recovery seems to limit all these manifestations of fatigue.

The role of the peripheral and central nervous systems in rotator cuff disease

Rotator cuff (RC) disease is an extremely common condition associated with shoulder pain, reduced functional capacities, and impaired quality of life. It primarily involves alterations in tendon health and mechanical properties that can ultimately lead to tendon failure. RC tendon tears induce progressive muscle changes that have a negative impact on surgical reparability of the RC tendons and clinical outcomes. At the same time, a significant base of clinical data suggests a relatively weak relationship between RC integrity and clinical presentation, emphasizing the multifactorial aspects of RC disease. This review aims to summarize the potential contribution of peripheral, spinal, and supraspinal neural factors that may (1) exacerbate structural and functional muscle changes induced by tendon tear, (2) compromise the reversal of these changes during surgery and rehabilitation, (3) contribute to pain generation and persistence of pain, (4) impair shoulder function through reduced proprioception, kinematics, and muscle recruitment, and (5) help explain interindividual differences and response to treatment. Given the current clinical and scientific interest in peripheral nerve injury in the context of RC disease and surgery, we carefully reviewed this body of literature with a particular emphasis on suprascapular neuropathy that has generated a large number of studies in the past decade. Within this process, we highlight the gaps in current knowledge and suggest research avenues for scientists and clinicians.

Peak torque and rate of torque development influence on repeated maximal exercise performance: contractile and neural contributions

Rapid force production is critical to improve performance and prevent injuries. However, changes in rate of force/torque development caused by the repetition of maximal contractions have received little attention. The aim of this study was to determine the relative influence of rate of torque development (RTD) and peak torque (T_peak) on the overall performance (i.e. mean torque, T_mean) decrease during repeated maximal contractions and to investigate the contribution of contractile and neural mechanisms to the alteration of the various mechanical variables. Eleven well-trained men performed 20 sets of 6-s isokinetic maximal knee extensions at 240°·s^-1, beginning every 30 seconds. RTD, T_peak and T_mean as well as the Rate of EMG Rise (RER), peak EMG (EMG_peak) and mean EMG (EMG_mean) of the vastus lateralis were monitored for each contraction. A wavelet transform was also performed on raw EMG signal for instant mean frequency (if_mean) calculation. A neuromuscular testing procedure was carried out before and immediately after the fatiguing protocol including evoked RTD (eRTD) and maximal evoked torque (eT_peak) induced by high frequency doublet (100 Hz). T_mean decrease was correlated to RTD and T_peak decrease (R²=0.62; p<0.001; respectively β=0.62 and β=0.19). RER, eRTD and initial if_mean (0-225 ms) decreased after 20 sets (respectively -21.1±14.1, -25±13%, and ~20%). RTD decrease was correlated to RER decrease (R²=0.36; p<0.05). The eT_peak decreased significantly after 20 sets (24±5%; p<0.05) contrary to EMG_peak (-3.2±19.5 %; p=0.71). Our results show that reductions of RTD explained part of the alterations of the overall performance during repeated moderate velocity maximal exercise. The reductions of RTD were associated to an impairment of the ability of the central nervous system to maximally activate the muscle in the first milliseconds of the contraction.

Individuals with intellectual disability have lower voluntary muscle activation level

The aim of this study was to explore the voluntary activation level during maximal voluntary contraction (MVC) in individuals with intellectual disability (ID) versus individuals without ID using the twitch interpolation technique. Ten individuals with mild ID (ID group) and 10 sedentary men without ID (control group) participated in this study. The evaluation of neuromuscular function consisted in three brief MVCs (3s) of the knee extension superimposed with electrical nerve stimulation (NES) to measure voluntary activation. Muscle activity levels were also measured with surface EMG. The root mean square (RMS) was extracted from the EMG signal. The RMS/Mmax ratio and the neuromuscular efficiency (NME) were calculated. Our results reported that individuals with ID present lower muscle strength (p < 0.001), lower voluntary activation level (p < 0.001), lower RMS values of vastus lateralis (p < 0.05), vastus medialis (p < 0.05), and rectus femoris (p < 0.001) muscles. In addition, our results showed lower RMS/Mmax values in the ID group than in the control group for the VM (0.05 ± 0.01 mV vs. 0.04 ± 0.01 mV; p < 0.05) and the RF (0.06 ± 0.02 mV vs. 0.05 ± 0.02 mV; p < 0.05) muscles. However, no significant difference was reported for the VL muscle (0.05 ± 0.02 mV vs. 0.05 ± 0.02 mV; p=0.463). Moreover, Individuals with ID present smaller potentiated twitch (p < 0.001). However, no significant difference was reported in the NME ratio. These results suggest that the lower muscle strength known in individuals with ID is related to a central nervous system failure to activate motor units and to some abnormal intrinsic muscle properties. It seems that the inactive lifestyle adopted by individuals with ID is one of the most important factors of their lower voluntary activation levels. Therefore, physical activities should be introduced in life style of individuals with ID to improve their neuromuscular function.

The effect of muscle fatigue on stimulus intensity requirements for central and peripheral fatigue quantification

PURPOSE

The present study was designed to determine the stimulation intensity necessary for an adequate assessment of central and peripheral components of neuromuscular fatigue of the knee extensors.

METHODS

Three different stimulation intensities (100, 120 and 150% of the lowest intensity evoking a plateau in M-waves and twitch amplitudes, optimal stimulation intensity, OSI) were used to assess voluntary activation level (VAL) as well as M-wave, twitch and doublet amplitudes before, during and after an incremental isometric exercise performed by 14 (8 men) healthy and physically active volunteers. A visual analog scale was used to evaluate the associated discomfort.

RESULTS

There was no difference (p > 0.05) in VAL between the three intensities before and after exercise. However, we found that stimulating at 100% OSI may overestimate the extent of peripheral fatigue during exercise, whereas 150% OSI stimulations led to greater discomfort associated with doublet stimulations as well as to an increased antagonist co-activation compared to 100% OSI.

CONCLUSION

We recommend using 120% OSI, as it constitutes a good trade-off between discomfort and reliable measurements.

Fatigue in healthy and diseased individuals

OBJECTIVES

Although fatigue is experienced by everyone, its definition and classification remains under debate.

METHODS

A review of the previously published data on fatigue.

RESULTS

Fatigue is influenced by age, gender, physical condition, type of food, latency to last meal, mental status, psychological conditions, personality type, life experience, and the health status of an individual. Fatigue may not only be a symptom but also a measurable and quantifiable dimension, also known as fatigability. Additionally, it may be classified as a condition occurring at rest or under exercise or stress, as physiologic reaction or pathologic condition, as spontaneous phenomenon or triggerable state, as resistant or irresistant to preconditioning, training, or attitude, as prominent or collateral experience, and as accessible or inaccessible to any type of treatment or intervention. Fatigue may be the sole symptom of a disease or one among others. It may be also classified as acute or chronic. Quantification of fatigability is achievable by fatigue scores, force measurement, electromyography, or other means. Fatigue and fatigability need to be delineated from conditions such as sleepiness, apathy, exhaustion, exercise intolerance, lack of vigor, weakness, inertia, or tiredness. Among neurological disorders, the prevalence of fatigue is particularly increased in multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, traumatic brain injury, stroke, and bleeding and also in neuromuscular disorders. Fatigue may be influenced by training, mental preconditioning, or drugs.

CONCLUSIONS

Fatigue needs to be recognized as an important condition that is not only a symptom but may also be quantified and can be modified by various measures depending on the underlying cause.