Muscle architectural characteristics in young and elderly men and women

Age-related differences in the loss and recovery of serial sarcomere number following disuse atrophy in rats

BACKGROUND

Older adults exhibit a slower recovery of muscle mass following disuse atrophy than young adults. At a smaller scale, muscle fibre cross-sectional area (i.e., sarcomeres in parallel) exhibits this same pattern. Less is known, however, about age-related differences in the recovery of muscle fibre length, driven by increases in serial sarcomere number (SSN), following disuse. The purpose of this study was to investigate age-related differences in SSN adaptations and muscle mechanical function during and following muscle immobilization. We hypothesized that older adult rats would experience a similar magnitude of SSN loss during immobilization, however, take longer to recover SSN than young following cast removal, which would limit the recovery of muscle mechanical function.

METHODS

We casted the plantar flexors of young (8 months) and old (32 months) male rats in a shortened position for 2 weeks, and assessed recovery during 4 weeks of voluntary ambulation. Following sacrifice, legs were fixed in formalin for measurement of soleus SSN and physiological cross-sectional area (PCSA) with the un-casted soleus acting as a control. Ultrasonographic measurements of pennation angle (PA) and muscle thickness (MT) were conducted weekly. In-vivo active and passive torque-angle relationships were constructed pre-cast, post-cast, and following 4 weeks of recovery.

RESULTS

From pre- to post-cast, young and older adult rats experienced similar decreases in SSN (-20%, P < 0.001), muscle wet weight (-25%, P < 0.001), MT (-30%), PA (-15%, P < 0.001), and maximum isometric torque (-40%, P < 0.001), but there was a greater increase in passive torque in older (+ 180%, P < 0.001) compared to young adult rats (+ 68%, P = 0.006). Following cast removal, young exhibited quicker recovery of SSN and MT than old, but SSN recovered sooner than PA and MT in both young and old. PCSA nearly recovered and active torque fully recovered in young adult rats, whereas in older adult rats these remained unrecovered at ∼ 75%.

CONCLUSIONS

This study showed that older adult rats retain a better ability to recover longitudinal compared to parallel muscle morphology following cast removal, making SSN a highly adaptable target for improving muscle function in elderly populations early on during rehabilitation.

Effect of resistance training on quadriceps femoris muscle thickness obtained by ultrasound: A systematic review with meta-analysis

OBJECTIVE

The present study aimed to determine the magnitude and intervention time of resistance training required to generate adaptations in the muscle thickness of the quadriceps muscle obtained by ultrasound in healthy adults.

METHOD

A systematic review with meta-analysis was conducted on studies recovered from Pubmed, Web of Science, and Scopus databases up to March 2022. The study selection process was carried out by two independent researchers, with the presence of a third researcher in case of disagreements. The methodological quality of the studies was determined with the TESTEX scale, and the risk of bias analysis was determined using Cochrane's RoB 2.0 tool. The meta-analysis used the inverse of the variance with a fixed model, and the effect size was reported by the standardized mean difference (SMD) with a confidence interval of 95%.

RESULTS

Ten studies were included in a meta-analysis. The overall analysis of the studies demonstrated an SMD = 0.35 [95% CI: 0.13-0.56] (P = 0.002), with a low heterogeneity of I2 = 0% (P = 0.52). No publication bias was detected using a funnel plot followed by Egger's test (P = 0.06). The degree of certainty of the meta-analysis was high using the GRADE tool.

CONCLUSION

We found that resistance training can generate significant average increases of 16.6% in muscle thickness obtained by ultrasound in the quadriceps femoris muscles of healthy adults. However, the subgroup analysis showed that significant effect sizes were only observed after eight weeks of training.

Low handgrip strength is related to elevated echogenicity in patients with chronic kidney disease: A pilot, cross-sectional and exploratory study

OBJECTIVES

Evaluate associations between triceps braqui muscle ultrasound measures (TB US) and handgrip strength (HGS), and the sensibility of TB US for low HGS in non-dialysis-dependent chronic kidney disease (nd-CKD) patients.

PARTICIPANTS AND METHODS

This pilot, cross-sectional, and exploratory study evaluated TB cross-sectional images from A-mode US and processed by FIJI-Image J to obtain muscle thickness (MT), echogenicity (EI), cross-sectional area (CSA), pennation angle (PA), and fascicle length (Lf) associating them with absolute HGS by simple and, multiple linear regression. The HGS was normalized to body mass index (BMI) and separated into low HGS (HGS/BMI≤10p according to sex and age) and adequate HGS (HGS/BMI>10p) groups. The body composition was from multifrequency bioimpedance. ROC analysis verified the TB US diagnostic accuracy to low HGS.

RESULTS

Were included 42 (21M/21F) adults with 65.5 (60-70) y median age, 47.22% in 3b CKD stage. The low HGS group (45.23%) showed a higher fat mass (FM), TB muscle medium head's PA, and EI than adequate HGS (p<0.05). In crude model, a pixels increase in EI was associated with a 0.452kgf HGS reduction (p=0.019); adjusted for sex, age, and FM, a one-unit increase in EI was associated with a 0.510kgf HGS reduction (p=0.011). The EI also showed moderate diagnostic accuracy (AUC=0.730; CI 95%=0.589; 0.919) to low HGS and a sensitivity of 86.9% (cutoff≥13.52 pixels).

CONCLUSION

In nd-CKD patients, of all measurements from US, the EI was the most associated with HGS, and the only one sensitive to low HGS diagnosis.

Influence of muscle length on the three-dimensional architecture and aponeurosis dimensions of rabbit calf muscles

The function of a muscle is highly dependent on its architecture, which is characterized by the length, pennation, and curvature of the fascicles, and the geometry of the aponeuroses. During in vivo function, muscles regularly undergo changes in length, thereby altering their architecture. During passive muscle lengthening, fascicle length (FL) generally increases and the angle of fascicle pennation (FP) and the fascicle curvature (FC) decrease, while the aponeuroses increase in length but decrease in width. Muscles are differently structured, making their change during muscle lengthening complex and multifaceted. To obtain comprehensive data on architectural changes in muscles during passive length, the present study determined the three-dimensional fascicle geometry of rabbit M. gastrocnemius medialis (GM), M. gastrocnemius lateralis (GL), and M. plantaris (PLA). For this purpose, the left and right legs of three rabbits were histologically fixed at targeted ankle joint angles of 95° (short muscle length [SML]) and 60° (long muscle length [LML]), respectively, and the fascicles were tracked by manual three-dimensional digitization. In a second set of experiments, the GM aponeurosis dimensions of ten legs from five rabbits were determined at varying muscle lengths via optical marker tracking. The GM consisted of a uni-pennated compartment, whereas the GL and PLA contained multiple compartments of differently pennated fascicles. In the LML compared to the SML, the GM, GL, and PLA had on average a 41%, 29%, and 41% increased fascicle length, and a 30%, 25%, and 33% decrease in fascicle pennation and a 32%, 11%, and 35% decrease in fascicle curvature, respectively. Architectural properties were also differentiated among the different compartments of the PLA and GL, allowing for a more detailed description of their fascicle structure and changes. It was shown that the compartments change differently with muscle length. It was also shown that for each degree of ankle joint angle reduction, the proximal GM aponeurosis length increased by 0.11%, the aponeurosis width decreased by 0.22%, and the area was decreased by 0.20%. The data provided improve our understanding of muscles and can be used to develop and validate muscle models.

Assessing Muscle Mass in the Orthopedic Clinical Setting: Application of the Ultrasound Sarcopenia Index in Elderly Subjects with a Recent Femoral Fracture

BACKGROUND

Sarcopenia poses a risk factor for falls, disability, mortality, and unfavorable postoperative outcomes. Recently, the Ultrasound Sarcopenia Index (USI) has been validated to assess muscle mass, and this study aimed to apply the USI in the clinical setting.

METHODS

This prospective observational study included 108 patients aged >65 years, hospitalized for proximal femoral traumatic fracture. Patients were divided into two groups based on anamnestic data: patients with independent walking (IW) and patients requiring walking aid (WA) before admission. All the participants received an ultrasound examination. Other parameters evaluated were handgrip strength, limb circumferences, nutrition (MNA), and activity of daily living (ADL) scores.

RESULTS

Fifty-six IW patients (83 ± 6 y; 38 females) and 52 WA patients (87 ± 7 y; 44 females) were recruited. The USI was significantly higher in the IW group compared to the WA group (p = 0.013, Cohen's d = 0.489). Significant correlations were found between the USI and other sarcopenia-associated parameters, such as handgrip strength, MNA, ADLs, other muscle ultrasound parameters, and limb circumferences.

CONCLUSION

The application of the USI in the orthopedic surgery setting is feasible and might support the diagnosis of sarcopenia when combined with other measures of strength and function.

A classification of the plantar intrinsic foot muscles based on the physiological cross-sectional area and muscle fiber length in healthy young adult males

BACKGROUND

Plantar intrinsic foot muscles (PIFMs) are composed of 10 muscles and play an essential role in achieving functional diversity in the foot. Previous studies have identified that the morphological profiles of PIFMs vary between individuals. The morphological profiles of a muscle theoretically reflect its output potentials: the physiological cross-sectional area (PCSA) of a muscle is proportional to its maximum force generation, and the muscle fiber length (FL) is its shortening velocity. This implies that the PCSA and FL may be useful variables for characterizing the functional diversity of the individual PIFM. The purpose of this study was to examine how individual PIFMs can be classified based on their PCSA and FL.

METHODS

In 26 healthy young adult males, the muscle volume and muscle length of seven PIFMs (abductor hallucis, ABDH; abductor digiti minimi, ABDM; adductor hallucis oblique head, ADDH-OH; ADDH transverse head, ADDH-TH; flexor digitorum brevis, FDB; flexor hallucis brevis, FHB; quadratus plantae, QP) were measured using magnetic resonance imaging. The PCSA and FL of each of the seven PIFMs were then estimated by combining the data measured from the participants and those of muscle architectural parameters documented from cadavers in previous studies. A total of 182 data samples (26 participants × 7 muscles) were classified into clusters using k-means cluster analysis. The optimal number of clusters was evaluated using the elbow method.

RESULTS

The data samples of PIFMs were assigned to four clusters with different morphological profiles: ADDH-OH and FHB, characterised by large PCSA and short FL (high force generation and slow shortening velocity potentials); ABDM and FDB, moderate PCSA and moderate FL (moderate force generation and moderate shortening velocity potentials); QP, moderate PCSA and long FL (moderate force generation and rapid shortening velocity potentials); ADDH-TH, small PCSA and moderate FL (low force generation and moderate shortening velocity potentials). ABDH components were assigned equivalently to the first and second clusters.

CONCLUSIONS

The approach adopted in this study may provide a novel perspective for interpreting the PIFMs' function based on their maximal force generation and shortening velocity potentials.

Sex-related differences in motor unit behavior are influenced by myosin heavy chain during high- but not moderate-intensity contractions

AIMS

Motor unit recruitment and firing rate patterns of the vastus lateralis (VL) have not been compared between sexes during moderate- and high-intensity contraction intensities. Additionally, the influence of fiber composition on potential sex-related differences remains unquantified.

METHODS

Eleven males and 11 females performed 40% and 70% maximal voluntary contractions (MVCs). Surface electromyographic (EMG) signals recorded from the VL were decomposed. Recruitment thresholds (RTs), MU action potential amplitudes (MUAPAMP ), initial firing rates (IFRs), mean firing rates (MFRs), and normalized EMG amplitude (N-EMGRMS ) at steady torque were analyzed. Y-intercepts and slopes were calculated for MUAPAMP , IFR, and MFR versus RT relationships. Type I myosin heavy chain isoform (MHC) was determined with muscle biopsies.

RESULTS

There were no sex-related differences in MU characteristics at 40% MVC. At 70% MVC, males exhibited greater slopes (p = 0.002) for the MUAPAMP , whereas females displayed greater slopes (p = 0.001-0.007) for the IFR and MFR versus RT relationships. N-EMGRMS at 70% MVC was greater for females (p < 0.001). Type I %MHC was greater for females (p = 0.006), and was correlated (p = 0.018-0.031) with the slopes for the MUAPAMP , IFR, and MFR versus RT relationships at 70% MVC (r = -0.599-0.585).

CONCLUSION

Both sexes exhibited an inverse relationship between MU firing rates and recruitment thresholds. However, the sex-related differences in MU recruitment and firing rate patterns and N-EMGRMS at 70% MVC were likely due to greater type I% MHC and smaller twitch forces of the higher threshold MUs for the females. Evidence is provided that muscle fiber composition may explain divergent MU behavior between sexes.

Influence of Pennation Angle and Muscle Thickness on Mechanomyographic Amplitude-Torque Relationships and Sex-Related Differences in the Vastus Lateralis

This study examined potential sex-related differences and correlations among the pennation angle (PA), muscle thickness (MT), and mechanomyographic amplitude (MMG_RMS)-torque relationships of the vastus lateralis (VL) in 11 healthy males and 12 healthy females. The PA and MT of the VL were quantified with ultrasound. Participants performed an isometric muscle action of the knee extensors that linearly increased to 70% of maximal strength followed by a 12 s plateau. MMG was recorded from the VL. Linear regression models were fit to the log-transformed MMG_RMS-torque relationships to calculate b terms (slopes) for the linearly increasing segment. MMG_RMS was averaged during the plateau. Males exhibited greater PA (p < 0.001), MT (p = 0.027), b terms (p = 0.005), and MMG_RMS (p = 0.016). The b terms were strongly (p < 0.001, r = 0.772) and moderately correlated (p = 0.004, r = 0.571) with PA and MT, respectively, while MMG_RMS was moderately correlated with PA (p = 0.018, r = 0.500) and MT (p = 0.014, r = 0.515). The greater mechanical behavior of individuals possessing a larger PA and MT of the VL may reflect increased cross-bridge activity within the muscle fibers. Additionally, PA may help explain sex-related differences in MMG_RMS between sexes.

Do Intramuscular Temperature and Fascicle Angle Affect Ultrasound Echo Intensity Values?

PURPOSE

Ultrasound-derived echo intensity (EI) has been used as a physiological marker for changes in skeletal muscle "quality" with physical training, disuse, aging, and neuromuscular disorders. However, the methodological and physiological factors influencing EI and its longitudinal change are still unclear. Here, we performed two separate experiments to investigate the effects of muscle temperature and fascicle angle, which are known to influence muscle tissue and sound wave properties and therefore affect EI.

METHODS

In experiment 1 ( n = 16, 28.0 ± 6.6 yr), vastus lateralis (VL) ultrasonographic images were acquired and intramuscular temperature continuously recorded for 15 min after 20 min of heating to 40.4°C ± 0.7°C using a microwave device. In experiment 2 ( n = 17, 30.2 ± 9.8 yr), VL sonographic images were obtained with the knee both fully extended (0°) and flexed to 90° and EI and fascicle angle measured post hoc . Fascicle movement was tracked during the passive knee flexion to ensure that sonographic images were obtained at the same muscle region. Knee flexion reduced muscle thickness, and we therefore reran analyses calculating EI using identical dimensions to minimize this effect.

RESULTS

EI decreased only immediately after the passive heating, and although a moderate, negative correlation was observed between EI and temperature ( rrm = -0.36), the effect of muscle temperature was small ( β = 0.97 (-1.89 to -0.06) per degree Celsius, P = 0.051). Nonetheless, EI increased as fascicle angle decreased, and a large, negative correlation ( rrm = -0.85) was observed; the effect of fascicle angle on EI was large ( β = 3.0 (-3.8 to -2.2) per degree, P < 0.01), and this was maintained when analyses were performed at a constant depth of the region of interest ( β = 3.5 (-4.4 to -2.7) per degree, P < 0.01).

CONCLUSIONS

These findings support the hypothesis that fascicle angle meaningfully affects VL EI but provides weak evidence of a temperature effect in vivo . Thus, acute fascicle angle alterations should be accounted for in studies using EI measurements, and longer-term studies should consider whether changes in EI might be partly explained by a change in fascicle angle.

Is the Interpolated-Twitch Technique-Derived Voluntary Activation Just Neural? Novel Perspectives from Mechanomyographic Data

PURPOSE

Voluntary activation (VA) determined by interpolation-twitch technique could be affected by the characteristics of the in-series elastic components. To overcome this possible bias, a novel approach based on the mechanomyographic (MMG) signal to detect voluntary activation (VA MMG ) has been proposed. We examined the changes in VA and VA MMG after passive stretching to check the influence of neural and mechanical factors in the force output.

METHODS

Twenty-six healthy men underwent VA assessment using the interpolated-twitch technique before and after unilateral passive stretching of the plantarflexors (five 45-s on + 15-s off). In addition to the force signal, the MMG signal was detected on gastrocnemius medialis, gastrocnemius lateralis, and soleus. From the force and MMG signal analysis, VA and VA MMG were calculated in the stretched and contralateral nonstretched limbs. Joint passive stiffness was also defined.

RESULTS

In the stretched limb, passive stretching increased dorsiflexion range (mean ± SD = +18% ± 10%, P < 0.001, ES = 1.54) but reduced joint passive stiffness (-22% ± 8%, P < 0.001, ES = -1.75), maximum voluntary contraction (-15% ± 7%, P < 0.001, ES = -0.87), VA (-7% ± 3%, P < 0.001, ES = -2.32), and VA MMG (~-5% ± 2%, P < 0.001, ES = -1.26/-1.14). In the contralateral nonstretched limb, passive stretching increased dorsiflexion range (+10% ± 6%, P < 0.001, ES = 0.80) but reduced joint passive stiffness (-3% ± 2%, P = 0.041, ES = -0.27), maximum voluntary contraction (-4% ± 3%, P = 0.035, ES = -0.24), VA (-4% ± 2%, P < 0.001, ES = -1.77), and VA MMG (~- 2% ± 1%, P < 0.05, ES = -0.54/-0.46). The stretch-induced changes in VA correlated with VA MMG ( R ranging from 0.447 to 0.583 considering all muscles) and with joint passive stiffness (stretched limb: R = 0.503; contralateral nonstretched limb: R = 0.530).

CONCLUSIONS

VA output is overall influenced by both neural and mechanical factors, not distinguishable using the interpolated-twitch technique. VA MMG is a complementary index to assess the changes in VA not influenced by mechanical factors and to examine synergistic muscles.

Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations

ABSTRACT

Nuzzo, JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res 37(2): 494-536, 2023-Biological sex and its relation with exercise participation and sports performance continue to be discussed. Here, the purpose was to inform such discussions by summarizing the literature on sex differences in numerous strength training-related variables and outcomes-muscle strength and endurance, muscle mass and size, muscle fiber type, muscle twitch forces, and voluntary activation; strength training participation rates, motivations, preferences, and practices; and injuries and changes in muscle size and strength with strength training. Male subjects become notably stronger than female subjects around age 15 years. In adults, sex differences in strength are more pronounced in upper-body than lower-body muscles and in concentric than eccentric contractions. Greater male than female strength is not because of higher voluntary activation but to greater muscle mass and type II fiber areas. Men participate in strength training more frequently than women. Men are motivated more by challenge, competition, social recognition, and a desire to increase muscle size and strength. Men also have greater preference for competitive, high-intensity, and upper-body exercise. Women are motivated more by improved attractiveness, muscle "toning," and body mass management. Women have greater preference for supervised and lower-body exercise. Intrasexual competition, mate selection, and the drive for muscularity are likely fundamental causes of exercise behaviors in men and women. Men and women increase muscle size and strength after weeks of strength training, but women experience greater relative strength improvements depending on age and muscle group. Men exhibit higher strength training injury rates. No sex difference exists in strength loss and muscle soreness after muscle-damaging exercise.

The Frequency of Daily Consumption of Sugar-Sweetened Beverages Is Associated with Reduced Muscle Mass Index in Adolescents

The consumption of sugar-sweetened beverages (SSBs) has increased in recent years and has become a cause of concern because these beverages pose a risk to human health. Thus, we evaluated the association between SSBs consumption and muscle mass index (MMI) in adolescents. This cross-sectional study evaluated 2393 adolescents (18/19-years-old). Consumption of SSBs was analyzed based on the frequency of daily consumption and energy contribution categorized into tertiles. MMI was examined using the ratio of muscle mass (kilograms) to height (meters squared). The highest tertile of the frequency of daily SSB intake was associated with a reduced MMI in men (β = -0.31; 95%CI: -0.60, -0.01) and women (β = -0.24; 95%CI: -0.45, -0.02). However, these associations were not observed after adjusting for sugar contained in SSBs in men (β = -0.26; 95%CI: -0.69, 0.17) and for carbohydrate, lipid, and protein intake in women (β = -0.19; 95%CI: -0.42, 0.04). The highest energy contribution tertile of SSBs was associated with a reduced MMI in male adolescents (β = -0.34; 95%CI: -0.64, -0.04). This association was not observed after adjusting for intake of sugar in SSBs (β = -0.38; 95%CI: -0.75, 0.01). The frequency of daily consumption of SSBs was considered a risk factor for decreased MMI in both sexes, and the energy contribution of these drinks was a risk factor for MMI reduced only in male adolescents.

The non-modifiable factors age, gender, and genetics influence resistance exercise

Muscle mass and force are key for movement, life quality, and health. It is well established that resistance exercise is a potent anabolic stimulus increasing muscle mass and force. The response of a physiological system to resistance exercise is composed of non-modifiable (i.e., age, gender, genetics) and modifiable factors (i.e., exercise, nutrition, training status, etc.). Both factors are integrated by systemic responses (i.e., molecular signaling, genetic responses, protein metabolism, etc.), consequently resulting in functional and physiological adaptations. Herein, we discuss the influence of non-modifiable factors on resistance exercise: age, gender, and genetics. A solid understanding of the role of non-modifiable factors might help to adjust training regimes towards optimal muscle mass maintenance and health.

Architectural Ultrasound Pennation Angle Measurement of Lumbar Multifidus Muscles: A Reliability Study

The pennation angle has been shown to be a relevant parameter of muscle architecture. This parameter has not previously been measured in the lumbar multifidus musculature, and it is for this reason that it has been considered of great interest to establish an assessment protocol to generate new lines of research in the future. Objective: The objective of this study was to establish a protocol for measuring the pennation angle of the multifidus muscles, with a study of intra-rater and interrater reliability values. Design: This was a reliability study following the recommendations of the Guidelines for Reporting Reliability and Agreement Studies (GRRAS). Setting: The study was carried out at University of Alcalá, Department of Physiotherapy. Subjects: Twenty-seven subjects aged between 18 and 55 years were recruited for this study. Methods: Different ultrasound images of the lumbar multifidus musculature were captured. Subsequently, with the help of ImageJ software, the pennation angle of this musculature was measured. Finally, a complex statistical analysis determined the intra- and interrater reliability. Results: The intra-rater reliability of the pennation angle measurement protocol was excellent for observer 1 in the measurement of the left-sided superficial multifidus 0.851 (0.74, 0.923), and for observer 2 in the measurement of the right-sided superficial 0.711 (0.535, 0.843) and deep multifidus 0.886 (0.798, 0.942). Interrater reliability was moderate to poor, and correlation analysis results were high for thickness vs. pennation angle. Conclusions: The designed protocol for ultrasound measurement of the pennation angle of the lumbar multifidus musculature has excellent intra-rater reliability values, supporting the main conclusions and interpretations. Normative ranges of pennation angles are reported. High correlation between variables is described.

Ultrasound Assessment of Changes in Muscle Architecture of the Brachialis Muscle After Stroke—A Prospective Study

Objective

To investigate changes in ultrasound-derived muscle architecture parameters of the brachialis and correlations in patients with subacute stroke.

Design

Prospective longitudinal observational study.

Setting

Tertiary inpatient rehabilitation center.

Participants

Fifty adult patients (N=50) who were recruited within the first month poststroke. The patients had a mean age of 57.2±12.3 years and 68.0% were male. The majority of patients had significant upper limb weakness with a low mean Motricity Index of 18.5±24.7 and median elbow flexor strength of grade 0.

Intervention

Not applicable.

Main Outcome Measures

Ultrasound of the intact and hemiparetic brachialis was performed at 3-time intervals: within 1 month of stroke onset and at 1 and 6 months after first assessment. Clinical variables captured included upper limb motor power and elbow flexor spasticity.

Results

Compared to the intact brachialis, there was reduced muscle thickness (1.93 cm vs 2.07 cm, 1.86 cm vs 2.08 cm, 1.85 cm vs 2.05 cm; P=.022) and increased echo intensity (63.3 arbitrary units [AU] vs 56.8 AU, 69.4 AU vs 56.6 AU, 77.4 AU vs 58.2 AU; P<.001) in the hemiparetic brachialis at all assessment intervals (baseline, 1 month, 6 months). Reduction in muscle mass was greater in older patients, with the correlation coefficient ranging from −0.30 (P=.03) at baseline to −0.50 (P<.001) at 6 months. Presence of elbow flexor spasticity at 1-month assessment interval was associated with lower muscle mass reduction (1.93 cm vs 1.74 cm; P=.017), lower echo intensity (65.1 AU vs 75.1 AU; P=.023), and longer fascicle lengths (12.92 cm vs 9.83 cm; P=.002).

Conclusions

Changes including decreased muscle thickness and increased echo intensity of the hemiparetic brachialis were noted over time. Elbow flexor spasticity at 1-month assessment interval appears to mitigate against these changes.

Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review

Cerebral palsy (CP) is caused by a static lesion to the brain occurring in utero or up to the first 2 years of life; it often manifests as musculoskeletal impairments and movement disorders including spasticity and contractures. Variable manifestation of the pathology across individuals, coupled with differing mechanics and treatments, leads to a heterogeneous collection of clinical phenotypes that affect muscles and individuals differently. Growth of muscles in CP deviates from typical development, evident as early as 15 months of age. Muscles in CP may be reduced in volume by as much as 40%, may be shorter in length, present longer tendons, and may have fewer sarcomeres in series that are overstretched compared to typical. Macroscale and functional deficits are likely mediated by dysfunction at the cellular level, which manifests as impaired growth. Within muscle fibres, satellite cells are decreased by as much as 40-70% and the regenerative capacity of remaining satellite cells appears compromised. Impaired muscle regeneration in CP is coupled with extracellular matrix expansion and increased pro-inflammatory gene expression; resultant muscles are smaller, stiffer, and weaker than typical muscle. These differences may contribute to individuals with CP participating in less physical activity, thus decreasing opportunities for mechanical loading, commencing a vicious cycle of muscle disuse and secondary sarcopenia. This narrative review describes the effects of CP on skeletal muscles encompassing substantive changes from whole muscle function to cell-level effects and the effects of common treatments. We discuss growth and mechanics of skeletal muscles in CP and propose areas where future work is needed to understand these interactions, particularly the link between neural insult and cell-level manifestation of CP.

Evaluation of Muscle Mass and Stiffness with Limb Ultrasound in COVID-19 Survivors

BACKGROUND

acute illnesses, like COVID-19, can act as a catabolic stimulus on muscles. So far, no study has evaluated muscle mass and quality through limb ultrasound in post-COVID-19 patients.

METHODS

cross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound (US) to characterize their muscle mass and quality.

RESULTS

two hundred fifty-nine individuals (median age 67, 59.8% males) were included in the study. COVID-19 survivors with reduced muscle strength had a lower muscle US thickness (1.6 versus 1.73 cm, p =0.02) and a higher muscle stiffness (87 versus 76.3, p = 0.004) compared to patients with normal muscle strength. Also, patients with reduced Short Physical Performance Battery (SPPB) scores had a lower muscle US thickness (1.3 versus 1.71 cm, p = 0.01) and a higher muscle stiffness (104.9 versus 81.07, p = 0.04) compared to individuals with normal SPPB scores. The finding of increased muscle stiffness was also confirmed in patients with a pathological value (≥ 4) at the sarcopenia screening tool SARC-F (103.0 versus 79.55, p < 0.001). Muscle stiffness emerged as a significant predictor of probable sarcopenia (adjusted OR 1.02, 95% C.I. 1.002 - 1.04, p = 0.03). The optimal ultrasound cut-offs for probable sarcopenia were 1.51 cm for muscle thickness (p= 0.017) and 73.95 for muscle stiffness (p = 0.004).

DISCUSSION

we described muscle ultrasound characteristics in post COVID-19 patients. Muscle ultrasound could be an innovative tool to assess muscle mass and quality in this population. Our preliminary findings need to be confirmed by future studies comparing muscle ultrasound with already validated techniques for measuring muscle mass and quality.

Gastrocnemius Muscle Architecture in Elite Basketballers and Cyclists: A Cross-Sectional Cohort Study

Eccentric and concentric actions produce distinct mechanical stimuli and result in different adaptations in skeletal muscle architecture. Cycling predominantly involves concentric activity of the gastrocnemius muscles, while playing basketball requires both concentric and eccentric actions to support running, jumping, and landing. The aim of this study was to examine differences in the architecture of gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) between elite basketballers and cyclists. A trained sonographer obtained three B-mode ultrasound images from GM and GL muscles in 44 athletes (25 basketballers and 19 cyclists; 24 ± 5 years of age). The images were digitized and average fascicle length (FL), pennation angle (θ), and muscle thickness were calculated from three images per muscle. The ratio of FL to tibial length (FL/TL) and muscle thickness to tibial length (MT/TL) was also calculated to account for the potential scaling effect of stature. In males, no significant differences were identified between the athletic groups in all parameters in the GM, but a significant difference existed in muscle thickness in the GL. In basketballers, GL was 2.5 mm thicker (95% CI: 0.7-4.3 mm, p = 0.011) on the left side and 2.6 mm thicker (95% CI: 0.6-5.7 mm, p = 0.012) on the right side; however, these differences were not significant when stature was accounted for (MT/TL). In females, significant differences existed in the GM for all parameters including FL/TL and MT/TL. Female cyclists had longer FL in both limbs (MD: 11.2 and 11.3 mm), narrower θ (MD: 2.1 and 1.8°), and thicker muscles (MD: 2.1 and 2.5 mm). For the GL, female cyclists had significantly longer FL (MD: 5.2 and 5.8 mm) and narrower θ (MD: 1.7 and 2.3°) in both limbs; no differences were observed in absolute muscle thickness or MT/TL ratio. Differences in gastrocnemius muscle architecture were observed between female cyclists and basketballers, but not between males. These findings suggest that participation in sport-specific training might influence gastrocnemius muscle architecture in elite female athletes; however, it remains unclear as to whether gastrocnemius architecture is systematically influenced by the different modes of muscle activation between these respective sports.

Neural and muscular alterations of the plantar flexors in middle-aged women

INTRODUCTION

Considering the large population of middle-aged adults, it is important to understand the age-related change in lower limb muscles and the possible mechanisms before old age (> 65 years old). The purpose of this study was to investigate age-related neural and muscular alterations of the plantar flexors in young and middle-aged women.

METHODS

Twenty two middle-aged (54.0 ± 5.8 yrs) and 17 young (21.8 ± 1.4 yrs) recreationally active women performed rapid maximal voluntary isometric contractions (MVIC) of the plantar flexors. Absolute and normalized rate of torque development (RTD) and electromyography (EMG) were examined. Electrical stimulation was used to examine voluntary activation and contractile properties of the muscle. Ultrasonography was used to examine medial and lateral gastrocnemius muscle thickness and pennation angle. A 6-minute walk and sit to stand task were also performed by all participants.

RESULTS

The middle-aged women had significantly lower MVIC torque (141 ± 49 vs. 109 ± 30 Nm, P = 0.031), absolute RTD (753.0 ± 313.6 vs. 423.0 ± 156.1 Nm/s, P = 0.001), and normalized peak RTD (554.0 ± 191.0 vs. 388.0 ± 91.9% MVIC/s, P = 0.001). Normalized early RTD_0-50 and late RTD_100-200, voluntary activation, and EMG were similar between groups. Resting twitch data showed that time to peak (124.0 ± 20.4 vs. 143.0 ± 16.7 ms, P = 0.002) and half relaxation time (73.1 ± 15.2 vs. 107.0 ± 28.2 ms, P < 0.001) was significantly faster for the young women. Thickness was greater in the lateral gastrocnemius (1.6 ± 0.2 vs. 1.4 ± 0.2 cm, P = 0.006) for the young women. Pennation angle of both muscles were greater for the young women (15.8 ± 3.9 vs. 13.1 ± 2.7 degrees, P < 0.05). Performance of the 6-minute walk was similar between groups, however, the young women performed more repetitions during the sit to stand task (25.6 ± 6.7 vs. 18.3 ± 4.7 reps, P < 0.001).

CONCLUSION

Compared to young women, middle-age women were shown to have lower MVIC torque, peak RTD, and functional performance. Muscle architecture and contractile properties are affected by aging.

Changes in muscle architecture on ultrasound in patients early after stroke

BACKGROUND

Early muscle changes are believed to occur in patients with stroke. However, there are insufficient data on the changes in muscle mass and architecture of these patients.

OBJECTIVES

This study investigates differences in ultrasound-derived muscle architecture parameters of the hemiplegic upper and lower limbs in patients with subacute stroke.

METHODS

This is a prospective observational study, which recruited 40 adult patients who had experienced a first ever unilateral stroke (ischemic or hemorrhagic), with a duration of < 1 month post stroke. The brachialis, vastus lateralis and medial gastrocnemius on both the hemiplegic and normal side were evaluated via ultrasound. We recorded clinical variables including Motricity Index, Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM)-walk.

RESULTS

We found reduced mean muscle thickness (p < 0.001) and increased echo intensity (p < 0.001) in the brachialis muscle, increased echo intensity (p = 0.002) in the vastus lateralis muscle, and reduced muscle thickness (p < 0.001) with increased echo intensity (p < 0.001) in the medial gastrocnemius muscle compared to the normal side. There were no significant correlations between ultrasound findings and Motricity Index.

CONCLUSIONS

We report changes in ultrasound-derived muscle architecture in the hemiplegic limbs of patients with subacute stroke, with consistent findings of decreased muscle mass and increased echo intensity.

Age-dependent mechanical and microstructural properties of the rabbit soleus muscle

During growth there are serious changes in the skeletal muscles to compensate for the changed requirements in terms of body weight and size. In this study, the age-dependent (between 21 and 100 days) mechanical and microstructural properties of rabbit soleus muscle tissue were investigated. For this purpose, morphological properties (animal mass, soleus muscle mass, tibial length) were measured at 5 different times during aging. On the other hand, fibre orientation-dependent axial and semi-confined compression experiments were realised. In addition, the essential components (muscle fibres, extracellular matrix, remaining components), dominating the microstructure of muscle tissue, were analysed. While the mechanical results show hardly any age-dependent differences, the morphological and microstructural results show clear age-dependent differences. All morphological parameters increase significantly (animal mass by 839.2%, muscle mass 1050.6%, tibial length 233.6%). In contrast, microstructural parameters change differently. The percentage of fibres (divided into slow-twitch (ST) and fast-twitch (FT) fibres) increases significantly (137.6%), while the proportions of the extracellular matrix and the remaining components (48.2% and 46.1%) decrease. At the same time, the cross-sectional area of the fibres increases significantly (697.9%). The totality of this age-dependent information provides a deeper understanding of age-related changes in muscle structure and function and may contribute to successful development and validation of growth models in the future. STATEMENT OF SIGNIFICANCE: This article reports the first comprehensive data set on age-dependent morphological (animal mass, soleus muscle mass, tibial length), mechanical (axial and semi-confined compression), and microstructural (muscle fibres, extracellular matrix, remaining components) properties of the rabbit soleus muscle. On the one hand, the results of this study contribute to the understanding of muscle mechanics and thus to understanding of load transfer mechanisms inside the muscle tissue during growth. On the other hand, these results are relevant to the fields of constitutive formulation of age-dependent muscle tissue.

Age-related alterations in muscle architecture are a signature of sarcopenia: the ultrasound sarcopenia index

BACKGROUND

The assessment of muscle mass is a key determinant of the diagnosis of sarcopenia. We introduce for the first time an ultrasound imaging method for diagnosing sarcopenia based on changes in muscle geometric proportions.

METHODS

Vastus lateralis muscle fascicle length (Lf) and thickness (Tm) were measured at 35% distal femur length by ultrasonography in a population of 279 individuals classified as moderately active elderly (MAE), sedentary elderly (SE) (n = 109), mobility impaired elderly (MIE) (n = 43), and in adult young controls (YC) (n = 60). The ratio of Lf/Tm was calculated to obtain an ultrasound index of the loss of muscle mass associated with sarcopenia (USI). In a subsample of elderly male individuals (n = 76) in which corresponding DXA measurements were available (MAE, n = 52 and SE, n = 24), DXA-derived skeletal muscle index (SMI, appendicular limb mass/height2 ) was compared with corresponding USI values.

RESULTS

For both young and older participants, USI values were found to be independent of sex, height and body mass. USI values were 3.70 ± 0.52 for YC, 4.50 ± 0.72 for the MAE, 5.05 ± 1.11 for the SE and 6.31 ± 1.38 for the MIE, all significantly different between each other (P < 0.0001). Based on the USI Z-scores, with reference to the YC population, the 219 elderly participants were stratified according to their muscle sarcopenic status. Individuals with USI values within a range of 3.70 < USI ≥ 4.23 were classified as non-sarcopenic (prevalence 23.7%), those with USI values within 4.23 < USI ≥ 4.76 were classified as pre-sarcopenic (prevalence 23.7%), those with USI values within 4.76 < USI ≥ 5.29 were classified as moderately sarcopenic (prevalence 15.1%), those with USI values within range 5.29 < USI ≥ 5.82 were classified as sarcopenic (prevalence 27.9%), and those with USI values >5.82 were classified as severely sarcopenic (prevalence 9.6%). The DXA-derived SMI was found to be significantly correlated with USI (r = 0.61, P < 0.0001). Notably, the USI cut-off value for moderate sarcopenia (4.76 a.u.) was found to coincide with the DXA cut-off value of sarcopenia (7.26 kg/m2 ).

CONCLUSIONS

We propose a novel, practical, and inexpensive imaging marker of the loss of muscle mass associated with sarcopenia, called the ultrasound sarcopenic index (USI), based on changes in muscle geometric proportions. These changes provide a useful 'signature of sarcopenia' and allow the stratification of individuals according to the presence and severity of muscle sarcopenia. We are convinced that the USI will be a useful clinical tool for confirming the diagnosis of sarcopenia, of which the assessment of muscle mass is a key-component.

The key role of physical activity against the neuromuscular deterioration in patients with Parkinson's disease

AIM

Decreased muscle strength has been frequently observed in individuals with Parkinson's disease (PD). However, this condition is still poorly examined in physically active patients. This study compared quadriceps (Q) maximal force and the contribution of central and peripheral components of force production during a maximal isometric task between physically active PD and healthy individuals. In addition, the correlation between force determinants and energy expenditure indices were investigated.

METHODS

Maximal voluntary contraction (MVC), resting twitch (RT) force, pennation angle (θp), physiological cross-sectional area (PCSA) and Q volume were assessed in 10 physically active PD and 10 healthy control (CTRL) individuals matched for age, sex and daily energy expenditure (DEE) profile.

RESULTS

No significant differences were observed between PD and CTRL in MVC (142 ± 85; 142 ± 47 N m), Q volume (1469 ± 379; 1466 ± 522 cm³ ), PCSA (206 ± 54; 205 ± 71 cm² ), θp (14 ± 7; 13 ± 3 rad) and voluntary muscle-specific torque (MVC/PCSA [67 ± 35; 66 ± 19 N m cm^-2 ]). Daily calories and MVC correlated (r = 0.56, P = .0099). However, PD displayed lower maximal voluntary activation (MVA) (85 ± 7; 95 ± 5%), rate of torque development (RTD) in the 0-0.05 (110 ± 70; 447 ± 461 N m s^-1 ) and the 0.05-0.1 s (156 ± 135; 437 ± 371 N m s^-1 ) epochs of MVCs, whereas RT normalized for PCSA was higher (35 ± 14; 20 ± 6 N m cm^-2 ).

CONCLUSION

Physically active PDs show a preserved strength of the lower limb. This resulted by increasing skeletal muscle contractility, which counterbalances neuromuscular deterioration, likely due to their moderate level of physical activity.

Association between medial gastrocnemius muscle-tendon unit architecture and ankle dorsiflexion range of motion with and without consideration of slack angle

Joint flexibility is theoretically considered to associate with muscle-tendon unit (MTU) architecture. However, this potential association has not been experimentally demonstrated in humans in vivo. We aimed to identify whether and how MTU architectural parameters are associated with joint range of motion (RoM), with a special emphasis on slack angle. The fascicle length, pennation angle, tendinous tissue length, MTU length, and shear modulus of the medial gastrocnemius (MG) were assessed during passive ankle dorsiflexion using ultrasound shear wave elastography in 17 healthy males. During passive dorsiflexion task, the ankle joint was rotated from 40° plantar flexion to the maximal dorsiflexion joint angle at which each subject started experiencing pain. From the ankle joint angle-shear modulus relationship, the angle at which shear modulus began to rise (slack angle) was calculated. Two dorsiflexion RoMs were determined as follows; 1) range from the anatomical position to maximal angle (RoM_anat-max) and 2) range from the MG slack angle to maximal angle (RoM_slack-max). The MTU architectural parameters were analyzed at the anatomical position and MG slack angle. The resolved fascicle length (fascicle length × cosine of pennation angle) and ratios of resolved fascicle or tendinous tissue length to MTU length measured at the MG slack angle significantly correlated with the RoM_slack-max (r = 0.491, 0.506, and -0.506, respectively). Any MTU architectural parameters assessed at the anatomical position did not correlate with RoM_anat-max or RoM_slack-max. These results indicate that MTUs with long fascicle and short tendinous tissue are advantageous for joint flexibility. However, this association cannot be found unless MTU architecture and joint RoM are assessed with consideration of muscle slack.

Muscles adaptation to aging and training: architectural changes - a randomised trial

Background

To investigate how anatomical cross-sectional area and volume of quadriceps and triceps surae muscles were affected by ageing, and by resistance training in older and younger men, in vivo.

Methods

The old participants were randomly assigned to moderate (O55, n = 13) or high-load (O80, n = 14) resistance training intervention (12 weeks; 3 times/week) corresponding to 55% or 80% of one repetition maximum, respectively. Young men (Y55, n = 11) were assigned to the moderate-intensity strengthening exercise program. Each group received the exact same training volume on triceps surae and quadriceps group (Reps x Sets x Intensity). The fitting polynomial regression equations for each of anatomical cross-sectional area-muscle length curves were used to calculate muscle volume (contractile content) before and after 12 weeks using magnetic resonance imaging scans.

Results

Only Rectus femoris and medial gastrocnemius muscle showed a higher relative anatomical cross-sectional area in the young than the elderly on the proximal end. The old group displayed a higher absolute volume of non-contractile material than young men in triceps surae (+ 96%). After training, Y55, O55 and O80 showed an increase in total quadriceps (+ 4.3%; + 6.7%; 4.2% respectively) and triceps surae (+ 2.8%; + 7.5%; 4.3% respectively) volume. O55 demonstrated a greater increase on average gains compared to Y55, while no difference between O55 and O80 was observed.

Conclusions

Muscle loss with aging is region-specific for some muscles and uniform for others. Equivalent strength training volume at moderate or high intensities increased muscle volume with no differences in muscle volume gains for old men. These data suggest that physical exercise at moderate intensity (55 to 60% of one repetition maximum) can reverse the aging related loss of muscle mass.

Trial registration

NCT03079180 in ClinicalTrials.gov. Registration date: March 14, 2017.

Muscle architecture, voluntary activation, and low-frequency fatigue do not explain the greater fatigue of older compared with young women during high-velocity contractions

Although high-velocity contractions elicit greater muscle fatigue in older than young adults, the cause of this difference is unclear. We examined the potential roles of resting muscle architecture and baseline contractile properties, as well as changes in voluntary activation and low-frequency fatigue in response to high-velocity knee extensor work. Vastus lateralis muscle architecture was determined in quiescent muscle by ultrasonography in 8 young (23.4±1.8 yrs) and 8 older women (69.6±1.1). Maximal voluntary dynamic (MVDC) and isometric (MVIC), and stimulated (80Hz and 10Hz, 500ms) isometric contractions were performed before and immediately after 120 MVDCs (240°.s-1, one every 2s). Architecture variables did not differ between groups (p≥0.209), but the half-time of torque relaxation (T1/2) was longer in older than young women at baseline (151.9±6.0 vs. 118.8±4.4 ms, respectively, p = 0.001). Older women fatigued more than young (to 33.6±4.7% vs. 55.2±4.2% initial torque, respectively; p = 0.004), with no evidence of voluntary activation failure (ΔMVIC:80Hz torque) in either group (p≥0.317). Low-frequency fatigue (Δ10:80Hz torque) occurred in both groups (p<0.001), as did slowing of T1/2 (p = 0.001), with no differences between groups. Baseline T1/2 was inversely associated with fatigue in older (r2 = 0.584, p = 0.045), but not young women (r2 = 0.147, p = 0.348). These results indicate that differences in muscle architecture, voluntary activation, and low-frequency fatigue do not explain the greater fatigue of older compared with young women during high-velocity contractions. The inverse association between baseline T1/2 and fatigue in older women suggests that factors related to slower muscle contractile properties may be protective against fatigue during fast, repetitive contractions in aging.

Age-related changes in isolated mouse skeletal muscle function are dependent on sex, muscle, and contractility mode

The present study aimed to simultaneously examine the age-related, muscle-specific, sex-specific, and contractile mode-specific changes in isolated mouse skeletal muscle function and morphology across multiple ages. Measurements of mammalian muscle morphology, isometric force and stress (force/cross-sectional area), absolute and normalized (power/muscle mass) work-loop power across a range of contractile velocities, fatigue resistance, and myosin heavy chain (MHC) isoform concentration were measured in 232 isolated mouse (CD-1) soleus, extensor digitorum longus (EDL), and diaphragm from male and female animals aged 3, 10, 30, 52, and 78 wk. Aging resulted in increased body mass and increased soleus and EDL muscle mass, with atrophy only present for female EDL by 78 wk despite no change in MHC isoform concentration. Absolute force and power output increased up to 52 wk and to a higher level for males. A 23–36% loss of isometric stress exceeded the 14–27% loss of power normalized to muscle mass between 10 wk and 52 wk, although the loss of normalized power between 52 and 78 wk continued without further changes in stress ( P > 0.23). Males had lower power normalized to muscle mass than females by 78 wk, with the greatest decline observed for male soleus. Aging did not cause a shift toward slower contractile characteristics, with reduced fatigue resistance observed in male EDL and female diaphragm. Our findings show that the loss of muscle quality precedes the loss of absolute performance as CD-1 mice age, with the greatest effect seen in male soleus, and in most instances without muscle atrophy or an alteration in MHC isoforms.

Comparison of fascicle behaviors between superficial and deeper muscles of triceps brachii during isometric contractions

PURPOSE

We assessed fascicle behaviors of the upper extremities during isometric contractions at different joint angles in this study.

METHODS

Thirteen healthy men and women performed isometric elbow extension tasks at 50% and 75% of maximal voluntary contraction (MVC) at 60°, 90°, and 120° of elbow extension (full extension = 180°). Extended field-of-view B-mode ultrasonography was used to obtain sagittal plane panoramic images of the long head (TB-Long) and medial head (TB-Med) of the triceps brachii at rest and during contraction; fascicle length and pennation angle were measured.

RESULTS

In the TB-Long, significant fascicle shortening from rest was found during 50% and 75%MVC at 60° and during 75%MVC at 90° of extension. There was no significant fascicle shortening in the TB-Med muscle under any conditions. There was no significant pennation angle change from rest in either muscle. The pennation angle of the TB-Long was significantly greater than that of the TB-Med under all conditions.

CONCLUSIONS

These results suggest that fascicle shortening in the TB-Long muscle occurs in flexion; however, no change was found in the TB-Med. In the upper extremity muscle-tendon complex, the superficial and deeper muscles may have different force-transmission efficiency at flexed joint angles.

Ankle kinetics and plantarflexor morphology in older runners with different lifetime running exposures

Running promotes better cardiovascular health and has positive effects on the musculoskeletal system in older adults. However, older adults have lower ankle plantarflexor torques and positive powers during running, and exhibit changes in plantarflexor morphology than young adults. Since older runners who run as much as younger runners exhibit youthful ankle mechanical outputs, running exposure may preserve the locomotor factors that mediate running speed. The purpose of this study was to compare ankle mechanical output during running and plantarflexor morphological characteristics between older runners who have low or high lifetime running exposure. Ten older runners with low lifetime running exposure and nine older runners with high lifetime running exposure performed over-ground running trials at 3.0 m/s (±5%) while kinematic and ground reaction force (GRF) data were collected and used to compute joint angular kinetics. Right medial gastrocnemius morphological characteristics were assessed using ultrasonography at rest and during isometric contractions. Ankle torques, powers, and plantarflexor morphology were compared between groups. Older runners with different lifetime running exposures ran with similar ankle mechanical output (i.e. no effect of running exposure) (p > .05) and exhibited similar medial gastrocnemius morphology during isometric testing. The findings from this study demonstrate that lifetime running exposure does not appear to influence ankle mechanical output or plantarflexor morphology in middle-aged runners.

Age-related differences in vastus lateralis fascicle behavior during fast accelerative leg-extension movements

Leg-extensor rate of power development (RPD) decreases during aging. This study aimed to identify the underlying mechanism of the age-related decline in RPD during a fast acceleration in terms of in vivo vastus lateralis (VL) fascicle shortening behavior. Thirty-nine men aged between 25 and 69 years performed three maximal isokinetic leg-extensor tests with a fixed initial acceleration of 45° knee extension in 150 ms until 340°/s knee angular velocity. RPD, VL activity, and ultrasound images were recorded to assess (relative) fascicle shortening and mean shortening velocity for the phases of electromechanical delay, pretension, and acceleration. Our findings show that fascicle shortening and mean shortening velocity during a fast action increase with aging (0.002 per year, P = .035 and 0.005 s^-1 per year, P = .097, respectively), mainly due to a higher amount of shortening in the phase of electromechanical delay. The ratio of VL fascicle length over upper leg length at rest showed a negative correlation (r = -.46, P = .004) with RPD/body mass, while pennation angle at rest showed a trend toward a positive correlation (r = .28, P = .089). To conclude, our findings indicate that the ability to reach high VL fascicle shortening velocities in vivo is not reduced in older men while performing preprogrammed fast accelerations. The greater amount of fascicle shortening in old age is probably the result of age-related differences in the tendinous properties of the muscle-tendon complex, forcing the fascicles to shorten more in order to transmit the muscle force to the segment.

Muscle structure governs joint function: linking natural variation in medial gastrocnemius structure with isokinetic plantar flexor function

Despite the robust findings linking plantar flexor muscle structure to gross function within athletes, the elderly and patients following Achilles tendon ruptures, the link between natural variation in plantar flexor structure and function in healthy adults is unclear. In this study, we determined the relationship between medial gastrocnemius structure and peak torque and total work about the ankle during maximal effort contractions. We measured resting fascicle length and pennation angle using ultrasound in healthy adults (N=12). Subjects performed maximal effort isometric and isokinetic contractions on a dynamometer. We found that longer fascicles were positively correlated with higher peak torque and total work (R²>0.41, P<0.013) across all isokinetic velocities, ranging from slow (30°/s) to fast (210°/s) contractions. Higher pennation angles were negatively correlated with peak torque and total work (R²>0.296, P<0.067). These correlations were not significant in isometric conditions. We further explored this relationship using a simple computational model to simulate isokinetic contractions. These simulations confirmed that longer fascicle lengths generate more joint torque and work throughout a greater range of motion. This study provides evidence that ankle function is strongly influenced by muscle structure in healthy adults.

Summary: Using ultrasound measurements of muscle structure and dynamometer measurements of ankle function, we found that longer muscle fascicles positively correlated with increased ankle kinetics.

Physical Exercise in the Oldest Old

Societies are progressively aging, with the oldest old (i.e., those aged >80-85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so-called age-related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age-related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or "exercise mimetics" in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse-induced negative adaptations in those oldest old people who are unable to do physical exercise. © 2019 American Physiological Society. Compr Physiol 9:1281-1304, 2019.

The usefulness of muscle architecture assessed with ultrasound to identify hospitalized older adults with physical decline

BACKGROUND

Muscle mass and strength decline are known to be key factors in the development of physical incapacities in later life. These structural and functional declines are even more significant in older people during hospitalizations, increasing risk of falls, fractures, and loss of quality of life. In clinical daily practice, functional and muscular decline are assessed using the validated Short Physical Performance Battery (SPPB). Nevertheless, psychological conditions (pain, demotivation, depression) and temporary physical incapacities (e.g: hip fracture) during hospitalization can be significant barriers to evaluate these patients. Skeletal muscle ultrasound assessment could be an alternative in clinical daily practice since muscle architecture (MA) is related to poor muscle function. However, this potential objective and clinical tool is not yet implemented in geriatric setting during hospitalization. Our study aimed at: 1) comparing MA, muscle mass and strength measurements in hospitalized older adults with different functional levels, 2) evaluating the association between these measurements.

METHODS

Forty-four hospitalized older adults were divided in 2 groups: 21 Pre-Disabled (PDis (SPPB_score: 6-9): 81 ± 7 years old, SPPB_score:7.6 ± 1.1) and 23 Disabled (Dis (SPPB_score:<6): 83 ± 7 years old, SPPB_score:3.6 ± 1.6). SPPB, body mass (BM) and composition (bio-impedance), handgrip strength (HS, dynamometer) and MA (Pennation angle (PA), muscle thickness (MT); ultrasound) were evaluated.

RESULTS

Relative muscle strength (HS/BM: 0.28 ± 0.08 vs 0.34 ± 0.09 kg/kg), PA (10.6 ± 1.8 vs 12.3 ± 1.9°), and MT (16.4 ± 0.4 vs 19.2 0.4 mm) but not lean body mass were significantly different between Dis and PDis, respectively. Significant associations between PA and the SPPB_score (r² = 0.37) or walking speed (r² = 0.38); between SCF and walking speed (r² = -0.36); as well as between MT and SPPB_score (r² = 0.29), walking speed (r² = 0.30), LBM (r² = 0.382) or MMI (r² = 0.361) were observed.

CONCLUSION

Muscle architecture (proxy of muscle quality) and functional capacities/status of hospitalized older adults are related. Thus, ultrasound seems to be a potential useful and objective screening tool for clinicians to assess/prevent physical decline during hospitalization. Larger and/or longitudinal studies are needed to confirm our findings from a pilot pragmatic study.

Muscular Morphomechanical Characteristics After an Achilles Repair

BACKGROUND

The purpose of the study was to compare the morphomechanical and functional characteristics during maximal isometric, concentric, and eccentric contractions in the legs of patients that underwent unilateral Achilles tendon repair with those in their noninjured control legs.

METHODS

Twenty participants (median age = 38.2 years; range, 21.1-57.3 years) who underwent Achilles repair between 3 and 12 months ago were recruited with the following measures: (1) mechanical stiffness of the aponeurosis and (2) electromyography and medial gastrocnemius fascicle angle and length, standing muscle and tendon length, and height of heel rise with isometric contraction.

RESULTS

Compared to the noninjured legs, the repaired legs showed less resting fascicle length, standing muscle length, isometric plantarflexion torque, and heel raise distance ( Ps ranged between .044 and <.001). During the concentric and eccentric phases of the raising and lowering test, the repaired legs demonstrated less fascicle length ( P ≤ .028) but greater tendinous tissue length ( Ps ranged between .084 and <.001) and fascicle angle ( Ps ranged between .247 and .008) and fewer change magnitudes of the fascicle length and tendinous tissue length ( P ≤ .003). The change magnitudes of the morphological characteristics showed correlations with the torque or distance.

CONCLUSION

Selecting the appropriate surgical repair and rehabilitation for Achilles tendon ruptures is recommended for restoring the length and mechanical strength of the muscle-tendon unit of plantar-flexion muscles.

LEVEL OF EVIDENCE

Level III, comparative study.

Sex-related differences in muscle size explained by amplitudes of higher-threshold motor unit action potentials and muscle fibre typing

AIM

To investigate the relationships between motor unit action potential amplitudes (MUAP_AMP ), muscle cross-sectional area (mCSA) and composition (mEI), per cent myosin heavy chain (%MHC) areas and sex in the vastus lateralis (VL).

METHODS

Ten males and 10 females performed a submaximal isometric trapezoid muscle action that included a linearly increasing, steady torque at 40% maximal voluntary contraction, and linearly decreasing segments. Surface electromyographic decomposition techniques were utilized to determine MUAP_AMPS in relation to recruitment thresholds (RT). Ultrasound images were taken to quantify muscle mCSA and mEI. Muscle biopsies were collected to calculate %MHC areas. Y-intercepts and slopes were calculated for the MUAP_AMP vs RT relationships for each subject. Independent-samples t tests and ANOVA models examined sex-related differences in mCSA, mEI, slopes and y-intercepts for the MUAP_AMP vs RT relationships and %MHC areas. Correlations were performed among type IIA and total type II %MHC area, mCSA and the slopes and y-intercepts for the MUAP_AMP vs RT relationships.

RESULTS

Males exhibited greater slopes for the MUAP_AMP vs RT relationships (P = .003), mCSA (P < .001) and type IIA %MHC (P = .011), whereas females had greater type I %MHC area (P = .010) and mEI (P = .024). The mCSA, type IIA and total II %MHC area variables were correlated (P < .001-.015, r = .596-.836) with the slopes from the MUAP_AMP vs RT relationships.

CONCLUSION

Sex-related differences in mCSA and MUAP_AMPS of the higher-threshold MUs were likely the result of larger muscle fibres expressing type II characteristics for males.

Physiologically based pharmacokinetic modelling to guide drug delivery in older people

Older patients are generally not included in Phase 1 clinical trials despite being the population group who use the largest number of prescription medicines. Physiologically based pharmacokinetic (PBPK) modelling provides an understanding of the absorption and disposition of drugs in older patients. In this review, PBPK models used for the prediction of absorption and exposure of drugs after parenteral, oral and transdermal administration are discussed. Comparisons between predicted drug pharmacokinetics (PK) and observed PK are presented to illustrate the accuracy of the predictions by the PBPK models and their potential use in informing clinical trial design and dosage adjustments in older patients. In addition, a case of PBPK modelling of a bioequivalence study on two controlled release products is described, where PBPK predictions reproduced the study showing bioequivalence in healthy volunteers but not in older subjects with achlorhydria, indicating further utility in prospectively identifying challenges in bioequivalence studies.

Sex-Related Responses to Eccentric-Only Resistance Training in Knee-Extensors Muscle Strength and Architecture

PURPOSE

The present study aimed to investigate whether or not eccentric-only training induced different sex-related adaptations in vastus lateralis muscle architecture and knee extensors strength.

METHODS

Thirteen healthy women and 13 healthy men were recruited. Vastus lateralis pennation angle, fascicle length, and muscle thickness, as well as knee extensors eccentric, isometric, and concentric peak torque and one-repetition maximum (1RM) were measured. Both women and men underwent a unilateral iso-load knee-extension eccentric-only training with 120% of the concentric 1RM, consisting of 4 sets × 10 repetitions twice a week for a total of 8 weeks.

RESULTS

Pennation angle increased in women (+ 14%, 95% CI [10, 17], effect size [ES] = 1.54) but not in men (+ 5%, 95% CI [-1, 11], ES = 0.28), while fascicle length increased in both women (+ 7%, 95% CI [4, 10], ES = 1.02) and men (+ 12%, 95% CI [8, 16], ES = 1.82) and muscle thickness increased in women (+ 13%, 95% CI [8, 18], ES = 1.11) and men (+ 11%, 95% CI [7, 15], ES = 0.89). In both women and men, eccentric (18%, 95% CI [11, 25], ES = 0.96, and 16%, 95% CI [9, 22], ES = 0.82, respectively), isometric (17%, 95% CI [11, 23], ES = 0.53, and 17%, 95% CI [10, 24], ES = 0.62), concentric (12%, 95% CI [7, 16], ES = 0.49, and 9%, 95% CI [5, 13], ES = 0.42) peak torque and 1RM (10%, 95% CI [6, 14], ES = 0.53, and 10%, 95% CI [5, 15], ES = 0.50) similarly increased after the intervention.

CONCLUSIONS

This study showed that the adaptations in strength are not sex-dependent, but the increases in pennation angle only in women suggest that the changes in muscle architecture may depend on sex.

Differences in elbow extensor muscle characteristics between resistance-trained men and women

PURPOSE

Muscular strength is suggested to be dependent upon muscle characteristics. Yet, sex-specific relationships of muscle characteristics to strength in the resistance-trained require investigation. Therefore, the purpose was to evaluate sex differences in muscle characteristics and isometric strength in the elbow extensors, as well as their respective associations.

METHODS

Resistance-trained men (n = 15, mean ± SD 22 ± 4 years, 87.5 ± 12.8 kg, 16.9 ± 2.9% body fat) and women (n = 15, mean ± SD 25 ± 5 years, 59.3 ± 7.3 kg, 22.4 ± 4.2% body fat) were tested. B-mode ultrasound images assessed muscle thickness, pennation angle, and echo intensity. Muscle volume and fascicle length were estimated from previously validated equations. Maximal voluntary isometric contraction measured elbow extensors isometric strength. Independent samples t-tests and Fisher's r-to-z test examined differences between sexes.

RESULTS

Sex differences existed in all muscle characteristics (p < 0.05). Men's absolute strength (27.86 ± 3.55 kg) was significantly greater than women (16.15 ± 3.15 kg), but no differences were noted when controlling for muscle volume (men 0.069 ± 0.017, women 0.077 ± 0.022 kg/cm³). Sex differences did not exist in the relationships of muscle characteristics to strength with muscle size having the largest correlations. However, the relationship between echo intensity and body fat was different in men (r = - 0.311) and women (r = 0.541, p = 0.0143).

CONCLUSIONS

Sex differences in isometric elbow extensor strength are eliminated when expressed relative to muscle volume. Relationships of echo intensity and body fat were different between men and women and may be indicative of greater adipose infiltration in women.

Association of Gastrocnemius Muscle Stiffness With Passive Ankle Joint Stiffness and Sex-Related Difference in the Joint Stiffness

Passive ankle joint stiffness is affected by all structures located within and over the joint, and is greater in men than in women. Localized muscle stiffness can be assessed by ultrasound shear wave elastography, and muscle architecture such as fascicle length and pennation angle can be measured by B-mode ultrasonography. Thus, the authors assessed localized muscle stiffness of the medial gastrocnemius (MG) with consideration of individual variability in the muscle architecture, and examined the association of the muscle stiffness with passive ankle joint stiffness and the sex-related difference in the joint stiffness. Localized muscle stiffness of the MG in 16 men and 17 women was assessed at 10° and 20° plantar flexion, neutral anatomical position, and 10° and 20° dorsiflexion. Fascicle length and pennation angle of the MG were measured at these joint positions. Passive ankle joint stiffness was determined by the ankle joint angle–torque relationship. Localized MG muscle stiffness was not significantly correlated with passive ankle joint stiffness, and did not show significant sex-related difference, even when considering the muscle architecture. This finding suggests that muscle stiffness of the MG would not be a prominent factor in determining passive ankle joint stiffness and the sex-related difference in the joint stiffness.

Quadriceps concentric-eccentric force and muscle architecture in COPD patients vs healthy men

The aim of this study was to compare quadriceps concentric and eccentric strength and muscle architecture in chronic obstructive pulmonary disease (COPD) patients vs healthy men. Thirty-five COPD patients (age = 65 ± 4 yrs, forced expiratory volume (FEV₁) = 63 ± 10%; FEV₁/forced vital capacity (FVC)=57 ± 13% of predicted) and 25 age-matched healthy men (age = 65 ± 4 yrs, FEV₁=114 ± 17%; FEV₁/FVC = 101 ± 6% of predicted) (CON) participated in the present cross-sectional study. Concentric and eccentric isokinetic peak-torque was measured at low and high angular-velocity. Vastus lateralis pennation angle, fascicle length and muscle thickness were recorded using ultrasound device. Similar eccentric peak-torque was found in COPD and CON at low (2.57 ± 0.55 and 2.80 ± 0.60 N⋅m⋅kg^-1, p = 0.128 respectively) and high (2.44 ± 0.51 and 2.58 ± 0.46 N⋅m⋅kg^-1, p = 0.259) angular-velocity. Lower concentric peak-torque was found in COPD than in CON (p < 0.05). Smaller pennation angle (13.8 ± 3.4 vs 16.2 ± 3.9°) and muscle thickness (17.1 ± 2.8 vs 20.3 ± 3.0 mm) were found in COPD patients vs healthy men, with no difference in fascicle length. In COPD patients only, FEV₁ and FEV₁/FVC were negatively correlated with the eccentric-to-concentric peak-torque ratio (r = -0.465 and r = -0.414, respectively); irrespective of the testing-modality, FEV₁ and FEV₁/FVC were moderately correlated with peak-torque (p < 0.05). The preserved eccentric strength in COPD patients could be accounted for both mechanical and neural adaptations caused by the disease severity.

Morphomechanical alterations in the medial gastrocnemius muscle in patients with a repaired Achilles tendon: Associations with outcome measures

BACKGROUND

Functional deficits are found in ankles that have sustained an Achilles rupture. This study sought to evaluate and compare the morphomechanical characteristics of the medial gastrocnemius muscle in the legs of participants within six months of a unilateral Achilles repair to determine any correlations between those characteristics and objective outcomes and self-reported functional levels.

METHODS

Fifteen participants were assessed via measurements of muscle morphologies (fascicle length, pennation angle, and muscle thickness) in a resting state, the mechanical properties of the proximal aponeurosis of the medial gastrocnemius muscle, the pennation angle during ramping maximal voluntary isometric contractions (MVIC), the heel raise test, and the Taiwan Chinese version of the Lower Extremity Functional Scale (LEFS-TC) questionnaire. Findings Compared with the non-injured legs, the repaired legs showed a lower muscle fascicle length (mean 4.4 vs. 5.0cm) and thickness (1.7 vs. 1.9cm), lower stiffness of the GM tendon and aponeurosis (174.1 vs. 375.6N/mm), and a greater GM pennation angle (31.2 vs. 28.9°) during 90% MVIC (all p≤0.05). Correlations were found between the morphomechanical results and maximal heel raise heights or the LEFS-TC score, and between the symmetry ratios of the fascicle lengths and the LEFS-TC score. Interpretation There are decreases in fascicle length, muscle thickness and mechanical properties in the medial gastrocnemius muscles of the participants within the first six months after an Achilles repair. These morphomechanical alterations demonstrate associations with functional levels in the lower extremities and indicated the need for early mobilization of the calf muscles after the repair.

Different Effect of Local and General Fatigue on Knee Joint Stiffness

PURPOSE

This study aimed to investigate the influence of locally and generally induced fatigue on the stiffness properties of the knee joint.

METHODS

Twenty-two male (24.9 ± 4.5 yr, 1.78 ± 0.06 m, 75.4 ± 6.4 kg, 23.9 ± 1.8 kg·m) and 18 female (21.1 ± 1.5 yr, 1.66 ± 0.05 m, 63.4 ± 6.5 kg, 22.9 ± 2.5 kg·m) amateur athletes participated. Peak torque (PT) of the knee extensor musculature, muscle stiffness (MS) of the vastus lateralis, and musculoarticular stiffness (MAS) of the knee joint were assessed pre- and postlocally and generally induced fatigue (undertaken on two separate days with a 1-wk interval).

RESULTS

Males were characterized by higher values of MAS, relaxed and contracted MS, normalized PT (PT/body mass), and normalized MAS (MAS/external load) irrespective of time point (P < 0.05).

LOCALLY INDUCED FATIGUE

Contracted MS increased more (P < 0.01) and normalized PT decreased more (P = 0.03) in males than in females postfatigue. Significant increases occurred in MAS in females (P = 0.01); relaxed MS (males, P < 0.001; females, P < 0.001), contracted MS (males, P < 0.001; females, P = 0.04), and normalized MAS (males, P = 0.001; females, P = 0.01) in both sexes; and normalized contracted MS (contracted MS/external load) in males (P < 0.001). Normalized PT decreased significantly in males (P < 0.01) postfatigue.

GENERALLY INDUCED FATIGUE

Contracted MS (P = 0.01) and MAS (P = 0.05) decreased significantly in males post-fatigue.

CONCLUSION

The stiffness properties of the knee joint are influenced by locally and generally induced fatigue, with different responses being observed in males and females.

Effects of age and sex on neuromuscular-mechanical determinants of muscle strength

The aim of this study was to concurrently assess the effect of age on neuromuscular and mechanical properties in 24 young (23.6 ± 3.7 years) and 20 older (66.5 ± 3.8 years) healthy males and females. Maximal strength of knee extensors (KE) and flexors (KF), contractile rate of torque development (RTD) and neural activation of agonist-antagonist muscles (surface EMG) were examined during maximal voluntary isometric contraction (MVIC). Tissue stiffness (i.e. musculo-articular stiffness (MAS) and muscle stiffness (MS)) was examined via the free-oscillation technique, whereas muscle architecture (MA) of the vastus lateralis and subcutaneous fat were measured by ultrasonography. Males exhibited a greater age-related decline for KE (47.4 %) and KF (53.1 %) MVIC, and RTD (60.4 %) when compared to females (32.9, 42.6 and 34.0 %, respectively). Neural activation of agonist muscles during KE MVIC falls markedly with ageing; however, no age and sex effects were observed in the antagonist co-activation. MAS and MS were lower in elderly compared with young participants and in females compared with males. Regarding MA, main effects for age (young 23.0 ± 3.3 vs older 19.5 ± 2.0 mm) and sex (males 22.4 ± 3.5 vs females 20.4 ± 2.7 mm) were detected in muscle thickness. For fascicle length, there was an effect of age (young 104.6 ± 8.8 vs older 89.8 ± 10.5 mm), while for pennation angle, there was an effect of sex (males 13.3 ± 2.4 vs females 11.5 ± 1.7°). These findings suggest that both neuromuscular and mechanical declines are important contributors to the age-related loss of muscle strength/function but with some peculiar sex-related differences.

Active muscle and tendon stiffness of plantar flexors in sprinters

The aim of the present study was to investigate and compare muscle and tendon stiffness under active conditions in sprinters and untrained participants. In total, 14 sprinters and 24 untrained men participated in this study. Active muscle stiffness in the medial gastrocnemius muscle was calculated based on changes in estimated muscle force and fascicle length during fast stretching after submaximal isometric contractions. Tendon stiffness was determined during isometric plantar flexion using ultrasonography. No significant differences were observed in active muscle stiffness between sprinters and untrained men at any torque levels. Furthermore, no significant difference was noted in tendon stiffness between the two groups. These results suggest that muscle and tendon mechanical properties in the plantar flexors under active conditions are similar in sprinters and untrained participants.

Ultrasound-Derived Abdominal Muscle Thickness Better Detects Metabolic Syndrome Risk in Obese Patients than Skeletal Muscle Index Measured by Dual-Energy X-Ray Absorptiometry

Sarcopenia has never been diagnosed based on site-specific muscle loss, and little is known about the relationship between site-specific muscle loss and metabolic syndrome (MetS) risk factors. To this end, this cross-sectional study aimed to investigate the relationship between site-specific muscle size and MetS risk factors. Subjects were 38 obese men and women aged 40-82 years. Total body fat and lean body mass were assessed by whole-body dual-energy X-ray absorptiometry (DXA) scan. Muscle thickness (MTH) was measured using B-mode ultrasound scanning in six body regions. Subjects were classified into general obesity (GO) and sarcopenic obesity (SO) groups using the threshold values of one standard deviation below the sex-specific means of either MTH or skeletal muscle index (SMI) measured by DXA. MetS risk score was acquired by standardizing and summing the following continuously distributed variables: visceral fat area, mean blood pressure, HbA1c, and serum triglyceride / high density lipoprotein cholesterol, to obtain the Z-score. Multiple regression analysis revealed that the MetS risk score was independently associated with abdominal MTH in all subjects, but not with MTH in other muscle regions, including the thigh. Although HbA1c and the number of MetS risk factors in the SO group were significantly higher than those in the GO group, there were no significant differences between GO and SO groups as defined by SMI. Ultrasound-derived abdominal MTH would allow a better assessment of sarcopenia in obese patients and can be used as an alternative to the conventionally-used SMI measured by DXA.