Sense of Effort During a Fatiguing Exercise Protocol in Chronic Fatigue Syndrome

Clinical signs of bruxism in CrossFit® practitioners: observational study

INTRODUCTION

CrossFit® is a physical training method that aims to promote physical fitness through the development of components such as aerobic capacity, strength and muscular endurance. Data regarding bruxism behaviors in CrossFit® practitioners are scarce, but previous studies have shown increased dental clenching behavior during weightlifting practices.

OBJECTIVE

The present study aimed to evaluate clinical signs of bruxism in CrossFit® practitioners.

METHODS

The sample comprised a convenience sample of CrossFit® practitioners (n=57), of both genders, aged 19-58 years. Outcome variables were as follows: Oral Behavior Checklist, the International Physical Activity Questionnaire and the Standardized Tool for the Assessment of Bruxism. Data were expressed in terms of absolute values and percentages. Spearman's correlation and Fisher exact tests were used for statistical analysis, and a significance level of 5% was considered.

RESULTS

The mean age was 32.82 years, with a female majority (63.15%). CrossFit® practitioners frequently reported clenching their teeth during training practice (61.40%) and presented linea alba (82.45%), lip impression (54.38%), tongue impression (26.31%), bone exostosis (19.29%), tooth wear (61.40%) and non-carious cervical lesions (35.09%).

CONCLUSIONS

No correlation was found between clinical signs of bruxism, oral behaviors and physical activity intensity; however, the results suggest that individuals who practice CrossFit® training have oral behaviors that can cause morpho-functional changes in the stomatognathic system, especially the habit of clenching their teeth during training. In addition, data emphasize the need for dental health education among CrossFit® practitioners, and more studies with a representative sample are necessary.

Prior physical exertion modulates allocentric distance perception: a demonstration of task-irrelevant cross-modal transfer

Physical exertion has been previously shown to influence distance perception in the egocentric framework. In this study, we show that physical exertion influences allocentric distance perception. Twenty healthy volunteers made allocentric line length estimates following varying levels of physical exertion. Each participant was presented with 30 different line lengths ranging from 1 to 12 cm, and each length was presented three times. Each line presentation was preceded by the participant exerting one of the following three levels of their maximal voluntary force (MVF): 20, 50, or 80 % MVF using their hand in the pinch force task. Psychometric curves were obtained for the lines perceived as ‘long’ following each of the three force levels. Lines that were perceived as ‘short’ following 20 and 50 % MVF were perceived as ‘long’ following 80 % MVF; that is, there was a significant leftward shift in the psychometric curve following 80 % MVF when compared to 20 and 50 % MVF. Here, we demonstrate that physical exertion influences perception of distances in the allocentric framework. We discuss our findings with respect to cross-modal interactions, fatigue physiology, peri- and extra-personal space interactions.

Submaximal exercise testing with near-infrared spectroscopy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients compared to healthy controls: a case-control study

BACKGROUND

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating illness. Symptoms include profound fatigue and distinctive post-exertional malaise (PEM). We asked whether a submaximal exercise test would prove useful for identifying different patterns of tissue oxygen utilization in individuals with ME/CFS versus healthy subjects. Such a test has potential to aid with ME/CFS diagnosis, or to characterize patients' illness.

METHODS

A case-control study of 16 patients with ME/CFS compared to 16 healthy controls completing a 3-min handgrip protocol was performed. Response was measured using near-infrared spectroscopy, resulting in measurements of oxygenated (O2Hb) and deoxygenated hemoglobin (HHb) over wrist extensors and flexors. Changes in O2Hb (delta (d)O2Hb) and HHb (dHHb) absorbance between the first and last contraction were calculated, as were the force-time product of all contractions, measured as tension-time index (TTI), and ratings of perceived exertion (RPE).

RESULTS

Individuals with ME/CFS demonstrated smaller dO2Hb and dHHb than controls. However, after adjusting for TTI and change in total hemoglobin (delta (d)tHb), differences in dO2Hb and dHHb were reduced, with large overlapping variances. RPE was significantly higher for cases than controls, particularly at rest.

CONCLUSIONS

Relative to controls, participants with ME/CFS demonstrated higher RPE, lower TTI, and reduced dO2Hb and dHHb during repetitive handgrip exercise, although considerable variance was observed. With further study, submaximal exercise testing may prove useful for stratifying patients with a lower propensity for inducing PEM, and have the ability to establish baseline intensities for exercise prescription.

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is an illness characterized by disabling fatigue of at least 6 months. The aetiology of the condition has been hotly debated. In this chapter the evidence for CFS as a post viral condition and/or a neurological condition is reviewed. Although there is evidence that CFS is triggered by certain viruses in some patients and that neurobiological changes such as hypocortisolism are associated with the syndrome, neither mechanism is sufficient to explain the extent of the symptoms or disability experienced by patients. It is unlikely that CFS can be understood through one aetiological mechanisms. Rather it is a complex illness which is best explained in terms of a multifactorial cognitive behavioural model. This model proposes that CFS is precipitated by life events and/or viral illness in vulnerable individuals, such as those who are genetically predisposed, prone to distress, high achievement, and over or under activity. A self perpetuating cycle where physiological changes, illness beliefs, reduced and inconsistent activity, sleep disturbance, medical uncertainty and lack of guidance interact to maintain symptoms. Treatments based on this model including cognitive behavioural therapy and graded exercise therapy are effective at significantly reducing fatigue and disability in CFS. This chapter provides a description of these approaches and details of the trials conducted in the area.

Sensitivity to cognitive effort mediates psychostimulant effects on a novel rodent cost/benefit decision-making task

Amotivational states and insufficient recruitment of mental effort have been observed in a variety of clinical populations, including depression, traumatic brain injury, post-traumatic stress disorder, and attention deficit hyperactivity disorder. Previous rodent models of effort-based decision making have utilized physical costs whereas human studies of effort are primarily cognitive in nature, and it is unclear whether the two types of effortful decision making are underpinned by the same neurobiological processes. We therefore designed a novel rat cognitive effort task (rCET) based on the 5-choice serial reaction time task, a well-validated measure of attention and impulsivity. Within each trial of the rCET, rats are given the choice between an easy or hard visuospatial discrimination, and successful hard trials are rewarded with double the number of sugar pellets. Similar to previous human studies, stable individual variation in choice behavior was observed, with 'workers' choosing hard trials significantly more than their 'slacker' counterparts. Whereas workers 'slacked off' in response to administration of amphetamine and caffeine, slackers 'worked harder' under amphetamine, but not caffeine. Conversely, these stimulants increased motor impulsivity in all animals. Ethanol did not affect animals' choice but invigorated behavior. In sum, we have shown for the first time that rats are differentially sensitive to cognitive effort when making decisions, independent of other processes such as impulsivity, and these baseline differences can influence the cognitive response to psychostimulants. Such findings could inform our understanding of impairments in effort-based decision making and contribute to treatment development.

Exercise-induced pain requires NMDA receptor activation in the medullary raphe nuclei

PURPOSE

Pain in response to physical activity is common in people with chronic musculoskeletal pain and is likely a barrier to regular exercise, which would lead to a sedentary lifestyle. We recently developed a model of exercise-induced pain that is associated with increased activation of neurons in the medullary raphe nuclei, i.e., the nucleus raphe obscurus (NRO) and nucleus raphe pallidus (NRP). Because the NRO and NRP not only modulate motor output but also respond to noxious stimuli, we hypothesized that the NRO and NRP were key nuclei in the interaction between pain and exercise. We tested whether exercise enhances hyperalgesia through activation of N-methyl D-aspartate (NMDA) receptors in the NRO/NRP.

METHODS

Muscle insult was induced by two injections of pH 5.0 saline 5 d apart into one gastrocnemius muscle. We initially tested whether hyperalgesia developed in mice injected with acidic saline (pH 5.0) into the gastrocnemius muscle immediately after a 30-min or 2-h exercise task or 2 h after a 2-h exercise task. Next, we tested whether blockade of NMDA receptors in the NRO/NRP during the exercise task prevented the development of exercise-induced hyperalgesia. Finally, we evaluated changes in phosphorylation of the NR1 subunit of the NMDA receptor (pNR1) after the exercise task at times in which muscle insult was given in behavioral experiments, i.e., immediately after a 30-min or 2-h exercise task or 2 h after the 2-h exercise task.

RESULTS

All exercise conditions enhanced nociception (hyperalgesia) after combining with two injections of pH 5.0 saline. Microinjection of AP5 (1.0-0.1 nmol; 2-amino-5-phophonopenanoate) dose-dependently prevented the development of exercise-induced hyperalgesia. All exercise conditions increased pNR1 in the NRO and NRP.

CONCLUSIONS

Thus, exercise-induced pain in sedentary mice is associated with increased phosphorylation and activation of NMDA receptors in the NRO/NRP, suggesting that changes in central excitability mediate an interaction between unaccustomed exercise and pain.

Evaluation of the numeric rating scale for perception of effort during isometric elbow flexion exercise

The aim of the study was to examine the reliability and validity of the numerical rating scale (0-10 NRS) for rating perception of effort during isometric elbow flexion in healthy people. 33 individuals (32 ± 8 years) participated in the study. Three re-test measurements within one session and three weekly sessions were undertaken to determine the reliability of the scale. The sensitivity of the scale following 10 min isometric fatiguing exercise of the elbow flexors as well as the correlation of the effort with the electromyographic (EMG) activity of the flexor muscles were tested. Perception of effort was tested during isometric elbow flexion at 10, 30, 50, 70, 90, and 100% MVC. The 0-10 NRS demonstrated an excellent test-retest reliability [intra class correlation (ICC) = 0.99 between measurements taken within a session and 0.96 between 3 consecutive weekly sessions]. Exploratory curve fitting for the relationship between effort ratings and voluntary force, and underlying EMG showed that both are best described by power functions (y = ax ( b )). There were also strong correlations (range 0.89-0.95) between effort ratings and EMG recordings of all flexor muscles supporting the concurrent criterion validity of the measure. The 0-10 NRS was sensitive enough to detect changes in the perceived effort following fatigue and significantly increased at the level of voluntary contraction used in its assessment (p < 0.001). These findings suggest the 0-10 NRS is a valid and reliable scale for rating perception of effort in healthy individuals. Future research should seek to establish the validity of the 0-10 NRS in clinical settings.

Conceptual model for physical therapist management of chronic fatigue syndrome/myalgic encephalomyelitis

Fatigue is one of the most common reasons why people consult health care providers. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is one cause of clinically debilitating fatigue. The underdiagnosis of CFS/ME, along with the spectrum of symptoms that represent multiple reasons for entry into physical therapy settings, places physical therapists in a unique position to identify this health condition and direct its appropriate management. The diagnosis and clinical correlates of CFS/ME are becoming better understood, although the optimal clinical management of this condition remains controversial. The 4 aims of this perspective article are: (1) to summarize the diagnosis of CFS/ME with the goal of promoting the optimal recognition of this condition by physical therapists; (2) to discuss aerobic system and cognitive deficits that may lead to the clinical presentation of CFS/ME; (3) to review the evidence for graded exercise with the goal of addressing limitations in body structures and functions, activity, and participation in people with CFS/ME; and (4) to present a conceptual model for the clinical management of CFS/ME by physical therapists.

Fatiguing exercise enhances hyperalgesia to muscle inflammation

Since many people with chronic fatigue present with pain and many people with chronic pain present with fatigue, we tested if fatigue would enhance the response to pain in male and female mice. We further tested for the activation of brainstem nuclei by the fatigue task using c-fos as a marker. Fatigue was induced by having mice spontaneously run in running wheel for 2h. Carrageenan (0.03%) was injected into the gastrocnemius muscle either 2h before or 2h after the fatigue task. The mechanical sensitivity of the paw (von Frey filaments), muscle (tweezers), grip force and running wheel activity was assessed before and 24h after injection of carrageenan. Both male and female mice that performed the fatigue task, either before or after intramuscular injection of carrageenan, showed an enhanced mechanical sensitivity of the paw, but not the muscle. Ovariectomized mice showed a similar response to male mice. There was a decrease in running wheel activity after carrageenan injection, but no change in grip force suggesting that mice had no deficit in motor performance induced by the carrageenan. C-fos expression was observed in the nucleus raphe pallidus, obscurus, and magnus after the fatigue task suggesting an increased activity in the raphe nuclei in response to the fatigue task. Therefore, widespread hyperalgesia is enhanced by the fatigue response but not hyperalgesia at the site of insult. We suggest that this effect is sex-dependent and involves mechanisms in the brainstem to result in an enhanced hyperalgesia.

Enhanced muscle fatigue occurs in male but not female ASIC3-/- mice

Muscle fatigue is associated with a number of clinical diseases, including chronic pain conditions. Decreases in extracellular pH activates acid-sensing ion channel 3 (ASIC3), depolarizes muscle, protects against fatigue, and produces pain. We examined whether ASIC3-/- mice were more fatigable than ASIC3+/+ mice in a task-dependent manner. We developed two exercise protocols to measure exercise-induced muscle fatigue: (fatigue task 1, three 1-h runs; fatigue task 2, three 30-min runs). In fatigue task 1, male ASIC3+/+ mice muscle showed less fatigue than male ASIC3-/- mice and female ASIC3+/+ mice. No differences in fatigue were observed in fatigue task 2. We then tested whether the development of muscle fatigue was dependent on sex and modulated by testosterone. Female ASIC3+/+ mice that were ovariectomized and administered testosterone developed less muscle fatigue than female ASIC3+/+ mice and behaved similarly to male ASIC3+/+ mice. However, testosterone was unable to rescue the muscle fatigue responses in ovariectomized ASIC3-/- mice. Plasma levels of testosterone from male ASIC3-/- mice were significantly lower than in male ASIC3+/+ mice and were similar to female ASIC3+/+ mice. Muscle fiber types, measured by counting ATPase-stained whole muscle sections, were similar in calf muscles from male and female ASIC3+/+ mice. These data suggest that both ASIC3 and testosterone are necessary to protect against muscle fatigue in a task-dependent manner. Also, differences in expression of ASIC3 and the development of exercise-induced fatigue could explain the female predominance in clinical syndromes of pain that include muscle fatigue.