Reliability and reproducibility of a four arterial occlusions protocol for assessing muscle oxidative metabolism at rest and after exercise using near-infrared spectroscopy

Intra- and Inter-Day Reliability of the NIRS Portamon Device after Three Induced Muscle Ischemias

(1) Background: Near-infrared spectroscopy (NIRS) is an innovative and non-invasive technology used to investigate muscular oxygenation. The aim of this study is to assess the within- and between-session reliability of the NIRS Portamon (Artinis, Elst, Netherlands) device following three sets of induced muscle ischemia. (2) Methods: Depending on the experimental group (G1, G2 or G3), a cuff was inflated three times on the left upper arm to 50 mmHg (G1), systolic blood pressure (SBP) + 50 mmHg (G2) or 250 mmHg (G3). Maximum, minimum and reoxygenation rate values were assessed after each occlusion phase, using a Portamon device placed on the left brachioradialis. Reliability was assessed with intraclass correlation coefficient (ICC) value and ICC 95% confidence interval (CI-95%), coefficient of variation (CV) and standard error of measurement (SEM) (3) Results: Our results showed a good to excellent reliability for maximums and minimums within-session. However, the reoxygenation rate within sessions as well as measurements between sessions cannot predominantly show good reliability. (4) Conclusions: Multiple measurements of maximums and minimums within a single session appeared to be reliable which shows that only one measurement is necessary to assess these parameters. However, it is necessary to be cautious with a comparison of maximum, minimum and reoxygenation rate values between sessions.

Comparison of Different Approaches Estimating Skeletal Muscle Oxygen Consumption Using Continuous-Wave Near-Infrared Spectroscopy at a Submaximal Contraction Level—A Comparative Study

Continuous-wave near-infrared spectroscopy (CW-NIRS) is a method used to non-invasively estimate skeletal muscle oxygen consumption (mVO2). Three different signals are provided by CW-NIRS devices: (1) oxygenated hemoglobin (O2Hb); (2) deoxygenated hemoglobin (HHb); and (3) tissue saturation index (TSI). Typically, the signal’s slope is interpreted with respect to high or low mVO2 during a muscle action. What signal (or combination of signals) is used for slope interpretation differs according to what approach is used, and there are several published in literature. It is unclear if resulting mVO2 estimates can be used interchangeably. Hence, this work aimed to compare five commonly used approaches on the same set of CW-NIRS data regarding their agreement in estimated mVO2. A controlled, lab-based study setting was used for this experiment. Data are based on isometric dorsiflexion contractions of 15 subjects at 30% of voluntary maximum torque, at two different ankle angles. CW-NIRS was placed on the m. tibialis anterior and blood flow was occluded. The approaches for mVO2 estimation included calculations based on (1) TSI, (2) the difference between O2Hb and HHb (Hbdiff), (3) the mean of slopes from O2Hb and HHb (Hbmean), (4) the HHb signal, and (5) the O2Hb signal. Linear regression modelling was used to calculate respective slopes (r2 > 0.99). Repeated measures ANOVA identified significant differences between the approaches (p < 0.001, ω2 = 0.258). Post-hoc tests revealed that only TSI vs. Hbmean and Hbdiff vs. HHb gave comparable results (p > 0.271). In addition, Bland–Altman plots showed good accuracy (mean bias ~2%) but low precision (±20%) between the comparisons. Thus, the different approaches to estimate mVO2 cannot be used interchangeably. The results from different studies using different approaches should be compared with caution.

Muscle Oxygenation of the Paretic and Nonparetic Legs During and After Arterial Occlusion in Chronic Stroke

Oxygen delivery and demand are reduced in the paretic leg post-stroke, reflecting decreased vascular function and reduced muscle quantity and quality. However, it is unknown how muscle oxygenation, the balance between muscle oxygen delivery and utilization, is altered in chronic stroke during and after occlusion-induced ischemia.

OBJECTIVES

The objective was to determine muscle oxygen consumption rate, microvascular responsiveness and reactive hyperemia in the paretic and nonparetic legs during and after arterial occlusion post-stroke.

MATERIALS AND METHODS

Muscle oxygen saturation was measured with near-infrared spectroscopy on the vastus lateralis of each leg during 3-minute arterial occlusion and recovery (3 min). Muscle oxygen consumption was derived from the desaturation slope during ischemia, microvascular responsiveness was derived from the resaturation slope after ischemia and reactive hyperemia was derived from the area under the curve above baseline after ischemia.

RESULTS

Eleven subjects (91% male; 32.2±6.1 months post-stroke; age 62.9±13.6 years) with a hemiparetic gait pattern participated. There was no significant between-leg muscle oxygenation difference at rest (paretic: 64.9±16.6%; nonparetic: 70.6±15.6%, p = 0.13). Muscle oxygen consumption in the paretic leg (-0.53±0.24%/s) was significantly reduced compared to the nonparetic leg (-0.70±0.36%/s; p = 0.03). Microvascular responsiveness was significantly reduced in the paretic leg compared to the nonparetic leg (paretic: 4.6±1.8%/s; nonparetic: 5.7±1.6%/s, p = 0.04). Reactive hyperemia was not significantly different between legs (paretic:4384±2341%·s; nonparetic: 3040±2216%·s, p = 0.07).

CONCLUSION

Muscle oxygen consumption and microvascular responsiveness are impaired in the paretic compared to the nonparetic leg, suggesting both reduced skeletal muscle aerobic function and reduced ability to maximally perfuse muscle tissue.

Men exhibit faster skeletal muscle tissue desaturation than women before and after a fatiguing handgrip

Purpose

The purpose was to test the hypothesis that sex and fatigue effect of the early phase of skeletal muscle tissue oxygenation (StO₂, %) desaturation rate as well as that strength matched adults may exhibit similar responses.

Methods

Twenty-four adults visited the laboratory twice to quantify this early phase of desaturation during vascular occlusion tests (VOT) while in a rested state. The second visit included a sustained handgrip task at 25% of maximal muscular strength until task failure. At failure, a post-task VOT was initiated. Muscle desaturation was defined as StO₂ and collected by a near-infrared spectroscopy device. The muscle size and adipose thickness were determined via ultrasonography. Linear regression was used to quantify the rates of desaturation during the VOTs as well as during the fatiguing handgrip.

Results

There were sex differences in the rate of desaturation pre- and post-handgrip, such that independent of fatigue, the men (p < 0.001) desaturated more rapidly than the women (pre: b = − 0.208 vs. − 0.123%∙s⁻¹; post: − 0.079 vs. − 0.070%∙s⁻¹). During the fatiguing handgrip, the transformed StO₂ values indicated that the males desaturated more rapidly than the females (b = − 0.070 vs. − 0.015). The matched pairs exhibited the same responses as the total sample.

Conclusion

Overall, muscle size and strength as well as adipose tissue were likely not the primary cause of the differences in rates of muscle desaturation. We hypothesized that differences in fiber type and mitochondria were the principle mechanisms provoking the differences in muscle oxygenation.

Measuring tibial hemodynamics and metabolism at rest and after exercise using near-infrared spectroscopy

The bone vascular system is important, yet evaluation of bone hemodynamics is difficult and expensive. This study evaluated the utility and reliability of near-infrared spectroscopy (NIRS), a portable and relatively inexpensive device, in measuring tibial hemodynamics and metabolic rate. Eleven participants were tested twice using post-occlusive reactive hyperemia technique with the NIRS probes placed on the tibia and the medial gastrocnemius (MG) muscle. Measurements were made at rest and after 2 levels of plantarflexion exercise. The difference between oxygenated and deoxygenated hemoglobin signal could be reliably measured with small coefficients of variation (CV; range 5.7-9.8%) and high intraclass correlation coefficients (ICC; range 0.73-0.91). Deoxygenated hemoglobin rate of change, a potential marker for bone metabolism, also showed good reliability (CV range 7.5-9.8%, ICC range 0.90-0.93). The tibia was characterized with a much slower metabolic rate compared with MG (p < 0.001). While exercise significantly increased MG metabolic rate in a dose-dependent manner (all p < 0.05), no changes were observed for the tibia after exercise compared with rest (all p > 0.05). NIRS is a suitable tool for monitoring hemodynamics and metabolism in the tibia. However, the local muscle exercise protocol utilized in the current study did not influence bone hemodynamics or metabolic rate. Novelty: NIRS can be used to monitor tibial hemodynamics and metabolism with good reliability. Short-duration local muscle exercise increased metabolic rate in muscle but not in bone. High level of loading and exercise volume may be needed to elicit measurable metabolic changes in bone.

The Case for Measuring Long Bone Hemodynamics With Near-Infrared Spectroscopy

Diseases and associated fragility of bone is an important medical issue. There is increasing evidence that bone health is related to blood flow and oxygen delivery. The development of non-invasive methods to evaluate bone blood flow and oxygen delivery promise to improve the detection and treatment of bone health in human. Near-infrared spectroscopy (NIRS) has been used to evaluate oxygen levels, blood flow, and metabolism in skeletal muscle and brain. While the limited penetration depth of NIRS restricts its application, NIRS studies have been performed on the medial aspect of the tibia and some other prominent bone sites. Two approaches using NIRS to evaluate bone health are discussed: (1) the rate of re-oxygenation of bone after a short bout of ischemia, and (2) the dynamics of oxygen levels during an intervention such as resistance exercise. Early studies have shown these approaches to have the potential to evaluate bone vascular health as well as the predicted efficacy of an intervention before changes in bone composition are detectable. Future studies are needed to fully develop and exploit the use of NIRS technology for the study of bone health.