1
|
Harmon KK, Girts RM, Rodriguez G, Beausejour JP, Pagan JI, Carr JC, Garcia J, Roberts MD, Hahs‐Vaughn DL, Stout JR, Fukuda DH, Stock MS. Combined action observation and mental imagery versus neuromuscular electrical stimulation as novel therapeutics during short-term knee immobilization. Exp Physiol 2024; 109:1145-1162. [PMID: 38687158 PMCID: PMC11215482 DOI: 10.1113/ep091827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
Limb immobilization causes rapid declines in muscle strength and mass. Given the role of the nervous system in immobilization-induced weakness, targeted interventions may be able to preserve muscle strength, but not mass, and vice versa. The purpose of this study was to assess the effects of two distinct interventions during 1 week of knee joint immobilization on muscle strength (isometric and concentric isokinetic peak torque), mass (bioimpedance spectroscopy and ultrasonography), and neuromuscular function (transcranial magnetic stimulation and interpolated twitch technique). Thirty-nine healthy, college-aged adults (21 males, 18 females) were randomized into one of four groups: immobilization only (n = 9), immobilization + action observation/mental imagery (AOMI) (n = 10), immobilization + neuromuscular electrical stimulation (NMES) (n = 12), or control group (n = 8). The AOMI group performed daily video observation and mental imagery of knee extensions. The NMES group performed twice daily stimulation of the quadriceps femoris. Based on observed effect sizes, it appears that AOMI shows promise as a means of preserving voluntary strength, which may be modulated by neural adaptations. Strength increased from PRE to POST in the AOMI group, with +7.2% (Cohen's d = 1.018) increase in concentric isokinetic peak torque at 30°/s. However, NMES did not preserve muscle mass. Though preliminary, our findings highlight the specific nature of clinical interventions and suggest that muscle strength can be independently targeted during rehabilitation. This study was prospectively registered: ClinicalTrials.gov NCT05072652.
Collapse
Affiliation(s)
- Kylie K. Harmon
- Department of Exercise ScienceSyracuse UniversitySyracuseNew YorkUSA
| | - Ryan M. Girts
- Department of Natural and Health SciencesPfeiffer UniversityMisenheimerNorth CarolinaUSA
| | - Gabriela Rodriguez
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Jonathan P. Beausejour
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Jason I. Pagan
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Joshua C. Carr
- Department of KinesiologyTexas Christian UniversityFort WorthTexasUSA
- Department of Medical EducationAnne Burnett Marion School of Medicine at Texas Christian UniversityFort WorthTexasUSA
| | - Jeanette Garcia
- School of Sport SciencesWest Virginia UniversityMorgantownWest VirginiaUSA
| | | | - Debbie L. Hahs‐Vaughn
- Department of Learning Sciences and Educational ResearchUniversity of Central FloridaOrlandoFloridaUSA
| | - Jeffrey R. Stout
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - David H. Fukuda
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Matt S. Stock
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| |
Collapse
|
2
|
Girts RM, Harmon KK, Rodriguez G, Beausejour JP, Pagan JI, Carr JC, Garcia J, Stout JR, Fukuda DH, Stock MS. Sex differences in muscle-quality recovery following one week of knee joint immobilization and subsequent retraining. Appl Physiol Nutr Metab 2024; 49:805-817. [PMID: 38382056 DOI: 10.1139/apnm-2023-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
This manuscript represents the second phase of a clinical trial designed to examine the effects of knee joint immobilization and retraining on muscle strength and mass. In Phase 2, we examined sex differences in the recovery of multiple indices of muscle quality after a resistance training-based rehabilitation program. Following 1 week of immobilization, 27 participants (16 males, 11 females) exhibiting weakness underwent twice weekly resistance training sessions designed to re-strengthen their left knee. Unilateral retraining sessions utilizing leg press, extension, and curl exercises were conducted until participants could reproduce their pre-immobilization knee extension isometric maximal voluntary contraction (MVC) peak torque. Post-immobilization, both sexes demonstrated impaired MVC peak torque (males = -10.8%, females = -15.2%), specific torque (-9.8% vs. -13.1%), echo intensity of the vastus lateralis (+6.9% vs. +5.9%) and rectus femoris (+5.9% vs. +2.1), and extracellular water/intracellular water ratio (+7.8% vs. +9.0%). The number of retraining sessions for peak torque to return to baseline for males (median = 1, mean = 2.13) versus females (median = 2, mean = 2.91) was not significantly different, though the disparity in recovery times may be clinically relevant. Following retraining, specific torque was the only muscle-quality indicator that improved along with MVC peak torque (males = 20.1%, females = 22.4%). Our findings indicate that measures of muscle quality demonstrate divergent recovery rates following immobilization, with muscle mass lagging behind improvements in strength. Greater immobilization-induced strength loss among females suggests that sex-specific rehabilitation efforts may be justified.
Collapse
Affiliation(s)
- Ryan M Girts
- Department of Natural and Health Sciences, Pfeiffer University, Misenheimer, NC, USA
| | - Kylie K Harmon
- Department of Exercise ScienceSyracuse University, Syracuse, NY, USA
| | - Gabriela Rodriguez
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Jonathan P Beausejour
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Jason I Pagan
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Joshua C Carr
- Department of Kinesiology, Texas Christian University, Fort Worth, TX, USA
- Department of Medical Education, Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, TX, USA
| | - Jeanette Garcia
- School of Sport Sciences West Virginia University, Morgantown, WV, USA
| | - Jeffrey R Stout
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - David H Fukuda
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Matt S Stock
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
3
|
MacLennan RJ, Ogilvie D, McDorman J, Vargas E, Grusky AR, Kim Y, Garcia JM, Stock MS. The time course of neuromuscular impairment during short-term disuse in young women. Physiol Rep 2021; 9:e14677. [PMID: 33426809 PMCID: PMC7797948 DOI: 10.14814/phy2.14677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 12/27/2022] Open
Abstract
Skeletal muscle disuse results in rapid functional declines. Previous studies have typically been at least 1 week in duration and focused on the responsiveness of men. Herein, we report the timeline of initial impairments in strength, voluntary activation (VA), and motor unit control during 2 weeks of knee joint immobilization. Thirteen women (mean age =21 years) underwent 2 weeks of left knee joint immobilization via ambulation on crutches and use of a brace. Participants visited the laboratory for testing on seven occasions (two familiarization visits, pretest, 48 and 72 h, 1 and 2 weeks). Knee extensor isometric and concentric isokinetic strength at two velocities (180 and 360 degrees⋅s-1 ), VA, and submaximal vastus lateralis motor unit activity were evaluated. Moderate-to-large decreases in isometric and concentric strength at 180 degrees⋅s-1 and VA were observed within 48 hours. Isometric strength continued to decline beyond 72 h, whereas other variables plateaued. The B-term of the motor unit mean firing rate versus action potential amplitude relationship demonstrated a moderate increase 1 week into immobilization, suggesting that greater firing rates were necessary to maintain pretest torque levels. Concentric strength at a velocity of 360 degrees s-1 was not affected. Decreases in knee extensor strength occur within a matter of days after immobilization, although the time course and magnitude vary among assessment methods. These changes are mediated by the nervous system's capacity to activate skeletal muscle. Clinically appropriate interventions which target nervous system plasticity should be implemented early to minimize the rapid functional impairments associated with disuse.
Collapse
Affiliation(s)
- Rob J MacLennan
- Applied Neuromuscular Physiology Laboratory, Oklahoma State University, Stillwater, OK, USA
| | - David Ogilvie
- School of Kinesiology & Physical Therapy, University of Central Florida, Orlando, FL, USA.,Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - John McDorman
- School of Kinesiology & Physical Therapy, University of Central Florida, Orlando, FL, USA.,Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Ernest Vargas
- School of Kinesiology & Physical Therapy, University of Central Florida, Orlando, FL, USA.,Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Arielle R Grusky
- School of Kinesiology & Physical Therapy, University of Central Florida, Orlando, FL, USA.,Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeanette M Garcia
- Department of Health Sciences, University of Central Florida, Orlando, FL, USA
| | - Matt S Stock
- School of Kinesiology & Physical Therapy, University of Central Florida, Orlando, FL, USA.,Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
4
|
Abstract
BACKGROUND Muscle strength loss following immobilisation has been predominantly attributed to rapid muscle atrophy. However, this cannot fully explain the magnitude of muscle strength loss, so changes in neuromuscular function (NMF) may be involved. OBJECTIVES We systematically reviewed literature that quantified changes in muscle strength, size and NMF following periods of limb immobilisation in vivo in humans. METHODS Studies were identified following systematic searches, assessed for inclusion, data extracted and quality appraised by two reviewers. Data were tabulated and reported narratively. RESULTS Forty eligible studies were included, 22 immobilised lower and 18 immobilised upper limbs. Limb immobilisation ranged from 12 h to 56 days. Isometric muscle strength and muscle size declined following immobilisation; however, change magnitude was greater for strength than size. Evoked resting twitch force decreased for lower but increased for upper limbs. Rate of force development either remained unchanged or slowed for lower and typically slowed for upper limbs. Twitch relaxation rate slowed for both lower and upper limbs. Central motor drive typically decreased for both locations, while electromyography amplitude during maximum voluntary contractions decreased for the lower and presented mixed findings for the upper limbs. Trends imply faster rates of NMF loss relative to size earlier in immobilisation periods for all outcomes. CONCLUSIONS Limb immobilisation results in non-uniform loss of isometric muscle strength, size and NMF over time. Different outcomes between upper and lower limbs could be attributed to higher degrees of central neural control of upper limb musculature. Future research should focus on muscle function losses and mechanisms following acute immobilisation. REGISTRATION PROSPERO reference: CRD42016033692.
Collapse
|
5
|
Deschenes MR, McCoy RW, Mangis KA. Chronic Resistance Training Does Not Ameliorate Unloading-Induced Decrements in Neuromuscular Function. Am J Phys Med Rehabil 2017; 96:549-556. [DOI: 10.1097/phm.0000000000000681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Snow R, Granata J, Ruhil AVS, Vogel K, McShane M, Wasielewski R. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. J Bone Joint Surg Am 2014; 96:e165. [PMID: 25274793 DOI: 10.2106/jbjs.m.01285] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. METHODS Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. RESULTS The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). CONCLUSIONS The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care services. This association was sustained after adjusting for comorbidities, demographic characteristics, and procedural variables. CLINICAL RELEVANCE Health-care providers can use this methodology to achieve an integrative, cost-effective, patient care pathway using preoperative physical therapy.
Collapse
Affiliation(s)
- Richard Snow
- OhioHealth, 155 East Broad Street, 18th Floor, Columbus, OH 43215. E-mail address for R. Snow: . E-mail address for K. Vogel:
| | - Jaymes Granata
- Orthopedic Foot and Ankle Center, 300 Polaris Parkway, Suite 2000, Westerville, OH 43082. E-mail address:
| | - Anirudh V S Ruhil
- Ohio University, The Voinovich School of Leadership and Public Affairs, Building 21, Room 115, 1 Ohio University, Athens, OH 45701-2979. E-mail address:
| | - Karen Vogel
- OhioHealth, 155 East Broad Street, 18th Floor, Columbus, OH 43215. E-mail address for R. Snow: . E-mail address for K. Vogel:
| | - Michael McShane
- Ohio Orthopedic Center of Excellence, 4605 Sawmill Road, Upper Arlington, OH 43220. E-mail address:
| | - Ray Wasielewski
- Minimally Invasive Orthopedics, 340 East Town Street, Suite 7-250, Columbus, OH 43215. E-mail address:
| |
Collapse
|
7
|
Deschenes MR, McCoy RW, Mangis KA. Factors relating to gender specificity of unloading-induced declines in strength. Muscle Nerve 2012; 46:210-7. [PMID: 22806370 DOI: 10.1002/mus.23289] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This investigation aimed to: (1) confirm whether women were more vulnerable to the negative neuromuscular adaptations elicited by muscle unloading and if so, (2) determine which physiological mechanism(s) explain those gender-related differences. METHODS Healthy young men (20.7 ± 0.3 years) and women (20.3 ± 0.3 years)-(N = 12/group)-participated by completing neuromuscular functional tests before and after 7 days of unloading. RESULTS During isokinetic testing of peak torque, work performed, and power, women displayed significantly (P ≤ 0.05) greater declines in performance than men at 1.05 and 2.09, but not 0.53 rads/s. During maximal isometric contractions, women experienced greater strength decrements. Similar gender-specific adaptations to unloading were found in EMG activity, but not muscle mass, neuromuscular transmission, or force relative to EMG. CONCLUSIONS Women are more susceptible to the adaptations of muscle unloading, and disturbances in neural drive from the central nervous system are probably responsible.
Collapse
Affiliation(s)
- Michael R Deschenes
- Department of Kinesiology & Health Sciences, The College of William & Mary, Williamsburg, Virginia 23187-8795, USA.
| | | | | |
Collapse
|