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Sousa MV, Goethel M, Becker KM, Diefenthaeler F, Fernandes RJ, de Santana Toro Batista I, Vilas-Boas JP, Ervilha U. Effect of experimentally induced muscle pain on neuromuscular control of force production. Hum Mov Sci 2024; 95:103219. [PMID: 38636393 DOI: 10.1016/j.humov.2024.103219] [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] [Received: 01/04/2024] [Revised: 03/20/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Neural and peripheral effects of induced muscle pain on explosive force production were investigated. METHODS Nine participants performed two maximal, six explosive, and six electrical stimulations induced (twitches and octets) isometric knee extensions before and after (15 min of rest) receiving an intramuscular injection of hypertonic saline (pain inducer) or isotonic (placebo) infusions in two laboratory visits separated by 7 days. RESULTS It was observed a reduction of peak torque production in maximal voluntary contraction in both conditions (9.3 and 3.3% for pain and placebo, respectively) and in the rate of torque development in placebo (7%). There was an increase in the rate of torque development for twitch and octets (10.5 and 15.8%, respectively) in the pain condition and peak torque for twitch (12%) in both conditions (as did the total rate of torque development for octets). CONCLUSION Force production decreases and increases during voluntary and involuntary contractions, respectively, suggesting that acute pain impairs force production via central mechanisms.
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Affiliation(s)
- Manoela Vieira Sousa
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal.
| | - Márcio Goethel
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Klaus M Becker
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Fernando Diefenthaeler
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Ricardo J Fernandes
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Isabella de Santana Toro Batista
- Laboratory of Physical Activity Sciences, School of Arts, Sciences, and Humanities, University of São Paulo, 03828-000 São Paulo, Brazil
| | - João Paulo Vilas-Boas
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Ulysses Ervilha
- Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal; Laboratory of Physical Activity Sciences, School of Arts, Sciences, and Humanities, University of São Paulo, 03828-000 São Paulo, Brazil
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Dutra YM, Lopes JPF, Murias JM, Zagatto AM. Within- and between-day reliability and repeatability of neuromuscular function assessment in females and males. J Appl Physiol (1985) 2023; 135:1372-1383. [PMID: 37916269 DOI: 10.1152/japplphysiol.00539.2023] [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: 08/03/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/03/2023] Open
Abstract
The study evaluated the reliability and repeatability of the force and surface electromyography activity (EMG) outcomes obtained through voluntary and electrically evoked contractions of knee extensors in females (n = 18) and males (n = 20) and compared these data between sexes. Maximal isometric voluntary contractions (iMVCs) of knee extensors associated with electrical stimulation of the femoral nerve were performed over 4 days (48-h interval), with the first day involving familiarization procedures, the second involving three trials (1-h interval), and the third and fourth involving just one trial. The intraclass correlation coefficient (ICC), coefficient of variation (CV), and repeatability of outcomes from within- and between-day trials were determined for each sex. Females presented lower maximal voluntary force during iMVC (iMVCForce) and associated vastus lateralis EMG activity (root mean square, RMSVL), force evoked by potentiated doublet high-frequency (Db100Force) and single stimuli (Qtw), and M-wave amplitude than males (P ≤ 0.01, partial eta squared ≥0.94). Voluntary activation (VA) and RMSVL/M-wave amplitude did not differ between sexes. iMVCForce, VA, Db100Force, Qtw, and M-wave amplitude were the most reliable outcomes in within-day trials, with similar results between sexes (ICC > 0.62; CV < 6.4%; repeatability: 12.2%-22.6%). When investigating between-day trials, the iMVCForce, VA, Db100Force, and Qtw were the most reliable (ICC > 0.66; CV < 7.5%; repeatability: 13.2%-33.45%) with similar results between sexes. In conclusion, females presented lower iMVCForce and evoked response than males. Although reliability and repeatability statistics vary between trials, data (e.g., from EMG or force signal), and sexes, most of the outcomes obtained through this technique are reliable in females and males.NEW & NOTEWORTHY Although reliability and repeatability of knee extensors vary according to the type of neuromuscular function outcome (e.g., from force or EMG responses), the trial intervals (i.e., hours or days), and the sex of the participant, most force and EMG outcomes obtained through these neuromuscular assessment protocols present ICC > 0.75, very good CV (<10%), and repeatability <25% in within- and between-day trials in both sexes.
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Affiliation(s)
- Yago Medeiros Dutra
- Department of Physical Education, Laboratory of Physiology and Sport Performance (LAFIDE), School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - João Pedro Fialho Lopes
- Department of Physical Education, Laboratory of Physiology and Sport Performance (LAFIDE), School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Juan M Murias
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Alessandro Moura Zagatto
- Department of Physical Education, Laboratory of Physiology and Sport Performance (LAFIDE), School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
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Santos PDG, Vaz JR, Correia J, Neto T, Pezarat-Correia P. Long-Term Neurophysiological Adaptations to Strength Training: A Systematic Review With Cross-Sectional Studies. J Strength Cond Res 2023; 37:2091-2105. [PMID: 37369087 DOI: 10.1519/jsc.0000000000004543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Santos, PDG, Vaz, JR, Correia, J, Neto, T, and Pezarat-Correia, P. Long-term neurophysiological adaptations to strength training: a systematic review with cross-sectional studies. J Strength Cond Res 37(10): 2091-2105, 2023-Neuromuscular adaptations to strength training are an extensively studied topic in sports sciences. However, there is scarce information about how neural mechanisms during force production differ between trained and untrained individuals. The purpose of this systematic review is to better understand the differences between highly trained and untrained individuals to establish the long-term neural adaptations to strength training. Three databases were used for the article search (PubMed, Web of Science, and Scopus). Studies were included if they compared groups of resistance-trained with untrained people, aged 18-40 year, and acquired electromyography (EMG) signals during strength tasks. Twenty articles met the eligibility criteria. Generally, strength-trained individuals produced greater maximal voluntary activation, while reducing muscle activity in submaximal tasks, which may affect the acute response to strength training. These individuals also presented lower co-contraction of the antagonist muscles, although it depends on the specific training background. Global intermuscular coordination may be another important mechanism of adaptation in response to long-term strength training; however, further research is necessary to understand how it develops over time. Although these results should be carefully interpreted because of the great disparity of analyzed variables and methods of EMG processing, chronic neural adaptations seem to be decisive to greater force production. It is crucial to know the timings at which these adaptations stagnate and need to be stimulated with advanced training methods. Thus, training programs should be adapted to training status because the same stimulus in different training stages will lead to different responses.
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Affiliation(s)
- Paulo D G Santos
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
| | - João R Vaz
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
- CIPER, Faculty of Human Kinetics, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Monte da Caparica, Portugal; and
| | - Joana Correia
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
| | - Tiago Neto
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Pedro Pezarat-Correia
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
- CIPER, Faculty of Human Kinetics, Lisbon, Portugal
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Romare M, Elcadi GH, Johansson E, Tsaklis P. Relative Neuroadaptive Effect of Resistance Training along the Descending Neuroaxis in Older Adults. Brain Sci 2023; 13:brainsci13040679. [PMID: 37190644 DOI: 10.3390/brainsci13040679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/01/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Age-related decline in voluntary force production represents one of the main contributors to the onset of physical disability in older adults and is argued to stem from adverse musculoskeletal alterations and changes along the descending neuroaxis. The neural contribution of the above is possibly indicated by disproportionate losses in voluntary activation (VA) compared to muscle mass. For young adults, resistance training (RT) induces muscular and neural adaptations over several levels of the central nervous system, contributing to increased physical performance. However, less is known about the relative neuroadaptive contribution of RT in older adults. The aim of this review was to outline the current state of the literature regarding where and to what extent neural adaptations occur along the descending neuroaxis in response to RT in older adults. We performed a literature search in PubMed, Google Scholar and Scopus. A total of 63 articles met the primary inclusion criteria and following quality analysis (PEDro) 23 articles were included. Overall, neuroadaptations in older adults seemingly favor top-down adaptations, where the preceding changes of neural drive from superior levels affect the neural output of lower levels, following RT. Moreover, older adults appear more predisposed to neural rather than morphological adaptations compared to young adults, a potentially important implication for the improved maintenance of neuromuscular function during aging.
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Affiliation(s)
- Mattias Romare
- ErgoMech-Lab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
| | - Guilherme H Elcadi
- ErgoMech-Lab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, 14157 Huddinge, Sweden
| | - Elin Johansson
- Pain in Motion Research Group, Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, PC 1050 Brussel, Belgium
| | - Panagiotis Tsaklis
- ErgoMech-Lab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
- Centre of Orthopaedics and Regenerative Medicine, C.O.R.E.-C.I.R.I., Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
- Department of Molecular Medicine and Surgery, Karolinska Institute, SE-171 76 Solna, Sweden
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5
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Mackay-Phillips K, Orssatto LBR, Polman R, Van der Pols JC, Trajano GS. Effects of α-lactalbumin on strength, fatigue and psychological parameters: a randomised double-blind cross-over study. Eur J Appl Physiol 2023; 123:381-393. [PMID: 36443490 DOI: 10.1007/s00421-022-05103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The neurotransmitter serotonin has a strong effect on behaviour and motor control. Regarding motor control, serotonin contributes to the development of fatigue and is also involved in the ability of motor neurones to operate across a large range of forces (gain control). The consumption of tryptophan-rich supplements (such as α-lactalbumin) is of interest because this amino acid is the only precursor for brain serotonin synthesis. Therefore, the purpose of this study was to determine the effects of α-lactalbumin supplementation on neuromuscular performance. METHODS Using a randomised double-blind cross-over design, 16 healthy participants performed plantar flexor and handgrip maximal voluntary contractions, a 30-s submaximal handgrip contraction, and a plantar flexor fatigue protocol before and 90 min after consuming either 40 g of α-lactalbumin, an isonitrogenous beverage (Zein) or an isocaloric beverage (corn-starch). Sleepiness, mood, and cognition were assessed to evaluate any psychological effects. RESULTS α-Lactalbumin decreased force steadiness by 25% during the sustained submaximal handgrip contraction (p < 0.01) and induced greater fatigue (15% reduction in total torque-time integral, p = 0.01) during the fatigue protocol. These effects were not observed for the other control beverages. No effects were found for maximal or explosive strength, or psychological measurements. CONCLUSIONS 40 g of α-lactalbumin increased handgrip force variability and reduced performance during fatiguing muscle contractions but did not influence brief maximal contractions or psychological parameters in healthy individuals. These findings support the hypothesis that the consumption of α-lactalbumin can increase motor neurone input-output gain and exacerbate central fatigue during sustained maximal exercise.
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Affiliation(s)
- Karen Mackay-Phillips
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, 149 Victoria Park Rd, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Lucas B R Orssatto
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, 149 Victoria Park Rd, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Remco Polman
- Institute of Health and Wellbeing, Federation University, Berwick, Australia
| | - Jolieke C Van der Pols
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, 149 Victoria Park Rd, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, 149 Victoria Park Rd, Kelvin Grove, Brisbane, QLD, 4059, Australia
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Orssatto LBR, Fernandes GL, Blazevich AJ, Trajano GS. Facilitation-inhibition control of motor neuronal persistent inward currents in young and older adults. J Physiol 2022; 600:5101-5117. [PMID: 36284446 PMCID: PMC10092053 DOI: 10.1113/jp283708] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/07/2022] [Indexed: 01/05/2023] Open
Abstract
A well-coordinated facilitation-inhibition control of motor neuronal persistent inward currents (PICs) via diffuse neuromodulation and local inhibition is essential to ensure motor units discharge at required times and frequencies. Present best estimates indicate that PICs are reduced in older adults; however, it is not yet known whether PIC facilitation-inhibition control is also altered with ageing. We investigated the responses of PICs to (i) a remote handgrip contraction, which is believed to diffusely increase serotonergic input onto motor neurones, and (ii) tendon vibration of the antagonist muscle, which elicits reciprocal inhibition, in young and older adults. High-density surface electromyograms were collected from soleus and tibialis anterior of 18 young and 26 older adults during triangular-shaped plantar and dorsiflexion contractions to 20% (handgrip experiments) and 30% (vibration experiments) of maximum torque (rise-decline rate of 2%/s). A paired-motor-unit analysis was used to calculate ∆F, which is assumed to be proportional to PIC strength. ΔF increased in both soleus (0.55 peaks per second (pps), 16.0%) and tibialis anterior (0.42 pps, 11.4%) after the handgrip contraction independent of age. Although antagonist tendon vibration reduced ΔF in soleus (0.28 pps, 12.6%) independent of age, less reduction was observed in older (0.42 pps, 10.7%) than young adults (0.72 pps, 17.8%) in tibialis anterior. Our data indicate a preserved ability of older adults to amplify PICs following a remote handgrip contraction, during which increased serotonergic input onto the motor neurones is expected, in both lower leg muscles. However, PIC deactivation in response to reciprocal inhibition was impaired with ageing in tibialis anterior despite being preserved in soleus. KEY POINTS: Motor neuronal persistent inward currents (PICs) are facilitated via diffuse neuromodulation and deactivated by local inhibition to ensure motor units discharge at required times and frequencies, allowing normal motor behaviour. PIC amplitudes appear to be reduced with ageing; however, it is not known whether PIC facilitation-inhibition control is also altered. Remote handgrip contraction, which should diffusely increase serotonergic input onto motor neurones, facilitated PICs similarly in both soleus and tibialis anterior of young and older adults. Antagonist tendon vibration, which induces reciprocal inhibition, reduced PICs in soleus in both young and older adults but had less effect in tibialis anterior in older adults. Data from lower-threshold motor units during low-force contractions suggest that PIC facilitation is preserved with ageing in soleus and tibialis anterior. However, the effect of reciprocal inhibition on the contribution of PICs to motor neurone discharge seems reduced in tibialis anterior but preserved in soleus.
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Affiliation(s)
- Lucas B R Orssatto
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Gabriel L Fernandes
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - A J Blazevich
- School of Medical and Exercise Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
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Balshaw TG, Massey GJ, Maden-Wilkinson TM, Lanza MB, Folland JP. Effect of long-term maximum strength training on explosive strength, neural, and contractile properties. Scand J Med Sci Sports 2022; 32:685-697. [PMID: 34978747 PMCID: PMC9305549 DOI: 10.1111/sms.14120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/30/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
The purpose of this cross‐sectional study was to compare explosive strength and underpinning contractile, hypertrophic, and neuromuscular activation characteristics of long‐term maximum strength‐trained (LT‐MST; ie, ≥3 years of consistent, regular knee extensor training) and untrained individuals. Sixty‐three healthy young men (untrained [UNT] n = 49, and LT‐MST n = 14) performed isometric maximum and explosive voluntary, as well as evoked octet knee extension contractions. Torque, quadriceps, and hamstring surface EMG were recorded during all tasks. Quadriceps anatomical cross‐sectional area (QACSAMAX; via MRI) was also assessed. Maximum voluntary torque (MVT; +66%) and QACSAMAX (+54%) were greater for LT‐MST than UNT ([both] p < 0.001). Absolute explosive voluntary torque (25–150 ms after torque onset; +41 to +64%; [all] p < 0.001; 1.15≤ effect size [ES]≤2.36) and absolute evoked octet torque (50 ms after torque onset; +43, p < 0.001; ES = 3.07) were greater for LT‐MST than UNT. However, relative (to MVT) explosive voluntary torque was lower for LT‐MST than UNT from 100 to 150 ms after contraction onset (−11% to −16%; 0.001 ≤ p ≤ 0.002; 0.98 ≤ ES ≤ 1.11). Relative evoked octet torque 50 ms after onset was lower (−10%; p < 0.001; ES = 1.14) and octet time to peak torque longer (+8%; p = 0.001; ES = 1.18) for LT‐MST than UNT indicating slower contractile properties, independent from any differences in torque amplitude. The greater absolute explosive strength of the LT‐MST group was attributable to higher evoked explosive strength, that in turn appeared to be due to larger quadriceps muscle size, rather than any differences in neuromuscular activation. In contrast, the inferior relative explosive strength of LT‐MST appeared to be underpinned by slower intrinsic/evoked contractile properties.
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Affiliation(s)
- Thomas G Balshaw
- Versus Arthritis, Centre for Sport, Exercise and Osteoarthritis, Loughborough University, Leicestershire, UK.,School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UK
| | - Garry J Massey
- Versus Arthritis, Centre for Sport, Exercise and Osteoarthritis, Loughborough University, Leicestershire, UK.,School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UK.,School of Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Thomas M Maden-Wilkinson
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UK.,Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Collegiate Campus, Sheffield Hallam University, Sheffield, UK
| | - Marcel B Lanza
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UK.,Department of Physical Therapy and Rehabilitation, University of Maryland Baltimore, Baltimore, US
| | - Jonathan P Folland
- Versus Arthritis, Centre for Sport, Exercise and Osteoarthritis, Loughborough University, Leicestershire, UK.,School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UK
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Sakugawa RL, Orssatto LBR, Sampaio LT, de Brito Fontana H, Diefenthaeler F. Pressure on the electrode to reduce discomfort during neuromuscular electrical stimulation in individuals with different subcutaneous-fat thickness: is the procedure effective and reliable? IEEE Trans Neural Syst Rehabil Eng 2021; 30:1-7. [PMID: 34941513 DOI: 10.1109/tnsre.2021.3138202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The addition of manual pressure on the electrode during neuromuscular electrical stimulation (NMES) has been used to reduce current intensity and perceived discomfort. In this study we aimed to test i) whether this approach affect the reliability of commonly made torque output measurements and ii) whether subcutaneous-fat thickness influence the efficacy of this approach in reducing current intensity and perceived discomfort. Twenty-one men (24±3.1 years) performed knee extension maximal voluntary isometric contractions with and without manual pressure on the NMES femoral nerve electrode (superimposed and resting doublets, 2 pulses at 100 Hz) during two separate sessions. Torque output was measured in an isokinetic dynamometer and thigh subcutaneous-fat thickness assessed with ultrasonography. A scale of perceived discomfort was presented after contractions. Reductions in current intensity (p<0.001) and discomfort during superimposed doublet (p=0.002) and resting doublet (p=0.002) were confirmed for the condition in which pressure was applied to the electrode. Fat thickness was correlated to changes in current intensity (r=0.63; p=0.002) and changes in discomfort (r=0.45; p=0.04) and no differences between pressure conditions and testing sessions were observed for torque output (p>0.05; ICC 0.95). Adding manual pressure during NMES on femoral nerve reduces discomfort and the maximal NMES intensity required to reach maximum torque without affecting torque output magnitude and reliability. Greater reduction in intensity and discomfort were observed in participants with higher subcutaneous-fat thickness levels after adding pressure on the electrode.
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