Neural Drive Impairment in Chronic Kidney Disease Patients Is Associated with Neuromuscular Fatigability and Fatigue

INTRODUCTION

Chronic kidney disease (CKD) patients have a high degree of fatigue relating to neuromuscular symptoms. There is a lack of evidence regarding the etiology of neuromuscular fatigability in elderly CKD patients.

METHODS

Inclusion criteria are as follows: age ≥60 yr, glomerular filtration rate (GFR) <45 mL·min -1 per 1.73 m 2 in CKD patients, and GFR >60 mL·min -1 ·1.73 m -2 in controls. The fatigability protocol consisted in a submaximal handgrip task at 40% peak force. Fatigue was assessed using the Multidimensional Fatigue Inventory-20 items (MFI-20) and the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaires. Peak rate of force development (RFD peak , normalized: NRFD peak ) and rate of EMG rise (RER) were measured during explosive contractions; peak force and mean surface EMG were measured during maximum voluntary contractions. Multilevel models tested neuromuscular parameters adjusted for clinical and Multidimensional Fatigue Inventory-20 items subscales. Neuromuscular fatigability contribution to fatigue description was tested using model comparison.

RESULTS

The study included 102 participants; 45 CKD patients and 57 controls. CKD mainly affected the mental and the reduced motivation subscales of fatigue. CKD was associated with greater neuromuscular fatigability assessed using NRFD peak (group-time interaction, -16.7 % MVF·s -1 , P = 0.024), which increased with fatigue severity ( P = 0.018) and with a higher rate of decrement in RER compared with controls (RER at 50 ms: β = -121.2 μV·s -1 , P = 0.016, and β = -48.5 μV·s -1 , P = 0.196, respectively). Furthermore, these patients show an association between the reduced motivation subscale and the RER (e.g., 30 ms: β = -59.8% EMG peak ·s -1 , P < 0.001). Only peak force fatigability contributed to fatigue variance, whereas RFD peak did not.

CONCLUSIONS

In CKD patients, the neuromuscular fatigability assessed using RFD peak is related to an impairment in motor-unit recruitment or discharge rates, whereas only peak force fatigability was related to fatigue. This suggests that targeting exercise interventions might lessen fatigue and improve quality of life in CKD patients.

Cross-sectional Study of EMG and EMG Rise During Fast and Slow Hamstring Exercises

BACKGROUND

Hamstring injuries remain a major burden in football while the effective prevention exercise the Nordic Hamstring is poorly adopted, despite the added positive effects on performance. Better understanding of hamstring function during Nordic Hamstring compared to other exercises may provide better insight to the physiological adaptations of different types of hamstring curls.

PURPOSE

This cross-sectional study therefore aimed to compare the Nordic Hamstring curl with a conventional prone Leg Curl at different loads, and novel high velocity Hamstring Catches; in terms of peak normalized electromyographical activity (nEMG) and rate of electromyographic rise (RER) of Biceps Femoris long head, and angular velocity of the knee.

STUDY DESIGN

Cross-sectional study.

METHODS

Out of 28 participants enrolled, the final sample included 23 recreationally active male participants who attended a session for determining RM (repetition maximum) to establish loading (8 and 16RM for Hamstring Catches, and 8, 16 and 24RM for Leg Curl) and to familiarize themselves with the three different exercises (Nordic Hamstring, Leg Curl and Hamstring Catch), and a testing session >4 days after during which EMG data were collected during 3 repetitions of each exercise performed in a random order.

RESULTS

The Nordic Hamstring evoked higher RER (1091.8 nEMG/s) than Hamstring Catches (mean difference: 421 nEMG/s, p<0.0001) and Leg Curl (mean difference: 705 nEMG/s, p<0.001), and at the earliest numerical timepoint from onset of muscle contraction (the Nordic Hamstring: 6 ms; Hamstring Catches: 36-41 ms; Leg Curl: 12-14 ms). Hamstring Catches displayed high peak angular velocity (mean: 471°/s). There was no difference in peak nEMG, irrespective of load for Leg Curl (8, 16 or 24RM) or Hamstring Catches (8- or 16RM).

CONCLUSION

The Nordic Hamstring displayed the highest level muscle activity and most explosive recruitment characteristics with early and high rate of electromyographic rise, compared to even high velocity exercises, thus providing a possible mechanism by which it may increase performance and reduce injuries.

LEVELS OF EVIDENCE

3.

WHAT IS KNOWN ABOUT THE SUBJECT

Early phase force and muscle recruitment have been linked to both performance and hamstring-related inhibition and fatiguability. However, the potential for different hamstring exercises to elicit explosive recruitment is unknown.

WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE

Early phase recruitment was higher and faster during the Nordic Hamstring exercise compared with conventional hamstring Leg Curl exercises with different loads and a high-velocity hamstring exercise.

CLINICAL RELEVANCE

The surprisingly fast and explosive recruitment characteristics during the Nordic Hamstring exercise suggests the possibility that this exercise have the potential to improve the rate of force development and perhaps counter the effects of hamstring-related inhibition and fatigue.

Age-related changes in the rate of muscle activation and rapid force characteristics

Declines in muscle size and strength are commonly reported as a consequence of aging; however, few studies have investigated the influence of aging on the rate of muscle activation and rapid force characteristics across the lifespan. This study aims to investigate the effects of aging on the rate of muscle activation and rapid force characteristics of the plantar flexors. Plantar flexion peak force (PF), absolute (peak, 50, and 100-200 ms), and relative (10 %, 30 %, and 50 %) rate of force development (RFD), the rapid to maximal force ratio (RFD/PF), and the rate of electromyography rise (RER) were examined during an isometric maximal voluntary contraction (MVC) in young (age = 22 ± 2 years), middle-aged (43 ± 2 years), and old (69 ± 5 years) men. The old men exhibited lower PF (30.7 % and 27.6 % lower, respectively) and absolute (24.4-55.1 %) and relative (16.4-28.9 %) RFD values compared to the young and middle-aged men (P ≤ 0.03). RER values were similar between the young and old men (P ≥ 0.30); however, RER values were greater for the middle-aged men when compared to the young and old men for the soleus (P < 0.01) and the old men for the medial gastrocnemius (P ≤ 0.02). Likewise, RFD/PF ratios were similar between young and old men (P ≥ 0.26); however, these ratios were greater for the middle-aged men at early (P ≤ 0.03), but not later (P ≥ 0.10), time intervals. The lower PF and absolute and relative RFD values for the old men may contribute to the increased functional limitations often observed in older adults. Interestingly, higher rates of muscle activation and greater early RFD/PF ratios in middle-aged men may be a reflection of physiological alterations in the neuromuscular system occurring in the fifth decade.