The relationship between plasma potassium, muscle membrane excitability and force following quadriceps fatigue

A century of exercise physiology: effects of muscle contraction and exercise on skeletal muscle Na+,K+-ATPase, Na+ and K+ ions, and on plasma K+ concentration-historical developments

This historical review traces key discoveries regarding K+ and Na+ ions in skeletal muscle at rest and with exercise, including contents and concentrations, Na+,K+-ATPase (NKA) and exercise effects on plasma [K+] in humans. Following initial measures in 1896 of muscle contents in various species, including humans, electrical stimulation of animal muscle showed K+ loss and gains in Na+, Cl- and H20, then subsequently bidirectional muscle K+ and Na+ fluxes. After NKA discovery in 1957, methods were developed to quantify muscle NKA activity via rates of ATP hydrolysis, Na+/K+ radioisotope fluxes, [3H]-ouabain binding and phosphatase activity. Since then, it became clear that NKA plays a central role in Na+/K+ homeostasis and that NKA content and activity are regulated by muscle contractions and numerous hormones. During intense exercise in humans, muscle intracellular [K+] falls by 21 mM (range - 13 to - 39 mM), interstitial [K+] increases to 12-13 mM, and plasma [K+] rises to 6-8 mM, whilst post-exercise plasma [K+] falls rapidly, reflecting increased muscle NKA activity. Contractions were shown to increase NKA activity in proportion to activation frequency in animal intact muscle preparations. In human muscle, [3H]-ouabain-binding content fully quantifies NKA content, whilst the method mainly detects α2 isoforms in rats. Acute or chronic exercise affects human muscle K+, NKA content, activity, isoforms and phospholemman (FXYD1). Numerous hormones, pharmacological and dietary interventions, altered acid-base or redox states, exercise training and physical inactivity modulate plasma [K+] during exercise. Finally, historical research approaches largely excluded female participants and typically used very small sample sizes.

Six weeks of high-load resistance and low-load blood flow restricted training increase Na/K-ATPase sub-units α2 and β1 equally, but does not alter ClC-1 abundance in untrained human skeletal muscle

Contractile function of skeletal muscle relies on the ability of muscle fibers to trigger and propagate action potentials (APs). These electrical signals are created by transmembrane ion transport through ion channels and membrane transporter systems. In this regard, the Cl^- ion channel 1 (ClC-1) and the Na⁺/K^--ATPase (NKA) are central for maintaining ion homeostasis across the sarcolemma during intense contractile activity. Therefore, this randomized controlled trial aimed to investigate the changes in ClC-1 and specific NKA subunit isoform expression in response to six weeks (18 training sessions) of high-load resistance exercise (HLRE) and low-load blood flow restricted resistance exercise (BFRRE), respectively. HLRE was conducted as 4 sets of 12 repetitions of knee extensions performed at 70% of 1 repetition maximum (RM), while BFRRE was conducted as 4 sets of knee extensions at 30% of 1RM performed to volitional fatigue. Furthermore, the potential associations between protein expression and contractile performance were investigated. We show that muscle ClC-1 abundance was not affected by either exercise modality, whereas NKA subunit isoforms [Formula: see text]² and [Formula: see text]¹ increased equally by appx. 80-90% with BFRRE (p < 0.05) and 70-80% with HLRE (p < 0.05). No differential impact between exercise modalities was observed. At baseline, ClC-1 protein expression correlated inversely with dynamic knee extensor strength (r=-0.365, p = 0.04), whereas no correlation was observed between NKA subunit content and contractile performance at baseline. However, training-induced changes in NKA [Formula: see text]² subunit (r = 0.603, p < 0.01) and [Formula: see text]¹ subunit (r = 0.453, p < 0.05) correlated with exercise-induced changes in maximal voluntary contraction. These results suggest that the initial adaptation to resistance-based exercise does not involve changes in ClC-1 abundance in untrained skeletal muscle, and that increased content of NKA subunits may facilitate increases in maximal force production.

Muscle Ionic Shifts During Exercise: Implications for Fatigue and Exercise Performance

Exercise causes major shifts in multiple ions (e.g., K⁺ , Na⁺ , H⁺ , lactate^- , Ca²⁺ , and Cl^- ) during muscle activity that contributes to development of muscle fatigue. Sarcolemmal processes can be impaired by the trans-sarcolemmal rundown of ion gradients for K⁺ , Na⁺ , and Ca²⁺ during fatiguing exercise, while changes in gradients for Cl^- and Cl^- conductance may exert either protective or detrimental effects on fatigue. Myocellular H⁺ accumulation may also contribute to fatigue development by lowering glycolytic rate and has been shown to act synergistically with inorganic phosphate (Pi) to compromise cross-bridge function. In addition, sarcoplasmic reticulum Ca²⁺ release function is severely affected by fatiguing exercise. Skeletal muscle has a multitude of ion transport systems that counter exercise-related ionic shifts of which the Na⁺ /K⁺ -ATPase is of major importance. Metabolic perturbations occurring during exercise can exacerbate trans-sarcolemmal ionic shifts, in particular for K⁺ and Cl^- , respectively via metabolic regulation of the ATP-sensitive K⁺ channel (K_ATP ) and the chloride channel isoform 1 (ClC-1). Ion transport systems are highly adaptable to exercise training resulting in an enhanced ability to counter ionic disturbances to delay fatigue and improve exercise performance. In this article, we discuss (i) the ionic shifts occurring during exercise, (ii) the role of ion transport systems in skeletal muscle for ionic regulation, (iii) how ionic disturbances affect sarcolemmal processes and muscle fatigue, (iv) how metabolic perturbations exacerbate ionic shifts during exercise, and (v) how pharmacological manipulation and exercise training regulate ion transport systems to influence exercise performance in humans. © 2021 American Physiological Society. Compr Physiol 11:1895-1959, 2021.

Changes in contractile and metabolic parameters of skeletal muscle as rats age from 3 to 12 months

Laboratory rats are considered mature at 3 months despite that musculoskeletal growth is still occurring. Changes in muscle physiological and biochemical characteristics during development from 3 months, however, are not well understood. Whole muscles and single skinned fibres from fast-twitch extensor digitorum longus (EDL) and predominantly slow-twitch soleus (SOL) muscles were examined from male Sprague-Dawley rats (3, 6, 9, 12 months). Ca²⁺ sensitivity of contractile apparatus decreased with age in both fast- (~ 0.04 pCa units) and slow-twitch (~ 0.07 pCa units) muscle fibres, and specific force increased (by ~ 50% and ~ 25%, respectively). Myosin heavy chain composition of EDL and SOL muscles altered to a small extent with age (decrease in MHCIIa proportion after 3 months). Glycogen content increased with age (~ 80% in EDL and 25% in SOL) and GLUT4 protein density decreased (~ 35 and 20%, respectively), whereas the glycogen-related enzymes were little changed. GAPDH protein content was relatively constant in both muscle types, but COXIV protein decreased ~ 40% in SOL muscle. Calsequestrin (CSQ) and SERCA densities remained relatively constant with age, whereas there was a progressive ~ 2-3 fold increase in CSQ-like proteins, though their role and importance remain unclear. There was also ~ 40% decrease in the density of the Na⁺, K⁺-ATPase (NKA) α1 subunit in EDL and the α2 subunit in SOL. These findings emphasise there are substantial changes in skeletal muscle function and the density of key proteins during early to mid-adulthood in rats, which need to be considered in the design and interpretation of experiments.

Muscle and Limb Mechanics

Understanding of the musculoskeletal system has evolved from the collection of individual phenomena in highly selected experimental preparations under highly controlled and often unphysiological conditions. At the systems level, it is now possible to construct complete and reasonably accurate models of the kinetics and energetics of realistic muscles and to combine them to understand the dynamics of complete musculoskeletal systems performing natural behaviors. At the reductionist level, it is possible to relate most of the individual phenomena to the anatomical structures and biochemical processes that account for them. Two large challenges remain. At a systems level, neuroscience must now account for how the nervous system learns to exploit the many complex features that evolution has incorporated into muscle and limb mechanics. At a reductionist level, medicine must now account for the many forms of pathology and disability that arise from the many diseases and injuries to which this highly evolved system is inevitably prone. © 2017 American Physiological Society. Compr Physiol 7:429-462, 2017.

Renal tubular acidosis type 4 in pregnancy

We describe the clinical course of renal tubular acidosis (RTA) type 4 in pregnancy, which has not been previously published. Renal tubular acidosis type 4 is a condition associated with increased urinary ammonia secondary to hypoaldosteronism or pseudohypoaldosteronism. Pregnancy may worsen the hyperkalaemia and acidosis of renal tubular acidosis type 4, possibly through an antialdosterone effect. We advise regular monitoring of potassium and pH throughout pregnancy to ensure safe levels are maintained.

M-wave potentiation after voluntary contractions of different durations and intensities in the tibialis anterior

The study was undertaken to provide insight into the mechanisms underlying the potentiation of the muscle compound action potential (M wave) after conditioning contractions. M waves were evoked in the tibialis anterior before and after isometric maximal voluntary contractions (MVC) of 1, 3, 6, 10, 30, and 60 s, and after 3-s contractions at 10, 30, 50, 70, 90, and 100% MVC. The amplitude, duration, and area of the first and second phases of the M wave, together with the median frequency (Fmedian) and muscle fiber conduction velocity (MFCV) were recorded. Furthermore, twitch force, muscle fascicle length, and pennation angle were measured at rest, before, and 1 s after the conditioning contractions. The results indicate that only the amplitude of the second phase of the M wave was significantly increased after conditioning contractions. The extent of this potentiation was similar for MVC durations ranging from 1 to 10 s and augmented progressively with contraction intensity from 30 to 70% MVC. After these conditioning contractions, the duration and area of the two M-wave phases decreased ( P < 0.05), whereas MFCV and Fmedian increased ( P < 0.05). For all of these parameters, the greatest changes occurred 1 s after the conditioning contraction. Changes in MFCV after the contractions were correlated with those in M-wave second-phase amplitude ( r2 = 0.42; P < 0.05) and Fmedian ( r2 = 0.53; P < 0.05). In contrast, fascicle length and pennation angle did not change after the conditioning contractions. It is concluded that the potentiation of the second phase of the M wave is mainly due to an increased MFCV.

Twitch and M-wave potentiation induced by intermittent maximal voluntary quadriceps contractions: differences between direct quadriceps and femoral nerve stimulation

INTRODUCTION

The aim of this study was to investigate differences in twitch and M-wave potentiation in the quadriceps femoris when electrical stimulation is applied over the quadriceps muscle belly versus the femoral nerve trunk.

METHODS

M-waves and mechanical twitches were evoked using direct quadriceps muscle and femoral nerve stimulation between 48 successive isometric maximal voluntary contractions (MVC) from 10 young, healthy subjects. Potentiation was investigated by analyzing the changes in M-wave amplitude recorded from the vastus medialis (VM) and vastus lateralis (VL) muscles and in quadriceps peak twitch force.

RESULTS

Potentiation of twitch, VM M-wave, and VL M-wave were greater for femoral nerve than for direct quadriceps stimulation (P < 0.05). Despite a 50% decrease in MVC force, the amplitude of the M-waves increased significantly during exercise.

CONCLUSIONS

In addition to enhanced electrogenic Na(+) -K(+) pumping, other factors (such as synchronization in activation of muscle fibers and muscle architectural properties) may significantly influence the magnitude of M-wave enlargement.

Comparison of neuromuscular adjustments associated with sustained isometric contractions of four different muscle groups

The extent and characteristics of muscle fatigue of different muscle groups when subjected to a similar fatiguing task may differ. Thirteen healthy young men performed sustained contractions at 50% maximal voluntary contraction (MVC) force until task failure, with four different muscle groups, over two sessions. Per session, one upper limb and one lower limb muscle group were tested (knee extensors and thumb adductor, or plantar and elbow flexors). Changes in voluntary activation level and contractile properties were derived from doublet responses evoked during and after MVCs before and after exercise. Time to task failure differed ( P < 0.05) between muscle groups (220 ± 64 s for plantar flexors, 114 ± 27 s for thumb adductor, 77 ± 25 s for knee extensors, and 72 ± 14 s for elbow flexors). MVC force loss immediately after voluntary task failure was similar (−30 ± 11% for plantar flexors, −37 ± 13% for thumb adductor, −34 ± 15% for knee extensors, and −40 ± 12% for elbow flexors, P > 0.05). Voluntary activation was decreased for plantar flexors only (from 95 ± 5% to 82 ± 9%, P < 0.05). Potentiated evoked doublet amplitude was more depressed for upper limb muscles (−59.3 ± 14.7% for elbow flexors and −60.1 ± 24.1% for thumb adductor, P < 0.05) than for knee extensors (−28 ± 15%, P < 0.05); no reduction was found in plantar flexors (−7 ± 12%, P > 0.05). In conclusion, despite different times to task failure when sustaining an isometric contraction at 50% MVC force for as long as possible, diverse muscle groups present similar loss of MVC force after task failure. Thus the extent of muscle fatigue is not affected by time to task failure, whereas this latter determines the etiology of fatigue.

Mechanisms of fatigue and task failure induced by sustained submaximal contractions

PURPOSE

The present study was designed to investigate whether central neural mechanisms limit the duration of a sustained low-force isometric contraction and the maximal force-generating capacity of the knee extensors.

METHODS

Fourteen healthy males (28 ± 7 yr) were asked to sustain, until voluntary exhaustion, an isometric contraction with their right knee extensor muscles at a target force equal to 20% of their maximal voluntary contraction (MVC) force. At task failure, the muscle was immediately electrically stimulated for 1 min aiming the same target force (20% MVC force). Subsequently, subjects were asked to resume the voluntary contraction for as long as possible. Knee extensor neuromuscular function was assessed before and after the entire protocol for comparison.

RESULTS

When electrically stimulated at the point of task failure, all subjects developed the 20% MVC force target, indicating that lack of force-generating capacity from peripheral impairment had not limited the duration of the first task. We observed a reduction in MVC force after the entire protocol (-57% ± 12%), which correlated with a decrease in potentiated peak doublet force (-48% ± 17%, P < 0.001). The level of voluntary activation, as quantified with the interpolated twitch technique, was slightly depressed after the entire protocol (from 93% ± 7% to 87% ± 10%, P < 0.01).

CONCLUSIONS

It follows that task failure from a sustained isometric contraction is mainly affected by central/motivational factors, whereas MVC force loss is largely explained by the extent of contractile failure of the muscle.

Neuromuscular fatigue in healthy muscle: underlying factors and adaptation mechanisms

OBJECTIVES

This review aims to define the concept of neuromuscular fatigue and to present the current knowledge of the central and peripheral factors at the origin of this phenomenon. This review also addresses the literature that focuses on the mechanisms responsible for the adaption to neuromuscular fatigue.

METHOD

One hundred and eighty-two articles indexed in PubMed (1954-2010) have been considered.

RESULTS

Neuromuscular fatigue has central and peripheral origins. Central fatigue, preponderant during long-duration, low-intensity exercises, may involve a drop in the central command (motor, cortex, motoneurons) elicited by the activity of cerebral neurotransmitters and muscular afferent fibers. Peripheral fatigue, associated with an impairment of the mechanisms from excitation to muscle contraction, may be induced by a perturbation of the calcium ion movements, an accumulation of phosphate, and/or a decrease of the adenosine triphosphate stores. To compensate for the consequent drop in force production, the organism develops several adaptation mechanisms notably implicating motor units.

CONCLUSION

Fatigue onset is associated with an alteration of the mechanisms involved in force production. Then, the interaction between central and peripheral mechanisms leads to a series of events that ultimately contribute to the observed decrease in force production.

Influence of activity-induced axonal hypoexcitability on transmission of descending and segmental signals

In this experiment, the changes in excitability of motor axons produced after natural activity were measured in nine healthy subjects using 1 min of maximal voluntary contractions (MVC) of the abductor digiti minimi (ADM) by studying the relationship between stimulus intensity applied to the ulnar nerve and the size of the ADM compound muscle action potential (CMAP). On cessation of the contraction, there was a prominent right-shift of the input-output curve: the intensity required to produce a control CMAP approximately 60% of maximum, generated a post-contraction response approximately 25% of maximum. Similar changes occurred in the input-output curves obtained by recording the ulnar nerve volley evoked by same test stimulus for CMAP. Motor-evoked potential (MEP) and F-waves (and H-reflex in one subject) were recorded from ADM before and after 1 min of MVC. On cessation of contraction, the MEP input-output curves exhibited a significant right-shift: the stimulus required to evoke a pre-contraction maximum MEP ( approximately 60% of maximum CMAP) generated a post-contraction response approximately 65% of initial values. One minute of MVC produced similar decreases of F ( approximately 35%)- and H ( approximately 30%)-ADM responses. All responses recovered their control value in 15-20 min after the end of contraction. The almost identical depressive effect produced by 1 min of MVC on peripherally and centrally generated muscle responses suggests a common conditioning factor. These findings are discussed within the context of activity-induced motor axonal hyperpolarizion.

Recurrence quantification analysis of surface electromyographic signal: sensitivity to potentiation and neuromuscular fatigue

This study aimed to assess the capacity of recurrence quantification analysis (RQA) to detect potentiation and to determine the fatigue components to which RQA is sensitive. Fifteen men were divided in two groups [8 endurance-trained athletes (END) and 7 power-trained athletes (POW)]. They performed a 10-min intermittent (5s contraction, 5s rest) knee extension exercise at 50% of their maximal voluntary isometric contraction. Muscular fatigue and potentiation were evaluated with neurostimulation technique. Mechanical (peak torque, Pt) and electrophysiological (M-wave) responses following electrical stimulation of the femoral nerve were measured at rest and every 10s throughout exercise. Vastus lateralis muscle activity (root mean square, RMS) was recorded during each contraction, and RMS was normalized to M-wave area (RMS/M). During contraction, muscle activity was analyzed with RQA to obtain the percentage of determinism (%Det). At the beginning of exercise, a significant Pt increase (+52%, P<0.001) was observed in both groups, indicating potentiation. At this time, %Det remained constant in both groups, indicating that RQA did not detect potentiation. Thereafter, Pt decreased in POW from 5min 30s of exercise (-30%, P<0.001), reflecting impairment in excitation-contraction coupling, and %Det increased from 3min 30s (P<0.01). In END, Pt remained high and %Det was unchanged. These two results indicated that RQA detected the peripheral component of fatigue. Conversely, RQA did not detect central adaptation to fatigue since %Det remained constant when a significant increase in RMS/M (P<0.01) appeared in END.

Skeletal Muscle Fatigue: Cellular Mechanisms

Repeated, intense use of muscles leads to a decline in performance known as muscle fatigue. Many muscle properties change during fatigue including the action potential, extracellular and intracellular ions, and many intracellular metabolites. A range of mechanisms have been identified that contribute to the decline of performance. The traditional explanation, accumulation of intracellular lactate and hydrogen ions causing impaired function of the contractile proteins, is probably of limited importance in mammals. Alternative explanations that will be considered are the effects of ionic changes on the action potential, failure of SR Ca2+release by various mechanisms, and the effects of reactive oxygen species. Many different activities lead to fatigue, and an important challenge is to identify the various mechanisms that contribute under different circumstances. Most of the mechanistic studies of fatigue are on isolated animal tissues, and another major challenge is to use the knowledge generated in these studies to identify the mechanisms of fatigue in intact animals and particularly in human diseases.

Neuromuscular fatigue during a prolonged intermittent exercise: Application to tennis

The time course of alteration in neuromuscular function of the knee extensor muscles was characterized during a prolonged intermittent exercise. Maximal voluntary contraction (MVC) and surface EMG activity of both vastii were measured during brief interruptions before (T(0)), during (30, 60, 90, 120, 150 and 180min: T(30), T(60), T(90), T(120), T(150), T(180)) and 30min after (T(+30)) a 3h tennis match in 12 trained players. M-wave and twitch contractile properties were analyzed following single stimuli. Short tetani at 20Hz and 80Hz were also applied to six subjects at T(0) and T(180). Significant reductions in MVC (P<0.05; -9%) and electromyographic activity normalized to the M wave for both vastii (P<0.01) occurred with fatigue at T(180). No significant changes in M-wave duration and amplitude nor in twitch contractile properties were observed. The ratio between the torques evoked by 20Hz and 80Hz stimulation declined significantly (P<0.001; -12%) after exercise. Central activation failure and alterations in excitation-contraction coupling are probable mechanisms contributing to the moderate impairment of the neuromuscular function during prolonged tennis playing.

The relationships between plasma potassium, muscle excitability and fatigue during voluntary exercise in humans

The relationships between extracellular potassium elevation and EMG variables in relation to muscle fatigue were investigated during handgrip exercise in humans. Acid-base state, lactate, potassium ([K+](v)) and sodium in venous plasma, as well as variables of surface voluntary and evoked (M-wave) EMG were determined during repeated dynamic (DE) and static (SE) exercise (1 min exercise, 4 min rest). The different rises of [K+](v) were induced by randomly varied workloads. After 15 min of warming up, the M-wave area increased to 124.9 +/- 19.6% (P < 0.001) in comparison with the control value. Simultaneously, the [K+](v) decreased from 4.1 +/- 0.3 to 3.6 +/- 0.3 mmol l(-1) (P < 0.01). During both SE and DE, there were marked intensity-dependent signs of fatigue. The [K+](v) correlated with changes of the integrated EMG (r = 0.87, P < 0.001 for both DE and SE). Changes in the M-wave area during the exercise bouts correlated inversely with the [K+](v) (r = -0.73, P < 0.001). The M-wave area did not decrease below the control value at any intensity. The median frequency of the EMG decreased during exercise, depending on the exercise intensity (r = -0.73 for SE, r = -0.47 for DE, P < 0.001) with a maximal decrease to about 80% after SE with the maximal workload. The muscle action potential propagation velocity changed in the range of about +/-2%. For the first time, a negative relationship between venous potassium and M-wave area was shown during voluntary exercise. However, there was no evidence that the decrease in muscle performance was mainly caused by a decrease in sarcolemmal excitability resulting from a high extracellular [K+].

Exercise and heat stress: cerebral challenges and consequences

This review deals with new aspects of exercise in the heat as a challenge that not only influences the locomotive and cardiovascular systems, but also affects the brain. Activation of the brain during such exercise is manifested in the lowering of the cerebral glucose to oxygen uptake ratio, the elevated ratings of perceived exertion and increased release of hypothalamic hormones. While the slowing of the electroencephalographic (EEG), the decreased endurance and hampered ability to activate the skeletal muscles maximally during sustained isometric and repeated isokinetic contractions appear to relate to central fatigue arising as the core/brain increases, the central fatigue during exercise with hyperthermia thus can be considered as the ultimate safety break against catastrophic hyperthermia. This would force the subject to stop exercising or decrease the internal heat production. It appears that the dopaminergic system is important, but several other factors may interact and feedback from the skeletal muscles and internal temperature sensors are probably also involved. The complexity of brain fatigue response is discussed based on our own investigations and in the light of recent literature.

Changes in neuromuscular function after tasks involving control of EMG versus torque feedback of the same duration

This study was designed to compare alterations in neuromuscular function after two tasks of similar duration involving the control of (1) torque level fixed at 40% maximal voluntary contraction (MVC) torque (torque task) and (2) EMG level when exerting 40% MVC torque on the knee extensor muscles. Ten healthy subjects volunteered to participate in two testing sessions separated by approximately 2 h. Contraction duration for the EMG task was fixed for each subject to the time to task failure of the torque task (104+/-20s). MVC, maximal voluntary activation level, muscle compound action potential (M-wave), peak twitch and potentiated peak doublet were assessed before and immediately after each task using electrical stimulation of the femoral nerve. Average EMG activity of quadriceps muscle increased (p<0.01) during the torque task from 27.7+/-5.4% to 46.2+/-19.3% maximal EMG, whereas torque decreased during the EMG task from 41.5+/-2.9% to 28.9+/-3.8% MVC torque. Alterations in MVC torque (p<0.01) and maximal voluntary activation level (p<0.05) were comparable at termination of the two tasks. Rate of perceived exertion was greater (p<0.05) at the end of the torque task compared to the EMG task. Despite the absence of change in the M-wave for either task, potentiated peak doublet was altered after the torque task (-18+/-14%, p<0.01), whereas there was no change after the EMG task (p>0.05). The absence of peripheral failure at the end of the EMG task could be attributed to (1) a lower intramuscular pressure allowing a lesser accumulation of metabolites and (2) a slower rate of PCr hydrolysis compared to the torque task.

The influence of contraction amplitude and firing history on spike-triggered averaged trapezius motor unit potentials

The spike-triggered averaged (STA) technique was used to examine trapezius motor unit potentials and their dependence on contraction amplitude and firing history. Individual motor unit firings were identified by a fine-wire intramuscular electrode, while STA-derived potentials were extracted from the simultaneously recorded surface electromyographic (SEMG) signal. Amplitude-controlled contractions and contractions with typing tasks and mental stress were carried out. STA potentials were mostly derived from 20 s intervals of firing. Motor unit synchrony was estimated by peristimulus time histograms (PSTHs). An association between SEMG amplitude and STA-derived motor unit potentials was found: motor unit area showed a four-fold increase when SEMG amplitude increased from 1.5 to 10.5% of the root mean square-detected SEMG signal at maximal voluntary contraction (%EMG(max)). Low- and higher threshold motor unit potentials, all with recruitment thresholds <10% EMG(max), had similar area at the same contraction amplitude. A significant increase in the STA-derived potentials was observed after 3 min of constant-amplitude contractions; however, this difference was reduced after 10 min and no longer present after 30 min of contraction. Motor unit synchrony accounted for, on average, 2.8% additional firings within 2 ms of the triggering motor unit. We conclude that the increase in STA-derived potentials with contraction amplitude is, to a major extent, due to motor unit synchrony, limiting the applicability of this method in postural muscles presenting wide motor unit potentials. The similar area of motor units at same SEMG amplitude may indicate that trapezius motor units recruited below 10% EMG(max) are of similar size and thus not organized according to the Henneman size principle.

Cerebral perturbations provoked by prolonged exercise

This review addresses cerebral metabolic and neurohumoral alterations during prolonged exercise in humans with special focus on associations with fatigue. Global energy turnover in the brain is unaltered by the transition from rest to moderately intense exercise, apparently because exercise-induced activation of some brain regions including cortical motor areas is compensated for by reduced activity in other regions of the brain. However, strenuous exercise is associated with cerebral metabolic and neurohumoral alterations that may relate to central fatigue. Fatigue should be acknowledged as a complex phenomenon influenced by both peripheral and central factors. However, failure to drive the motorneurons adequately as a consequence of neurophysiological alterations seems to play a dominant role under some circumstances. During exercise with hyperthermia excessive accumulation of heat in the brain due to impeded heat removal by the cerebral circulation may elevate the brain temperature to >40 degrees C and impair the ability to sustain maximal motor activation. Also, when prolonged exercise results in hypoglycaemia, perceived exertion increases at the same time as the cerebral glucose uptake becomes low, and centrally mediated fatigue appears to arise as the cerebral energy turnover becomes restricted by the availability of substrates for the brain. Changes in serotonergic activity, inhibitory feed-back from the exercising muscles, elevated ammonia levels, and alterations in regional dopaminergic activity may also contribute to the impaired voluntary activation of the motorneurons after prolonged and strenuous exercise. Furthermore, central fatigue may involve depletion of cerebral glycogen stores, as signified by the observation that following exhaustive exercise the cerebral glucose uptake increases out of proportion to that of oxygen. In summary, prolonged exercise may induce homeostatic disturbances within the central nervous system (CNS) that subsequently attenuates motor activation. Therefore, strenuous exercise is a challenge not only to the cardiorespiratory and locomotive systems but also to the brain.

Na+-K+ Pump Regulation and Skeletal Muscle Contractility

Clausen, Torben. Na+-K+ Pump Regulation and Skeletal Muscle Contractility. Physiol Rev 83: 1269-1324, 2003; 10.1152/physrev.00011.2003.—In skeletal muscle, excitation may cause loss of K+, increased extracellular K+ ([K+]o), intracellular Na+ ([Na+]i), and depolarization. Since these events interfere with excitability, the processes of excitation can be self-limiting. During work, therefore, the impending loss of excitability has to be counterbalanced by prompt restoration of Na+-K+ gradients. Since this is the major function of the Na+-K+ pumps, it is crucial that their activity and capacity are adequate. This is achieved in two ways: 1) by acute activation of the Na+-K+ pumps and 2) by long-term regulation of Na+-K+ pump content or capacity. 1) Depending on frequency of stimulation, excitation may activate up to all of the Na+-K+ pumps available within 10 s, causing up to 22-fold increase in Na+ efflux. Activation of the Na+-K+ pumps by hormones is slower and less pronounced. When muscles are inhibited by high [K+]o or low [Na+]o, acute hormone- or excitation-induced activation of the Na+-K+ pumps can restore excitability and contractile force in 10-20 min. Conversely, inhibition of the Na+-K+ pumps by ouabain leads to progressive loss of contractility and endurance. 2) Na+-K+ pump content is upregulated by training, thyroid hormones, insulin, glucocorticoids, and K+ overload. Downregulation is seen during immobilization, K+ deficiency, hypoxia, heart failure, hypothyroidism, starvation, diabetes, alcoholism, myotonic dystrophy, and McArdle disease. Reduced Na+-K+ pump content leads to loss of contractility and endurance, possibly contributing to the fatigue associated with several of these conditions. Increasing excitation-induced Na+ influx by augmenting the open-time or the content of Na+ channels reduces contractile endurance. Excitability and contractility depend on the ratio between passive Na+-K+ leaks and Na+-K+ pump activity, the passive leaks often playing a dominant role. The Na+-K+ pump is a central target for regulation of Na+-K+ distribution and excitability, essential for second-to-second ongoing maintenance of excitability during work.

Tourniquet obliteration of exercise-induced sensory nerve conduction augmentation

OBJECTIVE

We previously discovered that minimally suprathreshold sensory nerve action potential amplitudes increased during isometric muscle contraction. In this study, the hypothesis was that the exercise-induced response could be blocked with a tourniquet.

METHODS

A total of 21 healthy male and female subjects were recruited from the medical center. Baseline and postevent serial sural nerve recordings were made in the leg of 16 healthy subjects under the following conditions: (1) blood pressure cuff inflation at the arm, (2) isometric muscle contraction in the hand, and (3) conditions 1 and 2 combined.

RESULTS

Results showed there was a 2.9 microV increase in the sural nerve response 5 min after muscle contraction compared to baseline at rest. The exercise-induced sensory response was largely obliterated by the blood pressure cuff with exception of the 1-min postexercise recording.

CONCLUSION

In conclusion, the results show a tourniquet placed on the proximal arm blocks the effect of the muscle contraction of the hand on the minimally suprathreshold sensory sural nerve conduction recording in the ankle. The likely reason for this is the interruption of a thus far unidentified circulating factor. The clinical implication is the discovery of a sensory regulatory mechanism controlled by the motor system.

Evidence of neuromuscular fatigue after prolonged cycling exercise

PURPOSE

The purpose of this study was to analyze the effects of prolonged cycling exercise on metabolic, neuromuscular, and biomechanical parameters.

METHODS

Eight well-trained male cyclists or triathletes performed a 2-h cycling exercise at a power output corresponding to 65% of their maximal aerobic power. Maximal concentric (CON; 60, 120, 240 degrees x s(-1)), isometric (ISO; 0 degrees s(-1)), and eccentric (ECC; -120, -60 degrees x s(-1)) contractions, electromyographic (EMG) activity of vastus lateralis (VL) and vastus medialis (VM) muscles were recorded before and after the exercise. Neural (M-wave) and contractile (isometric muscular twitch) parameters of quadriceps muscle were also analyzed using electrical stimulation techniques.

RESULTS

Oxygen uptake (VO2), minute ventilation (VE), and heart rate (HR) significantly increased (P < 0.01) during the 2-h by, respectively, 9.6%, 17.7%, and 12.7%, whereas pedaling rate significantly decreased (P < 0.01) by 21% (from 87 to 69 rpm). Reductions in muscular peak torque were quite similar during CON, ISO, and ECC contractions, ranging from 11 to 15%. M-wave duration significantly increased (P < 0.05) postexercise in both VL and VM, whereas maximal amplitude and total area decreased (VM: P < 0.05, VL: NS). Significant decreases in maximal twitch tension (P < 0.01), total area of mechanical response (P < 0.01), and maximal rate of twitch tension development (P < 0.05) were found postexercise.

CONCLUSIONS

A reduction in leg muscular capacity after prolonged cycling exercise resulted from both reduced neural input to the muscles and a failure of peripheral contractile mechanisms. Several hypothesis are proposed to explain a decrease in pedaling rate during the 2-h cycling with a constancy of power output and an increase in energy cost.

Increased threshold sural amplitude after upper limb isometric contraction in complete paraplegics

OBJECTIVE

To determine whether the enhancement of threshold sural sensory nerve action potentials (SNAPs) occurred in patients with spinal cord injury after upper limb isometric contraction.

DESIGN

This prospective study, in which ten paraplegic patients with spinal cord injury were recruited from the Harris County community and served as his/her own control, was performed in the electromyography laboratory at Harris County Hospital District Quentin Mease Hospital. The baseline SNAP was established using ten threshold, signal-averaged stimuli to the sural nerve. With the same stimulus strength, the SNAP was recorded while the subjects' arms were pulled apart against a force gauge at 50% and 100% maximum force. Responses were recorded every 4 min until the values returned to baseline.

RESULTS

Results showed an increase in the SNAP amplitude after 50% and 100% maximum force. The mean preexercise SNAP amplitude was 4.0 +/- 0.6 (SE) microV. At 50% force, the SNAP amplitude was 7.57 +/- 1.2 microV; at 100% force, it was 7.29 +/- 1.2 microV. The post hoc analysis of the data revealed P = 0.009 and P = 0.01 for 50% and 100% maximum force, respectively.

CONCLUSIONS

The threshold SNAP of the sural nerve was enhanced after isometric exercise in paraplegic patients with spinal cord injury.

Caffeine potentiates low frequency skeletal muscle force in habitual and nonhabitual caffeine consumers

The mechanism of action underlying the ergogenic effect of caffeine is still unclear. Caffeine increases the force of muscular contraction during low-frequency stimulation by potentiating calcium release from the sarcoplasmic reticulum. Studies have also suggested an enhancement of lipid oxidation and glycogen sparing as potential mechanisms. Given that several studies have found an ergogenic effect of caffeine with no apparent metabolic effects, it is likely that a direct effect upon muscle is important. Twelve healthy male subjects were classified as habitual (n = 6) or nonhabitual (n = 6) caffeine consumers based on a 4-day diet record analysis, with a mean caffeine consumption of 771 and 14 mg/day for each group, respectively. Subjects were randomly allocated to receive caffeine (6 mg/kg) and placebo (citrate) in a double-blind, cross-over fashion approximately 100 min before a 2-min tetanic stimulation of the common peroneal nerve in a custom-made dynamometer (2 trials each of 20 and 40 Hz). Tetanic torque was measured every 30 s during and at 1, 5, and 15 min after the stimulation protocol. Maximal voluntary contraction strength and peak twitch torque were measured before and after the stimulation protocol. Caffeine potentiated the force of contraction during the final minute of the 20-Hz stimulation (P<0.05) with no effect of habituation. There was no effect of caffeine on 40-Hz stimulation strength nor was there an effect on maximal voluntary contraction or peak twitch torque. These data support the hypothesis that some of the ergogenic effect of caffeine in endurance exercise performance occurs directly at the skeletal muscle level.

Dynamics and consequences of potassium shifts in skeletal muscle and heart during exercise

Since it became clear that K(+) shifts with exercise are extensive and can cause more than a doubling of the extracellular [K(+)] ([K(+)](s)) as reviewed here, it has been suggested that these shifts may cause fatigue through the effect on muscle excitability and action potentials (AP). The cause of the K(+) shifts is a transient or long-lasting mismatch between outward repolarizing K(+) currents and K(+) influx carried by the Na(+)-K(+) pump. Several factors modify the effect of raised [K(+)](s) during exercise on membrane potential (E(m)) and force production. 1) Membrane conductance to K(+) is variable and controlled by various K(+) channels. Low relative K(+) conductance will reduce the contribution of [K(+)](s) to the E(m). In addition, high Cl(-) conductance may stabilize the E(m) during brief periods of large K(+) shifts. 2) The Na(+)-K(+) pump contributes with a hyperpolarizing current. 3) Cell swelling accompanies muscle contractions especially in fast-twitch muscle, although little in the heart. This will contribute considerably to the lowering of intracellular [K(+)] ([K(+)](c)) and will attenuate the exercise-induced rise of intracellular [Na(+)] ([Na(+)](c)). 4) The rise of [Na(+)](c) is sufficient to activate the Na(+)-K(+) pump to completely compensate increased K(+) release in the heart, yet not in skeletal muscle. In skeletal muscle there is strong evidence for control of pump activity not only through hormones, but through a hitherto unidentified mechanism. 5) Ionic shifts within the skeletal muscle t tubules and in the heart in extracellular clefts may markedly affect excitation-contraction coupling. 6) Age and state of training together with nutritional state modify muscle K(+) content and the abundance of Na(+)-K(+) pumps. We conclude that despite modifying factors coming into play during muscle activity, the K(+) shifts with high-intensity exercise may contribute substantially to fatigue in skeletal muscle, whereas in the heart, except during ischemia, the K(+) balance is controlled much more effectively.

Effect of isometric contraction on threshold somatosensory evoked potentials

We previously described the augmentation of sensory nerve action potential amplitudes after near and remote isometric muscle contraction. In this study, we wished to determine if the sensory cortex was involved in this process. In this prospective, intrinsically controlled study, we studied threshold somatosensory evoked potentials in 12 normal subjects with stimulation of the median nerve at 5.1 Hz. The subjects were tested during the following conditions: baseline, 25%, and 75% maximum isometric abductor digiti minimi contraction for 4 min. Each of these conditions was recorded before, during, and 4 min and 8 min after contraction. Results showed that at 25% contraction, there was a significant temporal increase in N9 amplitude (2.1-2.6 microV; P = 0.05, analysis of variance, repeated measures) and a decrease in N20 amplitude with 75% contraction (1.9-1.6 microV; P = 0.03, analysis of variance, repeated measure). No significant changes were noted in the spinal cord or brainstem recordings. In conclusion, it appears that augmentation of the brachial plexus peripheral nervous system recording occurs concurrently with central inhibitory gating. The possibility of peripheral nervous system adaptability will be discussed.