Combined in situ analysis of metabolic and myoelectrical changes associated with electrically induced fatigue

Effects of three neuromuscular electrical stimulation methods on muscle force production and neuromuscular fatigue

This study compared the acute responses of three neuromuscular electrical stimulation (NMES) methods on muscle torque-time integral (TTI) and neuromuscular fatigue. Narrow-pulse (0.2 ms; NP), wide-pulse (1 ms; WP), and tendon vibration superimposed onto wide-pulse (WP + VIB)-NMES conditions were applied to sixteen healthy individuals (n = 16) in three separate sessions in a randomized order. Stimulation intensity was set to elicit 20% of maximal voluntary contraction (MVC); the stimulus pattern comprised four sets of 20 repetitions (5 s On and 5 s Off) with a one-minute inter-set interval. TTI was measured for each NMES condition and MVC, voluntary activation (VA), peak twitch torque (Peak_twitch ), and peak soleus (EMG_SOL ), medial (EMG_MG ), and lateral gastrocnemius (EMG_LG ) electromyography were measured before and immediately after each NMES condition. TTI was higher during WP + VIB (19.63 ± 6.34 MVC.s, mean difference = 3.66, p < 0.001, Cohen's d = 0.501) than during WP (15.97 ± 4.79 MVC.s) condition. TTI was higher during WP + VIB (mean difference = 3.79, p < 0.001, Cohen's d = 0.626) than during NP (15.84 ± 3.73 MVC.s) condition. MVC and Peak_twitch forces decreased (p ≤ 0.001) immediately after all conditions. No changes were observed for VA (p = 0.365). EMG_SOL amplitude reduced (p = 0.040) only after NP, yet EMG_LG and EMG_MG amplitudes decreased immediately after all conditions (p = 0.003 and p = 0.013, respectively). WP + VIB produced a higher TTI than WP and NP-NMES, with similar amounts of neuromuscular fatigue across protocols. All NMES protocols induced similar amounts of peripheral fatigue and reduced EMG amplitudes.

The Etiology of Muscle Fatigue Differs between Two Electrical Stimulation Protocols

PURPOSE

This study aimed at investigating the mechanisms involved in the force reduction induced by two electrical stimulation (ES) protocols that were designed to activate motor units differently.

METHODS

The triceps surae of 11 healthy subjects (8 men; age, ~28 yr) was activated using ES applied over the tibial nerve. Two ES protocols (conventional [CONV]: 20 Hz, 0.05 ms vs wide-pulse high-frequency [WPHF]: 80 Hz, 1 ms) were performed and involved 40 trains (6 s on-6 s off) delivered at an intensity (IES) evoking 20% of maximal voluntary contraction. To analyze the mechanical properties of the motor units activated at IES, force-frequency relation was evoked before and after each protocol. H-reflex and M-wave responses evoked by the last stimulation pulse were also assessed during each ES protocol. Electromyographic responses (∑EMG) were recorded after each train to analyze the behavior of the motor units activated at IES. Metabolic variables, including relative concentrations of phosphocreatine and inorganic phosphate as well as intracellular pH, were assessed using P-MR spectroscopy during each protocol.

RESULTS

Larger H-reflex amplitudes were observed during WPHF as compared with CONV, whereas opposite findings were observed for M-wave amplitudes. Despite this difference, both the force reduction (-26%) and metabolic changes were similar between the two protocols. The CONV protocol induced a rightward shift of the force-frequency relation, whereas a significant reduction of the ∑EMG evoked at IES was observed only for the WPHF.

CONCLUSIONS

These results suggest that a decreased number of active motor units mainly contributed to WPHF-induced force decrease, whereas intracellular processes were most likely involved in the force reduction occurring during CONV stimulation.

Predicting muscle fatigue: a response surface approximation based on proper generalized decomposition technique

A novel technique is proposed to predict force reduction in skeletal muscle due to fatigue under the influence of electrical stimulus parameters and muscle physiological characteristics. Twelve New Zealand white rabbits were divided in four groups ([Formula: see text]) to obtain the active force evolution of in vitro Extensor Digitorum Longus muscles for an hour of repeated contractions under different electrical stimulation patterns. Left and right muscles were tested, and a total of 24 samples were used to construct a response surface based in the proper generalized decomposition. After the response surface development, one additional rabbit was used to check the predictive potential of the technique. This multidimensional surface takes into account not only the decay of the maximum repeated peak force, but also the shape evolution of each contraction, muscle weight, electrical input signal and stimulation protocol. This new approach of the fatigue simulation challenge allows to predict, inside the multispace surface generated, the muscle response considering other stimulation patterns, different tissue weight, etc.

Effects of Constant and Doublet Frequency Electrical Stimulation Patterns on Force Production of Knee Extensor Muscles

This study compared knee extensors’ neuromuscular fatigue in response to two 30-minute stimulation patterns: constant frequency train (CFT) and doublet frequency train (DFT). Fifteen men underwent two separate sessions corresponding to each pattern. Measurements included torque evoked by each contraction and maximal voluntary contractions (MVC) measured before and immediately after the stimulation sessions. In addition, activation level and torque evoked during doublets (Pd) and tetanic contractions at 80-Hz (P80) and 20-Hz (P20) were determined in six subjects. Results indicated greater mean torque during the DFT stimulation session as compared with CFT. But, no difference was obtained between the two stimulation patterns for MVC and evoked torque decreases. Measurements conducted in the subgroup depicted a significant reduction of Pd, P20 and P80. Statistical analyses also revealed bigger P20 immediate reductions after CFT than after DFT. We concluded that DFT could be a useful stimulation pattern to produce and maintain greater force with quite similar fatigue than CFT.

Whole body oxygen uptake and evoked torque during subtetanic isometric electrical stimulation of the quadriceps muscles in a single 30-minute session

OBJECTIVE

To evaluate the time course of fatigue in torque output and oxygen uptake during isometric subtetanic neuromuscular electrical stimulation (NMES) to facilitate the design of NMES-based rehabilitation protocols that can accumulate a defined aerobic exercise volume within a given time period.

DESIGN

Single-arm intervention study with within-subject comparisons.

SETTING

University research laboratory.

PARTICIPANTS

Volunteer sample of healthy men (N=11; mean age, 34.2 ± 11.5 y; range, 19-53 y; body mass, 79.1 ± 11.7 kg; range, 58-100 kg).

INTERVENTION

A single 30-minute session of continuous bilateral isometric quadriceps NMES at 4 Hz evoking a mean twitch amplitude of 12% of the maximum voluntary contraction.

MAIN OUTCOME MEASURES

Whole body oxygen consumption rate (V˙o2), and evoked torque were measured simultaneously throughout.

RESULTS

Mean increment in V˙o2 was 596 ± 238 mL/min, and average exercise intensity during the session was 3 ±.47 metabolic equivalents. The V˙o2 and torque declined slowly at a rate of -.54%±.31% and -.47%±.57% per minute, respectively.

CONCLUSIONS

Despite having a higher incremental V˙o2, the observed fatigue rate was considerably less than that previously reported during intermittent isometric tetanic stimulation, suggesting that subtetanic isometric NMES is more sustainable for exercise interventions aimed at accumulating a therapeutic aerobic exercise volume.

Neuromuscular fatigue is not different between constant and variable frequency stimulation

This study compared fatigue development of the triceps surae induced by two electrical stimulation protocols composed of constant and variable frequency trains (CFTs, VFTs, 450 trains, 30 Hz, 167 ms ON, 500 ms OFF and 146 ms ON, 500 ms OFF respectively). For the VFTs protocol a doublet (100 Hz) was used at the beginning of each train. The intensity used evoked 30% of a maximal voluntary contraction (MVC) and was defined using CFTs. Neuromuscular tests were performed before and after each protocol. Changes in excitation-contraction coupling were assessed by analysing the M-wave [at rest (M_max) and during MVC (M_sup)] and associated peak twitch (Pt). H-reflex [at rest (H_max) and during MVC (H_sup)] and the motor evoked potential (MEP) during MVC were studied to assess spinal and corticospinal excitability of the soleus muscle. MVC decrease was similar between the protocols (−8%, P<0.05). M_max, M_sup and Pt decreased after both protocols (P<0.01). H_max/M_max was decreased (P<0.05), whereas H_sup/M_sup and MEP/M_sup remained unchanged after both protocols. The results indicate that CFTs and VFTs gave rise to equivalent neuromuscular fatigue. This fatigue resulted from alterations taking place at the muscular level. The finding that cortical and spinal excitability remained unchanged during MVC indicates that spinal and/or supraspinal mechanisms were activated to compensate for the loss of spinal excitability at rest.

The mechanisms of the widespread production of phosphorylated HSP25 after fatiguing muscle stimulation

We previously showed that a widespread heat shock protein (HSP) response to fatigue of a single hindlimb muscle was responsible for a global adaptive response to an acute localized stress. We also demonstrated that the HSP response resulted from the activation of nerve afferents from the stimulated muscle. However, we did not examine the role played by the different muscle afferents or the efferent arm of HSP response. In the present study we measured the changes in phosphorylated HSP25 (pHSP25) levels in resting hindlimb muscles and the diaphragm, kidney and brain in response to a fatiguing stimulation of one tibialis anterior muscle that was repeated in five series of experiments: (1) intact muscle innervation, (2) during the selective procaine block of conduction in group IV muscle afferents, (3) after muscle nerve transection to suppress all the sensory messages, and under pharmacological blockade of the (4) alpha-adrenergic or (5) glutamatergic neurotransmission. The data showed that: (1) the pHSP25 response in hindlimb muscles resulted from the stimulation of both group III and IV muscle afferents while the pHSP25 response in the diaphragm, kidney and brain resulted from the sole activation of the group IV fibres, and (2) the blockade of alpha-adrenergic, but not glutamatergic, neurotransmission suppressed the pHSP25 response in all explored tissues except the brain. The present study highlights the role played by the group III and IV muscle afferents in the fatigue-induced pHSP25 response and shows that the sympathetic nerve supply to the muscles and kidney represents the efferent arm of the pHSP25 activation. However, the pHSP25 changes in the brain cannot be explained by the pathways investigated here.

Fatiguing stimulation of one skeletal muscle triggers heat shock protein activation in several rat organs: the role of muscle innervation

We hypothesised that activation of muscle afferents by fatigue triggers a widespread activation of heat shock proteins (HSPs) in resting muscles and different organs. In anaesthetised rats, HSP25 and HSP70 levels were determined in both tibialis anterior (TA) and extensor digitorum longus (EDL) muscles and in the diaphragm, kidney and brain by ELISA, which mostly identifies phosphorylated HSP, and western blotting. One TA muscle was electrically stimulated and tissues were sampled 10 or 60 min after the stimulation had ended. The nerve supply to the stimulated TA or its counterpart in the contralateral limb was left intact or suppressed. In control rats, no muscle stimulation was performed and tissues were sampled at the same time points (10 or 60 min). After TA stimulation, ELISA showed an increased HSP25 content in the contralateral TA, EDL and diaphragm at 10 min but not at 60 min, and HSP70 increased in all sampled tissues at 60 min. Western blotting did not show any changes in HSP25 and HSP70 at 10 min, while at 60 min HSP25 increased in all sampled tissues except the brain and HSP70 was elevated in all tissues. Denervation of the contralateral non-stimulated limb suppressed HSP changes in TA and after denervation of the stimulated TA the widespread activation of HSPs in other organs was absent. Our data suggest that fatigue-induced activation of skeletal muscle afferents triggers an early increase in phosphorylated HSP25 in muscles and a delayed elevation of non-phosphorylated HSP25 and HSP70 in skeletal and respiratory muscles, kidney and brain.

A peripheral governor regulates muscle contraction

Active skeletal muscles are capable of keeping the global [adenosine triphosphate (ATP)] reasonably constant during exercise, whether it is mild exercise, activating a few motor units, or all-out exercise using a substantial mass of muscle. This could only be accomplished if there were regulatory processes in place not only to replenish ATP as quickly as possible, but also to modulate the rate of ATP use when that rate threatens to exceed the rate of ATP replenishment, a situation that could lead to metabolic catastrophe. This paper proposes that there is a regulatory process or "peripheral governor" that can modulate activation of muscle to avoid metabolic catastrophe. A peripheral governor, working at the cellular level, should be able to reduce the cellular rate of ATP hydrolysis associated with muscle contraction by attenuating activation. This would necessarily cause something we call peripheral fatigue (i.e., reduced contractile response to a given stimulation). There is no doubt that peripheral fatigue occurs. It has been demonstrated in isolated muscles, in muscles in situ with no central nervous system input, and in intact human subjects performing voluntary exercise with small muscle groups or doing whole-body exercise. The regulation of muscle activation is achieved in at least 3 ways (decreasing membrane excitability, inhibiting Ca2+ release through ryanodine receptors, and decreasing the availability of Ca2+ in the sarcoplasmic reticulum), making this a highly redundant control system. The peripheral governor attenuates cellular activation to reduce the metabolic demand, thereby preserving ATP and the integrity of the cell.

Effects of stimulation frequency and pulse duration on fatigue and metabolic cost during a single bout of neuromuscular electrical stimulation

We have investigated the effects of stimulation frequency and pulse duration on fatigue and energy metabolism in rat gastrocnemius muscle during a single bout of neuromuscular electrical stimulation (NMES). Electrical pulses were delivered at 100 Hz (1-ms pulse duration) and 20 Hz (5-ms pulse duration) for the high (HF) and low (LF) frequency protocols, respectively. As a standardization procedure, the averaged stimulation intensity, the averaged total charge, the initial peak torque, the duty cycle, the contraction duration and the torque-time integral were similar in both protocols. Fatigue was assessed using two testing trains delivered at a frequency of 100 Hz and 20 Hz before and after each protocol. Metabolic changes were investigated in vivo using 31P-magnetic resonance spectroscopy (31P-MRS) and in vitro in freeze-clamped muscles. Both LF and HF NMES protocols induced the same decrease in testing trains and metabolic changes. We conclude that, under carefully controlled and comparable conditions, the use of low stimulation frequency and long pulse duration do not minimize the occurrence of muscle fatigue or affect the corresponding stimulation-induced metabolic changes so that this combination of stimulation parameters would not be adequate in the context of rehabilitation.

Reactive oxygen species activate the group IV muscle afferents in resting and exercising muscle in rats

We tested the hypothesis that the reactive oxygen species (ROS) produced at rest and mostly during muscle contraction may stimulate the group IV muscle afferents. In rats, afferent activity was recorded in the peroneal nerve innervating the tibialis anterior muscle. Group IV afferents were identified from measurements of their conduction velocity and response to lactic acid. Comparing the group IV response to an intramuscular injection of buffered isotonic NaCl solution, we searched for the effects of a ROS donor (H2O2) or a ROS inhibitor (superoxide dismutase, SOD) on the baseline afferent activity in resting muscles. We also explored the consequences of a pre-treatment with SOD on the afferent nerve response to H2O2 injection or electrical muscle stimulation (MS). In other animals, we measured the changes in intramuscular level of a marker of oxidative stress (isoprostanes) after each test agent. H2O2 injection markedly activated all recorded group IV afferents. SOD injection lowered the baseline activity of 50 out of 70 afferent units, suppressed the afferent response to H2O2 injection, and delayed and reduced the MS-induced activation of all recorded units. Intramuscular isoprostanes level significantly increased after H2O2 injection or MS, the oxidative stress being absent in muscles pre-treated with SOD. We concluded that ROS influence both the spontaneous and contraction-induced activities of the group IV muscle afferents and are a potent stimulus of muscle metaboreceptors.

Differences in twitch potentiation between voluntary and stimulated quadriceps contractions of equal intensity

This study compared the extent of twitch and M-wave potentiation (POT) between voluntary and stimulated quadriceps contractions performed at the same intensity. Sixteen healthy men completed 10-s isometric knee extensions at 40% of the maximal voluntary contraction torque under electrical stimulation and voluntary conditions. Single stimuli were delivered to the femoral nerve to evoke twitches before (PRE) and from 3 to 600 s after the end of each conditioning contraction. Changes in twitch contractile properties and M-wave characteristics were compared between the conditions. The extent of twitch peak torque POT was smaller for the stimulated (122+/-20% of PRE) than for the voluntary condition (133+/-20% of PRE). The magnitude of POT for the maximal rate of twitch torque development was also smaller for the stimulated trial. Rectus femoris M-wave amplitude was potentiated by the voluntary but not by the stimulated contraction. It was concluded that stimulated contractions resulted in smaller twitch and M-wave POT than voluntary contractions, despite equivalent torque output and duration. The spatially and temporally fixed recruitment of motor units with electrical stimulation and therefore the lower number of activated motor units compared with voluntary actions of equal intensity could explain the present findings.

De electricitatis catholici musculari - Concerning the electrical properties of muscles, with emphasis on meat quality

This study aims to explore the potential of evoked non-invasive surface electromyography (SEMG) analysis, in predicting meat quality traits in livestock. Evoked SEMG is a system that records, transdermally, electrical signals generated in muscle fibres upon external stimulation. These signals are reported as compound muscle action potentials (CMAP). CMAP parameters of LD correlated negatively and significantly to ultimate pH (pH 24h) at day 61, but not at day 153 after birth, and a similar albeit positive correlation was observed for muscle glycogen content. Muscle glycogen content and pH 24h correlated negatively in LD and BF. Negative significant correlations between CMAP parameters and shear force were found in LD at day 153 after birth, which might, in the range of the recording electrodes, reflect the combined effect of large cross-sectional area fibres and reduced perimysium content per unit volume of muscle. The fact that correlations between CMAP characteristics and quality traits of both metabolic and non metabolic origin could be established, warrants a fuller investigation of this method in terms of its potential as a predictive tool for meat quality traits in live animals.

Muscle Metabolites: Functional MR Spectroscopy during Exercise Imposed by Tetanic Electrical Nerve Stimulation

Permission from the ethics committee and informed consent were obtained. The purpose of this study was to prospectively evaluate a method developed for the noninvasive assessment of muscle metabolites during exercise. Hydrogen 1 magnetic resonance (MR) spectroscopy peaks were measured during tetanic isometric muscle contraction imposed by supramaximal repetitive nerve stimulation. The kinetics of creatine-phosphocreatine and acetylcarnitine signal changes (P < .001) could be assessed continuously before, during, and after exercise. The control peak (trimethylammonium compounds), which served as an internal reference, did not change. This technique-that is, functional MR spectroscopy-opens the possibility for noninvasive diagnostic muscle metabolite testing in a clinical setting.

Posttetanic Potentiation in Knee Extensors after High-Frequency Submaximal Percutaneous Electrical Stimulation

Context:

The understanding of posttetanic potentiation (PTP) in human muscles induced by percutaneous electrical stimulation (PES) is important for effective application of electrical stimulation in rehabilitation.

Objective:

To examine the effect of 7-second high-frequency (100-Hz) submaximal (25% of maximal voluntary contraction force) direct PES on contractile characteristics of the knee-extensor (KE) muscles.

Design:

Single-group repeated measures.

Setting:

Kinesiology laboratory.

Subjects:

13 healthy men age 18–27 years.

Measurement:

Peak force (PF), maximal rates of force development (RFD) and relaxation (RR) of supramaximal twitch, and PF of doublet and 10-Hz tetanic contractions before and after direct tetanic PES.

Results:

A significant potentiation of twitch, doublet, and 10-Hz tetanic-contraction PF has been observed at 1–5 minutes posttetanic. Twitch RFD and RR were markedly potentiated throughout the 10-minute posttetanic period.

Conclusions:

A brief high-frequency submaximal tetanic PES induces PTP in KE muscles associated with small increase at 1–5 minutes.

Intraneural microstimulation of motor axons in the study of human single motor units

Single motor unit activity has been studied in depth since the first intramuscular electrodes were developed more than 70 years ago. Many techniques have been combined or used in isolation since then. Intraneural motor axon microstimulation allows the detailed study of single motor units in awake human subjects in a manner most analogous to that used in reduced animal preparations. A microelectrode, inserted percutaneously into a peripheral nerve, stimulates the axon of a single alpha-motoneuron at a site remote from the contracting muscle, allowing detailed analyses of the contractile properties of a single motor unit in an otherwise quiescent muscle, that is, without interference of simultaneously active motor units or the presence of an electrode within the muscle. The methods and results obtained using this technique are described and compared to those of other studies of single motor units in human subjects. Differences have been found between human and animal motor units and between motor units of various muscles. Studying human and animal motor units using an analogous technique provides insight into the interpretation of human data when results differ from animal data, and when human motor units cannot be examined in the same way, or at a similar level of detail, as animal motor units.

In vivo MR investigation of skeletal muscle function in small animals

In vivo 31P-MRS investigations have been widely used in small animals to study skeletal muscle function under normal and pathological conditions. Paradoxically in these studies, the benefit provided by 31P-MRS in terms of non-invasiveness is lost because of the utilization of experimental setups that integrate invasive devices for inducing muscle contractions and for measuring mechanical performance. These traditional methodologies, which require surgical preparations, have obvious limitations regarding repeatability in the same animal. The purpose of this review is to highlight the technical aspects of the in vivo MR investigations of skeletal muscle function in small animal models. We will more particularly address the issue related to the invasiveness of different procedures used so far in order to show finally that a further step into non-invasiveness can be achieved, in particular with the support of muscle functional 1H-MRI.

Effect of lactate infusion on M-wave characteristics and force in the rat plantaris muscle during repeated stimulation in situ

It is unclear whether accumulation of lactate in skeletal muscle during exercise contributes to muscle fatigue. The purpose of the present study was to examine the effect of lactate infusion on muscle fatigue during prolonged indirect stimulation in situ. For this purpose, the plantaris muscle was electrically stimulated (50 Hz, for 200 ms, every 2.7 s, 5 V) in situ through the sciatic nerve to perform concentric contractions for 60 min while either saline or lactate was infused intravenously (8 rats/group). Lactate infusion (lactate concentration ∼12 mM) attenuated the reduction in submaximal dynamic force (-49 vs. -68% in rats infused with saline; P < 0.05). Maximum dynamic and isometric forces at the end of the period of stimulation were also higher ( P < 0.05) in rats infused with lactate (3.8 ± 0.3 and 4.4 ± 0.3 N) compared with saline (3.1 ± 0.2 and 3.6 ± 0.2 N). The beneficial effect of lactate infusion on muscle force during prolonged stimulation was associated with a better maintenance of M-wave characteristics compared with control. In contrast, lactate infusion was not associated with any reduction in muscle glycogen utilization or with any reduction of fatigue at the neuromuscular junction (as assessed through maximal direct muscle stimulation: 200 Hz, 200 ms, 150 V).