Ultrasound Does Not Detect Acute Changes in Glycogen in Vastus Lateralis of Man

Muscle Ultrasound Echo Intensity and Fiber Type Composition in Young Females

Ultrasonography has been extensively used to evaluate skeletal muscle morphology. The echo intensity, i.e., the mean pixel intensity of a specific region of interest in an ultrasound image, may vary among muscles and individuals with several intramuscular parameters presumed to influence it. The purpose of this study was to investigate the correlation between muscle echo intensity and muscle fiber type composition in humans. Thirteen female physical education students (age: 22.3 ± 5.4 years, height: 1.63 ± 0.06 m, body mass: 59.9 ± 7.4 kg) with no history of systematic athletic training participated in the study. Body composition with dual X-ray absorptiometry, leg-press maximum strength (1-RM), echo intensity, and the cross-sectional area (CSA) of the vastus lateralis (VL) muscle according to ultrasonography were measured. Muscle biopsies were harvested from the VL site where the echo intensity was measured. VL echo intensity was not significantly correlated with the percentage of type I muscle fibers or with the percentage area of type I muscle fibers. However, when VL echo intensity was corrected for the subcutaneous fat thickness at the site of the measurement, it was significantly correlated with the percentage of type I muscle fibers (r = 0.801, p < 0.01) and the percentage area of type I muscle fibers (r = 0.852, p < 0.01). These results suggest that the echo intensity of the vastus lateralis muscle corrected for the subcutaneous fat thickness at the measurement site may provide an estimate of the muscle fiber type composition, at least in young moderately trained females.

Effects of plyometric- and cycle-based high-intensity interval training on body composition, aerobic capacity, and muscle function in young females: a field-based group fitness assessment

High-intensity interval training (HIIT) is an effective alternative to moderate intensity continuous training for improvements in body composition and aerobic capacity; however, there is little work comparing different modalities of HIIT. The purpose of this study was to compare the effects of plyometric- (PLYO) and cycle-oriented (CYC) HIIT on body composition, aerobic capacity, and skeletal muscle size, quality, and function in recreationally trained females. Young (21.7 ± 3.1 yrs), recreationally active females were quasi-randomized (1:1 ratio) to 8 weeks of twice weekly PLYO (n = 15) or CYC (n = 15) HIIT. Body composition (four-compartment model), VO2peak, countermovement jump performance, muscle size, and echo intensity (muscle quality), as well as strength and power of the knee extensors and plantar flexors were measured before and after training. Both groups showed a similar decrease in body fat percentage (p < 0.001;η p 2   = 0.409) and echo intensity (p < 0.001;η p 2 = 0.558), and an increase in fat-free mass (p < 0.001;η p 2   = 0.367) and VO2peak (p = 0.001;η p 2 = 0.318). Muscle size was unaffected (p > 0.05), whereas peak torque was reduced similarly in both groups (p = 0.017;η p 2 = 0.188) and rapid torque capacity was diminished only for the knee extensors after CYC (p = 0.022; d = -0.67). These results suggest that PLYO and CYC HIIT are similarly effective for improving body composition, aerobic capacity, and muscle quality, whereas muscle function may express moderate decrements in recreationally active females. ClinicalTrials.gov (NCT05821504).

Do Intramuscular Temperature and Fascicle Angle Affect Ultrasound Echo Intensity Values?

PURPOSE

Ultrasound-derived echo intensity (EI) has been used as a physiological marker for changes in skeletal muscle "quality" with physical training, disuse, aging, and neuromuscular disorders. However, the methodological and physiological factors influencing EI and its longitudinal change are still unclear. Here, we performed two separate experiments to investigate the effects of muscle temperature and fascicle angle, which are known to influence muscle tissue and sound wave properties and therefore affect EI.

METHODS

In experiment 1 ( n = 16, 28.0 ± 6.6 yr), vastus lateralis (VL) ultrasonographic images were acquired and intramuscular temperature continuously recorded for 15 min after 20 min of heating to 40.4°C ± 0.7°C using a microwave device. In experiment 2 ( n = 17, 30.2 ± 9.8 yr), VL sonographic images were obtained with the knee both fully extended (0°) and flexed to 90° and EI and fascicle angle measured post hoc . Fascicle movement was tracked during the passive knee flexion to ensure that sonographic images were obtained at the same muscle region. Knee flexion reduced muscle thickness, and we therefore reran analyses calculating EI using identical dimensions to minimize this effect.

RESULTS

EI decreased only immediately after the passive heating, and although a moderate, negative correlation was observed between EI and temperature ( rrm = -0.36), the effect of muscle temperature was small ( β = 0.97 (-1.89 to -0.06) per degree Celsius, P = 0.051). Nonetheless, EI increased as fascicle angle decreased, and a large, negative correlation ( rrm = -0.85) was observed; the effect of fascicle angle on EI was large ( β = 3.0 (-3.8 to -2.2) per degree, P < 0.01), and this was maintained when analyses were performed at a constant depth of the region of interest ( β = 3.5 (-4.4 to -2.7) per degree, P < 0.01).

CONCLUSIONS

These findings support the hypothesis that fascicle angle meaningfully affects VL EI but provides weak evidence of a temperature effect in vivo . Thus, acute fascicle angle alterations should be accounted for in studies using EI measurements, and longer-term studies should consider whether changes in EI might be partly explained by a change in fascicle angle.

Muscle Glycogen Assessment and Relationship with Body Hydration Status: A Narrative Review

Muscle glycogen is a crucial energy source for exercise, and assessment of muscle glycogen storage contributes to the adequate manipulation of muscle glycogen levels in athletes before and after training and competition. Muscle biopsy is the traditional and gold standard method for measuring muscle glycogen; alternatively, ¹³C magnetic resonance spectroscopy (MRS) has been developed as a reliable and non-invasive method. Furthermore, outcomes of ultrasound and bioimpedance methods have been reported to change in association with muscle glycogen conditions. The physiological mechanisms underlying this activity are assumed to involve a change in water content bound to glycogen; however, the relationship between body water and stored muscle glycogen is inconclusive. In this review, we discuss currently available muscle glycogen assessment methods, focusing on ¹³C MRS. In addition, we consider the involvement of muscle glycogen in changes in body water content and discuss the feasibility of ultrasound and bioimpedance outcomes as indicators of muscle glycogen levels. In relation to changes in body water content associated with muscle glycogen, this review broadens the discussion on changes in body weight and body components other than body water, including fat, during carbohydrate loading. From these discussions, we highlight practical issues regarding muscle glycogen assessment and manipulation in the sports field.

Contrast With Compression Therapy Enhances Muscle Function Recovery and Attenuates Glycogen Disruption After Exercise

BACKGROUND

Exercise-associated muscle damage (EAMD) temporally impairs muscle function and intramuscular glycogen storage. Contrast with compression (CwC) therapy provides localized EAMD treatment with minimal changes in core/tissue temperature that can impair glycogen resynthesis.

HYPOTHESIS

CwC will enhance the recovery of strength, power, and joint mobility, reduce markers of EAMD, and attenuate the disruption of glycogen storage observed after damaging exercise.

STUDY DESIGN

Randomized controlled trial with crossover design.

LEVEL OF EVIDENCE

Level 2.

METHODS

Ten men completed 2 bouts of eccentric elbow flexor exercise, separated by 1 week, using contralateral arms. After each bout, participants received either CwC therapy (at 0, 24, and 48 h postexercise) or no therapy with intervention order and limb randomly assigned. Prior to (pre-exercise) and 1, 24, 48, and 72 h after each exercise bout, muscular strength, muscular power, intramuscular glycogen, creatine kinase, muscle thickness, muscle soreness, pressure pain threshold, active elbow flexion, passive elbow extension, and dietary intake were assessed. Comparisons were made between conditions over time (interaction effects) using separate repeated-measures analyses of variance/multivariate analyses of variance and effect sizes (Cohen d) to describe treatment effect at each time point.

RESULTS

Significant interaction effects were observed for muscular strength (d = 0.67-1.12), muscular power (d = 0.20-0.65), intramuscular glycogen (d = 0.29-0.81), creatine kinase (d = 0.01-0.96), muscle thickness (d = 0.35-0.70), muscle soreness (d = 0.18-0.85), and active elbow flexion (d = 0.65-1.17) indicating a beneficial effect of CwC over time (P ≤ 0.05). In contrast, no significant interaction effect was observed for pressure pain threshold or passive elbow extension (P > 0.05).

CONCLUSION

These results support the use of CwC for the recovery of muscle function after damaging exercise in male patients and indicate that CwC attenuates, but does not remove, the disruption of intramuscular glycogen stores observed after intense eccentric exercise.

CLINICAL RELEVANCE

Glycolysis-dependent athletes may benefit from CwC therapy after training/competition that causes EAMD.

Examination of Changes in Echo Intensity Following Resistance Exercise among Various Regions of Interest

AIM

Within the resistance exercise literature, echo intensity (EI) is often quantified using different regions of interest (ROI).

PURPOSE

To compare changes in the EI of images of the biceps muscle using different ROI immediately following exercise as well as 24 and 48 h following exercise.

METHODS

Twenty seven non-resistance trained individuals visited the laboratory 4 times. One arm was assigned to the experimental condition, and the other was a non-exercise control. During visit 1, paperwork and strength were measured. During visit, 2 participant's muscles were imaged before performing biceps curls. Additional muscle images were taken immediately after exercise, as well as 24 and 48 h post. EI was measured using three different ROI: 1) Trace around the entire muscle; 2) Small box placed in the middle of the muscle (2 × 2cm); and 3) Maximal rectangular box. Results are displayed as means (95%CI).

RESULTS

There was no condition (experimental vs. control) x time (pre, post, 24h and 48h) x box size (small, large, full trace) interaction (p = 0·592). However, there was a main effect for box size (p < 0·001). EI values were higher with the small box [28·2 (23·3, 33·1) AU] compared to the large box [26·8 (22·3, 31·2) AU, p = 0·016] and compared to the full trace [24·2 (20·3, 28·0) AU p < 0·001)]. In addition, EI values were higher with the large box compared to the full trace technique (p = 0·001).

CONCLUSION

Similar changes in EI are detected when using different commonly used ROI for analysing EI. However, when larger ROI are examined, EI values appear to be lower.

The Validity of Ultrasound Technology in Providing an Indirect Estimate of Muscle Glycogen Concentrations Is Equivocal

Researchers and practitioners in sports nutrition would greatly benefit from a rapid, portable, and non-invasive technique to measure muscle glycogen, both in the laboratory and field. This explains the interest in MuscleSound^®, the first commercial system to use high-frequency ultrasound technology and image analysis from patented cloud-based software to estimate muscle glycogen content from the echogenicity of the ultrasound image. This technique is based largely on muscle water content, which is presumed to act as a proxy for glycogen. Despite the promise of early validation studies, newer studies from independent groups reported discrepant results, with MuscleSound^® scores failing to correlate with the glycogen content of biopsy-derived mixed muscle samples or to show the expected changes in muscle glycogen associated with various diet and exercise strategies. The explanation of issues related to the site of assessment do not account for these discrepancies, and there are substantial problems with the premise that the ratio of glycogen to water in the muscle is constant. Although further studies investigating this technique are warranted, current evidence that MuscleSound^® technology can provide valid and actionable information around muscle glycogen stores is at best equivocal.

The Relationship Between Muscle Size and Strength Does not Depend on Echo Intensity in Healthy Young Adults

Muscle quality is typically defined as muscle strength relative to muscle size. Echo intensity has gained popularity as an index of skeletal muscle quality. There is common agreement that muscle size is related to strength at baseline and echo intensity is purported to impact this relationship. Thus, the purpose of this study was to examine whether echo intensity can be used as a physiological marker for muscle quality by investigating the moderating effect of echo intensity on the relationship between muscle size and strength. A sample of 96 participants was used for the upper body analysis and a separate sample of 96 participants was used for the lower body analysis. Echo intensity, muscle thickness, and strength measurements were measured on each limb. For strength, participants performed unilateral elbow flexion (upper body analysis) and knee extension (lower body analysis) to quantify 1-repetition maximum. Muscle thickness and echo intensity were determined from images captured using B-mode ultrasound. Muscle size correlated with muscle strength for all limbs. However, the relationship between muscle size and strength was not significantly moderated by echo intensity for Arm 1 (b = 0.042, p = 0.54) or Arm 2 (b = -0.002, p = 0.97). At the proximal site, no significant moderating effect of echo intensity was found in Leg 1 (b = 0.037, p = 0.67) or Leg 2 (b = -0.085, p = 0.29). Similarly, no significant moderating effect was observed at the distal site for Leg 1 (b = 0.03, p = 0.69) or Leg 2 (b = -0.026, p = 0.75). The results would indicate that the relationship between muscle size and strength does not depend on echo intensity. Therefore, the use of echo intensity as an index of muscle quality in healthy young adults may need to be reconsidered.

Examination of the confounding effect of subcutaneous fat on muscle echo intensity utilizing exogenous fat

We aimed to provide an unbiased estimate of the confounding effect of subcutaneous fat thickness on ultrasound echo intensity (EI) measures of muscle quality. The effect of fat thickness on EI was verified for an approximate range of 0 to 3 cm of fat using exogeneous layers of pork fat over the human tibialis anterior muscle. Sonograms were obtained (i) with focus constant across fat thickness conditions, and (ii) with focus position adjusted to the muscle region of interest (ROI) position for each fat thickness level. In agreement with our hypothesis, increasing fat between the probe and the ROI resulted in a decrease in EI. This overestimating effect of fat on muscle quality differs between sonograms with constant focus and sonograms with focus position adjusted to the vertical displacement in ROI position that occurs for different levels of fat thickness. Correcting equations to account for the overestimating effect of fat on muscle quality are provided for both focus conditions. This is the first study to systematically analyze the confounding effect of fat thickness as an independent factor and the provided equations can be used for improved accuracy in estimates of muscle quality in obese/overweight subjects/patients.

Novelty: The independent confounding effect of subcutaneous fat thickness on ultrasound (US) estimates of muscle quality was quantified. US estimates of muscle quality depend on whether focus is adjusted to the muscle region of interest or not. Equations for correcting muscle quality estimates are provided.

Echo intensity as an indicator of skeletal muscle quality: applications, methodology, and future directions

PURPOSE

This narrative review provides an overview of the current knowledge of B-mode ultrasound-derived echo intensity (EI) as an indicator of skeletal muscle quality.

METHOD

PubMed and Google Scholar were used to search the literature. Advanced search functions were used to find original studies with the terms 'echo intensity' and/or 'muscle quality' in the title and/or abstract. Publications that conceptually described muscle quality but did not include measurement of EI were not a focus of the review.

RESULT

Importantly, the foundational premise of EI remains unclear. While it is likely that EI reflects intramuscular adiposity, data suggesting that these measurements are influenced by fibrous tissue is limited to diseased muscle and animal models. EI appears to show particular promise in studying muscular aging. Studies have consistently reported an association between EI and muscle function, though not all chronic interventions have demonstrated improvements. Based on the existing literature, it is unclear if EI can be used as a marker of muscle glycogen following exercise and nutritional interventions, or if EI is influenced by hydration status. Inconsistent methodological approaches used across laboratories have made comparing EI studies challenging. Image depth, rest duration, participant positioning, probe tilt, and the decision to correct for subcutaneous adipose tissue thickness are all critical considerations when interpreting the literature and planning studies.

CONCLUSION

While some areas show conflicting evidence, EI shows promise as a novel tool for studying muscle quality. Collaborative efforts focused on methodology are necessary to enhance the consistency and quality of the EI literature.

Comment on: "Changes in Skeletal Muscle Glycogen Content in Professional Soccer Players before and after a Match by a NonInvasive MuscleSound® Technology. A Cross Sectional Pilot Study Nutrients 2020, 12(4), 971"

San-Millán and colleagues [...].

Indirect Assessment of Skeletal Muscle Glycogen Content in Professional Soccer Players before and after a Match through a Non-Invasive Ultrasound Technology

Skeletal muscle glycogen (SMG) stores in highly glycolytic activities regulate muscle contraction by controlling calcium release and uptake from sarcoplasmic reticulum, which could affect muscle contraction. Historically, the assessment of SMG was performed through invasive and non-practical muscle biopsies. In this study we have utilized a novel methodology to assess SMG through a non-invasive high-frequency ultrasound. Nine MLS professional soccer players (180.4 ± 5.9 cm; 72.4 ± 9.3 kg; 10.4% ± 0.7% body fat) participated. All followed the nutritional protocol 24 h before the official match as well as performing the same practice program the entire week leading to the match. The SMG decreased from 80 ± 8.6 to 63.9 ± 10.2; p = 0.005 on MuscleSound^® score (0–100) representing a 20% ± 10.4% decrease in muscle glycogen after match. Inter-individual differences in both starting glycogen content (65–90) and in percentage decrease in glycogen after the match (between 6.2% and 44.5%). Some players may not start the match with adequate SMG while others’ SMG decreased significantly throughout the game. Adequate pre-match SMG should be achieved during half-time and game-play in order to mitigate the decrease in glycogen. Further and more ample studies are needed before the application of this technology.

Exercise induced changes in echo intensity within the muscle: a brief review

Echo intensity is the mean pixel intensity of a specific region of interest from an ultrasound image. This variable has been increasingly used in the literature as a physiological marker. Although there has been an increased interest in reporting changes in echo intensity in response to exercise, little consensus exists as to what a change in echo intensity represents physiologically. The purpose of this paper is to review some of the earliest, as well as the most up to date literature regarding the changes in echo intensity in response to exercise. Echo intensity has been used to measure muscle quality, muscle damage, acute swelling, and intramuscular glycogen. The changes in echo intensity, however, are not consistent throughout the literature and often times lead to conclusions that seem contrary to the physiologic effects of exercise. For example, echo intensity increases in conjunction with increases in strength, contrary to what would be expected if echo intensity was a marker of muscle quality/muscle damage. It is conceivable that a change in echo intensity represents a range of physiologic effects at different time points. We recommend that these effects should be determined experimentally in order to rule out what echo intensity might and might not represent. Until this is done, caution should be employed when interpreting changes in echo intensity with acute and chronic exercise.