Motivation and preferences of cancer patients to perform physical training

OBJECTIVE

The aims of this cross-sectional study were to investigate the knowledge about and experience with exercise as well as the motivation and preferences (e.g. availability) of cancer patients to participate in training groups.

METHODS

From 11/2017-06/2018, 181 cancer patients undergoing or completing treatment responded to a compiled questionnaire. The stage of motivation (transtheoretical model of behavioural change), exercise-related knowledge, experience and preferences were evaluated.

RESULTS

Knowledge about the positive effects of exercise was not associated with higher motivation stages. Higher motivation stages showed significant correlations with age (p = 0.044), exercise experience before cancer disease onset (p = 0.022) and exercise experience during cancer therapy (p = 0.013). For 59% of patients, group offers were an attractive option. Physically inactive patients preferred specialised cancer exercise groups (p = 0.002), whereas physically active patients preferred cross-disease rehabilitation exercise groups (p = 0.034) and exercise groups with healthy people (p = 0.018).

CONCLUSIONS

Results indicate that motivation of cancer patients for exercise depends on their experiences with physical training before and during disease treatment. Motivation could be increased by integrating exercise programmes during cancer therapy. These programmes should focus on patients inexperienced in physical training.

Ischemic Preconditioning Did Not Affect Central and Peripheral Factors of Performance Fatigability After Submaximal Isometric Exercise

The present study was designed to provide further insight into the mechanistic basis for the improved exercise tolerance following ischemic preconditioning (IPC) by investigating key-determinants of performance and perceived fatigability. Using a randomized, counterbalanced, single-blind, sham-controlled, crossover design, 16 males performed an isometric time-to-exhaustion test with the knee extensors at 20% maximal voluntary torque (MVT) after an IPC and a sham treatment (SHAM). Those who improved their time-to-exhaustion following IPC performed a time-matched IPC trial corresponding to the exercise duration of SHAM (IPC_tm). Neuromuscular function was assessed before and after exercise termination during each condition (IPC, IPC_tm, and SHAM) to analyze the impact of IPC on performance fatigability and its central and peripheral determinants. Muscle oxygenation (SmO₂), muscle activity, and perceptual responses (effort and muscle pain) were recorded during exercise. Performance fatigability as well as its central and peripheral determinants were quantified as percentage pre-post changes in MVT (ΔMVT) as well as voluntary activation (ΔVA) and quadriceps twitch torque evoked by paired electrical stimuli at 100 and 10 Hz (ΔPS100 and ΔPS10⋅PS100^-1 ratio), respectively. Time-to-exhaustion, performance fatigability, its determinants, muscle activity, SmO₂, and perceptual responses during exercise were not different between IPC and SHAM. However, six participants improved their performance by >10% following IPC (299 ± 71 s) compared to SHAM (253 ± 66 s, d = 3.23). The time-matched comparisons (IPC_tm vs. SHAM) indicated that performance fatigability, its determinants, and SmO₂ were not affected, while effort perception seemed to be lower (η_p ² = 0.495) in those who improved their time-to-exhaustion. The longer time-to-exhaustion following IPC seemed to be associated with a lower effort perception (η_p ² = 0.380) and larger impairments in neuromuscular function, i.e., larger ΔMVT, ΔVA, and ΔPS10⋅PS100^-1 ratio (d = 0.71, 1.0, 0.92, respectively). IPC did neither affect exercise tolerance, performance fatigability, as well as its central and peripheral determinants, nor muscle activity, SmO₂, and perceptual responses during submaximal isometric exercise. However, IPC seemed to have an ergogenic effect in a few subjects, which might have resulted from a lower effort perception during exercise. These findings support the assumption that there are 'responders' and 'non-responders' to IPC.

Mental Fatigue Increases Gait Variability During Dual-task Walking in Old Adults

Background

Mental fatigue is a psychobiological state induced by sustained periods of demanding cognitive activity and is characterized by feelings of tiredness which are common in everyday life. Recently, it has been hypothesized that mental fatigue might have an impact on gait performance in old adults. Therefore, the effect of mental fatigue on gait performance under single- and dual-task conditions was investigated in young and old participants.

Methods

Spatio-temporal gait parameters of 16 young and 16 old healthy participants were measured using a photoelectric system during single- and dual-task walking before and after a randomly assigned mental fatigue (performing a stop-signal task for 90 minutes) and control intervention (watching a video for 90 minutes), respectively. Changes in subjective fatigue, wakefulness, mood, arousal, and psychophysiological workload (heart rate variability indices) were assessed.

Results

Psychometric measures indicated increased subjective fatigue and arousal as well as decreased mood and wakefulness after the mental fatigue task. Heart rate variability indices revealed a higher psychophysiological workload during the mental fatigue intervention in old compared to young participants. Gait measures (coefficient of variation of speed, stride length, and stance time) revealed impaired dual-task walking performance following the mental fatigue intervention only in old participants.

Conclusion

Data indicate that mental fatigue, induced by sustained cognitive activity, can impair gait performance during dual-task walking in old adults. The susceptibility to mental fatigue could be a new intrinsic risk factor for falls in older people and should be taken into account when dual-task gait analyses are performed.

Dietary Nitrate Supplementation Improves Exercise Tolerance by Reducing Muscle Fatigue and Perceptual Responses

The present study was designed to provide further insight into the mechanistic basis for the improved exercise tolerance following dietary nitrate supplementation. In a randomized, double-blind, crossover design, twelve recreationally active males completed a dynamic time-to-exhaustion test of the knee extensors after 5 days of consuming both nitrate-rich (NITRATE) and nitrate-depleted beetroot juice (PLACEBO). Participants who improved their time-to-exhaustion following NITRATE performed a time-matched trial corresponding to the PLACEBO exercise duration with another 5 days of dietary nitrate supplementation. This procedure was performed to obtain time-matched exercise trials with (NITRATE_tm) and without dietary nitrate supplementation (PLACEBO). Neuromuscular tests were performed before and after each time-matched condition. Muscle fatigue was quantified as percentage change in maximal voluntary torque from pre- to post-exercise (ΔMVT). Changes in voluntary activation (ΔVA) and quadriceps twitch torque (ΔPS100) were used to quantify central and peripheral factors of muscle fatigue, respectively. Muscle oxygen saturation, quadriceps muscle activity as well as perceptual data (i.e., perception of effort and leg muscle pain) were recorded during exercise. Time-to-exhaustion was improved with NITRATE (12:41 ± 07:18 min) compared to PLACEBO (09:03 ± 04:18 min; P = 0.010). NITRATE_tm resulted in both lower ΔMVT and ΔPS100 compared to PLACEBO (P = 0.002; P = 0.001, respectively). ΔVA was not different between conditions (P = 0.308). NITRATE_tm resulted in reduced perception of effort and leg muscle pain. Our findings extend the mechanistic basis for the improved exercise tolerance by showing that dietary nitrate supplementation (i) attenuated the development of muscle fatigue by reducing the exercise-induced impairments in contractile muscle function; and (ii) lowered the perception of both effort and leg muscle pain during exercise.

Impact of Blood Flow Restriction Exercise on Muscle Fatigue Development and Recovery

PURPOSE

The present study was designed to provide mechanistic insight into the time course and etiology of muscle fatigue development and recovery during and after low-intensity exercise when it is combined with blood flow restriction (BFR).

METHODS

Seventeen resistance-trained males completed four sets of low-intensity isotonic resistance exercise under two experimental conditions: knee extension exercise (i) with BFR and (ii) without BFR (CON). Neuromuscular tests were performed before, during (immediately after each set of knee extension exercise), and 1, 2, 4, and 8 min after each experimental condition. Maximal voluntary torque, quadriceps twitch torque in response to paired electrical stimuli at 10 Hz (PS10) and 100 Hz (PS100), PS10·PS100 ratio as an index of low-frequency fatigue, and voluntary activation were measured under isometric conditions. Perceptual and EMG data were recorded during each exercise condition.

RESULTS

After the first set of exercise, BFR induced significantly greater reductions in maximal voluntary torque, PS100, and PS10·PS100 ratio compared with CON. These parameters progressively declined throughout the BFR protocol but recovered substantially within 2 min postexercise when blood flow was restored. Neither a progressive decline in the course of the exercise protocol nor a substantial recovery of these parameters occurred during and after CON. Only at exercise termination, voluntary activation differed significantly between BFR and CON with greater reductions during BFR.

CONCLUSION

At the early stage of exercise, BFR exacerbated the development of muscle fatigue mainly due to a pronounced impairment in contractile function. Despite the high level of muscle fatigue during BFR exercise, the effect of BFR on muscle fatigue was diminished after 2 min of reperfusion, suggesting that BFR has a strong but short-lasting effect on neuromuscular function.

Intersession reliability of the interpolated twitch technique applied during isometric, concentric, and eccentric actions of the human knee extensor muscles

INTRODUCTION

Although it has been shown that voluntary activation (%VA) of the knee extensors during isometric contractions can be reliably assessed with the interpolated twitch technique, little is known about the reliability of %VA during concentric and eccentric muscle actions. Therefore, relative and absolute intersession reliability of quadriceps muscle's %VA during different contraction modes was determined.

METHODS

After a familiarization session, 21 participants (17 males, 25 ± 2 yrs) completed two testing sessions. Paired supramaximal electrical stimuli were administered to the femoral nerve during isometric, concentric, eccentric MVCs, and at rest to assess %VA (stimuli were applied at 70° knee flexion).

RESULTS AND DISCUSSION

Data indicate that %VA of the knee extensors can be reliably measured during isometric [intraclass correlation coefficient (ICC) = 0.89, coefficient of variation (CV) = 4.1%], concentric (ICC = 0.87, CV = 6.6%), and eccentric muscle actions (ICC = 0.86, CV = 7.0%). Muscle Nerve 56: 324-327, 2017.

The Bindex(®) ultrasound device: reliability of cortical bone thickness measures and their relationship to regional bone mineral density

The Bindex(®) quantitative ultrasound (QUS) device is currently available and this study analyzed (I) its relative and absolute intra- and inter-session reliability and (II) the relationship between the data provided by Bindex(®)-QUS and the bone mineral density (BMD) measured by dual-energy x-ray absorptiometry at corresponding skeletal sites in young and healthy subjects (age: 25.0  ±  3.6 years). Bindex(®)-QUS calculates a density index on the basis of the thickness of cortical bone measured at the distal radius and the distal plus proximal tibia. The data show a very good relative and absolute intra- (ICC  =  0.977, CV  =  1.5%) and inter-session reliability (ICC  =  0.978, CV  =  1.4%) for the density index. The highest positive correlations were found between cortical thickness and BMD for the distal radius and distal tibia (r  ⩾  0.71, p  <  0.001). The data indicate that the Bindex(®)-QUS parameters are repeatable within and between measurement sessions. Furthermore, the measurements reflect the BMD at specific skeletal sites. Bindex(®)-QUS might be a useful tool for the measurement of skeletal adaptations.

Relationship between muscle volume and contractile properties of the human knee extensors

The present study was designed to investigate the relationship between volume and electrically evoked twitch properties of the quadriceps muscle. Supramaximal single and doublet stimulation of the femoral nerve was used to assess contractile properties at 45° and 80° knee flexion. Muscle volume was measured using a 1.5-Tesla magnetic resonance imaging scanner. Quadriceps muscle volume was only significantly correlated (r = 0.629) with peak twitch torque induced by doublet stimulation at 80° but not at 45° knee flexion.

Interaction against different environmental dynamics during a leg extension task is controlled by temporal rather than amplitude scaling of muscular activity

Force exertion against different mechanical environments can affect motor control strategies in order to account for the altered environmental dynamics and to maintain the ability to produce force. Here, we investigated the change of muscular activity of selected muscles of the lower extremities while the participants interacted with an external mechanical device of variable stability. Twenty-five healthy participants exerted force against the device by performing a unilateral ballistic leg extension task under 1 or 3 degrees of freedom (DoF). Directional force data and electromyographic responses from four leg muscles (TA, VM, GM, PL) were recorded. Muscle responses to the altered experimental conditions were analyzed by calculating time to peak electrical activity (TTP), peak electrical activity (PEA), slope of EMG-signal and muscle activity. It was found that neuromuscular system adjustments to the task are expressed mainly by temporal (TTP) rather than amplitude (PEA) scaling of muscular activity. This change was specific for the investigated muscles. Moreover, a selective increase of muscle activity occurred while increasing external DoF. This scheme was accompanied by a significant reduction of applicable force against the device in the unstable 3 DoF condition. The findings suggest that orchestration of movement control is linked to environmental dynamics also affecting the ability to produce force under dynamic conditions. The adjustments of the neuromuscular system are rather temporal in nature being consistent with the impulse timing hypothesis of motor control.

The effect of increasing external degrees of freedom on force production and neuromuscular stabilisation

Evidence suggests that during interaction with different environmental dynamics the necessity to stabilise the involved joints leads to altered efficiency in force transmission to the surroundings and a specific orchestration of motor control strategies. However, little is known about the modalities of the changes associated with altered environmental dynamics. In 29 healthy participants, electromyographic (EMG) signals from four muscles of the right leg (M. peroneus longus, M. tibialis anterior, M. vastus medialis, M. gastrocnemius medialis) and three dimensions of force (Fx, Fy, Fz) were recorded. The participants were to exert force against an external object by performing a unilateral leg extension task with the task being influenced by either 0, 1 or 3 mechanical degrees of freedom. We hypothesised that the ankle stabilising muscles would increase their activities with increasing degrees of freedom (DoF), and that increasing external degrees of freedom results in decreased muscle force exerted during the movement task. The progressive change in the type of mechanical interaction from stable to unstable caused a loss of the ability to apply force in movement direction (Fz) which was accompanied by a reduction of Fy and Fx force dimensions. These reductions corresponded to maximum losses of 23% for Fz, 33% for Fx and 41% for Fy in the three degrees of freedom condition (all P < 0.001). Next, the individual muscles showed specific tuning effects, depending on the type of mechanical interaction. Our results suggest that the loss of the ability to exert force effectively against the external object is due to the neuromuscular stabilisation process of the involved joints. The change of the degrees of freedom conditions allowed for assessment of movement- or stabilisation-related adjustments of the motor system.

Investigation of first ray mobility during gait by kinematic fluoroscopic imaging--a novel method

Background

It is often suggested that sagittal instability at the first tarso-metatarsal joint level is a primary factor for hallux valgus and that sagittal instability increases with the progression of the deformity. The assessment of the degree of vertical instability is usually made by clinical evaluation while any measurements mostly refer to a static assessment of medial ray mobility (i.e. the plantar/dorsal flexion in the sagittal plane). Testing methods currently available cannot attribute the degree of mobility to the corresponding anatomical joints making up the medial column of the foot. The aim of this study was to develop a technique which allows for a quantification of the in-vivo sagittal mobility of the joints of the medial foot column during the roll-over process under full weight bearing.

Methods

Mobility of first ray bones was investigated by dynamic distortion-free fluoroscopy (25 frames/s) of 14 healthy volunteers and 8 patients with manifested clinical instability of the first ray. A CAD-based evaluation method allowed the determination of mobility and relative displacements and rotations of the first ray bones within the sagittal plane during the stance phase of gait.

Results

Total flexion of the first ray was found to be 13.63 (SD 6.14) mm with the healthy volunteers and 13.06 (SD 8.01) mm with the patients (resolution: 0.245 mm/pixel). The dorsiflexion angle was 5.27 (SD 2.34) degrees in the healthy volunteers and increased to 5.56 (SD 3.37) degrees in the patients. Maximum rotations were found at the naviculo-cuneiform joints and least at the first tarso-metatarsal joint level in both groups.

Conclusions

Dynamic fluoroscopic assessment has been shown to be a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait.

A significant difference in first ray flexion and angular rotation between the patients and healthy volunteers however could not be found.

Repetitive Peripheral Magnetic Stimulation (15 Hz RPMS) of the Human Soleus Muscle did not Affect Spinal Excitability

The electric field induced by repetitive peripheral magnetic stimulation (RPMS) is able to activate muscles artificially due to the stimulation of deep intramuscular motor axons. RPMS applied to the muscle induces proprioceptive input to the central nervous system in different ways. Firstly, the indirect activation of mechanoreceptors and secondly, direct activation of afferent nerve fibers. The purpose of the study was to examine the effects of RPMS applied to the soleus. Thirteen male subjects received RPMS once and were investigated before and after the treatment regarding the parameters maximal M wave (Mmax), maximal H-reflex (Hmax), Hmax/Mmax-ratio, Hmax and Mmax onset latencies and plantar flexor peak twitch torque associated with Hmax (PTH). Eleven male subjects served as controls. No significant changes were observed for Hmax and PTH of the treatment group but the Hmax/Mmax-ratio increased significantly (p = 0.015) on account of a significantly decreased Mmax (p = 0.027). Hmax onset latencies were increased for the treatment group (p = 0.003) as well as for the control group (p = 0.011) while Mmax onset latencies did not change. It is concluded that the RPMS protocol did not affect spinal excitability but acted on the muscle fibres which are part of fast twitch units and mainly responsible for the generation of the maximal M wave. RPMS probably modified the integrity of neuromuscular propagation. Key pointsRPMS probably did not affect spinal excitability.Data suggested that RPMS likely acted on the muscle fibres which are part of fast twitch units and mainly responsible for the generation of the maximal M wave.RPMS probably modified the integrity of neuromuscular propagation.

The nature of the stabilizing functions of skeletal muscles

The paper defines the term coordination interval (CI), suggesting that it should replace the term electromechanical delay (EMD), if this parameter is determined in vivo for a muscle functioning in a biomechanical system with considerable mobility, but not in a kinematic pair with one degree of rotational freedom (DOF). It was adopted that CI is the time elapsing between the moment of exertion of the resultant muscular force to the surroundings by the ending of the biokinematic chain with many DOFs, and the onset of myopotential in the muscle involved in its actuation. Tested at the same time was the utility efficiency of the system: man--unstable external object with adjustable mobility, as well as the participation and coordination patterns of the upper extremity muscles engaged in stabilizing and motor activities. Twelve adult men, students of physical education, took part in the experiment. The experimental set-up was in the form of a 3.08 m long physical pendulum with the inertial moment of 574 kg m2 and with an exchangeable ending that served as a handle. Three endings were used with zero, one or two DOFs in relation to the pendulum shaft. The subjects of the test were told to push the pendulum ending with maximum force using the upper extremity, so as to impart to it the highest possible kinetic energy, irrespective of its stability type and mobility. The muscles straightening the upper extremity and stabilizing the wrist joint were tested in the EMG measurements. As a result of the experiment, it was found that (1) the utility efficiency of the organism in relation to the force and muscular power exerted on the surroundings decreases to 80 and 60%, respectively, if a driven object requires stabilization, and (2) the patterns of muscular synergism expressed by sequences and frequencies of muscular activation by the nervous system, on the grounds of CI, undergo characteristic changes if a driven object becomes unstable.