Neuromuscular recovery from severe- and extreme-intensity exercise in men and women

Maximal voluntary contraction force (MVC), potentiated twitch force (Qpot), and voluntary activation (%VA) recover to baseline within 90s following extreme-intensity exercise. However, methodological limitations masked important recovery kinetics. We hypothesized reductions in MVC, Qpot, and %VA at task failure following extreme-intensity exercise would be less than following severe-intensity exercise, and Qpot and MVC following extreme-intensity exercise would show significant recovery within 120s but remain depressed following severe-intensity exercise. Twelve subjects (6 men) completed two severe-intensity (40, 50%MVC) and two extreme-intensity (70, 80%MVC) isometric knee-extension exercise bouts to task failure (Tlim). Neuromuscular function was measured at baseline, Tlim, and through 150s of recovery. Each intensity significantly reduced MVC and Qpot compared to baseline. MVC was greater at T¬lim (p<0.01) and at 150s of recovery (p=0.004) following exercise at 80%MVC compared to severe-intensity exercise. Partial recovery of MVC and Qpot were detected within 150s following Tlim for each exercise intensity; Qpot recovered to baseline values within 150s of recovery following exercise at 80%MVC. No differences in %VA were detected pre- to post-exercise or across recovery for any intensity. Although further analysis showed sex-specific differences in MVC and Qpot, future studies should closely examine sex-dependent responses to extreme-intensity exercise. It is clear, however, that these data reinforce that mechanisms limiting exercise tolerance during extreme-intensity exercise recover quickly. NOVELTY: •Severe- and extreme-intensity exercise cause independent responses in fatigue accumulation and the subsequent recovery time courses. •Recovery of MVC and Qpot occurs much faster following extreme-intensity exercise in both men and women.

The Effect of Limb Position on a Static Knee Extension Task can be Explained with a Simple Spinal Cord Circuit Model

The influence of proprioceptive feedback on muscle activity during isometric tasks is the subject of conflicting studies. We performed an isometric knee extension task experiment based on two common clinical tests for mobility and flexibility. The task was carried out at four pre-set angles of the knee and we recorded from five muscles for two different hip positions. We applied muscle synergy analysis using non-negative matrix factorisation on surface electromyograph recordings to identify patterns in the data which changed with internal knee angle, suggesting a link between proprioception and muscle activity. We hypothesised that such patterns arise from the way proprioceptive and cortical signals are integrated in neural circuits of the spinal cord. Using the MIIND neural simulation platform, we developed a computational model based on current understanding of spinal circuits with an adjustable afferent input. The model produces the same synergy trends as observed in the data, driven by changes in the afferent input. In order to match the activation patterns from each knee angle and position of the experiment, the model predicts the need for three distinct inputs: two to control a non-linear bias towards the extensors and against the flexors, and a further input to control additional inhibition of rectus femoris. The results show that proprioception may be involved in modulating muscle synergies encoded in cortical or spinal neural circuits.

Establishing Reference Values for Isometric Knee Extension and Flexion Strength

Single-joint isometric and isokinetic knee strength assessment plays an important role in strength and conditioning, physical therapy, and rehabilitation. The literature, however, lacks absolute reference values. We systematically reviewed the available studies that assessed isometric knee strength. Two scientific databases (PubMed and PEDro) were searched for the papers that are published from the inception of the field to the end of 2019. We included studies that involved participants of both genders and different age groups, regardless of the study design, that involved isometric knee extension and/or flexion measurement. The extracted data were converted to body-mass-normalized values. Moreover, the data were grouped according to the knee angle condition (extended, mid-range, and flexed). A meta-analysis was performed on 13,893 participants from 411 studies. In adult healthy males, the pooled 95% confidence intervals (CI) for knee extension were 1.34–2.23Nm/kg for extended knee angle, 2.92–3.45Nm/kg for mid-range knee angle, and 2.50–3.06Nm/kg for flexed knee angle, while the CIs for flexion were 0.85–1.20, 1.15–1.62, and 0.96–1.54Nm/kg, respectively. Adult females consistently showed lower strength than adult male subgroups (e.g., the CIs for knee extension were 1.01–1.50, 2.08–2.74, and 2.04–2.71Nm/kg for extended, mid-range, and flexed knee angle condition). Older adults consistently showed lower values than adults (e.g., pooled CIs for mid-range knee angle were 1.74–2.16Nm/kg (male) and 1.40–1.64Nm/kg (female) for extension, and 0.69–0.89Nm/kg (male) and 0.46–0.81Nm/kg (female) for flexion). Reliable normative for athletes could not be calculated due to limited number of studies for individual sports.

EARLY STRENGTH TESTING AFTER ACL RECONSTRUCTION IMPACTS ISOKINETIC STRENGTH PERFORMANCE AT TIME OF RETURN TO SPORT

Background: The standard of care in ACL reconstruction (ACLR) typically involves standardized strength testing at 6 months or later to assess a patient’s readiness to return to play (RTP) using isokinetic and isometric testing, and functional strength testing. Recent literature suggests that isokinetic knee extension strength should demonstrate 89% limb symmetry index (LSI) or greater prior to returning to sport. However, there is little known on the effects of strength testing early in the rehabilitation process and the relationship to strength test performance at time of RTP. Purpose: The purpose of this study was to examine how early post-operative strength test performance impacts isokinetic strength outcomes at RTP testing in adolescents. Methods: The retrospective cohort study included patients undergoing primary ACLR between 12 and 18 years of age, early post-operative strength measures, and isokinetic dynamometer strength at RTP from July 2017 and April 2019. Data was dichotomized into desired outcomes at 3 months: >70% isometric knee extension LSI, > 20 repetitions on anterior stepdown test (AST), > 90% LSI Y Balance. At RTP testing, isokinetic knee extension strength data was categorized into >89% LSI at 3 speeds (300, 180, 60°/sec). Chi square testing and odds ratio statistics were used to examine association and its magnitude. Results: 63 patients met inclusion criteria (38 females; 15.37±1.66 years old). >70% LSI isometric knee extension strength at 3 months showed a significant association (Table 2) and demonstrated the strongest odds of having >89% LSI on isokinetic strength tests at all 3 speeds at RTP with 180°/sec being the highest (OR=14.5; 95% CI=4.25,49.43; p= <0.001). Performance on AST showed a significant association (χ2 (1, n=63) = 17.00, p <0.001), and highest odds at 180°/sec (OR=4.61; 95% CI = 1.59, 13.39, p=<0.001) and 60°/sec (OR= 3.07; 95% CI = 1.10, 8.63, p= 0.04). Combination of performance on isometric strength tests and AST showed a significant association to isokinetic strength at all three speeds, but less predictive then isometrics in isolation. (Table 2). There was no significant relationship between YBR LSI at 3 months and isokinetic strength at 6 months. Conclusion: Standardized strength testing early in rehabilitation can help identify patients that will successfully complete RTP testing. Our results suggest that isometric knee extension strength and timed anterior stepdown test provide meaningful clinical information early in the rehabilitation process. This data also suggests that the use of YBAL for predicting isokinetic strength performance is limited. [Table: see text][Table: see text]

Older Compared With Younger Adults Performed 467 Fewer Sit-to-Stand Trials, Accompanied by Small Changes in Muscle Activation and Voluntary Force

Background: Repetitive sit-to-stand (rSTS) is a fatigue perturbation model to examine the age-effects on adaptability in posture and gait, yet the age-effects on muscle activation during rSTS per se are unclear. We examined the effects of age and exhaustive rSTS on muscle activation magnitude, onset, and duration during ascent and descent phases of the STS task.Methods: Healthy older (n = 12) and younger (n = 11) adults performed rSTS, at a controlled frequency dictated by a metronome (2 s for cycle), to failure or for 30 min. We assessed muscle activation magnitude, onset, and duration of plantar flexors, dorsiflexors, knee flexors, knee extensors, and hip stabilizers during the initial and late stages of rSTS. Before and after rSTS, we measured maximal voluntary isometric knee extension force, and rate of perceived exertion, which was also recorded during rSTS task.Results: Older vs. younger adults generated 35% lower maximum voluntary isometric knee extension force. During the initial stage of rSTS, older vs. younger adults activated the dorsiflexor 60% higher, all 5 muscle groups 37% longer, and the hip stabilizers 80% earlier. Older vs. younger adults completed 467 fewer STS trials and, at failure, their rate of perceived exertion was ~17 of 20 on the Borg scale. At the end of the rSTS, maximum voluntary isometric knee extension force decreased 16% similarly in older and younger, as well as the similar age groups decline in activation of the dorsiflexor and knee extensor muscles (all p &lt; 0.05).Conclusion: By performing 467 fewer STS trials, older adults minimized the potential effects of fatigability on muscle activation, voluntary force, and motor function. Such a sparing effect may explain the minimal changes in gait after rSTS reported in previous studies, suggesting a limited scope of this perturbation model to probe age-effects on muscle adaptation in functional tasks.

Motor unit recruitment patterns of the quadriceps differ between continuous high- and low-torque isometric knee extension to momentary failure

The size principle is a theory of motor unit (MU) recruitment that suggests MUs are recruited in an orderly manner from the smallest (lower threshold) to the largest (higher threshold) MUs. A consequence of this biophysical theory is that, for isometric contractions, recruitment is dependent on the intensity of actual effort required to meet task demands. This concept has been supported by modelling work demonstrating that, in tasks performed to momentary failure, full MU recruitment will have occurred upon reaching failure irrespective of the force requirements of the task. However, in vivo studies examining this are limited. Therefore, the aim of the current study was to examine MU recruitment of the quadriceps under both higher- and lower-torque (70% and 30% of MVC, respectively) isometric knee extension, performed to momentary failure. Specifically, we compared surface electromyography (sEMG) frequency characteristics, determined by wavelet analysis, across the two continuous isometric knee extension tasks to identify potential differences in recruitment patterns. A convenience sample of 10 recreationally active adult males (height: mean = 179.6, SD = 6.0 cm; mass: mean = 76.8, SD = 7.3 kg; age: mean = 26 SD = 7 years) with previous resistance training experience (mean = 6, SD = 3 years) were recruited. Using a within-session, repeated-measures, randomised crossover design participants performed the knee extension tasks whilst sEMG was collected from the vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL). Myoelectric signals were decomposed into intensities as a function of time and frequency using an EMG-specific wavelet transformation. Our first analysis compared the mean frequency at momentary failure; second, we investigated the effects of load on relative changes in wavelet intensities; finally, we quantified the degree of wavelet similarity over time. Wavelet-based calculation of the mean signal frequency appeared to show similar mean frequency characteristics occurring when reaching momentary failure. However, individual wavelets revealed that different changes in frequency components occurred between the two tasks, suggesting that patterns of recruitment differed. Low-torque conditions resulted in an increase in intensity of all frequency components across the trials for each muscle whereas high-torque conditions resulted in a wider range of frequency components contained within the myoelectric signals at the beginning of the trials. However, as the low-torque trial neared momentary failure there was an increased agreement between conditions across wavelets. Our results corroborate modelling studies as well as recent biopsy evidence, suggesting overall MU recruitment may largely be similar for isometric tasks performed to momentary failure with the highest threshold MUs likely recruited, despite being achieved with differences in the pattern of recruitment over time utilised.

Physical Activity, Sedentary Behavior, And Skeletal Muscle Strength In Patients With Chronic Kidney Disease: An Isotemporal Substitution Approach

Objective Insufficient physical activity and excessive sedentary behavior can contribute to decreased skeletal muscle strength, which is strongly associated with increased mortality in patients with chronic kidney disease (CKD). However, the potential impact of replacing sedentary behavior with physical activity on skeletal muscle strength remains unclear in these patients. The purpose of this study was to examine the associations of physical activity, sedentary behavior, and skeletal muscle strength in patients with CKD using an isotemporal substitution model to estimate the associations on replacing time from one behavior to another while keeping the total time and other behaviors fixed. Methods A total of 108 patients with CKD (mean age = 65 [SD = 9] y; mean estimated glomerular filtration rate = 57 [SD = 22] mL/min/1.73m2) participated in this cross-sectional analysis study. The time spent in sedentary behavior, light-intensity physical activity, and moderate- to vigorous-intensity physical activity (MVPA) were assessed using a triaxial accelerometer. Handgrip strength, isometric knee extension strength, and 30-second chair stand test were used to measure skeletal muscle strength. Results In multivariate analyses (single-factor and partition models), the time spent in MVPA was beneficially associated with both isometric knee extension strength and 30-second chair stand test. Furthermore, the isotemporal substitution model found that replacing 10 minutes per day of sedentary behavior or light-intensity physical activity with equivalent MVPA time was beneficially associated with both isometric knee extension strength and 30-second chair stand test. Conclusions Our cross-sectional findings indicate that MVPA time is beneficially associated with lower extremity muscle strength and that a slight increase in the MVPA time may contribute to maintaining skeletal muscle strength in patients with CKD. Impact Increasing the time spent in MVPA (10 min/day) may be a feasible strategy in patients with CKD, who have a high prevalence of impaired physical function.