The effects of low vs. high rating of perceived exertion clamp exercise on performance, neuromuscular, and muscle oxygen saturation responses in females.

PURPOSE: This study examined the time course of changes in force, relative to critical force (CF), electromyographic amplitude (EMG AMP), neuromuscular efficiency (NE), and muscle oxygen saturation (SmO2), as well as time to task failure (TTF) and performance fatigability (PF) during isometric handgrip holds to failure (HTF) anchored to the rating of perceived exertion (RPE) at 3 and 7. METHODS: Ten females completed pre-test maximal voluntary isometric contractions (MVICs), submaximal HTF at four percentages of MVIC, an HTF at RPE = 3 and 7, and post-test MVICs. Analyses included paired samples t-tests, repeated measures ANOVAs and planned comparisons. RESULTS: TTF was not different between RPE 3 (540.4 ± 262.1 s) and 7 (592.2 ± 299.6 s), but PF for RPE 7 (42.1 ± 19.1%) was greater than RPE 3 (33.5 ± 15.4%) (p < 0.05). There were RPE-dependent decreases in force, EMG AMP, and NE across three discernable phases during the HTF (p < 0.01), but there were no significant changes in SmO2 across time. CONCLUSION: Although there were overall similar patterns across time for force, neuromuscular, and muscle metabolic responses between the RPE holds, the greater PF at RPE 7 than RPE 3 may be explained by the longer sustained time above CF at RPE 7, resulting in greater accumulation of intramuscular metabolites and afferent feedback. Throughout each trial, it is possible that force was adjusted to avoid the sensory tolerance limit, and the task was ended when force could no longer be reduced to maintain the assigned RPE, resulting in a similar TTF for RPE 7 and RPE 3.

Examination of sex differences in fatigability and neuromuscular responses during continuous, maximal, isometric leg extension.

BACKGROUND: This study examined sex-related differences in fatigability and neuromuscular responses using surface electromyographic (sEMG) and mechanomyographic (sMMG) amplitude (AMP) and frequency (MPF) during fatiguing, maximal, bilateral isometric leg extensions. Methods: Twenty recreationally active males and females with resistance training experience performed continuous, maximal effort, bilateral isometric leg extensions until their force reduced by 50%. Linear mixed effect models analyzed patterns of force, sEMG, and sMMG AMP and MPF responses in the dominant limb. An independent samples t-test compared time-to-task failure (TTF) between sexes. Results: There were no significant differences in TTF between males and females. However, males experienced a greater rate of force loss compared to females. Furthermore, sEMG AMP and MPF and sMMG AMP responses followed similar linear trends for both sexes, while sMMG MPF showed non-linear responses with sex-dependent differences. Conclusion: These data suggest that although TTF was similar, males had a higher rate of force reduction, likely due to greater absolute strength. Furthermore, despite parallel changes in sEMG AMP and MPF, as well as sMMG AMP, the divergent responses observed in sMMG MPF highlight sex-dependent differences in how males and females experience changes in the firing rates of active motor units during sustained maximal contractions. .

The effects of sex and contraction intensity on fatigability and muscle oxygenation in trained individuals.

Fatigability varies depending on sex and contraction intensity during sustained exercise. This study examined the responses of time to task failure (TTF), performance fatigability (PF), and muscle oxygenation (SmO2) in males and females during isometric handgrip holds to failure (HTF) at 30% and 60% maximum voluntary isometric contraction (MVIC). Males (n=12) and females (n=12) performed a pre-MVIC, handgrip HTF at randomly ordered percentages of MVIC (either 30% or 60%), followed by a post-MVIC on the dominant arm. During the HTF testing, the TTF and SmO2 responses were recorded, and PF was determined from the pre- to post-MVICs. TTF for 30% MVIC HTF was greater than 60% MVIC HTF (p<0.001), but was not different between males and females (p=0.117). PF exhibited an inverse relationship with intensity for each sex, while males demonstrated greater PF than females for both 30% and 60% MVIC HTF. For the 60% MVIC HTF, males demonstrated greater desaturation than females (CI95% = [-28.1, -2.6%], p=0.021 d=0.621), but not for the 30% MVIC HTF (CI95% = [-12.2, 7.9%], p=0.315, d=0.621). Sex differences in PF and SmO2 may be attributed to the differences in muscle mass, absolute strength, contractile properties, and muscle metabolism between males and females. However, these proposed differences between males and females may not fully inform exercise performance (e.g., TTF). Sex-specific fatigue responses may be affected by complex physio-psychological mechanisms, and therefore, additional investigations under diverse exercise conditions are required to better prescribe exercise for both males and females.

Comparison of Force, Neuromuscular, and Metabolic Responses During Sustained, Isometric Handgrip Holds to Failure Anchored to Low and High Perceptual Intensities in Men: An Exploratory Study.

ABSTRACT: Kwak, M, Succi, PJ, Benitez, B, Mitchinson, C, Samaan, MA, Abel, MG, and Bergstrom, HC. Comparison of force, neuromuscular, and metabolic responses during sustained, isometric handgrip holds to failure anchored to low and high perceptual intensities in men: An exploratory study. J Strength Cond Res 38(8): e405-e416, 2024-This study examined the responses of force alterations, relative to critical force (CF), neuromuscular parameters, and muscle oxygenation (SmO2) for isometric handgrip holds to failure (HTF) anchored to ratings of perceived exertion (RPE) of 3 and 7. Twelve men completed pre-maximal voluntary isometric contractions (pre-MVIC), submaximal HTF at 4 percentages of pre-MVIC, HTF at RPE = 3 and 7, and post-MVIC. Mechanomyograpic (MMG) signals and SmO2 were recorded during the RPE HTF. Analyses included paired-samples t-tests and repeated-measures ANOVAs at an alpha level of p ≤ 0.05. Time to task failure was not different between RPE 3 (478.7 ± 196.6 s) and RPE 7 (495.8 ± 173.8 s). Performance fatigability (PF) and MMG amplitude (AMP) were greater for RPE 7 (PF: 37.9 ± 12.9%; MMG AMP: 15.7 ± 7.4% MVIC) than RPE 3 (PF: 30.0 ± 14.5%; MMG AMP: 10.2 ± 6.5% MVIC), but MMG mean power frequency (MPF) was greater for RPE 3 (146.2 ± 31.1% MVIC) than RPE 7 (128.8 ± 23.0% MVIC). There were RPE-dependent decreases in force (p ≤ 0.01) across 3 discernable phases during the HTF. There were decreases in MMG AMP across time for both RPEs, but there were no significant changes in MMG MPF or SmO2. There were overall similar motor unit control strategies and local metabolic demand between RPEs. The majority of the HTF performed below CF at RPE 3 and 7 indicated CF did not reflect the highest sustainable force. When prescribing isometric exercise anchored to RPE, practitioners should be aware of the magnitude of force loss and relative intensity of the task to be sure desired training loads are met.

Force and Neuromuscular Responses During a Handgrip Hold to Failure Anchored to a Moderate Perceptual Intensity in Males.

OBJECTIVES: The current study investigated performance fatigability (PF) and time course of changes in force, electromyographic amplitude (EMG AMP) and frequency (EMG MPF), and neuromuscular efficiency (NME) during a sustained, isometric, handgrip hold to failure (HTF) using the rating of perceived exertion (RPE)-Clamp Model. METHODS: Twelve males performed a handgrip HTF anchored to RPE=5. The time to task failure (Tlim), force (N), EMG AMP and MPF, and NME (normalized force/ normalized EMG AMP) were recorded. Analyses included a paired samples t-test for PF at an alpha of p<0.05, 1-way repeated measures ANOVA across time and post-hoc t-tests (p<0.0025) for force, EMG AMP and MPF, and NME responses. RESULTS: The PF (pre- to post- maximal force % decline) was 38.2±11.5%. There were decreases in responses, relative to 0% Tlim, from 40% to 100% Tlim (force), at 30%, 60%, and 100% Tlim (EMG AMP), from 10% to 100% Tlim(EMP MPF), and from 50% to 65%, and 80% to 100% Tlim (NME) (p<0.0025). CONCLUSIONS: The RPE-Clamp Model in this study demonstrated that pacing strategies may be influenced by the integration of anticipatory, feedforward, and feedback mechanisms, and provided insights into the relationship between neuromuscular and perceptual responses, and actual force generating capacity.

No sex differences in time-to-task failure and neuromuscular patterns of response during submaximal, bilateral, isometric leg extensions.

BACKGROUND: In general, it has been suggested that females are more fatigue-resistant than males, with the magnitude of difference being most pronounced during low-intensity sustained contractions. However, the mechanisms for the apparent sex difference have not yet been fully elucidated in the literature. This study aimed to examine sex-related differences in fatigability and patterns of neuromuscular responses for surface electromyographic (sEMG) and mechanomyographic (sMMG) amplitude and frequency (MPF) characteristics during a sustained submaximal bilateral, isometric leg extension muscle action. METHODS: A sample of 20 young recreationally active males and females with previous resistance training experience performed a sustained, submaximal, bilateral isometric leg extension until task failure. Time-to-task failure was compared using a nonparametric bootstrap of the 95% confidence interval for the mean difference between males and females. Additionally, patterns of response for sEMG and sMMG amplitude and MPF of the dominant limb were examined using linear mixed effect models. RESULTS: There were no differences in time-to-task failure between males and females. Additionally, neuromuscular responses revealed similar patterns of responses between males and females. Interestingly, sEMG amplitude and sMMG amplitude and MPF all revealed non-linear responses, while sEMG MPF demonstrated linear responses. CONCLUSION: These data revealed that time-to-task failure was not different between males and females during sustained submaximal bilateral, isometric leg extension. Interestingly, the parallel, non-linear, increases in sEMG and sMMG amplitude may indicate fatigue induced increases in motor unit recruitment, while the parallel decreases in sMMG MPF may be explained by the intrinsic properties of later recruited motor units, which may have inherently lower firing rates than those recruited earlier.

COVID-19 Imposed Closure of Rural Co-Housing and Loneliness in Older Adults Living Alone: Longitudinal Evidence From South Korea.

This study aimed to examine the impact of COVID-19 on loneliness among rural older women in senior cohousing in Korea. Using a natural experimental study design, we investigated how the pandemic-induced closure of cohousing affected the former residents' loneliness. The sample comprised 84 cohousing residents and 51 individuals in conventional homes. The dependent variable is loneliness, and the independent variables include housing transition, social contact, and support from neighbors and friends. Our findings from fixed effect regression models showed former cohousing residents were less likely to experience loneliness when they had more contact with their friends and neighbors, while negative relationships exacerbated feelings of loneliness. Sharing meals and participating in activities with friends and neighbors in cohousing helped the residents develop effective coping strategies. Senior cohousing in rural areas has the potential to strengthen social ties and protect the most vulnerable subgroup of older adults from social isolation and loneliness.

Metabolic and Perceptual Responses to Constant Heart Rate Exercise at Vigorous Intensities in Women.

PURPOSE: This study quantified the metabolic demands (oxygen uptake (V̇O 2 )), power output adjustments, changes in the V̇O 2 /power output ratio, and perceptual responses (rating of perceived exertion (RPE)) during constant heart rate (HR) exercise performed within the vigorous intensity range (77%-95% HR peak ). METHODS: Twelve women (mean ± SD age, 22 ± 4 yr) performed a graded exercise test to exhaustion to determine peak parameters, and three randomly ordered, constant HR trials to exhaustion or for 60 min at the lower (HR L = 77% HR peak ), middle (HR M = 86% HR peak ), and higher (HR H = 95% HR peak ) end of the vigorous intensity range. Time course of changes and patterns of responses were examined for V̇O 2 , power output, V̇O 2 /power output, and RPE for the composite and for each subject. RESULTS: Across the HR L (time to exhaustion ( Tlim ) = 56.3 ± 9.9 min), HR M (51.8 ± 13.5 min), and HR H (27.2 ± 17.7 min) trials, V̇O 2 and power output decreased quadratically ( P < 0.05) relative to the initial value from 10% to 100% of Tlim , whereas the V̇O 2 /power output increased quadratically from 20% to 100% Tlim , and RPE increased linearly from 50% to 100% Tlim . The V̇O 2 and RPE, collapsed across time, for HR L (54.3% ± 3.3% V̇O 2peak , 11 ± 1.5 RPE) were lower than HR M (64.9% ± 4.5% V̇O 2peak , 14 ± 1.7 RPE), and both were lower than HR H (80.1% ± 4.1% V̇O 2peak , 17 ± 1.4 RPE). None of the 12 subjects at HR L , 6 at HR M , and 7 at HR H were within the vigorous V̇O 2 range. CONCLUSIONS: The HR L was not sufficient to meet the desired metabolic intensity for vigorous exercise, whereas the middle to higher end of the range elicited a V̇O 2 within the prescribed range of only ~50%-60% of the subjects. This study indicated that exercise held constant at a percentage of HR peak cannot consistently be used to prescribe a desired metabolic stimulus.

Application of xanthan and locust bean gum mix or sorbitol in the jelly formulation to improved jelly 3D printing using a fused deposition modeling printer.

This study examined the impacts of applying a xanthan and locust bean gum mix or sorbitol to a jelly formulation on the rheological parameters necessary for 3D printing a jelly applying the fused deposition modeling method. A jelly formulation was fortified with a gum mix (xanthan gum:locust bean gum = 0.625:0.375) at 1% (w/w), or added with sorbitol instead of sugar. Both treatments increased the values of storage modulus and yield stress, related to fidelity and shape retention, and adding the gum mix, in particular, increased the gel strength. Applying these treatments to the formulation that lacks the rheological parameters and gel strength required for 3D printing changed those values in a direction fulfilling the material requirements. This research confirmed that the application of xanthan and locust bean gum mix or sorbitol could adjust the properties of materials used in 3D printing for improved printability.

National enrollment of lung cancer clinical trials is disproportionate based on race and health care access.

OBJECTIVE: Despite declining lung cancer mortality in the United States, survival differences remain among racial and ethnic minorities in addition to those with limited health care access. Improvements in lung cancer treatment can be obtained through clinical trials, yet there are disparities in clinical trial enrollment of other cancer types. This study aims to evaluate disparities in lung cancer clinical trial enrollment to inform future enrollment initiatives. METHODS: We analyzed patients with non-small cell lung cancer from the National Cancer Database (2004-2018), categorizing them as enrolled or not enrolled in clinical trials based on "rx_summ_other" data element. Clinical, demographic, and institutional factors associated with trial enrollment were assessed using bivariate and multivariate analysis, adjusting for institutional-level clustering. RESULTS: A total of 1924 (0.12%) patients with lung cancer were enrolled in clinical trials. Enrolled patients were predominantly non-Hispanic White (82%), with greater socioeconomic status, treated at academic programs (67%), and had private insurance (42%) or Medicare (44%). They also traveled further for treatment compared with unenrolled patients (56 vs 27 miles, P < .001). After adjusting for demographic and clinical factors, lung cancer trial enrollment was significantly less likely among Black (odds ratio, 0.55; 95% confidence interval, 0.5-0.7, P < .001) and Hispanic (0.66; 95% confidence interval, 0.5-0.9, P = .01) patients. Patients with Medicaid or uninsured, in the lowest socioeconomic status group, and those treated at community-based cancer programs were the least likely to enroll. CONCLUSIONS: Enrollment in lung cancer trials disproportionally excludes minority patients, those in the lowest socioeconomic status, community cancer programs, and the underinsured. These disparities in demographic and access for trial participation show a need for improved enrollment strategies.

Evaluating the Optimal Time Between Diagnosis and Surgical Intervention for Early-Stage Lung Cancer.

INTRODUCTION: There is no consensus on the optimal timing for lung cancer surgery. We aim to evaluate the impact of timing of surgical intervention. We hypothesize delay in intervention is associated with worse overall survival and higher pathologic upstaging in early-stage lung cancer. METHODS: We identified patients with cT1/2N0M0 nonsmall cell lung cancer in the National Cancer Database from 2004 to 2018. Patients were categorized by time to surgery groups: early (<26 d), average (26-60 d), and delayed (61-365 d). Primary outcome was overall survival and secondary outcome was pathologic upstaging. Multivariate models and survival analyses were used to determine factors associated with time from diagnosis to surgery, pathologic upstaging, and overall survival. RESULTS: In multivariate model, advanced age, non-Hispanic Black patients, nonprivate insurance, low median income and education, and treatment at low-volume facilities were less likely to undergo early intervention and compared to the average group were more likely to receive delayed intervention. Pathologic upstaging was more likely in the delayed group (odds ratio 1.11, 1.07-1.14) compared to early group (odds ratio 0.96, 0.93-0.99). Early intervention was associated with improved overall survival (hazard ratio 0.93, 0.91-0.95), while delayed intervention was associated with inferior survival (hazard ratio 1.11, 1.09-1.14). CONCLUSIONS: Expeditious surgical intervention is associated with lower rates of pathologic upstaging and improved overall survival in early-stage lung cancer. Delays in surgery are associated with social and economic factors, suggesting disparities in access to surgery. Lung cancer surgery should be performed as quickly as possible to maximize oncologic outcomes.

Analysis of Individual V˙O2max Responses during a Cardiopulmonary Exercise Test and the Verification Phase in Physically Active Women.

This study aimed to investigate the test-retest reliability, mean, and individual responses in the measurement of maximal oxygen consumption (V˙O2max) during a cardiopulmonary exercise test (CPET) and the verification phase during cycle ergometry in women. Nine women (22 ± 2 yrs, 166.0 ± 4.5 cm, 58.6 ± 7.7 kg) completed a CPET, passively rested for 5 min, and then completed a verification phase at 90% of peak power output to determine the highest V˙O2 from the CPET (V˙O2CPET) and verification phase (V˙O2verification) on 2 separate days. Analyses included a two-way repeated measures ANOVA, intraclass correlation coefficients (ICC2,1), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (CoV). There was no test (test 1 versus test 2) × method (CPET vs. verification phase) interaction (p = 0.896) and no main effect for method (p = 0.459). However, test 1 (39.2 mL·kg-1·min-1) was significantly higher than test 2 (38.3 mL·kg-1·min-1) (p = 0.043). The V˙O2CPET (ICC = 0.984; CoV = 1.98%; SEM = 0.77 mL·kg-1·min-1; MD = 2.14 mL·kg-1·min-1) and V˙O2verification (ICC = 0.964; CoV = 3.30%; SEM = 1.27 mL·kg-1·min-1; MD = 3.52 mL·kg-1·min-1) demonstrated "excellent" reliability. Two subjects demonstrated a test 1 V˙O2CPET that exceeded the test 2 V˙O2CPET, and one subject demonstrated a test 1 V˙O2verification that exceeded the test 2 V˙O2verification by more than the respective CPET and verification phase MD. One subject demonstrated a V˙O2CPET that exceeded the V˙O2verification, and one subject demonstrated a V˙O2verification that exceeded the V˙O2CPET by more than the MD. These results demonstrate the importance of examining the individual responses in the measurement of the V˙O2max and suggest that the MD may be a useful threshold to quantify real individual changes in V˙O2.

Unilaterally Induced Quadriceps Fatigue during Sustained Submaximal Isometric Exercise Does Not Alter Contralateral Leg Extensor Performance.

This study investigated the effects of fatiguing unilateral exercise on the ipsilateral, exercised, and contralateral, non-exercised limb's post-exercise performance in males and females. Ten males and ten females performed a fatiguing, unilateral isometric leg extension at 50% maximal voluntary isometric contraction (MVIC) force. Prior to and immediately after the fatiguing tasks, MVICs were performed for the exercised and non-exercised limb, with surface electromyographic (sEMG) and mechanomyography (sMMG) amplitude (AMP) and mean power frequency (MPF) recorded from each limb's vastus lateralis. There were no fatigue-induced, sex-dependent, differences in time to task failure (p = 0.265) or ipsilateral performance fatigability (p = 0.437). However, there was a limb by time interaction (p < 0.001) which indicated decreases in MVIC force of the ipsilateral, exercised (p < 0.001), but not the contralateral, non-exercised limb (p = 0.962). There were no sex-dependent, fatigue-induced differences in neurophysiological outcomes between the limbs (p > 0.05), but there was a fatigue-induced difference in sEMG MPF (p = 0.005). To summarize, there were no differences in fatigability between males and females. Moreover, there was insufficient evidence to support the presence of a general crossover effect following submaximal unilateral isometric exercise. However, independent of sex, the neurophysiological outcomes suggested that competing inputs from the nervous system may influence the performance of both limbs following unilateral fatigue.

Sustainability and perceptual responses during handgrip holds to failure at two fatigue thresholds.

PURPOSE: Critical force (CF) provides an estimate of the asymptote of the force-duration curve and the physical working capacity at the rating of perceived exertion (PWCRPE) estimates the highest force that can be sustained without an increase in perceived exertion. Handgrip-related musculoskeletal disorders and injuries derived from sustained or repetitive motion-induced muscle fatigue are prevalent in the industrial workforce. Thus, it is important to understand the physiological mechanisms underlying performance during handgrip specific tasks to describe individual work capacities. This study examined prolonged, isometric, handgrip exercises by comparing the relative force levels, sustainability, and perceptual responses at two fatigue thresholds, CF and PWCRPE. METHODS: Ten women (26.5 ± 3.5 years) performed submaximal, isometric handgrip holds to failure (HTF) with the dominant hand at four, randomly ordered percentages (30, 40, 50, and 60%) of maximal voluntary isometric contraction (MVIC) force to determine CF and PWCRPE. Isometric handgrip HTF were performed at CF and PWCRPE. Time to task failure and RPE responses were recorded. RESULTS: There were no differences in the relative forces (p = 0.381) or sustainability (p = 0.390) between CF (18.9 ± 2.5% MVIC; 10.1 ± 2.7 min) and PWCRPE (19.5 ± 7.9% MVIC; 11.6 ± 8.4 min), and the RPE increased throughout both holds at CF and PWCRPE. CONCLUSION: It is possible that complex physio-psychological factors may have contributed to the fatigue-induced task failure. CF and PWCRPE may overestimate the highest force output that can be maintained for an extended period of time without fatigue or perceptions of fatigue for isometric handgrip holds.

Electromyographic and mechanomyographic responses of the biceps brachii during concentric and eccentric muscle actions to failure at high and low relative loads.

PURPOSE: This study examined neuromuscular responses of the biceps brachii (BB) for concentric and eccentric muscle actions during bilateral, dynamic constant external resistance (DCER), reciprocal forearm flexions and extensions to failure at high (80% 1 repetition maximum [1RM]) and low (30% 1RM) relative loads. METHODS: Nine women completed 1RM testing and repetitions to failure (RTF) at 30 and 80% 1RM. Electromyographic (EMG) and mechanomyographic (MMG) amplitude (AMP) and mean power frequency (MPF) signals were measured from the BB. Analyses included repeated measures ANOVAs (p < 0.05) and post-hoc pairwise comparisons with Bonferroni corrected alpha of p < 0.008 and p < 0.01 for between and within factor pairwise comparisons, respectively. RESULTS: EMG AMP and MPF were significantly greater for concentric than eccentric muscle actions, regardless of load or time. However, time course of change analysis revealed parallel increases in EMG AMP for concentric and eccentric muscle actions during the RTF trials at 30% 1RM, but no change at 80% 1RM. There were significant increases in MMG AMP during concentric muscle actions, but decreases or no change during eccentric muscle actions. EMG and MMG MPF decreased over time, regardless of muscle action type and loading condition. CONCLUSION: The greater EMG AMP and MPF values during concentric compared to eccentric muscle actions may reflect the difference in the efficiency characteristic of these muscle actions. The neuromuscular responses suggested that fatigue may be mediated by recruitment of additional motor units with lower firing rates during concentric muscle actions, and changes in motor unit synchronization during eccentric muscle actions.

Load-Specific Performance Fatigability, Coactivation, and Neuromuscular Responses to Fatiguing Forearm Flexion Muscle Actions in Women.

ABSTRACT: Benitez, B, Dinyer-McNeeley, TK, McCallum, L, Kwak, M, Succi, PJ, and Bergstrom, HC. Load-specific performance fatigability, coactivation, and neuromuscular responses to fatiguing forearm flexion muscle actions in women. J Strength Cond Res 37(4): 769-779, 2023-This study examined the effects of fatiguing, bilateral, dynamic constant external resistance (DCER) forearm flexion on performance fatigability, coactivation, and neuromuscular responses of the biceps brachii (BB) and triceps brachii (TB) at high (80% 1 repetition maximum [1RM]) and low (30% 1RM) relative loads in women. Ten women completed 1RM testing and repetitions to failure (RTF) at 30 and 80% 1RM. Maximal voluntary isometric force was measured before and after RTF. Electromyographic (EMG) and mechanomyographic (MMG) amplitude (AMP) and mean power frequency (MPF) signals were measured from the BB and TB. Performance fatigability was greater (p < 0.05) after RTF at 30% (%∆ = 41.56 ± 18.61%) than 80% (%∆ = 19.65 ± 8.47%) 1RM. There was an increase in the coactivation ratio (less coactivation) between the initial and final repetitions at 30%, which may reflect greater increases in agonist muscle excitation (EMG AMP) relative to the antagonist for RTF at 30% than 80% 1RM. The initial repetitions EMG AMP was greater for 80% than 30% 1RM, but there was no difference between loads for the final repetitions. For both loads, there were increases in EMG MPF and MMG AMP and decreases in MMG MPF that may suggest fatigue-dependent recruitment of higher-threshold motor units. Thus, RTF at 30 and 80% 1RM during DCER forearm flexion may not necessitate additional muscle excitation to the antagonist muscle despite greater fatigability after RTF at 30% 1RM. These specific acute performance and neuromuscular responses may provide insight into the unique mechanism underlying adaptations to training performed at varying relative loads.

The Minimal Difference as an Individual Threshold to Examine the Utility of a Verification Bout in Determining V̇O 2max.

PURPOSE: A square-wave verification bout to confirm maximal oxygen uptake (V̇O 2max ) from a graded exercise test (GXT) has been recommended based on mean responses. This study used the test-retest reliability, mean, and individual differences between the highest V̇O 2 from the GXT (V̇O 2GXT ) and verification bout (V̇O 2verification ) to examine the efficacy of a verification bout in the determination of O 2max in healthy, recreationally trained, well-motivated men. METHODS: Ten men (24 ± 4 yr) completed a GXT on a cycle ergometer followed by a submaximal verification bout to determine V̇O 2GXT and V̇O 2verification . After completion of the initial GXT, subjects rested for 5 min then performed the verification bout at 90% of the peak power output from the initial GXT. Analyses included a two-way repeated-measures ANOVA, intraclass correlation coefficients (ICC 2,1 ), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (COV). RESULTS: There was no test (test 1 vs test 2)-method (GXT vs verification) interaction ( P = 0.300) and no main effect for test ( P = 0.690), but there was a main effect for method ( P = 0.003). The V̇O 2GXT (46.0 mL⋅kg -1 ⋅min -1 ) was significantly greater than V̇O 2verification (43.9 mL⋅kg -1 ⋅min -1 ), collapsed across test. The V̇O 2GXT (ICC = 0.970, SEM = 1.63 mL⋅kg -1 ⋅min -1 , MD = 4.51 mL⋅kg -1 ⋅min -1 , COV = 3.54%) and the V̇O 2verification (ICC = 0.953, SEM = 1.87 mL⋅kg -1 ⋅min -1 , MD = 5.17 mL⋅kg -1 ⋅min -1 , COV = 4.25%) demonstrated "excellent" reliability. No subject exceeded the MD test-retest for V̇O 2GXT or V̇O 2verification . No subject had a V̇O 2verification that exceeded V̇O 2GXT by more than the MD, but two subjects had a V̇O 2GXT , which exceeded V̇O 2verification by more than the MD. CONCLUSIONS: The excellent reliability of V̇O 2GXT in addition to the examination of the individual differences between V̇O 2GXT and V̇O 2verification using the MD indicated that a standalone GXT was sufficient to determine V̇O 2max .

Regional control after precision lymph node dissection for clinically evident melanoma metastasis.

INTRODUCTION: Completion lymph node dissection (CLND) for microscopic lymph node metastases has been replaced by observation; however, CLND is standard for clinically detectable nodal metastases (cLN). CLND has high morbidity, which may be reduced by excision of only the cLN (precision lymph node dissection [PLND]). We hypothesized that same-basin recurrence risk would be low after PLND. METHODS: Retrospective review at four tertiary care hospitals identified patients who underwent PLND. The primary outcome was 3-year cumulative incidence of isolated same-basin recurrence. RESULTS: Twenty-one patients underwent PLND for cLN without synchronous distant metastases. Reasons for forgoing CLND included patient preference (n = 11), comorbidities (n = 5), imaging indeterminate for distant metastases (n = 2), partial response to checkpoint blockade (n = 1), or not reported (n = 2). A median of 2 nodes (range: 1-6) were resected at PLND, and 68% contained melanoma. Recurrence was observed in 33% overall. Only 1 patient (5%) developed an isolated same-basin recurrence. Cumulative incidences at 3 years were 5.0%, 17.3%, and 49.7% for isolated same-basin recurrence, any same-basin recurrence, and any recurrence, respectively. Complications from PLND were reported in 1 patient (5%). CONCLUSIONS: These pilot data suggest that PLND may provide adequate regional disease control with less morbidity than CLND. These data justify prospective evaluation of PLND in select patients.

Methodological considerations for the determination of VO2max in healthy men.

PURPOSE: A square-wave verification bout to confirm maximal oxygen uptake ([Formula: see text]O2max) from a graded exercise test (GXT) has been recommended. This study ascertained if a verification bout is necessary to determine [Formula: see text]O2max in moderately trained men. METHODS: Ten men (24 ± 4 years) completed familiarization and two treadmill GXTs, followed by a submaximal verification bout to determine [Formula: see text]O2GXT and [Formula: see text]O2verification (highest [Formula: see text]O2 from each testing method). After completing the GXT, subjects rested for 5 min then performed a verification bout at 90% speed and 50% incline at termination of the GXT. The analyses included a 2-way repeated-measures ANOVA, intra-class correlation coefficients (ICC2,1), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (CoV). RESULTS: There was no test (test 1 vs test 2) × method (GXT vs verification) interaction (p = 0.584), or main effect for test (p = 0.320), but there was a main effect for method (p = 0.011). The [Formula: see text]O2GXT (50.9±3.0 mL·kg-1·min-1) was greater than [Formula: see text]O2verification (46.9 ± mL·kg-1·min-1). The [Formula: see text]O2GXT (ICC = 0.988, SEM = 1.0 mL·kg-1 min-1, MD = 2.9 mL kg-1 min-1, CoV = 2.03%) and [Formula: see text]O2verification (ICC = 0.976, SEM = 1.0 mL·kg-1 min-1, MD = 2.7 mL·kg-1·min-1, CoV = 2.03%) demonstrated "excellent" reliability. No subject exceeded the MD for [Formula: see text]O2GXT test-retest or for [Formula: see text]O2verification test-retest, but 50% of subjects had a [Formula: see text]O2GXT that was greater than the [Formula: see text]O2verification (> MD). CONCLUSION: While [Formula: see text]O2GXT and [Formula: see text]O2verification demonstrated excellent reliability, [Formula: see text]O2GXT from a stand-alone GXT provided higher estimates of [Formula: see text]O2 and, therefore, should be considered [Formula: see text]O2max. The lack of test-retest differences in [Formula: see text]O2GXT above the MD indicated that subjects achieved their highest [Formula: see text]O2 ([Formula: see text]O2max) from a standalone GXT. Therefore, the verification bout may not be required to confirm [Formula: see text]O2max in this population.