Acute effects of simultaneous electromyostimulation and vibration on leg blood flow in spinal cord injury.

STUDY DESIGN: Randomized crossover. OBJECTIVES: To analyze the acute effects of isolated and simultaneous application of whole-body vibration (WBV) and electromyostimulation (ES) on popliteal artery blood velocity (BV) and skin temperature (ST) of the calf in subjects with spinal cord injury (SCI). SETTING: Valladolid, Spain. METHODS: Ten subjects with SCI were assessed in five different sessions. After a familiarization session, four interventions were applied in random order; WBV, ES, simultaneous WBV and ES (WBV+ES), and 30 s of WBV followed by 30 s of ES (WBV30/ES30). Each intervention consisted of 10 sets × 1 min ON+1 min OFF. Subjects were seated on their own wheelchairs with their feet on the vibration platform (10 Hz, 5 mm peak-to-peak), and ES was applied on the gastrocnemius muscle of both legs (8 Hz, 400 µs). RESULTS: The simultaneous application (WBV+ES) produced the greatest increase in mean BV (MBV; 36% and 42%, respectively) and peak BV (PBV; 30% and 36%, respectively) during the intervention. This intervention produced the greatest mean increases in MBV (21%) and PBV (19%) during the recovery period. Last, this intervention produced the highest increase in ST during the intervention (2.1 °C). CONCLUSION: The simultaneous application of WBV+ES seems to produce a greater increase in MBV and PBV of the popliteal artery and ST of the calf than the isolated (WBV or ES) or consecutive application of both stimuli (WBV30/ES30). This study provides an efficient therapeutic methodology to improve peripheral arterial properties, which is pivotal in SCI patient's rehabilitation.

Chronic effects of simultaneous electromyostimulation and vibration on leg blood flow in spinal cord injury.

STUDY DESIGN: Randomized two-group parallel. OBJECTIVES: The objective of this study was to analyze the adaptations on the popliteal artery (mean blood velocity (MBV), peak blood velocity (PBV), arterial resting diameter (RD) and blood flow (BF)) induced by 12 weeks of simultaneous application of whole-body vibration and electromyostimulation (WBV+ES) in patients with spinal cord injury (SCI). Secondarily, the musculoskeletal effects of this therapy on the gastrocnemius muscle thickness (MT) and femoral neck bone mineral density (BMD) were analyzed. SETTING: Valladolid, Spain. METHODS: Seventeen SCI patients (American Spinal Injury Association (ASIA) A or B) were randomly assigned to the experimental group (EG=9) or the control group (CG=8). Each subject was assessed in four different occasions: at baseline, after 6 weeks (Post-6) and 12 weeks of the treatment (Post-12) and 8 weeks after the end of the treatment (Post-20). Subjects in the EG performed 30 10-min sessions of WBV+ES during 12 weeks. RESULTS: In the EG, RD increased compared with the baseline value at Post-6 (9.5%, P<0.01), Post-12 (19.0%, P<0.001) and Post-20 (16.7%, P<0.001). Similarly, in the EG, BF increased compared with the baseline value and with CG only at Post-12 ((33.9%, P<0.01) and (72.5%, P<0.05), respectively). Similarly, WBV+ES increased the MT of the gastrocnemius. BMD of both hips remained invariable during the study. CG showed no change at any point. CONCLUSIONS: WBV+ES improved popliteal artery BF, RD and MT after 12 weeks in SCI patients. This increase in RD remained above baseline after 8 weeks. The combination of WBV and ES could be considered a promising alternative to reverse the musculoskeletal atrophy and improve peripheral vascular properties in SCI patients.

Reliability of infrared thermography in skin temperature evaluation of wheelchair users.

STUDY DESIGN: Test-retest reliability analysis segmented by body parts. OBJECTIVES: To examine the reliability of infrared thermography (IRT) in wheelchair users (WCUs), as a noninvasive and risk-free technique to detect the natural thermal radiation emitted by human skin and to allow subsequent interpretations of temperature distributions. SETTING: Research Center on Physical Disability of Valladolid, ASPAYM Castilla y León Foundation, Spain. METHODS: Twenty-four manual WCUs (22 men, 2 women) participated in this study. Skin temperature (Tsk) of 16 and 20 areas of the front and rear upper body, respectively, were measured using an infrared camera. Two thermographic images were recorded in each session during two days separated by 24 h. Results were analyzed using descriptive statistics, intraclass correlation coefficients, coefficients of variation and side-to-side skin temperature differences (δTsk). RESULTS: The intraclass correlation coefficient produced values ranging from 15 to 95 for the various regions of interest. The coefficient of variation ranged between 1.05-6.18%. The mean Tsk of the front upper body was 31.92 °C, and that of the rear upper body was 31.77 °C. The total δTsk was 0.09±0.44°C, r=0.583. CONCLUSION: The reliability of IRT varies depending on the analyzed areas. IRT is a noninvasive and noncontact technique that allows measuring the temperature of the skin, with which to advance in WCU research.

Muscular adaptations after two different volumes of blood flow-restricted training.

This study aimed to gain an insight into the adaptations of muscle strength and skeletal muscle thickness after two different volumes of blood flow restriction training (BFRT), and compare them with high-intensity training. The sample was divided into four groups: low-volume, low-intensity BFRT (BFRT LV); high-volume, low-intensity BFRT (BFRT HV); traditional high-intensity resistance training (HIT); and a control group, which maintained their routine activities (CON). Leg extension one repetition maximum (1RM), isokinetic peak knee extension, and flexion torques at 60°/s and 180°/s as well as muscle thickness of the rectus femoris (RF) and vastus lateralis (VL) were assessed at baseline and after 5 weeks of training BFRT LV (7.03%, P < 0.05), BFRT HV (6.24%, P < 0.05) and HIT (18.86%, P < 0.001) groups increased 1RM performance, while no changes were observed in the CON group. Muscle thickness of the RF and VL was increased irrespective of the training group (7.5%, P < 0.001; and 9.9%, P < 0.001, respectively). We conclude that doubling the exercise volume with BFRT causes no further benefit with muscular size or strength. Although similar increases in muscle thickness were observed between training groups, HIT increased 1RM performance to a greater extent compared to either volume of BFRT.

Effects of whole-body vibration on blood flow and neuromuscular activity in spinal cord injury.

STUDY DESIGN: Crossover trial. OBJECTIVES: To investigate the effects of whole-body vibration (WBV) on muscular activity and blood flow velocity after different vibration treatments in patients with spinal cord injury (SCI). SETTING: Research Center on Physical Disability (Spain). METHODS: Eight individuals with SCI received six 3-min WBV treatments depending on a combination of frequency (10, 20 or 30 Hz) and protocol (constant, that is, three consecutive minutes of WBV, or fragmented, that is, three sets of 1 min of WBV with 1 min of rest between the sets). Femoral artery blood flow velocity was registered at minutes 1, 2 and 3 of WBV, and at minutes 1 and 2 after the end of the stimulus. Electromyography activity (EMG) of vastus lateralis (VL) and vastus medialis (VM) was registered at baseline and during WBV. RESULTS: Peak blood velocity (PBV) increased after 1, 2 and 3 min of WBV. The 10 Hz frequency did not alter blood flow, whereas the 20 Hz frequency increased PBV after 2 and 3 min of WBV, and the 30 Hz frequency increased PBV after 1, 2 and 3 min of WBV and during the first minute after the end of the stimulus. No protocol effect was observed for blood parameters. EMG activity of VL and VM increased independently of the applied frequency or protocol. CONCLUSION: WBV is an effective method to increase leg blood flow and to activate muscle mass in SCI patients, and could be considered to be incorporated in their rehabilitation programs.

Changes in muscle architecture induced by low load blood flow restricted training.

In order to ascertain whether differing structural mechanisms could underlie blood flow restricted training (BFRT) and high intensity training (HIT), this study had two aims: (i) to gain an insight into the acute variations of muscle architecture following a single bout of two different volumes of BFRT, and (ii) to compare these variations with those observed after HIT. Thirty-five young men volunteered for the study and were randomly divided into three groups: BFRT low volume (BFRT LV), BFRT high volume (BFRT HV) and traditional high intensity resistance training (HIT). All subjects performed a bilateral leg extension exercise session with a load of 20% of one repetition maximum (1RM) in the BFRT groups, whereas the load of the HIT group was equivalent to an 85% of their 1RM. Before and immediately after the exercise bout, ultrasound images were taken from the rectus femoris (RF) and the vastus lateralis (VL). All groups increased their RF (p < 0.001) and VL (p < 0.001) muscle thickness, while the increases in pennation angle were larger in HIT as compared to BFRT LV (p = 0.013) and BFRT HV (p = 0.037). These results support the hypothesis that acute muscle cell swelling may be involved in the processes underlying BFRT induced muscle hypertrophy. Furthermore, our data indicate differing structural responses to exercise between BFRT and HIT.