Age and sex differences in steadiness of elbow flexor muscles with imposed cognitive demand.

PURPOSE: These studies determined (1) age- and sex-related differences in steadiness of isometric contractions when high cognitive demand was imposed across a range of forces with the elbow flexor muscles (study 1) and; (2) sex differences in steadiness among older adults when low cognitive demand was imposed (study 2). METHODS: 36 young adults (18-25 years; 18 women) and 30 older adults (60-82 years; 17 women) performed isometric contractions at 5, 30 and 40 % of maximum voluntary contraction (MVC). Study 1 involved a high-cognitive demand session (serial subtractions by 13 during the contraction) and a control session (no mental math). Study 2 (older adults only) involved a low-cognitive demand session (subtracting by 1s). RESULTS: Older individuals exhibited greater increases in force fluctuations (coefficient of variation of force, CV) with high cognitive demand than young adults, with the largest age difference at 5 % MVC (P = 0.01). Older adults had greater agonist EMG activity with high-cognitive demand and women had greater coactivation than men (P < 0.05). In study 2, CV of force increased with low cognitive demand for the older women but not for the older men (P = 0.03). CONCLUSION: Older adults had reduced steadiness and increased muscle activation when high cognitive demand was imposed while low cognitive demand induced increased force fluctuations in older women but not older men. These findings have implications for daily and work-related tasks that involve cognitive demand performed simultaneously during submaximal isometric contractions in an aging workforce.

Sex Differences in Arm Muscle Fatigability With Cognitive Demand in Older Adults.

BACKGROUND: Muscle fatigability can increase when a stressful, cognitively demanding task is imposed during a low-force fatiguing contraction with the arm muscles, especially in women. Whether this occurs among older adults (>60 years) is currently unknown. QUESTIONS/PURPOSES: We aimed to determine if higher cognitive demands, stratified by sex, increased fatigability in older adults (>60 years). Secondarily, we assessed if varying cognitive demand resulted in decreased steadiness and was explained by anxiety or cortisol levels. METHODS: Seventeen older women (70±6 years) and 13 older men (71±5 years) performed a sustained, isometric, fatiguing contraction at 20% of maximal voluntary contraction until task failure during three sessions: high cognitive demand (high CD=mental subtraction by 13); low cognitive demand (low CD=mental subtraction by 1); and control (no subtraction). RESULTS: Fatigability was greater when high and low CD were performed during the fatiguing contraction for the women but not for the men. In women, time to failure with high CD was 16±8 minutes and with low CD was 17±4 minutes, both of which were shorter than time to failure in control contractions (21±7 minutes; high CD mean difference: 5 minutes [95% confidence interval {CI}, 0.78-9.89], p=0.02; low CD mean difference: 4 minutes [95% CI, 0.57-7.31], p=0.03). However, in men, no differences were detected in time to failure with cognitive demand (control: 13±5 minutes; high CD mean difference: -0.09 minutes [95% CI, -2.8 to 2.7], p=1.00; low CD mean difference: 0.75 minutes [95% CI, -1.1 to 2.6], p=0.85). Steadiness decreased (force fluctuations increased) more during high CD than control. Elevated anxiety, mean arterial pressure, and salivary cortisol levels in both men and women did not explain the greater fatigability during high CD. CONCLUSIONS: Older women but not men showed marked increases in fatigability when low or high CD was imposed during sustained static contractions with the elbow flexor muscles and contrasts with previous findings for the lower limb. Steadiness decreased in both sexes when high CD was imposed. CLINICAL RELEVANCE: Older women are susceptible to greater fatigability of the upper limb with heightened mental activity during sustained postural contractions, which are the foundation of many work-related tasks.

Oscillations in neural drive and age-related reductions in force steadiness with a cognitive challenge.

A cognitive challenge when imposed during a low-force isometric contraction will exacerbate sex- and age-related decreases in force steadiness, but the mechanism is not known. We determined the role of oscillations in the common synaptic input to motor units on force steadiness during a muscle contraction with a concurrent cognitive challenge. Forty-nine young adults (19-30 yr; 25 women, 24 men) and 36 old adults (60-85 yr; 19 women, 17 men) performed a cognitive challenge (counting backward by 13) during an isometric elbow flexion task at 5% of maximal voluntary contraction. Single-motor units were decomposed from high-density surface EMG recordings. For a subgroup of participants, motor units were matched during control and cognitive challenge trials, so the same motor unit was analyzed across conditions. Reduced force steadiness was associated with greater oscillations in the synaptic input to motor units during both control and cognitive challenge trials ( r = 0.45-0.47, P < 0.01). Old adults and young women showed greater oscillations in the common synaptic input to motor units and decreased force steadiness when the cognitive challenge was imposed, but young men showed no change across conditions (session × age × sex, P < 0.05). Oscillations in the common synaptic input to motor units is a potential mechanism for altered force steadiness when a cognitive challenge is imposed during low-force contractions in young women and old adults. NEW & NOTEWORTHY We found that oscillations in the common synaptic input to motor units were associated with a reduction in force steadiness when a cognitive challenge was imposed during low-force contractions of the elbow flexor muscles in young women and old men and women but not young men. Age- and sex-related muscle weakness was associated with these changes.

Force Steadiness During a Cognitively Challenging Motor Task Is Predicted by Executive Function in Older Adults.

Motor performance and cognitive function both decline with aging. Older adults for example are usually less steady for a constant-force task than young adults when performing low-intensity contractions with limb muscles. Healthy older adults can also show varying degrees of cognitive decline, particularly in executive function skills. It is not known, however, whether age-related changes in steadiness of low-force tasks and cognitive function are independent of one another. In this study, we determined if executive function skills in aging are associated with the steadiness during a low-force muscle contraction performed with and without the imposition of a cognitive challenge. We recruited 60 older adults (60-85 years old, 34 women, 26 men) and 48 young adults (19-30 years old, 24 women, 24 men) to perform elbow flexor muscle contractions at 5% of maximal voluntary contraction (MVC) force in the presence and absence of a difficult mental-math task (counting backward by 13 from a four-digit number). Force steadiness was quantified as the coefficient of variation (CV) of force and executive function was estimated with the Trail-making Test part A and B. The cognitive challenge increased the CV of force (i.e., decreased force steadiness) with greater changes in older adults than young adults (5.2 vs. 1.3%, respectively, cognitive challenge × age: P < 0.001). Older adults were 35% slower in both parts A and B of the Trail-making Test (P < 0.001), and to eliminate the effects of age and education on this variable, all further analyses were performed with the age-corrected z-scores for each individual using established normative values. Hierarchical regression models indicated that decreased force steadiness during a cognitive challenge trial was in part, explained by the performance in the Trail-making Test part A and B in older (r = 0.53 and 0.50, respectively, P < 0.05), but not in young adults (P > 0.05). Thus, healthy community-dwelling older adults, who have poorer executive function skills, exhibit reduced force steadiness during tasks when also required to perform a high cognitive demand task, and are likely at risk of reduced capacity to perform daily activities that involve cognitively challenging motor tasks.

Muscle fatigability and control of force in men with posttraumatic stress disorder.

INTRODUCTION: Acute stress can increase fatigability and decrease steadiness of sustained low-force contractions that are required for functional tasks in upper limb muscles. Whether motor performance is more impaired in people with a chronic stress disorder is not known. PURPOSE: This study compared the fatigability and steadiness (force fluctuations) of handgrip muscles in veterans with posttraumatic stress disorder (PTSD) and civilian controls in the presence and absence of varying levels of cognitive demand. METHODS: Eighteen veterans with PTSD and 21 healthy controls (33 ± 9 yr) attended three randomized experimental sessions to perform an isometric fatiguing contraction (20% of maximal strength) with the handgrip muscles. Two sessions involved performing a cognitive task during the fatiguing contraction: 1) difficult mental math task (stressor) and 2) a simple mental math task (mental attentiveness). A third session involved a fatiguing contraction with no mental task (control). RESULTS: Stress elevated heart rate, blood pressure, and levels of anxiety in veterans with PTSD (P < 0.05) but blunted cortisol levels (P < 0.05). Time to failure was briefer (7.2 ± 2.5 vs 9.3 ± 5.2 min, P = 0.03), and force fluctuations increased at a greater rate for veterans with PTSD than for controls (P < 0.05). Cognitive stress did not influence time to failure or force fluctuations for either group (P > 0.05). CONCLUSIONS: Veterans with PTSD demonstrated greater fatigability and loss of steadiness (greater force fluctuations) of the handgrip muscles compared with healthy controls. SIGNIFICANCE: Male veterans with PTSD demonstrated altered neuromuscular function of arm muscles that potentially affects functional tasks during daily, ergonomic, and military activities.

Stressor-induced increase in muscle fatigability of young men and women is predicted by strength but not voluntary activation.

This study investigated mechanisms for the stressor-induced changes in muscle fatigability in men and women. Participants performed an isometric-fatiguing contraction at 20% maximal voluntary contraction (MVC) until failure with the elbow flexor muscles. Study one (n = 55; 29 women) involved two experimental sessions: 1) a high-stressor session that required a difficult mental-math task before and during a fatiguing contraction and 2) a control session with no mental math. For some participants (n = 28; 14 women), cortical stimulation was used to examine mechanisms that contributed to muscle fatigability during the high-stressor and control sessions. Study two (n = 23; nine women) determined the influence of a low stressor, i.e., a simple mental-math task, on muscle fatigability. In study one, the time-to-task failure was less for the high-stressor session than control (P < 0.05) for women (19.4%) and men (9.5%): the sex difference response disappeared when covaried for initial strength (MVC). MVC force, voluntary activation, and peak-twitch amplitude decreased similarly for the control and high-stressor sessions (P < 0.05). In study two, the time-to-task failure of men or women was not influenced by the low stressor (P > 0.05). The greater fatigability, when exposed to a high stressor during a low-force task, was not exclusive to women but involved a strength-related mechanism in both weaker men and women that accelerated declines in voluntary activation and slowing of contractile properties.

Fatigability and recovery of arm muscles with advanced age for dynamic and isometric contractions.

This study determined whether age-related mechanisms can increase fatigue of arm muscles during maximal velocity dynamic contractions, as it occurs in the lower limb. We compared elbow flexor fatigue of young (n=10, 20.8±2.7 years) and old men (n=16, 73.8±6.1 years) during and in recovery from a dynamic and an isometric postural fatiguing task. Each task was maintained until failure while supporting a load equivalent to 20% of maximal voluntary isometric contraction (MVIC) torque. Transcranial magnetic stimulation (TMS) was used to assess supraspinal fatigue (superimposed twitch, SIT) and muscle relaxation. Time to failure was longer for the old men than for the young men for the isometric task (9.5±3.1 vs. 17.2±7.0 min, P=0.01) but similar for the dynamic task (6.3±2.4 min vs. 6.0±2.0 min, P=0.73). Initial peak rate of relaxation was slower for the old men than for the young men, and was associated with a longer time to failure for both tasks (P<0.05). Low initial power during elbow flexion was associated with the greatest difference (reduction) in time to failure between the isometric task and the dynamic task (r=-0.54, P=0.015). SIT declined after both fatigue tasks similarly with age, although the recovery of SIT was associated with MVIC recovery for the old (both sessions) but not for the young men. Biceps brachii and brachioradialis EMG activity (% MVIC) of the old men were greater than that of the young men during the dynamic fatiguing task (P<0.05), but were similar during the isometric task. Muscular mechanisms and greater relative muscle activity (EMG activity) explain the greater fatigue during the dynamic task for the old men compared with the young men in the elbow flexor muscles. Recovery of MVC torque however relies more on the recovery of supraspinal fatigue among the old men than among the young men.

Supraspinal fatigue impedes recovery from a low-intensity sustained contraction in old adults.

This study determined the contribution of supraspinal fatigue and contractile properties to the age difference in neuromuscular fatigue during and recovery from a low-intensity sustained contraction. Cortical stimulation was used to evoke measures of voluntary activation and muscle relaxation during and after a contraction sustained at 20% of maximal voluntary contraction (MVC) until task failure with elbow flexor muscles in 14 young adults (20.9 ± 3.6 yr, 7 men) and 14 old adults (71.6 ± 5.4 yr, 7 men). Old adults exhibited a longer time to task failure than the young adults (23.8 ± 9.0 vs. 11.5 ± 3.9 min, respectively, P < 0.001). The time to failure was associated with initial peak rates of relaxation of muscle fibers and pressor response (P < 0.05). Increments in torque (superimposed twitch; SIT) generated by transcranial magnetic stimulation (TMS) during brief MVCs, increased during the fatiguing contraction (P < 0.001) and then decreased during recovery (P = 0.02). The increase in the SIT was greater for the old adults than the young adults during the fatiguing contraction and recovery (P < 0.05). Recovery of MVC torque was less for old than young adults at 10 min post-fatiguing contraction (75.1 ± 8.7 vs. 83.6 ± 7.8% of control MVC, respectively, P = 0.01) and was associated with the recovery of the SIT (r = -0.59, r(2) = 0.35, P < 0.001). Motor evoked potential (MEP) amplitude and the silent period elicited during the fatiguing contraction increased less for old adults than young adults (P < 0.05). The greater fatigue resistance with age during a low-intensity sustained contraction was attributable to mechanisms located within the muscle. Recovery of maximal strength after the low-intensity fatiguing contraction however, was impeded more for old adults than young because of greater supraspinal fatigue. Recovery of strength could be an important variable to consider in exercise prescription of old populations.

Supraspinal fatigue is similar in men and women for a low-force fatiguing contraction.

PURPOSE: This study determined the contribution of supraspinal fatigue to the sex difference in neuromuscular fatigue for a low-intensity fatiguing contraction. Because women have greater motor responses to arousal than men, we also examined whether cortical and motor nerve stimulation, techniques used to quantify central fatigue, would alter the sex difference in muscle fatigue. METHODS: In study 1, cortical stimulation was elicited during maximal voluntary contractions (MVC) before and after a submaximal isometric contraction at 20% MVC with the elbow flexor muscles in 29 young adults (20 ± 2.6 yr, 14 men). In study 2, 10 men and 10 women (19.1 ± 2.9 yr) performed a fatiguing contraction in the presence and absence of cortical and motor nerve stimulation. RESULTS: Study 1: Men had a briefer time to task failure than women (P = 0.009). Voluntary activation was reduced after the fatiguing contraction (P < 0.001) similarly for men and women. Motor-evoked potential area and the EMG silent period increased similarly with fatigue for both sexes. Peak relaxation rates, however, were greater for men than women and were associated with time to task failure (P < 0.05). Force fluctuations, RPE, HR, and mean arterial pressure increased at a greater rate for men than for women during the fatiguing contraction (P < 0.05). Study 2: Time to task failure, force fluctuations, and all other physiological variables assessed were similar for the control session and stimulation session (P > 0.05) for both men and women. CONCLUSIONS: Supraspinal fatigue was similar for men and women after the low-force fatiguing contraction, and the sex difference in muscle fatigue was associated with peripheral mechanisms. Furthermore, supraspinal fatigue can be quantified in both men and women without influencing motor performance.

Mechanisms of fatigue differ after low- and high-force fatiguing contractions in men and women.

The magnitude of failure in voluntary drive after fatiguing contractions of different intensities in men and women is not known. The purpose of this study was to compare the time to task failure and voluntary activation of men and women for a sustained isometric contraction performed at a low and high intensity with the elbow flexor muscles. Nine men and nine women sustained an isometric contraction at 20% and 80% of maximal voluntary contraction (MVC) force until task failure during separate sessions. The men had a shorter time to failure than women for the 20% but not the 80% MVC task. Voluntary activation was reduced to similar levels for the men and women at the end of the fatiguing contractions but was reduced less after the 80% MVC task than the 20% MVC contraction. Twitch amplitude was reduced similarly at task failure for both sexes and to similar levels at termination of the 20% and 80% MVC tasks. The rate of change in mean arterial pressure was the main predictor of time to failure for the low-force sustained contraction. These results suggest that women experienced greater muscle perfusion, less peripheral fatigue, and a longer time to task failure than men during the low-force fatiguing contraction. However, the low-force task induced greater central fatigue than the high-force contraction for both men and women. Thus, low-force, long-duration fatiguing contractions can be used in rehabilitation to induce significant fatigue within the central nervous system and potentially greater neural adaptations in men and women.