Postexercise Hypotension as a Predictor for Long-Term Training-Induced Blood Pressure Reduction: A Large-Scale Randomized Controlled Trial.

OBJECTIVE: To investigate the correlation between acute exercise effects and chronic training effects on blood pressure (BP). DESIGN: Randomized, controlled training study focusing on the optimization of preventive effects of physical training. SETTING: The study was performed in a university department. PARTICIPANTS: One hundred twenty-seven healthy, untrained subjects. INTERVENTION: Subjects were divided into 4 groups: interval endurance training (IET) (n = 26, 4 × 4 min at 95% maximal heart rate), continuous endurance training (CET) (n = 23, 45 minutes at 60% heart rate reserve), strength endurance training (SET) (n = 40, 8 machine-based exercises, each 2 x 15 repetitions at the 20 repetition maximum), and control (CON) (n = 38). In the 3 training groups, subjects trained 3 times a week for 6 months, the CON group was asked to retain their sedentary lifestyle. MAIN OUTCOME MEASURES: The acute exercise effect on BP was defined as the change of BP after an exhaustive stage test, compared with baseline. The chronic training effect on BP was determined as the change of resting BP after the 6-month training period. RESULTS: For CET, a significant correlation between acute and chronic effects on systolic (r = 0.66, P = 0.001) and diastolic (r = 0.66, P = 0.001) BP was observed. For SET, a significant correlation (r = 0.45, P = 0.007) was found only for diastolic BP. No significant correlations were found for IET. CONCLUSIONS: It can be assumed that postexercise hypotension is an easy-to-use predictor for the efficacy of CET to reduce BP, and may be a valuable tool for physicians to individualize prescribed training schedules for patients to reduce cardiovascular risk. TRIAL REGISTRATION: www.clinicaltrials.gov; ID: NCT01263522.

Accurate and representative decoding of the neural drive to muscles in humans with multi-channel intramuscular thin-film electrodes.

Intramuscular electrodes developed over the past 80 years can record the concurrent activity of only a few motor units active during a muscle contraction. We designed, produced and tested a novel multi-channel intramuscular wire electrode that allows in vivo concurrent recordings of a substantially greater number of motor units than with conventional methods. The electrode has been extensively tested in deep and superficial human muscles. The performed tests indicate the applicability of the proposed technology in a variety of conditions. The electrode represents an important novel technology that opens new avenues in the study of the neural control of muscles in humans. We describe the design, fabrication and testing of a novel multi-channel thin-film electrode for detection of the output of motoneurones in vivo and in humans, through muscle signals. The structure includes a linear array of 16 detection sites that can sample intramuscular electromyographic activity from the entire muscle cross-section. The structure was tested in two superficial muscles (the abductor digiti minimi (ADM) and the tibialis anterior (TA)) and a deep muscle (the genioglossus (GG)) during contractions at various forces. Moreover, surface electromyogram (EMG) signals were concurrently detected from the TA muscle with a grid of 64 electrodes. Surface and intramuscular signals were decomposed into the constituent motor unit (MU) action potential trains. With the intramuscular electrode, up to 31 MUs were identified from the ADM muscle during an isometric contraction at 15% of the maximal force (MVC) and 50 MUs were identified for a 30% MVC contraction of TA. The new electrode detects different sources from a surface EMG system, as only one MU spike train was found to be common in the decomposition of the intramuscular and surface signals acquired from the TA. The system also allowed access to the GG muscle, which cannot be analysed with surface EMG, with successful identification of MU activity. With respect to classic detection systems, the presented thin-film structure enables recording from large populations of active MUs of deep and superficial muscles and thus can provide a faithful representation of the neural drive sent to a muscle.

Development, manufacturing and application of double-sided flexible implantable microelectrodes.

Many neuroprosthetic applications require the use of very small, flexible multi-channel microelectrodes (e.g. polyimide-based film-like electrodes) to fit anatomical constraints. By arranging the electrode contacts on both sides of the polyimide film, selectivity can be further increased without increasing size. In this work, two approaches to create such double-sided electrodes are described and compared: sandwich electrodes prepared by precisely gluing two single-sided structures together, and monolithic electrodes created using a new double-sided photolithography process. Both methods were successfully applied to manufacture double-sided electrodes for stimulation of the vestibular system. In a case study, the electrodes were implanted in the semicircular canals of three guinea pigs and proven to provide electrical stimulation of the vestibular nerve. For both the monolithic electrodes and the sandwich electrodes, long-term stability and functionality was observed over a period of more than 12 months. Comparing the two types of electrodes with respect to the manufacturing process, it can be concluded that monolithic electrodes are the preferred solution for very thin electrodes (<20 µm), while sandwich electrode technology is especially suitable for thicker electrodes (40-50 µm).

Blind identification of the spinal cord output in humans with high-density electrode arrays implanted in muscles.

Invasive electromyography opened a new window to explore motoneuron behavior in vivo. However, the technique is limited by the small fraction of active motoneurons that can be concurrently detected, precluding a population analysis in natural tasks. Here, we developed a high-density intramuscular electrode for in vivo human recordings along with a fully automatic methodology that could detect the discharges of action potentials of up to 67 concurrently active motoneurons with 99% accuracy. These data revealed that motoneurons of the same pool receive common synaptic input at frequencies up to 75 Hz and that late-recruited motoneurons inhibit the discharges of those recruited earlier. These results constitute an important step in the population coding analysis of the human motor system in vivo.

Does Cold-Water Immersion After Strength Training Attenuate Training Adaptation?

PURPOSE: Cold-water immersion is increasingly used by athletes to support performance recovery. Recently, however, indications have emerged suggesting that the regular use of cold-water immersion might be detrimental to strength training adaptation. METHODS: In a randomized crossover design, 11 participants performed two 8-week training periods including 3 leg training sessions per week, separated by an 8-week "wash out" period. After each session, participants performed 10 minutes of either whole-body cold-water immersion (cooling) or passive sitting (control). Leg press 1-repetition maximum and countermovement jump performance were determined before (pre), after (post) and 3 weeks after (follow-up) both training periods. Before and after training periods, leg circumference and muscle thickness (vastus medialis) were measured. RESULTS: No significant effects were found for strength or jump performance. Comparing training adaptations (pre vs post), small and negligible negative effects of cooling were found for 1-repetition maximum (g = 0.42; 95% confidence interval [CI], -0.42 to 1.26) and countermovement jump (g = 0.02; 95% CI, -0.82 to 0.86). Comparing pre versus follow-up, moderate negative effects of cooling were found for 1-repetition maximum (g = 0.71; 95% CI, -0.30 to 1.72) and countermovement jump (g = 0.64; 95% CI, -0.36 to 1.64). A significant condition × time effect (P = .01, F = 10.00) and a large negative effect of cooling (g = 1.20; 95% CI, -0.65 to 1.20) were observed for muscle thickness. CONCLUSIONS: The present investigation suggests small negative effects of regular cooling on strength training adaptations.

High resolution electroencephalography in freely moving mice.

Electroencephalography (EEG) is a standard tool for monitoring brain states in humans. Understanding the molecular and cellular mechanisms underlying diverse EEG rhythms can be facilitated by using mouse models under molecular, pharmacological, or electrophysiological manipulations. The small size of the mouse brain, however, poses a severe limitation in the spatial information of EEG. To overcome this limitation, we devised a polyimide based microelectrode array (PBM array) with nanofabrication technologies. The microelectrode contains 32 electrodes, weighs 150 mg, and yields noise-insensitive signals when applied on the mouse skull. The high-density microelectrode allowed both global and focused mapping of high resolution EEG (HR-EEG) in the mouse brain. Mapping and dynamical analysis tools also have been developed to visualize the dynamical changes of spatially resolved mouse EEG. We demonstrated the validity and utility of mouse EEG in localization of the seizure onset in absence seizure model and phase dynamics of abnormal theta rhythm in transgenic mice. Dynamic tracking of the EEG map in genetically modified mice under freely moving conditions should allow study of the molecular and cellular mechanisms underlying the generation and dynamics of diverse EEG rhythms.

A thin-film multichannel electrode for muscle recording and stimulation in neuroprosthetics applications.

OBJECTIVE: We propose, design and test a novel thin-film multichannel electrode that can be used for both recording from and stimulating a muscle in acute implants. APPROACH: The system is built on a substrate of polyimide and contains 12 recording and three stimulation sites made of platinum. The structure is 420 µm wide, 20 µm thick and embeds the recording and stimulation contacts on the two sides of the polyimide over an approximate length of 2 cm. We show representative applications in healthy individuals as well as tremor patients. The designed system was tested by a psychometric characterization of the stimulation contacts in six tremor patients and three healthy individuals determining the perception threshold and current limit as well as the success rate in discriminating elicited sensations (electrotactile feedback). Also, we investigated the possibility of using the intramuscular electrode for reducing tremor in one patient by electrical stimulation delivered with timing based on the electromyographic activity recorded with the same electrode. MAIN RESULTS: In the tremor patients, the current corresponding to the perception threshold and the current limit were 0.7 ± 0.2 and 1.4 ± 0.7 mA for the wrist flexor muscles and 0.4 ± 0.2 and 1.5 ± 0.7 mA for the extensors. In one patient, closed-loop stimulation resulted in a decrease of the tremor power >50%. In healthy individuals the perception threshold and current limits were 0.9 ± 0.6 and 2.1 ± 0.6 mA for the extensor carpi radialis muscle. The subjects could distinguish four or six stimulation patterns (two or three stimulation sites × two stimulation current amplitudes) with true positive rate >80% (two subjects) and >60% (one subject), respectively. SIGNIFICANCE: The proposed electrode provides a compact multichannel interface for recording electromyogram and delivering electrical stimulation in applications such as neuroprostheses for tremor suppression and closed-loop myoelectric prostheses.

Massage and Performance Recovery: A Meta-Analytical Review.

BACKGROUND: Post-exercise massage is one of the most frequently applied interventions to enhance recovery of athletes. However, evidence to support the efficacy of massage for performance recovery is scarce. Moreover, it has not yet been concluded under which conditions massage is effective. OBJECTIVE: The objective of this study was to perform a systematic review and meta-analysis of the available literature on massage for performance recovery. METHODS: We conducted a structured literature search and located 22 randomized controlled trials. These were analysed with respect to performance effects and various characteristics of the study design (type and duration of massage, type of exercise and performance test, duration of recovery period, training status of subjects). RESULTS: Of the 22 studies, 5 used techniques of automated massage (e.g., vibration), while the other 17 used classic manual massage. A tendency was found for shorter massage (5-12 min) to have larger effects (+6.6%, g = 0.34) than massage lasting more than 12 min (+1.0%, g = 0.06). The effects were larger for short-term recovery of up to 10 min (+7.9%, g = 0.45) than for recovery periods of more than 20 min (+2.4%, g = 0.08). Although after high-intensity mixed exercise, massage yielded medium positive effects (+14.4%, g = 0.61), the effects after strength exercise (+3.9%, g = 0.18) and endurance exercise (+1.3%, g = 0.12) were smaller. Moreover, a tendency was found for untrained subjects to benefit more from massage (+6.5%, g = 0.23) than trained athletes (+2.3%, g = 0.17). CONCLUSION: The effects of massage on performance recovery are rather small and partly unclear, but can be relevant under appropriate circumstances (short-term recovery after intensive mixed training). However, it remains questionable if the limited effects justify the widespread use of massage as a recovery intervention in competitive athletes.

A new generation of double-sided intramuscular electrodes for multi-channel recording and stimulation.

In this work, a new generation of intramuscular multi-channel electrode for EMG recording and muscle stimulation is presented. The electrode is based on double-sided polyimide microtechnology, and features electrode contacts on both sides of a thin polyimide filament. The structure is attached to a cannula, allowing insertion and application of the electrode system similar to conventional intramuscular wire electrodes. In the presented design, the electrode has 12 small recording sites on one side of the structure, and 3 large stimulation sites on the other side. Applications of the system include diagnosis and treatment of tremor. To this end, the electrode has been successfully tested in tremor patients. In the future, the concept will be extended to other fields of application including intraneural electrodes.

Cooling and performance recovery of trained athletes: a meta-analytical review.

PURPOSE: Cooling after exercise has been investigated as a method to improve recovery during intensive training or competition periods. As many studies have included untrained subjects, the transfer of those results to trained athletes is questionable. METHODS: Therefore, the authors conducted a literature search and located 21 peer-reviewed randomized controlled trials addressing the effects of cooling on performance recovery in trained athletes. RESULTS: For all studies, the effect of cooling on performance was determined and effect sizes (Hedges' g) were calculated. Regarding performance measurement, the largest average effect size was found for sprint performance (2.6%, g = 0.69), while for endurance parameters (2.6%, g = 0.19), jump (3.0%, g = 0.15), and strength (1.8%, g = 0.10), effect sizes were smaller. The effects were most pronounced when performance was evaluated 96 h after exercise (4.3%, g = 1.03). Regarding the exercise used to induce fatigue, effects after endurance training (2.4%, g = 0.35) were larger than after strength-based exercise (2.4%, g = 0.11). Cold-water immersion (2.9%, g = 0.34) and cryogenic chambers (3.8%, g = 0.25) seem to be more beneficial with respect to performance than cooling packs (-1.4%, g= -0.07). For cold-water application, whole-body immersion (5.1%, g = 0.62) was significantly more effective than immersing only the legs or arms (1.1%, g = 0.10). CONCLUSIONS: In summary, the average effects of cooling on recovery of trained athletes were rather small (2.4%, g = 0.28). However, under appropriate conditions (whole-body cooling, recovery from sprint exercise), postexercise cooling seems to have positive effects that are large enough to be relevant for competitive athletes.

Pre-cooling and sports performance: a meta-analytical review.

Pre-cooling is used by many athletes for the purpose of reducing body temperature prior to exercise and, consequently, decreasing heat stress and improving performance. Although there are a considerable number of studies showing beneficial effects of pre-cooling, definite conclusions on the effectiveness of pre-cooling on performance cannot yet be drawn. Moreover, detailed analyses of the specific conditions under which pre-cooling may be most promising are, so far, missing. Therefore, we conducted a literature search and located 27 peer-reviewed randomized controlled trials, which addressed the effects of pre-cooling on performance. These studies were analysed with regard to performance effects and several test circumstances (environmental temperature, test protocol, cooling method, aerobic capacity of the subjects). Eighteen studies were performed in a hot (>26°C) environment and eight in a moderate. The cooling protocols were water application (n = 12), cooling packs (n = 3), cold drinks (n = 2), cooling vest (n = 6) and a cooled room (n = 4). The following different performance tests were used: short-term, high-intensity sprints (n = 2), intermittent sprints (n = 6), time trials (n = 10), open-end tests (n = 7) and graded exercise tests (n = 2). If possible, subjects were grouped into different aerobic capacity levels according to their maximal oxygen consumption (VO(2max)): medium 55-65 mL/kg/min (n = 11) and high >65 mL/kg/min (n = 6). For all studies the relative changes of performance due to pre-cooling compared with a control condition, as well as effect sizes (Hedges' g) were calculated. Mean values were weighted according to the number of subjects in each study. Pre-cooling had a larger effect on performance in hot (+6.6%, g = 0.62) than in moderate temperatures (+1.4%, g = 0.004). The largest performance enhancements were found for endurance tests like open-end tests (+8.6%, g = 0.52), graded exercise tests (+6.0%, g = 0.44) and time trials (+4.2%, g = 0.44). A similar effect was observed for intermittent sprints (+3.3%, g = 0.43), whereas performance changes were smaller during short-term, high-intensity sprints (-0.5%, g = 0.03). The most promising cooling methods were cold drinks (+15.0%, g = 1.68), cooling packs (+5.6%, g = 0.70) and a cooled room (+10.7%, g = 0.49), whereas a cooling vest (+4.8%, g = 0.31) and water application (+1.2%, g = 0.21) showed only small effects. With respect to aerobic capacity, the best results were found in the subjects with the highest VO(2max) (high +7.7%, g = 0.65; medium +3.8%, g = 0.27). There were four studies analysing endurance-trained athletes under time-trial conditions, which, in a practical sense, seem to be most relevant. Those studies found an average effect on performance of 3.7% (g = 0.48). In summary, pre-cooling can effectively enhance endurance performance, particularly in hot environments, whereas sprint exercise is barely affected. In particular, well trained athletes may benefit in a typical competition setting with practical and relevant effects. With respect to feasibility, cold drinks, cooling packs and cooling vests can be regarded as best-practice methods.

Ethical issues in the development of a vestibular prosthesis.

During the development of a neural prosthesis, various ethical aspects have to be considered. These range from the basic design of the prosthesis and manufacturing of the various components and the system using biocompatible materials to extensive in vitro and in vivo testing and investigations in the animal model, before taking the final step and going to human trials. As medical systems, neural prostheses have to be proven absolutely safe before considering any clinical study. In this work, the various steps accompanying the development are described taking the example of a vestibular prosthesis currently developed within the European project CLONS.

3D hybrid electrode structure as implantable interface for a vestibular neural prosthesis in humans.

Implantable interfaces are essential components of vestibular neural prostheses. They interface the biological system with electrical stimulation that is used to restore transfer of vestibular information. Regarding the anatomical situation special 3D structures are required. In this paper, the design and the manufacturing process of a novel 3D hybrid microelectrode structure as interface to the human vestibular system are described. Photolithography techniques, assembling technology and rapid prototyping are used for manufacturing.

Acquisition of myoelectric signals to control a hand prosthesis with implantable epimysial electrodes.

The acquisition of myoelectric signals from the Musculus deltoideus of a rhesus monkey is described. Such signals are aimed to be used as control signal for an active myoelectric hand prosthesis. For recording, implantable flexible, polyimide-based multi-site microelectrodes were placed epimysially on the muscle. EMG signals were recorded during voluntary goal-directed movements of the arm, and analyzed with respect to signal amplitude and frequency.

A flexible microelectrode for mouse EEG.

Electroencephalography (EEG) of the mouse brain offers the advantage to monitor brain states in freely moving conditions under genetic or molecular manipulation. We present a novel, flexible, and biocompatible microfabricated electrode based on polyimide to record a multi-channel EEG from a mouse. Our microelectrode has 32 recording electrodes, including two ground electrodes. The connectors for the signal transmission are carefully affixed to the microelectrode. The overall weight of the microelectrode does not exceed 150 mg, including connectors. The implantation of the microelectrodes does not require invasive surgery and the mouse can be easily discharged from the wires when it is not being recorded. Simultaneous measurements with the microelectrode and a conventional screw electrode show that the microelectrode successfully collects the broad band EEG signals from the skull.

Long-term characterization of electrode materials for surface electrodes in biopotential recording.

The long-term electrical behavior of 16 different electrode materials was investigated by using continuous impedance spectroscopy over a period of 10 days. The materials included bare and electrolytically treated metals, metals coated with intrinsically conductive polymers, and polymers with conductive particles. Electrolytic treatment of metal electrodes yielded a significant impedance reduction. The lowest impedance values could be reached with the polymer-coated metal electrodes. The impedance behavior is an important aspect when choosing an electrode material, and has to be considered in signal processing. The choice of a material depends on the application of the electrode. Moreover, for long-term applications, the electrochemical stability of a material has to be considered.