The 1-min sit-to-stand test induces a significant and reliable level of neuromuscular fatigability: insights from a mobile app analysis.

PURPOSE: The performance metric associated with the execution of the 1-min sit-to-stand (1STS) typically relies on the number repetitions completed in 1 min. This parameter presents certain limitations (e.g., ceiling effect, motivational factors) which can impede its interpretation. Introducing additional parameters, such as neuromuscular fatigability level, could enhance the informative value of the 1STS and facilitate its interpretation. This study aimed to assess (i) whether the 1STS induces fatigability and (ii) the reliability of the fatigability level. METHODS: Forty young, healthy, and active participants underwent the 1STS twice during the same session. Isolated sit-to-stand maneuvers were performed before, immediately, and 1 min after completing the 1STS. A mobile app was utilized to obtain time (STST), velocity (STSV), and muscle power (STSP) from these sit-to-stand maneuvers. The pre-post change in these parameters served as the fatigability marker. Reliability was assessed using the intra-class correlation coefficient (ICC) and the coefficient of variation (CV). RESULTS: The mean number of repetitions during the 1STS was 63 ± 9. Significant decline in performance was observed for STST (13 ± 8%), STSV (-11.2 ± 6%), and STSP (-5.2 ± 3%), with more than 74% of participants exhibiting a decline beyond the minimal detectable change. Excellent between-session reliability (ICC ≥ 0.9; CV ≤ 5.3) was observed for the mobile app variables. CONCLUSION: The 1STS induces significant levels of fatigability. The fatigability indicators derived from the mobile app demonstrated remarkable reliability. Utilizing this user-friendly interface for computing fatigability may empower professionals to acquire insightful complementary indicators from the 1STS.

Enhancing endurance performance with combined imagined and actual physical practice.

PURPOSE: The perception of effort exerts influence in determining task failure during endurance performance. Training interventions blending physical and cognitive tasks yielded promising results in enhancing performance. Motor imagery can decrease the perception of effort. Whether combining motor imagery and physical training improves endurance remains to be understood, and this was the aim of this study. METHODS: Participants (24 ± 3 year) were assigned to a motor imagery (n = 16) or a control (n = 17) group. Both groups engaged in physical exercises targeting the knee extensors (i.e., wall squat, 12 training sessions, 14-days), with participants from the motor imagery group also performing motor imagery. Each participant visited the laboratory Pre and Post-training, during which we assessed endurance performance through a sustained submaximal isometric knee extension contraction until task failure, at either 20% or 40% of the maximal voluntary contraction peak torque. Perceptions of effort and muscle pain were measured during the exercise. RESULTS: We reported no changes in endurance performance for the control group. Endurance performance in the motor imagery group exhibited significant improvements when the intensity of the sustained isometric exercise closely matched that used in training. These enhancements were less pronounced when considering the higher exercise intensity. No reduction in perception of effort was observed in both groups. There was a noticeable decrease in muscle pain perception within the motor imagery group Post training. CONCLUSION: Combining motor imagery and physical training may offer a promising avenue for enhancing endurance performance and managing pain in various contexts.

Mild to moderate damage in knee extensor muscles accumulates after two bouts of maximal eccentric contractions.

PURPOSE: This study aimed to determine whether mild to moderate muscle damage accumulates on the knee extensors after two bouts of maximal eccentric contractions performed over two consecutive days. METHODS: Thirty participants performed an initial bout of maximal eccentric contractions of knee extensors during the first day of the protocol (ECC1). Then, they were separated in two groups. The Experimental (EXP) group repeated the eccentric bout 24 h later (ECC2) while the Control (CON) group did not. Indirect markers of muscle damage (i.e., strength loss, muscle soreness, and shear modulus) were measured to quantify the amount of muscle damage and its time course. RESULTS: Two days after the initial eccentric session, participants from EXP had a higher strength deficit (- 14.5 ± 10.6%) than CON (- 6.6 ± 8.7%) (P = 0.017, d = 0.9). Although both groups exhibited an increase in knee extensors shear modulus after ECC1, we found a significant increase in muscle shear modulus (+ 13.3 ± 22.7%; P < 0.01; d = 0.5) after ECC2 for the EXP group, despite the presence of mild to moderate muscle damage (i.e., strength deficit about 16%). CONCLUSION: Although the markers of muscle damage used in the current study were indirect, they suggest that the repetition of two bouts of maximal eccentric contractions with 24 h apart induces additional muscle damage in the knee extensors in presence of mild to moderate muscle damage.

Acute effects of quadriceps muscle versus tendon prolonged local vibration on force production capacities and central nervous system excitability.

PURPOSE: The present study aimed to directly compare the effects of 30 min muscle (VIBmuscle) vs. tendon (VIBtendon) local vibration (LV) to the quadriceps on maximal voluntary isometric contraction (MVIC) and rate of torque development (RTD) as well as on central nervous system excitability (i.e. motoneuron and cortical excitability). METHODS: Before (PRE) and immediately after (POST) LV applied to the quadriceps muscle or its tendon, we investigated MVIC and RTD (STUDY #1; n = 20) or vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) electromyography responses to thoracic electrical stimulation (TMEPs; motoneuron excitability) and transcranial magnetic stimulation (MEPs; corticospinal excitability) (STUDY #2; n = 17). MEP/TMEP ratios were further calculated to quantify changes in cortical excitability. RESULTS: MVIC decreased at POST (P = 0.017) without any difference between VIBtendon and VIBmuscle, while RTD decreased for VIBtendon (P = 0.013) but not VIBmuscle. TMEP amplitudes were significantly decreased for all muscles (P = 0.014, P < 0.001 and P = 0.004 for VL, VM and RF, respectively) for both LV sites. While no changes were observed for MEP amplitude, MEP/TMEP ratios increased at POST for VM and RF muscles (P = 0.009 and P = 0.013, respectively) for both VIBtendon and VIBmuscle. CONCLUSION: The present results suggest that prolonged muscle and tendon LV are similarly effective in modulating central nervous system excitability and decreasing maximal force. Yet, altered explosive performance after tendon but not muscle LV suggests greater neural alterations when tendons are vibrated.

Reductions in motoneuron excitability during sustained isometric contractions are dependent on stimulus and contraction intensity.

Cervicomedullary stimulation provides a means of assessing motoneuron excitability. Previous studies demonstrated that during low-intensity sustained contractions, small cervicomedullary evoked potentials (CMEPs) conditioned using transcranial magnetic stimulation (TMS-CMEPs) are reduced, whereas large TMS-CMEPs are less affected. As small TMS-CMEPs recruit motoneurons most active during low-intensity contractions whereas large TMS-CMEPs recruit a high proportion of motoneurons inactive during the task, these results suggest that reductions in motoneuron excitability could be dependent on repetitive activation. To further test this hypothesis, this study assessed changes in small and large TMS-CMEPs across low- and high-intensity contractions. Twelve participants performed a sustained isometric contraction of the elbow flexor for 4.5 min at the electromyography (EMG) level associated with 20% maximal voluntary contraction force (MVC; low intensity) and 70% MVC (high intensity). Small and large TMS-CMEPs with amplitudes of ∼15% and ∼50% Mmax at baseline, respectively, were delivered every minute throughout the tasks. Recovery measures were taken at 1-, 2.5- and 4-min postexercise. During the low-intensity trial, small TMS-CMEPs were reduced at 2-4 min (P ≤ 0.049) by up to -10% Mmax, whereas large TMS-CMEPs remained unchanged (P ≥ 0.16). During the high-intensity trial, small and large TMS-CMEPs were reduced at all time points (P < 0.01) by up to -14% and -33% Mmax, respectively, and remained below baseline during all recovery measures (P ≤ 0.02). TMS-CMEPs were unchanged relative to baseline during recovery following the low-intensity trial (P ≥ 0.24). These results provide novel insight into motoneuron excitability during and following sustained contractions at different intensities and suggest that contraction-induced reductions in motoneuron excitability depend on repetitive activation.NEW & NOTEWORTHY This study measured motoneuron excitability using cervicomedullary evoked potentials conditioned using transcranial magnetic stimulation (TMS-CMEPs) of both small and large amplitudes during sustained low- and high-intensity contractions of the elbow flexors. During the low-intensity task, only the small TMS-CMEP was reduced. During the high-intensity task, both small and large TMS-CMEPs were substantially reduced. These results indicate that repetitively active motoneurons are specifically reduced in excitability compared with less active motoneurons in the same pool.

Task failure during sustained low-intensity contraction is not associated with a critical amount of central fatigue.

Fatigue-related mechanisms induced by low-intensity prolonged contraction in lower limb muscles are currently unknown. This study investigated central fatigue kinetics in the knee extensors during a low-intensity sustained isometric contraction. Eleven subjects sustained a 10% maximal voluntary contraction (MVC) until task failure (TF) with neuromuscular evaluation every 3 minutes. Testing encompassed transcranial magnetic stimulation to evaluate maximal voluntary activation (VATMS ), motor evoked potential (MEP), and silent period (SP), and peripheral nerve stimulation to assess M-wave. Rating of perceived exertion (RPE) was also recorded. MVC progressively decreased up to 50% of the time to TF (ie, 50%TTF ) and then plateaued, reaching ~50% at TF (P < .001). VATMS progressively decreased up to 90%TTF and then plateaued, the decrease reaching ~20% at TF (P < .001). SP was lengthened early (ie, from 20%TTF ) during the exercise and then plateaued (P < .01). No changes were reported for MEP evoked during MVC (P = .87), while MEP evoked during submaximal contractions decreased early (ie, from 20%TTF ) during the exercise and then plateaued (P < .01). RPE increased linearly during the exercise to be almost maximal at TF. M-waves were not altered (P = .88). These findings confirm that TF is due to the subjects reaching their maximal perceived effort rather than any particular central event or neuromuscular limitations since MVC at TF was far from 10% of its original value. It is suggested that strategies minimizing RPE (eg, motivational self-talk) should be employed to enhance endurance performance.

Vibration-induced depression in spinal loop excitability revisited.

KEY POINTS: While it has been well described that prolonged vibration locally applied to a muscle or its tendon (up to 1 h) decreases spinal loop excitability between homonymous Ia afferents and motoneurons, the involved mechanisms are not fully understood. By combining electrophysiological methods, this study aimed to provide new insights into the mechanisms involved in soleus decreased spinal excitability after prolonged local vibration. We report that prolonged vibration induces a decrease in motoneuron excitability rather than an increase in presynaptic mechanisms (as commonly hypothesized in the current literature). The present results may help to design appropriate clinical intervention and could reinforce the interest in vibration as a treatment for spastic patients who are characterized by spinal hyper-excitability responsible for spasms and long-lasting reflexes. ABSTRACT: The mechanisms that can explain the decreased spinal loop excitability in response to prolonged local vibration (LV), as assessed by the H-reflex, remain to be precisely determined. This study provides new insights into how prolonged Achilles' tendon LV (30 min, 100 Hz) acutely interacts with the spinal circuitry. The roles of presynaptic inhibition exerted on Ia afferents (Experiment A, n = 15), neurotransmitter release at the synapse level (Experiment B, n = 11) and motoneuron excitability (Experiment C, n = 11) were investigated in soleus. Modulation of presynaptic inhibition was assessed by conditioning the soleus H-reflex (tibial nerve electrical stimulation) with fibular nerve (D1 inhibition) and femoral nerve (heteronymous facilitation, HF) electrical stimulations. Potential vibration-induced changes in neurotransmitter depletion at the Ia afferent terminals was assessed through paired stimulations applied over the tibial nerve (HD). Intrinsic motoneuron excitability was assessed with thoracic motor evoked potentials (TMEPs) in response to electrical stimulation over the thoracic spine. Non-conditioned H-reflex was depressed by ∼60% after LV (P < 0.001), while D1 and HF H-reflexes increased by ∼75% after LV (P = 0.03 and 0.06, respectively). In Experiment B, HD remained unchanged after LV (P = 0.80). In Experiment C, TMEPs were reduced by ∼13% after LV (P = 0.01). Overall, presynaptic mechanisms do not seem to be involved in the depression of spinal excitability after LV. It rather seems to rely, at least in part, on a decrease in intrinsic motoneuron excitability. These results may have implications in reducing spinal hyper-excitability in spastic patients.

Changes in central and peripheral neuromuscular fatigue indices after concentric versus eccentric contractions of the knee extensors.

PURPOSE: To better understand neuromuscular characteristics of eccentric exercise-induced muscle damage, this study compared between concentric (CONC) and eccentric (ECC) exercises of knee extensor muscles, and the first (ECC1) and second bouts of the eccentric exercise (ECC2) for central and peripheral parameters associated with neuromuscular fatigue. METHODS: Twelve young men performed three exercise bouts separated by at least 1 week between CONC and ECC1, and 2 weeks between ECC1 and ECC2. In each exercise, maximal voluntary concentric or eccentric contractions of the knee extensors were performed until a reduction in maximal voluntary isometric contraction (MVC) torque of at least 40% MVC was achieved immediately post-exercise. MVC torque, central (voluntary activation and normalised electromyographic activity), and peripheral neuromuscular indices (evoked torque and M-wave amplitude), and muscle soreness were assessed before (PRE), immediately after (POST), 1 h (1H), and 1-4 days after exercise (D1, D2, D3, and D4). RESULTS: MVC torque decreased at only POST for CONC (- 52.8%), but remained below the baseline at POST (- 48.6%), 1H (- 34.1%), and D1-D4 (- 34.1 to - 18.2%) after ECC1, and at POST (- 45.2%), 1H (- 24.4%) and D1 (- 13.4%) after ECC2 (p < 0.05). Voluntary activation decreased immediately after ECC1 (- 21.6%) and ECC2 (- 21.1%), but not after CONC. Electrically evoked torques decreased similarly at POST and 1H for the three conditions, but remained below the baseline at D1 only post-ECC1. CONCLUSION: These results showed that both central and peripheral factors contributed to the MVC decrease after ECC1 and ECC2, but the decrease was mainly due to peripheral factors after CONC.

Correction to: Acute and chronic neuromuscular adaptations to local vibration training.

The author would like to correct the reference in the publication of the original article. The corrected reference is given below for your reading.

Acute and chronic neuromuscular adaptations to local vibration training.

Vibratory stimuli are thought to have the potential to promote neural and/or muscular (re)conditioning. This has been well described for whole-body vibration (WBV), which is commonly used as a training method to improve strength and/or functional abilities. Yet, this technique may present some limitations, especially in clinical settings where patients are unable to maintain an active position during the vibration exposure. Thus, a local vibration (LV) technique, which consists of applying portable vibrators directly over the tendon or muscle belly without active contribution from the participant, may present an alternative to WBV. The purpose of this narrative review is (1) to provide a comprehensive overview of the literature related to the acute and chronic neuromuscular changes associated with LV, and (2) to show that LV training may be an innovative and efficient alternative method to the 'classic' training programs, including in the context of muscle deconditioning prevention or rehabilitation. An acute LV application (one bout of 20-60 min) may be considered as a significant neuromuscular workload, as demonstrated by an impairment of force generating capacity and LV-induced neural changes. Accordingly, it has been reported that a training period of LV is efficient in improving muscular performance over a wide range of training (duration, number of session) and vibration (frequency, amplitude, site of application) parameters. The functional improvements are principally triggered by adaptations within the central nervous system. A model illustrating the current research on LV-induced adaptations is provided.

Cortical voluntary activation testing methodology impacts central fatigue.

PURPOSE: Currently, cortical voluntary activation (VATMS) is assessed by superimposing transcranial magnetic stimulation (TMS) on a maximal voluntary contraction (MVC), 75% MVC and 50% MVC, each contraction being interspersed with 5-10 s of relaxation. Here, we assessed whether this traditional approach (TRADI) underestimates central fatigue due to this short recovery compared to a continuous method (CONTI). METHODS: VATMS, motor-evoked potential (MEP), and cortical silent period (CSP) of the vastus lateralis were determined in 12 young healthy adults before and after a 2-min sustained MVC of knee extensors in two randomly assigned sessions. In TRADI, evaluations comprised a 7-s rest between the three contractions (100, 75, and 50% MVC) and evaluation following the 2-min sustained MVC started after a minimal rest (3-4 s). In CONTI, evaluations were performed with no rest allowed between the three levels of contraction, and evaluation after the 2-min sustained MVC commenced without any rest. RESULTS: MVC was equally depressed at the end of the 2 min in both conditions. Post 2-min sustained MVC, VATMS change was greater in CONTI than in TRADI (-29 (15)% [-42, -17] vs. -9 (4)% [-13, -5], respectively, P < 0.001). Differences were also observed between TRADI and CONTI for MEP and CSP immediately after the fatiguing exercise. All differences between the two methods disappeared after 2 min of recovery. CONCLUSION: After a 2-min sustained MVC, a few seconds of recovery change the amount of measured VATMS and associated parameters of central fatigue. The continuous method should be preferred to determine deficits in voluntary activation.

Changes in tibialis anterior corticospinal properties after acute prolonged muscle vibration.

PURPOSE: Prolonged local vibration is known to impair muscle performance. While involved mechanisms were previously evidenced at the spinal level, changes at the cortical level were also hypothesized. The aims of the present study were to investigate the effects of 30 min of 100-Hz tibialis anterior muscle vibration on force production capacities and to further identify the respective changes in spinal loop properties, descending voluntary drive and corticospinal properties. METHODS: Thirteen subjects were tested before and after a vibration condition, and before and after a resting control condition. Maximal voluntary contraction (MVC) in dorsiflexion was measured. Transcranial magnetic stimulation was superimposed during MVCs to assess cortical voluntary activation (VATMS), motor-evoked potential amplitude (MEP) and cortical silent period length (CSP). MEP and CSP were also measured during 50 and 75 % MVC contractions. Spinal excitability was investigated by mean of H-reflex. RESULTS: There were no vibration effects on MVC (p = 0.805), maximal EMG activity (p = 0.653), VATMS (p = 1), and CSP (p = 0.877). Vibration tended to decrease MEP amplitude (p = 0.117). H-reflex amplitude was depressed following vibration (p = 0.008). CONCLUSIONS: Dorsiflexion maximal force production capacities were unaffected by 30 min of tibialis anterior muscle vibration, despite spinal loop and corticospinal excitabilities being reduced. These findings suggest that acute prolonged vibration has the potential to modulate corticospinal excitability of lower limb muscles without a concomitant functional consequence.

Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review.

BACKGROUND: Surgical residents in France lack a clear pedagogical framework for achieving autonomy in the operating room. The progressive acquisition of surgical autonomy is a determining factor in the confidence of operators for their future independent practice. Currently, there is no autonomy scale commonly used in Europe. The objective of this study is to identify existing tools for quantifying the autonomy of residents and the factors that influence it. MATERIALS AND METHODS: We conducted a qualitative systematic review following the recommendations of the Systematic Review Without Meta-Analysis (SWiM) guidelines. Publications were extracted from the MEDLINE (PubMed), EMBASE, and PSYCINFO databases. All publications without date restrictions up to July 2022 were identified. RESULTS: Among the 231 identified publications, 21 met the inclusion criteria. Seventeen publications used a graded autonomy assessment tool by the student and/or the teacher, while 4 used evaluations by an observing third party. We found 8 different autonomy scales, with the Zwisch Scale representing 57.1% of the cases. Factors influencing autonomy were diverse, including the work context, experience, and gender of the resident and their teacher. DISCUSSION: We found heterogeneity in the tools used to "measure" the autonomy of a resident in the operating room. The SIMPL tool or the Zwisch Scale appear to be the most frequently used tools. The relationship between autonomy, performance, confidence, and knowledge may require multidimensional tools that encompass various areas of competence, but this could make their daily application more challenging. The factors influencing autonomy are numerous; and understanding them would improve teaching in the operating room. There is a significant lack of data on surgical autonomy in France, as well as a lack of evaluation in the field of gynecology-obstetrics worldwide.

Persistent inward currents in tibialis anterior motoneurons can be reliably estimated within the same session.

The response of spinal motoneurons to synaptic input greatly depends on the activation of persistent inward currents (PICs), the contribution of which can be estimated through the paired motor unit technique. Yet, the intra-session test-retest reliability of this measurement remains to be fully established. Twenty males performed isometric triangular dorsiflexion contractions to 20 and 50 % of maximal torque at baseline and after a 15-min resting period. High-density electromyographic signals (HD-EMG) of the tibialis anterior were recorded with a 64-electrode matrix. HD-EMG signals were decomposed, and motor units tracked across time points to estimate the contribution of PICs to motoneuron firing through quantification of motor unit recruitment-derecruitment hysteresis (ΔF). A good intraclass correlation coefficient (ICC = 0.75 [0.63, 0.83]) and a large repeated measures correlation coefficient (rrm = 0.65 [0.49, 0.77]; p < 0.001) were found between ΔF values obtained at both time points for 20 % MVC ramps. For 50 % MVC ramps, a good ICC (0.77 [0.65, 0.85]) and a very large repeated measures correlation coefficient (rrm = 0.73 [0.63, 0.80]; p < 0.001) were observed. Our data suggest that ΔF scores can be reliably investigated in tibialis anterior motor units during both low- and moderate-intensity contractions within a single experimental session.

Prevalence of self-reported fatigue in intensive care unit survivors 6 months-5 years after discharge.

Prolonged stays in intensive care units (ICU) are responsible for long-lasting consequences, fatigue being one of the more debilitating. Yet, fatigue prevalence for patients that have experienced ICU stays remains poorly investigated. This study aimed to evaluate fatigue prevalence and the level of physical activity in ICU survivors from 6 months to 5 years after ICU discharge using the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) and Godin questionnaires, respectively. Data from 351 ICU survivors (out of 1583 contacted) showed that 199 (57%) and 152 (43%) were considered as fatigued and non-fatigued, respectively. The median FACIT-F scores for fatigued versus non-fatigued ICU survivors were 21 (14-27) and 45 (41-48), respectively (p < 0.001). Time from discharge had no significant effect on fatigue prevalence (p = 0.30) and fatigued ICU survivors are less active (p < 0.001). In multivariate analysis, the only risk factor of being fatigued that was identified was being female. We reported a high prevalence of fatigue among ICU survivors. Sex was the only independent risk factor of being fatigued, with females being more prone to this symptom. Further studies should consider experimental approaches that help us understand the objective causes of fatigue, and to build targeted fatigue management interventions.

Differences in time to task failure and fatigability between children and young adults: A systematic review and meta-analysis.

The transition from childhood to adulthood is characterized by many physiological processes impacting exercise performance. Performance fatigability and time to task failure are commonly used to capture exercise performance. This review aimed to determine the differences in fatigability and TTF between youth (including both children and adolescents) and young adults, and to evaluate the influence of exercise modalities (i.e., exercise duration and type of exercise) on these differences. Medline, SPORTDiscus and Cochrane Library were searched. Thirty-four studies were included. The meta-analyses revealed that both children (SMD -1.15; p < 0.001) and adolescents (SMD -1.26; p = 0.022) were less fatigable than adults. Additional analysis revealed that children were less fatigable during dynamic exercises (SMD -1.58; p < 0.001) with no differences during isometric ones (SMD -0.46; p = 0.22). Children (SMD 0.89; p = 0.018) but not adolescents (SMD 0.75; p = 0.090) had longer TTF than adults. Additional analyses revealed 1) that children had longer TTF for isometric (SMD 1.25; p < 0.001) but not dynamic exercises (SMD -0.27; p = 0.83), and 2) that TTF differences between children and adults were larger for short- (SMD 1.46; p = 0.028) than long-duration exercises (SMD 0.20; p = 0.64). Children have higher endurance and are less fatigable than adults. These differences are influenced by the exercise modality, suggesting distinct physiological functioning during exercise between children and adults. The low number of studies comparing these outcomes between adolescents versus children and adults prevents robust conclusions and warrants further investigations in adolescent individuals.

Local vibration training improves the recovery of quadriceps strength in early rehabilitation after anterior cruciate ligament reconstruction: A feasibility randomised controlled trial.

BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), quadriceps strength must be maximised as early as possible. OBJECTIVES: We tested whether local vibration training (LVT) during the early post-ACLR period (i.e., ∼10 weeks) could improve strength recovery. METHODS: This was a multicentric, open, parallel-group, randomised controlled trial. Thirty individuals attending ACLR were randomised by use of a dedicated Web application to 2 groups: vibration (standardised rehabilitation plus LVT, n=16) or control (standardised rehabilitation alone, n=14). Experimenters, physiotherapists and participants were not blinded. Both groups received 24 sessions of standardised rehabilitation over ∼10 weeks. In addition, the vibration group received 1 hour of vibration applied to the relaxed quadriceps of the injured leg at the end of each rehabilitation session. The primary outcome - maximal isometric strength of both injured and non-injured legs (i.e., allowing for limb asymmetry measurement) - was evaluated before ACLR (PRE) and after the 10-week rehabilitation (POST). RESULTS: Seven participants were lost to follow-up, so data for 23 participants were used in the complete-case analysis. For the injured leg, the mean (SD) decrease in maximal strength from PRE to POST was significantly lower for the vibration than control group (n=11, -16% [10] vs. n=12, -30% [11]; P=0.0045, Cohen's d effect size=1.33). Mean PRE-POST change in limb symmetry was lower for the vibration than control group (-19% [11] vs. -29% [13]) but not significantly (P=0.051, Cohen's d effect size=0.85). CONCLUSION: LVT improved strength recovery after ACLR. This feasibility study suggests that LVT applied to relaxed muscles is a promising modality of vibration therapy that could be implemented early in ACLR. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02929004.

Is Accelerometry an Effective Method to Assess Muscle Vibrations in Comparison to Ultrafast Ultrasonography?

OBJECTIVE: The purpose of this study was to assess whether accelerometry effectively reflects muscle vibrations measured with ultrafast ultrasonography. METHODS: Vibration characteristics initiated on the vastus lateralis muscle by an impactor were compared when assessed with accelerometry and ultrasonography. Continuous wavelet transforms and statistical parametric mapping (SPM) were performed to identify discrepancies in vibration power over time and frequency between the two devices. RESULTS: The SPM analysis revealed that the accelerometer underestimated the muscle vibration power above 50 Hz during the first 0.06 seconds post impact. Furthermore, the accelerometer overestimated the muscle vibration power under 20 Hz, from 0.1 seconds after the impact. Linear regression revealed that the thicker the subcutaneous fat localized under the accelerometer, the more the muscle vibration frequency and damping were underestimated by the accelerometer. CONCLUSION: The skin and the fat tissues acted like a low-pass filter above 50 Hz and oscillated in a less damped manner than the muscle tissue under 20 Hz. SIGNIFICANCE: To eliminate some artifacts caused by the superficial tissues and assess the muscle vibration characteristics with accelerometry, it is suggested to 1) high-pass filter the acceleration signal at a frequency of 20 Hz, under certain conditions, and 2) include participants with less fat thickness. Therefore, the subcutaneous thickness must be systematically quantified under each accelerometer location to clarify the differences between subjects and muscles.

Relationship between intensive care unit-acquired weakness, fatigability and fatigue: What role for the central nervous system?

PURPOSE: To provide a comprehensive review of studies that have investigated fatigue in intensive care unit (ICU) survivors and questions the potential link between intensive care unit-acquired weakness (ICUAW), fatigability and fatigue. We also question whether the central nervous system (CNS) may be the link between these entities. MATERIAL AND METHODS: A narrative review of the literature that investigated fatigue in ICU survivors and review of clinical trials enabling understanding of CNS alterations in response to ICU stays. RESULTS: Fatigue is a pervasive and debilitating symptom in ICU survivors that can interfere with rehabilitation. Due to the complex pathophysiology of fatigue, more work is required to understand the roles of ICUAW and/or fatigability in fatigue to provide a more holistic understanding of this symptom. While muscle alterations have been well documented in ICU survivors, we believe that CNS alterations developing early during the ICU stay may play a role in fatigue. CONCLUSIONS: Fatigue should be considered and treated in ICU survivors. The causes of fatigue are likely to be specific to the individual. Understanding the role that ICUAW and fatigability may have in fatigue would allow to tailor individual treatment to prevent this persistent symptom and improve quality of life.

Sex Influence on the Functional Recovery Pattern After a Graded Running Race: Original Analysis to Identify the Recovery Profiles.

This study investigated the sex influence on the acute and delayed fatigue effects of a 20 km graded running race. Eighteen recreational runners, 10 women and 8 men, completed the race. The testing protocol included five sessions: a week before the race (PRE), 35 ± 15 min after (POST), 2 h, 2 and 4 days (2D and 4D) later. Each session included uni- and bilateral maximal isometric voluntary contractions of the knee extensors (MVC), a squat jump (SJ), and a drop jump (DJ). Acute and delayed muscle soreness (DOMS) were evaluated for the quadriceps, hamstring and triceps surae muscle groups. The 2D and 4D sessions included also a horizontal force-velocity test (HF-V) performed under five resistive conditions. For each test, a set of key variables was computed to characterize the lower limb functional recovery. Mixed ANOVA analyses revealed significant (sex × time) interactions, with larger acute drops for men in MVCs and earlier recovery for women in the bilateral MVC (p < 0.001) and DJ (p < 0.05) tests. Only women reported DOMS for the hamstrings at 2D (p < 0.001) and showed small improvements in pure concentric SJ (p < 0.05) and HF-V (p < 0.01) tests at 4D. As expected, DOMS disappeared prior to the complete functional recovery. These results confirmed the combined influence of testing task and sex on the functional recovery pattern while supporting a lesser and faster recovery in women. The originality of this study lies in the complexity and sex-dependence of the functional recovery pattern revealed by a multiple factorial analysis which was used to identify the most discriminating tests and variables in the recovery pattern. The obtained clusters highlighted some recovery profiles associated with greater risks of injury when starting to run again. However, the lack of sex × time interaction for normalized values emphasizes the major influence of men's initially higher functional values compared to women.