Intermuscular coherence of plantar and dorsiflexor muscles in older adults with Parkinson's disease and age-matched controls during bipedal and unipedal stance.

Introduction: Postural instability increases with age and is exacerbated in neurological disorders such as Parkinson's disease (PD). Reducing the base of support from bipedal to unipedal stance increases center of pressure (CoP) parameters and intermuscular coherence in lower-leg muscles of healthy older adults. To further develop an understanding of postural control in an altered state of neurological impairment, we explored intermuscular coherence in lower-leg muscles and CoP displacement in older adults with PD. Methods: This study measured surface EMG from the medial (MG) and lateral (LG) gastrocnemii, soleus (SOL), and tibialis anterior (TA), and examined EMG amplitude and intermuscular coherence during bipedal and unipedal stance on a force plate with firm (no foam) and compliant (standing on foam) surface conditions in nine older adults with PD (70±5 years, 6 females) and 8 age-matched non-Parkinsonian older adults (5 females). Intermuscular coherence was analyzed between agonist-agonist and agonist-antagonist muscle pairs in the alpha (8-13 Hz) and beta (15-35 Hz) frequency bands. Results: CoP parameters increased from bipedal to unipedal stance in both groups (p < 0.01), but did not increase from the firm to compliant surface condition (p > 0.05). During unipedal stance, CoP path length was shorter in older adults with PD (2027.9 ± 1074.1 mm) compared to controls (3128.5 ± 1198.7 mm) (p < 0.01). Alpha and beta agonist-agonist and agonist-antagonist coherence increased by 28% from bipedal to unipedal stance (p > 0.05), but did not differ between older adults with PD (0.09 ± 0.07) and controls (0.08 ± 0.05) (p > 0.05). The older adults with PD also had greater normalized EMG amplitude of the LG (63.5 ± 31.7%) and TA (60.6 ± 38.4%) during the balance tasks (p > 0.05) than the non-Parkinsonian counterparts. Discussion: Older adults with PD had shorter path lengths during unipedal stance and required greater muscle activation than older adults without PD to perform the tasks, but intermuscular coherence did not differ between the groups. This may be attributable to their early disease stage and high motor function.

Resting Tendon Cross-Sectional Area Underestimates Biceps Brachii Tendon Stress: Importance of Measuring During a Contraction.

Force produced by the muscle during contraction is applied to the tendon and distributed through the cross-sectional area (CSA) of the tendon. This ratio of force to the tendon CSA is quantified as the tendon mechanical property of stress. Stress is traditionally calculated using the resting tendon CSA; however, this does not take into account the reductions in the CSA resulting from tendon elongation during the contraction. It is unknown if calculating the tendon stress using instantaneous CSA during a contraction significantly increases the values of in vivo distal biceps brachii (BB) tendon stress in humans compared to stress calculated with the resting CSA. Nine young (22 ± 1 years) and nine old (76 ± 4 years) males, and eight young females (21 ± 1 years) performed submaximal isometric elbow flexion tracking tasks at force levels ranging from 2.5 to 80% maximal voluntary contraction (MVC). The distal BB tendon CSA was recorded on ultrasound at rest and during the submaximal tracking tasks (instantaneous). Tendon stress was calculated as the ratio of tendon force during contraction to CSA using the resting and instantaneous measures of CSA, and statistically evaluated with multi-level modeling (MLM) and Johnson-Neyman regions of significance tests to determine the specific force levels above which the differences between calculation methods and groups became statistically significant. The tendon CSA was greatest at rest and decreased as the force level increased (p < 0.001), and was largest in young males (23.0 ± 2.90 mm2) followed by old males (20.87 ± 2.0 mm2) and young females (17.08 ± 1.54 mm2) (p < 0.001) at rest and across the submaximal force levels. Tendon stress was greater in the instantaneous compared with the resting CSA condition, and young males had the greatest difference in the values of tendon stress between the two conditions (20 ± 4%), followed by old males (19 ± 5%), and young females (17 ± 5%). The specific force at which the difference between the instantaneous and resting CSA stress values became statistically significant was 2.6, 6.6, and 10% MVC for old males, young females, and young males, respectively. The influence of using the instantaneous compared to resting CSA for tendon stress is sex-specific in young adults, and age-specific in the context of males. The instantaneous CSA should be used to provide a more accurate measure of in vivo tendon stress in humans.

Contribution of Achilles tendon mechanical properties to torque steadiness in persons with transfemoral amputation.

BACKGROUND: How Achilles tendon mechanics and plantar flexion strength and torque steadiness are altered in the intact leg of persons with trauma-related amputation is unknown. Understanding Achilles tendon mechanics following amputation will further inform rehabilitation approaches to enhance posture, balance, and force control. OBJECTIVE: Conduct a pilot study to quantify plantar flexion maximal voluntary contraction torque, torque steadiness, and Achilles tendon mechanics in persons with unilateral trauma-related transfemoral amputation and controls without amputation. STUDY DESIGN: Cross-sectional study. METHODS: Isometric plantar flexion maximal voluntary contractions were performed with the intact leg of ten males with transfemoral amputation (48 ± 14 years) and the dominant leg of age-matched male controls without amputation. Torque steadiness was calculated as the coefficient of variation in torque over 6 s during submaximal tracking tasks (5%, 10%, 25%, 50%, and 75% maximal voluntary contraction). Achilles tendon elongation and cross-sectional area were recorded with ultrasound to calculate strain, stress, and stiffness. RESULTS: Maximal voluntary contraction and torque steadiness did not differ between persons with amputation (90.6 ± 31.6 N m, 3.7 ± 2.0%) and controls (95.8 ± 26.8 N m, 2.9 ± 1.2%; p > 0.05). Tendon stiffness (21.1 ± 18.2 N/mm) and strain (5.2 ± 1.3%) did not differ between groups (p > 0.05). Tendon cross-sectional area was 10% greater in persons with amputation leading to 29% lower stress (p = 0.021). Maximal voluntary contraction was a predictor of a lower coefficient of variation in torque (R2 = 0.11, p < 0.05). CONCLUSION: Persons with trauma-related transfemoral amputation do not differ in plantar flexion maximal voluntary contraction and torque steadiness of the intact leg compared with controls without amputation. Larger tendon cross-sectional area reduces stress and enables distribution of force across a greater area.

Importance of Maximal Strength and Muscle-Tendon Mechanics for Improving Force Steadiness in Persons with Parkinson's Disease.

Although plantar flexion force steadiness (FS) is reduced in persons with Parkinson's disease (PD), the underlying causes are unknown. The aim of this exploratory design study was to ascertain the influence of maximal voluntary contraction (MVC) force and gastrocnemius-Achilles muscle-tendon unit behaviour on FS in persons with PD. Nine persons with PD and nine age- and sex-matched non-PD controls (~70 years, 6 females per group) performed plantar flexion MVCs and sub-maximal tracking tasks at 5, 10, 25, 50 and 75% MVC. Achilles tendon elongation and medial gastrocnemius fascicle lengths were recorded via ultrasound during contraction. FS was quantified using the coefficient of variation (CV) of force. Contributions of MVC and tendon mechanics to FS were determined using multiple regression analyses. Persons with PD were 35% weaker during MVC (p = 0.04) and had 97% greater CV (p = 0.01) with 47% less fascicle shortening (p = 0.004) and 38% less tendon elongation (p = 0.002) than controls. Reduced strength was a direct contributor to lower FS in PD (ß = 0.631), and an indirect factor through limiting optimal muscle-tendon unit interaction. Interestingly, our findings indicate an uncoupling between fascicle shortening and tendon elongation in persons with PD. To better understand limitations in FS and muscle-tendon unit behavior, it is imperative to identify the origins of MVC decrements in persons with PD.

Is there sufficient evidence to explain the cause of sexually dimorphic behaviour in force steadiness?

Neuromuscular noise is a determining factor in the control of isometric force steadiness (FS), quantified as coefficient of variation (CV) of force around a preestablished target output. In this paper we examine sex-related differences of neural, muscular, and tendon influences on neuromuscular noise to understand FS in females and males. We use evidence from the literature to identify that CV of force is higher in females compared with males in the upper and lower body, with sex-related differences becoming less apparent with increasing age. Evaluation of sex-related physiology in tandem with results from FS studies indicate that differences in fibre type, contractile properties, and number of motor units (MUs) are unlikely contributors to differences in FS between females and males. MU type, behaviour of the population (inclusive of number of active MUs from the population), agonist-antagonist activity, maximal strength, and tendon mechanics are probable contributors to sexually dimorphic behaviour in FS. To clearly determine underlying causes of sex-related differences in FS, further study and reporting between females and males is required. Females and males are included in many studies; however, rich data on sexually dimorphic behaviour is lost when data are collapsed across sex or identified as nonsignificant without supporting values. This poses a challenge to identifying the underlying cause of females having higher CV of force than males. This review provides evidence of sexually dimorphic behaviour in FS and suggests that physiological differences between females and males effect neuromuscular noise, and in-turn contribute to sex-related differences in FS.

Influence of forearm orientation on biceps brachii tendon mechanics and elbow flexor force steadiness.

Achilles tendon mechanics influence plantar flexion force steadiness (FS) and balance. In the upper limb, elbow flexor FS is greater in supinated and neutral forearm orientations compared to pronated, with contributions of tendon mechanics remaining unknown in position-dependent FS. This study investigated whether distal biceps brachii (BB) tendon mechanics across supinated, neutral and pronated forearm orientations influence position-dependent FS of the elbow flexors. Eleven males (23 ±â€¯3 years) performed submaximal isometric elbow flexion tasks at low (5, 10% maximal voluntary contraction (MVC)) and high (25, 50, 75% MVC) force levels in supinated, neutral and pronated forearm orientations. Distal BB tendon elongation and CSA were recorded on ultrasound to calculate mechanics of tendon stress, strain and stiffness. Relationships between FS, calculated as coefficient of variation (CV) of force, and tendon mechanics were evaluated with multiple regressions. Supinated and neutral were ∼50% stronger and ∼60% steadier than pronated (p < 0.05). Tendon stress was ∼52% greater in supinated and neutral compared to pronated, tendon strain was ∼36% greater in neutral than pronated (p < 0.05), while tendon stiffness (267.4 ±â€¯78.9 N/mm) did not differ across orientations (p > 0.05). At low forces, CV of force was predicted by MVC (r2: 0.52) in supinated, and MVC and stress in neutral and pronated (r2: 0.65-0.81). At high force levels, CV of force was predicted by MVC and stress in supinated (r2: 0.49), and MVC in neutral (r2: 0.53). Absolute strength and tendon mechanics influence the ability of the BB tendon to distribute forces, and thus are key factors in position-dependent FS.

Influence of fascicle length on twitch potentiation of the medial gastrocnemius across three ankle angles.

PURPOSE: Length dependence of post-activation potentiation (PAP) is a well-established phenomenon in animal models but less certain in intact whole human muscles. Recent advances in B-mode ultrasonography provide real-time imaging and evaluation of human muscle fascicles in vivo, thus removing the assumption that joint positioning alters fascicle length and influences the extent of PAP. The purpose of this study was to determine whether a conditioning maximal voluntary contraction (MVC) would influence the return of medial gastrocnemius (MG) fascicles to baseline length and alter the extent of twitch potentiation between three ankle positions. METHODS: Ultrasonography was used to measure MG fascicle length for baseline and potentiated twitches at angles of 10° dorsiflexion (DF), 0° neutral (NEU-tibia perpendicular to the sole of the foot), and 20° plantar flexion (PF). A MVC was used as a conditioning contraction and PAP determined for each ankle angle. RESULTS: PAP of the plantar flexors was greater in PF (28.8 ± 2.6%) compared to NEU (19.8 ± 1.8%; p < 0.05) and DF (9.3 ± 2.8%; p < 0.0001). In PF, fascicle lengths (4.64 ± 0.17 cm) were shorter than both NEU (5.78 ± 0.15 cm; p < 0.0001) and DF (6.09 ± 0.15 cm; p < 0.0001). Fascicle lengths for the baseline twitches were longer (5.92 ± 0.11 cm) than the potentiated twitches (5.83 ± 0.10 cm; p < 0.01) at all joint angles. CONCLUSION: Although PAP is greatest in PF compared to NEU and DF, the higher PAP in the PF joint angle cannot be attributed to fascicles remaining shortened following the MVC because across all joint positions, fascicles are similarly shortened following the MVC.

Voluntary activation and twitch potentiation of the elbow flexors across supinated, neutral, and pronated forearm orientations.

Elbow flexion force depends on forearm orientation with supinated and neutral being stronger than pronated. The purpose of this study was to assess the influence of forearm orientation on voluntary activation (VA), postactivation potentiation (PAP), and twitch properties. Eleven males (23 ± 3 years) performed isometric elbow flexion maximal voluntary contractions (MVC) in supinated, neutral, and pronated forearm orientations with supramaximal stimulation to the biceps brachii muscle belly before, during, and after the MVC. MVC and VA were higher in supinated (213.6 ± 49.6 N; 93.0 ± 5.2%) and neutral (243.6 ± 48.0 N; 96.1 ± 3.2%) compared with pronated (113.6 ± 21.3 N; 70.9 ± 20.4%) (P < 0.05), while PAP did not differ across the three orientations (71.6 ± 42.2%) (P > 0.05). In the rested state, pronated peak tension (PT) was less compared with supinated (42%). In the potentiated state, pronated PT was less than supinated (50%) and neutral (53%) (P < 0.05). Reduced strength in the pronated orientation is partially attributed to reduced drive; however, reductions in peak tension indicate that there also is a mechanical disadvantage when the forearm is placed into a pronated orientation, and this does not alter PAP.

Validity and reliability of an iPhone App to assess time, velocity and leg power during a sit-to-stand functional performance test.

The purposes of this study were: (i) Analyze the concurrent validity and reliability of an iPhone App for measuring time, velocity and power during a single sit-to-stand (STS) test compared with measurements recorded from a force plate; and (ii) Evaluate the relationship between the iPhone App measures with age and functional performance. Forty-eight healthy individuals (age range: 26-81 years) were recruited. All participants completed a STS test on a force plate with the movement recorded on an iPhone 6 at 240 frames-per-second. Functional ability was also measured using isometric handgrip strength and self-paced walking time tests. Intraclass correlation coefficients (ICC), Pearson's correlation coefficient, Cronbach's alpha (α) and Bland-Altman plots with 95% confidence intervals (CI) were used to test validity and reliability between instruments. The results showed a good agreement between all STS measurement variables; time (ICC=0.864, 95%CI=0.77-0.92; α=0.926), velocity (ICC=0.912, 95%CI=0.85-0.95; α=0.953) and power (ICC=0.846, 95%CI=0.74-0.91; α=0.917) with no systematic bias between instruments for any variable analyzed. STS time, velocity and power derived from the iPhone App show moderate to strong associations with age (|r|=0.63-0.83) and handgrip strength (|r|=0.4-0.64) but not the walking test. The results of this study identify that this iPhone App is reliable for measuring STS and the derived values of time, velocity and power shows strong associations with age and handgrip strength.

Velocity of the muscle tendon unit is sex-dependent and not altered with acute static stretch.

Contraction velocity of a muscle tendon unit (MTU) is dependent upon the interrelationship between fascicles shortening and the tendon lengthening. Altering the mechanical properties of these tissues through a perturbation such as static stretching slows force generation. Females, who have inherently greater compliance compared with males, have slower velocity of MTU components. The addition of a static stretch might further exacerbate this sex difference. The purpose of this study was to investigate the velocity of fascicle shortening and tendon lengthening in males and females during isometric maximal voluntary contraction (MVC) of the plantar flexors prior to and following an acute static stretch. The MTU was imaged with ultrasound and voluntary activation tested with twitch interpolation for the 5-s plantar flexion MVC, which proceeded and followed an acute stretch. For the 3-min stretch the ankle was passively rotated to maximal dorsi-flexion. The males were stronger (128.71 ± 7.88 Nm) than the females (89.92 ± 4.70 Nm) but voluntary activation did not differ. Tendon lengthening velocity (p = 0.001) and fascicle shortening velocity (p = 0.01) were faster in males than females. Tendon velocity was positively and significantly correlated with fascicle velocity, (r2 = 0.307, p = 0.02). Although sex was significant as a predictor (p = 0.05) time was not independently significant. Thus, stretch did not alter this relationship in either sex (p = 0.6). The velocity of the individual components of the MTU is slower in females when compared with males; however, acute stretch does not alter the relationship between these components in males or females.

Exercise prescription to reverse frailty.

Frailty is a clinical geriatric syndrome caused by physiological deficits across multiple systems. These deficits make it challenging to sustain homeostasis required for the demands of everyday life. Exercise is likely the best therapy to reverse frailty status. Literature to date suggests that pre-frail older adults, those with 1-2 deficits on the Cardiovascular Health Study-Frailty Phenotype (CHS-frailty phenotype), should exercise 2-3 times a week, for 45-60 min. Aerobic, resistance, flexibility, and balance training components should be incorporated but resistance and balance activities should be emphasized. On the other hand, frail (CHS-frailty phenotype ≥ 3 physical deficits) older adults should exercise 3 times per week, for 30-45 min for each session with an emphasis on aerobic training. During aerobic, balance, and flexibility training, both frail and pre-frail older adults should work at an intensity equivalent to a rating of perceived exertion of 3-4 ("somewhat hard") on the Borg CR10 scale. Resistance-training intensity should be based on a percentage of 1-repetition estimated maximum (1RM). Program onset should occur at 55% of 1RM (endurance) and progress to higher intensities of 80% of 1RM (strength) to maximize functional gains. Exercise is the medicine to reverse or mitigate frailty, preserve quality of life, and restore independent functioning in older adults at risk of frailty.