Exploring the Relationship between Ultrasonographic Measures of the Quadriceps and Knee Extensor Muscle Fitness in Endurance-Trained Individuals.

Background: B-mode ultrasonography is an accessible and cost-effective method to assess muscle size and quality through muscle thickness (MT) and echo intensity (EI), respectively. Muscle thickness and EI have demonstrated relationships with maximal strength and local muscle endurance, providing a noninvasive and efficient modality to examine muscle fitness. However, these relationships have not been quantified in the individual quadriceps muscles of habitually endurance-trained populations, which may provide information to practitioners regarding rehabilitation and performance. Methods: Twenty-three participants (males: N = 10; females: N = 13) underwent B-mode ultrasonography to assess MT, EI, and adipose tissue thickness-corrected echo intensity (cEI) in the vastus intermedius (VI), vastus lateralis (VL), and rectus femoris (RF). Muscle fitness was evaluated through maximal strength (1RM) and local muscle endurance (4 sets to failure at 50% 1RM) during dynamic knee extension. Relationships between ultrasonography outcomes and muscle fitness were examined through stepwise multiple linear regression. Results: The results indicate that VI cEI is the strongest predictor of 1RM strength (r = -0.643), while no ultrasonography-derived measures significantly predicted local muscle endurance. Conclusion: The study demonstrates that ultrasonography, specifically measures of cEI in the VI, has the greatest association with maximal strength in endurance-trained individuals. These findings suggest monitoring VI muscle size and quality may benefit practitioners who aim to improve knee extension strength for performance or following injury. In addition, the findings support the use of EI examinations in trained populations.

Combined action observation and mental imagery versus neuromuscular electrical stimulation as novel therapeutics during short-term knee immobilization.

Limb immobilization causes rapid declines in muscle strength and mass. Given the role of the nervous system in immobilization-induced weakness, targeted interventions may be able to preserve muscle strength, but not mass, and vice versa. The purpose of this study was to assess the effects of two distinct interventions during 1 week of knee joint immobilization on muscle strength (isometric and concentric isokinetic peak torque), mass (bioimpedance spectroscopy and ultrasonography), and neuromuscular function (transcranial magnetic stimulation and interpolated twitch technique). Thirty-nine healthy, college-aged adults (21 males, 18 females) were randomized into one of four groups: immobilization only (n = 9), immobilization + action observation/mental imagery (AOMI) (n = 10), immobilization + neuromuscular electrical stimulation (NMES) (n = 12), or control group (n = 8). The AOMI group performed daily video observation and mental imagery of knee extensions. The NMES group performed twice daily stimulation of the quadriceps femoris. Based on observed effect sizes, it appears that AOMI shows promise as a means of preserving voluntary strength, which may be modulated by neural adaptations. Strength increased from PRE to POST in the AOMI group, with +7.2% (Cohen's d = 1.018) increase in concentric isokinetic peak torque at 30°/s. However, NMES did not preserve muscle mass. Though preliminary, our findings highlight the specific nature of clinical interventions and suggest that muscle strength can be independently targeted during rehabilitation. This study was prospectively registered: ClinicalTrials.gov NCT05072652.

Sex differences in fatiguability during single-joint resistance exercise in a resistance-trained population.

The primary aim of this study was to compare the fatiguability and acute recovery from a session of unilateral biceps curl exercise between habitually resistance-trained males and females. Twenty participants performed biceps curl one repetition maximum (1RM) and maximal voluntary contraction (MVC) testing of the elbow flexors. The exercise protocol consisted of four sets of unilateral biceps curls at 50% of the measured 1RM to volitional failure. MVC force and EMG activity of the elbow flexors were assessed following each set and during the recovery phase. The outcome variables compare the repetition volume, MVC strength loss, and EMG responses between males and females during the exercise and recovery phases. Across the exercise protocol, females completed significantly more repetitions compared to males (p < 0.01, d = 1.7) and lost significantly less strength across time (76% versus 69%, d = 0.48, p = 0.046). Additionally, females maintained a higher level of normalized EMG amplitude compared to males across the protocol (p = 0.035; d = 0.510). However, there were no sex differences in the strength (p = 0.562) or EMG (p = 0.607) responses during the recovery phase. In a resistance-trained population, females were able to perform a greater number of repetitions during the biceps curl exercise compared to their male counterparts at the same relative intensity of exercise. The ability of females to maintain a greater proportion of their maximal elbow flexor strength and muscle excitation during exercise suggests females can tolerate greater upper-body resistance exercise volume than males.

fNIRS is capable of distinguishing laterality of lower body contractions.

The use of functional near-infrared spectroscopy (fNIRS) for brain imaging during human movement continues to increase. This technology measures brain activity non-invasively using near-infrared light, is highly portable, and robust to motion artifact. However, the spatial resolution of fNIRS is lower than that of other imaging modalities. It is unclear whether fNIRS has sufficient spatial resolution to differentiate nearby areas of the cortex, such as the leg areas of the motor cortex. Therefore, the purpose of this study was to determine fNIRS' ability to discern laterality of lower body contractions. Activity in the primary motor cortex was recorded in forty participants (mean = 23.4 years, SD = 4.5, female = 23, male = 17) while performing unilateral lower body contractions. Contractions were performed at 30% of maximal force against a handheld dynamometer. These contractions included knee extension, knee flexion, dorsiflexion, and plantar flexion of the left and right legs. fNIRS signals were recorded and stored for offline processing and analysis. Channels of fNIRS data were grouped into regions of interest, with five tolerance conditions ranging from strict to lenient. Four of five tolerance conditions resulted in significant differences in cortical activation between hemispheres. During right leg contractions, the left hemisphere was more active than the right hemisphere. Similarly, during left leg contractions, the right hemisphere was more active than the left hemisphere. These results suggest that fNIRS has sufficient spatial resolution to distinguish laterality of lower body contractions. This makes fNIRS an attractive technology in research and clinical applications in which laterality of brain activity is required during lower body activity.

Sex differences in muscle-quality recovery following one week of knee joint immobilization and subsequent retraining.

This manuscript represents the second phase of a clinical trial designed to examine the effects of knee joint immobilization and retraining on muscle strength and mass. In Phase 2, we examined sex differences in the recovery of multiple indices of muscle quality after a resistance training-based rehabilitation program. Following 1 week of immobilization, 27 participants (16 males, 11 females) exhibiting weakness underwent twice weekly resistance training sessions designed to re-strengthen their left knee. Unilateral retraining sessions utilizing leg press, extension, and curl exercises were conducted until participants could reproduce their pre-immobilization knee extension isometric maximal voluntary contraction (MVC) peak torque. Post-immobilization, both sexes demonstrated impaired MVC peak torque (males = -10.8%, females = -15.2%), specific torque (-9.8% vs. -13.1%), echo intensity of the vastus lateralis (+6.9% vs. +5.9%) and rectus femoris (+5.9% vs. +2.1), and extracellular water/intracellular water ratio (+7.8% vs. +9.0%). The number of retraining sessions for peak torque to return to baseline for males (median = 1, mean = 2.13) versus females (median = 2, mean = 2.91) was not significantly different, though the disparity in recovery times may be clinically relevant. Following retraining, specific torque was the only muscle-quality indicator that improved along with MVC peak torque (males = 20.1%, females = 22.4%). Our findings indicate that measures of muscle quality demonstrate divergent recovery rates following immobilization, with muscle mass lagging behind improvements in strength. Greater immobilization-induced strength loss among females suggests that sex-specific rehabilitation efforts may be justified.

Sex differences in the fractal dynamics of force control during maximal handgrip.

This work examines the temporal structure of force fluctuations during maximal handgrip with detrended fluctuation analysis (DFA α). Here, we assess the influence of fatigue and sex on force complexity during unimanual handgrip for the fatigued and the contralateral, non-fatigued hand. Participants randomly completed experimental sessions requiring fatiguing handgrip contractions or control measurements only. Maximal unimanual forces of both hands were measured before and after the fatigue trial or a time-matched control visit. DFA revealed substantially lower alpha values for females (PRE = 1.15, POST = 1.25) compared to males (PRE = 1.30, POST = 1.33) regardless of fatigue (p < 0.01, d = 0.738) for the dominant hand with a similar pattern observed for the contralateral, non-fatigued hand (p = 0.045, d = 0.561). Females also showed greater alpha changes (Δ = 0.09) versus males (Δ = 0.01) following fatigue (p = 0.028, ηp2 = 0.151). The data provide evidence of reduced force complexity during successive maximal handgrip contractions for females, but not males. Our findings highlight task-specific factors involving force control and demonstrate the utility of complexity analyses to provide insights regarding the influence of sex on motor control strategies.

The Influence of Resistance Training Experience on the Efficacy of Motor Imagery for Acutely Increasing Corticospinal Excitability.

Both motor imagery and resistance-training enhance motor function and corticospinal excitability. We tested the hypothesis that young participants with significant resistance-training experience would show heightened corticospinal excitability during a single session of motor imagery training. Fifty-six participants (mean ± SD age = 22 ± 2 years) were divided into resistance-trained and untrained groups. Forty-one upper-body resistance trained (21 males, 20 females; mean ± SD relative one repetition maximum bench press = 0.922 ± 0.317 kg/kg) and 15 untrained (4 males, 11 females; mean ± SD relative one repetition maximum bench press = 0.566 ± 0.175 kg/kg) participants visited the laboratory on three separate occasions. The first visit served as the familiarization session. During visits 2 and 3, participants engaged in a hand/wrist motor imagery protocol or rested quietly (control condition) in a randomized order. Before and after the interventions, single-pulse transcranial magnetic stimulation (TMS) over the motor cortex was used to measure resting motor-evoked potential amplitude of the first dorsal interosseous muscle. Our main finding was that motor imagery acutely increased corticospinal excitability by ~64% (marginal means pre = 784.1 µV, post = 1246.6 µV; p < 0.001, d = 0.487). However, there was no evidence that the increase in corticospinal excitability was influenced by resistance-training experience. We suspect that our results may have been influenced by the specific nature of the motor imagery task. Our findings have important implications for motor imagery prescription and suggest that motor imagery training may be equally beneficial for both resistance-trained and untrained populations. This study was prospectively registered at ClinicalTrials.gov (Identifier: NCT03889548).

A Pilot Study of the Effect of a Non-Contact Boxing Exercise Intervention on Respiratory Pressure and Phonation Aerodynamics in People with Parkinson's Disease.

This study investigated the effects of a non-contact boxing exercise program on maximum expiratory pressure and aerodynamic voice measurements. METHODS: Eight adult males diagnosed with Parkinson's disease participated in the study. Individuals participated in twice-weekly exercise classes lasting one hour across 12-months. Dependent variables were measured on three baseline days and then at six additional time points. A pressure meter acquired maximum expiratory pressure, and a pneumotachograph system acquired transglottal airflow and subglottal air pressure. RESULTS: Measures of average maximum expiratory pressure significantly increased after 9- and 12- months of exercise when compared to baseline. There was an increasing trend for these measures in all participants, with a corresponding large effect size. Measures of transglottal airflow and subglottal pressure did not change over the course of 9- or 12-months, although their stability may indicate that the exercise program influenced maintenance of respiratory-phonatory coordination during voicing. CONCLUSIONS: A non-contact boxing exercise program had a significant effect on maximum expiratory pressure in people with Parkinson's disease. The aerobic nature of the program and challenges to the respiratory muscles potentially explain the "ingredient" causing this effect. The small sample size of this pilot study necessitates future research incorporating larger and more diverse participants.

Sex-Specific Reliability of Lower-Limb Corticospinal Excitability and Silent Periods.

ABSTRACT: Pagan, JI, Harmon, KK, Girts, RM, MacLennan, RJ, Beausejour, JP, Hernandez-Sarabia, JA, Coker, NA, Carr, JC, Ye, X, DeFreitas, JM, and Stock, MS. Sex-specific reliability of lower-limb corticospinal excitability and silent periods. J Strength Cond Res 37(9): 1882-1887, 2023-Transcranial magnetic stimulation (TMS) is a research tool that has potential to provide new insights into strength training-induced adaptations. However, using TMS to study the lower limbs is challenging, and sex-specific reliability has yet to be reported. We examined the reliability of corticospinal excitability and silent periods for the rectus femoris, vastus lateralis, and biceps femoris in both sexes. Thirteen males and 14 females reported to the laboratory twice. During both trials, a double cone coil was used to deliver 20 pulses to the rectus femoris hotspot with a stimulator output of 130% of active motor threshold. Motor-evoked potential peak-to-peak amplitude, which reflects corticospinal excitability, and silent period duration were quantified. Our results offer 4 novel findings. First, corticospinal excitability and silent period demonstrated higher reliability for the females. Second, regardless of sex and muscle, the silent period was more reliable than corticospinal excitability. Third, reliability was highest for our target muscle (rectus femoris), with lower reliability for the vastus lateralis and biceps femoris, suggesting that these methods cannot be used to study coactivation. Fourth, active motor threshold showed less variability than corticospinal excitability and silent period but increased at trial 2 in females. Many of the intraclass correlation coefficients were excellent (≥0.90), although we attribute this finding to variability between subjects. Reliability of lower-limb TMS measures may be sex, muscle, and variable dependent. Our findings suggest that both males and females should be included in lower-limb TMS research, although combining data between sexes should be approached cautiously.

Exercise prescription and strategies to promote the cross-education of strength: a scoping review.

The cross-education of strength is moderated by exercise design and prescription in clinical and non-clinical populations. This review synthesizes the available evidence regarding exercise design strategies for unilateral resistance training and provides evidence-based recommendations for the prescription of unilateral training to maximize the cross-education of strength. Greater insights regarding the timing and effectiveness of cross-education interventions in clinical scenarios will strengthen the use of unilateral resistance training for individuals who may benefit from its use.

Sex and limb comparisons of neuromuscular function in the morning versus the evening.

The time-of-day influence on neuromuscular function is well-documented, but important details remain elusive. It is currently unknown whether males and females differ in their diurnal variation for optimal neuromuscular performance. The purpose of this study is to identify the time-of-day influence on neuromuscular function between sexes and determine whether these responses differ for the upper versus lower limbs. A group of males (n = 12) and females (n = 15) completed neuromuscular performance testing in the morning (07:00-09:00) and evening (17:00-19:00) on separate days in a randomized order. Maximal force, the normalized rate of force development, EMG, normalized EMG rise, and submaximal force steadiness were compared between morning and evening hours. The main findings show that maximal force was greater in the evening for the knee extensors (d = 0.570, p < 0.01) but not the elbow flexors (d = 0.212, p = 0.281), whereas maximal muscle excitation was greater in the evening for the biceps brachii (d = 0.348, p < 0.01) but not the vastus lateralis (d = 0.075, p = 0.526) with no influence of sex. However, force steadiness during knee extension was superior in the evening versus the morning for males (d = 0.734, p = 0.025) and compared to evening values for females (g = 1.19, p = 0.032). Overall, these findings show that time-of-day affects the knee extensors more than the elbow flexors and that diurnal variability between sexes appears to be task-dependent.

Strength and Electromyographic Responses of Upper and Lower Limbs During Maximal Intermittent Contractions in Males and Females.

ABSTRACT: Carr, JC and Ye, X. Strength and electromyographic responses of upper and lower limbs during maximal intermittent contractions in males and females. J Strength Cond Res 36(9): 2403-2409, 2022-This study examined the strength and electromyographic (EMG) responses of upper vs. lower limb muscles during intermittent maximal contractions in both sexes. Twenty subjects ( n = 7 women) performed a fatiguing protocol (6, 30-second intermittent maximal isometric contractions with a 50% duty cycle) with either the elbow flexors or the knee extensors on separate visits. Bipolar surface EMG signals were detected from the biceps brachii and vastus lateralis muscles ( n = 5 women retained). Women maintained more of their maximal force than men (Δforce: men vs. women = -55.0 ± 12.8% vs. -43.3 ± 9.9%, p = 0.042). Although force loss was similar between the elbow flexors and knee extensors, the EMG responses showed greater reductions for the biceps brachii than those for the vastus lateralis (Δamplitude: biceps brachii vs. vastus lateralis: -32.0 ± 22.3% vs. -18.9 ± 28.9%; Δmedian frequency: biceps brachii vs. vastus lateralis: -31.1 ± 14.5% vs. -10.3 ± 17.0%). During a series of maximal intermittent isometric contractions with 30 seconds of recovery between work bouts, women are more fatigue resistant than men. In addition, the greater electrophysiological fatigue exhibited by the biceps brachii than that by the vastus lateralis suggests that high-intensity contractions involving elbow flexion will have a greater rate of fatigue progression than those involving knee extension.

The Influence of Sonographer Experience on Skeletal Muscle Image Acquisition and Analysis.

The amount of experience with ultrasonography may influence measurement outcomes while images are acquired or analyzed. The purpose of this study was to identify the interrater reliability of ultrasound image acquisition and image analysis between experienced and novice sonographers and image analysts, respectively. Following a brief hands-on training session (2 h), the experienced and novice sonographers and analysts independently performed image acquisition and analyses on the biceps brachii, vastus lateralis, and medial gastrocnemius in a sample of healthy participants (n = 17). Test-retest reliability statistics were computed for muscle thickness (transverse and sagittal planes), muscle cross-sectional area, echo intensity and subcutaneous adipose tissue thickness. The results show that image analysis experience generally has a greater impact on measurement outcomes than image acquisition experience. Interrater reliability for measurements of muscle size during image acquisition was generally good-excellent (ICC2,1: 0.82-0.98), but poor-moderate for echo intensity (ICC2,1: 0.43-0.77). For image analyses, interrater reliability for measurements of muscle size for the vastus lateralis and biceps brachii was poor-moderate (ICC2,1: 0.48-0.70), but excellent for echo intensity (ICC2,1: 0.90-0.98). Our findings have important implications for laboratories and clinics where members possess varying levels of ultrasound experience.

Ipsilateral and contralateral responses following unimanual fatigue with and without illusionary mirror visual feedback.

Illusionary mirror visual feedback alters interhemispheric communication and influences cross-limb interactions. Combining forceful unimanual contractions with the mirror illusion is a convenient way to provoke robust alterations within ipsilateral motor networks. It is unknown, however, if the mirror illusion affects cross-limb fatigability. We examine this concept by comparing the ipsilateral and contralateral handgrip force and electromyographic (EMG) responses following unimanual fatigue with and without illusionary mirror visual feedback. Participants underwent three experimental sessions (mirror, no-mirror, and control), performing a unimanual fatigue protocol with and without illusionary mirror visual feedback. Maximal handgrip force and EMG activity were measured before and after each session for both hands during maximal unimanual and bimanual contractions. The associated EMG activity from the inactive forearm during unimanual contraction was also examined. The novel findings demonstrate greater relative fatigability during bimanual versus unimanual contraction following unimanual fatigue (-31.8% vs. -23.4%, P < 0.01) and the mirror illusion attenuates this difference (-30.3% vs. -26.3%, P = 0.169). The results show no evidence for a cross-over effect of fatigue with (+0.62%, -2.72%) or without (+0.26%, -2.49%) the mirror illusion during unimanual or bimanual contraction. The mirror illusion resulted in significantly lower levels of associated EMG activity in the contralateral forearm. There were no sex differences for any of the measures of fatigability. These results demonstrate that the mirror illusion influences contraction-dependent fatigue during maximal handgrip contractions. Alterations in facilitatory and inhibitory transcallosal drive likely explain these findings.NEW & NOTEWORTHY Illusionary mirror visual feedback is a promising clinical tool for motor rehabilitation, yet many features of its influence on motor output are unknown. We show that maximal bimanual force output is compromised to a greater extent than unimanual force output following unimanual fatigue, yet illusionary mirror visual feedback attenuates this difference. The mirror illusion also reduces the unintended EMG activity of the inactive, contralateral forearm during unimanual contraction.

Bilateral deficit in strength but not rapid force during maximal handgrip contractions.

The purpose of this experiment was to evaluate the bilateral index in force and electromyographic (EMG) responses for the dominant and non-dominant hands during maximal handgrip contractions in males and females. Thirty-two right-handed participants (16 females) performed maximal unilateral and bilateral handgrip contractions on two separate visits. Bilateral indices were computed for maximal force, rate of force development (RFD100), EMG amplitude, and the rate of EMG rise (RER). There was a bilateral deficit for maximal force in the dominant (-4.98 ± 7.39%, p < 0.001; d = 0.674) but not the non-dominant hand (-1.57 ± 9.10%, p = 0.334; d = 0.173). No deficits were observed for rapid force. The non-dominant flexor carpi radialis showed a bilateral facilitation in EMG amplitude (+12.32 ± 19.29%, p < 0.001; d = 0.638), yet a bilateral deficit for RER (-22.10 ± 27.80%, p < 0.001; d = 0.795). No sex differences were observed for any of the bilateral indices. These data suggest that maximal but not rapid force is susceptible to a bilateral deficit during contractions of the hands. The EMG responses did not parallel the force data. We show sex does not influence the magnitude or direction of the bilateral index in this muscle group.

The time course of cross-education during short-term isometric strength training.

PURPOSE: This study examined the time course of contralateral adaptations in maximal isometric strength (MVC), rate of force development (RFD), and rate of electromyographic (EMG) rise (RER) during 4 weeks of unilateral isometric strength training with the non-dominant elbow flexors. METHODS: Twenty participants were allocated to strength training (n = 10, three female, two left hand dominant) or control (n = 10, three female, two left hand dominant) groups. Both groups completed testing at baseline and following each week of training to evaluate MVC strength, EMG amplitude, RFD and RER at early (RFD50, RER50) and late (RFD200, RER200) contraction phases for the dominant 'untrained' elbow flexors. The training group completed 11 unilateral isometric training sessions across 4 weeks. RESULTS: The contralateral improvements for MVC strength (P < 0.01) and RFD200 (P = 0.017) were evidenced after 2 weeks, whereas RFD50 (P < 0.01) and RER50 (P = 0.02) showed significant improvements after 3 weeks. Each of the dependent variables was significantly (P < 0.05) greater than baseline values at the end of the training intervention for the trained arm. No changes in any of the variables were observed for the control group (P > 0.10). CONCLUSIONS: Unilateral isometric strength training for 2-3 weeks can produce substantial increases in isometric muscle strength and RFD for both the trained and untrained arms. These data have implications for rehabilitative exercise design and prescription.

Sex comparisons of the bilateral deficit in proximal and distal upper body limb muscles.

Bilateral deficit (BLD) describes a phenomenon that the force produced during maximal simultaneous bilateral contraction is lower than the sum of those produced unilaterally. The aim of this study was to examine the potential sex-related differences in BLD in upper body proximal and distal limb muscles. Ten men and eight women performed single-joint maximal contractions with their elbow flexors and index finger abductors at separate laboratory visits, during which the maximal isometric voluntary contractions (MVICs) were performed unilaterally and bilaterally with a randomized order in the designated muscle group. Surface electromyographic (EMG) signals were recorded from the prime movers of the designated muscle groups (biceps brachii and first dorsal interosseous) during the maximal contractions. Both men and women demonstrated BLD in their elbow flexors (deficit: men = -11.0 ±â€¯6.3%; women = -10.2 ±â€¯5.0%). Accompanied by this force deficit was the reduced EMG amplitude from the dominant biceps brachii (collapsed across sex: p = 0.045). For the index finger abductors, only men (deficit = -13.7 ±â€¯6.1%), but not women showed BLD. Our results suggested that the BLD in the proximal muscle group is likely induced by the decreased maximal muscle activity from the dominant prime mover. The absence of BLD in women's index finger muscle is largely due to the inter-subject variability possibly related to the sex hormone flux and unique levels of interhemispheric inhibition.

Additional insight into biarticular muscle function: The influence of hip flexor fatigue on rectus femoris activity at the knee.

We evaluated the compensatory adaptations in muscle regionalization and synergist activity after fatiguing a biarticular muscle at one joint with different muscle lengths. Eleven men (mean ±â€¯SD age = 23 ±â€¯3 years) performed 50 maximal concentric isokinetic contractions of the dominant hip flexors on two occasions. For one trial, the knee joint was fully extended. For the other, the knee joint was fixed at 70°. Maximal voluntary contractions of the knee extensors were performed immediately before and after the hip flexion fatigue protocol while bipolar surface electromyographic signals were detected from the vastus lateralis and at five points along the length of the rectus femoris. Regardless of knee joint angle during the hip flexion fatigue protocol, knee extension peak torque was unchanged following hip flexion fatigue. Electromyographic amplitude for the vastus lateralis (p = .047, η2 = .338) and rectus femoris (p < .001, η2 = .667) showed main effects for time, indicating higher and lower post-fatigue values, respectively. There was no evidence of region-specific rectus femoris adaptations during extension at the knee following fatigue of the hip flexors. These data suggest that synergistic adaptations were involved in maintaining knee extension peak torque following hip flexion fatigue.