Biomedical subjects
Publications and source records attributed to A J Sargeant.
Formulas are derived for the average level density of deformed, or transition, Gaussian orthogonal random matrix ensembles. After some general considerations about Gaussian ensembles, we derive formulas for the average level density for (i) the transition from the Gaussian orthogonal ensemble (GOE) to the Poisson ensemble and (ii) the transition from the GOE to m GOEs.
This study investigated the recruitment of type I, IIA and IIAX fibres after seven isometric contractions at 40, 70 and 100% maximal voluntary knee extension torque (MVC, 1 s on/1 s off). Biopsies of the vastus lateralis muscle were collected from seven subjects at rest and immediately post-exercise. Fibre fragments were dissected from the freeze-dried samples and characterized as type I, IIA and IIAX using mATPase staining. Phosphocreatine (PCr) and creatine (Cr) content were measured in the remaining part of characterized fibres. A decline in the ratio of PCr to Cr (PCr/Cr) was used as an indication of activation. The mean peak torques were, respectively, 39 (2), 72 (2) and 87 (6)% MVC. Cumulative distributions of type I and IIA fibres were significantly shifted to lower PCr/Cr ratios at all intensities (Kolmogorov-Smirnov test, P<0.05). The cumulative distribution of type IIAX fibres showed a significant leftward shift only at 87% MVC ( P<0.05). A hierarchical order of fibre activation with increasing intensity of exercise was found, with some indication of rate coding for type I and IIA fibres. Evidence for activation of type IIAX fibres was only found at 87% MVC.
Voluntary activation levels during lengthening, isometric, and shortening contractions (angular velocity 60 degrees/s) were investigated by using electrical stimulation of the femoral nerve (triplet, 300 Hz) superimposed on maximal efforts. Recruitment of fiber populations was investigated by using the phosphocreatine-to-creatine ratio (PCr/Cr) of single characterized muscle fibers obtained from needle biopsies at rest and immediately after a series of 10 lengthening, isometric, and shortening contractions (1 s on/1 s off). Maximal voluntary torque was significantly higher during lengthening (270 +/- 55 N.m) compared with shortening contractions (199 +/- 47 N.m, P < 0.05) but was not different from isometric contractions (252 +/- 47 N.m). Isometric torque was higher than torque during shortening (P < 0.05). Voluntary activation level during maximal attempted lengthening contractions (79 +/- 8%) was significantly lower compared with isometric (93 +/- 5%) and shortening contractions (92 +/- 3%, P < 0.05). Mean PCr/Cr values of all fibers from all subjects at rest were 2.5 +/- 0.6, 2.0 +/- 0.7, and 2.0 +/- 0.7, respectively, for type I, IIa, and IIax fibers. After 10 contractions, the mean PCr/Cr values for grouped fiber populations (regardless of fiber type) were all significantly different from rest (1.3 +/- 0.2, 0.7 +/- 0.3, and 0.8 +/- 0.6 for lengthening, isometric, and shortening contractions, respectively; P < 0.05). The cumulative distributions of individual fiber populations after either contraction mode were significantly different from rest (P < 0.05). Curves after lengthening contractions were less shifted compared with curves from isometric and shortening contractions (P < 0.05), with a smaller shift for the type IIax compared with type I fibers in the lengthening contractions. The results indicate a reduced voluntary drive during lengthening contractions. PCr/Cr values of single fibers indicated a hierarchical order of recruitment of all fiber populations during maximal attempted lengthening contractions.
AIM: This methodological study investigated the number of brief maximal voluntary isometric contractions (MVC) needed to show evidence of fibre activation, as indicated by changes in the phosphocreatine to creatine (PCr/Cr) ratio. METHODS: Subjects performed series of four, seven and/or 10 MVC (1 s on, 1 s off) of the m. quadriceps (60 degrees -flexion angle). Biopsy samples of the m. vastus lateralis were taken at rest and immediately post-exercise. Single muscle fibres were dissected from the freeze-dried samples and classified as types I, IIA or IIAX, using mATPase stainings. Fragments of characterized fibres were analysed for PCr and Cr content. Analyses of variance were performed to investigate changes in PCr/Cr per fibre group over time, followed by Bonferroni post-hoc test (P < 0.01). The fifth percentile of resting values of each fibre group was determined. RESULTS: Mean PCr/Cr ratio after four, seven and 10 MVCs were significantly lower for all fibre groups (P < 0.01). The mean decreases were 44, 64 and 76%, respectively. However, only after seven and 10 contractions PCr/Cr ratios of all, but three type I and two type IIAX fibres, individual fibres were below the fifth percentile. CONCLUSION: In very short duration exercise, involving seven brief maximal voluntary contractions, changes in the PCr/Cr ratio indicated activation of different characterized muscle fibre fragments. The results suggest that this approach may be useful for investigating the pattern of fibre type activation in exercise of very short duration.
AIM: The present study investigated the energy cost of lengthening, isometric and shortening contractions in rat muscle (n = 19). METHODS: With electrical stimulation the rat medial gastrocnemius muscle was maximally stimulated to perform 10 lengthening, isometric and shortening contractions (velocity 25 mm s(-1)) under experimental conditions (e.g. temperature, movement velocity) that resemble conditions in human movement. RESULTS: Mean +/- SD force-time-integral of the first contraction was significantly different between the three protocols, 2.4 +/- 0.2, 1.7 +/- 0.2 and 1.0 +/- 0.2 N s, respectively (P < 0.05). High-energy phosphate consumption was not significantly different between the three modes of exercise but a trend could be observed from lengthening (7.7 +/- 2.7 micromol approximately P muscle(-1)) to isometric (8.9 +/- 2.2 micromol approximately P muscle(-1)) to shortening contractions (10.4 +/- 1.6 micromol approximately P muscle(-1)). The ratio of high-energy phosphate consumption to force-time-integral was significantly lower for lengthening [0.3 +/- 0.1 micromol approximately P (N s)(-1)] and isometric [0.6 +/- 0.2 micromol approximately P (N s)(-1)] contractions compared with shortening [1.2 +/- 0.2 micromol approximately P (N s)(-1)] contractions (P < 0.05). CONCLUSION: The present results of maximally stimulated muscles are comparable with data in the literature for voluntary human exercise showing that the energy cost of force production during lengthening exercise is approximately 30% of that in shortening exercise. The present study suggests that this finding in humans probably does reflect intrinsic muscle properties rather than effects of differential recruitment and/or coactivation.
The effect of hamstring fatigue on knee extension torque was examined at different knee angles for seven male subjects. Before and after a dynamic flexion fatigue protocol (180 degrees s(-1), until dynamic torque had declined by 50%), maximal voluntary contraction extension torque was measured at four knee flexion angles (90 degrees, 70 degrees, 50 degrees and 30 degrees ). Maximal torque generating capacity and voluntary activation of the quadriceps muscle were determined using electrical stimulation. Average rectified EMG of the biceps femoris was determined. Mean dynamic flexion torque declined by 48+/-11%. Extensor maximal voluntary contraction torque, maximal torque generating capacity, voluntary activation and average rectified EMG at the four knee angles were unaffected by the hamstring fatigue protocol. Only at 50 degrees knee angle was voluntary activation significantly lower (15.7%) after fatigue ( P<0.05). In addition, average rectified EMG before fatigue was not significantly influenced by knee angle. It was concluded that a fatigued hamstring muscle did not increase the maximal voluntary contraction extension torque and knee angle did not change coactivation. Three possible mechanisms may explain the results: a potential difference in recruited fibre populations in antagonist activity compared with the fibres which were fatigued in the protocol, a smaller loss in isometric torque generating capacity of the hamstring muscle than was expected from the dynamic measurements and/or a reduction in voluntary activation.
A spinal cord injury usually leads to an increase in contractile speed and fatigability of the paralysed quadriceps muscles, which is probably due to an increased expression of fast myosin heavy chain (MHC) isoforms and reduced oxidative capacity. Sometimes, however, fatigue resistance is maintained in these muscles and also contractile speed is slower than expected. To obtain a better understanding of the diversity of these quadriceps muscles and to determine the effects of training on characteristics of paralysed muscles, fibre characteristics and whole muscle function were assessed in six subjects with spinal cord lesions before and after a 12-week period of daily low-frequency electrical stimulation. Relatively high levels of MHC type I were found in three subjects and this corresponded with a high degree of fusion in 10-Hz force responses (r=0.88). Fatigability was related to the activity of succinate dehydrogenase (SDH) (r=0.79). Furthermore, some differentiation between fibre types in terms of metabolic properties were present, with type I fibres expressing the highest levels of SDH and lowest levels of alpha-glycerophosphate dehydrogenase. After training, SDH activity increased by 76+/-26% but fibre diameter and MHC expression remained unchanged. The results indicate that expression of contractile proteins and metabolic properties seem to underlie the relatively normal functional muscle characteristics observed in some paralysed muscles. Furthermore, training-induced changes in fatigue resistance seem to arise, in part, from an improved oxidative capacity.
Effects of two different training regimens on the contractile properties of the quadriceps muscle were studied in six individuals with spinal cord injury. Each subject had both limbs trained with the two regimens, consisting of stimulation with low frequencies (LF) at 10 HZ or high frequencies (HF) at 50 HZ; one limb of each subject was stimulated with the LF protocol and the other with the HF regimen. Twelve weeks of daily training increased tetanic tension by approximately 20%, which was not significantly different between training regimens. Interestingly, after HF but not LF training, the unusual high forces at the low frequency range of the force-frequency relationship decreased, possibly due to a reduced activation per impulse. After LF but not HF training, force oscillation amplitudes declined (by 33%) as relaxation tended to slow, which may have opposed possible effects of reduced activation as seen after HF training. Finally, fatigue resistance also increased rapidly after LF training (by 43%) but not after HF training. These results indicate that different types of training may selectively change different aspects of function in disused muscles.
The influence of stimulation frequency on efficiency (= total work output/high-energy phosphate consumption) was studied using in situ medial gastrocnemius muscle tendon complexes of the rat. The muscles performed 20 repeated concentric contractions (2/s) at 34 degrees C. During these repeated contractions, the muscle was stimulated via the severed sciatic nerve with either 60, 90, or 150 Hz. The muscle was freeze-clamped immediately after these contractions, and high-energy phosphate consumption was determined by measuring intramuscular chemical change relative to control muscles. The average values (+/-SD) of efficiency calculated for 60, 90, and 150 Hz were 18.5 +/- 1.5 (n = 7), 18.6 +/- 1.5 (n = 9), and 14.7 +/- 1.3 mJ/micromol phosphate (n = 9). The results indicate that the efficiency of the muscles that were submaximally activated (60 or 90 Hz) was higher (+26%, P < 0.05) than that of those maximally activated (150 Hz). Additional experiments showed that the low efficiency at maximal activation levels is unlikely to be the result of a higher energy turnover by the Ca2+ -ATPase relative to the total energy turnover. Therefore, alternative explanations are discussed.
1. It has been established that pulmonary oxygen uptake is greater during cycle exercise in humans at high compared to low contraction frequencies. However, it is unclear whether this is due to more work being performed at the high frequencies and whether the energy turnover of the working muscles is higher. The present study tested the hypothesis that human skeletal muscle oxygen uptake and energy turnover are elevated during exercise at high compared to low contraction frequency when the total power output is the same. 2. Seven subjects performed single-leg dynamic knee-extensor exercise for 10 min at contraction frequencies of 60 and 100 r.p.m. where the total power output (comprising the sum of external and internal power output) was matched between frequencies (54 +/- 5 vs. 56 +/- 5 W; mean +/- S.E.M.). Muscle oxygen uptake was determined from measurements of thigh blood flow and femoral arterial - venous differences for oxygen content (a-v O(2) diff). Anaerobic energy turnover was estimated from measurements of lactate release and muscle lactate accumulation as well as muscle ATP and phosphocreatine (PCr) utilisation based on analysis of muscle biopsies obtained before and after each exercise bout. 3. Whilst a-v O(2) diff was the same between contraction frequencies during exercise, thigh blood flow was higher (P < 0.05) at 100 compared to 60 r.p.m. Thus, muscle V(O2) was higher (P < 0.05) during exercise at 100 r.p.m. Muscle V(O2) increased (P < 0.05) by 0.06 +/- 0.03 (12 %) and 0.09 +/- 0.03 l min(-1) (14 %) from the third minute to the end of exercise at 60 and 100 r.p.m., respectively, but there was no difference between the two frequencies. 4. Muscle PCr decreased by 8.1 +/- 1.7 and 9.1 +/- 2.0 mmol (kg wet wt)(-1), and muscle lactate increased to 6.8 +/- 2.1 and 9.8 +/- 2.5 mmol (kg wet wt)(-1) during exercise at 60 and 100 r.p.m., respectively. The total release of lactate during exercise was 48.7 +/- 8.8 and 64.3 +/- 10.6 mmol at 60 and 100 r.p.m. (not significant, NS). The total anaerobic ATP production was 47 +/- 8 and 61 +/- 12 mmol kg(-1), respectively (NS). 5. Muscle temperature increased (P < 0.05) from 35.8 +/- 0.3 to 38.2 +/- 0.2 degrees C at 60 r.p.m. and from 35.9 +/- 0.3 to 38.4 +/- 0.3 degrees C at 100 r.p.m. Between 1 and 7 min muscle temperature was higher (P < 0.05) at 100 compared to 60 r.p.m. 6. The estimated mean rate of energy turnover during exercise was higher (P < 0.05) at 100 compared to 60 r.p.m. (238 +/- 16 vs. 194 +/- 11 J s(-1)). Thus, mechanical efficiency was lower (P < 0.05) at 100 r.p.m. (24 +/- 2 %) compared to 60 r.p.m. (28 +/- 3 %). Correspondingly, efficiency expressed as work per mol ATP was lower (P < 0.05) at 100 than at 60 r.p.m. (22.5 +/- 2.1 vs. 26.5 +/- 2.5 J (mmol ATP)(-1)). 7. The present study showed that muscle oxygen uptake and energy turnover are elevated during dynamic contractions at a frequency of 100 compared with 60 r.p.m. It was also observed that muscle oxygen uptake increased as exercise progressed in a manner that was not solely related to the increase in muscle temperature and lactate accumulation.
The recovery of high-energy phosphate levels in single human skeletal muscle fibres following short-term maximal (all-out) exercise was investigated. Three male volunteers exercised maximally for 25 s on an isokinetic cycling ergometer. Muscle biopsy samples from the vastus lateralis were collected at rest, immediately post-exercise and at 1.5 min of recovery. The subjects also performed a second exercise bout 1.5 min after the first, on a separate occasion. Single muscle fibres were dissected, characterized and assigned to one of four groups according to their myosin heavy chain (MyHC) isoform content; namely, type I, IIA, IIAx and IIXa (the latter two groups containing either less or more than 50% IIX MyHC). Fibres were analysed for adenosine 5'-triphosphate (ATP), inosine-5'-monophosphate (IMP), phosphocreatine (PCr) and creatine (Cr) levels. Type I fibres had a lower Cr content than type II fibres (P<0.01). Within type II fibres resting [PCr] increased with increasing MyHC IIX isoform content (r=0.59, P<0.01). Post-exercise [PCr] was very low in all fibre groups (P<0.01 versus rest) while great reductions in ATP were also observed (P<0.01 versus rest), especially in the type II fibre groups. [PCr] at 1.5 min of recovery was still lower compared to rest for all fibre groups (P<0.01) especially in the IIAx and IIXa fibres.
This study assessed the reproducibility of electrically evoked, isometric quadriceps contractile properties in eight people with spinal cord injury (SCI) and eight able-bodied (AB) individuals. Over all, the pooled coefficients of variation (CVps) in the SCI group were significantly lower (ranging from 0.03 to 0.15) than in the AB group (ranging from 0.08 to 0.21) (P<0.05). Furthermore, in all subjects, the variability of force production increased as stimulation frequency decreased (P<0.01). In subjects with SCI, variables of contractile speed are clearly less reproducible than tetanic tension or resistance to fatigue. Contractile properties of quadriceps muscles of SCI subjects were significantly different from that of AB subjects. Muscles of people with SCI were less fatigue resistant (P<0.05) and produced force-frequency relationships that were shifted to the left, compared with AB controls (P<.01). In addition, fusion of force responses resulting from 10 Hz stimulation was reduced (P<.05) and speed of contraction (but not relaxation) was increased (P<0.05), indicating an increased contractile speed in paralysed muscles compared with non-paralysed muscles. These results correspond with an expected predominance of fast glycolytic muscle fibres in paralysed muscles. It is concluded that quadriceps dynamometry is a useful technique to study muscle function in non-paralysed as well as in paralysed muscles. Furthermore, these techniques can be reliably used, for example, to assess therapeutic interventions on paralysed muscles provided that expected differences in relative tetanic tension and fatigue resistance are larger than approximately 5% and differences in contractile speed are larger than approximately 15%.
OBJECTIVE: To test whether a short period of training leads to adaptations in the cross-sectional area of large conduit arteries and improved blood flow to the paralyzed legs of individuals with spinal cord injury (SCI). DESIGN: Before-after trial. SETTING: Rehabilitation center, academic medical center. PARTICIPANTS: Nine men with spinal cord lesions. INTERVENTION: Six weeks of cycling using a functional electrically stimulated leg cycle ergometer (FES-LCE). MAIN OUTCOME MEASURES: Longitudinal images and simultaneous velocity spectra were measured in the common carotid (CA) and femoral (FA) arteries using quantitative duplex Doppler ultrasound examination. Arterial diameters, peak systolic inflow volumes (PSIVs), mean inflow volumes (MIVs), and a velocity index (VI), representing the peripheral resistance, were obtained at rest. PSIVs and VI were obtained during 3 minutes of hyperemia following 20 minutes of FA occlusion. RESULTS: Training resulted in significant increases in diameter (p < .01), PSIVs (p < .01), and MIVs (p < .05), and reduced VI (p < .01) of the FA, whereas values in the CA remained unchanged. Postocclusive hyperemic responses were augmented, indicated by significantly higher PSIVs (p <.01) and a trend toward lower VI. CONCLUSION: Six weeks of FES-LCE training increased the cross-sectional area of large conduit arteries and improved blood flow to the paralyzed legs of individuals with SCI.
OBJECTIVES: To compare the submaximal exercise capacity of polio subjects with postpoliomyelitis syndrome (PPS) and without (non-PPS) with that of healthy control subjects, to investigate the relationship of this capacity with maximal short-term power and quadriceps strength, and to evaluate movement economy. DESIGN: Cross-sectional survey. SETTING: University hospital. PARTICIPANTS: Forty-three polio subjects (25 PPS, 18 non-PPS) and 12 control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Power output, oxygen uptake, and heart rate were measured in an incremental submaximal cycle ergometry test. Maximal short-term power was measured in 5-second all-out efforts. Knee extensor strength was measured on a chair dynamometer. RESULTS: The mean submaximal power +/- standard deviation at 80% of heart rate reserve of 83.8 +/- 29.9 watts in the polio subjects was significantly less than the mean submaximal power of 142.1 +/- 30.4 watts in the control group. However, expressed as a percentage of the maximal short-term power, submaximal power did not differ between the groups. Strength and maximal short-term power correlated significantly (p < .005) with submaximal power (r = .64 and .76, respectively). The oxygen uptake was higher than theoretically expected for the given submaximal power output in polio subjects, and appeared to increase with increasing asymmetry in strength and power between legs. No differences were found between PPS and non-PPS subjects. CONCLUSION: The submaximal work capacity of polio subjects was severely reduced, mainly in association with the reduced muscle capacity. And, because of a reduced movement economy, their energy cost was elevated. Although muscle loads in activities such as walking and climbing stairs differ from cycling, they also may require elevated relative levels of effort, predisposing subjects to premature fatigue in sustained activity.
Changes in high-energy phosphate levels in single human skeletal muscle fibres after 10 s of maximal (all-out) dynamic exercise were investigated. Muscle biopsies from vastus lateralis of two volunteers were collected at rest and immediately post exercise. Single muscle fibres were dissected from dry muscle and were assigned into one of four groups according to their myosin heavy chain (MyHC) isoform content: that is type I, IIA, IIAx and IIXa (the latter two groups containing either less or more than 50% IIX MyHC). Fragments of characterised fibres were analysed by HPLC for ATP, inosine-monophosphate (IMP), phosphocreatine (PCr) and creatine levels. After 10 s of exercise, PCr content ([PCr]) declined by approximately 46, 53, 62 and 59 % in type I, IIA, IIAx and IIXa fibres, respectively (P < 0.01 from rest). [ATP] declined only in type II fibres, especially in IIAx and IIXa fibres in which [IMP] reached mean values of 16 +/- 1 and 18 +/- 4 mmol (kg dry mass)(-1), respectively. While [PCr] was reduced in all fibre types during the brief maximal dynamic exercise, it was apparent that type II fibres expressing the IIX myosin heavy chain isoform were under a greatest metabolic stress as indicated by the reductions in [ATP].
In this study, we estimated the specific tensions of soleus (Sol) and tibialis anterior (TA) muscles in six men. Joint moments were measured during maximum voluntary contraction (MVC) and during electrical stimulation. Moment arm lengths and muscle volumes were measured using magnetic resonance imaging, and pennation angles and fascicular lengths were measured using ultrasonography. Tendon and muscle forces were modeled. Two approaches were followed to estimate specific tension. First, muscle moments during electrical stimulation and moment arm lengths, fascicular lengths, and pennation angles during MVC were used (data set A). Then, MVC moments, moment arm lengths at rest, and cadaveric fascicular lengths and pennation angles were used (data set B). The use of data set B yielded the unrealistic specific tension estimates of 104 kN/m(2) in Sol and 658 kN/m(2) in TA. The use of data set A, however, yielded values of 150 and 155 kN/m(2) in Sol and TA, respectively, which agree with in vitro results from fiber type I-predominant muscles. In fact, both Sol and TA are such muscles. Our study demonstrates the feasibility of accurate in vivo estimates of human muscle intrinsic strength.
The aim of the present study was to estimate and compare in vivo measurement-based Achilles tendon moment arm lengths at rest and during isometric plantarflexion maximum voluntary contraction (MVC) using the centre-of-rotation (COR) and the tendon-excursion (TE) methods. Both methods were based on morphometric analysis of sagittal-plane magnetic resonance images of the foot. Using the COR method, moment arms were obtained at ankle angles from 15 degrees of dorsiflexion to 30 degrees of plantarflexion in steps of 15 degrees, digitizing the perpendicular distance from a moving centre of rotation in the tibio-talar joint to the Achilles tendon action line. The TE method was based on measurement of calcaneal displacement along the tibial axis during 15 degrees rotations of the ankle joint, from 30 degrees of dorsiflexion to 45 degrees of plantarflexion. The two methods gave similar estimations at rest varying from 4.3 to 5.6 cm. Using the COR method, the Achilles tendon moment arm during MVC was larger by 1-1.5 cm (22-27%, P < 0.01) than the respective resting value. In contrast, no difference (P > 0.05) was found between the resting and MVC moment arm estimations of the TE method. The disagreement in moment arms during MVC may be attributed to differences in the assumptions made between the two methods. The TE method has more limitations than the COR method and its estimations during MVC should be treated with caution. Resting Achilles tendon moment arm estimations of the COR method should be multiplied by 1.22-1.27 when maximal isometric plantarflexion joint moments, musculotendon forces and stresses are predicted using modelling.
STUDY DESIGN: A longitudinal training study. OBJECTIVES: To assess if contractile speed and fatigability of paralysed quadriceps muscles in individuals with spinal cord injury (SCI) can be altered by functional electrical stimulation leg cycle ergometry (FES-LCE) training. SETTINGS: The Sint Maartenskliniek rehabilitation centre and the University of Nijmegen, Nijmegen, the Netherlands. METHODS: Contractile properties of the quadriceps muscle were studied in seven people with motor-complete SCI who participated in a FES-LCE training program. Subjects trained for 30 min, three times per week for 6 weeks. Contractile speed and fatigue characteristics of electrically stimulated isometric contractions were compared before and after 6 weeks of FES-LCE. RESULTS: Fatigue resistance improved following FES-LCE training as indicated by the higher forces maintained in response to repetitive electrical stimulation. In contrast with an improved fatigue resistance, the maximal rate of force rise was unaffected, the speed of relaxation increased and the fusion of a 10 Hz force signal decreased. Furthermore, the force-frequency relationship shifted to the right at low stimulation frequencies, indicated by a decline in the ratio of 1 and 100 Hz force responses as well as the ratio of 10 and 100 Hz force responses. CONCLUSION: FES-LCE training can change the physiological properties of the quadriceps muscle in people with SCI. Even after a short period of training, the stimulated muscles become more resistant to fatigue. Furthermore, the increased speed of relaxation and associated decreased fusion and altered force-frequency relationship following training may be related to adaptations in the calcium handling processes, which reflect an early response of long-term disused muscles.