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Quadriceps femoris muscle torques and fatigue generated by neuromuscular electrical stimulation with three different waveforms.

BACKGROUND AND PURPOSE: Neuromuscular electrical stimulation is used by physical therapists to improve muscle performance. Optimal forms of stimulation settings are yet to be determined, as are possible sex-related differences in responsiveness to electrical stimulation. The objectives of the study were: (1) to compare the ability of 3 different waveforms to generate isometric contractions of the quadriceps femoris muscles of individuals without known impairments, (2) to compare muscle fatigue caused by repeated contractions induced by these same waveforms, and (3) to examine the effect of sex on muscle force production and fatigue induced by electrical stimulation. SUBJECTS: Fifteen women and 15 men (mean age=29.5 years, SD=5.4, range=22-38) participated in the study. METHODS: A portable battery-operated stimulator was used to generate either a monophasic or biphasic rectangular waveform. A stimulator that was plugged into an electrical outlet was used to generate a 2,500-Hz alternating current. Phase duration, frequency, and on-off ratios were kept identical for both stimulators. Participants did not know the type of waveform being used. Torque was measured using a computerized dynamometer. A maximal voluntary isometric contraction (MVIC) of the right quadriceps femoris muscle set at 60 degrees of knee flexion was determined during the first session. In each of the 3 testing sessions, torque of contraction and fatigue elicited by one waveform were measured. Order of testing was randomized. Torque elicited by electrical stimulation was expressed as a percentage of average MVIC. A mixed-model analysis of variance was used to determine the effect of stimulation and sex on strength of contraction and fatigue. Bonferroni-corrected post hoc tests were used to further distinguish between the effects of the 3 stimulus waveforms. RESULTS: The results indicated that the monophasic and biphasic waveforms generated contractions with greater torque than the polyphasic waveform. These 2 waveforms also were less fatiguing. The torques from the maximally tolerated electrically elicited contractions were greater for the male subjects than for the female subjects. DISCUSSION AND CONCLUSION: Muscle torque and fatigue of electrically induced contractions depend on the waveform used to stimulate the contraction, with monophasic and biphasic waveforms having an advantage over the polyphasic waveform. All tested waveforms elicited, on average, stronger contractions in male subjects than in female subjects when measured as a percentage of MVIC.

Adult↗

The effects of a twenty-four-week aquatic training program on muscular strength performance in healthy elderly women.

The purpose of the present study was to determine the effectiveness of a 24-week aquatic training (AT) program, which included both aerobic and resistance components, on muscle strength (isometric and dynamic), flexibility, and functional mobility in healthy women over 60 years of age. Twenty-two subjects were assigned randomly to either an AT (n = 12) or a control (C, n = 10) group. Volunteers participated in a supervised shallow-water exercise program for 60 minutes a day, 3 days a week; the exercise program consisted of a 10-minute warm-up and stretching, 25 minutes of endurance-type exercise (dancing) at 80% of heart rate (HR)(max), 20 minutes of upper- and lower-body resistance exercises with specialized water-resistance equipment, and a 5-minute cool down. Maximal isometric torque of knee extensors (KEXT) and knee flexors (KFLEX) were evaluated by a Cybex Norm dynamometer, grip strength (HGR) was evaluated using a Jamar hydraulic dynamometer, and dynamic strength was evaluated via the 3 repetition maximum (3RM) test for chest press, knee extension, lat pull down, and leg press. Jumping performance was evaluated using the squat jump (SJ), functional mobility with the timed up-and-go (TUG) test, and trunk flexion with the sit-and-reach test. Body composition was measured using the bioelectrical impedance method. The AT induced significant improvements in KEXT (10.5%) and KFLEX (13.4%) peak torque, HGR strength (13%), 3RM (25.7-29.4%), SJ (24.6%), sit-and-reach (11.6%), and TUG (19.8%) performance. The AT group demonstrated a significant increase in lean body mass (3.4%). No significant changes in these variables were observed in the C group. The results indicate that AT, with both aerobic and resistance components, is an alternative training method for improving neuromuscular and functional fitness performance in healthy elderly women.

Aged↗

Biomechanical behavior of the plantar flexor muscle-tendon unit after an Achilles tendon rupture.

The purpose of this study was to examine the biomechanical behavior of the plantar flexor muscle-tendon unit in subjects who had ruptured their Achilles tendon. Twenty-six men and 14 women volunteered for the study. Eighteen subjects had been treated operatively and 22, nonoperatively. All subjects had ruptured their Achilles tendon more than 1 year before the study, and 28 of the 40 ruptures occurred 5 years or less before the day of testing. A KinCom dynamometer was used to measure ankle joint angle, passive torque, and maximal isometric plantar flexor torque. During a 2-minute passive calf stretch, stiffness and torque relaxation were calculated. Isometric torque and peak passive torque were 17% and 10% greater for the uninvolved versus the involved limb, whereas stiffness and torque relaxation were not different between limbs. The time since injury did not influence the results, nor did the mode of initial treatment, that is, whether the subjects were treated operatively or nonoperatively. These findings suggest that changes in strength and peak passive torque may be chronic adaptations associated with Achilles tendon rupture.

Achilles Tendon↗

An experimental study of attention, labelling and memory in people suffering from chronic pain.

Cognitive-behavioural approaches to treatment have become an important part of the clinical management of chronic pain. More recent developments in cognitive-behavioural theory, based on recent developments in the understanding and treatment of health anxiety, have emphasized the importance of catastrophizing appraisals, which drive both attentional processes and behavioural responses, which in turn are believed to be crucial for the maintenance of chronic pain. The experiment conducted here investigated the responses of pain patients (n=39) and controls (n=71) to a behavioural task (prolonged squeezing a dynamometer). Subsequently, the impact of a cognitive task, which fully engaged participants' attention (dichotic listening) was examined. Participants were asked, firstly, to sustain an isometric muscle contraction task (squeezing); secondly, to learn an attentional demanding task (dichotic listening); thirdly, to recall the discomfort experienced in the squeezing task and lastly, to perform both squeezing and dichotic listening at the same time. The squeezing tasks were experimentally manipulated by attaching a more or less negative label ("pain tolerance test" vs. "muscle stamina and strength test"). Patients were found to be less able to sustain prolonged muscle tension than controls, but the effect was not evident once the distracting task was introduced; similar effects were found for discomfort. All participants subsequently recalled the squeezing task as being longer and associated with less discomfort than they had actually recorded it at the time. In the dichotic listening tasks, although patients detected the same number of words overall as controls did, they were less able to focus on the target channel (i.e. they detected more of the words included as distractors on the unattended channel).

Adolescent↗

Eccentric knee strength of elderly females.

This study compared the strength of the knee extension and flexion muscles in groups of young and elderly women under two conditions: eccentric exercise in which the muscles were lengthened while subjects tried to resist an external force, versus concentric contractions in which the muscles shortened. Twenty-six females, aged 20 to 29 (Mean 25 +/- 3 SD), and 26 elderly women, aged 66 to 89 (Mean 73 +/- 6 SD), were tested at two angular velocities of movement, 45 degrees and 90 degrees/s, on a KinCom isokinetic dynamometer. Elderly women had significantly lower peak and average torque values in all comparisons with the young female group (25 to 54% lower, p less than .01). However, differences between the age groups were consistently smaller for the eccentric type of muscle action than the concentric, in both knee extensors and flexors.

Adult↗

Feasibility, safety, and efficacy of myoblast transfer therapy on Duchenne muscular dystrophy boys.

Five billion normal myoblasts were injected into each of 21 Duchenne muscular dystrophy (DMD) boys aged 6-14 yr to assess the feasibility, safety, and efficacy of the Phase II myoblast transfer therapy (MTT). The Phase II study was designed to strengthen muscles of both lower limbs. Forty-eight intramuscular injections transferred the myoblasts into 22 major muscles at 55.6 x 10(6)/mL in 10 min under general anesthesia. Eleven boys had received 8 million myoblasts each 1 yr ago in the Phase I MTT. In the Phase II study, eight of them had their myoblasts subcultured from reserves frozen 1 yr ago. The donor myoblasts for each of the remaining boys were cultured from satellite cells derived from a 1-g muscle biopsy of a normal male who might or might not be histocompatible with the recipient. The immunosuppressant cyclosporine (Cy) is being administered to recipients for 6 mo after MTT to facilitate donor cell survival. There was no evidence of an adverse reaction to MTT or Cy as determined by serial laboratory evaluations including electrolytes, creatinine, and urea. Early objective functional tests using the KinCom Robotic Dynamometer were conducted on 13 subjects aged 6 to 13 before MTT and at 3 mo after MTT. Of the 69 muscle groups (knee extensors, knee flexors, plantar flexors) tested for isometric force generation in these subjects, 43% showed mean increase of 41.3% +/- 5.9 SEM, 38% showed no change, and 19% showed continuous force reduction of 23.4% +/- 3.1 SEM. The remaining subjects await the 3-mo post-MTT evaluation. The results indicate that 1) MTT is safe; 2) MTT increases muscle strength in DMD: 81% of the muscles tested showed either increase in strength or did not show continuous loss of strength; 3) more than 5 billion myoblasts can be cultured from 1 g normal muscle biopsy, providing unprecedented numbers of cells for MTT; 4) myoblasts, frozen over 1 yr, retain the ability to proliferate from 10 million to 5 billion, and to form normal myofibers; 5) injections of 5 billion myoblasts have not provoked any immunological rejection symptoms in the Phase II subjects, 11 of whom received 8 million myoblasts in the Phase I MTT a year ago; 6) it is safe to perform multiple injections of myoblasts into lower limb muscles without formation of emboli; and 7) donor cell rejection by the recipient can be prevented with Cy when properly managed.

Adolescent↗

Effects of whole body vibration training on muscle strength and sprint performance in sprint-trained athletes.

Despite the expanding use of Whole Body Vibration training among athletes, it is not known whether adding Whole Body Vibration training to the conventional training of sprint-trained athletes will improve speed-strength performance. Twenty experienced sprint-trained athletes (13 male symbol, 7 female symbol, 17-30 years old) were randomly assigned to a Whole Body Vibration group (n=10: 6 male symbol and 4 female symbol) or a Control group (n=10: 7 male symbol, 3 female symbol). During a 5-week experimental period all subjects continued their conventional training program, but the subjects of the Whole Body Vibration group additionally performed three times weekly a Whole Body Vibration training prior to their conventional training program. The Whole Body Vibration program consisted of unloaded static and dynamic leg exercises on a vibration platform (35-40 Hz, 1.7-2.5 mm, Power Plate). Pre and post isometric and dynamic (100 degrees/s) knee-extensor and -flexor strength and knee-extension velocity at fixed resistances were measured by means of a motor-driven dynamometer (Rev 9000, Technogym). Vertical jump performance was measured by means of a contact mat. Force-time characteristics of the start action were assessed using a load cell mounted on each starting block. Sprint running velocity was recorded by means of a laser system. Isometric and dynamic knee-extensor and knee-flexor strength were unaffected (p>0.05) in the Whole Body Vibration group and the Control group. As well, knee-extension velocity remained unchanged (p>0.05). The duration of the start action, the resulting start velocity, start acceleration, and sprint running velocity did not change (>0.05) in either group. In conclusion, this specific Whole Body Vibration protocol of 5 weeks had no surplus value upon the conventional training program to improve speed-strength performance in sprint-trained athletes.

Adaptation, Physiological↗

Effects of electrical stimulation or voluntary contraction for strengthening the quadriceps femoris muscles in an aged male population.

Since musculoskeletal impairment increases with age, it is important to determine if exercise changes age-related muscle weakness. This study compared the training effects of electrical stimulation and voluntary isometric contraction, the traditional exercise, on the quadriceps femoris in males 65 years and older. Eighteen informed, nondisabled males, 72 +/- 4 years of age, participated in 12 training sessions over 4 weeks. Maximal voluntary isometric contraction (MVIC) torque was measured with a Cybex II dynamometer prior to and following training. An interclass correlation coefficient (3,1) of 0.982 demonstrated repeated reliable torque measurement. The electrical stimulation group trained at an average of 36% of pretest MVIC; the traditional exercise group trained at an average of 42% MVIC. Average (F = 14.06, p = 0.004) and peak (F = 14.32, p = 0.004) torque values were increased with both modes of training. Both methods of training using a low training load were effective in increasing torque in this older male sample. Electrical stimulation has the same potential as traditional exercise to provide improved strength for aged males. Future research should examine electrical stimulation in older persons with compromised ability to exercise using traditional methods.

Aged↗

Skeletal muscle fatigue and endurance in young and old men and women.

The effects of increasing age on skeletal muscle fatigue and endurance were assessed in 22 healthy young (14 men and 8 women; mean age, 28 +/- 6 years) and 16 healthy old (8 men and 8 women; mean age, 73 +/- 3 years) individuals. All subjects performed 100 repeated maximum dynamic knee extensions at 90 degrees.s-1 (1.57 rad.s-1) using an isokinetic dynamometer (Cybex II). Peak torque was recorded during every contraction, and for each individual the maximal voluntary contraction (MVC), the fatigue rate, the endurance level, and the relative reduction in muscle force were determined. MVC and endurance level were significantly lower in old men and women, but there was no discernible difference in relative muscle force reduction and fatigue rate between young and old individuals. We conclude that thigh muscles of older individuals are weaker than those of younger individuals, but relative to their strength, older individuals have similar properties as younger individuals with respect to muscle fatigue and endurance.

Adult↗

Peak torque values for antagonist muscle groups and concentric and eccentric contraction types for elite sprinters.

The purpose of this study was to provide descriptive strength estimates of the major muscle groups of the lower limbs for a group of elite sprinters by comparing both the eccentric and concentric and the agonist and antagonist peak torques. The peak torque values of the flexor and extensor muscle groups of the hip, knee, and ankle joints of the lower extremities were tested in a group of elite male and female sprinters. These values were measured both eccentrically and concentrically for each of the joint movements tested, using a Kin/Com isokinetic dynamometer. The peak torque values for the knee joint were found to be substantially larger than those reported for nonathletes, and comparable to those for other athletic populations. No comparable scores were located for the results of the hip and ankle scores. The flexion and extension ratios for the knee joint, at approximately .60, were similar to others reported, whereas the ratios for the hip joint were larger at .76. The concentric and eccentric ratios varied, depending on the speed of testing and the joint tested.

Adolescent↗

Influence of concentric resistance training on concentric and eccentric strength.

This study investigated the effects of isokinetic concentric training on isokinetic concentric and eccentric torque outputs. Sixteen female subjects (mean age in years +/- SE = 21 +/- 1) were randomly assigned to either a training or a control group. Concentric and eccentric torques of the right knee extensors were assessed at 1.05rad.s-1 using a KinCom isokinetic dynamometer system. Each test consisted of a set of four maximal concentric and four maximal eccentric contractions of the knee extensors. The peak and average torques for each contraction were calculated using the computer software supplied by the KinCom manufacturer. On a separate day, after abstaining from heavy exercise for at least 12 hours, a single cross-sectional image of the thigh at midfemur was obtained using computer tomography (CT) scanning. From this image, cross-sectional area of the quadriceps femoris group was calculated using the computer software associated with the General Electric 9800 CT Scanning System. Training group subjects trained three days weekly for six weeks on a Cybex II+ isokinetic dynamometer, completing five sets of ten maximal effort knee extensions at an angular velocity of 1.05rad.s-1. Each set of exercise was separated by two minutes of self-selected recovery. Torque outputs were monitored daily to ensure that adequate recovery was provided between sets of exercise, and to document changes in strength as the program progressed. Significant (p less than .01) increases in peak and average concentric torque (11% and 12%, respectively), peak and average eccentric torque (18% and 21%, respectively), and muscle cross-sectional area (3.2%) were observed for training group subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Effects of training and creatine supplement on muscle strength and body mass.

The purpose of this study was to test the effect of creatine supplement on the size of the extra- and intracellular compartments and on the increase of isokinetic force during a strength training-program. Twenty-five healthy male subjects (age 22.0+/-2.9 years) participated in this experiment. Seven subjects formed the control-group. They did not complete any training and did not have any dietary supplement. The eighteen other subjects were randomly divided into a creatine- (n = 8) and a placebo-group (n = 10). They were submitted to a controlled strength-training program for 42 days followed by a detraining period of 21 days. Creatine and placebo were given over a period of 9 weeks. The size of the body water compartments was assessed by bioimpedance spectroscopy and the isokinetic force was determined during a single squat by means of an isokinetic dynamometer. These measurements were completed beforehand, at the end of the training period, and after the determining period. Both placebo- and creatine-group increased the isokinetic force by about 6% after the training period, showing that creatine ingestion does not induce a higher increase of the force measured during a single movement. No change in body mass was observed in the control- and placebo-groups during the entire experiment period while the body mass of the creatine-group was increased by 2 kg (P < 0.001). This change can be attributed partially to an increase (P = 0.039) in the body water content (+1.11), and more specifically, to an increase (P < 0.001) in the volume of the inter-cellular compartment (+0.61). Nevertheless, the relative volumes of the body water compartments remained constant and therefore the gain in body mass cannot be attributed to water retention, but probably to dry matter growth accompanied with a normal water volume.

Adult↗

Test-retest reliability of hand-held dynamometric strength testing in young people with cerebral palsy.

OBJECTIVE: To evaluate the test-retest reliability of measuring lower-limb strength with a hand-held dynamometer in young people with cerebral palsy (CP). DESIGN: One rater measured the isometric strength of the lower limbs in 10 participants with CP on 2 occasions separated by 6 weeks. SETTING: University movement rehabilitation laboratory in Australia. PARTICIPANTS: Ten young people (mean age +/- standard deviation, 13.5+/-3.4 y) with spastic diplegic CP. Eight of the participants walked independently and 2 walked with assistive devices. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Retest reliability of lower-limb strength, expressed in the units of measurement for the interpretation of group mean and individual scores and as intraclass correlation coefficients (ICC(2,1)). RESULTS: For groups, mean lower-limb strength increases of 7 kg (30%) could be interpreted as real change using 95% confidence intervals (CIs). For individuals, for strength gains to be interpreted as real change using 95% CIs, strength increases would need to be greater than 16.8 kg (70%) for the measurement of knee extension and to be greater than 4.3 kg (25%) for ankle plantarflexion. Measurement of hip extension strength was not reliable for group mean or individual scores. All reliability coefficients were greater than.80. CONCLUSION: A hand-held dynamometer can reliably measure changes in lower-limb strength for groups of young people with CP. It is uncertain whether this method is useful for evaluating change in individuals. Relying only on a coefficient of reliability to decide the usefulness of a measurement can be misleading.

Adolescent↗

[Changes in muscle torque in patients after total knee arthroplasty].

AIM: The purpose of this study was to compare muscle torque during isokinetic knee movements of patients after total knee arthroplasty (TKA) with a similar healthy group. METHOD: 43 patients were examined 3 years after primary total knee arthroplasty with an isokinetic dynamometer (Cybex 340). Torque measurements were evaluated for extension and flexion with 4 different velocities. The results were compared with a group of 43 people without knee disease. Bouth groups consist of 29 women and 14 men. The mean age was also comparable (66.4 vs. 65.8 years). RESULTS: A mean peak torque of 65.9 Nm was measured during extension with low velocity (60 degrees /s) in the group of patients with TKA -- 84.3 % of the control group (p = 0.079). At the highest velocity the patients produced 30.2 Nm. This was 72.8 % of the control group (difference statistically significant, p = 0.006). No differences were found in the Extension/Flexion ratio between the two groups. CONCLUSION: The deficites of knee strength in patients after TKA are more distinct in high velocities of motion.

Aged↗

Measurement of upper and lower body strength and its relationship to underhand pitching speed.

This study investigated the possible relationship for legs, arms, shoulders, and grip strength with underhand throwing speed. 40 female subjects had their legs, arms, and shoulder strength measured using a multipurpose exercise machine for assessing resistive force. Grip strength was measured using a handgrip dynamometer. Underhand throwing speed was measured with a radar gun. Regression analysis indicated a relationship (p < or = .05) between strength of the arms and underhand pitching speed. No significant relationships were found for legs, shoulders, and grip strength, and underhand pitching speed.

Adult↗

A comparison of torque production during dynamic strength testing of shoulder abduction in the coronal plane and the plane of the scapula.

Quantitative measurement of the shoulder abductors is important in a comprehensive assessment of shoulder muscle performance. Testing in traditionally accepted positions may be compromising to the glenohumeral static and dynamic stabilizers; therefore, there is a need to investigate testing in other planes of motion. The purpose of this study was to compare torque produced during isokinetic testing of shoulder abduction in the coronal plane and the scapular plane. Twenty female subjects with no previous shoulder pathology were tested at 90 degrees/sec and 210 degrees/sec in the coronal and scapular planes using the Cybex II isokinetic dynamometer. Both peak torque and mean peak torque of three trials were recorded. A t test for related samples (p < .05) revealed no significant difference in the peak and mean peak torque produced at each speed. Using a two-way analysis of variance with repeated measures, no significant difference was found in the peak torque produced between the two planes. However, torque production at 90 degrees/sec in both test positions was significantly higher than torque production at 210 degrees/sec (F1,19 = 159.610, p < .001). Although anatomical, functional, and clinical reasons have been proposed for performing exercise and testing procedures of the shoulder abductors in the scapular plane, the results of this study indicate that in healthy young women, there is no difference in torque production between the two planes.

Adult↗

The relationship of upper extremity strength to throwing speed.

Cybex II Isokinetic Dynamometer (Lumex Corp. Ronkonkoma, NY) tests for the upper extremity strength of eight professional baseball players, together with radar gun measurements of their individual throwing speeds, were subjected to statistical analysis. Results of simple and multiple regression analysis showed a relationship between the strength of the elbow extension and wrist extension movements and throwing speed.

Arm↗

A randomized trial of weighted vest use in ambulatory older adults: strength, performance, and quality of life outcomes.

BACKGROUND: Lower extremity weakness is a major risk factor for falls and hip fractures. Aging muscle is capable of responding to strengthening techniques. Strategies for providing accessible, inexpensive, safe, and effective strengthening programs for older adults are needed. OBJECTIVE: To evaluate whether use of a weighted vest improved strength, physical performance, markers of bone turnover, or health-related quality of life. DESIGN: A 27-week randomized, controlled, unmasked clinical trial. The primary outcome was peak isokinetic knee extensor strength at follow-up, adjusted for baseline strength. SETTING: Home-based program. PARTICIPANTS: A total of 62 women and men, mean age 74 years. INTERVENTIONS: Subjects were randomized to: no vest (n = 21), 3% body weight (BW) vest (n = 19), or 5% BW vest (n = 22). The vest is a nylon garment with pockets that are loaded with adjustable weights. The vest was prescribed for 2 hours daily, 4 days per week. No specific physical activities were mandated. MEASUREMENTS: All measures were made at baseline and 27 weeks. These included: knee strength and endurance by isokinetic dynamometer; timed physical performance tests; serum osteocalcin and urinary N-telopeptides; and health-related quality of life scales. RESULTS: Follow-up values of muscular strength and endurance, physical performance, bone turnover markers, and health-related quality of life did not differ by treatment assignment. The final study visit was attended by 19 (90%), 15 (80%), and 20 (91%) of the control, 3%, and 5% groups, respectively. Three permanent discontinuations of vest use occurred. CONCLUSIONS: Weighted vest use did not result in improvement in multiple domains of strength and function and did not affect bone turnover markers. We conclude that the training stimulus afforded by the vest (at the dosage tested) was below the required amount to produce strength gains or bone stimulation.

Aged↗