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Effects of NMES pulse width and intensity on muscle mechanical output and oxygen extraction in able-bodied and paraplegic individuals

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European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

Neuromuscular Electrical Stimulation (NMES) is commonly used in neuromuscular rehabilitation protocols, and its parameters selection substantially affects the characteristics of muscle activation. Here, we investigated the effects of short pulse width (200 µs) and higher intensity (short-high) NMES or long pulse width (1000 µs) and lower intensity (long-low) NMES on muscle mechanical output and fractional oxygen extraction. Muscle contractions were elicited with 100 Hz stimulation frequency, and the initial torque output was matched by adjusting stimulation intensity.

Methods

Fourteen able-bodied and six spinal cord-injured (SCI) individuals participated in the study. The NMES protocol (75 isometric contractions, 1-s on–3-s off) targeting the knee extensors was performed with long-low or short-high NMES applied over the midline between anterior superior iliac spine and patella protrusion in two different days. Muscle work was estimated by torque–time integral, contractile properties by rate of torque development and half-relaxation time, and vastus lateralis fractional oxygen extraction was assessed by Near-Infrared Spectroscopy (NIRS).

Results

Torque–time integral elicited by the two NMES paradigms was similar throughout the stimulation protocol, with differences ranging between 1.4% (p = 0.877; able-bodied, mid-part of the protocol) and 9.9% (p = 0.147; SCI, mid-part of the protocol). Contractile properties were also comparable in the two NMES paradigms. However, long-low NMES resulted in higher fractional oxygen extraction in able-bodied (+ 36%; p = 0.006).

Conclusion

Long-low and short-high NMES recruited quadriceps femoris motor units that demonstrated similar contractile and fatigability properties. However, long-low NMES conceivably resulted in the preferential recruitment of vastus lateralis muscle fibers as detected by NIRS.

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Acknowledgements

We thank all research participants for their valuable contribution to this study. We also thank Dr. Sara Wagers (medical oversight), advocates, research nurses, and physiotherapists for additional support to the spinal cord-injured research volunteers. The study was supported by Fondazione Pietro Pittini (Italy), and by the Leona M. and Harry B. Helmsley Charitable Trust.

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Authors and Affiliations

  1. Department of Medicine, University of Udine, Udine, Italy

    Federica Gonnelli, Nicola Giovanelli, Mirco Floreani & Stefano Lazzer

  2. School of Sport Sciences, University of Udine, Udine, Italy

    Federica Gonnelli, Nicola Giovanelli, Mirco Floreani & Stefano Lazzer

  3. Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA

    Federica Gonnelli, Enrico Rejc, Susan Harkema, Andrea Willhite, Sean Stills & Tine Richardson

  4. Department of Neurosurgery, University of Louisville, Louisville, KY, USA

    Enrico Rejc & Susan Harkema

  5. Department of Molecular Medicine, University of Pavia, Pavia, Italy

    Simone Porcelli

  6. Institute of Biomedical Technologies, National Research Council, Segrate, Italy

    Simone Porcelli

  7. Department of Bioengineering, University of Louisville, Louisville, KY, USA

    Susan Harkema

Authors
  1. Federica Gonnelli
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  2. Enrico Rejc
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  8. Sean Stills
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  9. Tine Richardson
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  10. Stefano Lazzer
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Contributions

ER, FG, SH and SL contributed to conception and design of the study. FG, ER, SS, AW and TR contributed to data collection. FG, ER, MF contributed to data analysis. ER, FG, NG, MF, SP and SL contributed to the initial interpretation of results. FG and ER designed the figures. FG, ER and SL wrote the first draft of the manuscript. All authors contributed to data interpretation and writing the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Enrico Rejc.

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No conflicts of interest, financial or otherwise, are declared by the authors.

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Communicated by Nicolas place.

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Gonnelli, F., Rejc, E., Giovanelli, N. et al. Effects of NMES pulse width and intensity on muscle mechanical output and oxygen extraction in able-bodied and paraplegic individuals. Eur J Appl Physiol 121, 1653–1664 (2021). https://doi.org/10.1007/s00421-021-04647-y

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