Surface Electromyography Thresholds as a Measure for Performance Fatigability During Incremental Cycling in Patients With Neuromuscular Disorders

Nicoline B M Voet; Christiaan G J Saris; Dick H J Thijssen; Vincent Bastiaans; David E Sluijs; Mariska M H P Janssen

doi:10.3389/fphys.2022.821584

Surface Electromyography Thresholds as a Measure for Performance Fatigability During Incremental Cycling in Patients With Neuromuscular Disorders

Front Physiol. 2022 Mar 17:13:821584. doi: 10.3389/fphys.2022.821584. eCollection 2022.

Authors

Nicoline B M Voet^{1

2}, Christiaan G J Saris³, Dick H J Thijssen⁴, Vincent Bastiaans⁵, David E Sluijs⁵, Mariska M H P Janssen^{1

2}

Affiliations

¹ Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands.
² Klimmendaal, Rehabilitation Center, Arnhem, Netherlands.
³ Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands.
⁴ Department of Physiology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands.
⁵ Sports Medicine Center, HAN Seneca, HAN University of Applied Sciences, Nijmegen, Netherlands.

Abstract

In healthy persons, there is an excellent relation between the timing of the (two) surface electromyography (sEMG) thresholds and the (two) ventilatory thresholds during exercise. The primary aim of this study was to determine the relative timing of both sEMG and ventilatory thresholds in patients with neuromuscular disorders compared with healthy subjects during a maximal ergospirometry cycling test. We hypothesized that in patients with neuromuscular disorders, the sEMG thresholds would occur relatively earlier in time than the ventilatory thresholds, compared to healthy subjects, because performance fatigability occurs more rapidly. In total, 24 healthy controls and 32 patients with a neuromuscular disorder performed a cardiopulmonary exercise test on a bicycle using a 10-min ramp protocol, during which we collected ergospirometry data: power at both ventilatory and sEMG thresholds, and sEMG data of lower leg muscles. In line with our hypothesis, normalized values for all thresholds were lower for patients than healthy subjects. These differences were significant for the first ventilatory (p = 0.008) and sEMG threshold (p < 0.001) but not for the second sEMG (p = 0.053) and ventilatory threshold (p = 0.238). Most parameters for test-retest reliability of all thresholds did not show any fixed bias, except for the second ventilatory threshold. The feasibility of the sEMG thresholds was lower than the ventilatory thresholds, particularly of the first sEMG threshold. As expected, the sEMG thresholds, particularly the first threshold, occurred relatively earlier in time than the ventilatory thresholds in patients compared with healthy subjects. A possible explanation could be (a combination of) a difference in fiber type composition, disuse, and limited muscle-specific force in patients with neuromuscular disorders. sEMG measurements during submaximal dynamic exercises are needed to generalize the measurements to daily life activities for future use in prescribing and evaluating rehabilitation interventions.

Keywords: cycling; exercise; leg muscles; muscle fatigue; neuromuscular disorders; performance fatigability; surface electromyography thresholds; ventilatory thresholds.