Jennifer M. Jakobi

The effectiveness of exercise interventions for the management of frailty: a systematic review.

This systematic review examines the effectiveness of current exercise interventions for the management of frailty. Eight electronic databases were searched for randomized controlled trials that identified their participants as “frail” either in the title, abstract, and/or text and included exercise as an independent component of the intervention. Three of the 47 included studies utilized a validated definition of frailty to categorize participants. Emerging evidence suggests that exercise has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review. Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults. There was a paucity of evidence to characterize the most beneficial exercise program for this population. However, multicomponent training interventions, of long duration (≥5 months), performed three times per week, for 30–45 minutes per session, generally had superior outcomes than other exercise programs. In conclusion, structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty.

The effects of whole-body vibration on upper- and lower-body EMG during static and dynamic contractions.

Whole-body vibration (WBV) training uses a vertically oscillating platform and reports suggest that this perturbation elicits reflexive muscle contractions that augment muscle activity and contribute to increased strength. No WBV study has measured both upper- and lower-body muscle activation. The purpose of this study was to determine the optimal WBV stimulus (frequency x amplitude) to increase electromyography (EMG) in upper- and lower-body muscles for three distinctive unloaded actions: isometric semi-squat, dynamic leg squats, and static and dynamic bilateral bicep curls. Surface EMG was measured for the vastus lateralis (VL), biceps femoris (BF), biceps brachii (BB), and triceps brachii (TB) in 10 recreationally active male university students (24.4+/-2.0 years; mean+/-SD) when WBV was administered at 2 and 4 mm and at 25, 30, 35, 40, and 45 Hz. EMG changes are reported as the difference between WBV and no WBV EMG root mean square expressed as a percentage of maximum voluntary exertion (%MVE). In static semi-squat, WBV increased muscle activity 2.9%-6.7% in the VL and 0.8%-1.2% in the BF. During dynamic squatting, WBV increased muscle activity in the VL by 3.7%-8.7% and in the BF by 0.4%-2.0%. In a static biceps curl, WBV had no effect on BB EMG, but did increase TB activity 0.3%-0.7%. During dynamic biceps curls, WBV increased BB EMG activity by 0.6%-0.8% and TB activity by 0.2%-1.0%. The higher WBV amplitude (4 mm) and frequencies (35, 40, 45 Hz) resulted in the greatest increases in EMG activity.

Evaluation of Muscle Activity for Loaded and Unloaded Dynamic Squats during Vertical Whole-Body Vibration

Hazell, TJ, Kenno, KA, and Jakobi, JM. Evaluation of muscle activity for loaded and unloaded dynamic squats during vertical whole-body vibration. J Strength Cond Res 24(7): 1860-1865, 2010-The purpose of this investigation was to examine if the addition of a light external load would enhance whole-body vibration (WBV)-induced increases in muscle activity during dynamic squatting in 4 leg muscles. Thirteen recreationally active male university students performed a series of dynamic squats (unloaded with no WBV, unloaded with WBV, loaded with no WBV, and loaded with WBV). The load was set to 30% of body mass and WBV included 25-, 35-, and 45-Hz frequencies with 4-mm amplitude. Muscle activity was recorded with surface electromyography (EMG) on the vastus lateralis (VL), biceps femoris (BF), tibialis anterior (TA), and gastrocnemius (GC) and is reported as EMGrms (root mean square) normalized to %maximal voluntary exertion. During unloaded dynamic squats, exposure to WBV (45 Hz) significantly (p < 0.05) increased baseline muscle activity in all muscles, except the TA compared with no WBV. Adding a light external load without WBV increased baseline muscle activity of the squat exercise in all muscles but decreased the TA. This loaded level of muscle activity was further increased with WBV (45 Hz) in all muscles. The WBV-induced increases in muscle activity in the loaded condition (∼3.5%) were of a similar magnitude to the WBV-induced increases during the unloaded condition (∼2.5%) demonstrating the addition of WBV to unloaded or loaded dynamic squatting results in an increase in muscle activity. These results demonstrate the potential effectiveness of using external loads with exposure to WBV.

Differential age-related changes in motor unit properties between elbow flexors and extensors

Aim:  Healthy adult ageing of the human neuromuscular system is comprised of changes that include atrophy, weakness and slowed movements with reduced spinal motor neurone output expressed by lower motor unit discharge rates (MUDRs). The latter observation has been obtained mostly from hand and lower limb muscles. The purpose was to determine the extent to which elbow flexor and extensor contractile properties, and MUDRs in six old (83 ± 4 years) and six young (24 ± 1 years) men were affected by age, and whether any adaptations were similar for both muscle groups.

Daily muscle activity and quiescence in non-frail, pre-frail, and frail older women.

Reduced muscle mass and strength are likely fundamental components of frailty. The purpose of this study was to measure daily muscle activity and quiescence in non-frail, pre-frail, and frail older women using portable electromyography (EMG). Thirty-three community-dwelling older Greek women were categorized as non-frail (n=10, 74±4years), pre-frail (n=11, 75±4years), and frail (n=12, 81±6years) based upon the frailty phenotype. Surface EMG over a 9-hour typical day was recorded from the biceps brachii, triceps brachii, vastus lateralis, and biceps femoris of the dominant side. Burst and gap analysis was used to quantify muscle activity and quiescence. The total duration of the muscles that were active (~2.5h) and quiescent (~4h) did not differ across frailty groups. However, the number of bursts was 28% fewer and the mean burst duration was 26% longer in frail women compared with the non-frail women. In addition, muscle activity was greater in the arm muscles than the thigh muscles across all groups (e.g. ~60% greater burst percentage). Burst number and duration indicate that muscle activity differs across stages of frailty in older women and is greater in the upper compared with lower limbs.

A comparison of physical activity (PA) assessment tools across levels of frailty

PURPOSE Determine which PA assessment tools are most closely related to frailty and whether PA is different across levels of frailty. METHODS Fifty community-dwelling Greek older women (63-90 years) participated in this study. PA was measured objectively over 10h using an accelerometer, a heart rate (HR) monitor, a portable electromyography (EMG) unit, and a global positioning system (GPS) and subjectively using the short version of the Minnesota Leisure Time Activity Questionnaire (MLTAQ). Participants were divided into three tertiles based on level of frailty as calculated from a Frailty Index (FI): low FI group (<0.17 FI); intermediate FI group (0.17-0.38 FI); and high FI group (>0.38 FI). RESULTS Accelerometer step counts had the strongest correlation with frailty and were different across levels of frailty. The percentage of time engaged in PA was 31±15% when PA was determined using an accelerometer. Forty-five percent of the variability in the FI was explained by a combination of PA assessment tools including; accelerometer, EMG, GPS, and MLTAQ. The individual contribution of EMG determined activity from the biceps brachii (BB) to the FI prediction was 16%. Accelerometer contributed an additional 10% and time engaged in PA, as assessed with the MLTAQ, added an additional 6% to the prediction of FI score. CONCLUSIONS PA assessment tools, when used in combination, provide important information about the PA accumulation of older women across levels of frailty.

Utility of portable electromyography for quantifying muscle activity during daily use.

Background: Mobility has been studied using performance, questionnaire, pedometer and accelerometer measures, but these tools do not provide information about muscle activity. To better understand mechanisms associated with movement impairment as they relate to function, it is valuable to quantify muscle activity during everyday activities. Objective: This report presents electromyography (EMG) during daily activities from the affected and unaffected limbs of a 74-year-old man who survived a stroke 12 years ago, compared to 7 older healthy men who had not experienced a stroke. Methods: The biceps brachii, triceps brachii, quadriceps and hamstring muscles were recorded continuously for one 8-hour session in the unaffected limbs of the stroke survivor and control subjects. On a second day, EMG from these same muscles of the affected side was recorded for 4 h. Bursts (amplitude >2% maximum effort, duration >0.1 s) and gaps (amplitude <1% maximum effort, duration >0.1 s) of EMG were quantified for the number of times they occurred, mean event duration (seconds), mean peak amplitude (percent maximum voluntary efforts) and rate of activity (event activity/second). Results: Burst and gap patterns of the unaffected limb muscles were similar between the stroke survivor and controls. Increased numbers of bursts (approx. 40%) and gaps (approx. 44%) were seen in the subject’s lower limb muscles of his affected versus unaffected side. Biceps brachii burst activity of the affected limb was increased, whereas triceps brachii burst activity was decreased. These muscle activity changes in the affected limb suggest that the triceps brachii was relatively inactive and the biceps brachii and lower limb muscles were active in an ‘on’ and ‘off’ pattern. Conclusion: Muscle activity in the unaffected limb of the stroke survivor was similar compared to control subjects, but the affected limb differed from the unaffected after stroke. Portable EMG to monitor muscle activity for prolonged periods was not reported to be an impediment by the case or control subjects. Using this technology, EMG bursts and gaps can be recorded and used to describe muscle activity. Future work may consider the feasibility of this technique to monitor rehabilitation progression or long-term plasticity of muscle activity.

Stretch training induces unequal adaptation in muscle fascicles and thickness in medial and lateral gastrocnemii

This study compared adaptations in fascicle lengths, pennation angles, and muscle thickness of the lateral and medial gastrocnemii in response to 6 weeks of stretch training. The nondominant plantar flexors of 11 males were stretched five times per week for 6 weeks and compared with the contralateral leg and a nonstretched control group of 10 males. During stretch training, instantaneous electromyography was utilized to ensure passive muscle stretch. At baseline, week three, week six and 1 week after the conclusion of stretch training, ultrasound was used to measure fascicle lengths, pennation angles, muscle thickness of the lateral gastrocnemius and medial gastrocnemius, and Achilles tendon thickness and length. Plantar flexion torque was measured, and voluntary activation was assessed. Muscle thickness increased 5.6% after 6 weeks of stretch training (P=.009). The fascicles in the lateral gastrocnemius lengthened to a greater extent than the medial. Overall, fascicles lengthened 25% (P<.001) in the muscle tendon junction and 5.1% (P<.001) in the muscle belly. Pennation angles were unchanged in the medial gastrocnemius but decreased in the lateral gastrocnemius 7.1% (P=.02). There was no change in maximal voluntary contraction, voluntary activation, tendon length, or thickness. This study demonstrates that stretch training is a viable modality to alter muscle architecture of the human gastrocnemius through lengthening of muscle fascicles, decreasing pennation angles, and increasing muscle thickness, albeit adaptations are unequal between the lateral and medial heads.

Quality of Life As a Determinant of Frailty Phenotype in Community‐Dwelling Persons with Parkinson's Disease

mouth and lips, and choreatic movements of the arms. Positive snout, glabellar, and right palmomental reflexes were found. Psychiatric evaluation showed no signs of delirium. Neuropsychological testing showed mild cognitive impairment with predominantly extensive frontal symptomatology, resulting in social disinhibition, distractibility, utilization behavior, and a tendency to imitate. On hospital admission, laboratory testing showed high hemoglobin (Hb; 18.7 g/dL, reference 12–16 g/dL) and hematocrit (Ht; 0.57 L/L, reference 0.35–0.45 L/L) and a mean corpuscular volume of 88 fL (reference 80–98 fL). Other laboratory tests showed normal values. In retrospect, Hb and Ht had been rising since 6 months before presentation. Apart from mild ischemic white matter lesions, no abnormalities were seen on magnetic resonance imaging. Electroencephalogram and cerebral spinal fluid analysis revealed no specific pathology. The finding of a JAK2 mutation confirmed the diagnosis of polycythemia vera (PV), and phlebotomy was initiated at 500 mL twice a week. After her fourth phlebotomy, she was feeling better, the chorea attacks disappeared, and the motor restlessness declined significantly. Her Hb dropped to 13.1 g/dL and Ht to 0.40 L/L. Neuropsychological retesting revealed a significant improvement in frontal characteristics; 6 months later she was still in remission.

Parkinson’s disease and sex-related differences in electromyography during daily life

SCOPE Daily bilateral electromyography (EMG) recordings reveal muscle activation patterns implicated in asymmetric Parkinsons disease (PD)-related functional decline. Also, daily EMG recordings reveal sex-differences in muscle activity that give rise to unique PD presentation in males and females. PURPOSE Quantify handgrip strength and daily muscle quiescence through analysis of gaps in the EMG signal in males and females with PD. Bilateral daily EMG was recorded and normalized to maximal voluntary exertions (MVE). EMG gap was defined as <1% amplitude of MVE for >0.1s and characterized as number, duration and time occupied by gaps. A dynamometer evaluated maximal grip-strength. Three-way repeated measures ANOVA examined differences in gap characteristics and strength. Gap duration was shorter (p=0.04) and occupied less time (p=0.02) in PD than controls. Females had fewer gaps with shorter duration (p=0.004), occupying less time (p=0.004) compared with males. Gaps were fewer (p=0.04) and occupied less time (p=0.01) on more-affected than less-affected side. PD was weaker than controls (p=0.04), females were weaker than males (p=0.00), and the more-affected PD side was weaker than less-affected (p=0.04). CONCLUSIONS Quantification of muscle quiescence through gaps in the EMG signal recorded during daily life provides insight into mechanisms underlying differential change in functional performance in males and females with PD.