Evaluation de la fonction musculaire au grand âge

in Abstract Book des 10èmes Journées d’Automne de la Société Belge de Gérontologie et de Gériatrie (2007)

Use of magnetic resonance imaging and 31p-spectroscopy to explore muscle energetics in fibromyalgia patients

in Annals of the Rheumatic Diseases (2007), 66

Background: Fibromyalgia (FM) is defined as a chronic syndrome characterized by diffuse pain. FM patients generally complain of muscle fatigue during physical activities and symptoms worsening after ... [more ▼]

Background: Fibromyalgia (FM) is defined as a chronic syndrome characterized by diffuse pain. FM patients generally complain of muscle fatigue during physical activities and symptoms worsening after exercise. Some studies have explored muscle performances in FM patients. Similarly, we reported that all variables of muscle performances were decreased in FM patients as compared to the controls [1]. We found that muscle impairment predominated over aerobic processes. The 31P nuclear magnetic resonance spectroscopy (NMRS) appears especially useful to study muscle energy metabolism because it is non-invasive and allows the exploration during exercise. Objectives: The purposes were: (1) to determine the maximal transverse section (MTS) of calf muscles by Magnetic Resonance Imaging (MRI) in order to calculate the individual mechanical loads of exercise without requiring the measurement of the maximal voluntary torque; (2) to monitor, by 31P-NMRS, high-energy phosphate metabolism and intracellular pH at rest, during exercise and recovery periods by means of continuous spectra acquisitions with an adequate temporal resolution; (3) to determine an original efficacy muscular index with the help of the ergometric and spectroscopic parameters; (4) to explore the oxidative pathway by means of determination of the PCr rephosphorylation time constant. Methods: Eight women with fibromyalgia (FM) and 30 healthy volunteers were included in this study. MRI of the dominant leg was acquired in order to determine the MTS of calf muscles and thus to calculate the different loads of exercise (dynamic plantar flexions). Subjects performed 3-6 bouts of 2 minutes with workload increments until exhaustion. Spectra were acquired continuously at rest, during the exercise and recovery periods. The analysis concerned the gamma-, alpha- and beta- ATP, Pi, PCr peaks, and intracellular pH. At the end of the exercise, the muscular efficacy index and the PCr re-phosphorylation time constant were calculated. Results: The MTS of the ankle plantar flexors reached respectively 43 cm² and 36.7 cm² in the control and FM groups (p > 0.05). No significant difference (p > 0.05) was observed between both groups in spectroscopic data registered at rest [10.7 (control) vs 9.1 (FM) for PCr/Pi rest ; 7.01 (control) vs 6.99 (FM) for pHrest] and at the end of exercise [1.18 (control) vs 0.68 (FM) for PCr/Pi end ; 6.89 (control) vs 6.81 (FM) for pHend]. However, the muscular efficacy index was significantly reduced in FM patients (1.25) in comparison with control group (2.46) (p < 0.05). Two patients presented an index extremely low (0.3 and 0.4). The PCr time constant was not different between control subjects (27.7 s) and FM patients (25.6 s) (p > 0.05). Conclusion: Our original protocol, not based on maximum voluntary contraction assessment, did not indicate any abnormalities in glycolytic and oxydative pathways in FM patients. We demonstrated a low efficiency of chemical to mechanical energy shift in FM patients. These results suggested a deconditioning syndrome without primitive muscular abnormalities in FM patients and displayed the importance of aerobic muscular rehabilitation. References: [1]Maquet D, Croisier JL, Renard C, Crielaard JM. Muscle performance in patients with fibromyalgia. J Bone Spine. 2002;69:293-9. [less ▲]

Does neuromuscular electrical stimulation influence muscle recovery after maximal isokinetic exercise?

in Isokinetics & Exercise Science (2007), 15(2), 143-149

Neuromuscular electrical stimulation (ES) and passive recovery (PR) were compared in ten healthy men after a provocation exercise inducing delayed onset of muscle soreness (DOMS). The exercise consisted ... [more ▼]

Neuromuscular electrical stimulation (ES) and passive recovery (PR) were compared in ten healthy men after a provocation exercise inducing delayed onset of muscle soreness (DOMS). The exercise consisted of 3 sets of 30 maximal eccentric contractions performed by the knee flexor muscles of the dominant leg on an isokinetic dynamometer at 60 degrees/s angular velocity. There was an interval of 8 weeks between both bouts and the order of the recovery mode (ES or PR) was block-randomly assigned. ES recovery consisted of a 25-min continuous and non-tetanic (5 Hz) stimulation of the hamstring muscles. Concentric and eccentric hamstrings peak torques were evaluated before and immediately after the provocation exercise, after the recovery period, as well as 24 h (d1), 48 h (d2), 72 h (0) and 168 h (0) after the bout. Subjective perception of muscle soreness (VAS, 0-10 a.u.) was evaluated before exercise and at d1, d2, 0 and d7. To assess the CK activity, five blood samples were drawn before exercise and at d1, d2, d3 and d7. For both recovery modes, the greatest reductions in isokinefic muscle performances were measured on d2 (66.3 +/- 24.1 % of initial values (ES) vs. 57.4 +/- 26.5% (PR) for the concentric mode and 55.6 +/- 16% (ES) vs. 53.1 +/- 19.3% (PR) for the eccentric mode). d2 also corresponded to the highest painful sensations (5.4 +/- 2.14 a.u. (ES) vs. 6.15 +/- 2.55 a.u. (PR)). Peak activities of CK were reached on d3 (47507 +/- 19973 IU/l (ES) vs. 75887 41962 IU/l (PR)). Serum CK was lower with ES than PR at 0 (p <= 0.05) but all other parameters changed in a manner that was not statistically different between the two recovery protocols (p > 0.05). This strong trend could be explained by an electro-induced hyperperfusion that may efficiently wash out the muscle from the cellular debris resulting from the initial injury, and hence diminish the inflammatory response and the delayed amplification of tissue damages. [less ▲]

Whole body vibration in the treatment of fibromyalgia: Influence on muscle performances

in Isokinetics & Exercise Science (2007), 15

Les stimulations électriques ont-elles de réelles vertus antalgiques ? Revue de la littérature et expérience au Centre de la Douleur (CHU Liège)

in Abstract book du Symposium du CKULg « Actualités en électrophysiothérapie » (Liège) (2006, November)

Chronic Fatigue Syndrome: A Systematic Review

in Annales de Réadaptation et de Médecine Physique (2006), 49(6), 418-427

OBJECTIVE: A systematic review of the literature about chronic fatigue syndrome (CFS). METHODS: A search of the Medline database (via Ovid and PubMed) with the key words chronic fatigue syndrome ... [more ▼]

OBJECTIVE: A systematic review of the literature about chronic fatigue syndrome (CFS). METHODS: A search of the Medline database (via Ovid and PubMed) with the key words chronic fatigue syndrome, diagnosis, classification, epidemiology, etiology, physiopathology, metabolism, microbiology, immunology, virology, psychology, drug therapy, rehabilitation, and therapy. The reference lists of each article were examined for additional related articles. RESULTS: CFS was defined in 1988 by the US Centes for Disease Control and Prevention. The prevalence of chronic fatigue syndrome has ranged from 0.2% to 0.7% in the general population. In 1994, the definition of CFS was revised by Fukuda et al. Despite various research in several topics (e.g. infection, immune systems, neuroendocrinology, autonomic activity, neuromuscular involvement), the pathophysiology remains unknown. CONCLUSION: CFS, with its various major clinical and functional impacts, should be associated with a "biopsychosocial model". Progressive muscular rehabilitation, combined with behavioral and cognitive treatment, is an essential part of therapy. [less ▲]

Muscle energetics in fibromyalgia patients explored by magnetic resonance imaging and 31P-spectroscopy

in Pederson, John-A. (Ed.) New Research in Fibromyalgia (2006)

Objectives: The aim of this study was to use magnetic resonance imaging and 31P spectroscopy in order to explore muscle metabolism during exercise in fibromyalgia patients. Methods: Eight women with ... [more ▼]

Objectives: The aim of this study was to use magnetic resonance imaging and 31P spectroscopy in order to explore muscle metabolism during exercise in fibromyalgia patients. Methods: Eight women with fibromyalgia (FM) and 30 healthy volunteers were included in this study. Magnetic resonance imaging of the dominant leg was acquired in order to determine the maximal transverse section (MTS) of calf muscles and thus to calculate the different loads of exercise (dynamic plantar flexions). Subjects performed 3-6 bouts of 2 minutes with workload increments until exhaustion. Spectra were acquired continuously at rest, during the exercise and recovery periods. The analysis concerned the -, - and - ATP, Pi, PCr peaks, and intracellular pH. At the end of the exercise, a muscular efficacy index and the PCr re-phosphorylation time constant were calculated. Results: The MTS of the ankle plantar flexors reached respectively 43  7 cm² and 36.7  5 cm² in control and FM groups (p > 0.05). No significant difference (p > 0.05) was observed between both groups in spectroscopic data registered at rest [10.7 (control) vs 9.1 (FM) for PCr/Pirest ; 7.01 (control) vs 6.99 (FM) for pHrest] and at the end of exercise [1.18 (control) vs 0.68 (FM) for PCr/Piend ; 6.89 (control) vs 6.81 (FM) for pHend]. The muscular efficacy index was significantly reduced in FM patients (1.25) in comparison with control group (2.46) (p < 0.05). The PCr time constant was not different between control subjects (27.7 s) and FM patients (25.6 s) (p > 0.05). Conclusions: This study did not indicate any abnormalities in glycolytic and oxydative pathways in FM patients. We demonstrated a low efficiency of chemical to mechanical energy shift in FM patients. These results suggested a deconditioning syndrome without primitive muscular abnormalities in FM patients and displayed the importance of aerobic muscular rehabilitation. [less ▲]

Intérêts de la revalidation musculaire progressive dans la prise en charge de la fibromyalgie

in Revue du Rhumatisme (2006), 73

Objectif : Ce travail a pour objectif d’apprécier l’intérêt d’un programme de reconditionnement physique aérobie dans le traitement de la fibromyalgie. Patients et méthodes : Dix patientes fibromyalgiques ... [more ▼]

Objectif : Ce travail a pour objectif d’apprécier l’intérêt d’un programme de reconditionnement physique aérobie dans le traitement de la fibromyalgie. Patients et méthodes : Dix patientes fibromyalgiques, diagnostiquées selon les critères du Collège Américain de Rhumatologie (1990), réalisent trois séances hebdomadaires d’une durée d’une heure trente sur une période de 3 mois. Le programme de revalidation comporte principalement des activités musculaires aérobies (bicyclette ergométrique, tapis de marche, rameur et step), complétées par des étirements et de la relaxation. Les bénéfices éventuels sont objectivés à partir d’épreuves physiques maximales (isocinétisme) et sous-maximales (test de marche, bicyclette ergométrique, endurance musculaire statique), d’une évaluation du seuil de sensibilité douloureuse à l’aide d’un dolorimètre et de questionnaires de qualité de vie, de quantification de la fatigue et de satisfaction. En outre, les perceptions douloureuses et de pénibilité de l’effort sont respectivement quantifiées à partir des échelles visuelle analogique (EVA) et de Borg. Résultats : Au terme de cette revalidation, une amélioration significative de tous les paramètres physiques est objectivée. Les performances s’améliorent de 26 % lors de l’épreuve de force isocinétique maximale réalisée au niveau des muscles fléchisseurs et extenseurs de genou, de 43 % lors des épreuves isométriques sous-maximales prolongées, de 42 % lors de l’épreuve ergométrique et de 17 % lors de l’épreuve de marche. Ces bénéfices s’accompagnent d’une réduction systématique des perceptions douloureuses et de la difficulté de l’effort mais aussi d’un accroissement du seuil de sensibilité douloureuse. Les questionnaires de qualité de vie et de quantification de la fatigue confirment l’amélioration fonctionnelle. Le programme répond effectivement aux attentes des fibromyalgiques, comme le démontrent les scores du questionnaire de satisfaction. Discussion : Cette option thérapeutique de revalidation se justifie d’autant plus que la faiblesse des qualités musculaires du fibromyalgique a déjà été soulignée. Cette rééducation devrait idéalement se compléter par diverses interventions comme le soutien psychologique et les stratégies cognitivo-comportementales. Conclusion : Cette étude confirme l’intérêt d’un programme de revalidation musculaire progressive dans le cadre de la prise en charge rééducative de la fibromyalgie. Un tel programme réduit les répercussions physiques et psychologiques défavorables de l’affection. [less ▲]

Inter-session, inter-tester and inter-site reproducibility of isometric trunk muscle strength measurements

in Isokinetics & Exercise Science (2006), 14(4), 317-325

The purpose of this study was to investigate the inter-session, inter-tester and inter-site reproducibility of trunk muscle strength scores in flexion, extension, lateral flexion and rotation. Ten healthy ... [more ▼]

The purpose of this study was to investigate the inter-session, inter-tester and inter-site reproducibility of trunk muscle strength scores in flexion, extension, lateral flexion and rotation. Ten healthy students were tested on four apparatus with a 7-10 day break between sessions. The first two sessions were identical while the other two differed either by the tester or by the site. Furthermore, 10 patients with chronic low back dysfunction (CLBD) were assessed with the four apparatus, once only. For all tests, CV ranged from 3.4% to 7.6% and from 3.9% to 8.1% in the inter-session and inter-tester studies, respectively (p > 0.05 except for inter-session reproducibility of trunk flexor strength). Peak torque (PT) was more variable from site to site with a CV ranging from 4.2% to 12.7%, particularly in extension and left lateral flexion (p < 0.05). No statistically significant difference in the strength ratios (flexion/extension, right/left lateral-flexion and right/left rotation) were found between sessions or testers (4.9% < CV < 9.7%). The inter-site reproducibility of ratios was lower. Comparison between the CLBD patients and the healthy subjects with regard to PT normalized to body weight indicated significantly decreased performance for the former except for flexion and rotation scores in males. We conclude that in the case of healthy subjects, inter-session and inter-tester trunk strength measurements derived from these devices are reproducible. The low inter-site reproducibility suggests that caution should be exercised when interpreting findings originating from different sites. The lower extension strength scores in CLBD patients test lends some validity to the system. However, further studies focusing on reproducibility and validity of this system in CLBD patients are critical before any conclusion regarding their clinical viability may be drawn. [less ▲]

Méthodologie raisonnée des tests de résistance à la fatigue

in Abstract book des 8èmes Rencontres de Médimex (2006)

Les épreuves isocinétiques destinées à apprécier la qualité de force musculaire ont fait l’objet de nombreux travaux de validation. Ces épreuves maximales, de courte durée (nombre réduit de répétitions ... [more ▼]

Les épreuves isocinétiques destinées à apprécier la qualité de force musculaire ont fait l’objet de nombreux travaux de validation. Ces épreuves maximales, de courte durée (nombre réduit de répétitions), reconnaissent des applications dans des domaines variés : traumatologie et chirurgie de l’appareil locomoteur, affections neurologiques, insuffisances pulmonaire et cardiaque, prévention lésionnelle … Selon les contextes, les protocoles comportent des exercices concentriques et/ou excentriques à différentes vitesses angulaires. D’autres qualités musculaires, fondées sur des filières énergétiques différentes, peuvent bénéficier de l’exploration isocinétique. Ainsi, l’étude de la résistance à la fatigue, correspondant davantage au métabolisme anaérobie lactique, devrait représenter une application de choix. Cependant, les épreuves isocinétiques de résistance à la fatigue n’ont, à ce jour, pas bénéficié de la même attention méthodologique, rendant leur application clinique plus confidentielle. Il semble légitime de s’interroger sur les critères actuels d’interprétation d’un test de résistance à la fatigue, et en particulier sur la définition d’un résultat « anormal » impliquant une prise en charge thérapeutique. Plusieurs points retiennent notre attention : o groupes musculaires à explorer ; o choix du mode de contraction et de la vitesse angulaire ; o durée optimale de l’épreuve (nombre de répétions) ; o reproductibilité et caractère discriminant des paramètres mesurés et calculés ; o conséquences physiologiques de ce type d’effort et risques potentiels ; o champs d’application. Des résultats récents [1] indiquent, chez des sujets masculins sains pour les muscles quadriceps (Q) et fléchisseurs (Fl) du genou : - la bonne reproductibilité du paramètre Travail total (Wtot) mesuré sur le quadriceps au cours d’une épreuve à 180°/s, comportant 20, 30, 40 ou 50 répétitions ; le Wtot mesuré sur les Fl apparaît moins reproductible ; - les index de fatigue classiquement calculés par les dynamomètres isocinétiques mettent en relation les performances au terme de l’épreuve (3-5 dernières répétitions) avec la performance au début de l’exercice (3-5 premières répétitions). Sur base de la qualité de reproductibilité, de tels index de fatigue devraient laisser place à des index de fatigue rapportant la performance à la fin de l’exercice (3-5 dernières répétitions) au Wtot développé durant l’épreuve ; - les muscles ischio-jambiers se caractérisent par une résistance à la fatigue réduite en comparaison avec le quadriceps. Il est tentant d’ajouter cette particularité à la liste des facteurs intrinsèques de risque lésionnel des ischio-jambiers ; - les épreuves isocinétiques de résistance à la fatigue s’accompagnent d’une sollicitation cardio-vasculaire majeure : ainsi la fréquence cardiaque (FC) s’élève à 83 % de la FC maximale théorique dès la 20ème répétition, et atteint 87 % à la 50ème répétition. Une telle réponse indique clairement le risque potentiel des épreuves de résistance à la fatigue. Ainsi la durée (20 – 30 – 40 ou 50 répétitions) de l’épreuve sera adaptée à la population bénéficiant de l’évaluation. Références [1] Croisier et al. Analysis of a fatigue protocol for knee extenso rand flexor muscle groups. Isokin Exerc Sci (accepted). [less ▲]