La fonction neuromusculaire dans les maladies chroniques (évaluation, impact clinique et réentraînement)

La diminution de la force et l'exacerbation de la fatigue neuromusculaire sont fortement impliquées dans l'altération des capacités fonctionnelles, de la tolérance à l'effort et du pronostic de patients porteurs de pathologies chroniques variées. Ces altérations peuvent trouver leurs origines dans des atteintes primaires de la fonction neuromusculaire et/ou des atteintes secondaires causées par exemple, par une diminution de l'activité spontanée favorisée par une pathologie chronique. Ainsi, la faiblesse et la fatigabilité musculaire sont des symptômes très fréquemment rapportés dans les maladies neuromusculaires (myopathies/neuropathies d'origine génétique ou acquise), les pathologies impliquant le système cardiovasculaire (insuffisance cardiaque) et/ou respiratoire (broncho-pneumopathie chronique obstructive (BPCO)). Ces symptômes sont aussi fréquemment associés aux syndromes idiopathiques de douleurs chroniques accompagnées d'anomalies de la nociception (syndrome fibromyalgique). Le développement d'outils d'évaluation bien tolérés et fiables de la force, de l'endurance et de la fatigue neuromusculaire est d'une importance cruciale pour approfondir la compréhension des mécanismes physiopathologiques et pour disposer de critères de jugement de qualité dans le cadre d'études observationnelles et interventionnelles. Dans ce contexte, la stimulation artificielle électrique s'est révélée être un outil performant pour évaluer in situ la fonction musculaire chez l'humain au repos et au cours de l'exercice. Plus spécifiquement, la stimulation magnétique des troncs nerveux périphériques a montré des prédispositions intéressantes pour l'évaluation de la fonction des muscles locomoteurs et respiratoires dans le cadre clinique. Au cours de ce travail, nous avons développé des outils d'évaluation de la force, de l'endurance et de la fatigue neuromusculaire en utilisant la neurostimulation magnétique et des protocoles d'exercice potentiellement applicables chez le patient. Nous avons étudié leurs capacités à détecter des différences liées au sexe, l'âge et au statut d'entrainement. Dans un second temps, nous avons appliqué nos évaluations dans le cadre de maladies neuromusculaires et de syndromes douloureux chroniques. Chez le patient BPCO, nous avons étudié les phénomènes de fatigue des muscles respiratoires et locomoteurs, leur impact sur la réponse à l'effort ainsi que leurs relations entre eux et avec les symptômes perçus. Chez ces patients, nous avons recherché les effets d'un entraiment d'une prise en charge combinant un entrainement des muscles locomoteurs et un entrainement des muscles respiratoires sur ces paramètres.Strength loss and enhanced neuromuscular fatigue are major contributing factors of impaired functional capacities, exercise tolerance and prognosis in patients with various chronic diseases. These alterations can rely on primary deficiencies of neuromuscular function and/or secondary impairments caused by decreased spontaneous physical activity promoted by a chronic disease. Consequently, muscle weakness and enhanced fatigability are frequently reported symptoms in neuromuscular (inherited or noninherited myopathies/neuropathies), cardiovascular (chronic cardiac failure) and respiratory diseases (chronic obstructive pulmonary disease (COPD)) and idiopathic painful syndromes associated with alteration of nociception (fibromyalgia syndrome). The development of reliable and well-tolerated evaluations of muscle strength, endurance and fatigue is of major interest to better understand the physiopathology of the diseases and to provide relevant outcomes for observational or interventional studies. Artificially muscular electrical stimulation has been recognized as a valuable tool for noninvasive assessments of neuromuscular function at rest and during exercise in human. Recently, magnetic stimulation showed interesting skills to assess both peripheral and respiratory muscles in the clinical field. During this work, we developed tools to assess muscle strength, endurance and fatigue using magnetic neurostimulation and exercise protocols usable in patients. We studied its ability to detect differences related to sex, age and training status. Then we used these procedures in neuromuscular diseases and fibromyalgia syndrome. In COPD patients, we assessed respiratory and locomotor muscle fatigue and studied how these phenomena impact on exercise response and perceived symptoms. In these patients, we also assessed the combined effects of locomotor and respiratory muscle training on these parameters.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF

Safety and efficacy of a 6-month home-based exercise program in patients with facioscapulohumeral muscular dystrophy

Background: Previous randomized controlled trials investigating exercise training programs in facioscapulohumeral muscular dystrophy (FSHD) patients are scarce and of short duration only. This study assessed the safety and efficacy of a 6-month home-based exercise training program on fitness, muscle, and motor function in FSHD patients. Methods: Sixteen FSHD patients were randomly assigned to training (TG) and control (CG) groups (both n = 8) in a home-based exercise intervention. Training consisted of cycling 3 times weekly for 35 minutes (combination of strength, high-intensity interval, and low-intensity aerobic) at home for 24 weeks. Patients in CG also performed an identical training program (CTG) after 24 weeks. The primary outcome was change in peak oxygen uptake (VO 2 peak) measured every 6 weeks. The principal secondary outcomes were maximal quadriceps strength (MVC) and local quadriceps endurance every 12 weeks. Other outcome measures included maximal aerobic power (MAP) and experienced fatigue every 6 weeks, 6-minute walking distance every 12 weeks, and muscle characteristics from vastus lateralis biopsies taken pre- and postintervention. Results: The compliance rate was 91% in TG. Significant improvements with training were observed in the VO 2 peak (+19%, P = 0.002) and MAP by week 6 and further to week 24. Muscle endurance, MVC, and 6-minute walking distance increased and experienced fatigue decreased. Muscle fiber cross-sectional area and citrate synthase activity increased by 34% (P = 0.008) and 46% (P = 0.003), respectively. Dystrophic pathophysiologic patterns were not exacerbated. Similar improvements were experienced by TG and CTG. Conclusions: A combined strength and interval cycling exercise-training program compatible with patients' daily professional and social activities leads to significant functional benefits without compromising muscle tissue

The role of the peripheral and central nervous systems in rotator cuff disease

Rotator cuff (RC) disease is an extremely common condition associated with shoulder pain, reduced functional capacities and impaired quality of life. It primarily involves alterations in tendon health and mechanical properties that can ultimately lead to tendon failure. RC tendon tears induce progressive muscular changes that negatively impact surgical reparability of the RC tendons and clinical outcomes. At the same time, a significant base of clinical data suggests a relatively weak relationship between RC integrity and clinical presentation, emphasizing the multifactorial aspects of RC disease. This review aims to summarize the potential contribution of peripheral, spinal and supraspinal neural factors that may: (i) exacerbate structural and functional muscle changes induced by tendon tear, (ii) compromise the reversal of these changes during surgery and rehabilitation, (iii) contribute to pain generation and persistence of pain, iv) impair shoulder function through reduced proprioception, kinematics and muscle recruitment, and iv) help to explain interindividual differences and response to treatment. Given the current clinical and scientific interest in peripheral nerve injury in the context of RC disease and surgery, we carefully reviewed this body of literature with a particular emphasis for suprascapular neuropathy that has generated a large number of studies in the past decade. Within this process, we highlight the gaps in current knowledge and suggest research avenues for scientists and clinicians

La fonction neuromusculaire dans les maladies chroniques : évaluation, impact clinique et réentraînement

Strength loss and enhanced neuromuscular fatigue are major contributing factors of impaired functional capacities, exercise tolerance and prognosis in patients with various chronic diseases. These alterations can rely on primary deficiencies of neuromuscular function and/or secondary impairments caused by decreased spontaneous physical activity promoted by a chronic disease. Consequently, muscle weakness and enhanced fatigability are frequently reported symptoms in neuromuscular (inherited or noninherited myopathies/neuropathies), cardiovascular (chronic cardiac failure) and respiratory diseases (chronic obstructive pulmonary disease (COPD)) and idiopathic painful syndromes associated with alteration of nociception (fibromyalgia syndrome). The development of reliable and well-tolerated evaluations of muscle strength, endurance and fatigue is of major interest to better understand the physiopathology of the diseases and to provide relevant outcomes for observational or interventional studies. Artificially muscular electrical stimulation has been recognized as a valuable tool for noninvasive assessments of neuromuscular function at rest and during exercise in human. Recently, magnetic stimulation showed interesting skills to assess both peripheral and respiratory muscles in the clinical field. During this work, we developed tools to assess muscle strength, endurance and fatigue using magnetic neurostimulation and exercise protocols usable in patients. We studied its ability to detect differences related to sex, age and training status. Then we used these procedures in neuromuscular diseases and fibromyalgia syndrome. In COPD patients, we assessed respiratory and locomotor muscle fatigue and studied how these phenomena impact on exercise response and perceived symptoms. In these patients, we also assessed the combined effects of locomotor and respiratory muscle training on these parameters.La diminution de la force et l'exacerbation de la fatigue neuromusculaire sont fortement impliquées dans l'altération des capacités fonctionnelles, de la tolérance à l'effort et du pronostic de patients porteurs de pathologies chroniques variées. Ces altérations peuvent trouver leurs origines dans des atteintes primaires de la fonction neuromusculaire et/ou des atteintes secondaires causées par exemple, par une diminution de l'activité spontanée favorisée par une pathologie chronique. Ainsi, la faiblesse et la fatigabilité musculaire sont des symptômes très fréquemment rapportés dans les maladies neuromusculaires (myopathies/neuropathies d'origine génétique ou acquise), les pathologies impliquant le système cardiovasculaire (insuffisance cardiaque) et/ou respiratoire (broncho-pneumopathie chronique obstructive (BPCO)). Ces symptômes sont aussi fréquemment associés aux syndromes idiopathiques de douleurs chroniques accompagnées d'anomalies de la nociception (syndrome fibromyalgique). Le développement d'outils d'évaluation bien tolérés et fiables de la force, de l'endurance et de la fatigue neuromusculaire est d'une importance cruciale pour approfondir la compréhension des mécanismes physiopathologiques et pour disposer de critères de jugement de qualité dans le cadre d'études observationnelles et interventionnelles. Dans ce contexte, la stimulation artificielle électrique s'est révélée être un outil performant pour évaluer in situ la fonction musculaire chez l'humain au repos et au cours de l'exercice. Plus spécifiquement, la stimulation magnétique des troncs nerveux périphériques a montré des prédispositions intéressantes pour l'évaluation de la fonction des muscles locomoteurs et respiratoires dans le cadre clinique. Au cours de ce travail, nous avons développé des outils d'évaluation de la force, de l'endurance et de la fatigue neuromusculaire en utilisant la neurostimulation magnétique et des protocoles d'exercice potentiellement applicables chez le patient. Nous avons étudié leurs capacités à détecter des différences liées au sexe, l'âge et au statut d'entrainement. Dans un second temps, nous avons appliqué nos évaluations dans le cadre de maladies neuromusculaires et de syndromes douloureux chroniques. Chez le patient BPCO, nous avons étudié les phénomènes de fatigue des muscles respiratoires et locomoteurs, leur impact sur la réponse à l'effort ainsi que leurs relations entre eux et avec les symptômes perçus. Chez ces patients, nous avons recherché les effets d'un entraiment d'une prise en charge combinant un entrainement des muscles locomoteurs et un entrainement des muscles respiratoires sur ces paramètres

Locomotor and respiratory muscle fatigue in chronic diseases : evaluation and rehabilitation

La diminution de la force et l'exacerbation de la fatigue neuromusculaire sont fortement impliquées dans l'altération des capacités fonctionnelles, de la tolérance à l'effort et du pronostic de patients porteurs de pathologies chroniques variées. Ces altérations peuvent trouver leurs origines dans des atteintes primaires de la fonction neuromusculaire et/ou des atteintes secondaires causées par exemple, par une diminution de l'activité spontanée favorisée par une pathologie chronique. Ainsi, la faiblesse et la fatigabilité musculaire sont des symptômes très fréquemment rapportés dans les maladies neuromusculaires (myopathies/neuropathies d'origine génétique ou acquise), les pathologies impliquant le système cardiovasculaire (insuffisance cardiaque) et/ou respiratoire (broncho-pneumopathie chronique obstructive (BPCO)). Ces symptômes sont aussi fréquemment associés aux syndromes idiopathiques de douleurs chroniques accompagnées d'anomalies de la nociception (syndrome fibromyalgique). Le développement d'outils d'évaluation bien tolérés et fiables de la force, de l'endurance et de la fatigue neuromusculaire est d'une importance cruciale pour approfondir la compréhension des mécanismes physiopathologiques et pour disposer de critères de jugement de qualité dans le cadre d'études observationnelles et interventionnelles. Dans ce contexte, la stimulation artificielle électrique s'est révélée être un outil performant pour évaluer in situ la fonction musculaire chez l'humain au repos et au cours de l'exercice. Plus spécifiquement, la stimulation magnétique des troncs nerveux périphériques a montré des prédispositions intéressantes pour l'évaluation de la fonction des muscles locomoteurs et respiratoires dans le cadre clinique. Au cours de ce travail, nous avons développé des outils d'évaluation de la force, de l'endurance et de la fatigue neuromusculaire en utilisant la neurostimulation magnétique et des protocoles d'exercice potentiellement applicables chez le patient. Nous avons étudié leurs capacités à détecter des différences liées au sexe, l'âge et au statut d'entrainement. Dans un second temps, nous avons appliqué nos évaluations dans le cadre de maladies neuromusculaires et de syndromes douloureux chroniques. Chez le patient BPCO, nous avons étudié les phénomènes de fatigue des muscles respiratoires et locomoteurs, leur impact sur la réponse à l'effort ainsi que leurs relations entre eux et avec les symptômes perçus. Chez ces patients, nous avons recherché les effets d'un entraiment d'une prise en charge combinant un entrainement des muscles locomoteurs et un entrainement des muscles respiratoires sur ces paramètres.Strength loss and enhanced neuromuscular fatigue are major contributing factors of impaired functional capacities, exercise tolerance and prognosis in patients with various chronic diseases. These alterations can rely on primary deficiencies of neuromuscular function and/or secondary impairments caused by decreased spontaneous physical activity promoted by a chronic disease. Consequently, muscle weakness and enhanced fatigability are frequently reported symptoms in neuromuscular (inherited or noninherited myopathies/neuropathies), cardiovascular (chronic cardiac failure) and respiratory diseases (chronic obstructive pulmonary disease (COPD)) and idiopathic painful syndromes associated with alteration of nociception (fibromyalgia syndrome). The development of reliable and well-tolerated evaluations of muscle strength, endurance and fatigue is of major interest to better understand the physiopathology of the diseases and to provide relevant outcomes for observational or interventional studies. Artificially muscular electrical stimulation has been recognized as a valuable tool for noninvasive assessments of neuromuscular function at rest and during exercise in human. Recently, magnetic stimulation showed interesting skills to assess both peripheral and respiratory muscles in the clinical field. During this work, we developed tools to assess muscle strength, endurance and fatigue using magnetic neurostimulation and exercise protocols usable in patients. We studied its ability to detect differences related to sex, age and training status. Then we used these procedures in neuromuscular diseases and fibromyalgia syndrome. In COPD patients, we assessed respiratory and locomotor muscle fatigue and studied how these phenomena impact on exercise response and perceived symptoms. In these patients, we also assessed the combined effects of locomotor and respiratory muscle training on these parameters

Routine monitoring of isometric knee extension strength in patients with muscle impairments using a new portable device: cross-validation against a standard isokinetic dynamometer

International audienceOBJECTIVE: Muscle strength is a critical clinical hallmark in both health and disease. The current study introduces a novel portable device prototype (MyoQuad) for assessing and monitoring maximal voluntary isometric knee extension torque (MVIT).APPROACH: Fifty-six patients with inclusion body myositis were studied. Knee extension weakness is a key feature in this inflammatory muscle disease. Cross-validation with an isokinetic dynamometer (Biodex System 3 Pro) was performed. Between-day reproducibility and ability to monitor changes in muscle strength over time compared to the gold standard method as a reference, were also investigated.MAIN RESULTS: The measurement was feasible even in the weakest patients. Agreement between methods was excellent (standard error of measurement (SEM) was 3.8 Nm and intra-class correlation coefficient (ICC) was 0.973). Least significant difference (LSD) was 4.9 and 5.3 Nm for the MyoQuad and the Biodex, respectively Measurements using the MyoQuad exhibited excellent between-day reproducibility (SEM was 2.4 Nm and ICC was 0.989 versus 2.6 Nm and 0.988 using the Biodex). Changes in MVIT at 6 and 12 months were similar between methods (timepoint  ×  method interaction was not significant; all p   >  0.19); strength changes classified according to LSD at 6 and 12 months were consistent between methods (>70% consistent classification)).SIGNIFICANCE: The measurement of MVIT using the MyoQuad offers a cost-effective, portable and immediate alternative for the routine measurement of maximal voluntary isometric strength of the quadriceps. The MyoQuad offers a comfort and stability that cannot be provided by standard hand-held dynamometers. These results support quantitative muscle strength assessment using fixed yet flexible dynamometry within clinical routine and multicenter trials

Quadriceps and respiratory muscle fatigue following high-intensity cycling in COPD patients.

Exercise intolerance in COPD seems to combine abnormal ventilatory mechanics, impaired O2 transport and skeletal muscle dysfunction. However their relative contribution and their influence on symptoms reported by patients remain to be clarified. In order to clarify the complex interaction between ventilatory and neuromuscular exercise limiting factors and symptoms, we evaluated respiratory muscles and quadriceps contractile fatigue, dynamic hyperinflation and symptoms induced by exhaustive high-intensity cycling in COPD patients. Fifteen gold II-III COPD patients (age = 67 ± 6 yr; BMI = 26.6 ± 4.2 kg.m(-2)) performed constant-load cycling test at 80% of their peak workload until exhaustion (9.3 ± 2.4 min). Before exercise and at exhaustion, potentiated twitch quadriceps strength (Q(tw)), transdiaphragmatic (P(di,tw)) and gastric (P(ga,tw)) pressures were evoked by femoral nerve, cervical and thoracic magnetic stimulation, respectively. Changes in operational lung volumes during exercise were assessed via repetitive inspiratory capacity (IC) measurements. Dyspnoea and leg discomfort were measured on visual analog scale. At exhaustion, Q(tw) (-33 ± 15%, >15% reduction observed in all patients but two) and Pdi,tw (-20 ± 15%, >15% reduction in 6 patients) were significantly reduced (P15% reduction in 3 patients). Percentage reduction in Q(tw) correlated with the percentage reduction in P(di,tw) (r = 0.66; P<0.05). Percentage reductions in P(di,tw) and P(ga,tw) negatively correlated with the reduction in IC at exhaustion (r = -0.56 and r = -0.62, respectively; P<0.05). Neither dyspnea nor leg discomfort correlated with the amount of muscle fatigue. In conclusion, high-intensity exercise induces quadriceps, diaphragm and less frequently abdominal contractile fatigue in this group of COPD patients. In addition, the rise in end-expiratory lung volume and diaphragm flattening associated with dynamic hyperinflation in COPD might limit the development of abdominal and diaphragm muscle fatigue. This study underlines that both respiratory and quadriceps fatigue should be considered to understand the complex interplay of factors leading to exercise intolerance in COPD patients

Physical activity monitoring: A promising outcome measure in idiopathic inflammatory myopathies

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Muscle Shear Wave Elastography in Inclusion Body Myositis: Feasibility, Reliability and Relationships with Muscle Impairments

International audienceDegenerative muscle changes may be associated with changes in muscle mechanical properties. Shear wave elastography (SWE) allows direct quantification of muscle shear modulus (MSM). The aim of this study was to evaluate the feasibility and reliability of SWE in the severely disordered muscle as observed in inclusion body myositis. To explore the clinical relevance of SWE, potential relationships between MSM values and level muscle impairments (weakness and ultrasound-derived muscle thickness and echo intensity) were investigated. SWE was performed in the biceps brachii at 100°, 90°, 70° and 10° elbow flexion in 34 patients with inclusion body myositis. MSM was assessed before and after five passive stretch-shortening cycles at 4°/s from 70° to 10° elbow angle and after three maximal voluntary contractions to evaluate potential effects of muscle pre-conditioning. Intra-class correlation coefficients and standard errors of measurements were >0.83 and 0.64 and 0.18). MSM correlated to predicted muscle strength (all Spearman correlation coefficients (ρ) > 0.36; all p values  0.23 and all p values > 0.25, respectively). Within- and between-day reliability of muscle SWE was satisfactory and moderate, respectively. SWE shows promise for assessing changes in mechanical properties of the severely disordered muscle. Further investigations are required to clarify these findings and to refine their clinical value