Exercise has been shown to cause an increase in the concentration of brain serotonin (5-hydroxytryptamine, 5-HT) in humans and experimental animals. The increase in brain serotonin coincides with the onset of fatigue and is referred to as "central fatigue". Experiments in humans and animals involving serotonin receptor agonists have demonstrated reductions in exercise performance by simulating the exercise-induced increase in endogenous serotonin. Conversely, the administration of serotonin receptor antagonists has been shown to extend exercise performance in experimental animals, but not in humans. Although the relationship between the concentration of brain serotonin and exercise performance is well described in the literature, the precise effect of central fatigue on muscle function per se is unclear. Furthermore, there appear to be differences in serotonergic function between trained and untrained cohorts. However, it is not clear whether the differences are due to a training adaptation or if the differences are inherent in the individual. In addition, the time course of these adaptations and the mechanisms of adaptation are not known. The initial purpose of this thesis was to determine whether six weeks of endurance exercise training had any effect on central serotonin receptor sensitivity in Wistar rats. The rats ran on a treadmill 4 times per week with 2 exercise tests of endurance performance per week. Receptor sensitivity was determined indirectly, at the end of each training week, by the reduction in endurance performance, under the influence of a 5-HT1a agonist, (m-Chlorophenylpiperazine, m-CPP). Improved tolerance to the fatiguing effects of the serotonin agonist would suggest desensitisation of central serotonin receptors, probably 5-HT1a receptors. Two groups of controls were used to examine, i) the effect of the injection per se on exercise performance and ii) changes in serotonin receptor sensitivity associated with maturation, in the absence of any exercise training. In the training group, undrugged exercise performance significantly improved by 47% after 6 weeks of training (mean ± SEM, 4518 ± 729 s vs. 6640 ± 903 s, p=0.01). Drugged exercise performance also increased significantly from week 1 to week 6 (306 ± 69 s to 712 ± 192 s, p=0.004). Control group results indicated that the dose of m-CPP alone caused fatigue during exercise tests and that maturation was not responsible for any decrease in receptor sensitivity. Endurance training appears to stimulate an adaptive response to the fatiguing effects of increased brain serotonin, which may enhance endurance exercise performance. The purpose of the second set of experiments described in this thesis was to investigate changes in serotonin receptor sensitivity in response to exercise training in human subjects. Twelve male volunteers completed 30 minutes of stationary cycling at 70% of VO2peak, on 3 days per week, for 9 weeks. Serotonin receptor sensitivity was assessed indirectly by measuring the prolactin response to a serotonin receptor agonist (buspirone hydrochloride), using a placebo controlled, blind cross-over design. A sedentary group of control subjects were also recruited to control for possible seasonal variations in serotonin receptor sensitivity. Endurance capacity was also assessed as time to exhaustion while cycling at 60% of VO2peak. The exercise training caused a significant increase in aerobic power (VO2peak, 3.1±0.16 to 3.6±0.15 L.m-1, p< 0.05) and endurance capacity (93±8 to 168±11 min, p<0.05), but there was no change (p>0.05) in the prolactin response to a serotonin agonist. However, 25% of the subjects in the training group demonstrated a decrease in receptor sensitivity, as indicated by a decrease in prolactin response. These results suggest that while the exercise training caused an increase in aerobic power and endurance capacity, there was no measurable change in 5-HT receptor sensitivity. In addition, it is possible that changes in receptor sensitivity may take longer to occur, the training stimulus used in the present investigation was inadequate or that changes occurred in other 5-HT receptor subtypes that were not assessed by the present methodology. The third set of experiments described here, investigated the changes in neuromuscular function under the influence of a serotonin receptor agonist (buspirone hydrochloride). Subjects were administered the agonist or a placebo in a blind cross over design. Measures of neuromuscular function included reaction time (RT), hand eye coordination (HEC), isometric neuromuscular control (INC), maximal voluntary isometric contractile force (MVIC-F), isometric muscular endurance capacity (IMEC) and various electromyographic (EMG) indices of fatigue in biceps brachii. A preliminary experiment was conducted to determine a drug dose that did not cause sedation of the research subjects. The agonist caused a significant (p<0.05) decrease in MVIC-F, INC and IMEC. There was a non significant (p = 0.08) decrease in EMG amplitude during the MVIC-F trial with the agonist, compared to the effect of the placebo. The median EMG frequency during the IMEC test was also significantly less with the agonist, when compared to the placebo effect. There was a decline in RT and HEC, although this was not significant. These findings indicate that a serotonin receptor agonist causes a decrease in neuromuscular function during isometric muscle contractions. The decrements in muscle function reported in this study may help to explain previous reports of an association between increased brain serotonin concentration and a reduction in endurance performance. Although the present study does not exclude the possibility that an increase in brain serotonin does cause fatigue by affecting organs peripheral to the brain, it provides evidence of fatigue within the central nervous system. Further examination of the effect of a serotonin agonist on muscle function during non-isometric muscle contractions is warranted.

Bone disease and fractures are common in men and women with chronic kidney disease (CKD). The etiology of fractures in CKD is multi-factorial; identifying risk factors for fracture is important in CKD, so that patients who are at high risk can be treated before they fracture. The majority of studies have focused on risk factors associated with fracture in patients with stage 5 CKD on dialysis–there is a need for studies in pre-dialysis CKD. Three novel, non-radiological factors were assessed in 211 men and women with stage 3-5 CKD: cytokines osteoprotegerin (OPG) and receptor activator of nuclear factor kappa beta ligand (RANKL); tests of neuromuscular function including the timed up and go (TUG), 6 minute walk (6MW), and grip strength; and daily activity levels by accelerometry. Fractures were defined as self-reported low-trauma fractures since the age of 40 and/or prevalent vertebral fractures identified by morphometry. Logistic regression and receiver operating characteristic curves (ROC) were performed using STATA version 11.0. Those with fractures had elevated OPG compared to those without fractures (9.37±4.23 vs. 8.13±3.04 pmol/L, p=0.03), however, after adjusting for age OPG did not differ by fracture status. After adjusting for age, weight, and sex, impairments in both the TUG and 6MW tests were associated with fractures (TUG odds ratio (OR): 1.68, 95% confidence interval (CI): 1.40-2.02; 6MW OR: 0.53, 95% CI: 0.52-0.54). The diagnostic tests characteristics of the TUG and 6MW tests were excellent; both could discriminate fracture status (TUG AUROC: 0.90, 95% CI: 0.84-0.95; 6MW AUROC: 0.87, 95% CI: 0.84-0.95). Overall, subjects were primarily sedentary. After adjusting for stage of CKD, increased sedentary activity and decreased light intensity activity could discriminate fracture status (sedentary AUROC: 0.72, 95% CI: 0.56 to 0.87; light activity AUROC: 0.71, 95% CI: 0.55 to 0.87). In conclusion, non-radiological, novel factors including the TUG, the 6MW, and daily activity, but not OPG or RANKL were able to discriminate fracture status in men and women with stage 3-5 CKD.

Bone disease and fractures are common in men and women with chronic kidney disease (CKD). The etiology of fractures in CKD is multi-factorial; identifying risk factors for fracture is important in CKD, so that patients who are at high risk can be treated before they fracture. The majority of studies have focused on risk factors associated with fracture in patients with stage 5 CKD on dialysis–there is a need for studies in pre-dialysis CKD. Three novel, non-radiological factors were assessed in 211 men and women with stage 3-5 CKD: cytokines osteoprotegerin (OPG) and receptor activator of nuclear factor kappa beta ligand (RANKL); tests of neuromuscular function including the timed up and go (TUG), 6 minute walk (6MW), and grip strength; and daily activity levels by accelerometry. Fractures were defined as self-reported low-trauma fractures since the age of 40 and/or prevalent vertebral fractures identified by morphometry. Logistic regression and receiver operating characteristic curves (ROC) were performed using STATA version 11.0. Those with fractures had elevated OPG compared to those without fractures (9.37±4.23 vs. 8.13±3.04 pmol/L, p=0.03), however, after adjusting for age OPG did not differ by fracture status. After adjusting for age, weight, and sex, impairments in both the TUG and 6MW tests were associated with fractures (TUG odds ratio (OR): 1.68, 95% confidence interval (CI): 1.40-2.02; 6MW OR: 0.53, 95% CI: 0.52-0.54). The diagnostic tests characteristics of the TUG and 6MW tests were excellent; both could discriminate fracture status (TUG AUROC: 0.90, 95% CI: 0.84-0.95; 6MW AUROC: 0.87, 95% CI: 0.84-0.95). Overall, subjects were primarily sedentary. After adjusting for stage of CKD, increased sedentary activity and decreased light intensity activity could discriminate fracture status (sedentary AUROC: 0.72, 95% CI: 0.56 to 0.87; light activity AUROC: 0.71, 95% CI: 0.55 to 0.87). In conclusion, non-radiological, novel factors including the TUG, the 6MW, and daily activity, but not OPG or RANKL were able to discriminate fracture status in men and women with stage 3-5 CKD.

No description available.

Scandinavia has among the highest incidence of fragility fractures in the world. The reasons for this are unknown, but might involve differences in genetic and/or environmental factors, such as sunlight exposure and levels of physical activity. Weight-bearing exercise is thought to have a beneficial effect on bone health in the young, but few studies have evaluated whether exercise in older subjects affects bone density and protects against fragility fractures. The initial objective of this thesis was to evaluate whether a combined weight-bearing training programme twice a week would be beneficial as regards bone mineral density (BMD) and neuromuscular function in older women. Forty-eight community living women with a mean age of 73 years were recruited for this 12-month prospective, randomised controlled trial, and were randomly assigned to an intervention group (n=24) or a control group (n=24). The intervention group displayed significant increments in BMD at the Ward’s triangle, maximum walking speed, and isometric grip strength compared to the control group. The second objective was to investigate if training effects were retained in older women five years after the cessation of training. The 40 women who completed the first study included in this thesis were invited to take part in a follow-up assessment five years later, and 34 women (~79 years) agreed to participate. During these five years both groups had sustained significant losses in hip BMD and in all neuromuscular function tests, and the previous exercise-induced intergroup differences were no longer seen. The third and fourth objective of this thesis was to investigate whether exercise and weight-bearing leisure activities in middle-aged women are associated with a decreased risk of sustaining hip or wrist fractures at a later stage. A cohort of women participating in the Umeå Fracture and Osteoporosis (UFO) study, a longitudinal, nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures, was used for the purpose of this investigation. Eighty-one hip fracture cases and 376 wrist fracture cases, which had reported lifestyle data before they sustained their fracture, were identified. These cases were compared with age-matched controls identified from the same cohort. Using conditional logistic regression analysis with adjustments for height, BMI, smoking, and menopausal status, results showed that moderate frequency of leisure physical activities such as gardening and berry/mushroom picking, were associated with reduced hip fracture risk (OR 0.28; 95% CI 0.12 – 0.67), whereas active commuting (especially walking) along with dancing and snow shoveling in leisure time, reduced the wrist fracture risk (OR 0.48; 95% CI 0.27 – 0.88, OR 0.42; 95% CI 0.22 – 0.80 and OR 0.50; 95% CI 0.32 – 0.79 respectively). In summary, this thesis suggests that weight-bearing physical activity is beneficial for BMD and neuromuscular functions such as muscle strength and gait in older women, and that a physically active lifestyle, with outdoor activities, in middle age is associated with reduced risk of both hip and wrist fractures. Possible mechanisms underlying this association include improved muscle strength, coordination, and balance, resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

Žmogaus adaptacija prie karščio yra visapusiškai nagrinėjama ir plati problema (Hori, 1978). Literatūroje gausu tyrimų, nagrinėjančių hipertermijos poveikį neuroraumeninei funkcijai po fizinių pratimų karštyje (Nybo & Nielsen, 2001) ar pasyvaus šildymo (Thomas et al., 2006; Todd et al., 2005). M. M. Thomas et al. (2006) nustatė, kad pasyvaus šildymo metu, padidinus vidinę kūno temperatūrą iki 39,5 oC, sumažėja maksimali izometrinė pėdos lenkiamųjų raumenų jėga ir tai įtakoja raumenų aktyvacijos iš CNS sumažėjimas. Anksčiau atlikti tyrimai patvirtina, kad aukšta organizmo vidinė temperatūra paveikia CNS ir jos galimybę aktyvuoti dirbančius raumenis (Nybo & Nielsen, 2001; Todd et al., 2005). Organizmui aklimuojantis prie karščio, sumažėja TREKT, ŠSD, FSI ir padidėja prakaitavimas, kas lemia mažesnį fiziologinį-terminį stresą hipertermijos sąlygomis (Brazaitis ir kt., 2009; Brazaitis ir Skurvydas, 2010), tačiau sunku rasti tyrimų, nagrinėjančių kaip tai paveikia neuroraumeninę funkciją. M. Brazaitis ir A. Skurvydas (2010) nustatė, kad po 7 pasyvaus šildymo procedūrų (~44 oC vandenyje po 45 minutes), kurios buvo vykdomos kas antrą dieną 2 savaičių laikotarpyje, organizmas aklimavosi prie karščio, bet tai nepaveikė centrinio ir periferinio nuovargio MVJ-2min izometrinio krūvio metu hipertermijos sąlygomis. Mūsų atliktame tyrime buvo naudota unikali pasyvaus šildymo metodika (siekiama TREKT padidinti iki 39,5 0C, maksimalus šildymo procedūros laikas 120 min., šildymo procedūros... [toliau žr. visą tekstą] / Human adaptation to heat is comprehensive of a broad problem (Hori, 1978). The literature is rich in research of analyzing the influence of hyperthermia on neuromuscular function, after exercising in the heat (Nybo & Nielsen, 2001) or passive heating (Thomas et al., 2006; Todd et al., 2005). M. M. Thomas et al. (2006) ascertained that the increase to 39,5 oC of core temperature in passive heating, reduces maximal isometric force of plantar flexors and this is influence of the reduction on voluntary muscle activation from CNS. Earlier studies show, that high core temperature affects CNS and its ability to activate working muscles (Nybo & Nielsen, 2001; Todd et al., 2005). Heat acclimation occurs with reduced rectal temperature, heart rate, physiological strain index and increased sweat rate, which causes reduction in physiological-thermal stress in the hyperthermia (Brazaitis ir kt., 2009; Brazaitis ir Skurvydas, 2010), but it is difficult to find studies how this affects the neuromuscular function. M. Brazaitis & A. Skurvydas (2010) found out that after 7 passive heating procedures (in ~44 oC water, 45 minutes each), which was carried out every second day for two weeks, heat acclimation occurred, but did not change the central and peripheral fatigue during a 2-min MVC in hyperthermia. In our study, we used the unique passive heating technique (we tried to elevate rectal temperature to 39,5 0C, maximal passive heating time was 120 min., 16 days of passive heating procedure... [to full text]

La recherche de méthodes permettant de lutter contre le déconditionnement neuromusculaire à la suite par exemple d’une opération chirurgicale ou d’une immobilisation prolongée intéresse la communauté scientifique depuis de nombreuses années. Ce projet visait à proposer la technique de vibration locale (LV) comme une méthode alternative aux méthodes classiquement utilisées (e.g. vibration corps entier, stimulation électrique neuromusculaire) pour lutter contre ce déconditionnement neuromusculaire. Le premier objectif de ce travail de thèse était de déterminer les effets d’une application aigüe de LV sur la fonction neuromusculaire des muscles fléchisseurs dorsaux et extenseurs du genou de sujets sains. Nos résultats montrent une modulation de l’excitabilité du système nerveux central en réponse à l’application aigüe de LV, ce qui nous a permis d’envisager de potentielles adaptations si cette technique était utilisée de façon répétée sur plusieurs semaines. Ainsi, la seconde orientation de ce travail était d’évaluer les effets d’une application chronique (entraînement) de LV sur les propriétés fonctionnelles (force, hauteur de saut) et nerveuses (mesurées par stimulation magnétique transcrânienne) de sujets sains, jeunes et âgés. Nos résultats ont montré qu’un entraînement par LV était efficace pour améliorer les capacités fonctionnelles de ces deux populations, ces gains s’accompagnant d’adaptations nerveuses. Ces travaux nous ont alors conduits à la mise en place d’une dernière étude (en cours) à visée clinique, qui évaluait l’efficacité de LV en rééducation post-ligamentoplastie du ligament croisé antérieur du genou. / There is a need to find new methods to limit neuromuscular deconditioning that occurs after a surgery or prolonged immobilization. This thesis aimed to assess local vibration (LV) training as an alternative to methods classically used (e.g. whole body vibration, neuromuscular electrical stimulation) to fight against neuromuscular deconditioning. The first aim of this project was to determine the effects of a 30-min acute exposure to LV on the neuromuscular function of dorsiflexor and knee extensor muscles in a healthy population. Our results showed that acute LV intervention changed central nervous system excitability, allowing us to consider long-term adaptations to prolonged LV. Thus, the second aim of this thesis was to assess the effects of a chronic application (training) of LV on functional (maximal strength, squat jump performance) and neural (assessed with transcranial magnetic stimulation) properties of healthy young and old subjects. Our results showed that 4 to 8 weeks of LV increase functional capacities that were due to neural adaptations. Based on these results, an on-going study assessing the effectiveness of LV during a rehabilitation program for subjects who suffered from anterior cruciate ligament lesion has been proposed.

Chez l'homme, l'hypoxie correspond à une inadéquation entre les besoins tissulaires et les apports en oxygène. Cet état est une caractéristique commune à l'exposition à l'altitude et au syndrome d'apnées obstructives du sommeil (SAOS), bien que celle-ci soit continue dans le premier cas et intermittente et nocturne dans le second.L'hypoxie d'altitude entraine une altération des performances cognitives et motrices. La réduction de la performance à l'exercice en altitude a longtemps été attribuée à une altération du métabolisme musculaire du fait d'une réduction de l'apport en oxygène. Les perturbations cérébrales induites par l'hypoxie pourraient également avoir un rôle majeur dans cette limitation.Le SAOS, véritable enjeu de santé publique, est associé à des troubles cognitifs pouvant ainsi influencer le fonctionnement quotidien des patients souffrant de ce syndrome et résulter en une somnolence diurne excessive, une baisse de la qualité de vie ou encore une réduction de la productivité au travail et des performances scolaires. Le fait que ces altérations cérébrales puissent influencer les capacités motrices et à l'effort des patients atteints d’apnées obstructives du sommeil reste en revanche à investiguer.Au cours de ce travail de thèse, nous nous sommes intéressés à deux modèles d’exposition hypoxique et à leurs conséquences cérébrales et neuromusculaires. Nous avons tout d’abord étudié l'effet d'une exposition à l'hypoxie d'altitude aigue (quelques heures) et prolongée (plusieurs jours) sur la fonction neuromusculaire et ses répercussions à l'exercice chez le sujet sain. Nous avons ensuite étudié l'influence du modèle d'hypoxie intermittente associé au SAOS sur la fonction neuromusculaire et la tolérance à l'exercice de ces patients. Nous avons ainsi cherché à caractériser les altérations cérébrales à l'exercice en lien avec ce syndrome et leur réversibilité suite à un traitement en ventilation par pression positive continue.Chez le sujet sain, nous avons démontré que la performance à l'exercice impliquant une masse musculaire réduite (fléchisseurs du coude) n'était pas limitée par une fatigue centrale accrue après 1 et 5 jours d'exposition à une altitude de 4350 m. Nous avons mis en évidence que la dysfonction musculaire (force et endurance réduites) observée chez le patient SAOS est associée à un déficit d'activation supraspinal et une augmentation de l'inhibition intracorticale. De plus, nos résultats suggèrent qu'une altération de la réponse cérébrovasculaire à l'exercice puissent impacter négativement la tolérance à l'exercice des patients souffrant d'un SAOS sévère. Ces altérations neuromusculaires et cérébrovasculaires n'étaient pas corrigées après un traitement de huit semaines par ventilation nocturne en pression positive continue soulignant la nature persistante de ces altérations cérébrales. / In humans, hypoxia is defined as the mismatch between tissue requirement and oxygen delivery. This condition is a common feature between high-altitude exposure and obstructive sleep apnea syndrome (OSA), although it is continuous in the first instance and intermittent and nocturnal in the second one.High-altitude exposure causes an impairment in cognitive and motor performance. The reduction in exercise performance observed under hypoxic condition has been mainly attributed to altered muscle metabolism due to impaired oxygen delivery. However, hypoxia-induced cerebral perturbations may also play a major role in exercise limitation.OSA, a major public health concern, is associated with cognitive impairment that can alter patients' daytime functioning and result in excessive daytime sleepiness, reduced quality of life and lowered work productivity and school performance. The fact that these cerebral alterations can influence motor and exercise performance in patients with obstructive sleep apnea remains to be investigated.In this thesis, we investigated two different models of hypoxic exposure and their cerebral and neuromuscular consequences. First, we assessed the effect of acute (several hours) and prolonged (several days) high-altitude exposure on the neuromuscular function and its repercussions during exercise in healthy subject. Then, we then investigated the model of intermittent hypoxia associated with OSA and its influence on the neuromuscular function and exercise tolerance in these patients. We seeked to characterize cerebral alterations during exercise associated with this syndrome and their reversibility following continuous positive airway pressure treatment.In healthy subject, we showed that exercise performance involving a small muscle mass (elbow flexors) was not limited by an exacerbated amount of central fatigue after 1 and 5 days of high-altitude exposure (4,350 m). We highlighted that muscle dysfunction (reduced strength and endurance) was associated with a supraspinal activation deficit and an increase in intracortical inhibition. Moreover, our results suggest that an alteration in cerebrovascular response during exercise may contribute to reduced exercise tolerance observed in patients with severe OSA syndrome. The neuromuscular and cerebrovascular abnormalities were not reversed following an eight-week continuous positive airway pressure treatment, highlighting the persistent nature of the cerebral alterations.

Les objectifs de ce travail de thèse étaient d’évaluer les effets des différences (i) de niveau de force, en utilisant différents groupes et longueurs musculaires, et (ii) de profil métabolique entre enfants pré-pubères et adultes sur les différences de développement et d’origine de la fatigue neuromusculaire, ainsi que (iii) d’accroître nos connaissances sur les mécanismes de la fatigue neuromusculaire chez l’enfant pré-pubère. Les résultats de ce travail montrent que les différences de niveau de force pourraient être un facteur expliquant les différences de développement et d’origine de la fatigue neuromusculaire entre enfants et adultes. Toutefois, ce facteur n’est pas suffisant pour expliquer toutes les différences de fatigue entre ces deux populations. En effet, nos résultats soulignent aussi que les différences de profil métabolique pourraient être impliquées de façon importante dans les différences de développement et d’origine de la fatigue neuromusculaire entre enfants et adultes. Par ailleurs, les résultats de nos études rapportent que les enfants présentent généralement une fatigue périphérique plus faible par rapport aux adultes au profit d’une fatigue centrale plus importante suite à un protocole de fatigue maximal intermittent. Cette moindre fatigue périphérique est associée à une moindre altération des propriétés contractiles et du couplage excitation-contraction, et à une meilleure adaptation de l’oxygénation musculaire chez l’enfant pré-pubère. Nos résultats semblent suggérer que la fatigue spinale ne permettrait pas d’expliquer les différences de fatigue centrale entre enfants et adultes et donc que la fatigue centrale plus importante des enfants pourrait être attribuée à une fatigue supra-spinale plus élevée. / The aims of this PhD thesis were to evaluate the effects of differences of (i) force level, throughout different muscle groups and muscle lengths, and (ii) metabolic profile on the differences of development and etiology of the neuromuscular fatigue between prepubertal children and adults, as well as (iii) to improve our knowledge of the mechanisms of neuromuscular fatigue in children. The results of this PhD thesis showed that force level differences could be a factor underpinning the differences in the development and etiology of neuromuscular fatigue between children and adults. However, this factor cannot fully account for differences in fatigue between both populations. Indeed, our results also highlighted that metabolic profile differences could explain the difference of development and etiology of neuromuscular fatigue between children and adults. Additionally, the results of this thesis showed that children exhibit lower peripheral fatigue and greater central fatigue than adults after an intermittent maximal exercise. This lower peripheral fatigue was associated with a lower alteration of the contractile properties and excitation-contraction coupling, and a better adaptation of the muscle oxygenation in prepubertal children. Our results suggest that spinal fatigue could not explained the differences in central fatigue between children and adults, and that the greater central fatigue in children could be attributed to a greater supra-spinal fatigue.