Evaluation of a 5-Minute Endurance Test of Human Diaphragm Muscle
Main Article Content
Abstract
Diaphragmatic function is important in treating respiratory failure. Muscle endurance has been measured using twitch electrical stimulation and accelerometer-based mechanomyography. The purpose of this study was to evaluate the reproducibility and the time to perform an endurance test on the diaphragm muscle using electrical stimulation of the phrenic nerve. Twenty healthy subjects (21.6±1.6yrs) were tested in the supine position on two separate occasions. Stimulation electrodes were placed on the left (n=18) or right (n=2) phrenic nerve underneath the sternocleidomastoid muscle. A tri-axial accelerometer was placed on the abdomen and 5 minutes of submaximal electrical stimulation at 5Hz was performed. The resultant vector of acceleration at peak and end acceleration was analyzed: endurance index = end/peak*100). The test was successfully completed 41/47 times. The endurance index for the two days was 73.8±9.4% and 72.6±11.1%, respectively. The time to find the phrenic nerve was 34.8±13.1s for the first 10 subjects and 13.0±2.8s for the second 10 subjects. For the second group, the mean difference in endurance between days was 0.03% with a 95% confidence interval of -1.6% to 1.5%. In conclusion, the diaphragm endurance test was reproducible with practice.
Keywords:
Respiratory fatigue, fatigability, electrical stimulation, phrenic nerve
Article Details
How to Cite
PRYOR, Elizabeth K.; WACHSMUTH, Hallie R.; MCCULLY, Kevin K..
Evaluation of a 5-Minute Endurance Test of Human Diaphragm Muscle.
Medical Research Archives, [S.l.], v. 8, n. 8, aug. 2020.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2198>. Date accessed: 26 dec. 2024.
doi: https://doi.org/10.18103/mra.v8i8.2198.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Poole DC, Sexton WL, Farkas GA, Powers SK, Reid MB. Diaphragm structure and function in health and disease. Med Sci Sports Exerc. Jun 1997;29(6):738-54.
2. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006;1(3):253-60.
3. Fogarty MJ, Sieck GC. Evolution and Functional Differentiation of the Diaphragm Muscle of Mammals. Compr Physiol. Mar 14 2019;9(2):715-766. doi:10.1002/cphy.c180012
4. Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. Mar 27 2008;358(13):1327-35. doi:10.1056/NEJMoa070447
5. Syabbalo N. Respiratory muscle function in patients with neuromuscular disorders and cardiopulmonary diseases. Int J Clin Pract. Jul-Aug 1998;52(5):319-29.
6. Hamnegard CH, Wragg SD, Mills GH, et al. Clinical assessment of diaphragm strength by cervical magnetic stimulation of the phrenic nerves. Thorax. Dec 1996;51(12):1239-42. doi:10.1136/thx.51.12.1239
7. Ottenheijm CA, Heunks LM, Sieck GC, et al. Diaphragm dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. Jul 15 2005;172(2):200-5. doi:10.1164/rccm.200502-262OC
8. Levine S, Nguyen T, Kaiser LR, et al. Human diaphragm remodeling associated with chronic obstructive pulmonary disease: clinical implications. Am J Respir Crit Care Med. Sep 15 2003;168(6):706-13. doi:10.1164/rccm.200209-1070OC
9. Welvaart WN, Paul MA, van Hees HW, et al. Diaphragm muscle fiber function and structure in humans with hemidiaphragm paralysis. Am J Physiol Lung Cell Mol Physiol. Aug 2011;301(2):L228-35. doi:10.1152/ajplung.00040.2011
10. Fogarty MJ, Mantilla CB, Sieck GC. Impact of sarcopenia on diaphragm muscle fatigue. Exp Physiol. Mar 29 2019;doi:10.1113/EP087558
11. Powers SK, Hudson MB, Nelson WB, et al. Mitochondria-targeted antioxidants protect against mechanical ventilation-induced diaphragm weakness. Crit Care Med. Jul 2011;39(7):1749-59. doi:10.1097/CCM.0b013e3182190b62
12. Singh VK, Khanna P, Rao BK, Sharma SC, Gupta R. Outcome predictors for non-invasive positive pressure ventilation in acute respiratory failure. J Assoc Physicians India. May 2006;54:361-5.
13. Terminella L, Sharma G. Diagnostic studies in patients with acute respiratory distress syndrome. Semin Thorac Cardiovasc Surg. Spring 2006;18(1):2-7. doi:10.1053/j.semtcvs.2006.01.001
14. Green D, Cheetham C, Mavaddat L, et al. Effect of lower limb exercise on forearm vascular function: contribution of nitric oxide. Am J Physiol Heart Circ Physiol. September 1, 2002 2002;283(3):H899-907.
15. Mier A, Brophy C, Moxham J, Green M. Phrenic nerve stimulation in normal subjects and in patients with diaphragmatic weakness. Thorax. Nov 1987;42(11):885-8. doi:10.1136/thx.42.11.885
16. Mier A, Brophy C, Moxham J, Green M. Repetitive stimulation of phrenic nerves in myasthenia gravis. Thorax. Aug 1992;47(8):640-4. doi:10.1136/thx.47.8.640
17. Lyall RA, Donaldson N, Polkey MI, Leigh PN, Moxham J. Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis. Brain. Oct 2001;124(Pt 10):2000-13. doi:10.1093/brain/124.10.2000
18. Tarata MT. Mechanomyography versus electromyography, in monitoring the muscular fatigue. Biomed Eng Online. Feb 11 2003;2:3. doi:10.1186/1475-925x-2-3
19. Gobbo M, Ce E, Diemont B, Esposito F, Orizio C. Torque and surface mechanomyogram parallel reduction during fatiguing stimulation in human muscles. Eur J Appl Physiol. May 2006;97(1):9-15. doi:10.1007/s00421-006-0134-8
20. Shima N, Rice CL, Ota Y, Yabe K. The effect of postactivation potentiation on the mechanomyogram. Eur J Appl Physiol. Jan 2006;96(1):17-23. doi:10.1007/s00421-005-0053-0
21. McCully KK, Moraes C, Patel SV, M. G, Willingham TB. Muscle-specific endurance of the lower back erectors using electrical twitch mechanomyography. J Functional Morphology and Kinesiology. 2019;4(12):1-7. doi:10:3390/jfmk4010012
22. Faxon JL, Sanni AA, McCully KK. Hamstrings muscle endurance in subjects with prior knee injuries. J Functional Morphology and Kinesiology. 2018;3(56):1-10. doi:10.3390/jfmk3040056
23. Willingham TB, Backus D, McCully KK. Muscle Dysfunction and Walking Impairment in African American and Caucasian American Women with Multiple Sclerosis. International Journal of MS Care. 2018;
24. McCully KK, Prins P, Mistry K, Willingham TB. Muscle-specific endurance of the trapezius muscles using electrical twitch mechanomyography. Shoulder Elbow. Apr 2018;10(2):136-143. doi:10.1177/1758573217726269
25. Syabbalo N. Assessment of respiratory muscle function and strength. Postgraduate medical journal. Apr 1998;74(870):208-15. doi:10.1136/pgmj.74.870.208
26. Rafferty GF, Mustfa N, Man WD, et al. Twitch airway pressure elicited by magnetic phrenic nerve stimulation in anesthetized healthy children. Pediatr Pulmonol. Aug 2005;40(2):141-7. doi:10.1002/ppul.20241
27. Willingham TB, McCully KK. Assessment of Muscle Fatigue during Twitch Electrical Stimulation using Accelerometer-based Mechanomyography. Advances in Skeletal Muscle Function Assessment. August, 2017 2017;1(2):14-20.
28. Lakens D. Equivalence Tests: A Practical Primer for t Tests, Correlations, and Meta-Analyses. Soc Psychol Pers Sci. May 2017;8(4):355-362. doi:10.1177/1948550617697177
29. Wilcox PG, Stein HB, Clarke SD, Pare PD, Pardy RL. Phrenic nerve function in patients with diaphragmatic weakness and systemic lupus erythematosus. Chest. Feb 1988;93(2):352-8. doi:10.1378/chest.93.2.352
30. Aubier M, Farkas G, De Troyer A, Mozes R, Roussos C. Detection of diaphragmatic fatigue in man by phrenic stimulation. Journal of applied physiology: respiratory, environmental and exercise physiology. Mar 1981;50(3):538-44. doi:10.1152/jappl.1981.50.3.538
31. Mier A, Brophy C, Green M. Diaphragm weakness. J R Soc Med. May 1987;80(5):315-6.
32. Davis JN. Phrenic nerve conduction in man. Journal of neurology, neurosurgery, and psychiatry. Oct 1967;30(5):420-6. doi:10.1136/jnnp.30.5.420
33. Howland RH. Vagus Nerve Stimulation. Curr Behav Neurosci Rep. Jun 2014;1(2):64-73. doi:10.1007/s40473-014-0010-5
34. Fogarty MJ, Mantilla CB, Sieck GC. Breathing: Motor Control of Diaphragm Muscle. Physiology (Bethesda). Mar 1 2018;33(2):113-126. doi:10.1152/physiol.00002.2018
35. Eastwood PR, Panizza JA, Hillman DR, Finucane KE. Application of a cervical stimulating apparatus for bilateral transcutaneous phrenic nerve stimulation. J Appl Physiol (1985). Aug 1995;79(2):632-7. doi:10.1152/jappl.1995.79.2.632
36. McKenzie DK, Gandevia SC. Phrenic nerve conduction times and twitch pressures of the human diaphragm. J Appl Physiol (1985). May 1985;58(5):1496-504. doi:10.1152/jappl.1985.58.5.1496
2. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006;1(3):253-60.
3. Fogarty MJ, Sieck GC. Evolution and Functional Differentiation of the Diaphragm Muscle of Mammals. Compr Physiol. Mar 14 2019;9(2):715-766. doi:10.1002/cphy.c180012
4. Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. Mar 27 2008;358(13):1327-35. doi:10.1056/NEJMoa070447
5. Syabbalo N. Respiratory muscle function in patients with neuromuscular disorders and cardiopulmonary diseases. Int J Clin Pract. Jul-Aug 1998;52(5):319-29.
6. Hamnegard CH, Wragg SD, Mills GH, et al. Clinical assessment of diaphragm strength by cervical magnetic stimulation of the phrenic nerves. Thorax. Dec 1996;51(12):1239-42. doi:10.1136/thx.51.12.1239
7. Ottenheijm CA, Heunks LM, Sieck GC, et al. Diaphragm dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. Jul 15 2005;172(2):200-5. doi:10.1164/rccm.200502-262OC
8. Levine S, Nguyen T, Kaiser LR, et al. Human diaphragm remodeling associated with chronic obstructive pulmonary disease: clinical implications. Am J Respir Crit Care Med. Sep 15 2003;168(6):706-13. doi:10.1164/rccm.200209-1070OC
9. Welvaart WN, Paul MA, van Hees HW, et al. Diaphragm muscle fiber function and structure in humans with hemidiaphragm paralysis. Am J Physiol Lung Cell Mol Physiol. Aug 2011;301(2):L228-35. doi:10.1152/ajplung.00040.2011
10. Fogarty MJ, Mantilla CB, Sieck GC. Impact of sarcopenia on diaphragm muscle fatigue. Exp Physiol. Mar 29 2019;doi:10.1113/EP087558
11. Powers SK, Hudson MB, Nelson WB, et al. Mitochondria-targeted antioxidants protect against mechanical ventilation-induced diaphragm weakness. Crit Care Med. Jul 2011;39(7):1749-59. doi:10.1097/CCM.0b013e3182190b62
12. Singh VK, Khanna P, Rao BK, Sharma SC, Gupta R. Outcome predictors for non-invasive positive pressure ventilation in acute respiratory failure. J Assoc Physicians India. May 2006;54:361-5.
13. Terminella L, Sharma G. Diagnostic studies in patients with acute respiratory distress syndrome. Semin Thorac Cardiovasc Surg. Spring 2006;18(1):2-7. doi:10.1053/j.semtcvs.2006.01.001
14. Green D, Cheetham C, Mavaddat L, et al. Effect of lower limb exercise on forearm vascular function: contribution of nitric oxide. Am J Physiol Heart Circ Physiol. September 1, 2002 2002;283(3):H899-907.
15. Mier A, Brophy C, Moxham J, Green M. Phrenic nerve stimulation in normal subjects and in patients with diaphragmatic weakness. Thorax. Nov 1987;42(11):885-8. doi:10.1136/thx.42.11.885
16. Mier A, Brophy C, Moxham J, Green M. Repetitive stimulation of phrenic nerves in myasthenia gravis. Thorax. Aug 1992;47(8):640-4. doi:10.1136/thx.47.8.640
17. Lyall RA, Donaldson N, Polkey MI, Leigh PN, Moxham J. Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis. Brain. Oct 2001;124(Pt 10):2000-13. doi:10.1093/brain/124.10.2000
18. Tarata MT. Mechanomyography versus electromyography, in monitoring the muscular fatigue. Biomed Eng Online. Feb 11 2003;2:3. doi:10.1186/1475-925x-2-3
19. Gobbo M, Ce E, Diemont B, Esposito F, Orizio C. Torque and surface mechanomyogram parallel reduction during fatiguing stimulation in human muscles. Eur J Appl Physiol. May 2006;97(1):9-15. doi:10.1007/s00421-006-0134-8
20. Shima N, Rice CL, Ota Y, Yabe K. The effect of postactivation potentiation on the mechanomyogram. Eur J Appl Physiol. Jan 2006;96(1):17-23. doi:10.1007/s00421-005-0053-0
21. McCully KK, Moraes C, Patel SV, M. G, Willingham TB. Muscle-specific endurance of the lower back erectors using electrical twitch mechanomyography. J Functional Morphology and Kinesiology. 2019;4(12):1-7. doi:10:3390/jfmk4010012
22. Faxon JL, Sanni AA, McCully KK. Hamstrings muscle endurance in subjects with prior knee injuries. J Functional Morphology and Kinesiology. 2018;3(56):1-10. doi:10.3390/jfmk3040056
23. Willingham TB, Backus D, McCully KK. Muscle Dysfunction and Walking Impairment in African American and Caucasian American Women with Multiple Sclerosis. International Journal of MS Care. 2018;
24. McCully KK, Prins P, Mistry K, Willingham TB. Muscle-specific endurance of the trapezius muscles using electrical twitch mechanomyography. Shoulder Elbow. Apr 2018;10(2):136-143. doi:10.1177/1758573217726269
25. Syabbalo N. Assessment of respiratory muscle function and strength. Postgraduate medical journal. Apr 1998;74(870):208-15. doi:10.1136/pgmj.74.870.208
26. Rafferty GF, Mustfa N, Man WD, et al. Twitch airway pressure elicited by magnetic phrenic nerve stimulation in anesthetized healthy children. Pediatr Pulmonol. Aug 2005;40(2):141-7. doi:10.1002/ppul.20241
27. Willingham TB, McCully KK. Assessment of Muscle Fatigue during Twitch Electrical Stimulation using Accelerometer-based Mechanomyography. Advances in Skeletal Muscle Function Assessment. August, 2017 2017;1(2):14-20.
28. Lakens D. Equivalence Tests: A Practical Primer for t Tests, Correlations, and Meta-Analyses. Soc Psychol Pers Sci. May 2017;8(4):355-362. doi:10.1177/1948550617697177
29. Wilcox PG, Stein HB, Clarke SD, Pare PD, Pardy RL. Phrenic nerve function in patients with diaphragmatic weakness and systemic lupus erythematosus. Chest. Feb 1988;93(2):352-8. doi:10.1378/chest.93.2.352
30. Aubier M, Farkas G, De Troyer A, Mozes R, Roussos C. Detection of diaphragmatic fatigue in man by phrenic stimulation. Journal of applied physiology: respiratory, environmental and exercise physiology. Mar 1981;50(3):538-44. doi:10.1152/jappl.1981.50.3.538
31. Mier A, Brophy C, Green M. Diaphragm weakness. J R Soc Med. May 1987;80(5):315-6.
32. Davis JN. Phrenic nerve conduction in man. Journal of neurology, neurosurgery, and psychiatry. Oct 1967;30(5):420-6. doi:10.1136/jnnp.30.5.420
33. Howland RH. Vagus Nerve Stimulation. Curr Behav Neurosci Rep. Jun 2014;1(2):64-73. doi:10.1007/s40473-014-0010-5
34. Fogarty MJ, Mantilla CB, Sieck GC. Breathing: Motor Control of Diaphragm Muscle. Physiology (Bethesda). Mar 1 2018;33(2):113-126. doi:10.1152/physiol.00002.2018
35. Eastwood PR, Panizza JA, Hillman DR, Finucane KE. Application of a cervical stimulating apparatus for bilateral transcutaneous phrenic nerve stimulation. J Appl Physiol (1985). Aug 1995;79(2):632-7. doi:10.1152/jappl.1995.79.2.632
36. McKenzie DK, Gandevia SC. Phrenic nerve conduction times and twitch pressures of the human diaphragm. J Appl Physiol (1985). May 1985;58(5):1496-504. doi:10.1152/jappl.1985.58.5.1496