A novel technique for non-volitional assessment of quadriceps muscle endurance in humans

Assessment of quadriceps endurance is of interest to investigators studying human disease. We hypothesised that repetitive magnetic stimulation (rMS) of the intramuscular branches of the femoral nerve could be used to induce and quantify quadriceps endurance. To test this hypothesis we used a novel stimulating coil to compare the quadriceps endurance properties in 8 normal humans and, to confirm that the technique could be used in clinical practice, in 8 patients with advanced chronic obstructive pulmonary disease (COPD). To validate the method we compared in vivo contractile properties of the quadriceps muscle with the fibre type composition and oxidative enzyme capacity. We used a Magstim Rapid2 magnetic nerve stimulator with the coil wrapped around the quadriceps. Stimuli were given at 30Hz, a duty cycle of 0.4 (2s on, 3s off) for 50 trains. Force generation and the surface electromyogram were measured throughout. Quadriceps twitch force, elicited by supramaximal magnetic stimulation of the femoral nerve, was measured before and after the protocol. Quadriceps muscle biopsies were analysed for oxidative (citrate synthase, CS) and glycolytic (phosphofructokinase, PFK) enzyme activity and myosin heavy chain (MyHC) isoform protein expression. The time for force to fall to 70% of baseline (T70) was shorter in the COPD group than the control group, 55.6+/-26.0s vs. 121+/-38.7s (p=0.0014). Considering patients and controls together, positive correlations were observed between T70 and the proportion of type I fibres (r=0.68, p=0.004) and CS/PFK (r=0.67, p= 0.005). We conclude that quadriceps endurance assessed using rMS is feasible in clinical studies. Key words: skeletal muscle fatigue, magnetic stimulation, myosin heavy chains, oxidative capacity , COPD.