Título :	Effect of muscle length on maximum evoked torque, discomfort, contraction fatigue, and strength adaptations during electrical stimulation in adult populations : a systematic review
Autor :	Cavalcante, Jonathan Galvão Tenório Ribeiro, Victor Hugo de Souza Marqueti, Rita de Cássia Paz, Isabel de Almeida Bastos, Júlia Aguillar Ivo Vaz, Marco Aurélio Bault, Nicholas Durigan, João Luiz Quagliotti
metadata.dc.identifier.orcid:	https://orcid.org/0000-0003-4082-1092 https://orcid.org/0000-0001-6741-3502 https://orcid.org/0000-0001-6563-503X
metadata.dc.contributor.affiliation:	University of Brasília, Laboratory of Muscle and Tendon Plasticity, Graduate Program of Physical Education University of Brasília, Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences University of Brasília, Molecular Analysis Laboratory, Graduate Program of Rehabilitation Sciences Federal University of Rio Grande do Sul, Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance University of Brasília, Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences Federal University of Rio Grande do Sul, Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance University of Burgundy Franche-Comté, Centre d’Expertise de la Performance, INSERM UMR1093-CAPS, UFR des Sciences du Sport, Besançon, Dijon, France University of Brasília, Laboratory of Muscle and Tendon Plasticity, Graduate Program of Physical Education University of Brasília, Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences
Assunto::	Estimulação elétrica neuromuscular Músculos Adultos
Fecha de publicación :	10-jun-2024
Editorial :	Plos One
Citación :	CAVALCANTE, Jonathan Galvão Tenório et al. Effect of muscle length on maximum evoked torque, discomfort, contraction fatigue, and strength adaptations during electrical stimulation in adult populations: a systematic review. PLoS ONE, [S. l.], v. 19, n. 6, e0304205, 2024. DOI: https://doi.org/10.1371/journal.pone.0304205. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0304205.
Abstract:	Neuromuscular electrical stimulation (NMES) can improve physical function in different populations. NMES-related outcomes may be influenced by muscle length (i.e., joint angle), a modulator of the force generation capacity of muscle fibers. Nevertheless, to date, there is no comprehensive synthesis of the available scientific evidence regarding the optimal joint angle for maximizing the effectiveness of NMES. We performed a systematic review to investigate the effect of muscle length on NMES-induced torque, discomfort, contraction fatigue, and strength training adaptations in healthy and clinical adult populations (PROSPERO: CRD42022332965). We conducted searches across seven electronic databases: PUBMED, Web of Science, EMBASE, PEDro, BIREME, SCIELO, and Cochrane, over the period from June 2022 to October 2023, without restricting the publication year. We included cross-sectional and longitudinal studies that used NMES as an intervention or assessment tool for comparing muscle lengths in adult populations. We excluded studies on vocalization, respiratory, or pelvic floor muscles. Data extraction was performed via a standardized form to gather information on participants, interventions, and outcomes. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for cross-over trials and the Physiotherapy Evidence Database scale. Out of the 1185 articles retrieved through our search strategy, we included 36 studies in our analysis, that included 448 healthy young participants (age: 19–40 years) in order to investigate maximum evoked torque (n = 268), contraction fatigability (n = 87), discomfort (n = 82), and muscle strengthening (n = 22), as well as six participants with spinal cord injuries, and 15 healthy older participants. Meta-analyses were possible for comparing maximal evoked torque according to quadriceps muscle length through knee joint angle. At optimal muscle length 50° - 70° of knee flexion, where 0° is full extension), there was greater evoked torque during nerve stimulation compared to very short (0 – 30°) (p<0.001, CI 95%: -2.03, -1.15 for muscle belly stimulation, and -3.54, -1.16 for femoral nerve stimulation), short (31° - 49°) (p = 0.007, CI 95%: -1.58, -0.25), and long (71° - 90°) (p<0.001, CI 95%: 0.29, 1.02) muscle lengths. At long muscle lengths, NMES evoked greater torque than very short (p<0.001, CI 95%: -2.50, -0.67) and short (p = 0.04, CI 95%: -2.22, -0.06) lengths. The shortest quadriceps length generated the highest perceived discomfort for a given current amplitude. The amount of contraction fatigability was greater when muscle length allowed greater torque generation in the pre-fatigue condition. Strength gains were greater for a protocol at the optimal muscle length than for short muscle length. The quality of evidence was very high for most comparisons for evoked torque. However, further studies are necessary to achieve certainty for the other outcomes. Optimal muscle length should be considered the primary choice during NMES interventions, as it promotes higher levels of force production and may facilitate the preservation/gain in muscle force and mass, with reduced discomfort. However, a longer than optimal muscle length may also be used, due to possible muscle lengthening at high evoked tension. Thorough understanding of these physiological principles is imperative for the appropriate prescription of NMES for healthy and clinical populations.
metadata.dc.description.unidade:	Faculdade de Educação Física (FEF) Faculdade UnB Ceilândia (FCE) Curso de Fisioterapia (FCE-FISIO)
metadata.dc.description.ppg:	Programa de Pós-Graduação em Educação Física Programa de Pós-Graduação em Ciências da Reabilitação
Licença::	© 2024 Cavalcante et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI:	https://doi.org/10.1371/journal.pone.0304205
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