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PubMed1987

Forward and backward axial synergies in man.

Upper trunk and head forward and backward movements were analyzed in human subjects standing on a force platform. EMG of several flexor and extensor muscles was recorded together with the kinematics of the movement (EL.I.TE. system). It was found that upper trunk movements are accompanied by movements of hip and knees in the opposite direction, resulting in a slight displacement of the center of gravity projection on the ground. In fast movements, all the body segments were displaced at the same time, which suggests a feedforward control, whereas in slow movements, onset of displacement of the body segments was found to take place sequentially in a cranio-caudal direction. EMG analysis during fast movements revealed two different types of control, utilized in forward and backward movements. With forward bending movements the action of two sets of muscles could be recognized: the prime mover (R. Abd.), the activation of which was not correlated with that of the other muscles and preceded the onset of movement with a fairly constant lead, and a group of postural muscles, the activation (VM, TA) and inhibition (Sol) of which were closely correlated. By contrast, with backward movements, the prime mover (Er.S.) and the postural leg muscles (Hamstrings, Sol) were activated simultaneously. In both cases, a feedforward type of control is evident. Performance of the fast forward movements was accompanied by an initial forward displacement of the knee. The function of this phenomenon is discussed in term of a destabilizing action favouring the forward bending of the body or a prestretching of the knee extensor muscles increasing the strength of their subsequent contraction.

Adult↗

PubMed2005

Muscle, ligament, and joint-contact forces at the knee during walking.

PURPOSE: In vivo measurement of the forces and strains in human tissues is currently impracticable. Computer modeling and simulation allows estimates of these quantities to be obtained noninvasively. This paper reviews our recent work on muscle, ligament, and joint loading at the knee during gait. METHODS: Muscle and ground-reaction forces obtained from a sophisticated computer simulation of walking were input into a detailed model of the lower limb to obtain ligament and joint-contact loading at the knee for one full cycle of gait. RESULTS: Peak anterior cruciate ligament (ACL) force occurred in early stance and was mainly determined by the anterior pull of the patellar tendon on the tibia. The medial collateral ligament was the primary restraint to anterior tibial translation (ATT) in the ACL-deficient knee. ATT in the ACL-deficient knee can be reduced to the level calculated for the intact knee by increasing hamstrings muscle force. Reducing quadriceps force was insufficient to restore ATT to the level calculated for the intact knee. For both normal and ACL-deficient walking, the resultant force acting between the femur and tibia remained mainly on the medial side of the knee. The knee adductor moment was resisted by a combination of muscle and ligament forces. CONCLUSION: Knee-ligament loading during the stance phase of gait is explained by the pattern of anterior shear force applied to the leg. The distribution of force at the tibiofemoral joint is determined by the variation in the external adductor moment applied at the knee. The forces acting at the tibiofemoral and patellofemoral joints are similar during normal and ACL-deficient gait. Hamstrings facilitation is more effective than quadriceps avoidance in reducing ATT during ACL-deficient gait.

Anterior Cruciate Ligament↗

PubMed1995

Muscle response to heavy resistance exercise in children with spastic cerebral palsy.

Fourteen ambulatory children with spastic diplegia participated in a bilateral quadriceps strengthening program in an attempt to decrease the amount of knee crouch during gait. Each child exercised three times a week for six weeks using free ankle weights at a load of 65 per cent of maximum. A normal comparison group of 25 children was also tested under identical conditions. Children with cerebral palsy were significantly weaker in the quadriceps and hamstrings muscle groups than controls. Quadriceps strength increased significantly at all three angles of knee flexion as a result of the weight-training program and did not differ statistically from normal at the end of the program. Quadriceps weakness was shown to be a factor in crouch gait; restoring strength through resistance exercise may be a useful adjunct in the treatment of cerebral palsy.

Adolescent↗

PubMed1996

[Multidisciplinary treatment program for chronic low back pain, part 2. Somatic aspects].

PROBLEM: There is a great need to expand current knowledge of the various functional capacity measurements used in the rehabilitation of chronic low back pain (CLBP) patients. The literature on these patients reports that mobility, endurance, trunk strength and lifting capacity decrease during the process of chronicity. Chronically disabled patients appear to have lower functional capacity than asymptomatic persons. METHODS: Our study group consisted of 90 disabled CLBP patients (44 female, 46 male; average age 42 years) who underwent a multidisciplinary 8-week daily treatment program of functional restoration with behavioral support (instruction, endurance training, strength exercises, behavioral and treatment to facilitate return to work therapy). Initially these patients where compared with 107 asymptomatic persons (44 female, 63 male, average age 41 years). The patients were investigated before and after treatment, and at intervals of 6 and 12 months. The reliability of the functional measurements was evaluated by interrater comparison. Physical assessment included a medical examination (mainly diagnosis of radicular or nonradicular pain), changes in the lumbar spine revealed by X-ray studies according to Herron and Turner, rating of physical impairment according to Waddell, flexibility, length of hamstrings muscles (SLR), test of power and endurance of trunk movement by standardized exercises according to the Swiss group of Spring and isokinetic measurements (LIDO Back), tests of lifting capacity (LIDO Lift), and (in part) of general endurance on a cycle ergometer (CASE 15 Marquette). RESULTS: Physical findings showed that mobility was reduced substantially in patients suffering from back pain due to reduced SLR (shortened hamstrings) and decreased spinal mobility. Patients also demonstrated significant reductions in their ability to perform lifting tasks in comparison to healthy individuals. The results of trunk flexion showed no significant differences between patients and the control group, whereas the ability to perform trunk extension was much better in the control group. In principle we found the same results with isokinetic measurements as in the exercises without machines. Cardiovascular endurance was also much better in the control group than it was in the back pain patients. At the end of the treatment program all physical deficits were improved significantly. In many cases performance was comparable with that of the control group. With time, however, training effects gradually decreased. The success of treatment (return to work, absence from work, pain reduction, use of medical care) was independent of the functional status of the patients before and after treatment. CONCLUSION: Study results showed that physical capacity in disabled patients with low back pain is substantially reduced in comparison to persons who do not suffer from back pain. The only exception was in trunk flexor strength and endurance, in which measurements did not differ between the patients and the control group. However, even CLBP- patients with long-term pain and severe physical illness can successfully improve their physical condition by participating in an active treatment program. Back extensor muscle training has to be included in physical therapy. Because of loss of condition during the time after treatment, regular monitoring of patients and their home training programs is necessary. Overall, treatment of CLBP has to include physical training and psychosocial treatment to achieve satisfactory results.

English Abstract↗

PubMed2002

Differences in the movement pattern of a forward lunge in two types of anterior cruciate ligament deficient patients: copers and non-copers.

OBJECTIVE: To determine whether differences in the knee joint movement pattern of a forward lunge could be quantified in healthy subjects and in anterior cruciate ligament deficient subjects who were able to return to the same activity level as before their injury (copers) and in those who were not (non-copers). DESIGN: The movement patterns of the injured leg of the coper and non-coper anterior cruciate ligament deficient subjects and the right leg of the control subjects were compared statistically. BACKGROUND: The forward lunge seems to be a less stressful test than the commonly used one-legged hop test, which makes it a possible tool for evaluating and comparing the functional performance of non-copers and copers. METHODS: The movement pattern of a forward lunge was analysed by using a two-dimensional inverse dynamics method. The electromyographic activity of the quadriceps and hamstring muscles were recorded. RESULTS: The non-copers moved more slowly and loaded the knee joint less than the copers and controls. The copers moved more slowly during the knee flexion phase but as fast as the controls during the knee extension. The EMG results suggest that the copers stabilized their knee joint by increasing the co-contraction of the hamstrings during the extension phase. CONCLUSIONS: Differences between the three groups' movement patterns could be quantified. The forward lunge test seems appropriate to discriminate between the knee function in coper and non-coper anterior cruciate ligament deficient subjects. RELEVANCE: Information about the performance of movements, which significantly load the knee joint in coper and non-coper anterior cruciate ligament deficient patients may contribute to a better understanding of dynamic knee joint stabilization, which is relevant in relation to the development of rehabilitation strategies.

Adaptation, Physiological↗

PubMed2001

Knee muscle isometric strength, voluntary activation and antagonist co-contraction in the first six months after stroke.

PURPOSE: Muscle weakness may contribute to functional problems after stroke, but is rarely addressed during rehabilitation. Functional problems are commonly thought to be caused by abnormal movement patterns or possibly disuse atrophy. We investigated voluntary isometric strength, activation and the extent of co-contraction in the knee muscles during the first six months during stroke. METHODS: Twelve stroke patients (58 +/- 3 years, mean+/- SEM, 7 female) were studied bilaterally on admission for rehabilitation (21 +/- 1 days after stroke) and then at 1, 2, 3, and 6 months. Twenty healthy controls (61 +/- 5 years, 17 female) were tested once on their preferred leg. Subjects performed maximal voluntary contractions of the quadriceps and hamstring muscles. Simultaneous measurements were made of agonist force and surface EMG from agonist and antagonist muscles. Voluntary activation was estimated using the twitch superimposition technique. RESULTS: Both paretic muscles showed lower (p = 0.01-0.0005) voluntary strength than both non-paretic and control muscles until three months after stroke. Co-contraction of antagonists was similar in all groups and greater during knee extension than flexion. Stroke patients showed considerable bilateral voluntary activation failure (25-40%, p = 0.01-0.001) throughout the study while most control subjects did not (group mean 7%). CONCLUSIONS: The muscle weakness and bilateral activation failure in the stroke patients was not explained by either excessive antagonist activity or disuse atrophy. They had potential for increased voluntary strength and if this were addressed during rehabilitation, then the rate and extent of functional recovery might be enhanced.

Case-Control Studies↗

PubMed2006

Hindlimb withdrawal reflexes evoked by Er:YAG laser and scalpel incisions in rats.

OBJECTIVE: In this study, we assessed the magnitudes of nociceptive withdrawal reflexes evoked by skin and muscle incisions made with steel scalpel and erbium:yttrium-aluminum-garnet (Er:YAG) laser. BACKGROUND DATA: A few studies have suggested that laser incisions would be less painful than conventional scalpel incisions. METHODS: Twenty adult male Sprague-Dawley rats were used. Under light barbiturate anesthesia, graded incisions were made into the plantar surface of the animals' hindpaws. Electromyographic (EMG) recordings from a hamstring muscle were used to estimate the nociceptive response. RESULTS: The mean amplitude of EMG activity was significantly higher during incisions made with steel scalpel than with any of the laser irradiation parameters. All laser irradiation parameters produced similar nociceptive responses. CONCLUSION: Er:YAG laser incisions may be less painful, albeit considerably slower, than scalpel incisions. Laser incisional pain would be more closely related to the mechanical rather than the thermal effect of laser ablation.

Animals↗

PubMed1994

Effect of short-term unweighting on human skeletal muscle strength and size.

This study examined the effect of short-term unweighting on strength and size of lower limb muscle groups to predict probable responses to planned 16-d Shuttle flights. Subjects were 10 healthy males, exposed to 16 d of lower limb suspension (LLS). All ambulatory activity was performed on crutches while wearing a shoe with a 10-cm thick sole on the right foot. This eliminated ground contact by the left foot, and thereby, body weight bearing by the left lower limb. Biopsies of the left vastus lateralis muscle and T1 weighted magnetic resonance (MR) images (1.5 Tesla, TR/TE 600/20, 4 nex, 48 cm rectangular FOV, 10 mm transaxial slices at 5-mm intervals) of both thighs were used to examine muscle morphology. The in vivo speed-torque relation for the left and right quadriceps femoris (QF) muscle group was used to measure strength. Fiber type composition and average cross-sectional area were not altered by LLS. The speed-torque relation for the left QF was down-shifted 12% (p < 0.05) after LLS. There was no effect of speed or type of muscle action (eccentric, isometric, or concentric). The speed-torque relation for the right QF showed no change after LLS. Average cross-sectional area of the left QF in eight MR images of the mid-thigh decreased (p < 0.05) 8% with LLS (70 +/- 3 to 64 +/- 4 cm2), while the right QF showed no change (72 +/- 4 to 72 +/- 4 cm2). The hamstring muscle group showed no change in average cross-sectional area after LLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗

PubMed2002

Anterior cruciate ligament reconstruction using four-strand semitendinosus and gracilis tendon grafts and metal interference screw fixation.

PURPOSE: The purpose of this study was to determine the outcome of 200 anterior cruciate ligament (ACL) reconstructions using hamstring tendons. TYPE OF STUDY: This is a case series reporting on 200 endoscopic procedures for reconstruction of the ACL. METHODS: This study included patients over 18 years old with a healthy controlateral knee, intact posterior cruciate ligament, and without any peripheral surgical procedure or cartilage injury. Patients having undergone prior ligament reconstruction were excluded from the study. The minimum follow-up was 1 year. Clinical review allowed for documentation of International Knee Documentation Committee (IKDC), KT-1000 arthrometer laxity measurement, and isokinetic dynamometric analysis. RESULTS: Quadriceps and hamstring muscle strength loss was less than 17%. At review, overall IKDC evaluation found that 50% of patients graded A, 44% graded B, and 6% were C or D. The differential anterior laxity was graded A for 157 patients with a median of 1 mm. Of the 113 high-performance athletes, 98 (86%) had resumed a preinjury level of sporting activity. CONCLUSIONS: Endoscopic reconstruction using 4-strand hamstring autograft may be considered safe, reliable, and reproducible. Preliminary outcome is fulfilling and this technique corresponds completely to therapeutic fields regarding ACL reconstructions.

Adult↗

PubMed1998

Comprehensive nutritional status in patients with long-standing Crohn disease currently in remission.

Malnutrition is observed frequently and is an important complication in patients with Crohn disease (CD). The pathophysiology of malnutrition in this disorder is complex. To obtain a comprehensive picture of nutritional status in patients with long-standing CD that was clinically in remission, we assessed four measures of nutritional status in 32 patients (18 women and 14 men) and 32 matched healthy control subjects: 1) body composition, 2) dietary intake, 3) biochemical indexes of nutrition, and 4) and muscle strength (as a functional index). Mean daily intakes of fiber and phosphorus were significantly lower in CD patients than in control subjects. Serum concentrations of several nutrients (beta-carotene, vitamin C, vitamin E, selenium, and zinc) and activity of the enzyme glutathione peroxidase were also significantly lower in CD patients, as were antioxidant status and serum concentrations of magnesium and vitamin D. Percentage body fat and hamstring muscle strength were significantly lower in male CD patients than in control subjects, whereas muscle strength of the quadriceps was preserved. In conclusion, this study showed a variety of nutritional and functional deficiencies in patients with long-standing CD in remission, especially in male patients with a high lifetime prednisone dose. A comprehensive nutritional assessment seems superior to the assessment of a single dimension of nutritional status.

Adult↗

PubMed2004

Neuromuscular reflexes contribute to knee stiffness during valgus loading.

We have previously shown that abduction angular perturbations applied to the knee consistently elicit reflex responses in knee joint musculature. Although a stabilizing role for such reflexes is widely proposed, there are as of yet no studies quantifying the contribution of these reflex responses to joint stiffness. In this study, we estimate the mechanical contributions of muscle contractions elicited by mechanical excitation of periarticular tissue receptors to medial-lateral knee joint stiffness. We hypothesize that these reflex muscle contractions will significantly increase knee joint stiffness in the adduction/abduction direction and enhance the overall stability of the knee. To assess medial-lateral joint stiffness, we applied an abducting positional deflection to the fully extended knee using a servomotor and recorded the torque response using a six degree-of-freedom load-cell. EMG activity was also recorded in both relaxed and preactivated quadriceps and hamstrings muscles with surface electrodes. A simple, linear, second-order, delayed model was used to describe the knee joint dynamics in the medial/lateral direction. Our data indicate that excitation of reflexes from periarticular tissue afferents results in a significant increase of the joint's adduction-abduction stiffness. Similar to muscle stretch reflex action, which is modulated with background activation, these reflexes also show dependence on muscle activation. The potential significance of this reflex stiffness during functional tasks was also discussed. We conclude that reflex activation of knee muscles is sufficient to enhance joint stabilization in the adduction/abduction direction, where knee medial-lateral loading arises frequently during many activities.

Adult↗

PubMed2005

Efficacy of isokinetic exercise on joint position sense and muscle strength in patellofemoral pain syndrome.

OBJECTIVE: The objective of this study was to demonstrate the impairment of knee joint position sense in individuals with patellofemoral pain syndrome and investigate the effects of isokinetic exercise on knee joint position sense and muscle strength. DESIGN: A total of 24 male patients complaining of anterior knee pain caused by overexertion and 24 male healthy individuals without symptoms were included for this investigation. Isokinetic exercise protocol was carried out at angular velocities of 60 degrees/sec and 180 degrees/sec. These sessions were repeated three times per week and lasted for 6 wks. At the beginning and after 6 wks of knee passive joint position sense, quadriceps and hamstring muscle strength and pain assessments were performed. RESULTS: After the isokinetic exercise, flexion peak torque (P < 0.05), extension peak torque (P < 0.01), flexion total work (P < 0.001), extension total work (P < 0.001), passive reproduction of knee joint position sense for 40 degrees of flexion (P < 0.05) and 50 degrees of extension (P < 0.01), and pain score (P < 0.001) improved significantly in the patellofemoral pain syndrome group. CONCLUSION: Isokinetic exercises have positive effects on passive position sense of knee joints, increasing the muscular strength and work capacity. These findings show that using the present isokinetic exercise in rehabilitation protocols of patients with patellofemoral pain syndrome not only improves the knee joint stabilization but also the proprioceptive acuity.

Adult↗

PubMed2002

Weakness of respiratory and skeletal muscles after a short course of steroids in patients with acute lung rejection.

There have been occasional reports of acute respiratory and skeletal muscle weakness in intensive care unit patients treated with massive doses of corticosteroids. However, in this setting the concomitant use of other drugs may have influenced the finding. In this study the effects of 5 days of treatment with high doses of steroids in consecutive patients with acute lung rejection after transplantation were systematically evaluated. Maximal inspiratory pressure during phrenic nerve stimulation and peak torque of isokinetic contraction of the quadriceps and hamstring muscles were measured objectively. Compared to the pretreatment condition, approximately 45% of patients showed acute generalised muscle weakness that recovered after approximately 2 months. This demonstrates muscle weakness induced by steroids within patients.

Adrenal Cortex Hormones↗

PubMed2003

Effects of environmental cooling on force production in the quadriceps and hamstrings.

The purpose of this study was to determine the effects of environmental cooling on force production in the quadriceps and hamstring muscles. Ten men (mean +/- SD: age = 21.4 +/- 2.2 years, height = 168.5 +/- 35.9 cm, body mass = 78.0 +/- 6.4 kg) participated in this study. Each subject completed 2 sets of 10 maximal effort repetitions on a Cybex II isokinetic dynamometer at 3.14 rad x s(-1). Between sets, subjects sat in environmental temperatures of 20, 15, 10, or 5 degrees C for 40 minutes. A significant decrease (p </= 0.05) was observed in the pre- to postcooling peak torque values at 10 degrees C and 5 degrees C for both quadriceps and hamstrings. A significant decrease (p </= 0.05) was also observed in the pre- to postcooling average torque values for the hamstrings at 10 degrees C and 5 degrees C. A significant increase (p </= 0.05) in the amount of heat loss from the quadriceps and hamstrings occurred as environmental temperatures decreased. Force production of the quadriceps and hamstrings is significantly decreased when the body experiences environmental temperatures at or below 10 degrees C for at least 40 minutes. A significant amount of heat loss also occurred from the quadriceps and hamstrings as environmental temperature decreased. The take-home message is that after a certain period of time exposed to cool ambient temperatures, performance may be decreased and warm-up time will increase.

Adult↗

PubMedDate not supplied

Normal ranges of popliteal angle in children.

Measurement of the popliteal angle is used to assess hamstring contracture in children with cerebral palsy. The popliteal angle in 482 normal children, 1-10 years of age, was measured. Using a 360 degrees goniometer, the popliteal angle was measured with the hip held at 90 degrees flexion to indicate hamstring muscle tightness. Between the ages of 1 and 3 years, the mean angle was 6 degrees (range, 0-15). At age 4, the angle rose to 17 degrees in girls and 27 degrees in boys (range, 5-45). At greater than or equal to 5 years the mean angle was 26 degrees with little change (range, 0-50). A popliteal angle of greater than 50 degrees in the above age groups indicates abnormal hamstring tightness.

Cerebral Palsy↗

PubMed2006

Therapeutic cooling: no effect on hamstring reflexes and knee stability.

PURPOSE: Stretch reflexes contribute to joint stiffness, but the effects of therapeutic cooling on these reflexes are unknown. Therapeutic cooling is frequently used in knee rehabilitation, for instance, after rupture of the anterior cruciate ligament. Cooling a joint can affect nerve conduction velocity and the function of sensory organs. Such changes in neuromuscular coupling could reduce knee stability and increase the risk of knee injury. The aim of the present study was to evaluate whether there are negative effects of knee cooling on the hamstring short and medium latency reflex responses or on the anterior tibia trajectory after mechanically induced tibia translation. METHODS: In 15 healthy volunteers, the latency and size of short latency and medium latency reflex responses of hamstring muscles were assessed before and after 20 min of cold therapy of the knee joint as applied in rehabilitation. Reflex responses were evoked by a mechanically induced posterior-anterior tibia translation during standing. Reflexes were recorded by surface electromyography. The distance of anterior tibia motion and its velocity were assessed by potentiometric position transducer. RESULTS: Local cold therapy of the knee did not alter the latency or the size of short or medium latency responses. Also, the extent and the velocity of tibia translation were unchanged after knee cooling. CONCLUSION: Cold therapy does not seem to adversely influence the spinal reflexes of the hamstrings induced by anterior tibia translation. As neuromuscular coupling was not significantly affected, the cold therapy, as performed in the present study, is not likely to increase the risk of knee injury.

Adult↗

PubMed2006

Contribution of feedback and feedforward strategies to locomotor adaptations.

The aim of this study was to examine the strategies used by human subjects to adapt their walking pattern to a velocity-dependent resistance applied against hip and knee movements. Subjects first walked on a treadmill with their lower limbs strapped to an exoskeletal robotic gait orthosis with no resistance against leg motions (null condition). Afterward, a velocity-dependent resistance was applied against left hip and knee movements (force condition). Catch trials were interspersed throughout the experiment to track the development of adaptive changes in the walking pattern. After 188 steps in the force condition, subjects continued to step in the null condition for another 100 steps (washout period). Leg muscle activity and joint kinematics were recorded and analyzed. The adaptive modifications in the locomotor pattern suggest the involvement of both feedback and feedforward control strategies. Feedback-driven adaptations were reflected in increases in rectus femoris and tibialis anterior activity during swing, which occurred immediately, only in the presence of resistance, and not during the catch trials. Locomotor adaptations involving feedforward strategies were reflected in enhanced pre-swing activity in the biceps femoris and medial hamstrings muscles, which required experience and persisted in the catch trials. During washout subjects showed a gradual deadaptation of locomotor activity to control levels. In summary, adaptive changes in the walking pattern were driven by both feedback and feedforward adjustments in the walking pattern appropriate for overcoming the effects of resistance.

Adaptation, Physiological↗

PubMed2003

Electrical stimulation of human lower extremities enhances energy consumption, carbohydrate oxidation, and whole body glucose uptake.

Our laboratory has recently demonstrated that low-frequency electrical stimulation (ES) of quadriceps muscles alone significantly enhanced glucose disposal rate (GDR) during euglycemic clamp (Hamada T, Sasaki H, Hayashi T, Moritani T, and Nakao K. J Appl Physiol 94: 2107-2112, 2003). The present study is further follow-up to examine the acute metabolic effects of ES to lower extremities compared with voluntary cycle exercise (VE) at identical intensity. In eight male subjects lying in the supine position, both lower leg (tibialis anterior and triceps surae) and thigh (quadriceps and hamstrings) muscles were sequentially stimulated to cocontract in an isometric manner at 20 Hz with a 1-s on-off duty cycle for 20 min. Despite small elevation of oxygen uptake by 7.3 +/- 0.3 ml x kg(-1) x min(-1) during ES, the blood lactate concentration was significantly increased by 3.2 +/- 0.3 mmol/l in initial period (5 min) after the onset of the ES (P < 0.01), whereas VE showed no such changes at identical oxygen uptake (7.5 +/- 0.3 ml x kg(-1) x min(-1)). ES also induced enhanced whole body carbohydrate oxidation as shown by the significantly higher respiratory gas exchange ratio than with VE (P < 0.01). These data indicated increased anaerobic glycolysis by ES. Furthermore, whole body glucose uptake determined by GDR during euglycemic clamp demonstrated a significant increase during and after the cessation of ES for at least 90 min (P < 0.01). This post-ES effect was significantly greater than that of the post-VE period (P < 0.01). These results suggest that ES can substantially enhance energy consumption, carbohydrate oxidation, and whole body glucose uptake at low intensity of exercise. Percutaneous ES may become a therapeutic utility to enhance glucose metabolism in humans.

Adult↗