title: Reduced knee extensor function in heart failure is not explained by inactivity.
abstract: BACKGROUND
  The goal of this study was to determine if heart failure alters knee extensor muscle torque, power production or contractile velocity.
  
  
  METHODS
  Heart failure patients (n=11; 70.4±4.3 yrs) and controls (n=11; 70.3±3.4 yrs) matched for age and sex were evaluated for knee extensor contractile performance under isometric and isokinetic conditions and body composition by dual energy X-ray absorptiometry. Additionally, we recruited sedentary to minimally active elderly controls to match heart failure patients for habitual physical activity and assessed activity levels using accelerometry.
  
  
  RESULTS
  Groups did not differ for total or regional body composition or average daily physical activity level. Despite similar muscle size and use, heart failure patients exhibited 21-29% lower (P<0.05 to P<0.01) isometric knee extensor torque throughout a range of knee angles, 15-33% lower (P=0.05 to P<0.01) peak concentric torque measured at various isokinetic speeds and corresponding reductions (P=0.05 to P<0.01) in peak power output. Expression of peak isokinetic torque data relative to isometric torque eliminated group differences, suggesting that impaired contractile function under dynamic conditions is explained by deficits in the force generating capacity of muscle. No group differences were found in the time required to reach target velocity during isokinetic contractions, an index of contractile velocity.
  
  
  CONCLUSIONS
  Because group differences in muscle torque were independent of age, sex, physical activity level and muscle size, our results suggest that muscle contractile dysfunction in these patients is likely attributable to the heart failure syndrome.
authors.affiliation: Department of Medicine, University of Vermont, College of Medicine Burlington, VT 05405, United States. michael.toth@uvm.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Toth
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Shaw
authors.forename: Mark S
authors.initials: MS
authors.lastname: Miller
authors.forename: Peter
authors.initials: P
authors.lastname: VanBuren
authors.forename: Martin M
authors.initials: MM
authors.lastname: LeWinter
authors.forename: David W
authors.initials: DW
authors.lastname: Maughan
authors.forename: Philip A
authors.initials: PA
authors.lastname: Ades