title: Effects of electrical stimulation parameters on fatigue in skeletal muscle.
abstract: METHODS
  Experimental laboratory study.
  
  
  OBJECTIVE
  The primary purpose was to investigate the independent effects of current amplitude, pulse duration, and current frequency on muscle fatigue during neuromuscular electrical stimulation (NMES). A second purpose was to determine if the ratio of the evoked torque to the activated area could explain muscle fatigue.
  
  
  BACKGROUND
  Parameters of NMES have been shown to differently affect the evoked torque and the activated area. The efficacy of NMES is limited by the rapid onset of muscle fatigue.
  
  
  METHODS
  Seven healthy participants underwent 4 NMES protocols that were randomly applied to the knee extensor muscle group. The NMES protocols were as follows: standard protocol (Std), defined as 100-Hz, 450-micros pulses and amplitude set to evoke 75% of maximal voluntary isometric torque (MVIT); short pulse duration protocol (SP), defined as 100-Hz, 150-micros pulses and amplitude set to evoke 75% of MVIT; low-frequency protocol (LF), defined as 25-Hz, 450-micros pulses and amplitude set to evoke 75% of MVIT; and low-amplitude protocol (LA), defined as 100-Hz, 450-micros pulses and amplitude set to evoke 45% of MVIT. The peak torque was measured at the start and at the end of the 4 protocols, and percent fatigue was calculated. The outcomes of the 4 NMES protocols on the initial peak torque and activated cross-sectional area were recalculated from a companion study to measure torque per active area.
  
  
  RESULTS
  Decreasing frequency from 100 to 25 Hz decreased fatigue from 76% to 39%. Decreasing the amplitude and pulse duration resulted in no change of muscle fatigue. Torque per active area accounted for 57% of the variability in percent fatigue between Std and LF protocols.
  
  
  CONCLUSIONS
  Altering the amplitude of the current and pulse duration does not appear to influence the percent fatigue in NMES. Lowering the stimulation frequency results in less fatigue, by possibly reducing the evoked torque relative to the activated muscle area.
authors.affiliation: Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA. ashraf.gorgey@va.gov
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Gorgey
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Black
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Elder
authors.forename: Gary A
authors.initials: GA
authors.lastname: Dudley
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007717:Knee; D008297:Male; D009119:Muscle Contraction / Q000502:physiology*; D018763:Muscle Fatigue / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011999:Recruitment, Neurophysiological; D015203:Reproducibility of Results; D055815:Young Adult