Kevin Moll1, Alexander Gussew1, and Jürgen R. Reichenbach1
1Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
Synopsis
When performing exercise induced 31P MRS motion
and activities from the everyday life and the positioning of the
investigated extremities within the MR scanner should be considered, since this could
induce partial ischemia effects like muscular cramps. The aim of this study was to prove the effect of muscle tension on metabolic parameter measured by 31P MRS after an intense exercise. PCr recovery as well as pH kinetic was significantly slowed by a partial ischemia preventing a quantitative evaluation.
Purpose
Phosphorous MR spectroscopy (31P MRS) is a powerful
tool to quantify metabolites in skeletal muscle in vivo. It provides information about cellular pH homeostasis
dynamics by analyzing kinetics of pH, phosphocreatine (PCr) and inorganic phosphate
(Pi) during exercise and recovery1. Motion and activities from everyday
life as well as the positioning of the investigated extremities should, however,
be carefully considered, since this could induce partial ischemic effects, like
muscular cramps, due to a higher fiber tension. As a result, assessment of PCr
recovery time constants or pH values may be corrupted and may complicate interpretations
of metabolic conditions. The aim of this study was to prove the effect of two different
pedal positions of an MR compatible ergometer on the kinetics of high-energy metabolites
and acidification after intense exercise of the calf muscle.
Methods
Two
healthy volunteers (age: 23 and 22 years) participated in the study and
performed series of unilateral plantar flexion by pushing the right foot
against the pedal (3 min, 0.6 bar counter pressure, 100 bpm
frequency)2. Both subjects performed two identical runs of this
exercise. In the first run the pedal was unlocked during recovery which enables
the ankle to stretch in a plantar flexion up to 125° relative to the leg. In
the second run the pedal was locked resulting in a neutral position of the
ankle and 90° relative to the leg (Figure 1). 31P MR
spectroscopic (2D FID CSI, TR = 290 ms) data were acquired
during the complete exercise (rest – exercise – recovery).Results
In terms
of applied force both runs were comparable for subject 1 and 2, respectively
(mean force for subject 1: 239 N and 221 N; subject 2: 197 N and
200 N). PCr decreased within 60 s below 20% of its initial level. Releasing
the pedal after the exercise (125° relative to the leg) was associated with
typical PCr (τPCr = 80 s and τPCr = 120 s for subject 1 and 2,
respectively) as well as pH kinetics showing a short decrease immediately after
the exercise due to the PCr synthesis followed by a continuous increase back to
the resting pH value. In contrast, the fixated pedal (90° relative to the leg) led
to calf muscle cramps as reported by the participants after the examination.
This was also reflected by a significantly slower PCr recovery (τPCr = 590 s and τPCr = 1300 s) and constant low pH
values during the post-load phase (see red dots in Figure 2). This pedal position
also inhibited the removal of H+ and thus the acidification was
stable for the whole duration of the recovery.Discussion and Conclusion
These two
extreme cases demonstrate rather significant effects of muscle fiber tension on
tissue perfusion and metabolic processes during recovery after muscular load. As
a result this may lead to restricted blood flow and thus, an inhibited
perfusion by an almost closed system. Since the main H+ washout is
determined by the efflux, pH is not able to recover back to its resting value.
Furthermore, the lack of oxidative ATP synthesis is significantly slowing down the
PCr recovery and is additionally negatively affected by a stable low pH value
in terms of suppressed creatine kinase3. Intense exercises may
increase the tension on the fibers due to the connection between myofilaments4.
With a heterogeneous flexibility of the lower extremities the amount of tension
and thus the extent of the cramp on the calf muscle, is different among subjects.
This hampers the metabolical evaluation or even quantitation of this partial
ischemia and should be avoided in all circumstances.Acknowledgements
This work was supported by the Competence Centre for Interdisciplinary Prevention (KIP) atthe Friedrich Schiller University Jena and the German Professional Association for Statutory AccidentInsurance and Prevention in the Foodstuffs Industry and the Catering Trade (BGN). K.M.is supported by a graduate scholarship of the Friedrich-Schiller-University Jena (Landesgraduiertenstipendium).K.M. also acknowledges support by the German Academic ExchangeService (DAAD) for a short-term international scholarship at the University of Liverpool(57044996). The authors declare to have no relevant financial interests to disclose with regard tothis study.References
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