Journal of Applied Physiology

Background. Cardiopulmonary exercise testing (CPET) is a gold-standard test used to evaluate cardiopulmonary fitness and overall health by measuring physiological responses such as oxygen consumption during exercise. While traditional CPET warm-ups are typically low-intensity aerobic activities, alternative methods like coherence breathing may also prepare the body by influencing autonomic regulation. Breathing-based interventions have shown potential to improve heart rate recovery and performance, and heart rate variability (HRV) serves as a useful non-invasive indicator of autonomic nervous system activity. However, there is limited research on how brief breathing exercises before CPET affect outcomes. This study aims to investigate the effects of coherence breathing on oxygen uptake, HRV, and post-exercise heart rate recovery Objective. This study will aim to compare the acute cardiopulmonary and autonomic responses of coherence breathing versus spontaneous breathing immediately preceding cardiopulmonary exercise testing (CPET) in recreationally active healthy adults. Methods. This study will be a randomized counterbalanced crossover design. Healthy adults aged between 19 and 45 years of age will complete two separate CPETs over two non-consecutive test days (between 48 hours and 7days). During each visit, participants will complete five minutes of slow-paced coherence breathing (6 breaths per minute) or spontaneous breathing at normal breathing rate, followed by an incremental treadmill CPET protocol up to maximal exertion. HRV will be assessed at baseline, during the breathing interventions, and during cool-down for 5 minutes using the Emwave Pro Plus software. Gas exchange during the CPET protocol will be measured continuously using the VO2 Master Pro system. immediately after, and after 5 minutes of resting. The primary outcomes will be peak oxygen consumption and heart rate variability indices. Secondary outcomes will include heart rate recovery, peak heart rate, time to exhaustion, rate of perceived exertion and readiness, blood pressure, tidal volume, peak ventilation, and respiration rate. Analyses will use linear mixed-effects models and paired comparisons. Discussion. This protocol will determine whether pre-exercise coherence breathing can improve cardiopulmonary and autonomic nervous system responses to maximal performance. Findings may have practical implications for exercise testing and performance procedures as well as improving our understanding of pre-exercise breathing strategies for priming the autonomic and cardiopulmonary systems.

ABSTRACT Background: Athletes who return to soccer after anterior cruciate ligament reconstruction (ACLR) remain at elevated risk of secondary injury despite meeting conventional discharge criteria, and neuromuscular deficits in the reconstructed limb are known to be exposed by fatigue. Objective: To determine whether match-play fatigue differentially affects muscle stiffness, countermovement jump (CMJ) force symmetry, and rate of force development (RFD) asymmetry between soccer players with a history of ACLR and uninjured teammates. Methods: A prospective, cross-sectional, matched-control study enrolled 128 competitive soccer players (64 ACLR, 6-22 months post-surgery; 64 uninjured controls) across five recruitment waves (February-June 2026). Bilateral CMJ peak vertical force, jump height, RFD, and myotonometric stiffness of the rectus femoris (RF), vastus medialis (VM), and biceps femoris (BF) were recorded immediately before and after a standardized competitive match. Fatigue was quantified from second-half heart rate (percentage of age-predicted maximum) and end-match rating of perceived exertion (RPE). Within-group pre-to-post changes were evaluated with paired t-tests, between-group differences in the magnitude of change with independent-samples t-tests, and associations between fatigue indices and asymmetry changes with Pearson correlations. Results: Match play reduced CMJ limb symmetry index (LSI) in both groups, but the decline was more than three-fold greater in the ACLR group, 92.6% (SD 5.4%) to 85.1% (SD 7.1%), than in control group, 97.3% (SD 3.9%) to 95.0% (SD 4.2%), group-by-time difference, p < 0.001, (d = 0.64). RFD asymmetry approximately doubled in the ACLR group, 10.6% (SD 4.1%) to 17.6% (SD 6.5%), compared with a smaller rise in control group, 4.6% (SD 2.4%) to 6.3% (SD 3.7%); p < 0.001, d = 0.77). Involved-limb stiffness losses in the ACLR group exceeded those of controls for the RF (-21.2 vs. -9.2 N/m, p < 0.001), VM (-17.7 vs. -6.1 N/m, p < 0.001), and BF (-13.3 vs. -6.6 N/m, p < 0.001), whereas uninvolved-limb stiffness losses did not differ between groups (all p > 0.05). Fatigue markers (heart rate, RPE) were not significantly correlated with the magnitude of individual asymmetry change (|r| [&le;] 0.18, p > 0.15). Conclusions: In competitive soccer players 6-22 months after ACLR, match-play fatigue selectively compromises stiffness and explosive force output of the reconstructed limb, widening inter-limb asymmetries beyond what is seen in uninjured teammates, even though global cardiovascular and perceptual fatigue were comparable between groups. These findings suggest that return-to-sport testing performed only in a rested state may underestimate residual neuromuscular deficits, and support fatigue-inclusive assessment protocols before athletes are cleared for unrestricted competition. Abbreviations: ACL: anterior cruciate ligament, ACLR: anterior cruciate ligament reconstruction, BF: biceps femoris, CMJ: countermovement jump, HRmax: maximum heart rate, LSI: limb symmetry index, RF: rectus femoris, RFD: rate of force development, RPE: rating of perceived exertion, RTS: return to sport, VM: vastus medialis, SD: standard deviation. Keywords: Anterior cruciate ligament reconstruction, muscle fatigue, muscle stiffness, countermovement jump, limb symmetry index, rate of force development, soccer, return to sport.

Intense unilateral muscle contractions evoke measurable activity within the contralateral neuroaxis, which can be detected with surface electromyographic activity in the resting homologous muscle. Physiological mirror activity (PMA), the unintentional increase in contralateral muscle excitation, has been implicated in cross-limb interactions and adaptations. Despite longstanding observations of PMA, it remains unknown whether this low-level muscle excitation influences local muscle metabolism. We addressed this question using a vascular occlusion test in 10 healthy adults. Surface electromyography and near-infrared spectroscopy-derived measures of tissue oxygen saturation and muscle oxygen consumption (mVO2) were obtained from the resting left forearm during vascular occlusion at rest and during fatiguing unimanual contractions of the right hand. PMA in the contralateral resting arm was greater during unimanual fatigue than during rest (mean difference: 8.9%AA, 95% CI: 4.1 to 13.8; p = 0.002, g = 1.20). This increase was accompanied by a steeper rate of tissue oxygen desaturation (mean difference: -0.132 %{middle dot}s-1, 95% CI: -0.227 to -0.037; p = 0.012, g = -0.91) and greater mVO2 (mean difference: 0.188 mL O2{middle dot}min-1{middle dot}100 g-1, 95% CI: 0.057 to 0.320; p = 0.010, g = 0.94). Greater PMA was associated with both a faster rate of oxygen desaturation (r = -0.85, 95% CI: -0.96 to -0.46, p = 0.002) and greater mVO2 (r = 0.78, 95% CI: 0.28 to 0.94, p = 0.008). These findings suggest that PMA is accompanied by increased local metabolic demand, consistent with a coupling between unintentional muscle excitation and oxygen extraction in the resting limb.

Mammalian lungs operate within a thoracic cage composed of parietal pleura, rib cage, skeletal muscle, and diaphragm, yet clinical ventilator metrics largely reflect the combined mechanics of lung and surrounding structures and the thoracic cage. We hypothesized that thoracic boundary conditions selectively alter measured lung biomechanics. We performed paired pulmonary function testing (FlexiVent) in C57BL6 mice of both sexes spanning development through adulthood, measuring quasi-static pressure-volume behavior and dynamic forced-oscillation parameters in vivo (supine, mechanically ventilated) and again ex vivo in the same lungs. In a subset, we additionally compared in vivo and ex vivo microCT-derived lung volumes, including a pressure-fixed ex vivo protocol using snap freezing at controlled inflation pressure. Quasi-static pressure-volume curves were similar between conditions, with near-identity at higher pressures and only modest divergence at low pressures, consistent with thoracic structures primarily modulating recruitment/de-recruitment rather than intrinsic elastic recoil. Maximal volume at 30 cmH2O showed strong in vivo-ex vivo correlation and minimal bias, and static compliance and PV-loop hysteresis exhibited small biases relative to reported disease-model effect sizes. In contrast, dynamic mechanics demonstrated a clear in vivo elevation of tissue damping (G) with only modest change in tissue elastance (H) and little change in Newtonian resistance (Rn), producing a meaningful increase in hysteresivity (G/H). This dissociation implicates frequency-dependent mechanical heterogeneity (time-constant mismatch/pendelluft) imposed or amplified by nonuniform thoracic loading. Ex vivo microCT enabled reliable whole-lung segmentation and correlated with ex vivo PFT volumes at matched pressures, whereas in vivo volumetry showed weaker agreement. These results indicate that thoracic structures contribute modest restriction but disproportionately increase dynamic dissipation and heterogeneity, suggesting that ex vivo functional testing and oscillometry-like metrics may better detect biomechanical changes inherent to lung parenchyma.

Background: Automatic tube compensation (ATC) was designed to compensate for the additional resistive load imposed by the endotracheal tube during spontaneous breathing. In ATC mode, the ventilator adds or subtracts the flow-dependent pressure drop across the tube during both inspiration and expiration so that tracheal pressure remains close to PEEP. Early prototype ventilators achieved true tracheal-pressure control and showed physiological and clinical benefits, but clinical studies with commercial systems have failed to confirm these earlier findings. A 2003 bench study found that commercial ventilators provided, at best, only partial tube compensation, unlikely to result in meaningful clinical benefit. We therefore tested whether this limitation has been remedied in contemporary ICU ventilators. Methods: We performed a bench comparison of five commercial ICU ventilators and an ATC prototype ventilator designed to accurately compensate for the flow-dependent resistance over a wide range of flow rates. An active lung simulator generated spontaneous breathing patterns with weak, moderate, and strong inspiratory efforts at different PEEP levels. We tested each breathing pattern through endotracheal tubes with inner diameters of 7 and 8 mm, and measured airway pressure, tracheal pressure, and flow during CPAP with and without ATC. Breathing through the tube against open atmosphere served as a zero-PEEP/T-piece reference. Results: In CPAP mode, the commercial ventilators showed flow-dependent airway-pressure deviations, amounting to a substantial added resistance of 1.5 - 6.5 mbar/(L/s), whereas the ATC prototype ventilator imposed an added resistance of only 0.6 mbar/(L/s). In ATC mode, the commercial ventilators reduced the resistive load by no more than by 25%, and large tracheal-pressure deviations remained, especially at higher inspiratory effort and during expiration. In some cases, the residual load during ATC was even greater than the load during unsupported breathing through the tube. By contrast, the ATC prototype ventilator maintained tracheal pressure close to PEEP throughout the breathing cycle and eliminated on average 79% of the tube-related resistive load. Conclusions: In the commercial ventilators evaluated in this study, the defining physiological objective of ATC was only partially achieved. Therefore, clinical benefits previously reported for tracheal-pressure control support should be interpreted with caution when applied to commercial ATC implementations, unless effective tube compensation has been demonstrated under relevant conditions. These findings suggest that more advanced control approaches, such as those implemented in the ATC prototype ventilator, may be required to achieve consistent and physiologically accurate tube compensation.

Skeletal muscles secrete a variety of cytokines in response to inflammatory stimuli such as lipopolysaccharide (LPS); however, the contributions of resident macrophages or other non-muscle cells to the secretory responses are not well understood. To determine the potential impact of resident macrophages to inflammatory cytokine production, we tested the LPS responsiveness of isolated mouse soleus muscle when a critical toll receptor adapter protein (Myd88) was knocked down only in myeloid-derived cells within the muscle (e.g. resident macrophages). The phenotype is referred to as LyzMyd88-/- ; the litter mate controls were Myd88fl/fl. In solei from LyzMyd88-/- mice, cytokine secretory rates for interleukin-6 (IL-6) and keratinocyte-derived cytokine (KC, CXCL1) were significantly reduced to 56.3%, and 60.6% of control, respectively, over the first hour of LPS exposure. In the second hour, secretion of granulocyte colony stimulating factor (G-CSF), IL-6, KC(CXCL1) and monocyte chemoattractant protein-1 (MCP-1, CCL2) were greatly elevated by 5-10-fold in both phenotypes compared to the first hour. However, only MCP-1 secretion was decreased to 70.6% of control in the second hour. We also tested the secretory response to buffer containing 1% sterile mouse plasma because dilute plasma is known to amplify the responses of macrophages to LPS. Treatment with 1% plasma alone affected baseline measures of some cytokines but resulted in no further increases in secretion during either hour of exposure. However, small and gradual increases in secretory rates were observed for several cytokines over the study period, with or without plasma, with the largest responses seen in IL-6 and KC. Overall, the results are consistent with a significant early contribution of myeloid-derived, resident immune cells to the cytokine secretory responses of intact oxidative skeletal muscle. In addition, small quantities of plasma in the buffer have no independent stimulatory effects on cytokine secretion

Muscle force sharing during locomotion is influenced by the mechanical demands of movement and the contractile properties of synergistic muscles. In cats, plantarflexor muscles exhibit distinct functional specialization, with the slow-fibred soleus maintaining relatively constant force across conditions while faster muscles such as the plantaris and gastrocnemius increase force production with increasing locomotor demand. However, it remains unclear whether similar force-sharing patterns occur in larger animals with different musculoskeletal designs. Therefore, the purpose of this study was to examine force sharing between the superficial digital flexor (SDF) and medial gastrocnemius (MG) muscles during treadmill locomotion in sheep. Tendon buckle force transducers were surgically implanted on the SDF and MG tendons of seven sheep, and in vivo muscle forces were recorded during walking and trotting across different speeds and inclines. Both muscles increased force with increasing speed and incline; however, speed had a substantially greater effect than incline. The SDF consistently produced greater absolute force than the MG across all conditions, whereas the MG exhibited slightly larger relative increases in force with increasing speed. Time to peak force decreased with increasing speed in both muscles, although the SDF reached peak force later in stance than the MG across conditions. In contrast to the distinct specialization observed in cats, neither muscle displayed a relatively condition-independent, soleus-like force contribution. These findings suggest that force sharing in sheep is more distributed across synergistic muscles and may reflect the influence of musculoskeletal design, tendon compliance, and mixed fibre-type composition on muscle function in larger species.

Pedalling cadence during an acute eccentric cycling exercise altered physiological and perceptual responses. We examined the influence of cycling cadence on neuromuscular adaptation induced by a 6-week eccentric cycling training period. Eighteen participants performed training (eighteen sessions) at a cadence of 30 or 60 rpm over six weeks. Power output was the same between the two groups. Perceived effort and heart rate were recorded at each training session. Muscle pain and fatigue were reported the day after each session. Maximal voluntary contractions torque, as well as concentric and eccentric cycling efficiency, were assessed before and after training. Additionally, the loss of maximal voluntary isometric torque was assessed after the first and last training sessions. Heart rate and perceived effort increased in the second week of training and then plateaued, with no difference between groups. Muscle pain and fatigue remained low throughout the training, with no difference between groups. Isometric (+28%) and eccentric (+13%) maximal voluntary torque of knee extensor muscles increased regardless of training cadence. Concentric maximal voluntary torque increased for the group pedalling at 60 rpm only (+21%). Cycling efficiency was improved in eccentric mode only (+43%), with no difference between the two training groups. Finally, the voluntary isometric torque loss induced by the first and last sessions were similar. While six weeks of eccentric cycling training improved neuromuscular and functional capacities, cadence had no observable effect. This finding suggest that patients could choose their preferred cadence to obtain better adherence to the rehabilitation program without altering the adaptations.

Fascicle operating length during dynamic tasks is often compared to the isometric torque-length relationship, but there is a lack of evidence regarding the influence of joint velocity on optimal fascicle length. Moreover, there is no consensus in the literature regarding the influence of contraction initiation (pre-activation or passive start), although it could alter the interaction between fascicles and the tendon. This study aimed to investigate the effect of joint velocity and pre-activation on the torque-angle and torque-length relationships of the vastus lateralis during mono-articular isokinetic knee extensions. Twenty-one participants performed isometric, isokinetic (50{degrees}.s-1 to 450{degrees}.s-1), and isokinetic knee extensions with maximal isometric or eccentric pre-activation at 100{degrees}.s-1 and 300{degrees}.s-1. Torque, joint angle, fascicle length, and electromyographic activity of the quadriceps femoris muscles were recorded during contractions and then used to model the torque-angle and torque-length relationships. We were able to successfully fit the torque-angle and torque-length relationships (R{superscript 2}=0.93 and R{superscript 2}=0.92, respectively). A main effect of velocity was detected regarding the optimal angle (p<0.05), but no significant change was observed for the optimal fascicle length. Isometric pre-activation induced a reduction in maximal torque production compared with eccentric pre-activation and passive conditions at both isokinetic velocities (p<0.001), with no change in muscle activity. Our results suggest that muscle-tendon interactions may permit a dissimilar behavior between the torque-angle and the torque-fascicle length relationships. The reduction in torque following isometric pre-activation may be related to a contraction history-dependent phenomenon. NEW & NOTEWORTHYWe demonstrated that, at a given joint angle, increasing velocity altered fascicle operating length without shifting optimal fascicle length, likely because of muscle-tendon interactions. We also showed that maximal isometric pre-activation before a concentric contraction reduced mean and maximal torque during the isokinetic phase compared with eccentric pre-activation or no pre-activation. This effect may be linked to contraction history, since muscle activity did not differ between conditions.

ObjectiveReliable animal models of tracheal stenosis are necessary for the development and translational testing of anti-fibrotic and regenerative therapies, but existing rabbit models frequently demonstrate substantial variability in stenosis severity, which limits their translational utility. The objective of our study was to determine whether airway diameter-matched mechanical injury improves the severity and reproducibility of experimental tracheal stenosis in a rabbit model, and to evaluate whether rabbit body weight is a reliable surrogate for tracheal luminal diameter during model creation. MethodsFourteen male New Zealand White rabbits (weight range, 2.7-3.5 kg) underwent tracheal injury using steel-bristle brushes introduced through a tracheotomy. Animals were assigned to receive either airway diameter-matched injury, in which brush size was selected to closely approximate the directly measured tracheal lumen diameter, or non-matched injury, in which brush size was selected without regard to measured lumen diameter. At postoperative day 21 (POD21), the injured tracheal segment and a native uninjured segment from the same animal were harvested and compared. Stenosis degree was quantified grossly, and lamina propria-to-cartilage (LP:C) ratio was quantified histologically by three blinded reviewers. The relationship between rabbit weight and airway diameter was assessed, and inter-rater reliability was calculated using the intraclass correlation coefficient (ICC). ResultsTwelve of fourteen rabbits reached the POD21 endpoint; two were euthanized early for severe airway compromise meeting humane endpoint criteria, both with approximately 80% stenosis. Injured tracheas demonstrated significantly greater stenosis than native controls (66.0 {+/-} 13.0% vs 16.0 {+/-} 2.7%; p = 0.00012), with a corresponding increase in LP:C ratio (p = 0.031). Airway diameter-matched injury produced significantly greater stenosis than non-matched injury (74.6 {+/-} 6.1% vs 50.6 {+/-} 4.0%; p = 0.001), while LP:C ratio did not differ between injury techniques (p = 1.0). Rabbit weight did not correlate with airway diameter (r = 0.176, p = 0.515; R2 = 0.031). Inter-rater reliability was excellent for both stenosis degree (ICC = 0.989) and LP:C ratio (ICC = 0.992). ConclusionsDirect measurement and matching of injury instrument diameter to native airway diameter substantially improves both the severity and the reproducibility of stenosis in a rabbit tracheal injury model, whereas body weight is an unreliable surrogate for airway size. This optimized, standardized protocol offers a reproducible platform for future translational studies of airway fibrosis and anti-fibrotic or regenerative therapies.

Advanced footwear technology (AFT) has transformed competitive running, yet individual and sex-specific responses to different AFT models remain unclear, particularly near race pace. This study examined running economy (RE) and gait biomechanics in response to three top-tier AFT models (Shoe A: adidas Pro Evo 2; Shoe B: Nike Alphafly 3; Shoe C: On CloudBoom Strike 2) in 14 male and 12 female well-trained runners at sex-specific submaximal speeds (16 and 14 km{middle dot}h-{superscript 1}). RE, spatiotemporal, and joint kinematic/kinetic data were collected via indirect calorimetry, accelerometry, and three-dimensional motion capture with force platforms. RE was significantly lower in Shoe C than Shoe A (males: 2.1%; females: 1.4%) and Shoe B (males: 1.9%; females: 0.9%), with 73% of runners responding favourably to Shoe C, a more consistent response than previously reported. Despite being lightest, Shoe A produced the poorest RE, challenging conventional mass-economy assumptions. Biomechanically, Shoe C elicited greater impact magnitude, lower ankle quasi-stiffness, and greater ankle angular velocity during early stance. Female runners showed smaller RE improvements, potentially related to lower running velocity and body mass limiting midsole engagement. The most efficient AFT enabled these well-trained runners to be more spring-like through tolerating higher forces and faster angular velocities without greater demand on metabolic cost.

Older adults sustain disproportionately severe injuries from trip-induced falls during obstacle crossing. Such falls depend partly on forward momentum when the foot crosses the obstacle. MOSAP, an index of passive dynamic gait stability, reflects this momentum. We quantified MOSAP and a synergy index from uncontrolled manifold analysis of step length and extrapolated center of mass in 25 young (21.6 {+/-} 3.5 yr) and 23 older adults (68 {+/-} 4.3 yr) during unobstructed and obstructed walking, to test whether MOSAP increases during obstacle crossing and whether it is actively stabilized at each step. Both groups increased MOSAP progressively over two approach steps by reducing forward momentum and shifting the center of mass posteriorly. Older adults showed greater increases at the crossing steps. The synergy index was positive for all steps, showing that deviations in step length and extrapolated center of mass covaried to stabilize MOSAP at step-specific values. The synergy index was not influenced by age. We conclude that adults actively recruit passive body mechanics while approaching and crossing obstacles to reduce the risk of a trip becoming a fall. Older adults amplify this strategy to compensate for diminished neuromuscular corrective capabilities.

Energy expenditure (EE) during running depends on the interplay between active muscle work and elastic energy storage and return, yet the relative contribution of mechanical power to EE remains debated. Quantifying the relative contributions of segment-level mechanical power can provide a way to address this debate. In this study, we aimed to quantify how segment-level mechanical power contributes to EE during running and to demonstrate that these mechanistic insights support wearable-based EE estimation. Joint dynamics and respiratory gas-based EE were collected from healthy young adults running at multiple speeds. Scale factors were derived to quantitatively link efficiency-weighted segment power to measured EE. The stance leg consistently showed the strongest correlation with EE, and this dominance was preserved across speeds. Including swing-leg hip power further improved accuracy. Scale factors were approximately 0.45, suggesting that active muscle work and elastic energy return contribute comparably to the mechanical power associated with EE. Using a lightweight machine learning model, stance-leg and swing-leg hip joint power were reconstructed from a single sacral IMU, enabling accurate EE prediction. These findings demonstrate that lower-limb mechanical power is a robust predictor of running EE, supporting both the extensibility of biomechanically-informed frameworks and wearable-based EE monitoring.

The carotid body (CB) is the key peripheral oxygen sensor. CB mitochondria are hypothesised to be uniquely adapted with unusually low intrinsic oxygen affinity which, in association with nitric oxide (NO) and reactive oxygen species signalling, enables acute responsiveness to hypoxia. However, CB mitochondrial physiology or intrinsic oxygen affinity have never been measured directly. We sought to address this key gap by isolating sheep CB mitochondria and comprehensively characterising their phenotype and contrasting them to a non-oxygen sensing tissue, left ventricular myocardium (LV). High resolution respirometry, liquid chromatography mass spectrometry, enzymatic assays and in silico modelling were used to characterise mitochondrial content, aerobic capacity, oxygen affinity, complex subunit abundance and activity, H2O2 production and NO sensitivity in ovine CB and LV. Mitochondrial oxygen affinity (P50 = 0.089 mmHg) was lower in the CB than the LV (P50 = 0.058 mmHg; p = 0.005). Whilst mitochondrial content was lower in the CB, CB mitochondria had higher respiratory rates and enzymatic activity than LV. H2O2 production and NO sensitivity were similar in the two tissues. While intrinsic mitochondrial oxygen affinity is slightly lower in the oxygen sensing CB than in the non-oxygen sensing LV, this difference is small. Hence, any role of mitochondria in CB oxygen sensing is not due to an intrinsic difference in the O2 affinity of cytochrome oxidase due to differential expression of its subunits. Instead, this work suggests that differences in O2 affinity in vivo are secondary to other factors, perhaps including NO, that alter mitochondrial O2 affinity.

This study examined how tempo, dynamics, and string influence upper-extremity physical exposure in professional violinists and how exposure variability is distributed among musical characteristics, between-subject differences, and residual variability. Twelve violinists performed seven standardized scales while bilateral upper-arm and wrist kinematics and shoulder and forearm muscle activity were recorded. Linear mixed-effects models showed that faster tempo increased right upper-arm velocity and bilateral forearm activity while reducing right upper-arm and wrist ranges of motion. Louder dynamics increased bilateral forearm and right trapezius activity and right-wrist ranges of motion. Higher-posture strings increased right upper-arm elevation and right shoulder muscle activity. Variance analysis identified exposures predominantly related to musical characteristics, jointly related to musical characteristics and between-subject differences, predominantly related to between-subject differences, or mainly unexplained. These findings support future exposure prediction from musical characteristics and targeted prevention through repertoire-based workload management, structured recovery, and individualized technique-focused strategies.

Predictions of skeletal muscle energy consumption under a diverse range of muscle contractile conditions are critical for improving our understanding of locomotion. Existing mathematical models, while capturing the mechanical dependence of energy consuming processes, neglect the time-dependent behaviour and recovery costs associated with regenerating ATP. This time-dependence is important for predicting the energetic response of muscles during repetitive or cyclical tasks like locomotion, where muscle undergoes many contraction cycles. This study presents a novel model to predict energetic rates based on physiological processes: Ca2+ transport costs, cross-bridge cycling costs, and ATP regeneration. Previous mathematical models include the dependence on Ca2+ transport and cross-bridge cycling, but neglect the time-dependent response and the subsequent recovery of ATP following the contraction. Model parameters were obtained from existing data on isolated muscle preparations, and predicted energetic rates were validated on separate datasets across a range of contractile conditions including dynamic, sub-maximal, and twitch contractions. The time-dependent model was able to capture the influence of contraction frequency on peak energetic rates and the time-course of energetic recovery observed experimentally. The model captures key physiological processes while maintaining a minimal number of free parameters and low computational cost. This enables generalisability across muscles and species, and implementation into larger scale musculoskeletal models.

Skeletal muscle is a living, perfused soft tissue whose viscoelastic behavior is shaped by both voluntary contraction and hemodynamic state. However, the independent and superimposed contributions of contractile loading and blood flow restriction (BFR) have not been quantified simultaneously in real time. Twenty-six healthy adults underwent multi-frequency ultrasound time-harmonic elastography (THE, 60-80 Hz) of the vastus lateralis under six conditions: rest, 15% and 30% maximal voluntary contraction (MVC) before BFR, passive BFR after 4 min of cuff inflation, and 15% and 30% MVC shortly after cuff release. Shear wave speed (SWS), reflecting elasticity, and penetration rate (PR), reflecting inverse viscous damping, were extracted using the k-MDEV inversion algorithm. BFR significantly elevated SWS at all three contraction levels relative to the corresponding pre-BFR measurements (Holm-corrected p [&le;] 0.011; dz = 0.54-2.13). PR decreased during resting BFR (dz = 1.34, p < 0.001) and at 15% MVC after cuff release (dz = 0.94, p < 0.001), but not at 30% MVC (dz = 0.21, p = 0.294). BFR-related changes reduced the SWS-force slope by 14.5% and the PR-force slope by 40.7%. Men exhibited a greater BFR-induced increase in resting SWS than women. These findings show that THE can distinguish contractile and hemodynamic contributions to skeletal-muscle viscoelasticity and provide complementary information on elastic and dissipative tissue behavior in vivo.

Resistance training lasting a few weeks increases maximal force mainly through neural adaptations that enhance the drive from the nervous system to muscle. While these adaptations have been well documented at the motor unit (MU) level during submaximal force contractions, the mechanisms underlying force increases during maximal voluntary contractions are poorly understood. This is due to a classic technical limitation in tracking MUs longitudinally during maximal force tasks. Here, we solved this technical challenge, enabling the investigation of MU adaptations during MVCs in both the trained and untrained limbs following unilateral resistance training. High-density surface electromyography was recorded from the biceps brachii of both limbs before and after a 4-week unilateral resistance-training intervention, and the same MUs were longitudinally tracked across sessions during MVCs by concatenation of three MVC trials of ~5-s each.Unilateral training increased maximal force in the trained limb (+16%) and induced strength transfer to the untrained limb (+8%). In both limbs, maximal contractions after training were characterized by greater EMG amplitude, faster muscle-fiber conduction velocity, and higher MU discharge rates, indicating enhanced neural drive to the motoneuron pool. These adaptations were strongly associated with improvements in maximal force (R2 > 0.7 for all). Importantly, longitudinal MU tracking revealed a non-uniform adaptation across the MU pool: MUs with higher baseline conduction velocity, indicative of higher recruitment threshold, exhibited the largest pre-post increases in discharge rate, whereas lower-threshold units showed smaller changes. Collectively, these findings demonstrate that gains in maximal force and their transfer to the untrained limb are primarily mediated by enhanced rate coding of higher-threshold MUs during MVCs.

Tricuspid valve regurgitation is a frequent valve lesion and, if severe, an independent predictor of mortality. In most patients, the valve itself has historically been considered intact. Yet, we have previously shown that the valve may not be an innocent bystander. In multiple sheep models, we have shown that the tricuspid valve thickens and stiffens. This remodeling may contribute to valve disease. Our goal is to extend our investigation of tricuspid valve remodeling to a rodent model, potentially opening scientific opportunity and enabling scaling our studies. To this end, we used pulmonary artery banding (PAB) in male rats to induce pressure overload and right ventricular remodeling. After excising the tricuspid valve, we quantified anterior leaflet morphology, mapped anterior leaflet thickness using optical coherence tomography, and evaluated anterior leaflet belly mechanics using a custom bulge testing system. Compared with SHAM controls, PAB increased anterior leaflet area. Moreover, anterior leaflets in PAB animals exhibited region-specific thickening, with the largest increases near the annulus. Finally, anterior leaflets in PAB animals were significantly less compliant. However, leaflet stiffening stemmed from aforementioned thickening, i.e., structural stiffening, not constitutive stiffening. Our findings demonstrate that we can reliably quantify leaflet area, thickness, and stiffness in the minuscule tricuspid valves of rats. We also show that tricuspid valve remodeling is not ovine-specific, but also affects the tricuspid valves of rats. Together, our findings support our hypothesis that tricuspid valves are not innocent bystanders in regurgitation, and that rats may serve as a scalable model system for future investigations. NEW & NOTEWORTHYUsing a rat pulmonary artery banding model of pulmonary hypertension, we show that chronic right ventricular pressure overload induces leaflet enlargement and region-specific thickness remodeling of the tricuspid valve. Although structural mechanical metrics change under pressure loading, normalization by thickness reveals that geometric remodeling rather than intrinsic material stiffening predominates. These findings highlight leaflet structural (mal)adaptation as a potential contributor to functional tricuspid regurgitation and underscore the importance of considering leaflet geometry in therapeutic strategies.

Background. Maximal oxygen uptake (VO2max) is a leading marker of cardiorespiratory fitness and a strong predictor of all-cause mortality. Cardiopulmonary exercise testing (CPET) is the reference method but is resource-intensive, so consumer wearables estimate VO2max from passively collected signals; these estimates compress the fitness range, returning near-correct group averages while ranking individuals poorly. No peer-reviewed validation of a smart-ring VO2max estimate against CPET has been reported, and none in a South Asian cohort. Objective. To validate the Ultrahuman Ring AIR VO2max estimate against laboratory CPET, benchmark it against published prediction equations, and assess its generalization and construct validity. Methods. In a single-site paired ring-CPET cohort (N = 101; mean CPET peak VO2 43.3 mL{middle dot}kg-{superscript 1}{middle dot}min-{superscript 1}, SD 9.9), peak oxygen uptake was measured by treadmill or cycle-ergometer CPET, and the Ultrahuman Ring AIR estimate was computed from passively collected signals using a transparent ensemble based on published equations. Ensemble weights and calibration were selected on an 85-subject development set by an automated search minimizing a composite 5-fold cross-validated error criterion; the locked estimate was evaluated on a 16-subject held-out test set. The calibrated coefficients are proprietary. Agreement was quantified with mean absolute error (MAE), bias, Pearson r, regression slope and Lin's concordance correlation coefficient (CCC; bootstrap 95% CIs), and Bland-Altman limits of agreement. Separately, in 181,133 de-identified Ring users (no CPET reference), construct validity was assessed against ring-measured sleep, continuous glucose monitoring (n = 2,597), and a venous blood panel (n up to 15,203), adjusted for age, sex, and BMI, with lipoprotein(a) as a pre-specified negative control. Reporting followed TRIPOD and STARD. Results. With a self-reported fitness level provided, the estimate agreed with CPET peak VO2 at MAE 4.68 mL{middle dot}kg-{superscript 1}{middle dot}min-{superscript 1} (95% CI 3.93 to 5.49), Pearson r 0.79, CCC 0.79, and slope 0.71. The five published equations were worse on every metric (MAE 6.2 to 10.6, CCC 0.28 to 0.56, slope 0.32 to 0.42), each compressing the fitness range. On the held-out test set (n = 16), agreement held (r 0.84, slope 0.81, MAE essentially unchanged). Without the fitness input, full-cohort MAE was 5.16, still ahead of every published equation. At population scale, higher estimated fitness tracked a healthier profile on measurements the estimate does not use: better ring-measured sleep; higher continuous-glucose time in target range (79.6% versus 61.5%, top versus bottom decile; n = 222 and 399 of 2,597 users); and lower triglycerides, fasting glucose, and HOMA-IR (n up to 15,203 assayed per marker). These associations held after adjustment for age, sex, and BMI, whereas the pre-specified negative control lipoprotein(a) did not separate the deciles. Conclusions. The Ultrahuman Ring AIR VO2max estimate agreed with laboratory CPET substantially better than published prediction equations, held its agreement on held-out subjects, and ordered a large population along independent cardiometabolic gradients consistent with true fitness.