Muscle Oximetry in Sports Science: An Updated Systematic Review.

BACKGROUND: In the last 5 years since our last systematic review, a significant number of articles have been published on the technical aspects of muscle near-infrared spectroscopy (NIRS), the interpretation of the signals and the benefits of using the NIRS technique to measure the physiological status of muscles and to determine the workload of working muscles. OBJECTIVES: Considering the consistent number of studies on the application of muscle oximetry in sports science published over the last 5 years, the objectives of this updated systematic review were to highlight the applications of muscle oximetry in the assessment of skeletal muscle oxidative performance in sports activities and to emphasize how this technology has been applied to exercise and training over the last 5 years. In addition, some recent instrumental developments will be briefly summarized. METHODS: Preferred Reporting Items for Systematic Reviews guidelines were followed in a systematic fashion to search, appraise and synthesize existing literature on this topic. Electronic databases such as Scopus, MEDLINE/PubMed and SPORTDiscus were searched from March 2017 up to March 2023. Potential inclusions were screened against eligibility criteria relating to recreationally trained to elite athletes, with or without training programmes, who must have assessed physiological variables monitored by commercial oximeters or NIRS instrumentation. RESULTS: Of the identified records, 191 studies regrouping 3435 participants, met the eligibility criteria. This systematic review highlighted a number of key findings in 37 domains of sport activities. Overall, NIRS information can be used as a meaningful marker of skeletal muscle oxidative capacity and can become one of the primary monitoring tools in practice in conjunction with, or in comparison with, heart rate or mechanical power indices in diverse exercise contexts and across different types of training and interventions. CONCLUSIONS: Although the feasibility and success of the use of muscle oximetry in sports science is well documented, there is still a need for further instrumental development to overcome current instrumental limitations. Longitudinal studies are urgently needed to strengthen the benefits of using muscle oximetry in sports science.

Facilitating or disturbing? An investigation about the effects of auditory frequencies on prefrontal cortex activation and postural sway.

Auditory stimulation activates brain areas associated with higher cognitive processes, like the prefrontal cortex (PFC), and plays a role in postural control regulation. However, the effects of specific frequency stimuli on upright posture maintenance and PFC activation patterns remain unknown. Therefore, the study aims at filling this gap. Twenty healthy adults performed static double- and single-leg stance tasks of 60s each under four auditory conditions: 500, 1000, 1500, and 2000 Hz, binaurally delivered through headphones, and in quiet condition. Functional near-infrared spectroscopy was used to measure PFC activation through changes in oxygenated hemoglobin concentration, while an inertial sensor (sealed at the L5 vertebra level) quantified postural sway parameters. Perceived discomfort and pleasantness were rated through a 0-100 visual analogue scale (VAS). Results showed that in both motor tasks, different PFC activation patterns were displayed at the different auditory frequencies and the postural performance worsened with auditory stimuli, compared to quiet conditions. VAS results showed that higher frequencies were considered more discomfortable than lower ones. Present data prove that specific sound frequencies play a significant role in cognitive resources recruitment and in the regulation of postural control. Furthermore, it supports the importance of exploring the relationship among tones, cortical activity, and posture, also considering possible applications with neurological populations and people with hearing dysfunctions.

Modifications in Prefrontal Cortex Oxygenation in Linear and Curvilinear Dual Task Walking: A Combined fNIRS and IMUs Study.

Increased oxygenated hemoglobin concentration of the prefrontal cortex (PFC) has been observed during linear walking, particularly when there is a high attention demand on the task, like in dual-task (DT) paradigms. Despite the knowledge that cognitive and motor demands depend on the complexity of the motor task, most studies have only focused on usual walking, while little is known for more challenging tasks, such as curved paths. To explore the relationship between cortical activation and gait biomechanics, 20 healthy young adults were asked to perform linear and curvilinear walking trajectories in single-task and DT conditions. PFC activation was assessed using functional near-infrared spectroscopy, while gait quality with four inertial measurement units. The Figure-of-8-Walk-Test was adopted as the curvilinear trajectory, with the "Serial 7s" test as concurrent cognitive task. Results show that walking along curvilinear trajectories in DT led to increased PFC activation and decreased motor performance. Under DT walking, the neural correlates of executive function and gait control tend to be modified in response to the cognitive resources imposed by the motor task. Being more representative of real-life situations, this approach to curved walking has the potential to reveal crucial information and to improve people' s balance, safety, and life's quality.

The Role of Methemoglobin and Carboxyhemoglobin in COVID-19: A Review.

Following the outbreak of a novel coronavirus (SARS-CoV-2) associated with pneumonia in China (Corona Virus Disease 2019, COVID-19) at the end of 2019, the world is currently facing a global pandemic of infections with SARS-CoV-2 and cases of COVID-19. Since severely ill patients often show elevated methemoglobin (MetHb) and carboxyhemoglobin (COHb) concentrations in their blood as a marker of disease severity, we aimed to summarize the currently available published study results (case reports and cross-sectional studies) on MetHb and COHb concentrations in the blood of COVID-19 patients. To this end, a systematic literature research was performed. For the case of MetHb, seven publications were identified (five case reports and two cross-sectional studies), and for the case of COHb, three studies were found (two cross-sectional studies and one case report). The findings reported in the publications show that an increase in MetHb and COHb can happen in COVID-19 patients, especially in critically ill ones, and that MetHb and COHb can increase to dangerously high levels during the course of the disease in some patients. The medications given to the patient and the patient's glucose-6-phospate dehydrogenase (G6PD) status seem to be important factors determining the severity of the methemoglobinemia and carboxyhemoglobinemia. Therefore, G6PD status should be determined before medications such as hydroxychloroquine are administered. In conclusion, MetHb and COHb can be elevated in COVID-19 patients and should be checked routinely in order to provide adequate medical treatment as well as to avoid misinterpretation of fingertip pulse oximetry readings, which can be inaccurate and unreliable in case of elevated MetHb and COHb levels in the blood.

Validation of Fabric-Based Thigh-Wearable EMG Sensors and Oximetry for Monitoring Quadriceps Activity during Strength and Endurance Exercises.

Muscle oximetry based on near-infrared spectroscopy (NIRS) and electromyography (EMG) techniques in adherent clothing might be used to monitor the muscular activity of selected muscle groups while exercising. The fusion of these wearable technologies in sporting garments can allow the objective assessment of the quality and the quantity of the muscle activity as well as the continuous monitoring of exercise programs. Several prototypes integrating EMG and NIRS have been developed previously; however, most devices presented the limitations of not measuring regional muscle oxyhemoglobin saturation and did not embed textile sensors for EMG. The purpose of this study was to compare regional muscle oxyhemoglobin saturation and surface EMG data, measured under resting and dynamic conditions (treadmill run and strength exercises) by a recently developed wearable integrated quadriceps muscle oximetry/EMG system adopting smart textiles for EMG, with those obtained by using two "gold standard" commercial instrumentations for EMG and muscle oximetry. The validity and agreement between the wearable integrated muscle oximetry/EMG system and the "gold standard" instrumentations were assessed by using the Bland-Altman agreement plots to determine the bias. The results support the validity of the data provided by the wearable electronic garment developed purposely for the quadriceps muscle group and suggest the potential of using such device to measure strength and endurance exercises in vivo in various populations.

Diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy for measuring microvascular blood flow in dynamically exercising human muscles.

In the last 20 yr, near-infrared diffuse correlation spectroscopy (DCS) has been developed for providing a noninvasive estimate of microvascular blood flow (BF) as a BF index (BFi) in the human skin, muscle, breast, brain, and other tissue types. In this study, we proposed a new motion correction algorithm for DCS-derived BFi able to remove motion artifacts during cycling exercise. We tested this algorithm on DCS data collected during cycling exercise and demonstrated that DCS can be used to quantify muscle BFi during dynamic high-intensity exercise. In addition, we measured tissue regional oxygen metabolic rate (MRO2i) by combining frequency-domain multidistance near-infrared spectroscopy (FDNIRS) oximetry with DCS flow measures. Recreationally active subjects (n = 12; 31 ± 8 yr, 183 ± 4 cm, 79 ± 10 kg) pedaled at 80-100 revolutions/min until volitional fatigue with a work rate increase of 30 W every 4 min. Exercise intensity was normalized in each subject to the cycling power peak (Wpeak). Both rectus femoris BFi and MRO2i increased from 15% up to 75% Wpeak and then plateaued to the end of the exercise. During the recovery at 30 W cycling power, BFi remained almost constant, whereas MRO2i started to decrease. The BFi/MRO2i plateau was associated with the rising of the lactate concentration, indicating the progressive involvement of the anaerobic metabolism. These findings further highlight the utility of DCS and FDNIRS oximetry as effective, reproducible, and noninvasive techniques to assess muscle BFi and MRO2i in real time during a dynamic exercise such as cycling.NEW & NOTEWORTHY To the best of our knowledge, this study is the first to demonstrate that diffuse correlation spectroscopy in combination with frequency-domain near-infrared spectroscopy can monitor human quadriceps microvascular blood flow and oxygen metabolism with high temporal resolution during a cycling exercise. The optically measured parameters confirm the expected relationship between blood flow, muscle oxidative metabolism, and lactate production during exercise.

Trail Making Test Induces Prefrontal Cortex Activation as Revealed by a cw Wearable-Wireless fNIRS/DOT Imager.

The recent availability of low-cost wearable continuous wave (cw) fNIRS/DOT devices is supposed to revolutionize cortical human brain mapping in the real-life. Ecological paper-pencil tests, as the Trail Making Test (TMT), are commonly used in neuropsychological clinics but its neural substrates are not completely understood. The aim of this study was to map, using a new cw wearable fNIRS/DOT imager (NIRSIT), the prefrontal cortex (PFC) hemodynamic response in healthy subjects while performing the TMT. The ANOVA analysis, performed on the 60 region-DOT data, shows a significant task-related activation of the PFC. These preliminary results support the validity of this wearable technology to provide online high-density PFC activation maps.

Are ventrolateral and dorsolateral prefrontal cortices involved in the computerized Corsi block-tapping test execution? An fNIRS study.

The Corsi block-tapping test (CBT) is an old neuropsychological test that, requiring the storage and the reproduction of spatial locations, assesses spatial working memory (WM). Despite its wide use in clinical practice, the specific contribution of prefrontal cortex (PFC) subregions during CBT execution has not been clarified yet. Considering the importance of spatial WM in daily life and the well-known role of ventrolateral-PFC/dorsolateral-PFC (VLPFC/DLPFC) in WM processes, the present study was aimed at investigating, by a 20-channel functional near-infrared spectroscopy (fNIRS) system (including four short-separation channels), the hemodynamic response of the VLPFC/DLPFC during a computerized version of the CBT. Thirty-nine university students were asked to perform CBT standard version (CBTs), block-suppression CBT (CBTb), and control task (CBTc). A VLPFC activation during CBTs and a DLPFC activation during CBTb were hypothesized. The results of the Bayesian analysis have not shown a delineated specific activation of VLPFC/DLPFC during either CBTs or CBTb. These results together with the related ones obtained by others using fMRI are not sufficient to definitively state the role of the PFC subregions during CBT execution. The adoption of high-density diffuse optical tomography would be helpful in further exploration of the PFC involvement in spatial WM tasks.

Functional near-infrared spectroscopy to probe sensorimotor region activation during electrical stimulation-evoked movement.

This study used non-invasive functional near-infrared spectroscopy (fNIRS) neuroimaging to monitor bilateral sensorimotor region activation during unilateral voluntary (VOL) and neuromuscular electrical stimulation (NMES)-evoked movements. METHODS: In eight healthy male volunteers, fNIRS was used to measure relative changes in oxyhaemoglobin (O2 Hb) and deoxyhaemoglobin (HHb) concentrations from a cortical sensorimotor region of interest in the left (LH) and right (RH) hemispheres during NMES-evoked and VOL wrist extension movements of the right arm. RESULTS: NMES-evoked movements induced significantly greater activation (increase in O2 Hb and concomitant decrease in HHb) in the contralateral LH than in the ipsilateral RH (O2 Hb: 0·44 ± 0·16 µM and 0·25 ± 0·22 µM, P = 0·017; HHb: -0·19 ± 0·10 µM and -0·12 ± 0·09 µM, P = 0·036, respectively) as did VOL movements (0·51 ± 0·24 µΜ and 0·34 ± 0·21 µM, P = 0·031; HHb: -0·18 ± 0·07 µΜ and -0·12 ± 0·04 µΜ, P = 0·05, respectively). There was no significant difference between conditions for O2 Hb (P = 0·144) and HHb (P = 0·958). CONCLUSION: fNIRS neuroimaging enables quantification of bilateral sensorimotor regional activation profiles during voluntary and NMES-evoked wrist extension movements.

Does ventrolateral prefrontal cortex help in searching for the lost key? Evidence from an fNIRS study.

The Key Search Task (KST) is a neuropsychological test that requires strategies for searching a lost key in an imaginary field. This request may involve different cognitive processes as mental imagery and navigation planning. This study was aimed at investigating, by a twenty-channel functional near-infrared spectroscopy (fNIRS) system, the hemodynamic response (i.e., oxygenated-hemoglobin (O2Hb) and deoxygenated-hemoglobin (HHb) changes) of the prefrontal cortex in navigation planning. A right ventrolateral prefrontal cortex (rVLPFC) activation during the KST was hypothesized. Thirty-eight volunteers performed the KST and a Control Task (CT), the latter requiring the volunteers to mark the X letter. An activation (i.e., increase/decrease in O2Hb/HHb) of: 1) rVLPFC during the KST execution, and 2) bilateral dorsolateral prefrontal cortex (DLPFC) during the CT execution was found. The present study provides a contribution in localizing the rVLPFC as the critically active region, within the frontal lobes, that was found maximally activated during mental navigation in the mind's eye of healthy participants while performing the KST. Considering the contribution of rVLPFC in spatial navigation, its activation suggests that the KST could be adopted in the clinical routine for investigating navigation planning. Compared to other neuroimaging techniques, fNIRS (with its relatively low physical constraints) contributes to better clarifying the role of rVLPFC in some aspects of human navigation. Therefore, the combined use of the fNIRS and the KST could be considered as an innovative and valid tool to evaluate fundamental functions for everyday life, such as spatial navigation planning.

The Key of the Maze: The role of mental imagery and cognitive flexibility in navigational planning.

Spatial navigation planning ability relies on both mental imagery and cognitive flexibility. Considering the importance of planning ability in everyday life, several neuropsychological tests are used in clinical practice for its assessment, although some of these are not aimed at assessing the strategies of navigational planning. The Porteus Maze Test (PMT) and the Key Search Task (KST) require to plan a strategy in a maze and in an imagined space, respectively. To the best of our knowledge, although these two tests share some features, the relationship between them has never been explored. The purpose of the present study was to investigate, for the first time, the relationship between the PMT and the KST performances in 38 healthy subjects in order to understand the implications of this association for the assessment of spatial navigation ability. Subjects were subdivided in bad or good navigation planners on the basis of the their KST score. The results of the study have revealed a significant difference (t=2.35; p=0.03) in the number of errors made at the PMT by bad navigational planners (0.78±0.28) and good navigational planners (0.10±0.06). The first group (bad navigational planners) made more errors at the PMT than the good navigational planners (who made less errors at the PMT). This provides evidence of the possibility to use the KST and the PMT in a combined way as a new tool for the assessment of spatial navigational planning ability. Furthermore, this finding highlights the importance of mental imagery and cognitive flexibility in spatial navigation, suggesting that these functions could be the link between a good planning ability and a successful spatial navigation. In conclusion, this study suggests that an efficient navigation would not be possible without a good navigational planning ability.