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Motor imagery is the mental representation of a movement without physical execution. When motor imagery is performed to enhance motor learning and performance, participants must reach a temporal congruence between the imagined and actual movement execution. Identifying factors that can influence this capacity could enhance the effectiveness of motor imagery programs. Anxiety frequently occurs in sports and rehabilitation where motor imagery is a relevant technique. It is associated with increased muscle tension and impairs the memory processes involved in motor imagery. This study aimed to determine whether muscle relaxation before motor imagery practice can influence motor imagery capacity and temporal congruence in anxious individuals, during internal and external visual imagery, and kinesthetic imagery. A randomized clinical trial was conducted in 55 young adults (20.3±2.8 years; 40 females; 15 males) with anxiety (percentile ≥75% on the State-Trait Anxiety Inventory). 26 participants were assigned to the relaxation group and 29 to the control group through stratified randomization. Motor imagery capacity and temporal congruence were assessed using the Movement Imagery Questionnaire-3 at 2 points (t1 and t2). Between t1 and t2, participants in the relaxation group underwent abbreviated progressive relaxation training. Electrodermal activity and heart rate variability were recorded to evaluate the relaxation effect. Data revealed a significant improvement in motor imagery capacity in the relaxation group, while the temporal congruence was not impaired in both groups. Pre-motor imagery muscle relaxation might improve motor imagery capacity in anxious individuals. This finding may contribute to better tailor motor imagery programs and to adjust motor imagery guidelines and recommendations for people with anxiety. This study has been registered in ClinicalTrials.gov (NCT04973956).

Purpose Force production frequently remains depressed for several hours or even days after various types of strenuous physical exercise. We hypothesized that the pattern of force changes during the first hour after exercise can be used to reveal muscular mechanisms likely to underlie the decline in muscle performance during exercise as well as factors involved in the triggering the prolonged force depression after exercise. Methods Nine groups of recreationally active male volunteers performed one of the following types of exercise: single prolonged or repeated short maximum voluntary contractions (MVCs); single or repeated all-out cycling bouts; repeated drop jumps. The isometric force of the right quadriceps muscle was measured during stimulation with brief 20 and 100 Hz trains of electrical pulses given before and at regular intervals for 60 min after exercise. Results All exercises resulted in a prolonged force depression, which was more marked at 20 Hz than at 100 Hz. Short-lasting (≤2 min) MVC and all-out cycling exercises showed an initial force recovery (peak after ~ 5 min) followed by a secondary force depression. The repeated drop jumps, which involve eccentric contractions, resulted in a stable force depression with the 20 Hz force being markedly more decreased after 100 than 10 jumps. Conclusions In accordance with our hypothesis, the results propose at least three different mechanisms that influence force production after exercise: (1) a transiently recovering process followed by (2) a prolonged force depression after metabolically demanding exercise, and (3) a stable force depression after mechanically demanding contractions.

To examine the effects of progressive muscle relaxation combined with music on stress, fatigue and coping styles amongst intensive care unit (ICU) nurses. A randomised controlled trial of 56 nurses aged 18  years and older, with at least three months experience. The intervention group (n = 28) received a 20 minute session comprising progressive muscle relaxation combined with music for a total of eight weeks in the form of group sessions, while the control group (n = 28) received only a single-time face-to-face attention-matched education (20  minutes). The data collection tools were administered at baseline, at week four, eight and twelve. Internal Medicine, Anaesthesia, and Coronary Intensive care Unit of a training and research hospital. Primary outcome: Stress level. Secondary outcome: Fatigue severity and coping styles. Stress scores in the intervention group decreased significantly at week 8 and week 12 (p < 0.05). Similarly, the fatigue scores were observed to be significantly lower in the intervention group at week 8 and week 12 in comparison to those in the control group (p < 0.05). The scores of coping styles, obtained for the acceptance sub-dimension were significantly higher in the intervention group compared to the control group at week 4, 8, and 12 (p < 0.05). The use of instrumental support, venting and the emotional support scores were observed to be significantly higher in the intervention group compared to the control group at week 12 (p < 0.05). The results indicated that progressive muscle relaxation combined with music appears to be effective in decreasing stress and fatigue, and in improving the coping styles amongst intensive care nurses. Future studies should be conducted on a larger scale to make conclusions with higher probability.

Background The influence of sustained spinal loading on flexion relaxation phenomenon (FRP) in erector spinae (ES) in trunk anterior flexion–extension performance has been studied. However, no investigation has been reported on spasm after the loading. The aim of the study is to test if spasm as well as the increase of electromyography ( EMG) intensity of extensors in relaxation period could be found during and/or after prolonged asymmetric static loading. Methods Twenty six male healthy college students participated in the study. Participants finished two 30 min asymmetry load conditions (left load(LL), right load (RL)), randomly with total load 10 kg on the left or the right shoulder, respectively. EMG signals were recorded from the left(l) and the right(r) thoracic erector spinae (lTES, rTES), lumbar erector spinae (lLES, rTES), and hamstring (lHAM, rHAM) muscles in the first 10 min and the last 10 min during the interventions, and also recorded in three trunk anterior flexion–extension exertions before (pre) and after (post) the interventions, respectively. The rhythmic of flexion–extension performance was controlled by a metronome with 5 s flexion and 5 s extension at 60 Hz. Spasms were evaluated and an averaged electromyography (NEMG) was calculated for extensors at the first and last 10 min of 30 min intervention, as well as in the relaxation period of FRP during flexion–extension exertion in both pre and post the intervention. Results During asymmetry spinal loading process, there was no sign of spasms in any of extensors. NEMG of multiple erect spinae had a significant decrease (with the largest -60%, p  = 0.021 in rLES in LL) while that of hamstring increases significantly (the largest value 139%, p  = 0.001 in lHAM in LL). After the interventions, the prevalence of spasms in extensors in relaxation period was found with the value from 8 to 55%. Also, NEMG in multiple extensors had a significant increase (with the largest increase of 114% in lLES in LL, p  = 0.023). Conclusion During sustained asymmetry spinal loading, the NEMG in bilateral HAM has significant increase and the NEMG in bilateral erect spinea has a decrease tendency. After loading, the NEMG has a significant increase, in parallel with spasms elicited in multiple extensors in relation period in flexion–extension performance, with no significant difference between bilateral sides. It may indicate that sustained asymmetry spinal loading could lead to a weakness for tension ability, and/or a micro-damage in spinal bilateral passive tissues in low back area, the risk of developing low back disorder.

Background and ObjectivesThe transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration.MethodsSixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle–relaxing effect.ResultsThe lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191–310 cm2) and the medial part 76 cm2 (interquartile range, 54–127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9–15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512–716 minutes) and 609 minutes (490–724 minutes), respectively.ConclusionsCutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.

G protein-coupled receptor (GPCR)-mediated increases in intracellular calcium generally lead to constriction of airway smooth muscle. Deshpande et al . find that bitter taste receptors, another class of GPCRs, are also expressed on airway smooth muscle cells and, once activated, induce a localized increase in intracellular calcium. Paradoxically, this induces relaxation of airway smooth muscle cells via activation of BK Ca channels. These ligands also relax airways in a mouse model of asthma, suggesting they can be used in conjunction with β-adrenergic receptor agonists to treat obstructive lung disease. Bitter taste receptors (TAS2Rs) on the tongue probably evolved to evoke signals for avoiding ingestion of plant toxins. We found expression of TAS2Rs on human airway smooth muscle (ASM) and considered these to be avoidance receptors for inhalants that, when activated, lead to ASM contraction and bronchospasm. TAS2R agonists such as saccharin, chloroquine and denatonium evoked increased intracellular calcium ([Ca 2+ ] i ) in ASM in a Gβγ–, phospholipase Cβ (PLCβ)- and inositol trisphosphate (IP 3 ) receptor–dependent manner, which would be expected to evoke contraction. Paradoxically, bitter tastants caused relaxation of isolated ASM and dilation of airways that was threefold greater than that elicited by β-adrenergic receptor agonists. The relaxation induced by TAS2Rs is associated with a localized [Ca 2+ ] i response at the cell membrane, which opens large-conductance Ca 2+ -activated K + (BK Ca ) channels, leading to ASM membrane hyperpolarization. Inhaled bitter tastants decreased airway obstruction in a mouse model of asthma. Given the need for efficacious bronchodilators for treating obstructive lung diseases, this pathway can be exploited for therapy with the thousands of known synthetic and naturally occurring bitter tastants.

Background We examined the impact of muscle relaxation on surgical conditions and patients’ postoperative outcome during elective laparoscopic cholecystectomy under balanced anaesthesia. Methods After approval and consent, 57 anaesthetized patients were randomly assigned to group no neuromuscular blockade (No NMB) and deep neuromuscular blockade (Deep NMB), i.e. no twitch response to train-of-four nerve stimulation. Laparoscopic cholecystectomy was performed using the 4-trocar technique with a CO 2 -pneumoperitoneum. Surgical conditions were assessed using a Visual Analogue Scale. Movement of diaphragm or abdominal muscles, inadequate visibility, or breathing and coughing against the ventilator were documented as events reflecting inadequate muscle relaxation. Independently, surgeons could request 0.3 mg/kg rocuronium to improve surgical conditions. Workflow variables were obtained as a surrogate of surgical conditions. Data are presented as mean (95 % confidence interval). The trial is registered at ClinicalTrials.gov (NCT00895778). Results While in 12 of 25 patients of group “No NMB” one or more adverse events impaired the surgical procedure ( p  < 0.001), only 1 of 25 patients of group “Deep NMB” showed an adverse event. Deep NMB resulted in an absolute risk reduction of 0.44 (0.23–0.65) and a number needed to treat of 2.3 (1.5–4.4), respectively. Surgeons requested 0.3 mg/kg rocuronium in 10 of 25 cases (40 %) of group “No NMB” only. This dose significantly improved surgical conditions by an average 62 of 100 possible points. All further variables did not differ between groups. Conclusions Deep NMB ameliorates surgical conditions for laparoscopic cholecystectomy by improved visibility and reduction of involuntary movements.

Background: The increasing prevalence of kinesiophobia, or the fear of movement, among patients following meniscectomy has necessitated the exploration of effective rehabilitative interventions. Traditional methods of rehabilitation often do not adequately address the psychological components of recovery, leading to prolonged recovery times and decreased quality of life. Objective: The objective of this study is to explore the effectiveness of psychological and traditional Chinese medical techniques, including progressive muscle relaxation training (PMRT) and acupressure, in treating kinesiophobia among patients after meniscus surgery. Methods: This randomized clinical trial commenced in December 2021 at the Sports Medicine Department of a hospital in Gansu Province and concluded in February 2023. Seventy hospital inpatients with movement disorders who had undergone meniscus shaping surgery participated in the study (experimental Group 35 people, control Group 35 people). The control group received standard care. In addition to receiving routine care, the experimental group underwent an additional 30 min of PMRT and 5–10 min of acupressure. The kinesiophobia scores and pain scores were assessed using the Tampa Scale for Kinesiophobia (TSK) and Visual Analogue Scale (VAS) before the intervention, the first day after the intervention, the fifth day after the intervention, and on the day of discharge. On the day of discharge, the Knee Society Score (KSS) was used to assess the knee joint function of the patients. Statistical analysis was performed using repeated measures ANOVA. Results: The study included 70 kinesiophobia patients following meniscoplasty, equally split between the experimental and control groups. Attrition resulted in 3 experimental group withdrawals and 2 from the control group, leaving 65 for the final analysis (32 experimental, 33 control). The average age of the patients was (67.03 ± 8.26) years, with an average BMI of (25.09 ± 2.88) kg/cm 2 . Females accounted for 66.10% of the participants. There were no statistically significant differences between the two groups in terms of their preintervention TSK scores, VAS scores, and other baseline data ( p > 0.05).There were no statistically significant differences in the kinesiophobia scores (TSK scores) and pain scores (VAS scores) between the experimental group and the routine care group both before the intervention and on the first day after the intervention ( p > 0.05). However, the fifth‐day and discharge assessments revealed significant score improvements in the experimental group ( p < 0.05), along with KSS scores indicating enhanced knee joint function compared to controls ( p < 0.05). Conclusions: PMRT combined with acupressure effectively decreases kinesiophobia levels post‐meniscoplasty, mitigates pain, fosters early functional exercise participation, and promotes knee joint function recovery. Trial Registration: ClinicalTrials.gov identifier: NCT06409715

Background & objectives Diabetes distress (DD) is a mental condition that can develop in people with diabetes and shares characteristics with stress, anxiety, and depression. The aim was to determine the effect of Jacobson's Progressive Muscle Relaxation (PMR) therapy on DD, anxiety, glycemic control, hemodynamic and lipid measures among people with type 2 diabetes (T2DM). Methods A total of 80 participants were recruited for this prospective randomised intervention study and divided into two groups equally; group 1 (Control) (n=40) received general counselling for stress reduction and group 2 (Intervention) (n=40) received PMR therapy and general counselling for stress reduction. A pre-, and post-test was done with diabetes distress Scale (DDS) and generalized anxiety disorder (GAD) Scales. Baseline data on anthropometric, hemodynamic, biochemical details were collected and repeated after three months. Thirty-six participants, with four dropouts in each group, reported for follow up. Diabetes medication regimens in both groups remained unchanged throughout the study period. Results There was a significant reduction in the total mean scores of DDS (Pre vs. Post) (3.8 vs. 1.6) and GAD Scale (17.9 vs. 6.3; P<0.0001) in the intervention group. The PMR therapy group showed a significant reduction in HbA1c, fasting and post prandial (PP) glucose levels with HbA1c (baseline vs. follow up; 9.2% vs. 7.6%), fasting (194.5 mg/dl vs. 142.4 mg/dl) and PP glucose levels (266.5 mg/dl vs. 175.5 mg/dl) (P=0.001) whereas control group showed an increase in HbA1c, fasting and PP glucose levels. The impact of PMR therapy was also reflected in the lipid profile. Seventy per cent of the intervention group participants followed PMR therapy regularly. Interpretation & conclusions Our study findings highlighted that PMR therapy had a positive effect on diabetes distress and anxiety among people with T2DM. It also improved glycemic control and can be used as an adjunctive to the medications for better management of T2DM.

The \"super-relaxed state\" (SRX) of myosin represents a 'reserve' of motors in the heart. Myosin heads in the SRX are bound to the thick filament and have a very low ATPase rate. Changes in the SRX are likely to modulate cardiac contractility. We previously demonstrated that the SRX is significantly reduced in mouse cardiomyocytes lacking cardiac myosin binding protein-C (cMyBP-C). Here, we report the effect of mutations in the cMyBP-C gene (MYBPC3) using samples from human patients with hypertrophic cardiomyopathy (HCM). Left ventricular (LV) samples from 11 HCM patients were obtained following myectomy surgery to relieve LV outflow tract obstruction. HCM samples were genotyped as either MYBPC3 mutation positive (MYBPC3mut) or negative (HCMsmn) and were compared to eight non-failing donor hearts. Compared to donors, only MYBPC3mut samples display a significantly diminished SRX, characterised by a decrease in both the number of myosin heads in the SRX and the lifetime of ATP turnover. These changes were not observed in HCMsmn samples. There was a positive correlation (p < 0.01) between the expression of cMyBP-C and the proportion of myosin heads in the SRX state, suggesting cMyBP-C modulates and maintains the SRX. Phosphorylation of the myosin regulatory light chain in MYBPC3mut samples was significantly decreased compared to the other groups, suggesting a potential mechanism to compensate for the diminished SRX. We conclude that by altering both contractility and sarcomeric energy requirements, a reduced SRX may be an important disease mechanism in patients with MYBPC3 mutations.