Search Results (180)

Background and Objectives: Brachial plexus birth injury (BPBI) is a peripheral nerve injury occurring during birth that may result in upper-extremity weakness and functional impairment. This systematic review aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on motor function, muscle strength, range of motion, and upper-extremity function in children with BPBI. Materials and Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO. PubMed, CINAHL, Scopus, Web of Science, PEDro, and the Cochrane Library were searched from inception to 5 May 2026. Only randomized controlled trials were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated using the RoB 2 tool. Results: Seven randomized controlled trials involving 197 participants were included. Several studies reported improvements in shoulder abduction, elbow flexion, wrist extension, muscle strength, and motor function following NMES compared with conventional therapy. The combination of NMES and constraint-induced movement therapy demonstrated favorable outcomes in functional performance. However, substantial heterogeneity was observed across studies regarding participant characteristics, NMES parameters, treatment duration, and outcome measures. The certainty of evidence ranged from low to very low. Conclusions: Current evidence suggests that NMES may serve as a potential adjunct to conventional rehabilitation in children with BPBI. However, given the low to very low certainty of the evidence, high risk of bias, and substantial clinical and methodological heterogeneity among the included studies, definitive clinical recommendations cannot currently be made. Future well-designed randomized controlled trials using standardized protocols, consistent outcome measures, and longer follow-up periods are warranted. Full article

Background: Peripheral muscle electrostimulation (PME), encompassing neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES), has been increasingly acknowledged as an effective adjunctive or complementary treatment to voluntary exercise in elderly cardiac patients who cannot perform sufficient amounts of exercise, for whom there is limited research on optimal protocols. Sarcopenia, defined as a progressive decrease in muscle mass, strength and function, affects approximately 34% of heart failure (HF) patients and considerably worsens their prognosis. The objective of this systematic review is to summarize current evidence on the theoretical mechanisms, physiological pathways, safety and efficacy of PME in older adults within a cardiac rehabilitation (CR) setting, with a specific emphasis on sarcopenia reversal. Methods: We performed a systematic review following the PRISMA 2020 guidelines. A systematic search was conducted on the PubMed, Embase, Cochrane Library, CINAHL and PEDro databases from inception until December 2025. We searched for randomized controlled trials (RCTs) and controlled clinical trials focusing on PME in patients with cardiac diseases aged 65 years or older. The main outcomes were physical function (assessed with the Short Physical Performance Battery [SPPB] and 6 min walk distance [6MWD]), muscle strength, muscle mass and safety. The Cochrane Risk of Bias tool was used to evaluate the quality of the studies. Results: Eight studies were included, with 387 participants and a mean age between 78 and 85 years. PME consistently improved lower-extremity muscle strength (MD: 5.2% body weight, 95% CI = 1.2–9.1, p = 0.013) along with SPPB scores, which ranged from +2.3 to +2.67 points (all p < 0.05). Home-based PME (NMES) achieved 100% adherence rates, and no cardiovascular adverse events were reported. The mechanisms by which PME is beneficial involve peripheral skeletal muscle adaptations without eliciting central hemodynamic stress, increased endothelial function, aerobic enzyme activity, protein anabolism stimulation or muscle proteolysis inhibition. No significant effects were observed on BNP levels, hospital readmissions or mortality. PME has been shown to attenuate the progression of sarcopenia through hypertrophy of type I and II muscle fibers, as well as mitochondrial biogenesis. Conclusions: PME is a safe, feasible adjunct to conventional CR in frail, elderly cardiac patients, particularly those with exercise intolerance and sarcopenia. It improves peripheral muscle function, physical performance, and muscle protein balance without cardiovascular stress. Larger multicenter trials are needed to establish optimal protocols and long-term clinical outcomes. Full article

Background/Objectives: Stroke remains a leading cause of global disability, with upper limb impairment affecting over 80% of patients. During the acute phase (first seven days), a critical neuroplastic window exists where interventions may significantly influence recovery. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of electrical stimulation—specifically Functional Electrical Stimulation (FES) and Neuromuscular Electrical Stimulation (NMES)—on upper limb functional recovery and complication prevention during the acute phase of stroke. Methods: A systematic search was conducted across eight databases (including Medline, PEDRo, and Cochrane) for randomized and non-randomized clinical trials published between 2016 and 2025. Methodological quality was assessed using the PEDRo scale. Quantitative synthesis was performed via meta-analysis using a random-effects model, focusing on the Fugl-Meyer Assessment (FMA-UE). Results: Eight randomized clinical trials were selected with a total of 384 participants. The meta-analysis results showed a positive and statistically significant effect in favor of the experimental group compared to the control group (Z = 2.39; p = 0.02), with a combined Standardized Mean Difference of 0.53 (95% CI: 0.10 to 0.96), indicating a moderate effect size on the Fugl-Meyer Assessment Upper Extremity scale. Although high heterogeneity was detected (I² = 74%), the analysis suggests that Functional Electrical Stimulation (FES) and Neuromuscular Electrical Stimulation (NMES) improve manual dexterity, prevent disuse atrophy, and reduce glenohumeral subluxation. Conclusions: Electrical stimulation shows a positive trend in early stroke recovery; however, it should be considered a promising adjunct rather than a definitive treatment. Further research into standardized protocols is required to confirm their clinical significance. Full article

Neuromuscular electrical stimulation (NMES) is integral to studying muscle function in healthy and dystrophic mice. Certain commercial electrodes and laboratory stimulators used for NMES in mice are no longer in production. We developed and/or tested low-cost, open-source alternatives to discontinued commercial standards. We performed two studies—a comparison of electrodes and a comparison of stimulators. In the electrode study, in vivo NMES was applied to the left hindlimb ankle dorsiflexors in healthy C57BL/6J and dysferlin-null BLAJ mice using three electrode types: a previously available commercial electrode, a custom 3D-Printed electrode, and a custom Pen electrode assembled from off-the-shelf components. Twitch and tetanic torque were measured and compared using two-way repeated-measures ANOVA. Twitch torque differed by electrode type (p = 0.031), with lower values observed for the Pen electrode compared with the 3D-Printed electrode (e.g., 573 ± 72 vs. 666 ± 70 mN.mm in C57BL/6J mice), whereas tetanic torque did not differ significantly between electrode types (p = 0.060). In the stimulator study, twitch and tetanic contractions were elicited using the open-source StimJim stimulator and compared with contractions elicited by the discontinued Grass S48 stimulator. Twitch torque was lower with the StimJim (588 ± 107 mN.mm) compared with the Grass S48 (698 ± 116 mN.mm; p < 0.001), whereas tetanic torque values were not statistically different (p = 0.055). These findings indicate that open-source electrodes and stimulators can produce similar maximal tetanic torque under the tested conditions, although differences in twitch torque and stimulation parameters should be considered. These results reflect a methodological validation of accessible tools rather than a formal equivalence analysis. Full article

Background/Objectives: Stroke is a sudden neurological event caused by disrupted cerebral blood flow and represents a leading cause of acquired disability worldwide. Motor impairments and spasticity are among the most prevalent sequelae, significantly limiting functional independence and quality of life. Non-invasive electrotherapy has emerged as a complementary strategy in neurorehabilitation aimed at enhancing neuroplasticity and improving motor recovery. To systematically review current evidence regarding the effectiveness of non-invasive electrotherapy modalities in the rehabilitation of motor sequelae and spasticity following stroke, and to examine their theoretical and clinical rationale. Methods: A systematic literature review was conducted in accordance with PRISMA 2020 guidelines. The protocol was prospectively registered in the Open Science Framework (OSF). A comprehensive search was performed in Pubmed, Web of Science (WoS), and Scopus for studies published up to 14 November 2023, using the terms “Electric Stimulation Therapy” and “Stroke”. The methodological quality was assessed using the PEDro scale. The levels of evidence were classified according to the Oxford Centre for Evidence-Based Medicine criteria, and the risk of bias was evaluated using the Cochrane Risk of Bias tool (RoB 2). Results: Sixteen studies were included in the review. The analyzed interventions comprised neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), functional electrical stimulation (FES), neuromuscular electrical stimulation combined with transcranial magnetic stimulation (NMES + rTMS), transcranial direct current stimulation (tDCS), and afferent electrical stimulation (AES). Overall, the methodological quality of the included studies ranged from moderate to high, with PEDro scores between 6 and 9 out of 10. According to the Oxford Centre for Evidence-Based Medicine classification, most studies corresponded to level 1b evidence, while a smaller proportion were classified as level 2b. A risk of bias assessment using the Cochrane RoB 2 tool showed that the majority of the included studies presented a low risk of bias across most domains, although some concerns were identified in the domains of randomization and measurement in a limited number of trials. Across modalities, consistency within group improvement in motor function and spasticity was reported. However, between group comparisons with conventional rehabilitation were often inconsistent and did not consistently demonstrate superiority. The variability in stimulation parameters, intervention duration, and outcome measures further limited direct comparisons across studies. Conclusions: Non-invasive electrotherapy appears to be a safe and promising adjunct to conventional stroke rehabilitation. Nevertheless, further high-quality studies are required to clarify the underlying neurophysiological mechanisms and to establish standardized treatment protocols. Full article

Background: Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies. While surgical decompression is widely considered the definitive treatment, conservative options remain clinically relevant, particularly for symptom relief and functional recovery in the short term. Objectives: To update the evidence comparing surgical versus non-surgical interventions for CTS, assessing pain, function, and clinical recovery. Design: Systematic review of randomised controlled trials (RCTs). Data Sources and Methods: Six databases (CENTRAL, MEDLINE, Embase, Cochrane Neuromuscular Register, ClinicalTrials.gov, and WHO ICTRP) were searched for RCTs published between November 2022 and January 2025. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Due to clinical heterogeneity, a narrative synthesis was performed. Results: Four RCTs (n = 1158) were included. Corticosteroid injection and percutaneous electrical nerve stimulation (PENS) appeared to provide faster symptom relief than surgery at short-term follow-up. However, surgery was associated with a higher probability of sustained recovery at 12–18 months (RR 1.36; 95% CI 1.19–1.56). Evidence for PENS was limited to one female-only trial, which restricts generalisability. Certainty of evidence was moderate for long-term outcomes and low for short-term results and safety. Conclusions: The available evidence suggests that surgery may offer more durable long-term recovery, whereas corticosteroids and PENS may be useful for short-term symptom relief. These findings should be interpreted with caution given the limited number of trials and the risk of bias in most included studies. Treatment choice should align with patient goals and recovery timelines. Registration: PROSPERO (CRD420250650789). Full article

Transcutaneous electrical nerve stimulation (TENS) is constrained by high skin impedance and unstable electrode contact. This study proposes a novel composite electrode system comprising a polyvinyl alcohol/silver (PVA/Ag) microneedle array and a highly conductive polyacrylamide/lithium chloride (PAAm/LiCl) hydrogel. The PVA/Ag microneedles (~365 µm in height, ~48 µm tip diameter) possess sufficient mechanical strength to penetrate the stratum corneum, establishing a low-resistance pathway. The complementary PAAm/LiCl hydrogel exhibits high conductivity (10.28 S/m) and mechanical flexibility, further optimizing the interface contact. The experimental results demonstrate that this composite system achieves low electrochemical impedance and induces stable, clear electromyographic responses in vivo. It effectively addresses the common issues of electrode detachment and signal attenuation associated with conventional electrodes, offering a promising hardware solution for efficient and comfortable wearable rehabilitation devices. Full article

Introduction: Pelvic floor disorders (PFDs) are a very widespread clinical phenomenon and are known to affect millions of women worldwide, significantly impairing their quality of life. New technologies and innovations such as electrotherapy and photobiostimulation are currently revolutionizing what concerns conservative treatment, allowing clinicians to tailor therapy to every woman. The aim of this study was to evaluate the feasibility of use of electrotherapy and photobiostimulation in PFD management and the initial results of treatment in clinical practice. Methods: This prospective study (IRB code: GSM-RF 2025) aimed to analyze the impact of the innovative DAFNE system to treat PFDs through electrotherapy and photobiostimulation. We enrolled patients with mild pelvic organ prolapse and stress urinary incontinence who desired a conservative treatment for their conditions. The following validated scales were used for assessing baseline quality of life before and after treatment: Urinary Distress Inventory-6 (UDI-6), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Female Sexual Function Index-6 (FSFI-6), 0–100 VAS Scale, and Vaginal Health Index. Electrotherapy was delivered through 4 gold rings, providing Functional Electrical Stimulation (FES), Transcutaneous Electrical Nerve Stimulation (TENS) and/or Microcurrent Electrical Neuromuscular Stimulation (MENS). The photobiostimulation system consisted of 24 LEDs per wavelength (420 nm UVA; 630 nm RED; 870 nm NIR/INFRARED) positioned at 360° along the entire length of the handpiece for antimicrobial purposes, microcirculation improvement, and anti-inflammatory action. The cycle of treatment consisted of 3–5 sessions, according to necessity. Overall improvement was measured through the Patient Global Impression of Improvement (PGI-I). Statistical analysis was performed using Student’s t-Test. A value of p < 0.05 was considered as significant. Results: In the period of interest, 32 women were treated with the DAFNE system. The mean age was 57.0 ± 16.6 years. Indications for treatment were stress urinary incontinence (16/32), mild pelvic organ prolapse (14/32), or both (2/32). The mean number of treatments per patient was 4. Quality of life improved as a consequence of the treatment according to the considered scales. Specifically, 87.5% of patients considered themselves improved. Conclusions: The DAFNE system has been successful in managing mild pelvic organ prolapse and stress urinary incontinence, improving quality of life scores. Embracing new technologies such as electrotherapy and photobiostimulation appears to be successful in conservatively managing a variety of PFDs. Full article

Background: Chronic ankle instability (CAI) is a common functional disorder in older adults, affecting their balance and quality of life. Therefore, finding effective ways to enhance ankle stability and function under safe conditions remains a key issue for healthy aging. Objective: This study aims to explore the effects of the Otago Exercise Program (OEP) combined with Neuromuscular Electrical Stimulation (NMES) on ankle stability, the pain index, and balance ability in older adults aged 60 and above with CAI. Methods: This study is a single-blind pilot randomized controlled trial, including 36 eligible older adults with CAI, with 34 completing the trial. Participants were randomly assigned to the OEP group, the combined group (OEP + NMES), and the control group. The intervention period lasted 8 weeks. Evaluation measures included the Cumberland Ankle Instability Tool (CAIT), Visual Analog Scale (VAS), Eyes-closed Single-Leg Stance Test (UST), and the Modified Star Excursion Balance Test (mSEBT), with assessments conducted before the intervention, at week 4, and at week 8. Result: After the intervention, all three groups showed significant improvements in CAIT, VAS, UST, and mSEBT scores (p < 0.05), with a large group × time effect observed for the primary outcome CAIT (partial η² = 0.414). The combined group (OEP + NMES) demonstrated the most significant improvement in CAIT and UST scores (p < 0.05) and outperformed the other two groups in dynamic balance in the posteromedial and posterolateral directions. Conclusions: The combined intervention of OEP and NMES significantly improves ankle stability, both static and dynamic balance abilities, and alleviates pain in older adults with CAI. This combined approach offers a safe and effective rehabilitation strategy for the older adults, with promising clinical application prospects. Full article

Intensive Care Unit Acquired Weakness (ICUAW) is a highly prevalent neuromuscular complication affecting around 40% of critically ill patients, rising to over 80% in high-risk cohorts. It is independently associated with prolonged mechanical ventilation, increased intensive care unit (ICU) and hospital length of stay, elevated mortality (in-hospital, 1-year, and 5-year), higher healthcare costs, and long-term functional impairment. ICUAW is clinically defined by symmetric flaccid tetraparesis, frequently involving respiratory muscles, and exhibits significant pathobiological heterogeneity. Further subclassification is based on neurotopographic patterns: Critical Illness Polyneuropathy (CIP), Myopathy (CIM), and Polyneuromyopathy (CIPNM). Diagnosis typically relies on the Medical Research Council (MRC) Sum Score, with a threshold of <48 indicating clinically relevant weakness. While adjunct modalities such as electromyography/nerve conduction studies support assessment, their utility may be limited by patient cooperation and availability. Preventive strategies center on modifiable metabolic factors. Caloric and protein deficits exacerbate catabolism, while overfeeding—linked to anabolic resistance and stress hyperglycemia—also impairs recovery. To date, pharmacologic interventions remain inconclusive. However, early mobilization and neuromuscular electrical stimulation are promising non-pharmacologic strategies. The multifactorial and heterogeneous pathophysiology of ICUAW highlights the need for a biologically refined definition that can guide future targeted therapeutic interventions. Comprehensive multimodal strategies, together with structured long-term follow-up in Post-Intensive Care Syndrome (PICS) clinics, are essential for improving outcomes in this prevalent complication of critical care. Full article

Background: Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous disorder associated with substantial cardiometabolic morbidity. Although continuous positive airway pressure (CPAP) remains first-line therapy, long-term effectiveness is frequently limited by suboptimal adherence. Advances in airway devices, surgical techniques, neuromodulation, and pharmacologic therapies have expanded the therapeutic landscape and created opportunities for individualized, mechanism-based treatment. Methods: We conducted a selective, narrative review with structured quantitative synthesis of randomized controlled trials, comparative cohorts, long-term follow-up studies, registries, and mechanistic investigations addressing OSA therapies beyond CPAP. Evidence spanning oral appliances, upper-airway and skeletal surgery, hypoglossal nerve stimulation, neuromuscular electrical stimulation, positional therapy, and pharmacologic interventions targeting metabolic and non-anatomical endotypes was integrated. Outcomes of interest included apnea–hypopnea index (AHI), oxygenation, blood pressure, patient-reported symptoms, durability, safety, and real-world adherence. Results: Mandibular advancement devices (MADs) consistently reduced AHI relative to placebo and produced symptom relief comparable to CPAP in mild-to-moderate OSA, largely due to superior adherence. Palatal surgery yielded meaningful short-term improvement in selected patients but demonstrated limited long-term durability. In contrast, maxillomandibular advancement (MMA) achieved the largest and most durable reductions in OSA severity, with efficacy comparable to CPAP and superior to other surgical modalities in appropriate skeletal phenotypes. Hypoglossal nerve stimulation (HNS) produced substantial, durable improvements in AHI and symptoms with high adherence, supported by randomized trials, long-term follow-up, and real-world registry data; newer bilateral and proximal stimulation systems may further broaden candidacy. Neuromuscular electrical stimulation and positional therapy provided modest, phenotype-dependent benefits, primarily as adjunctive or early-stage interventions. A major advance is the emergence of metabolic and endotype-targeted pharmacotherapy: longitudinal data demonstrate a dose-dependent relationship between weight change and OSA progression or regression, while randomized trials show that GLP-1-based therapies—particularly dual GLP-1/GIP agonism with tirzepatide—produce large, clinically meaningful reductions in AHI and cardiometabolic risk in obesity-associated OSA. Additional pharmacologic strategies targeting ventilatory loop gain and arousal threshold further support an endotype-driven treatment paradigm. Conclusions: Contemporary OSA management is shifting from a CPAP-centric model toward a precision-guided, multimodal framework that aligns therapy with dominant anatomic and physiological contributors to airway collapse. Integrating metabolic, neuromodulatory, and structural interventions—often in combination—offers the potential for durable disease control and improved patient-centered outcomes. Future priorities include head-to-head and combination trials, long-term cardiovascular outcomes, cost-effectiveness analyses, and pragmatic tools to operationalize personalized OSA therapy in routine clinical practice. Full article

Background: To evaluate the effects of a motion-triggered neuromuscular electrical stimulation (NMES) shoulder strengthening program on rotational shoulder strength and throwing velocity in healthy, elite-level handball players. Methods: Fourteen male handball players were randomly allocated (1:1) to either the NMES or control group. Participants were assessed by a blinded investigator at baseline and after 6 weeks for clinical status, isometric dynamometer-based external (ER) and internal rotational (IR) maximal shoulder strength, and handball endurance and maximal throwing velocity (7 m free throw). Between time points, NMES subjects completed a standardized motion-triggered NMES shoulder strengthening program (3 sessions/week, 30 min for 6 weeks), whereas controls performed a conventional standardized strength program. Results: After completion of the motion-triggered NMES program, all NMES participants (100%) demonstrated significant gains in isometric ER strength (+1.4 ± 1.1 kg, p = 0.016) compared with 43% of controls, who demonstrated no overall improvement (−0.2 ± 1.8 kg, p = 0.740). Similarly, a significantly greater proportion of NMES participants improved endurance throwing velocity compared with controls (100% vs. 29%, p = 0.004), with a mean increase of +2.9 ± 2.8 km·h⁻¹ (p = 0.0.56). Maximum throwing velocity showed no between-group differences in the proportion of athletes with improved results (p = 0.899). Conclusions: A six-week motion-triggered NMES shoulder strengthening program improved external rotation strength and increased the proportion of athletes demonstrating enhanced endurance throwing velocity under fatigued conditions. However, when compared with conventional exercise alone, NMES did not confer additional benefits for maximal throwing velocity in this study. Therefore, NMES should be regarded as a complementary modality rather than a substitute for established shoulder strengthening exercises. Full article

Introduction: Sarcopenia and frailty are prevalent yet under-recognized contributors to disability, impaired quality of life, and adverse outcomes in chronic obstructive pulmonary disease (COPD). Shared mechanisms, including systemic inflammation, hormonal dysregulation, malnutrition, and physical inactivity, render these syndromes important targets for multimodal intervention. This review summarizes current evidence on exercise-based, nutritional, pharmacological, and adjunctive strategies for their management in COPD. Materials and Methods: This narrative review is based on a structured literature search of PubMed, Scopus, and Embase to identify relevant studies published between January 2000 and May 2025. Eligible publications included randomized controlled trials, meta-analyses, systematic reviews, and observational studies involving adults with COPD and documented sarcopenia and/or frailty. Interventions were categorized by modality, and outcomes included muscle mass, strength, physical performance, quality of life, and hospitalizations. Data were synthesized thematically. Results: Resistance and combined exercise training consistently improved muscle strength and physical function, while endurance training enhanced cardiorespiratory capacity, particularly within pulmonary rehabilitation programs. Nutritional interventions, especially protein, leucine, or β-hydroxy-β-methylbutyrate supplementation, supported gains in lean mass and exercise tolerance. Pharmacological strategies, including anabolic hormones and myostatin inhibitors, showed early promise but require further evaluation regarding safety and long-term efficacy. Adjunctive therapies, such as neuromuscular electrical stimulation and oxygen supplementation, benefited patients unable to participate in conventional exercise training. Conclusions: An integrated, multimodal approach combining structured exercise training and targeted nutritional support should be considered a cornerstone of COPD management to prevent and treat sarcopenia and frailty. Personalized rehabilitation strategies can substantially improve functional outcomes and quality of life, while future research should prioritize biomarker-guided personalization and long-term intervention studies. Full article

Background: Type 1 diabetes (T1D) is associated with metabolic and neuromuscular impairments that may influence fatigue mechanisms and limit exercise tolerance. Although previous investigations have characterized muscle performance in T1D, the peripheral fatigue threshold, defined as the maximal sustainable level of peripheral fatigue, remains poorly understood in this population. This study aimed to compare the amplitude of the maximal peripheral fatigue threshold between individuals with T1D and healthy controls to elucidate the effects of T1D on neuromuscular function. Methods: Twenty-two participants (11 with T1D and 11 healthy controls) completed two randomized experimental sessions. In each session, 60 quadriceps maximal voluntary contractions (MVCs) were completed, performed for 3 s with 2 s of rest between contractions. One session was conducted under a non-fatigued control condition (CTRL), and the other followed a fatiguing neuromuscular electrical stimulation (FNMES) protocol. Central and peripheral fatigue were evaluated from the pre- to post-exercise changes in potentiated twitch force (ΔPtw) and voluntary activation (ΔVA), respectively. Critical torque (CT) was calculated as the average torque produced during the last 12 contractions, whereas the curvature constant of the torque–duration relationship (W′) was quantified as the area above CT. Results: Although both groups exhibited a decline in pre-exercise Ptw following the FNMES condition, no significant within-group differences in ΔPtw were observed between sessions (T1D: p = 0.34; controls: p = 0.23). Nevertheless, the extent of peripheral fatigue was significantly lower in participants with T1D than in controls (ΔPtw = −38 ± 11% vs. −52 ± 17%; p < 0.05). Additionally, W′ values were reduced by 24% in the T1D group relative to controls during the CTRL condition (p = 0.02), and CT was significantly lower in T1D participants (262 ± 49 N) compared to controls (353 ± 71 N; p < 0.01). A significant positive correlation was observed between ΔPtw and W′ across groups (r² = 0.62, p < 0.001), suggesting a mechanistic link between peripheral fatigue tolerance and work capacity. Conclusions: The present results indicate that, although individuals with T1D retain the capacity to develop peripheral fatigue, their fatigue threshold and critical torque are markedly attenuated relative to those of healthy individuals. This reduction reflects impaired neuromuscular efficiency and diminished tolerance to sustained contractile activity. The strong relationship between peripheral fatigue and work capacity underscores the contribution of peripheral mechanisms to exercise intolerance in T1D. These results enhance current understanding of fatigue physiology in diabetes and emphasize the need for tailored exercise and rehabilitation strategies to improve fatigue resistance and functional performance in this population. Full article

As humanity continues to strive for extraplanetary exploration, which is quickly gaining marked governmental and industrial support and recognition, there are still substantial detriments to astronaut health during long-duration spaceflight (i.e., muscle atrophy) that must be addressed. The effects of long-duration spaceflight on muscle architecture, morphology, and function have been well documented since the Apollo and Space Shuttle Programs. Countermeasures focused on resistance or aerobic training, such as the Advanced Resistive Exercise Device, Multi-modal Exercise Device, flywheel exercise, and aerobic exercise on a mounted treadmill and/or a cycle ergometer with vibration isolation system, have been assessed to combat the functional and mechanical losses in muscle while astronauts are in low Earth orbit. However, a lesser-understood countermeasure to muscle atrophy during spaceflight is neuromuscular electrical muscle stimulation (NMES). Although utilization in spaceflight is limited, ground-based research on NMES in diseased or injured populations demonstrates its effectiveness as a promoter of muscle anabolism and growth. The previous literature has suggested the use of electrical muscle stimulation as a low-effort modality of exercise for astronauts, which could effectively enhance astronaut health and contribute to mission success. The efficacy and mechanisms of action of using NMES to attenuate atrophy in astronauts will be discussed in this review. Full article