Top

Published in:

01-09-2010 | Review Article

Physiological and methodological considerations for the use of neuromuscular electrical stimulation

Author: Nicola A. Maffiuletti

Published in: European Journal of Applied Physiology | Issue 2/2010

Abstract

The main aim of this review is to discuss some evidence-based physiological and methodological considerations for optimal use of neuromuscular electrical stimulation (NMES) in healthy and impaired skeletal muscles. After a quick overview of the main applications, interests and limits of NMES use, the first section concentrates on two crucial aspects of NMES physiology: the differences in motor unit recruitment pattern between NMES and voluntary contractions, and the involvement of the nervous system during peripheral NMES. The second section of the article focuses on the most common NMES parameters, which entail the characteristics of both the electrical current (the input) and the evoked contraction (the output).

Adams GR, Harris RT, Woodard D, Dudley GA (1993) Mapping of electrical muscle stimulation using MRI. J Appl Physiol 74:532–537PubMed

Amiridis I, Arabatzi F, Violaris P, Stavropoulos E, Hatzitaki V (2005) Static balance improvement in elderly after dorsiflexors electrostimulation training. Eur J Appl Physiol 94:424–433PubMedCrossRef

Babault N, Cometti G, Bernardin M, Pousson M, Chatard JC (2007) Effects of electromyostimulation training on muscle strength and power of elite rugby players. J Strength Cond Res 21:431–437PubMedCrossRef

Baker LL, Wederich C, McNeal D, Newsam CJ, Waters RL (2000) Neuromuscular electrical stimulation: a practical guide. Los Amigos Research and Educational Institute, Downey, CA

Bax L, Staes F, Verhagen A (2005) Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials. Sports Med 35:191–212PubMedCrossRef

Belanger M, Stein RB, Wheeler GD, Gordon T, Leduc B (2000) Electrical stimulation: can it increase muscle strength and reverse osteopenia in spinal cord injured individuals? Arch Phys Med Rehabil 81:1090–1098PubMedCrossRef

Binder-Macleod SA, Halden EE, Jungles KA (1995) Effects of stimulation intensity on the physiological responses of human motor units. Med Sci Sports Exerc 27:556–565PubMed

Boerio D, Jubeau M, Zory R, Maffiuletti NA (2005) Central and peripheral fatigue after electrostimulation-induced resistance exercise. Med Sci Sports Exerc 37:973–978PubMed

Brocherie F, Babault N, Cometti G, Maffiuletti N, Chatard JC (2005) Electrostimulation training effects on the physical performance of ice hockey players. Med Sci Sports Exerc 37:455–460PubMedCrossRef

Cabric M, Appell HJ, Resic A (1988) Fine structural changes in electrostimulated human skeletal muscle. Evidence for predominant effects on fast muscle fibres. Eur J Appl Physiol Occup Physiol 57:1–5PubMedCrossRef

Caggiano E, Emrey T, Shirley S, Craik RL (1994) Effects of electrical stimulation or voluntary contraction for strengthening the quadriceps femoris muscles in an aged male population. J Orthop Sports Phys Ther 20:22–28PubMed

Callaghan MJ, Oldham JA, Winstanley J (2001) A comparison of two types of electrical stimulation of the quadriceps in the treatment of patellofemoral pain syndrome. A pilot study. Clin Rehabil 15:637–646PubMedCrossRef

Collins DF (2007) Central contributions to contractions evoked by tetanic neuromuscular electrical stimulation. Exerc Sport Sci Rev 35:102–109PubMedCrossRef

Convertino VA (1996) Exercise as a countermeasure for physiological adaptation to prolonged spaceflight. Med Sci Sports Exerc 28:999–1014PubMed

Crameri RM, Weston AR, Rutkowski S, Middleton JW, Davis GM, Sutton JR (2000) Effects of electrical stimulation leg training during the acute phase of spinal cord injury: a pilot study. Eur J Appl Physiol 83:409–415PubMedCrossRef

Crevenna R, Marosi C, Schmidinger M, Fialka-Moser V (2006) Neuromuscular electrical stimulation for a patient with metastatic lung cancer—a case report. Support Care Cancer 14:970–973PubMedCrossRef

Currier DP, Mann R (1983) Muscular strength development by electrical stimulation in healthy individuals. Phys Ther 63:915–921PubMed

Dean JC, Yates LM, Collins DF (2007) Turning on the central contribution to contractions evoked by neuromuscular electrical stimulation. J Appl Physiol 103:170–176PubMedCrossRef

Deley G, Millet GY, Borrani F, Lattier G, Brondel L (2006) Effects of two types of fatigue on the VO(2) slow component. Int J Sports Med 27:475–482PubMedCrossRef

Delitto A, Rose SJ, McKowen JM, Lehman RC, Thomas JA, Shively RA (1988) Electrical stimulation versus voluntary exercise in strengthening thigh musculature after anterior cruciate ligament surgery. Phys Ther 68:660–663PubMed

Delitto A, Brown M, Strube MJ, Rose SJ, Lehman RC (1989) Electrical stimulation of quadriceps femoris in an elite weight lifter: a single subject experiment. Int J Sports Med 10:187–191PubMedCrossRef

Delitto A, Strube MJ, Shulman AD, Minor SD (1992) A study of discomfort with electrical stimulation. Phys Ther 72:410–421 (discussion on 421–424)PubMed

Dudley GA, Castro MJ, Rogers S, Apple DF Jr (1999) A simple means of increasing muscle size after spinal cord injury: a pilot study. Eur J Appl Physiol Occup Physiol 80:394–396PubMedCrossRef

Duvoisin MR, Convertino VA, Buchanan P, Gollnick PD, Dudley GA (1989) Characteristics and preliminary observations of the influence of electromyostimulation on the size and function of human skeletal muscle during 30 days of simulated microgravity. Aviat Space Environ Med 60:671–678PubMed

Enoka RM (2002a) Activation order of motor axons in electrically evoked contractions. Muscle Nerve 25:763–764PubMedCrossRef

Enoka RM (2002b) Neuromechanics of human movement. Human Kinetics, Champaign, IL

Eriksson E, Haggmark T (1979) Comparison of isometric muscle training and electrical stimulation supplementing isometric muscle training in the recovery after major knee ligament surgery. A preliminary report. Am J Sports Med 7:169–171PubMedCrossRef

Eriksson E, Haggmark T, Kiessling KH, Karlsson J (1981) Effect of electrical stimulation on human skeletal muscle. Int J Sports Med 2:18–22PubMedCrossRef

Feiereisen P, Duchateau J, Hainaut K (1997) Motor unit recruitment order during voluntary and electrically induced contractions in the tibialis anterior. Exp Brain Res 114:117–123PubMedCrossRef

Fitzgerald GK, Piva SR, Irrgang JJ (2003) A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 33:492–501PubMed

Gandevia SC (2001) Spinal and supraspinal factors in human muscle fatigue. Physiol Rev 81:1725–1789PubMed

Garnett R, Stephens JA (1981) Changes in the recruitment threshold of motor units produced by cutaneous stimulation in man. J Physiol 311:463–473PubMed

Gerovasili V, Stefanidis K, Vitzilaios K, Karatzanos E, Politis P, Koroneos A, Chatzimichail A, Routsi C, Roussos C, Nanas S (2009) Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study. Crit Care 13:R161PubMedCrossRef

Gibson JN, Smith K, Rennie MJ (1988) Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis. Lancet 2:767–770PubMedCrossRef

Gibson JN, Morrison WL, Scrimgeour CM, Smith K, Stoward PJ, Rennie MJ (1989) Effects of therapeutic percutaneous electrical stimulation of atrophic human quadriceps on muscle composition, protein synthesis and contractile properties. Eur J Clin Invest 19:206–212PubMedCrossRef

Glinsky J, Harvey L, Van Es P (2007) Efficacy of electrical stimulation to increase muscle strength in people with neurological conditions: a systematic review. Physiother Res Int 12:175–194PubMedCrossRef

Gondin J, Guette M, Ballay Y, Martin A (2005) Electromyostimulation training effects on neural drive and muscle architecture. Med Sci Sports Exerc 37:1291–1299PubMedCrossRef

Gondin J, Duclay J, Martin A (2006) Soleus- and gastrocnemii-evoked V-wave responses increase after neuromuscular electrical stimulation training. J Neurophysiol 95:3328–3335PubMedCrossRef

Gosker HR, Engelen MP, van Mameren H, van Dijk PJ, van der Vusse GJ, Wouters EF, Schols AM (2002) Muscle fiber type IIX atrophy is involved in the loss of fat-free mass in chronic obstructive pulmonary disease. Am J Clin Nutr 76:113–119PubMed

Gould N, Donnermeyer D, Gammon GG, Pope M, Ashikaga T (1983) Transcutaneous muscle stimulation to retard disuse atrophy after open meniscectomy. Clin Orthop Relat Res:190–197

Gregory CM, Bickel CS (2005) Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther 85:358–364PubMed

Hainaut K, Duchateau J (1992) Neuromuscular electrical stimulation and voluntary exercise. Sports Med 14:100–113PubMedCrossRef

Harris S, LeMaitre JP, Mackenzie G, Fox KA, Denvir MA (2003) A randomised study of home-based electrical stimulation of the legs and conventional bicycle exercise training for patients with chronic heart failure. Eur Heart J 24:871–878PubMedCrossRef

Henneman E, Somjen G, Carpenter DO (1965) Functional significance of cell size in spinal motoneurons. J Neurophysiol 28:560–580PubMed

Heyters M, Carpentier A, Duchateau J, Hainaut K (1994) Twitch analysis as an approach to motor unit activation during electrical stimulation. Can J Appl Physiol 19:451–461PubMed

Horstman AM, Beltman MJ, Gerrits KH, Koppe P, Janssen TW, Elich P, de Haan A (2008) Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke. Clin Physiol Funct Imaging 28:251–261PubMedCrossRef

Hortobagyi T, Lambert NJ, Tracy C, Shinebarger M (1992) Voluntary and electromyostimulation forces in trained and untrained men. Med Sci Sports Exerc 24:702–707PubMed

Hortobagyi T, Scott K, Lambert J, Hamilton G, Tracy J (1999) Cross-education of muscle strength is greater with stimulated than voluntary contractions. Mot Control 3:205–219

Howard JD, Enoka RM (1991) Maximum bilateral contractions are modified by neurally mediated interlimb effects. J Appl Physiol 70:306–316PubMed

Hultman E, Sjoholm H, Jaderholm-Ek I, Krynicki J (1983) Evaluation of methods for electrical stimulation of human skeletal muscle in situ. Pflugers Arch 398:139–141PubMedCrossRef

Jubeau M, Gondin J, Martin A, Sartorio A, Maffiuletti NA (2007) Random motor unit activation by electrostimulation. Int J Sports Med 28:901–904 PubMedCrossRef

Jubeau M, Sartorio A, Marinone PG, Agosti F, Van Hoecke J, Nosaka K, Maffiuletti NA (2008) Comparison between voluntary and stimulated contractions of the quadriceps femoris for growth hormone response and muscle damage. J Appl Physiol 104:75–81PubMedCrossRef

Kahanovitz N, Nordin M, Verderame R, Yabut S, Parnianpour M, Viola K, Mulvihill M (1987) Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 2: comparative analysis of electrical stimulation and exercises to increase trunk muscle strength and endurance. Spine (Phila Pa 1976) 12:112–118

Kanda F, Okuda S, Matsushita T, Takatani K, Kimura KI, Chihara K (2001) Steroid myopathy: pathogenesis and effects of growth hormone and insulin-like growth factor-I administration. Horm Res 56(Suppl 1):24–28PubMedCrossRef

Knaflitz M, Merletti R, De Luca CJ (1990) Inference of motor unit recruitment order in voluntary and electrically elicited contractions. J Appl Physiol 68:1657–1667PubMed

Knight CA, Kamen G (2005) Superficial motor units are larger than deeper motor units in human vastus lateralis muscle. Muscle Nerve 31:475–480PubMedCrossRef

Lai HS, De Domenico G, Strauss GR (1988) The effect of different electro-motor stimulation training intensities on strength improvement. Aust J Physiother 34:151–164

Lake DA (1992) Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries. Sports Med 13:320–336PubMedCrossRef

Lieber RL (1986) Skeletal muscle adaptability III: muscle properties following chronic electrical stimulation. Dev Med Child Neurol 28:662–670PubMedCrossRef

Lieber RL, Kelly MJ (1991) Factors influencing quadriceps femoris muscle torque using transcutaneous neuromuscular electrical stimulation. Phys Ther 71:715–721 (discussion 722–723)PubMed

Lieber RL, Kelly MJ (1993) Torque history of electrically stimulated human quadriceps: implications for stimulation therapy. J Orthop Res 11:131–141PubMedCrossRef

Lieber RL, Silva PD, Daniel DM (1996) Equal effectiveness of electrical and volitional strength training for quadriceps femoris muscles after anterior cruciate ligament surgery. J Orthop Res 14:131–138PubMedCrossRef

Lloyd T, De Domenico G, Strauss GR, Singer K (1986) A review of the use of electro-motor stimulation in human muscles. Aust J Physiother 32:18–30

Maffiuletti NA (2006) The use of electrostimulation exercise in competitive sport. Int J Sports Physiol Perform 1:406–407PubMed

Maffiuletti NA (2008) Caution is required when comparing the effectiveness of voluntary versus stimulated versus combined strength training modalities. Sports Med 38:437–438 (author reply 438–440)PubMedCrossRef

Maffiuletti NA, Dugnani S, Folz M, Di Pierno E, Mauro F (2002a) Effect of combined electrostimulation and plyometric training on vertical jump height. Med Sci Sports Exerc 34:1638–1644PubMedCrossRef

Maffiuletti NA, Pensini M, Martin A (2002b) Activation of human plantar flexor muscles increases after electromyostimulation training. J Appl Physiol 92:1383–1392PubMed

Maffiuletti NA, Pensini M, Scaglioni G, Ferri A, Ballay Y, Martin A (2003) Effect of electromyostimulation training on soleus and gastrocnemii H- and T-reflex properties. Eur J Appl Physiol 90:601–607PubMedCrossRef

Maffiuletti NA, Zory R, Miotti D, Pellegrino MA, Jubeau M, Bottinelli R (2006) Neuromuscular adaptations to electrostimulation resistance training. Am J Phys Med Rehabil 85:167–175PubMedCrossRef

Maffiuletti NA, Herrero AJ, Jubeau M, Impellizzeri FM, Bizzini M (2008) Differences in electrical stimulation thresholds between men and women. Ann Neurol 63:507–512PubMedCrossRef

Maffiuletti NA, Bramanti J, Jubeau M, Bizzini M, Deley G, Cometti G (2009) Feasibility and efficacy of progressive electrostimulation strength training for competitive tennis players. J Strength Cond Res 23:677–682PubMed

Malatesta D, Cattaneo F, Dugnani S, Maffiuletti NA (2003) Effects of electromyostimulation training and volleyball practice on jumping ability. J Strength Cond Res 17:573–579PubMedCrossRef

Martin V, Millet GY, Martin A, Deley G, Lattier G (2004) Assessment of low-frequency fatigue with two methods of electrical stimulation. J Appl Physiol 97:1923–1929PubMedCrossRef

Mayr W, Bijak M, Girsch W, Hofer C, Lanmuller H, Rafolt D, Rakos M, Sauermann S, Schmutterer C, Schnetz G, Unger E, Freilinger G (1999) MYOSTIM-FES to prevent muscle atrophy in microgravity and bed rest: preliminary report. Artif Organs 23:428–431PubMedCrossRef

Merrill DR (2009) Review of electrical stimulation in cerebral palsy and recommendations for future directions. Dev Med Child Neurol 51(Suppl 4):154–165PubMedCrossRef

Miller C, Thepaut-Mathieu C (1993) Strength training by electrostimulation conditions for efficacy. Int J Sports Med 14:20–28PubMedCrossRef

Morrissey MC (1988) Electromyostimulation from a clinical perspective. A review. Sports Med 6:29–41PubMedCrossRef

Newsam CJ, Baker LL (2004) Effect of an electric stimulation facilitation program on quadriceps motor unit recruitment after stroke. Arch Phys Med Rehabil 85:2040–2045PubMedCrossRef

Papaiordanidou M, Guiraud D, Varray A (2010) Kinetics of neuromuscular changes during low-frequency electrical stimulation. Muscle Nerve 41:54–62PubMedCrossRef

Petterson S, Snyder-Mackler L (2006) The use of neuromuscular electrical stimulation to improve activation deficits in a patient with chronic quadriceps strength impairments following total knee arthroplasty. J Orthop Sports Phys Ther 36:678–685PubMed

Pichon F, Chatard JC, Martin A, Cometti G (1995) Electrical stimulation and swimming performance. Med Sci Sports Exerc 27:1671–1676PubMed

Piva SR, Goodnite EA, Azuma K, Woollard JD, Goodpaster BH, Wasko MC, Fitzgerald GK (2007) Neuromuscular electrical stimulation and volitional exercise for individuals with rheumatoid arthritis: a multiple-patient case report. Phys Ther 87:1064–1077PubMedCrossRef

Querol F, Gallach JE, Toca-Herrera JL, Gomis M, Gonzalez LM (2006) Surface electrical stimulation of the quadriceps femoris in patients affected by haemophilia A. Haemophilia 12:629–632PubMedCrossRef

Quittan M, Wiesinger GF, Sturm B, Puig S, Mayr W, Sochor A, Paternostro T, Resch KL, Pacher R, Fialka-Moser V (2001) Improvement of thigh muscles by neuromuscular electrical stimulation in patients with refractory heart failure: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil 80:206–214 (quiz 215–216, 224)PubMedCrossRef

Reed B (1997) The physiology of neuromuscular electrical stimulation. Pediatr Phys Ther 9:96–102CrossRef

Roig M, Reid WD (2009) Electrical stimulation and peripheral muscle function in COPD: a systematic review. Respir Med 103:485–495PubMedCrossRef

Sale DG (1988) Neural adaptation to resistance training. Med Sci Sports Exerc 20:S135–S145PubMedCrossRef

Selkowitz DM (1985) Improvement in isometric strength of the quadriceps femoris muscle after training with electrical stimulation. Phys Ther 65:186–196PubMed

Smith GV, Alon G, Roys SR, Gullapalli RP (2003) Functional MRI determination of a dose–response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects. Exp Brain Res 150:33–39PubMed

Snyder-Mackler L, Ladin Z, Schepsis AA, Young JC (1991) Electrical stimulation of the thigh muscles after reconstruction of the anterior cruciate ligament. Effects of electrically elicited contraction of the quadriceps femoris and hamstring muscles on gait and on strength of the thigh muscles. J Bone Jt Surg Am 73:1025–1036

Snyder-Mackler L, Delitto A, Stralka SW, Bailey SL (1994) Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction. Phys Ther 74:901–907PubMed

Snyder-Mackler L, Delitto A, Bailey SL, Stralka SW (1995) Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation. J Bone Jt Surg Am 77:1166–1173

Stackhouse SK, Binder-Macleod SA, Stackhouse CA, McCarthy JJ, Prosser LA, Lee SC (2007) Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic cerebral palsy: a preliminary study. Neurorehabil Neural Repair 21:475–485PubMedCrossRef

Stefanovska A, Vodovnik L (1985) Change in muscle force following electrical stimulation. Dependence on stimulation waveform and frequency. Scand J Rehabil Med 17:141–146PubMed

Stevens JE, Mizner RL, Snyder-Mackler L (2004) Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series. J Orthop Sports Phys Ther 34:21–29PubMed

Suetta C, Aagaard P, Rosted A, Jakobsen AK, Duus B, Kjaer M, Magnusson SP (2004) Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse. J Appl Physiol 97:1954–1961PubMedCrossRef

Tanino Y, Daikuya S, Nishimori T, Takasaki K, Suzuki T (2003) M wave and H-reflex of soleus muscle before and after electrical muscle stimulation in healthy subjects. Electromyogr Clin Neurophysiol 43:381–384PubMed

Theurel J, Lepers R, Pardon L, Maffiuletti NA (2007) Differences in cardiorespiratory and neuromuscular responses between voluntary and stimulated contractions of the quadriceps femoris muscle. Respir Physiol Neurobiol 157:341–347PubMedCrossRef

Trimble MH, Enoka RM (1991) Mechanisms underlying the training effects associated with neuromuscular electrical stimulation. Phys Ther 71:273–280 (discussion 280–272)PubMed

Vanderthommen M, Duchateau J (2007) Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev 35:180–185PubMedCrossRef

Vanderthommen M, Depresseux JC, Dauchat L, Degueldre C, Croisier JL, Crielaard JM (2000) Spatial distribution of blood flow in electrically stimulated human muscle: a positron emission tomography study. Muscle Nerve 23:482–489PubMedCrossRef

Vanderthommen M, Duteil S, Wary C, Raynaud JS, Leroy-Willig A, Crielaard JM, Carlier PG (2003) A comparison of voluntary and electrically induced contractions by interleaved 1H- and 31P-NMRS in humans. J Appl Physiol 94:1012–1024PubMed

Vaquero AF, Chicharro JL, Gil L, Ruiz MP, Sanchez V, Lucia A, Urrea S, Gomez MA (1998) Effects of muscle electrical stimulation on peak VO₂ in cardiac transplant patients. Int J Sports Med 19:317–322PubMedCrossRef

Vivodtzev I, Pepin JL, Vottero G, Mayer V, Porsin B, Levy P, Wuyam B (2006) Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Chest 129:1540–1548PubMedCrossRef

Vivodtzev I, Lacasse Y, Maltais F (2008) Neuromuscular electrical stimulation of the lower limbs in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 28:79–91PubMed

Wust RC, Morse CI, de Haan A, Jones DA, Degens H (2008) Sex differences in contractile properties and fatigue resistance of human skeletal muscle. Exp Physiol 93:843–850PubMedCrossRef

Zizic TM, Hoffman KC, Holt PA, Hungerford DS, O’Dell JR, Jacobs MA, Lewis CG, Deal CL, Caldwell JR, Cholewczynski JG et al (1995) The treatment of osteoarthritis of the knee with pulsed electrical stimulation. J Rheumatol 22:1757–1761PubMed

Zory R, Boerio D, Jubeau M, Maffiuletti NA (2005) Central and peripheral fatigue of the knee extensor muscles induced by electromyostimulation. Int J Sports Med 26:847–853PubMedCrossRef

Title: Physiological and methodological considerations for the use of neuromuscular electrical stimulation
Author: Nicola A. Maffiuletti
Publication date: 01-09-2010
Publisher: Springer-Verlag
Published in: European Journal of Applied Physiology / Issue 2/2010
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI: https://doi.org/10.1007/s00421-010-1502-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Physiological and methodological considerations for the use of neuromuscular electrical stimulation

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2010

Early changes in vasoreactivity after simulated microgravity are due to an upregulation of the endothelium-dependent nitric oxide/cGMP pathway

Neural and morphological changes in response to a 20-day intense eccentric training protocol

Exercise-induced immune cell apoptosis: image-based model for morphological assessment

Acute resistance exercise reduces blood pressure and vascular reactivity, and increases endothelium-dependent relaxation in spontaneously hypertensive rats

Active biofeedback changes the spatial distribution of upper trapezius muscle activity during computer work

Obesity and catecholamine responses to maximal exercise in adolescent girls