The relationship between perception of effort and physiological responses to an acute fatiguing task of the elbow flexors. Evaluation of a new rating scale of perception of effort

Abstract

While fatigue is a common daily phenomenon, the exact relationship between perception of effort and fatigue is still unknown. Existing tools for assessing perception of effort are effectively limited to whole body exercise, while current methods for assessing voluntary activation are painful and not feasible for clinical application. The main aims of this thesis were to evaluate existing methodologies for their appropriateness in assessing perception of effort and voluntary activation following isolated muscle function testing, and to examine the relationship between subjective perception of effort and objective changes in the healthy motor control system. The implementation of reliable and valid assessment tools in clinical practice may enable clarification of the pathogenesis of many neurological conditions that have chronic fatigue as a key feature. Four studies of within-subjects repeated measures design have been conducted. Sixtynine healthy volunteers were recruited among staff and students of Brunel University. Magnetic stimulation was tested as a valid alternative to electrical stimulation in the conventional single-pulse Twitch Interpolation Technique. The 0–10 Numeric Rating Scale (NRS) was also tested for its reliability and validity in assessing the perception of effort during isometric exercise of elbow flexors. The changes of perception of effort following a submaximal elbow flexion fatiguing task, as well as following transcranial direct current stimulation (tDCS) over the motor cortex were also tested. The main findings showed significant differences between peripheral and magnetic stimulation in conventional single-pulse Twitch Interpolation Technique. The 0–10 NRS demonstrated linear properties and reported excellent test-retest reliability and good concurrent criterion validity in recording perception of effort under repeated isometric contractions of elbow flexors. Ten minutes of a submaximal intermittent isometric fatiguing exercise produced a significant elevation in rating of perceived effort, which was associated with central and peripheral neurophysiological changes of the motor control system. In contrast, perception of effort did not change significantly following 10 minutes of tDCS. The major findings of this thesis suggest the 0–10 NRS is a valid and reliable scale for rating perception of effort in healthy individuals. Further testing of the scale on patients is needed to establish its validity in clinical settings. Additionally, the findings indicate a substantial role of perception of effort in the voluntary motor control system. However, further research towards revealing the underlying mechanisms of perceived effort regulation in both health and disease is required.