Fatiguing Neuromuscular Electrical Stimulation Decreases the Sense of Effort During Subsequent Voluntary Contractions in Men.

As voluntary muscle fatigue increases, the perception of the effort required to produce a particular level of force also increases. This occurs because we produce greater neural outputs from the brain to compensate for the fatigue-induced loss of force. Muscle fatigue can also be generated following bouts of neuromuscular electrical stimulation (NMES), a technique widely used for rehabilitation and training purposes. Yet the effects of NMES-induced fatigue on the perception of effort have never been tested. In this study, we thus evaluated how electrically evoked fatigue would affect the sense of effort. For this purpose, we used two psychophysical tasks intended to assess effort perception: (i) a bilateral matching task in which subjects were asked to contract the elbow flexors of their reference and indicator arms with similar amounts of effort and (ii) a unilateral matching task in which they produced controlled levels of isometric force with their indicator arm and rated their perceived effort using the Borg CR10 scale. These tasks were performed before and after the biceps brachii of the indicator arm was submitted to a fatiguing NMES program that generated maximal force losses of 10-15%. Contrary to voluntary muscle fatigue, the sense of effort decreased post-NMES in both tasks despite increased neural outputs to the elbow flexors of the fatigued indicator arm. This shows that the relationship between motor command magnitude and effort perception was completely modified by NMES. It is proposed that NMES alters the sensory structures responsible for effort signal integration.