Intermittent neck flexion induces greater sternocleidomastoid deoxygenation than inspiratory threshold loading.

Purpose: To compare deoxygenation of the sternocleidomastoid, scalenes, and diaphragm/intercostals (Dia/IC) during submaximal intermittent neck flexion (INF) versus submaximal inspiratory threshold loading (ITL) in healthy adults.

Methods: Fourteen participants performed a randomized, cross-over, repeated measures design. After evaluation of maximal inspiratory pressures (MIP) and maximum voluntary contraction (MVC) for isometric neck flexion, participants were randomly assigned to submaximal ITL or INF until task failure. At least 2 days later, they performed the submaximal exercises in the opposite order. ITL or INF targeted 50 ± 5% of the MIP or MVC, respectively, until task failure. Near-infrared spectroscopy (NIRS) was applied to evaluate changes of deoxy-hemoglobin (ΔHHb), oxy-hemoglobin (ΔOHb), total hemoglobin (ΔtHb), and tissue saturation of oxygen (StO) of the sternocleidomastoid, scalenes, and Dia/IC. Breathlessness and perceived exertion were evaluated using Borg scales.

Results: Initially during INF, sternocleidomastoid HHb slope was greatest compared to the scalenes and Dia/IC. At isotime (6.5-7 min), ΔtHb (a marker of blood volume) and ΔOHb of the sternocleidomastoid were higher during INF than ITL. Sternocleidomastoid HHb, OHb, and tHb during INF also increased at quartile and task failure timepoints. In contrast, scalene ΔOHb was higher during ITL than INF at isotime. Further, Dia/IC OHb and tHb increased during ITL at the third quartile and at task failure. Borg scores were lower at task failure during INF compared to ITL.

Conclusion: Intermittent INF induces significant metabolic activity of the sternocleidomastoid and a lower perception of effort, which may provide an alternative inspiratory muscle training approach for mechanically ventilated patients.