Muscle metabolism and activation heterogeneity by combined 31P chemical shift and T2 imaging, and pulmonary O2 uptake during incremental knee-extensor exercise

The integration of skeletal muscle substrate depletion, metabolite accumulation, and fatigue during large muscle-mass exercise is not well understood. Measurement of intramuscular energy store degradation and metabolite accumulation is confounded by muscle heterogeneity. Therefore, to characterize regional metabolic distribution in the locomotor muscles, we combined P-31 magnetic resonance spectroscopy, chemical shift imaging, and T-2-weighted imaging with pulmonary oxygen uptake during bilateral knee-extension exercise to intolerance. Six men completed incremental tests for the following: 1) unlocalized P-31 magnetic resonance spectroscopy; and 2) spatial determination of P-31 metabolism and activation. The relationship of pulmonary oxygen uptake to whole quadriceps phosphocreatine concentration ([PCr]) was inversely linear, and three of four knee-extensor muscles showed activation as assessed by change in T-2. The largest changes in [PCr], [inorganic phosphate] ([Pi]) and pH occurred in rectus femoris, but no voxel (72 cm(3)) showed complete PCr depletion at exercise cessation. The most metabolically active voxel reached 11 +/- 9 mM [PCr] (resting, 29 +/- 1 mM), 23 +/- 11 mM [Pi] (resting, 7 +/- 1 mM), and a pH of 6.64 +/- 0.29 (resting, 7.08 +/- 0.03). However, the distribution of P-31 metabolites and pH varied widely between voxels, and the intervoxel coefficient of variation increased between rest (similar to 10%) and exercise intolerance (similar to 30-60%). Therefore, the limit of tolerance was attained with wide heterogeneity in substrate depletion and fatigue-related metabolite accumulation, with extreme metabolic perturbation isolated to only a small volume of active muscle (<5%). Regional intramuscular disturbances are thus likely an important requisite for exercise intolerance. How these signals integrate to limit muscle power production, while regional "recruitable muscle" energy stores are presumably still available, remains uncertain.