European Journal of Applied Physiology

, Volume 118, Issue 6, pp 1209–1219 | Cite as

Perfusion dynamics assessment with Power Doppler ultrasound in skeletal muscle during maximal and submaximal cycling exercise

  • H. M. Heres
  • T. Schoots
  • B. C. Y. Tchang
  • M. C. M. Rutten
  • H. M. C. Kemps
  • F. N. van de Vosse
  • R. G. P. Lopata
Original Article



Assessment of limitations in the perfusion dynamics of skeletal muscle may provide insight in the pathophysiology of exercise intolerance in, e.g., heart failure patients. Power doppler ultrasound (PDUS) has been recognized as a sensitive tool for the detection of muscle blood flow. In this volunteer study (N = 30), a method is demonstrated for perfusion measurements in the vastus lateralis muscle, with PDUS, during standardized cycling exercise protocols, and the test–retest reliability has been investigated.


Fixation of the ultrasound probe on the upper leg allowed for continuous PDUS measurements. Cycling exercise protocols included a submaximal and an incremental exercise to maximal power. The relative perfused area (RPA) was determined as a measure of perfusion. Absolute and relative reliability of RPA amplitude and kinetic parameters during exercise (onset, slope, maximum value) and recovery (overshoot, decay time constants) were investigated.


A RPA increase during exercise followed by a signal recovery was measured in all volunteers. Amplitudes and kinetic parameters during exercise and recovery showed poor to good relative reliability (ICC ranging from 0.2–0.8), and poor to moderate absolute reliability (coefficient of variation (CV) range 18–60%).


A method has been demonstrated which allows for continuous (Power Doppler) ultrasonography and assessment of perfusion dynamics in skeletal muscle during exercise. The reliability of the RPA amplitudes and kinetics ranges from poor to good, while the reliability of the RPA increase in submaximal cycling (ICC = 0.8, CV = 18%) is promising for non-invasive clinical assessment of the muscle perfusion response to daily exercise.


Power Doppler ultrasound Perfusion Exercise Skeletal muscle Test–retest reliability Probe fixation 



Anaerobic threshold


Contrast-enhanced ultrasound


Cardiopulmonary exercise test


Coefficient of variation




Intraclass coefficient


Mean response time


Power Doppler ultrasound


Pulse repetition frequency


Region of interest


Relative perfused area



This study was funded by the European Community’s Seventh Framework Programme (FP7/2007–2013) under Grant Agreement No. 318067.

Author contribution statement

MH, TS, HK, and RL conceived and designed the research. MH and TS conducted experiments and analyzed data. BT contributed to analytical and experimental tools. RL, FV and MR helped supervise the project. MH wrote the manuscript. All authors read and approved the manuscript.

Compliance with ethical standards

Conflict of interest

No conflicts of interest, financial or otherwise, are declared by the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiovascular Biomechanics Group, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
  2. 2.Department of CardiologyMáxima Medical CentreVeldhovenThe Netherlands

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