To what extent do the muscles and tendons influence metabolic cost and exercise tolerance in the hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders?
Bibliographic record
Abstract
BACKGROUND: Individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) often experience chronic pain, muscle fatigue, and exercise intolerance, potentially due to altered muscle-tendon mechanics. This study investigated the influence of Achilles tendon (AT) compliance and plantar flexor muscle function on the metabolic cost of walking in individuals with and without HSD/hEDS. METHODS: Eleven individuals with HSD/hEDS and 11 age- and sex-matched controls completed walking trials at, below, and above their preferred walking speed. Achilles tendon stiffness, medial gastrocnemius muscle shortening, AT energy storage, pain, and lower limb electromyographic activity were evaluated during stance phase. The energy cost of walking was also computed. FINDINGS: The hypermobile conditions were associated with significantly lower AT stiffness, higher energy cost of walking and increased pain. Muscle fascicle shortening, shortening velocity, muscle energy cost and mechanical efficiency were similar between groups. Greater muscle activation and antagonist coactivation were observed in HSD/hEDS, particularly during early stance, likely reflecting compensatory mechanisms for joint instability. INTERPRETATION: Elevated cost of walking in HSD/hEDS appears driven not by increased plantar flexor work, but by a redistribution of joint work to more proximal joints. These findings suggest that altered muscle-tendon properties and neuromuscular control strategies contribute to exercise intolerance and fatigue in the Hypermobility Spectrum Disorders and hypermobile Ehlers-Danlos Syndrome.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".