Sex-Specific Reliability of Lower-Limb Corticospinal Excitability and Silent Periods

Jason I. Pagan, Kylie K. Harmon, Ryan M. Girts, Rob J. Maclennan, Jonathan P. Beausejour, Jesus A. Hernandez-Sarabia, Nicholas A. Coker, Joshua C. Carr, Xin Ye, Jason M. Defreitas, Matt S. Stock

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Pagan, JI, Harmon, KK, Girts, RM, MacLennan, RJ, Beausejour, JP, Hernandez-Sarabia, JA, Coker, NA, Carr, JC, Ye, X, DeFreitas, JM, and Stock, MS. Sex-specific reliability of lower-limb corticospinal excitability and silent periods. J Strength Cond Res 37(9): 1882-1887, 2023 - Transcranial magnetic stimulation (TMS) is a research tool that has potential to provide new insights into strength training-induced adaptations. However, using TMS to study the lower limbs is challenging, and sex-specific reliability has yet to be reported. We examined the reliability of corticospinal excitability and silent periods for the rectus femoris, vastus lateralis, and biceps femoris in both sexes. Thirteen males and 14 females reported to the laboratory twice. During both trials, a double cone coil was used to deliver 20 pulses to the rectus femoris hotspot with a stimulator output of 130% of active motor threshold. Motor-evoked potential peak-to-peak amplitude, which reflects corticospinal excitability, and silent period duration were quantified. Our results offer 4 novel findings. First, corticospinal excitability and silent period demonstrated higher reliability for the females. Second, regardless of sex and muscle, the silent period was more reliable than corticospinal excitability. Third, reliability was highest for our target muscle (rectus femoris), with lower reliability for the vastus lateralis and biceps femoris, suggesting that these methods cannot be used to study coactivation. Fourth, active motor threshold showed less variability than corticospinal excitability and silent period but increased at trial 2 in females. Many of the intraclass correlation coefficients were excellent (≥0.90), although we attribute this finding to variability between subjects. Reliability of lower-limb TMS measures may be sex, muscle, and variable dependent. Our findings suggest that both males and females should be included in lower-limb TMS research, although combining data between sexes should be approached cautiously.

Original languageEnglish (US)
Pages (from-to)1882-1887
Number of pages6
JournalJournal of Strength and Conditioning Research
Issue number9
StatePublished - Sep 1 2023


  • TMS
  • cortical excitability
  • corticospinal inhibition
  • gender differences
  • knee extensors
  • motor cortex
  • sex differences

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine


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