Physiologic responses during functional electrical stimulation leg cycling and hybrid exercise in spinal cord injured subjects (original) (raw)
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Medicine and Science in Sports and Exercise, 2005
The purpose of the present study was to determine the effect of a 4-week training program on a newly developed hybrid functional electrical stimulation (FES)-cycle on physical fitness in spinal cord-injured (SCI) individuals. Ten SCI individuals (age 23-53 years, lesion level range T3-T11) participated and trained 8-12 times in 4 weeks on the hybrid FES-cycle (voluntary arm-contractions and stimulation of leg muscles). Leg volume was measured. During a graded hybrid exercise test, peak oxygen consumption (VO2peak), peak power output (POpeak) and power of the legs (dP) were measured pre and post training. Upper leg volume increased significantly (8.5% (p = 0.047) and 8.3% (p = 0.018) for the right and left leg, respectively). POpeak and VO2peak increased 11.7% (p = 0.012) and 9.3% (p = 0.015), respectively. There was no significant difference in dP between pre and post training. After only 4 weeks of training, considerable training effects were observed, which are comparable to longer training studies in literature. The results of this study indicate that hybrid training on the new hybrid FES-cycle is an appropriate training method for individuals with a spinal cord injury to increase physical fitness.
Medicine & Science in Sports & Exercise, 2013
Purpose: This study compared acute exercise responses during arm cranking, functional electrical stimulation (FES)-assisted leg cycling, and combined arm and leg (''hybrid'') cycling in individuals with spinal cord injury during maximal and submaximal exercise. Methods: Nine male subjects with long-standing neurological lesions from C7 to T12 were recruited. All subjects performed arm crank ergometry (ACE), FES leg cycle exercise (FES-LCE), combined ACE + FES-LCE, and cycling on a hybrid FES tricycle (HYBRID). They were assessed for their peak exercise responses in all four modalities. Subsequently, their submaximal heart rates (HR), cardiac outputs (Q), stroke volumes (SV), and arteriovenous oxygen extractions (Ca-Cv)O 2 were measured at 40%, 60%, and 80% of mode-specific V O 2peak . Results: Arm exercise alone and arm + leg exercise resulted in significantly higher V O 2peak and HR peak compared with FES-LCE (P G 0.05). Submaximal V O 2 during FES-LCE was significantly lower than all other modalities across the range of exercise intensities (P G 0.05). ACE elicited 70%-94% higher steady-state V O 2 , and HYBRID evoked 99%-148% higher V O 2 compared with FES-LCE. Steady-state FES-LCE also produced significantly lower Q, HR, and (Ca-Cv)O 2 . ACE evoked 31%-36% higher Q and 19%-47% greater HR than did FES-LCE. HYBRID elicited 31%-49% greater Q and 23%-56% higher HR than FES-LCE. Conclusions: Combined arm and leg exercise can develop a higher oxygen uptake and greater cardiovascular demand compared with ACE or FES-LCE alone. These findings suggested that combined arm + leg FES training at submaximal exercise intensities may lead to greater gains of aerobic fitness than would arm exercise alone. These data also proffered that FES leg cycling exercise by itself may be insufficient to promote aerobic fitness in the spinal cord injury population.
Journal of Rehabilitation Medicine, 2010
To determine the functional electrical stimulated (FES) cycling volume necessary to reach the recommended weekly exercise caloric expenditure of 1000-2200 kcal in FES-trained subjects with paraplegia. Subjects: Eight (7 males, 1 female) FES-trained subjects with traumatic motor and sensory complete paraplegia (AIS A, lesion level between Th3 and Th9) of at least 3 years duration were included. Methods: Subjects performed an FES-training session at the highest workload they were able to sustain for 60 min. During the training session respiratory gas exchange was measured, which allowed the calculation of mean fat and carbohydrate oxidation rates, and of total energy expenditure by means of indirect calorimetry. Results: Subjects revealed a mean energy expenditure of 288 (standard deviation 104) kcal/h. This corresponded to a mean oxidation rate of 49.5 (standard deviation 35.2) g/h for carbohydrate and 8.5 (standard deviation 8.4) g/hour for fat. Thus, 4-8 hours of FES-cycling are necessary to reach the recommended weekly exercise caloric expenditure of 1000-2200 kcal. Conclusion: FES-cycling appears to be a feasible and promising training alternative to upper body exercise for subjects with spinal cord injury. Four to 8 h of FES-cycling are necessary to reach the recommended weekly exercise caloric expenditure that seems to be essential to induce persistent health benefits.
The Journal of Rehabilitation Research and Development, 2008
Computer-controlled electrical stimulation (ES)induced leg cycle ergometer (ES-LCE) exercise can be beneficial for individuals with spinal cord injury (SCI), but exercise performance is often insufficient for eliciting continuous gains in cardiopulmonary training adaptations. The first purpose of this study was to determine whether a modified ES-LCE improved exercise performance and responses compared with the standard ES-LCE. Modifications to the ES-LCE included increased ES current amplitude (140-300 mA), added shank muscle activation, and increased ES firing angle ranges (+55°). The second purpose was to evaluate the effects of a 6-week interval training program (ITP) with this modified methodology on ES-LCE exercise performance, peak metabolic and cardiorespiratory responses, and muscle strength in experienced and novice riders. No significantly different peak values for power output and stroke volume were found for the two systems, but the modified ES-LCE elicited significantly higher peak values for oxygen uptake (+22%), carbon dioxide production (+51%), pulmonary ventilation (+37%), cardiac output (+32%), heart rate (+19%), and blood lactate concentration (+50%). Power output, metabolic rate, and lower-limb muscle strength increased significantly following training. This study showed that an ITP with the modified ES-LCE can elicit marked improvements in ES-LCE performance (peak power output), peak metabolic and cardiorespiratory responses, and muscle strength in men with SCI, even in those subjects whose performance has plateaued during training on the standard ES-LCE.
Artificial Organs, 2008
Functional electrical stimulation (FES)-induced leg exercise offers the potential for individuals with lowerlimb paralysis to otherwise gain some benefits conferred by leg exercise. Although its original intent is to reactivate the leg muscles to produce functional upright mobility, as a rehabilitation therapy, FES-evoked exercise increases the whole-body metabolism of individuals with spinal cord injury (SCI) so that they may gain general and localized health and fitness benefits. The physiological and psychosocial responses during FES-evoked cycling, standing, rowing, leg extension, or stepping have been extensively explored for over 20 years. Some of the advantages of such exercise include augmented cardiorespiratory fitness, promotion of leg blood circulation, increased activity of specific metabolic enzymes or hormones, greater muscle volume and fiber size, enhanced functional exercise capacity such as strength and endurance, and altered bone mineral density. Positive psychosocial adaptations have also been reported among SCI individuals who undergo FES exercise. This article presents a position review of the available literature on the effects of FES-evoked exercise since the earliest date until 2007, to warrant a conclusion about the current status and potential of FES-evoked exercise for paralyzed people.
Medicine, 2018
This study compared muscle oxygenation (StO2) during arm cranking (ACE), functional electrical stimulation-evoked leg cycling (FES-LCE), and hybrid (ACE+FES-LCE) exercise in spinal cord injury individuals. Eight subjects with C7-T12 lesions performed exercises at 3 submaximal intensities. StO2 was measured during rest and exercise at 40%, 60%, and 80% of subjects' oxygen uptake (VO2) peak using near-infrared spectroscopy. StO2 of ACE showed a decrease whereas in ACE+FES-LCE, the arm muscles demonstrated increasing StO2 from rest in all of VO2) peak respectively. StO2 of FES-LCE displayed a decrease at 40% VO2 peak and steady increase for 60% and 80%, whereas ACE+FES-LCE revealed a steady increase from rest at all VO2 peak. ACE+FES-LCE elicited greater StO2 in both limbs which suggested that during this exercise, upper- and lower-limb muscles have higher blood flow and improved oxygenation compared to ACE or FES-LCE performed alone.
International Journal of Sports and Exercise Medicine
The purpose of this study was to examine the performance and metabolic effects of two weeks of Arm Crank Ergometry (ACE) Sprint Interval Training (SIT) in men with Spinal Cord Injury (SCI). Eight paraplegic males 50.5 ± 9.0 yo, 180.8 ± 6.7 cm tall, 85.1 ± 19.5 kg, and 35.1 ± 5.7% body fat completed three Oral Glucose Tolerance Tests (OGTTs) at baseline, 2 weeks later, prior to SIT, and 48 hrs Post SIT. Six SIT sessions were performed on a Monark 891E ACE. Subjects cranked against 3.5% body mass for 30 sec, completing 4 sprints in session 1, then 5, 5, 6, 6, and 7 sprints in the final session. All data are presented as means ± SD with absolute change responses from baseline ± 95% confidence intervals and changes that failed to cross 0 considered significant. Peak and average power output increased across all subjects; peak power increased 11.9%, while average power increased 9.9%. AUC for neither glucose nor insulin significantly changed and ISI-Cederholm insulin sensitivity also failed to improve; OGTT change was 3.93 (-23.4, 31.3 95% CI). However, post-SIT plasma Non-Esterified Fatty Acids (NEFA) AUC dropped 0.34 (-0.53,-0.16 95% CI) mEq.L-1. In conclusion, two weeks of ACE SIT was effective at reducing NEFA in men with SCI, but did not improve insulin sensitivity or glucose levels. These data indicate that ACE SIT may be an effective adjunct training modality for those with SCI and other non-ambulatory populations.