A report of anticipated benefits of functional electrical stimulation after spinal cord injury (original) (raw)
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The Journal of Spinal Cord Medicine, 2014
Diet and exercise are cornerstones in the management of obesity and associated metabolic complications, including insulin resistance, type 2 diabetes, and disturbances in the lipid profile. However, the role of exercise in managing body composition adaptations and metabolic disorders after spinal cord injury (SCI) is not well established. The current review summarizes evidence about the efficacy of using neuromuscular electrical stimulation or functional electrical stimulation in exercising the paralytic lower extremities to improve body composition and metabolic profile after SCI. There are a number of trials that investigated the effects on muscle cross-sectional area, fat-free mass, and glucose/lipid metabolism. The duration of the intervention in these trials varied from 6 weeks to 24 months. Training frequency ranged from 2 to 5 days/week. Most studies documented significant increases in muscle size but no noticeable changes in adipose tissue. While increases in skeletal muscle size after twice weekly training were greater than those trials that used 3 or 5 days/week, other factors such as differences in the training mode, i.e. resistance versus cycling exercise and pattern of muscle activation may be responsible for this observation. Loading to evoke muscle hypertrophy is a key component in neuromuscular training after SCI. The overall effects on lean mass were modest and did not exceed 10% and the effects of training on trunk or pelvic muscles remain unestablished. Most studies reported improvement in glucose metabolism with the enhancement of insulin sensitivity being the major factor following training. The effect on lipid profile is unclear and warrants further investigation.
Journal of Electromyography and Kinesiology, 2009
Persons with spinal cord injury (SCI) are at a heightened risk of developing type II diabetes and cardiovascular disease. The purpose of this investigation was to conduct an analysis of metabolic, body composition, and neurological factors before and after 10 weeks of functional electrical stimulation (FES) cycling in persons with SCI. Eighteen individuals with SCI received FES cycling 2-3 times per week for 10 weeks. Body composition was analyzed by dual X-ray absorptiometry. The American Spinal Injury Association (ASIA) neurological classification of SCI test battery was used to assess motor and sensory function. An oral glucose tolerance (OGTT) and insulinresponse test was performed to assess blood glucose control. Additional metabolic variables including plasma cholesterol (total-C, HDL-C, LDL-C), triglyceride, and inflammatory markers (IL-6, TNF-a, and CRP) were also measured. Total FES cycling power and work done increased with training. Lean muscle mass also increased, whereas, bone and adipose mass did not change. The ASIA motor and sensory scores for the lower extremity significantly increased with training. Blood glucose and insulin levels were lower following the OGTT after 10 weeks of training. Triglyceride levels did not change following training. However, levels of IL-6, TNF-a, and CRP were all significantly reduced.
Does Upper Extremity Training Influence Body Composition after Spinal Cord Injury?
Aging and disease, 2015
Spinal cord injury (SCI) leads to serious body composition adaptations characterized by increasing whole body fat mass and decreased soft tissue lean mass (LM). These adaptations in body composition may lead to several cardio-metabolic disorders that reduce the quality of life, increase patients' and caregivers' burden and eventually leads to mortality. Exercise, an appropriate dietary regimen, and an active lifestyle may alleviate several of the negative effects on body composition after a SCI. Today however, there is no established consensus on the recommended dose, frequency or type of exercise to ameliorate several of the body composition sequelae after an acute SCI. Resistance training has been previously recommended as an effective strategy to restore soft tissue LM and decrease fat mass (FM). The strategy can be simply implemented as a routine home-based training program using free weights or resistance bands after a SCI. Additionally, upper extremity (UE) circuit resistance training has been previously used to improve cardiovascular and metabolic parameters after a SCI; however compared to the vast knowledge regarding the able-bodied (AB) population, the effects of UE circuit resistance training on body composition after a SCI is not well established. In summary, the available evidence does not support the rationale that UE circuit resistance training can lead to positive adaptations in body composition after a SCI. Further studies are suggested to examine the effects of UE circuit resistance training on body composition.
The Journal of Spinal Cord Medicine, 2016
Study design: Longitudinal design. Objectives: The study was undertaken to determine the effects of cessation of exercise interventions on body composition and metabolic profiles in men with chronic SCI. Settings: Clinical trials within a Medical Center. Methods: Eleven men with motor complete SCI were followed on average over a period of 2.5 years. Six men were involved in two different exercise interventions (functional electrical stimulation cycling versus arm cycling ergometer), 5 days/week for 16 weeks (exercise group), and five men served as a control (control group). Anthropometrics and dual energy X-ray absorptiometry (DXA) were captured to measure changes in lean mass (LM), fat mass (FM), percentage FM before, immediately after exercise, and after a period of 2.5 years. Basal metabolic rate (BMR) and lipid panel were also measured. Results: Thigh circumference increased by 8.5% following exercise (P = 0.042) and remained 6.4% greater than baseline measurements (P = 0.012). Leg LM increased by 9% following the exercise intervention (P = 0.03) and decreased by 16% in the follow-up visit (P = 0.02). Percentage trunk and total body FM increased by 4.5% (P = 0.008) and 3.5% (P = 0.019) in the follow-up visit, respectively, and whole body LM increased by 8.4% and decreased back by 5.4% following a 2.5 year-period. BMR significantly decreased by 15.5% following the exercise (P = 0.029) interventions. Conclusion: Exercise training is accompanied with positive changes in body composition as well as compensatory decrease in BMR, that regressed back following 2.5 years of exercise cessation. Participation in an exercise trial is unlikely to confound the measurements of a follow-up trial.
The Journal of Spinal Cord Medicine, 2020
The purpose of this pilot study was to determine the preliminary efficacy of interval functional electrical stimulation (FES) cycling combined with nutritional counseling in obese adults with SCI. Setting: Community-based individuals with chronic SCI. Participants: Ten participants with chronic SCI. Interventions: Participants were divided into 2 groups (1) FES cycling and nutritional counseling (FES & Nutri) and (2) nutritional counseling only (Nutri Only). The FES & Nutri group performed high intensity interval FES cycling for 30 min 3 times per week for 8 weeks and received nutritional counseling for 30 min once per week for 8 weeks. The Nutri Only group received the nutritional counseling only. Outcome Measures: Body composition (fat mass, lean mass, body fat percentage), blood glucose levels. Results: Participants in the FES & Nutri group had a statistically significant greater decrease in body fat percentage (M = −1.14) compared to those in the Nutri Only group (M = +0.28) and gained more lean mass in their legs (M = +0.66 kg) compared to the Nutri Only group (M =-1.05 kg). Discussion/Conclusion: The statistically significant decrease in body fat percentage for the FES & Nutri group provides evidence that further study is merited. Future studies should include larger numbers of participants and the possible introduction of a preliminary strengthening program before initiating interval FES cycling. In addition, an increase in exercise volume and a greater role for nutritional counseling should be considered in order to optimize the treatment for obesity.
Archives of Physical Medicine and Rehabilitation, 1999
Scremin AME, Kurta L, Gentili A, Wiseman B, Perell K, Kunkel C, Scremin OU. Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program. Arch Phys Med Rehabil 1999;80:1531-6. Objective: To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in personslwith spinal cord injury (SCI).
Archives of Physical Medicine and Rehabilitation, 2010
Jeon JY, Hettinga D, Steadward RD, Wheeler GD, Bell G, Harber V. Reduced plasma glucose and leptin after 12 weeks of functional electrical stimulation–rowing exercise training in spinal cord injury patients.To investigate the effects of exercise training with a functional electrical stimulation (FES) rowing machine on insulin resistance, plasma leptin levels, and body composition in people with spinal cord injury (SCI).Experimental study.A fitness and research center for people with disabilities.Healthy male participants with paraplegia (N=6) participated in the study (mean age, 48.6±6y; mean weight, 70.06±3.28kg; injury levels between T4-5 and T10).Twelve weeks of FES-rowing exercise training 3 to 4 times a week (600–800kcal).Peak oxygen consumption, plasma leptin, insulin, and glucose levels, insulin sensitivity, body composition.Twelve weeks of FES-rowing training improved aerobic fitness significantly (P=.048). In addition, plasma glucose and leptin levels were significantly decreased after exercise training by 10% and 28% (P<.028), respectively. A trend toward fat mass reduction was seen in 4 of the 6 subjects; this change did not reach statistical significance (P=.08).A 12-week training program that included FES rowing improved aerobic fitness and fasting glucose and leptin levels in the absence of significant change to body composition, fasting insulin levels, or calculated insulin sensitivity in people with SCI.
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.