Musculoskeletal effects of an electrical stimulation induced cycling programme in the spinal injured

Sloan, Karen; Bremner, Lesley A.; Byrne, Jeannette M.; Day, Robert E.; Scull, Edward

doi:10.1038/sc.1994.67

Cited by 56 publications

(45 citation statements)

References 11 publications

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“…27,38 ± 41 After 3 months with the same amount of training as in the present study Sloan et al 40 found an increase of 9% in the quadriceps, whereas no change was seen in the hamstrings. Block et al 39 found a signi®cant increase in cross sectional area of the anterior muscle group of the thigh after 6 weeks of training whereas Bremner et al 41 found no change and explained this by a small sample size.…”

Section: Thigh Girthsupporting

confidence: 59%

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

et al. 1997

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Spinal cord injured (SCI) individuals most often contract their injury at a young age and are deemed to a life of more or less physical inactivity. In addition to the primary implications of the SCI, severe SCI individuals are stigmatized by conditions related to their physically inactive lifestyle. It is unknown if these inactivity related conditions are potentially reversible and the aim of the present study was, therefore, to examine the e ect of exercise on SCI individuals. Ten such individuals (six with tetraplegia and four with paraplegia; age 27 ± 45 years; time since injury 3 ± 23 years) were exercise trained for 1 year using an electrically induced computerized feedback controlled cycle ergometer. They trained for up to three times a week (mean 2.3 times), 30 min on each occasion. The gluteal, hamstring and quadriceps muscles were stimulated via electrodes placed on the skin over their motor points. During the ®rst training bouts, a substantial variation in performance was seen between the subjects. A majority of them were capable of performing 30 min of exercise in the ®rst bout; however, two individuals were only able to perform a few minutes of exercise. After training for 1 year all of the subjects were able to perform 30 min of continuous training and the work output had increased from 4+1 (mean+SE) to 17+2 Kilo Joules per training bout (P50.05). The maximal oxygen uptake during electrically induced exercise increased from 1.20+0.08 litres per minute measured after a few weeks habituation to the exercise to 1.43+0.09 litres per minute after training for 1 year (P50.05).Magnetic resonance cross sectional images of the thigh were performed to estimate muscle mass and an increase of 12% (mean, P50.05) was seen in response to 1 year of training. In biopsies taken before exercise various degrees of atrophy were observed in the individual muscle ®bres, a phenomenon that was partially normalized in all subjects after training.The ®bre type distribution in skeletal muscles is known to shift towards type IIB ®bres (fast twitch, fast fatiguable, glycolytic ®bres) within the ®rst 2 years after the spinal cord injury. The muscle in the present investigation contained of 63% myosin heavy chain (MHC) isoform IIB, 33% MHC isoform IIA (fast twitch, fatigue resistant) and less than 5% MHC isoform I (slow twitch) before training. A shift towards more fatigue resistant contractile proteins was found after 1 year of training. The percentage of MHC isoform IIA increased to 61% of all contractile protein and a corresponding decrease to 32% was seen in the fast fatiguable MHC isoform IIB, whereas MHC isoform I only comprised 7% of the total amount of MHC. This shift was accompanied by a doubling of the enzymatic activity of citrate synthase, as an indicator of mitochondrial oxidative capacity.It is concluded that inactivity-associated changes in exercise performance capacity and skeletal muscle occurring in SCI individuals after injury are reversible, even up to over 20 years after the injury. It follows that electricall...

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Section: Thigh Girthsupporting

confidence: 59%

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

et al. 1997

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“…All were classified as level 4 or 5, with the exception of one level 2 trial. Training programs involving BWSTT, 32,34,35 FES cycling, 30,31,[36][37][38] FES ambulation, 39,40 neuromuscular electrical stimulation resistance training 41 and vibration exercise 42 produced significant increases in muscle mass, with training frequencies ranging from 2-7 Â per week, for 8-52 weeks duration. Of note, the level 2 trial showed significant increases in quadriceps muscle mass after 26 weeks of FES-assisted treadmill training, 2 times per week for 20 min per session.…”

Section: Standingmentioning

confidence: 99%

The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review

et al. 2011

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Study design: Systematic review. Objectives: To conduct a systematic review of evidence surrounding the effects of exercise on physical fitness in people with spinal cord injury (SCI). Setting: Canada. Methods: The review was limited to English-language studies (published prior to March 2010) of people with SCI that evaluated the effects of an exercise intervention on at least one of the four main components of physical fitness (physical capacity, muscular strength, body composition and functional performance). Studies reported at least one of the following outcomes: oxygen uptake/consumption, power output, peak work capacity, muscle strength, body composition, exercise performance or functional performance. A total of 166 studies were identified. After screening, 82 studies (69 chronic SCI; 13 acute SCI) were included in the review. The quality of evidence derived from each study was evaluated using established procedures. Results: Most studies were of low quality; however, the evidence was consistent that exercise is effective in improving aspects of fitness. There is strong evidence that exercise, performed 2-3 times per week at moderate-to-vigorous intensity, increases physical capacity and muscular strength in the chronic SCI population; the evidence is not strong with respect to the effects of exercise on body composition or functional performance. There were insufficient high-quality studies in the acute SCI population to draw any conclusions. Conclusions: In the chronic SCI population, there is good evidence that exercise is effective in improving both physical capacity and muscular strength, but insufficient quality evidence to draw meaningful conclusions on its effect on body composition or functional capacity.

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“…27 The expected favorable effect of FES has nevertheless not been confirmed by most 3-12-month FES programs, whether or not they were associated with cycling or assisted walking. 22,26,66,[77][78][79][80] Rodgers et al 78 used electrical stimulation of the quadriceps muscles in a knee extension exercise and reported that the bone density at the tibia remained unchanged despite improved muscle performance. The differences in training program characteristics (session frequency, training duration, and intensity) might explain these inconsistent findings.…”

Section: Physical Exercisementioning

confidence: 99%

Bone loss in spinal cord-injured patients: from physiopathology to therapy

et al. 2005

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Study design: Review article on bone metabolism and therapeutic approach on bone loss in patients with spinal cord injury (SCI). Objective: The first part aims to describe the process of bone demineralization and its effects on bone mass in patients with SCI. The second part describes and discusses the therapeutic approaches to limiting the alteration in bone metabolism related to neurological lesions. Setting: Propara Rehabilitation Center, Montpellier, France. Results: During the first 24 months postinjury, demineralization occurs exclusively in the sublesional areas and predominantly in weight-bearing skeletal sites such as the distal femur and proximal tibia, both of which are trabecular-rich sites. Reduced bone mass, in association with a modified bone matrix property and composition, is very likely at the origin of pathological fractures after minor trauma to which these patients are frequently exposed. Since these fractures may be asymptomatic yet may lead to complications, preventing and managing 'neurological osteoporosis' remains a considerable challenge. Two main approaches are considered: the first consists in applying a mechanical stimulus to the bone tissue by standing, orthotically aided walking or functional electrical stimulation (FES). The second uses medications, particularly antiresorptive drugs such as calcitonin or diphosphonates. Conclusion: To develop well-adapted treatments, a more precise understanding of bone loss etiology is needed. The current rehabilitation programs are based on the idea that the bone physiological changes observed in patients with SCI are due to immobility, but results indicate that alterations inherent to neurological damage may play an even greater role in inducing osteoporosis.

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Musculoskeletal effects of an electrical stimulation induced cycling programme in the spinal injured

Cited by 56 publications

References 11 publications

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review

Bone loss in spinal cord-injured patients: from physiopathology to therapy

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