The effect of FES-rowing training on cardiac structure and function: pilot studies in people with spinal cord injury

Gibbons, Robin; Stock, Christopher G; Andrews, B.J.; Gall, Angela; Shave, Rob

doi:10.1038/sc.2015.228

Cited by 28 publications

(23 citation statements)

References 45 publications

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“…Finally, the use of electrical stimulation of paralyzed leg muscles for either low force contraction ( Woelfel et al, 2017 ) or higher force activities such as cycling or rowing should be considered as a necessary adjunct to voluntary exercise. The supplement of electrical stimulation-based exercise should increase energy use, decrease overall body fat and perhaps in the case of rowing, even increase cardiovascular fitness in tetraplegia ( Taylor et al, 2014 ; Gibbons et al, 2016 ; Dolbow and Credeur, 2017 ; Dolbow et al, 2017 ). Given that bouts of voluntary exercise in those with tetraplegia are typically limited to a few minutes of continuous activity ( Gass et al, 1980 ), it will be important to incorporate as many strategies as possible to optimize the likelihood of generating a health benefit from exercise.…”

Section: Discussionmentioning

confidence: 99%

Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines

et al. 2018

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The World Health Organization recognizes obesity as a global and increasing problem for the general population. Because of their reduced physical functioning, people with spinal cord injury (SCI) face additional challenges for maintaining an appropriate whole body energy balance, and the majority with SCI are overweight or obese. SCI also reduces exercise capacity, particularly in those with higher-level injury (tetraplegia). Tetraplegia-specific caloric energy expenditure (EE) data is scarce. Therefore, we measured resting and exercise-based energy expenditure in participants with tetraplegia and explored the accuracy of general population-based energy use predictors. Body composition and resting energy expenditure (REE) were measured in 25 adults with tetraplegia (C4/5 to C8) and in a sex-age-height matched group. Oxygen uptake, carbon dioxide production, heart rate, perceived exertion, and exercise intensity were also measured in 125 steady state exercise trials. Those with motor-complete tetraplegia, but not controls, had measured REE lower than predicted (mean = 22% less, p < 0.0001). REE was also lower than controls when expressed per kilogram of lean mass. Nine had REE below 1200 kcal/day. We developed a graphic compendium of steady state EE during arm ergometry, wheeling, and hand-cycling. This compendium is in a format that can be used by persons with tetraplegia for exercise prescription (calories, at known absolute intensities). EE was low (55–450 kcal/h) at the intensities participants with tetraplegia were capable of maintaining. If people with tetraplegia followed SCI-specific activity guidelines (220 min/week) at the median intensities we measured, they would expend 563–1031 kcal/week. Participants with tetraplegia would therefore require significant time (4 to over 20 h) to meet a weekly 2000 kcal exercise target. We estimated total daily EE for a range of activity levels in tetraplegia and compared them to predicted values for the general population. Our analysis indicated that the EE values for sedentary through moderate levels of activity in tetraplegia fall well below predicted sedentary levels of activity for the general population. These findings help explain sub-optimal responses to exercise interventions after tetraplegia, and support the need to develop tetraplegia-specific energy-balance guidelines that reflects their unique EE situation.

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Section: Discussionmentioning

confidence: 99%

Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines

et al. 2018

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“…In AB individuals with and without diastolic dysfunctions, exercise training is associated with favorable improvements in indices of global LV function and diastolic LV mechanics. 40,41 In individuals with SCI, exercise-training studies examining cardiac outcomes are limited to lower-limb interventions 42,43 or hybrid training (active arm with lower limb functional electrical stimulation) 44 where positive cardiac adaptations have been reported, likely due to the facilitation of venous return by activation of the muscle pump. Given the cross-sectional nature of our study, it is unknown whether exercisetraining post-SCI prevented the reduction in diastolic function observed in UT or helped recover it normative levels.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia

Currie

West

Stöhr

et al. 2017

Journal of Neurotrauma

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Reduced left ventricular (LV) function is common in tetraplegia, yet it is unknown whether intrinsic myocardial function is attenuated. This study examined the effect of SCI and exercise-training status on LV mechanics (intrinsic function) and LV systolic/diastolic function by comparing untrained (UT) and trained (TT) individuals with tetraplegia and able-bodied (AB) individuals. Individuals with tetraplegia had a traumatic, chronic, motor-complete cervical spinal cord injury. Nine UT males (40 ± 10 years), 8 TT males (30 ± 5 years), and nine AB males (37 ± 9 years) participated in the study. LV indices were assessed using two-dimensional transthoracic echocardiography, with speckle-tracking analysis for the determination of LV mechanics. For systolic function, stroke volumes were lower in both UT (59 ± 9 mL; p < 0.001) and TT (63 ± 9 mL; p < 0.001) relative to AB (82 ± 11 mL), whereas systolic mechanics were similar across groups. Diastolic function was only reduced in UT, including a lower ratio of early-to-late transmitral filling velocity (1.55 ± 0.28) relative to TT (2.07 ± 0.42; p < 0.05) and AB (2.44 ± 0.61; p < 0.01) and longer isovolumetric relaxation times in UT (101 ± 7 ms) relative to TT (88 ± 11 ms; p < 0.05) and AB (85 ± 6 ms; p < 0.01). Diastolic mechanics (apical circumferential strain rate) were significantly enhanced in TT (3.03 ± 0.83 s) compared to AB (1.85 ± 0.65 s; p < 0.05). There was a trend (p = 0.062) for a between-group difference in apical radial diastolic strain rate (UT: -2.51 ± 0.83 s; TT: -3.92 ± 1.96 s; AB: -1.84 ± 0.46 s). In tetraplegia, attenuated LV systolic function is not attributed to intrinsic dysfunction, whereas exercise-training status appears to improve both global LV diastolic function and LV mechanics.

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“…Recent pilot studies suggest that a structured program of FES rowing may prevent the onset of CVD in chronic SCI, and mitigate SCI‐induced osteoporosis . Furthermore, an increase in steady‐state power output can be expected providing training compliance is maintained .…”

Section: Overview Of the Primary Life Threatening Secondary Conditionmentioning

confidence: 99%

“…Furthermore, an increase in steady‐state power output can be expected providing training compliance is maintained . Importantly, the volume and intensity of FES rowing training represents a dramatic increase in physical activity above normal ADL, especially in tetraplegia . Recently, we have reported significant force actions during FES rowing, exceeding 1.5 times BW, which have produced widely distributed stresses in the tibia, a bone highly susceptible to fragility fracture following SCI .…”

Section: Overview Of the Primary Life Threatening Secondary Conditionmentioning

confidence: 99%

Development of Functional Electrical Stimulation Rowing: The Rowstim Series

2017

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Potentially, functional electrical stimulation (FES)-assisted exercise may have an important therapeutic role in reducing comorbidities associated with spinal cord injury (SCI). Here, we present an overview of these secondary life-threatening conditions, discuss the rationale behind the development of a hybrid exercise called FES rowing, and describe our experience in developing FES rowing technology. FES rowing and sculling are unique forms of adaptive rowing for those with SCI. The paralyzed leg musculature is activated by multiple channels of electrical pulses delivered via self-adhesive electrodes attached to the skin. The stimulated muscle contractions are synchronized with voluntary rowing movements of the upper limbs. A range of steady-state FES rowing exercise intensities have been demonstrated from 15.2 ± 1.8 mL/kg/min in tetraplegia to 22.9 ±7.1 mL/kg/min in paraplegia. We expect that such high levels may help some to achieve significant reductions in the risks to their health, particularly where a dose-response relationship exists as is the case for cardiovascular disease and Type II diabetes. Furthermore, preliminary results suggest that cyclical forces more than 1.5 times body weight are imposed on the leg long bones which may help to reduce the risk of fragility fractures. We have demonstrated the feasibility of FES rowing on land and water using adapted rowing technology that includes; a fixed stretcher indoor ergometer (adapted Concept 2, Model E), a floating stretcher indoor ergometer (adapted Concept 2 Dynamic), a turbine powered water rowing tank, a custom hydraulic sculling simulator and a single scull (adapted Alden 16). This has involved volunteers with paraplegia and tetraplegia with SCI ranging from C4 to T12 AIS A using at least 4-channels of surface electrical stimulation. FES rowers, with SCI, have competed alongside non-SCI rowers over the Olympic distance of 2000 m at the British Indoor Rowing Championships in 2004, 2005, and 2006 and the World Indoor Rowing Championships in 2006 (CRASH-B's) in Boston, MA, USA. The best 2000 m FES rowing performance to date has been achieved by a 23-year-old male, Tom Aggar T12 AIS A, in 10 min 28 s. Moreover, two of our FES rowers with complete paraplegia have gone on to successfully compete in the Adaptive Rowing arms-only category (AM1x) at the World Rowing Championships and Paralympic Games.

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The effect of FES-rowing training on cardiac structure and function: pilot studies in people with spinal cord injury

Abstract: We thank the INSPIRE Foundation, UK, for funding these studies.

Cited by 28 publications

References 45 publications

Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines

Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines

Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia

Development of Functional Electrical Stimulation Rowing: The Rowstim Series

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