ContentList volumes - List articles in this issue
Effect of lower extremity functional electrical stimulation pulsed isometric contractions on arm cycling peak oxygen uptake in spinal cord injured individuals
OBJECTIVE: To compare peak oxygen uptake (VO2peak) between: (i) functional electrical stimulation lower extremity pulsed isometric muscle contractions combined with arm cycling (FES iso hybrid), (ii) functional electrical stimulation cycling combined with arm cycling (FES hybrid cycling), and (iii) arm cycling exercise (ACE) in individuals with spinal cord injury with level of injury above and below T6.
DESIGN: Cross-over repeated measures design.
Methods/participants: Individuals with spinal cord injury (n = 15) with level of injury between C4 and T12, were divided into groups; above (spinal cord injury – high, n = 8) and below (spinal cord injury – low, n = 7) T6 level. On separate days, VO2peak was compared between: (i) ACE, (ii) FES iso hybrid, and (iii) FES hybrid cycling.
RESULTS: In the SCI–high group, FES iso hybrid increased VO2peak (17.6 (standard deviation (SD) 5.0) to 23.6 (SD 3.6) ml/kg/min; p = 0.001) and ventilation (50.4 (SD 20.8) to 58.2 (SD 20.7) l/min; p = 0.034) more than ACE. Furthermore, FES hybrid cycling resulted in a 6.8 ml/kg/min higher VO2peak (p = 0.001) and an 11.0 litres/minute (p = 0.001) higher ventilation. ACE peak workload was 10.5 W (p = 0.001) higher during FES hybrid cycling compared with ACE. In the spinal cord injury – low group, no significant differences were found between the modalities.
CONCLUSION: VO2peak increased when ACE was combined with FES iso hybrid or FES hybrid cycling in persons with spinal cord injury above the T6 level. Portable FES may serve as a less resource-demanding alternative to stationary FES cycling, and may have important implications for exercise prescription for spinal cord injury.
Berit Brurok, Tom Tørhaug, Trine Karlsen, Gunnar Leivseth, Jan Helgerud, Jan Hoff
St Olavs Hospital, Department of Physical Medicine and Rehabilitation, Spinal Cord Injury Unit , Olav Kyrresgt 17, 7006 Trondheim, Norway. E-mail: firstname.lastname@example.org
2. Krassioukov A, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog brain res 2006; 152: 223–229.
3. Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil 2007; 86: 142–152.
4. Verellen J, Vanlandewijck Y, Andrews B, Wheeler GD. Cardiorespiratory responses during arm ergometry, functional electrical stimulation cycling, and two hybrid exercise conditions in spinal cord injured. Disabil Rehabil Assist Technol 2007; 2: 127–132.
5. Hettinga DM, Andrews BJ. Oxygen consumption during functional electrical stimulation-assisted exercise in persons with spinal cord injury: implications for fitness and health. Sports Med 2008; 38: 825–838.
6. Phillips W, Burkett LN. Arm crank exercise with static leg fns in persons with spinal cord injury. Med Sci Sports Exerc 1995; 27: 530–535.
7. Davis GM, Hamzaid NA, Fornusek C. Cardiorespiratory, metabolic, and biomechanical responses during functional electrical stimulation leg exercise: Health and fitness benefits. Artif Organs 2008; 32: 625–629.
8. Brurok B, Helgerud J, Karlsen T, Leivseth G, Hoff J. Effect of aerobic high-intensity hybrid training on stroke volume and peak oxygen consumption in men with spinal cord injury. Am J Phys Med Rehabil 2011; 90: 407–414 410.1097/PHM.1090b1013e31820f31960f.
9. Donovan-Hall MK, Burridge J, Dibb B, Ellis-Hill C, Rushton D. The views of people with spinal cord injury about the use of functional electrical stimulation. Artif Organs 2011; 35: 204–211.
10. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004; 21: 1371–1383.
11. Phillips WT, Kiratli BJ, Sarkarati M, Weraarchakul G, Myers J, Franklin BA, et al. Effect of spinal cord injury on the heart and cardiovascular fitness. Curr Probl Cardiol 1998; 23: 641–716.
12. Bluvshtein V, Korczyn AD, Akselrod S, Pinhas I, Gelernter I, Catz A. Hemodynamic responses to head-up tilt after spinal cord injury support a role for the mid-thoracic spinal cord in cardiovascular regulation. Spinal Cord 2011; 49: 251–256.
13. Teasell RW. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil 2000; 81: 506–516.
14. >Waring WP, 3rd, Biering-Sorensen F, Burns S, Donovan W, Graves D, Jha A, et al. 2009 review and revisions of the International Standards for the Neurological Classification of Spinal Cord Injury. J Spinal Cord Med 2010; 33: 346–352.
15. Medicine ACoS. Acsm’s guidelines for exercise testing and prescription. 8th ed. Philadelphia: Wolters Kluwer Health Ltd.; 2009.
16. Åstrand PO, Rodahl K, Dahl HA, SB. Textbook of work physiology: Physiological bases of excercise. 4th ed. New York: McGraw-Hill; 2003.
17. Hooker SP, Figoni SF, Rodgers MM, Glaser RM, Mathews T, Suryaprasad AG, et al. Metabolic and hemodynamic responses to concurrent voluntary arm crank and electrical stimulation leg cycle exercise in quadriplegics. J Rehabil Res Dev 1992; 29: 1–11.
18. Faghri PD, Yount JP, Pesce WJ, Seetharama S, Votto JJ. Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury. Arch Phys Med Rehabil 2001; 82: 1587–1595.
19. Ashley EA, Laskin JJ, Olenik LM, Burnham R, Steadward RD, Cumming DC, et al. Evidence of autonomic dysreflexia during functional electrical stimulation in individuals with spinal cord injuries. Paraplegia 1993; 31: 593–605.
20. Krassioukov A. Autonomic dysreflexia: current evidence related to unstable arterial blood pressure control among athletes with spinal cord injury. Clin J Sport Med 2012; 22: 39–45.
21. Mutton DL, Scremin AM, Barstow TJ, Scott MD, Kunkel CF, Cagle TG. Physiologic responses during functional electrical stimulation leg cycling and hybrid exercise in spinal cord injured subjects. Arch Phys Med Rehabil 1997; 78: 712–718.
22. Verellen J, Vanlandewijc Y, Andrews B, Wheeler GD. Cardiorespiratory responses during arm ergometry, functional electrical stimulation cycling, and two hybrid exercise conditions in spinal cord injured. disability and rehabilitation assistive technology 2007; 2: 127–132.
23. Raymond J, Davis GM, Climstein M, Sutton JR. Cardiorespiratory responses to arm cranking and electrical stimulation leg cycling in people with paraplegia. Med Sci Sports Exerc 1999; 31: 822–828.
24. Raymond J, Davis GM, Fahey A, Climstein M, Sutton JR. Oxygen uptake and heart rate responses during arm vs combined arm/electrically stimulated leg exercise in people with paraplegia. Spinal Cord 1997; 35: 680–685.
25. Keteyian SJ, Brawner CA, Savage PD, Ehrman JK, Schairer J, Divine G, et al. Peak aerobic capacity predicts prognosis in patients with coronary heart disease. Am Heart J 2008; 156: 292–300.
26. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346: 793–801.
27. Groah SL, Weitzenkamp D, Sett P, Soni B, Savic G. The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured. Spinal Cord 2001; 39: 310–317.
View at PubMed