FES Cycle Ergometry
Author Year; Country Score Research Design Total Sample Size |
Methods | Outcome |
---|---|---|
Craven et al. 2017; Canada PEDro = RCT Level 1 N=34 |
Population: 34 participants (26 men, 8 women) with chronic traumatic SCI; C2-T12; age: 55 years; TPI: 5 years; 13 AIS C, 20 AIS D. |
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Johnston et al. 2016; USA PEDro = 5 RCT Level 1 N=17 |
Population: 17 participants (14 men, 3 women); age: 42 ± 12 years; TPI: 12 ± 10 years; 8 cervical, 9 thoracic; AIS-A/B. Treatment: FES-cycling 1h per session, 3 times per week for 6 monthsLow cadence group: n=8 at 20 RPMHigh cadence group: n=7 at 50 RPMn=2 withdrew due to personal reasons Outcome Measures: Trabecular bone micro-architecture (apparent trabecular number; apparent trabecular separation; apparent bone volume to total volume), BMD by DXA, serum bone-specific ALP, urine NTX, other biochemical markers & muscle volume |
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Hammond et al. 2014; USA Cross-sectional Level 5 N=364 |
Population: 364 participants with SCI; age 39.8 ± 16.1 years; 276 traumatic, 88 nontraumatic; 79 ambulatory; 202 FES users; TPI: 6.9 (range: 1-8) years; 178 AIS A and B, 184 AIS C and D. |
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Ashe et al. 2010; Canada Case Series Level 4 N= 3 |
Population: 3 women with traumatic chronic motor SCI; TPI: >1 year; complete n=2, incomplete n=1; ages: 29, 19, 51 years. |
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Frotzler et al. 2009; Switzerland/UK Pre-Post Level 4 N = 5 |
Population: 4 men and 1 woman with traumatic SCI; age: 38.6 + 8.1 years; T4-T7; ASIA grade A; TPI: 11.4 years (range 3.6–19.8); who showed significant effects on bone parameters due to high-volume FES-cycling |
Participants who stopped training: Distal femur: 73%±13.4% of total gain in BMDtrab; 63.8%±8.0% in BMDtot, and 59.4%±3.9% in BMC were preserved after 12 months of detraining |
Frotzler et al. 2008; Switzerland/UK Pre-Post Level 4 N=11 |
Population: 11 participants (2 women, 9 men) with traumatic SCI; T3-T12; age: 41.9 ± 7.5 years; TPI: 11.0 ± 7.1 years; AIS A. |
Distal Femur: 1. Trabecular BMD increased by 14.4±21.1% 2. Total BMD increased by 7.0±10.8% 3. Total bone cross-sectional area increased by 1.2±1.5% Femoral Shaft: 1. Cortical BMD decreased by 0.4±0.4% 2. BMC decreased by 1.8+3.0% Tibia: No significant changes in bone parameters. |
Chen et al. 2005; Taiwan Pre-post Level 4 N=30 |
Population: 15 men, age: 28.67 (range: 23 ± 37) years; TPI: 9.3 ± 3.9 years; complete, C6-T8. 15 matched non-disabled controls. |
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Mohr et al. 1997; Denmark Pre-post Level 4 N=10 |
Population: 10 men and women; age: 27-45 years, injuries either C6 or T2, no controls. |
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BeDell et al. 1996; USA Pre-post Level 4 N=12 |
Population: 12 men; age: 34 ± 6 years (range: 23-46); complete traumatic injuries between C5-T12; TPI: >2 years; no controls. Treatment: FES-cycling. Participants participated in a 3-phase training program. Phase 1: quadriceps strengthening through NMES. Phase 2: FES-cycling progression until 30 min continuously. Phase 3a: 24x 30-mins continuous FES-cycling sessions performed 3x/week. Phase 3b: An extra 24x 30-min FES-cycling sessions adding simultaneous arm ergometry (8 participants only). Outcome measure: lumbar spine and hip BMD by DPA |
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Hangartner et al. 1994; USA Pre-post Level 4 N=15 |
Population: 15 participants; age: 17-46 years; complete and incomplete injury between C5-T10; no controls. Treatment: NMES and FES-cycling.1. NMES knee extension exercises (n=3);2. FES-cycling (n=9); or3. both (n=3). Sessions were 3x/week for 12 weeks except Group 3 had 24 weeks. Outcome measures: tibia BMD specify site (proximal and distal) via CT |
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Leeds et al. 1990; USA Pre-post Level 4 N=6 |
Population: 6 men; ages 18-27; C4-C6; traumatic tetraplegia; no controls. Treatment: NMES and FES cycle ergometry. 1-month quads strengthening exercise (NMES), followed by 6 months of FES-cycling. Knee extension sessions were 45 lifts/leg 3x/week for 1month. FES-cycling sessions were 3X/week up to 30 mins for 6 months. Outcome measures: Hip BMD by DXA |
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Pacy et al. 1988; UK Pre-post Level 4 N=4 |
Population: 4 men; age: 20-35 years; paraplegia; no controls. Treatment: NMES and FES-cycling. Part 1 was NMES of quads strengthening with ↑ load ranging from 1.4-11.4 kg bilateral for 15 mins for 5x/week (10 weeks). Part 2 was FES-cycling at 50 rpm with resistance (0-18.75 W). Performed for 15 mins, 5x/week (32 weeks). Outcome measures: Lumbar spine, hip, and distal tibia BMD by CT. |
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* All data expressed as mean±SD, unless expressed otherwise.
Discussion
There are mixed results for bone outcomes after FES-cycling. Three studies reported a regional increase in BMD (Mohr et al. 1997; Chen et al. 2005; Frotzler et al. 2008) at the distal femur or proximal tibia, while there was no significant within-participant BMD change at the hip in three pre-post studies (Pacy et al. 1988; Leeds et al. 1990; and BeDell et al. 1996). The FES-cycling studies which reported a positive effect on bone parameters used protocols that were at least 3 sessions/week for 6 months and increased bone parameters over areas directly affected by stimulated muscles (e.g., quads, distal femur and proximal tibia). Although one study showed that FES-cycling intervention needed to be maintained or bone gains were lost (Chen et al. 2005).
Frotzler et al. (2008) found BMD and BMC were preserved at the distal sites for some participants at 12 months. Hammond et al. (2014) suggested that FES-cycling may reduce the prevalence of osteoporosis in people with SCI compared to people with SCI that do not use FES-cycling; however, no minimal FES requirements (i.e. intensity, duration or frequency) were provided. Craven et. al, (2017) and Johnston et al. (2016) however, showed no difference in BMD after 4-6 months of FES-walking and FES-cycling, respectively. In summary, longitudinal FES-cycling shows promise as an effective treatment for regional BMD maintenance (around the knee, where fracture risk is highest). The limited availability of FES-cycling for home or longitudinal use may limit its generalizability outside a clinical trial scenario.
Conclusions
There is level I evidence that FES-walking did not elicit significant changes in bone biomarkers or BMD after 4 months of training (Craven et al. 2017)
Johnston et al. (2016) showed that 6 months of FES-cycling did not produce significant changes in bone architecture.
Hammond et al. 2014 suggested a decrease in the prevalence of osteoporosis after FES-cycling.
There is level 4 evidence (Mohr et al. 1997; Chen et al. 2005; Frotzler et al. 2008) that FES-cycling increased regional lower extremity BMD over areas stimulated.