The Effects of Two Functional Electrical Stimulation Cycling Paradigms

Background:

People with spinal cord injury (SCI) are at risk for many health conditions, some of which
can be decreased with exercise. Cycling with Functional Electrical Stimulation (FES) is one
way to obtain exercise after SCI. However, cycling with FES has only been done one way,
which involves pedaling more quickly with less force to work against. Pedaling more slowly
would allow the person to work against more force, which may lead to greater improvements in
bone mineral density and muscle size. It may also lead to greater changes in bone make-up,
body fat, and cholesterol levels. All of these improvements may lead to a decrease in bone
fractures and cardiovascular disease, two major medical issues that exist in the SCI
population. Study Aims: This study will compare the outcomes on bone, muscle and
cardiovascular health between the commonly used method of pedaling more quickly to a new
method of pedaling more slowly. Both groups will work against the maximal force possible. It
is expected that the group pedaling more slowly will work against greater force and thus
will have improved outcomes compared to other group pedaling faster. Methods: Twenty people
with SCI, ages 18-65 years, will be randomly assigned to a treatment group and will
participate in three 60-minute sessions per week for 6 months at an outpatient
rehabilitation center. All subjects must have complete paralysis of both legs, but may have
sensation preserved. Before and after 6 months of exercise, subjects will have an MRI scan
to assess muscle size and bone, a dexascan to assess bone, a strength test using electrical
stimulation to assess muscle force, an analysis of fat free body tissue, and lab work to
measure cholesterol, bone factors that provide insight into bone change, and nutritional
status. Relevance: If the protocol of pedaling more slowly results in greater improvements,
this technique can be applied to clinical practice. Some people with SCI have FES cycles in
their homes and many have been cycling for many years. This new technique may allow them to
obtain more benefits than what they currently are receiving from FES cycling. In addition,
it is important to maintain overall bone, muscle and cardiovascular health so that people
with SCI are health and ready when spinal cord regeneration becomes clinically available.