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Effect of FES controlled cycling training on cardiovascular and pulmonary systems in a spinal cord injured patient

Effect of FES controlled cycling training on cardiovascular and pulmonary systems in a spinal... DE GRUYTER Current Directions in Biomedical Engineering 2022;8(3): 29-32 Amelita Fodor, Márton Bese Naszlady, Mariann Mravcsik, Andras Klauber, Peter Cserháti, Jozsef Laczko*, Mónika Horváth Effect of FES controlled cycling training on cardiovascular and pulmonary systems in a spinal cord injured patient https://doi.org/10.1515/cdbme-2022-2008 1 Introduction Abstract: Introduction: The results of two spiroergometric measurements are presented that were taken from a spinal cord The present paper demonstrates through pulmonary injured patient who participated in FES cycling training sessions for 11 months. Methods: The two measurements were indicators that FES cycling is worth exercising for spinal cord taken 4 and 11 months after starting the training program. We injuries (SCI). Former studies showed in able-bodied persons investigated the respiratory exchange ratio (RER) and that aerobic exercises decrease body fat, and the risk of cardiac ventilation (VE/VO2, VE’/VCO2) ratios and the cycling illness [1,2]. Furthermore, able-bodied athletes who cadence in the two investigated training sessions. Results: In participated in aerobic training, have higher maximal O2 the first assessment, the RER was below 1, which is the uptake and better cardiovascular performance than those who anaerobic training limit. Seven months later, in the second performed non-aerobic trainings or who were untrained [3]. assessment, the RER value exceeded the anaerobic limit a few Regular aerobic exercise improves aerobic endurance and times and remained above it at the end of the session. The VE cardiorespiratory capacity [4]. Spinal cord injured persons /VO2 and VE/VCO2 curves did not intersect during the first have usually reduced or at some extent limited aerobic assessment. In the second one, the VE/VO2 and VE/VCO2 capacity [5]. Effective rehabilitation approaches are important curves intersected several times and the oxygen quotient curve to improve this capacity. FES cycling is such an approach. It exceeded the carbon dioxide quotient curve. The patient achieved a low but similar cycling speed during the two has been shown that FES cycling increased peak oxygen assessments. Conclusion: Through the activation of paralyzed uptake in SCI individuals [6]. The oxygen uptake during FES muscles with FES cycling we are able to train the paraplegic cycling may depend on stimulation patterns, particularly on patient in aerobic and anaerobic training zones. This is shown the timing of activation of the stimulated muscles [7]. It is by the value of RER, which reached the anaerobic training another question how FES cycling training protocols can be limit during the second assessment and remained in the defined to improve aerobic capacity of SCI patients. Recent anaerobic range for longer time. study reports about potential benefits of FES cycling exercise Keywords: Respiratory Exchange Ratio, Ventilation ratio, to improve aerobic and anaerobic capacity after SCI [8]. The Cycling cadence, aerobic and anaerobic training, Functional main aim of our present study is to investigate the effect of Electrical Stimulation regular FES cycling training of one spinal cord injured person on his pulmonary functions. In particular we were interested whether we were able to train the patient in both aerobic and anaerobic training zones. ______ Amelita Fodor: National Institute for Medical Rehabilitation & 2 Materials and Methods Semmelweis University, Faculty of Health Sciences, Dept. of Physiotherapy, Budapest, Hungary Márton Bese Naszlady: Pázmány Péter Catholic University, Faculty 2.1 Participant of InformationTechnology and Bionics, Budapest, Hungary Mariann Mravcsik: University of Pecs, Pecs, Hungary & Wigner A 27 years old man with spinal cord injury performed the FES Research Centre for Physics, Budapest Hungary cycling training sessions. Informed consent has been obtained Andras Klauber: National Institute of Locomotor Diseases and from the participant. The research was performed in Disabilities - National Institute for Medical Rehabilitation, Hungary accordance with the tenets of the Helsinki Declaration, and has Peter Cserhati: National Institute of Locomotor Diseases and Disabilities - National Institute for Medical Rehabilitation, & University been approved by the Ethics Committee of the National of Pecs, Hungary Institute for Medical Rehabilitation, Budapest, Hungary. The *Jozsef Laczko: Wigner Research Centre for Physics, participant’s level of injury was at T9. His ASIA scale was B. Monika Horvath: Semmelweis University, Faculty of Health His body mass was 100 kg and his height 185 cm. Sciences, Dept. of Physiotherapy, Budapest, Hungary Open Access. © 2022 The Author(s), published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 International License. 29 The participant started FES cycling trainings 2 months 2.3 Assessment after his injury. He participated in two training sessions For cardiopulmonary exercise testing a Metmax Cortex weekly. The first spiroergometric measurement was taken on rd ergospirometry system (Cortex Biophysik GmbH, Germany) the 23 occasion, which was 4 months after starting the was used with an oronasal mask to which a gas sensor was training. The second measurement was taken 7 months later. connected. This system approximates the maximal oxygen In the time between the two measured occasions the uptake by the Wassermann mass algorithm [10]. Respiratory participant kept performing FES cycling training generally Exchange Ratio (RER), that is the ratio of CO2 release and O2 two times weekly. uptake, and Ventilatory equivalents were analysed in 2 training sessions. Ventilation-to-Carbon Dioxide output (VE/VCO2) and the Ventilation-to- Oxygen uptake (VE/VO2) 2.2 Training protocol was also analysed. For monitoring blood pressure and heart For training we used a MOTOMED Viva 2 cycle-ergometer rate an automatic sphygmomanometer was used. The average and an 8-channel stimulator developed at the Pázmány Péter cadence of 30 sec. intervals was recorded. Catholic University, Budapest, Hungary. The stimulator was connected to a rotation (crank angle) sensor that recorded the ergometer’s crank position. The stimulator has sent the 3 Results electrical signals to the motor nerves of the muscles as the function of the angle and angular velocity of the ergometer’s st In the 1 measurement the initial RER value is around 0.7, then crank. it is increasing but it exceeds 1.0 only for a short time (after In each training session the quadriceps femoris and th nd the 25 minute) (Figure 2). During the 2 measurement the hamstring muscles of both legs were stimulated through th RER value starts at around 0.7 but it exceeds 1.0 in the 7 bipolar surface electrodes (PG473W TENS ELEC 45×80 minute and then it crosses this value several times, remaining mm). Pulse width (rectangular, monophasic) was set to 300 µs, around it, finally it remains above 1.0 (Figure 3). stimulation frequency was 30 Hz [9]. st In the 1 measurement VE/VO2 increased fast, at about ten Each training session started with a warmup period of five minutes after the start of the training session, but it reached the minutes and ended with a cooldown period that also lasted for value of VE/VCO2 only a few times and it did not remain 5 minutes. During this time the patient did not get stimulation, nd above VE/VCO2 (Figure 4.) Seven months later, in the 2 only the ergometer’s motor rotated the crank and that carried assessment VE/VO2 reached and exceeded the value of the legs. In between the warmup and cooldown phases the FES VE/VCO2 many times (Figure 5). driven cycling lasted for 20 minutes. During this phase the In both assessments the cadence dropped when the crank patient was cycling by their own muscle activities. In these 20 resistance increased. In the second assessment the heart rate th minutes, the level of crank resistance was changed in every 5 was in average higher during the active training phase minute (Figure 1.). At the beginning of the active training compared to the resting phase and dropped after the training. phase, the current amplitude was increased from 0 mA to 20 Blood pressure also increased throughout the training session. mA and then the maximal intensity (in our case 95 mA) was (Figure 6.) reached by increasing the current amplitude in 15mA steps. The maximal amplitude was reached in about 2 minutes. 4 Discussion Functional electrical stimulation driven cycling may be suitable for both aerobic and anaerobic training. The determination of aerobic gas exchange threshold helps to specify suitable exercise intensity for spinal cord injured population [11]. In previous studies evidence has been found that FES cycling improves aerobic fitness [8,12]. FES cycling protocol, what we presented in this study combines passive mobilisation exercise and active electrotherapy exercise. This is important because the lower extremities increased venous congestion, which may be a consequence of sedentary lifestyle Figure 1. The change of intensity of the training in one training of paralyzed persons, may be reduced by these types of session. Figure 5. Ventilatory equivalents during the second training as a Figure 2. Respiratory exchange ratio during the first training as a function of time function of time Figure 3. Respiratory exchange ratio during the second training as a function of time. Figure 6. Cadence, heart rate and blood pressure equivalents in two training sessions (7 months has passed between them). Dotted vertical lines represent systolic and diastolic blood pressures, heart symbol shows heart rate, continuous line shows Figure 4. Ventilatory equivalents during the first training as a the change of cadence. function of time. 31 Loss: A Systematic Review and Meta-Analysis of training [13]. This helps to reduce the load on the left heart Randomized Controlled Trials. The American Journal of ventricle and keep the blood vessels in good condition. Our Medicine, 2011;124(8):747–755. [2] Mersy, D. J. Health benefits of aerobic exercise. results suggest that FES cycling training include an aerobic Postgraduate Medicine, 1991:90(1). and anaerobic part and it is possible to adjust FES cycling https://doi.org/10.1080/00325481.1991.11700983 therapy for individual spinal cord injured patients. Note that in [3] Patel, H., Alkhawam, H., Madanieh, R., Shah, N., Kosmas, C. E., & Vittorio, T. J. (2017). Aerobic vs anaerobic exercise the second assessment, the RER value remained above 1 in the training effects on the cardiovascular system . World Journal cooldown phase. This was probably because the level of stress of Cardiology, 2017;9(2):134. https://doi.org/10.4330/wjc.v9.i2.134 on the patient's body was greater than the 5 minutes of passive [4] Evans, H. J. L., Ferrar, K. E., Smith, A. E., Parfitt, G., & exercise could have reduced. Eston, R. G. A systematic review of methods to predict Specific goals of the therapy can be defined and FES maximal oxygen uptake from submaximal, open circuit spirometry in healthy adults. Journal of Science and training parameters can be adjusted to these goals. For Medicine in Sport, 2015;18(2): 183–188. instance, in case of incomplete spinal cord injury, the primary [5] Bauman, W., Spungen, A. Coronary heart disease in individuals with spinal cord injury: assessment of risk aim may be to strengthen the muscles. For this purpose, it factors. Spinal Cord 2008;46:466–476 worth to cycle against higher crank resistance. Another [6] Brurok, B., Tørhaug, T., Karlsen, T., Leivseth, G., Helgerud, J., & Hoff, J. Effect of lower extremity functional electrical possible case is an obese patient, when an important goal may stimulation pulsed isometric contractions on arm cycling be to reduce body fat. It was shown that during exercises with peak oxygen uptake in spinal cord injured individuals. an arm ergometer, SCI patients reached exhaustion at Journal of Rehabilitation Medicine, 2013;45(3): 254–259. https://doi.org/10.2340/16501977-1098 significantly lower workloads than able bodied overweight [7] Hunt K., Ferrario C., Grant S., Stone B., McLean A., Fraser persons [14]. In the case of overweight SCI patients it might M., & Allan D. Comparison of stimulation patterns for FES- cycling using measures of oxygen cost and stimulation cost. be more adequate to perform FES cycling against low Medical engineering & physics, 2006; 28(7):710-71 resistance and keep the training in the aerob domain during the [8] Dolbow, D. R., Davis, G. M., Welsch, M., & Gorgey, A. S. major part of the training. Regarding cycling cadence, it was Benefits and interval training in individuals with spinal cord injury: A thematic review. Journal of Spinal Cord Medicine. found earlier that the cardiorespiratory effect was independent 2021:1-12. of cadence [15]. Our results suggest that the changes in the [9] Mravcsik, M., Klauber, A., & Laczko, J. FES driven lower limb cycling by four and eight channel stimulations – a investigated parameters (RER and ventilatory equivalents) comparison in a case study. The 12th Vienna International were rather affected by the resistance than cadence. However, Workshop on Functional Electrical Stimulation 2016; Proceedings Book :89-93. this assumption requires further investigation. [10] Medinger, A. E., Chan, T. W., Arabian, A., & Rohatgi, P. K. The differences between the cardiorespiratory parameters Interpretive Algorithms for the Symptom-Limited Exercise which were obtained in the two presented training sessions Test: Assessing Dyspnea in Persian Gulf War Veterans. Chest, 1998; 113(3): 612–618. suggest that the sequence of FES cycling training sessions that https://doi.org/10.1378/CHEST.113.3.612 were performed between the 2 assessements, helped to [11] Perret C, Berry H, Hunt KJ, Grant S, Kakebeeke TH. Determination and possible application of the aerobic gas improve aerobic capacity of the paraplegic patient. Having the exchange threshold in aerobically untrained paraplegic same stimulation parameters the patient needed less oxygen subjects based on stimulated cycle ergometry. Disabil uptake during the second assessment, that occurred seven Rehabil. 2009;31(17):1432-6. [12] van der Scheer, J. W., Goosey-Tolfrey, V. L., Valentino, S. months after the first one. This patient did not participate in E., Davis, G. M., & Ho, C. H. Functional electrical any other rehabilitation program during the seven months. stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. Although as this s a case study, the same training protocol Journal of NeuroEngineering and Rehabilitation, 2021; should be repeated with the participation of more SCI patients, 18(1): 1–16. https://doi.org/10.1186/s12984-021-00882-8 to further study its effect on aerobic capacities. [13] Figoni S.F., Dolbow D.R., Crawford E.C.,. White M.L.& Pattanaik S, Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic Author Statement review, The Journal of Spinal Cord Medicine, 2021; Research funding: This work was supported by the National 44(5): 690-703 Research, Development and Innovation Fund, Hungary, Grant [14] Widman LM, Abresch RT, Styne DM, McDonald CM. number: GINOP 2.3.3-15-2016-00032 & TKP2021-EGA-35. Aerobic fitness and upper extremity strength in patients Conflict of interest: Authors state no conflict of interest. aged 11 to 21 years with spinal cord dysfunction as compared to ideal weight and overweight controls. J Spinal Cord Med. 2007;30 Suppl 1(Suppl 1):S88-96. doi: 10.1080/10790268.2007.11754611. PMID: 17874693; References PMCID: PMC2031980. [15] Fornusek C, Davis GM. Cardiovascular and metabolic [1] Thorogood, A., Mottillo, S., Shimony, A., Filion, K. B., responses during functional electric stimulation cycling at Joseph, L., Genest, J., Pilote, L., Poirier, P., Schiffrin, E. L., different cadences. Arch Phys Med Rehabil. 2008 & Eisenberg, M. J. Isolated Aerobic Exercise and Weight Apr;89(4):719-25. doi: 10.1016/j.apmr.2007.09.035. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Directions in Biomedical Engineering de Gruyter

Effect of FES controlled cycling training on cardiovascular and pulmonary systems in a spinal cord injured patient

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DE GRUYTER Current Directions in Biomedical Engineering 2022;8(3): 29-32 Amelita Fodor, Márton Bese Naszlady, Mariann Mravcsik, Andras Klauber, Peter Cserháti, Jozsef Laczko*, Mónika Horváth Effect of FES controlled cycling training on cardiovascular and pulmonary systems in a spinal cord injured patient https://doi.org/10.1515/cdbme-2022-2008 1 Introduction Abstract: Introduction: The results of two spiroergometric measurements are presented that were taken from a spinal cord The present paper demonstrates through pulmonary injured patient who participated in FES cycling training sessions for 11 months. Methods: The two measurements were indicators that FES cycling is worth exercising for spinal cord taken 4 and 11 months after starting the training program. We injuries (SCI). Former studies showed in able-bodied persons investigated the respiratory exchange ratio (RER) and that aerobic exercises decrease body fat, and the risk of cardiac ventilation (VE/VO2, VE’/VCO2) ratios and the cycling illness [1,2]. Furthermore, able-bodied athletes who cadence in the two investigated training sessions. Results: In participated in aerobic training, have higher maximal O2 the first assessment, the RER was below 1, which is the uptake and better cardiovascular performance than those who anaerobic training limit. Seven months later, in the second performed non-aerobic trainings or who were untrained [3]. assessment, the RER value exceeded the anaerobic limit a few Regular aerobic exercise improves aerobic endurance and times and remained above it at the end of the session. The VE cardiorespiratory capacity [4]. Spinal cord injured persons /VO2 and VE/VCO2 curves did not intersect during the first have usually reduced or at some extent limited aerobic assessment. In the second one, the VE/VO2 and VE/VCO2 capacity [5]. Effective rehabilitation approaches are important curves intersected several times and the oxygen quotient curve to improve this capacity. FES cycling is such an approach. It exceeded the carbon dioxide quotient curve. The patient achieved a low but similar cycling speed during the two has been shown that FES cycling increased peak oxygen assessments. Conclusion: Through the activation of paralyzed uptake in SCI individuals [6]. The oxygen uptake during FES muscles with FES cycling we are able to train the paraplegic cycling may depend on stimulation patterns, particularly on patient in aerobic and anaerobic training zones. This is shown the timing of activation of the stimulated muscles [7]. It is by the value of RER, which reached the anaerobic training another question how FES cycling training protocols can be limit during the second assessment and remained in the defined to improve aerobic capacity of SCI patients. Recent anaerobic range for longer time. study reports about potential benefits of FES cycling exercise Keywords: Respiratory Exchange Ratio, Ventilation ratio, to improve aerobic and anaerobic capacity after SCI [8]. The Cycling cadence, aerobic and anaerobic training, Functional main aim of our present study is to investigate the effect of Electrical Stimulation regular FES cycling training of one spinal cord injured person on his pulmonary functions. In particular we were interested whether we were able to train the patient in both aerobic and anaerobic training zones. ______ Amelita Fodor: National Institute for Medical Rehabilitation & 2 Materials and Methods Semmelweis University, Faculty of Health Sciences, Dept. of Physiotherapy, Budapest, Hungary Márton Bese Naszlady: Pázmány Péter Catholic University, Faculty 2.1 Participant of InformationTechnology and Bionics, Budapest, Hungary Mariann Mravcsik: University of Pecs, Pecs, Hungary & Wigner A 27 years old man with spinal cord injury performed the FES Research Centre for Physics, Budapest Hungary cycling training sessions. Informed consent has been obtained Andras Klauber: National Institute of Locomotor Diseases and from the participant. The research was performed in Disabilities - National Institute for Medical Rehabilitation, Hungary accordance with the tenets of the Helsinki Declaration, and has Peter Cserhati: National Institute of Locomotor Diseases and Disabilities - National Institute for Medical Rehabilitation, & University been approved by the Ethics Committee of the National of Pecs, Hungary Institute for Medical Rehabilitation, Budapest, Hungary. The *Jozsef Laczko: Wigner Research Centre for Physics, participant’s level of injury was at T9. His ASIA scale was B. Monika Horvath: Semmelweis University, Faculty of Health His body mass was 100 kg and his height 185 cm. Sciences, Dept. of Physiotherapy, Budapest, Hungary Open Access. © 2022 The Author(s), published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 International License. 29 The participant started FES cycling trainings 2 months 2.3 Assessment after his injury. He participated in two training sessions For cardiopulmonary exercise testing a Metmax Cortex weekly. The first spiroergometric measurement was taken on rd ergospirometry system (Cortex Biophysik GmbH, Germany) the 23 occasion, which was 4 months after starting the was used with an oronasal mask to which a gas sensor was training. The second measurement was taken 7 months later. connected. This system approximates the maximal oxygen In the time between the two measured occasions the uptake by the Wassermann mass algorithm [10]. Respiratory participant kept performing FES cycling training generally Exchange Ratio (RER), that is the ratio of CO2 release and O2 two times weekly. uptake, and Ventilatory equivalents were analysed in 2 training sessions. Ventilation-to-Carbon Dioxide output (VE/VCO2) and the Ventilation-to- Oxygen uptake (VE/VO2) 2.2 Training protocol was also analysed. For monitoring blood pressure and heart For training we used a MOTOMED Viva 2 cycle-ergometer rate an automatic sphygmomanometer was used. The average and an 8-channel stimulator developed at the Pázmány Péter cadence of 30 sec. intervals was recorded. Catholic University, Budapest, Hungary. The stimulator was connected to a rotation (crank angle) sensor that recorded the ergometer’s crank position. The stimulator has sent the 3 Results electrical signals to the motor nerves of the muscles as the function of the angle and angular velocity of the ergometer’s st In the 1 measurement the initial RER value is around 0.7, then crank. it is increasing but it exceeds 1.0 only for a short time (after In each training session the quadriceps femoris and th nd the 25 minute) (Figure 2). During the 2 measurement the hamstring muscles of both legs were stimulated through th RER value starts at around 0.7 but it exceeds 1.0 in the 7 bipolar surface electrodes (PG473W TENS ELEC 45×80 minute and then it crosses this value several times, remaining mm). Pulse width (rectangular, monophasic) was set to 300 µs, around it, finally it remains above 1.0 (Figure 3). stimulation frequency was 30 Hz [9]. st In the 1 measurement VE/VO2 increased fast, at about ten Each training session started with a warmup period of five minutes after the start of the training session, but it reached the minutes and ended with a cooldown period that also lasted for value of VE/VCO2 only a few times and it did not remain 5 minutes. During this time the patient did not get stimulation, nd above VE/VCO2 (Figure 4.) Seven months later, in the 2 only the ergometer’s motor rotated the crank and that carried assessment VE/VO2 reached and exceeded the value of the legs. In between the warmup and cooldown phases the FES VE/VCO2 many times (Figure 5). driven cycling lasted for 20 minutes. During this phase the In both assessments the cadence dropped when the crank patient was cycling by their own muscle activities. In these 20 resistance increased. In the second assessment the heart rate th minutes, the level of crank resistance was changed in every 5 was in average higher during the active training phase minute (Figure 1.). At the beginning of the active training compared to the resting phase and dropped after the training. phase, the current amplitude was increased from 0 mA to 20 Blood pressure also increased throughout the training session. mA and then the maximal intensity (in our case 95 mA) was (Figure 6.) reached by increasing the current amplitude in 15mA steps. The maximal amplitude was reached in about 2 minutes. 4 Discussion Functional electrical stimulation driven cycling may be suitable for both aerobic and anaerobic training. The determination of aerobic gas exchange threshold helps to specify suitable exercise intensity for spinal cord injured population [11]. In previous studies evidence has been found that FES cycling improves aerobic fitness [8,12]. FES cycling protocol, what we presented in this study combines passive mobilisation exercise and active electrotherapy exercise. This is important because the lower extremities increased venous congestion, which may be a consequence of sedentary lifestyle Figure 1. The change of intensity of the training in one training of paralyzed persons, may be reduced by these types of session. Figure 5. Ventilatory equivalents during the second training as a Figure 2. Respiratory exchange ratio during the first training as a function of time function of time Figure 3. Respiratory exchange ratio during the second training as a function of time. Figure 6. Cadence, heart rate and blood pressure equivalents in two training sessions (7 months has passed between them). Dotted vertical lines represent systolic and diastolic blood pressures, heart symbol shows heart rate, continuous line shows Figure 4. Ventilatory equivalents during the first training as a the change of cadence. function of time. 31 Loss: A Systematic Review and Meta-Analysis of training [13]. This helps to reduce the load on the left heart Randomized Controlled Trials. The American Journal of ventricle and keep the blood vessels in good condition. Our Medicine, 2011;124(8):747–755. [2] Mersy, D. J. Health benefits of aerobic exercise. results suggest that FES cycling training include an aerobic Postgraduate Medicine, 1991:90(1). and anaerobic part and it is possible to adjust FES cycling https://doi.org/10.1080/00325481.1991.11700983 therapy for individual spinal cord injured patients. Note that in [3] Patel, H., Alkhawam, H., Madanieh, R., Shah, N., Kosmas, C. E., & Vittorio, T. J. (2017). Aerobic vs anaerobic exercise the second assessment, the RER value remained above 1 in the training effects on the cardiovascular system . World Journal cooldown phase. This was probably because the level of stress of Cardiology, 2017;9(2):134. https://doi.org/10.4330/wjc.v9.i2.134 on the patient's body was greater than the 5 minutes of passive [4] Evans, H. J. L., Ferrar, K. E., Smith, A. E., Parfitt, G., & exercise could have reduced. Eston, R. G. A systematic review of methods to predict Specific goals of the therapy can be defined and FES maximal oxygen uptake from submaximal, open circuit spirometry in healthy adults. Journal of Science and training parameters can be adjusted to these goals. For Medicine in Sport, 2015;18(2): 183–188. instance, in case of incomplete spinal cord injury, the primary [5] Bauman, W., Spungen, A. Coronary heart disease in individuals with spinal cord injury: assessment of risk aim may be to strengthen the muscles. For this purpose, it factors. Spinal Cord 2008;46:466–476 worth to cycle against higher crank resistance. Another [6] Brurok, B., Tørhaug, T., Karlsen, T., Leivseth, G., Helgerud, J., & Hoff, J. Effect of lower extremity functional electrical possible case is an obese patient, when an important goal may stimulation pulsed isometric contractions on arm cycling be to reduce body fat. It was shown that during exercises with peak oxygen uptake in spinal cord injured individuals. an arm ergometer, SCI patients reached exhaustion at Journal of Rehabilitation Medicine, 2013;45(3): 254–259. https://doi.org/10.2340/16501977-1098 significantly lower workloads than able bodied overweight [7] Hunt K., Ferrario C., Grant S., Stone B., McLean A., Fraser persons [14]. In the case of overweight SCI patients it might M., & Allan D. Comparison of stimulation patterns for FES- cycling using measures of oxygen cost and stimulation cost. be more adequate to perform FES cycling against low Medical engineering & physics, 2006; 28(7):710-71 resistance and keep the training in the aerob domain during the [8] Dolbow, D. R., Davis, G. M., Welsch, M., & Gorgey, A. S. major part of the training. Regarding cycling cadence, it was Benefits and interval training in individuals with spinal cord injury: A thematic review. Journal of Spinal Cord Medicine. found earlier that the cardiorespiratory effect was independent 2021:1-12. of cadence [15]. Our results suggest that the changes in the [9] Mravcsik, M., Klauber, A., & Laczko, J. FES driven lower limb cycling by four and eight channel stimulations – a investigated parameters (RER and ventilatory equivalents) comparison in a case study. The 12th Vienna International were rather affected by the resistance than cadence. However, Workshop on Functional Electrical Stimulation 2016; Proceedings Book :89-93. this assumption requires further investigation. [10] Medinger, A. E., Chan, T. W., Arabian, A., & Rohatgi, P. K. The differences between the cardiorespiratory parameters Interpretive Algorithms for the Symptom-Limited Exercise which were obtained in the two presented training sessions Test: Assessing Dyspnea in Persian Gulf War Veterans. Chest, 1998; 113(3): 612–618. suggest that the sequence of FES cycling training sessions that https://doi.org/10.1378/CHEST.113.3.612 were performed between the 2 assessements, helped to [11] Perret C, Berry H, Hunt KJ, Grant S, Kakebeeke TH. Determination and possible application of the aerobic gas improve aerobic capacity of the paraplegic patient. Having the exchange threshold in aerobically untrained paraplegic same stimulation parameters the patient needed less oxygen subjects based on stimulated cycle ergometry. Disabil uptake during the second assessment, that occurred seven Rehabil. 2009;31(17):1432-6. [12] van der Scheer, J. W., Goosey-Tolfrey, V. L., Valentino, S. months after the first one. This patient did not participate in E., Davis, G. M., & Ho, C. H. Functional electrical any other rehabilitation program during the seven months. stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. Although as this s a case study, the same training protocol Journal of NeuroEngineering and Rehabilitation, 2021; should be repeated with the participation of more SCI patients, 18(1): 1–16. https://doi.org/10.1186/s12984-021-00882-8 to further study its effect on aerobic capacities. [13] Figoni S.F., Dolbow D.R., Crawford E.C.,. White M.L.& Pattanaik S, Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic Author Statement review, The Journal of Spinal Cord Medicine, 2021; Research funding: This work was supported by the National 44(5): 690-703 Research, Development and Innovation Fund, Hungary, Grant [14] Widman LM, Abresch RT, Styne DM, McDonald CM. number: GINOP 2.3.3-15-2016-00032 & TKP2021-EGA-35. Aerobic fitness and upper extremity strength in patients Conflict of interest: Authors state no conflict of interest. aged 11 to 21 years with spinal cord dysfunction as compared to ideal weight and overweight controls. J Spinal Cord Med. 2007;30 Suppl 1(Suppl 1):S88-96. doi: 10.1080/10790268.2007.11754611. PMID: 17874693; References PMCID: PMC2031980. [15] Fornusek C, Davis GM. Cardiovascular and metabolic [1] Thorogood, A., Mottillo, S., Shimony, A., Filion, K. B., responses during functional electric stimulation cycling at Joseph, L., Genest, J., Pilote, L., Poirier, P., Schiffrin, E. L., different cadences. Arch Phys Med Rehabil. 2008 & Eisenberg, M. J. Isolated Aerobic Exercise and Weight Apr;89(4):719-25. doi: 10.1016/j.apmr.2007.09.035.

Journal

Current Directions in Biomedical Engineering – de Gruyter

Published: Sep 1, 2022

Keywords: Respiratory Exchange Ratio; Ventilation ratio; Cycling cadence; aerobic and anaerobic training; Functional Electrical Stimulation

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