Energy Expenditure, Cardiorespiratory Fitness, and Body Composition Following Arm Cycling or Functional Electrical Stimulation Exercises in Spinal Cord Injury: A 16-Week Randomized Controlled Trial

Abstract

Background: Physical deconditioning and inactivity following spinal cord injury (SCI) are associated with multiple cardiometabolic risks. To mitigate cardiometabolic risk, exercise is recommended, but it is poorly established whether arm cycling exercise (ACE) or functional electrical stimulation (FES) leg cycling yields superior benefits. Objectives: To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI. Methods: Thirteen physically untrained individuals were randomly assigned to FES (n = 6) or ACE (n = 7) exercise 5 days/week for 16 weeks. Pre- and post-intervention EEE, peak oxygen consumption (absolute and relative VO2Peak), and work were assessed using indirect calorimetry, while body composition was measured by dual-energy x-ray absorptiometry. Results: Main effects were found for peak power (p < .001), absolute (p = .046) and relative (p = .042) VO2Peak, and peak work (p = .013). Compared to baseline, the ACE group increased in EEE (+85%, p = .002), peak power (+307%, p < .001), VO2Peak (absolute +21%, relative +22%, p ≤ .024), peak work (19% increase, p = .003), and total body fat decreased (-6%, p = .05). The FES group showed a decrease in percentage body fat mass (-5%, p = .008). The ACE group had higher EEE (p = .008), peak power (p < .001), and relative VO2Peak (p = .025) compared to postintervention values in the FES group. Conclusion: In the current study, ACE induced greater increases in EEE and CRF, whereas ACE and FES showed similar results on body fat. Exercise promotional efforts targeting persons with SCI should use both FES and ACE to reduce sedentary behavior and to optimize different health parameters after SCI.

Keywords: arm cycling ergometry; body composition; cardiorespiratory fitness; energy expenditure; exercise; functional electrical stimulation; spinal cord injury.

Conflict of interest statement

Conflicts of Interest The authors declare no conflicts of interest.

© 2021 American Spinal Injury Association.

Figures

Figure 1.

Average (a) total (b) exercise energy expenditure during exercise rides (sessions) 1, 40, and 80 in the arm cycling exercise (ACE) and functional electrical stimulation leg cycle ergometry (FES-LCE) groups. *Significant increase from ride 1 to 80 in the ACE group, p = .002. ** A trend toward a significant increase from ride 1 to 41 in the ACE group, p = .055. ***A trend toward a significant increase from ride 41 to 80 in the ACE group, p = .076. Significant difference between the groups at ride 1 (^ p = .029), ride 40 († p = .041), and ride 80 (‡ p = .008).

Figure 2.

Peak power output during exercise rides (sessions) 1, 40, and 80 in the arm cycling exercise (ACE) and functional electrical stimulation (FES) leg cycle ergometry groups. *Significant increase from ride 1 to 80 in the ACE group, p

Figure 3.

Absolute (a) and relative (b) to bodyweight peak oxygen consumption (VO2Peak) and peak work (c) before and after the exercise program in the arm cycling exercise (ACE) and functional electrical stimulation (FES) leg cycle ergometry groups. *Significant increase in absolute VO2Peak from pre to post intervention in the ACE group, p = .02. **Significant increase in relative VO2Peak from pre to post intervention in the ACE group, p = .024. ***Significant increase in peak work from pre to post intervention in the ACE group, p = .003. ^Significant difference in relative VO2Peak between the groups post intervention (p = .025).