Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 8 , Pages 1379-1388 , August 2009

A Randomized Controlled Trial on the Effects of Cycling With and Without Electrical Stimulation on Cardiorespiratory and Vascular Health in Children With Spinal Cord Injury

Presented to the International Functional Electrical Stimulation Society, November 10–14, 2007, Philadelphia, PA; World Confederation for Physical Therapy Congress, June 2–6, 2007, Vancouver, BC; Physical Therapy Combined Sections Meeting, February 14–18, 2007, Boston, MA; and Injury and Dysfunction of the Spinal Cord in Children, November 30–December 2, 2006, Orlando, FL.

  • Therese E. Johnston, PT, PhD

      Affiliations

    • Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA
    • Shriners Hospital for Children, Philadelphia, PA
    • Corresponding Author InformationReprint requests to Therese E. Johnston, PT, PhD, MBA, University of the Sciences in Philadelphia, 600 S 43rd St, Box 39, Philadelphia, PA 19104
    • ,
  • Brian T. Smith, MS

      Affiliations

    • Shriners Hospital for Children, Philadelphia, PA
    • ,
  • Mary J. Mulcahey, OTL/R, PhD

      Affiliations

    • Shriners Hospital for Children, Philadelphia, PA
    • ,
  • Randal R. Betz, MD

      Affiliations

    • Shriners Hospital for Children, Philadelphia, PA
    • ,
  • Richard T. Lauer, PhD

      Affiliations

    • Shriners Hospital for Children, Philadelphia, PA
    • Department of Physical Therapy, Temple University Philadelphia, PA

References 

  1. Leger L. Aerobic performance. In:  Docherty D editors. Measurement in pediatric exercise science. Champaign: Human Kinetics; 1996;p. 183–223
  2. Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, Bussmann JB. Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature. Spinal Cord. 2006;44:642–652
  3. 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
  4. 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
  5. Nash MS. Exercise as a health-promoting activity following spinal cord injury. J Neurol Phys Ther. 2005;29:87–103106
  6. Jacobs PL, Nash MS. Modes, benefits, and risks of voluntary and electrically induced exercise in persons with spinal cord injury. J Spinal Cord Med. 2001;24:10–18
  7. Castro MJ, Apple DF, Staron RS, Campos GE, Dudley GA. Influence of complete spinal cord injury on skeletal muscle within 6 mo of injury. J Appl Physiol. 1999;86:350–358
  8. Bauman WA, Spungen AM. Coronary heart disease in individuals with spinal cord injury: assessment of risk factors. Spinal Cord. 2008;46:466–476
  9. Whiteneck GG, Charlifue SW, Frankel HL, et al. Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia. 1992;30:617–630
  10. Bauman WA, Kahn NN, Grimm DR, Spungen AM. Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury. Spinal Cord. 1999;37:601–616
  11. Dallmeijer AJ, van der Woude LH. Health related functional status in men with spinal cord injury: relationship with lesion level and endurance capacity. Spinal Cord. 2001;39:577–583
  12. Davis GM, Servedio FJ, Glaser RM, Gupta SC, Suryaprasad AG. Cardiovascular responses to arm cranking and FNS-induced leg exercise in paraplegics. J Appl Physiol. 1990;69:671–677
  13. Raymond J, Davis GM, van der PM. Cardiovascular responses during submaximal electrical stimulation-induced leg cycling in individuals with paraplegia. Clin Physiol Funct Imaging. 2002;22:92–98
  14. Raymond J, Davis GM, Der Plas MN, Groeller H, Simcox S. Carotid baroreflex control of heart rate and blood pressure during ES leg cycling in paraplegics. J Appl Physiol. 2000;88:957–965
  15. Raymond J, Davis GM, Bryant G, Clarke J. Cardiovascular responses to an orthostatic challenge and electrical-stimulation-induced leg muscle contractions in individuals with paraplegia. Eur J Appl Physiol Occup Physiol. 1999;80:205–212
  16. 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
  17. 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
  18. Hooker SP, Figoni SF, Glaser RM, Rodgers MM, Ezenwa BN, Faghri PD. Physiologic responses to prolonged electrically stimulated leg-cycle exercise in the spinal cord injured. Arch Phys Med Rehabil. 1990;71:863–869
  19. Hooker SP, Figoni SF, Rodgers MM, et al. Physiologic effects of electrical stimulation leg cycle exercise training in spinal cord injured persons. Arch Phys Med Rehabil. 1992;73:470–476
  20. Hooker SP, Figoni SF, Rodgers MM, 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
  21. Hooker SP, Greenwood JD, Hatae DT, Husson RP, Matthiesen TL, Waters AR. Oxygen uptake and heart rate relationship in persons with spinal cord injury. Med Sci Sports Exerc. 1993;25:1115–1119
  22. Hooker SP, Scremin AM, Mutton DL, Kunkel CF, Cagle G. Peak and submaximal physiologic responses following electrical stimulation leg cycle ergometer training. J Rehabil Res Dev. 1995;32:361–366
  23. Petrofsky JS. Blood pressure and heart rate response to isometric exercise: the effect of spinal cord injury in humans. Eur J Appl Physiol. 2001;85:521–526
  24. Petrofsky JS, Phillips CA. The use of functional electrical stimulation for rehabilitation of spinal cord injured patients. Cent Nerv Syst Trauma. 1984;1:57–74
  25. Ragnarsson KT. Physiologic effects of functional electrical stimulation-induced exercises in spinal cord-injured individuals. Clin Orthop Relat Res. 1988;233:53–63Aug
  26. Faghri PD, Glaser RM, Figoni SF. Functional electrical stimulation leg cycle ergometer exercise: training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise. Arch Phys Med Rehabil. 1992;73:1085–1093
  27. Silva AC, Neder JA, Chiurciu MV, et al. Effect of aerobic training on ventilatory muscle endurance of spinal cord injured men. Spinal Cord. 1998;36:240–245
  28. Nourry C, Deruelle F, Guinhouya C, et al. High-intensity intermittent running training improves pulmonary function and alters exercise breathing pattern in children. Eur J Appl Physiol. 2005;94:415–423
  29. Vogel LC, Krajci KA, Anderson CJ. Adults with pediatric-onset spinal cord injuries: part 3: impact of medical complications. J Spinal Cord Med. 2002;25:297–305
  30. Weaver FM, Smith B, Evans CT, et al. Outcomes of outpatient visits for acute respiratory illness in veterans with spinal cord injuries and disorders. Am J Phys Med Rehabil. 2006;85:718–726
  31. Johnston TE, Smith BT, Betz RR, Lauer RT. Exercise testing using upper extremity ergometry in pediatric spinal cord injury. Pediatr Phys Ther. 2008;20:146–151
  32. Bar-Or O, Rowland TW. Physiologic and perceptual responses to exercise in the healthy child (Pediatric exercise medicine). In: Champaign: Human Kinetics; 2004;p. 3–59
  33. Zapletal A. Lung function in children and adolescents (Methods, reference values). In:  Zapletal A,  Samanak M,  Paul T editor. Progress in respiration research. Basel: Karger; 1987;p. 114–218
  34. Polgar G, Promadhat V. Pulmonary function testing in children: techniques and standards. Philadelphia: Saunders; 1971;
  35. Tolfrey K, Jones AM, Campbell IG. Lipid-lipoproteins in children: an exercise dose-response study. Med Sci Sports Exerc. 2004;36:418–427
  36. Rowland TW, Boyajian A. Aerobic response to endurance exercise training in children. Pediatrics. 1995;96:654–658
  37. Burkett LN, Chisum J, Stone W, Fernhall B. Exercise capacity of untrained spinal cord injured individuals and the relationship of peak oxygen uptake to level of injury. Paraplegia. 1990;28:512–521
  38. Valent L, Dallmeijer A, Houdijk H, Talsma E, van der WL. The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review. Clin Rehabil. 2007;21:315–330
  39. Barstow TJ, Scremin AM, Mutton DL, Kunkel CF, Cagle TG, Whipp BJ. Changes in gas exchange kinetics with training in patients with spinal cord injury. Med Sci Sports Exerc. 1996;28:1221–1228
  40. Malina RM, Bouchard C. Growth, maturation, and physical activity. Champaign: Human Kinetics; 1991;
  41. Stewart MW, Melton-Rogers SL, Morrison S, Figoni SF. The measurement properties of fitness measures and health status for persons with spinal cord injuries. Arch Phys Med Rehabil. 2000;81:394–400
  42. Fornusek C, Davis GM. Maximizing muscle force via low-cadence functional electrical stimulation cycling. J Rehabil Med. 2004;36:232–237
  43. Kelley GA, Kelley KS. Aerobic exercise and lipids and lipoproteins in children and adolescents: a meta-analysis of randomized controlled trials. Atherosclerosis. 2007;191:447–453
  44. El Sayed MS, Younesian A. Lipid profiles are influenced by arm cranking exercise and training in individuals with spinal cord injury. Spinal Cord. 2005;43:299–305
  45. de Groot S, Dallmeijer AJ, Post MW, Angenot EL, van der Woude LH. The longitudinal relationship between lipid profile and physical capacity in persons with a recent spinal cord injury. Spinal Cord. 2008;46:344–351

 Supported by the Shriners Hospitals for Children (grant no. 8540).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Clinical Trials Registration Number: NCT00245726.

PII: S0003-9993(09)00314-1

doi: 10.1016/j.apmr.2009.02.018

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 8 , Pages 1379-1388 , August 2009

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