- •Hybrid functional electrical stimulation (FES) exercise combines arm cranking with FES leg cycling.
- •Hybrid FES exercise has not previously been investigated in people with multiple sclerosis (MS).
- •FES intensity during hybrid FES exercise was sufficient to enhance aerobic response.
- •Regular hybrid FES exercise might improve aerobic fitness in people with advanced MS.
To investigate through a pilot study the acute cardiorespiratory responses during functional electrical stimulation (FES) cycling, arm crank ergometry (ACE), and a combination of ACE and FES cycling (hybrid FES cycling) in people with advanced multiple sclerosis (MS) to provide preliminary guidance for effective aerobic exercise prescription.
Acute repeated measures.
Inclusion criteria was a diagnosis of MS, with Expanded Disability Status Scale (EDSS) 6.0-8.5. Included were 9 participants (N=9; 7 female, age 54.7±8.8y, EDSS 7.2±0.7).
Participants were assessed on 3 different exercise modalities (FES cycling, ACE, hybrid FES cycling) at 40%, 60%, 80%, and 100% of mode-specific peak workload.
Main Outcome Measures
Oxygen consumption and heart rate were measured at each workload.
Hybrid FES cycling evoked a significantly higher oxygen consumption relative to body weight (V̇o2relative) (mL/kg/min) and heart rate (beats per minute [BPM]) at most workloads compared with ACE or FES cycling. At the 100% workload, heart rate for hybrid FES cycling was 125 BPM (range, 113-148 BPM) and was significantly higher than ACE at 99 BPM (range, 95-119 BPM) (P=.008) and FES cycling at 94 BPM (range, 79-100 BPM) (P=.008). Similarly, at the 100% workload, V̇o2relative for hybrid FES cycling was 11.8 mL/kg/min (range, 7.6-17.6 mL/kg/min) and was significantly higher than ACE at 8.9 mL/kg/min (range, 5.3-12.5 mL/kg/min) (P=.012) and FES cycling at 6.8 mL/kg/min (range, 4.1-9.2 mL/kg/min) (P=.012).
This pilot study showed that hybrid FES cycling can elicit a greater cardiorespiratory response than ACE or FES cycling in people with advanced MS. Thus, hybrid FES cycling might provide a potent enough stimulus to induce clinically relevant changes in cardiorespiratory fitness. Training studies are warranted to document the magnitude and sustainability of aerobic capacity adaptations to hybrid FES cycling and associated health outcomes in advanced MS.
List of abbreviations:ACE (arm crank ergometry), BPM (beats per minute), EDSS (Expanded Disability Status Scale), FES (functional electrical stimulation), MS (multiple sclerosis), RPM (revolutions per minute), V̇o2 (oxygen consumption), V̇o2max (maximum oxygen consumption), V̇o2relative (oxygen consumption relative to body weight)
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- Multiple sclerosis.Lancet. 2008; 372: 1502-1517
- Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).Neurology. 1983; 33: 1444-1452
- Physical activity and perceived health status in persons with multiple sclerosis.J Neurosci Nurs. 1997; 29: 238-243
- Physical activity and multiple sclerosis: a meta-analysis.Mult Scler. 2005; 11: 459-463
- Muscular, cardiac, ventilatory and metabolic dysfunction in patients with multiple sclerosis: implications for screening, clinical care and endurance and resistance exercise therapy, a scoping review.J Neurol Sci. 2016; 367: 107-121
- Cardiopulmonary fitness is related to disease severity in multiple sclerosis.Mult Scler J. 2016; 22: 231-238
- General health issues in multiple sclerosis: comorbidities, secondary conditions, and health behaviors.Continuum (Minneap Minn). 2013; 19: 1046-1057
- High risk of cardiovascular diseases after diagnosis of multiple sclerosis.Mult Scler J. 2013; 19: 1336-1340
- Riebe D Ehrman JK Liguori G Magal M ACSM's guidelines for exercise testing and prescription. 10 edition. Wolters Kluwer, Philadelphia2018
- Aerobic capacity in persons with multiple sclerosis: a systematic review and meta-analysis.Sports Med. 2015; 45: 905-923
- Physical rehabilitation interventions in nonambulatory people with multiple sclerosis: a systematic review.Int J Rehabil Res. 2012; 35: 281-291
- Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training.Mult Scler. 2008; 14: 35-53
- Arm cranking: an exercise intervention for a severely disabled adult with multiple sclerosis.N Z J Physiother. 2006; 34: 172-178
- Accessible exercise equipment and individuals with multiple sclerosis: aerobic demands and preferences.NeuroRehabilitation. 2019; 45: 359-367
- Endurance training is feasible in severely disabled patients with progressive multiple sclerosis.Mult Scler J. 2014; 20: 627-630
- Exercise training in progressive multiple sclerosis: a comparison of recumbent stepping and body weight-supported treadmill training.Int J MS Care. 2016; 18: 221-229
- Neuromuscular electrical stimulation cycling exercise for persons with advanced multiple sclerosis.J Rehabil Med. 2014; 46: 698-702
- Cardiorespiratory metabolism during voluntary and electrical stimulation cycling in persons with advanced multiple sclerosis.in: 2014 IEEE 19th International Functional Electrical Stimulation Society Annual Conference (IFESS). IEEE, Kuala Lumpur, Malaysia2014: 1-4
- The use of functional electrical stimulation for rehabilitation of spinal cord injured patients.Centr Nerv Syst Trauma. 1984; 1: 57-74
- Development of an isokinetic functional electrical stimulation cycle ergometer.Neuromodulation. 2004; 7: 56-64
- Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment: a systematic review.Mult Scler Relat Disord. 2020; 37101485
- Exercise responses during functional electrical stimulation cycling in individuals with spinal cord injury.Med Sci Sports Exerc. 2013; 45: 1131-1138
- Cardiorespiratory responses during arm ergometry, functional electrical stimulation cycling, and two hybrid exercise conditions in spinal cord injured.Disabil Rehabil Assist Technol. 2007; 2: 127-132
- Cardiorespiratory responses to arm cranking and electrical stimulation leg cycling in people with paraplegia.Med Sci Sports Exerc. 1999; 31: 822-828
- Cardiorespiratory demand of acute voluntary cycling with functional electrical stimulation in individuals with multiple sclerosis with severe mobility impairment.Appl Physiol Nutr Metab. 2018; 43: 71-76
- Development of evidence-informed physical activity guidelines for adults with multiple sclerosis.Arch Phys Med Rehabil. 2013; 94: 1829-1836
- The effect of exercise training in adults with multiple sclerosis with severe mobility disability: a systematic review and future research directions.Mult Scler Relat Disord. 2017; 16: 31-39
- Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course.Mult Scler. 2020; 26: 1459-1469
- Cardiorespiratory responses during functional electrical stimulation cycling and electrical stimulation isometric exercise.Spinal Cord. 2014; 52: 635
- FES cycling reduces spastic muscle tone in a patient with multiple sclerosis.NeuroRehabilitation. 2007; 22: 335-337
- Functional electrical stimulation-assisted cycling of patients with multiple sclerosis: biomechanical and functional outcome - a pilot study.J Rehabil Med. 2009; 41: 674-680
- Pilot randomized controlled trial of functional electrical stimulation cycling exercise in people with multiple sclerosis with mobility disability.Mult Scler Relat Disord. 2018; 26: 103-111
- A pilot study of functional electrical stimulation cycling in progressive multiple sclerosis.NeuroRehabilitation. 2010; 27: 121-128
- Disseminated abnormalities of cardiovascular autonomic functions in multiple sclerosis.Neurology. 1985; 35: 1665-1668
- Multimodal exercise training in multiple sclerosis: a randomized controlled trial in persons with substantial mobility disability.Contemp Clin Trials. 2017; 61: 39-47
Published online: July 17, 2021
Accepted: July 12, 2021
Received in revised form: May 28, 2021
Received: February 16, 2021
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.