Reduction of breast lymphoedema secondary to breast cancer: a randomised controlled exercise trial.

BACKGROUND: Breast lymphoedema can occur following surgical treatment for breast cancer. We investigated whether an exercise program reduced breast lymphoedema symptoms compared to a non-exercise control group. METHODS: A single-blinded randomised controlled trial was conducted in which women with stable breast lymphoedema (n = 89) were randomised into an exercise (n = 41) or control (n = 47) group. The intervention comprised a 12-week combined aerobic and resistance training program, supervised weekly by an accredited exercise physiologist. All participants completed a weekly symptoms diary and were assessed monthly to ensure that there was no exacerbation of their lymphoedema. Changes in the breast were captured physically with ultrasound and bioimpedance spectroscopy and changes in symptoms were captured using European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer (BR23) and Lymphoedema Symptom Intensity and Distress questionnaires. RESULTS: The exercise group reported a greater reduction in breast-related symptoms than the control group, assessed by the EORTC BR23 breast symptom questions. Measures of extracellular fluid, assessed with bioimpedance spectroscopy ratio, decreased in the exercise group compared to the control group. No significant difference was detected in dermal thickness in the breast, assessed by ultrasound. Session attendance in the exercise sessions was high, with two musculoskeletal adverse events reported, but no exacerbations of lymphoedema observed. CONCLUSION: Combined resistance and aerobic exercise training is safe for women living with breast lymphoedema. Preliminary data suggest exercise training can reduce breast lymphoedema symptoms to a greater extent than usual care.

Can combined aerobic and muscle strength training improve aerobic fitness, muscle strength, function and quality of life in people with spinal cord injury? A systematic review.

STUDY DESIGN: A systematic review. OBJECTIVES: The aim of this systematic review was to establish whether combined aerobic training and muscle strength training is effective in improving aerobic fitness, muscle strength, function and/or quality of life (QoL) in people with spinal cord injury (SCI). SETTINGS: Faculty of Health Sciences. University of Sydney, NSW, Australia. METHODS: A search was conducted for randomized controlled trials (RCTs), controlled trials, uncontrolled clinical trials, case series and cross-over studies involving exercise interventions that included a combination of aerobic and strength components, either in circuit-mode or in sequence for people with SCI. Methodological quality was independently rated using the PEDro scale and key findings were extracted from trials by two reviewers. RESULTS: The search identified 7981 abstracts, from which nine trials met the inclusion criteria. From the nine selected trials, seven reported aerobic outcomes, two of which showed a statistically significant within-group difference in aerobic fitness. Five studies reported muscle strength outcomes, four of them showed a statistically significant within-group mean difference on at least one outcome measure. Two studies looked at QoL, one of them found a statistically significant between-group difference on one outcome measure. CONCLUSION: Our systematic review showed that literature on SCI population is scarce, of low quality and findings of existing studies are inconsistent. Thus, further RCTs with larger number of participants are needed to make a definite conclusion about the influence of combined aerobic and muscle strength training on aerobic fitness, muscle strength and QoL in people with SCI.

Electrical stimulation-evoked contractions blunt orthostatic hypotension in sub-acute spinal cord-injured individuals: two clinical case studies.

STUDY DESIGN: Prospective study of two cases. OBJECTIVES: To describe the effects of electrical stimulation (ES) therapy in the 4-week management of two sub-acute spinal cord-injured (SCI) individuals (C7 American Spinal Injury Association Impairment Scale (AIS) B and T9 AIS (B)). SETTING: University Malaya Medical Centre, Kuala Lumpur, Malaysia. METHODS: A diagnostic tilt-table test was conducted to confirm the presence of orthostatic hypotension (OH) based on the current clinical definitions. Following initial assessment, subjects underwent 4 weeks of ES therapy 4 times weekly for 1 h per day. Post-tests tilt table challenge, both with and without ES on their rectus abdominis, quadriceps, hamstrings and gastrocnemius muscles, was conducted at the end of the study (week 5). Subjects' blood pressures (BP) and heart rates (HR) were recorded every minute during pre-test and post-tests. Orthostatic symptoms, as well as the maximum tolerance time that the subjects could withstand head up tilt at 60°, were recorded. RESULTS: Subject A improved his orthostatic symptoms, but did not recover from clinically defined OH based on the 20-min duration requirement. With concurrent ES therapy, 60° head up tilt BP was 89/62 mm Hg compared with baseline BP of 115/71 mm Hg. Subject B fully recovered from OH demonstrated by BP of 105/71 mm Hg during the 60° head up tilt compared with baseline BP of 124/77 mm Hg. Both patients demonstrated longer tolerance time during head up tilt with concomitant ES (subject A: pre-test 4 min, post-test without ES 6 min, post-test with ES 12 min; subject B: pre-test 4 min, post-test without ES 28 min, post-test with ES 60 min). CONCLUSIONS: Weekly ES therapy had positive effect on OH management in sub-acute SCI individuals.

Mercury and methylmercury stream concentrations in a Coastal Plain watershed: a multi-scale simulation analysis.

Mercury is a ubiquitous global environmental toxicant responsible for most US fish advisories. Processes governing mercury concentrations in rivers and streams are not well understood, particularly at multiple spatial scales. We investigate how insights gained from reach-scale mercury data and model simulations can be applied at broader watershed scales using a spatially and temporally explicit watershed hydrology and biogeochemical cycling model, VELMA. We simulate fate and transport using reach-scale (0.1 km(2)) study data and evaluate applications to multiple watershed scales. Reach-scale VELMA parameterization was applied to two nested sub-watersheds (28 km(2) and 25 km(2)) and the encompassing watershed (79 km(2)). Results demonstrate that simulated flow and total mercury concentrations compare reasonably to observations at different scales, but simulated methylmercury concentrations are out-of-phase with observations. These findings suggest that intricacies of methylmercury biogeochemical cycling and transport are under-represented in VELMA and underscore the complexity of simulating mercury fate and transport.

Electrical stimulation plus progressive resistance training for leg strength in spinal cord injury: a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To determine the effectiveness of electrical stimulation (ES)-evoked muscle contractions superimposed on progressive resistance training (PRT) for increasing voluntary strength in the quadriceps muscles of people with spinal cord injuries (SCI). SETTING: Sydney, Australia. METHODS: A total of 20 people with established SCI and neurologically induced weakness of the quadriceps muscles participated in the trial. Participants were randomized between experimental and control groups. Volunteers in the experimental group received ES superimposed on PRT to the quadriceps muscles of one leg thrice weekly for 8 weeks. Participants in the control group received no intervention. Assessments occurred at the beginning and at the end of the 8-week period. The four primary outcomes were voluntary strength (Nm) and endurance (fatigue ratio) as well as the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM; points). RESULTS: The between-group mean differences (95% confidence interval (CI)) for voluntary strength and endurance were 14 Nm (1-27; P=0.034) and 0.1 (-0.1 to 0.3; P=0.221), respectively. The between-group median differences (95% CI) for the performance and satisfaction items of the COPM were 1.7 points (-0.2 to 3.2; P=0.103) and 1.4 points (-0.1 to 4.6; P=0.058), respectively. CONCLUSION: ES superimposed on PRT improves voluntary strength, although there is uncertainty about whether the size of the treatment effect is clinically important. The relative effectiveness of ES and PRT is yet to be determined.

Exercise capacity of children with pediatric lung disease.

BACKGROUND: Pulmonary function of children with cystic fibrosis (CF) and bronchopulmonary dysplasia (BPD) is similar at rest even though the mechanisms of injury differ. We sought to compare the peak exercise responses in children with BPD versus CF while controlling for pulmonary impairment, nutritional status, gender, age, height, and predicted forced expired volume in 1 second (approximately 73% of predicted). METHODS: Nine BPD children and 9 CF children underwent spirometry and a progressive exercise test to maximum on a cycle ergometer. RESULTS: There was no difference between groups in body mass percentile (CF:97 +/- 13%, BPD: 98 +/- 11%), peak power output (Wpeak) (CF:67 +/- 19 W, BPD:73 +/- 28 W), % predicted Wpeak (CF:83 +/- 28%, BPD:88 +/- 15%), peak oxygen uptake (VO2peak, CF: 38 +/- 7 ml/kg/min, BPD: 39 +/-6 ml/kg/min), or % predicted VO2peak (CF:99 +/- 16 %, BPD:96 +/- 27%). CONCLUSIONS: Children with mild pulmonary impairments are able to achieve a near normal peak power output and a normal VO2peak. Neither the aetiology nor the developmental onset of the process appears to be important influences on VO2peak or Wpeak.

Efficacy and stability performance of traditional versus motion sensor-assisted strategies for FES standing.

Standing by means of functional electrical stimulation (FES) after spinal cord injury is a topic widely reported in the neurorehabilitation literature. This practice commonly uses surface stimulation over the quadriceps muscle to evoke knee extension. To date, most FES neuroprostheses still operate without any artificial feedback, meaning that after a fatigue-driven knee buckle event, the stimulation amplitude or pulse width must be increased manually via button presses to re-establish knee-lock. This is often referred to as 'hand-controlled (HC) operation'. In an attempt to provide a safer, yet clinically practical approach, this study proposed two novel strategies to automate the control of knee extension based on the kinematic feedback of four miniaturised motion sensors. These strategies were compared to the traditional HC strategy on four individuals with complete paraplegia. The standing times observed over multiple trials were in general longer for the automated strategies when compared to HC (0.5-80%). With the automated strategies, three of the subjects tended to need less upper body support over a frame to maintain balance. A stability analysis based on centre of pressure (CoP) measurements also favoured the automated strategies. This analysis also revealed that although FES standing with the assistance of a frame was likely to be safe for the subjects, their stability was still inferior to that of able-bodied individuals. Overall, the unpredictability of knee buckle events could be more effectively controlled by automated FES strategies to re-establish knee-lock when compared to the traditional user-controlled approach, thus demonstrating the safety and clinical efficacy of an automated approach.

Effect of intrauterine treatment with cephapirin on the reproductive performance of seasonally calving dairy cows at risk of endometritis following periparturient disease.

OBJECTIVE: To determine the effect of intrauterine cephapirin (0.5 g) treatment on the reproductive performance of cows diagnosed as at risk of developing endometritis. METHODS: Cows (n = 1325) from 17 seasonal calving dairy herds were enrolled if they had been calved for more than 6 days and had a condition that placed them at risk of endometritis. Half were treated with intrauterine cephapirin at an examination performed 28-37 days prior to mating start date (MSD). Cows were scored for body condition, their vaginal discharge was scored using vaginoscopy (VV), and the uterus and ovaries were assessed by rectal palpation. RESULTS: Overall, there was no significant treatment effect on reproductive performance. In 945 modified at risk (MAR) cows the effect of treatment varied with the calving to treatment interval (CTI) and VV status. For the subset of 229 MAR cows with CTI < or = 28 days, treatment improved the proportions of first-service conception (OR 3.1; P < 0.01) and 6-week in-calf (OR 2.1; P < 0.05), and reduced the mean MSD to conception interval by 20 days (P < 0.05). The difference was greater in cows with a positive VV score (1-3). Treated VV-negative cows with CTI > 48 days had a reduced proportion of cows in-calf by 6 weeks (OR 0.58; P = 0.056) compared with untreated cows. CONCLUSION: Intrauterine cephapirin infusion of MAR cows improved reproductive performance, depending on CTI. The greater treatment effect in VV-positive cows suggests that VV scoring is a useful tool for the diagnosis of endometritis.

Use of postpartum vaginoscopic (visual vaginal) examination of dairy cows for the diagnosis of endometritis and the association of endrometritis with reduced reproductive performance.

OBJECTIVE: To assess the association between the findings from vaginoscopic examination of postpartum dairy cows with peripartum reproductive disease and their subsequent reproductive performance, and to determine the factors that might be associated with a positive vaginoscopic examination (VV). METHODS: Cows (n=1325) from 17 seasonal calving dairy herds were enrolled if they had been calved at least 7 days and had at least one of the following conditions that placed them at risk of endometritis: retained fetal membranes (RFM), dystocia, a dead calf, hypocalcaemia, twin birth, calving induction or an observed vulval discharge (VD). Examination was undertaken 28-37 days before mating start date (MSD) within each herd. All cows were body condition scored (BCS) and were VV scored on a scale of 0 (clear) to 3 (purulent). The uterus and ovaries were assessed by rectal palpation. RESULTS: Cows with a positive VV score (1-3) were less likely to conceive to first service and had a lower pregnancy proportion than cows that had a negative VV score (score 0). Mean MSD to conception interval was longer in VV-positive cows. A positive VV score was associated with a low BCS, primiparity, intrapelvic uterus, poor uterine tone, large uterus, RFM, VD, dystocia, dead calf and twins. CONCLUSION: In the present study a positive VV score was associated with reduced reproductive performance and was more common in primiparous and low BCS cows. Of the at-risk cows, those with RFM, VD, dystocia, dead calf or twins were more likely to have a positive VV score.

Benefits of FES gait in a spinal cord injured population.

STUDY DESIGN: Review. OBJECTIVES: This review article investigated the objective evidence of benefits derived from functional electrical stimulation (FES)-assisted gait for people with spinal cord injury (SCI). Both FES and gait have been proposed to promote not only augmented health and fitness, but specific ambulatory outcomes for individuals with neurological disabilities. However, due to small sample sizes and the lack of functionality of the intervention, it has not been widely used in clinical practice. This review assessed whether there is sufficient evidence to encourage a more widespread deployment of FES gait within the rehabilitation community. METHODS: Hand searches and online data collection were performed in Medline and Science Direct. Specific search terms used included SCI/paralysis/paraplegia and tetraplegia with electrical stimulation/FES, gait and walking. RESULTS: The searches generated 532 papers. Of these papers, 496 were excluded and 36 papers were included in the review. Many reported benefits were not carefully investigated, and small sample sizes or different methodologies resulted in insufficient evidence to draw definitive conclusions. CONCLUSIONS: FES gait can enhance gait, muscle strength and cardiorespiratory fitness for people with SCI. However, these benefits are dependent on the nature of the injury and further research is required to generalize these results to the widespread population of SCI individuals. Proof of the functionality and further evidence of the benefits of FES gait will assist in FES gait gaining clinical acceptance.

Electrically-evoked control of the swinging leg after spinal cord injury: open-loop or motion sensor-assisted control?

In paraplegics, gait can be restored by means of functional electrical stimulation (FES). Because the electrophysiological responses of the lower limbs to the neuromuscular stimulus are not completely deterministic, several stimulation strategies have been reported in an attempt to refine stepping motion. In open-loop (OL) systems, the electrical stimulation sequences applied over the leg muscles are often tuned for each patient in order to improve the quality of gait. Our aim was to contrast this traditional technique against variable stimulation sequences based on motion sensors (MS) data feedback. Both strategies were tested over 240 stepping trials in three complete paraplegics. In comparison to OL, which used a customised stimulation sequence for each subject, the same MS strategy was as functional for all three subjects. Despite MS producing a lower variability on step lengths, the toe clearances had a similar pattern of variability regardless of the strategy applied. Although the novel MS showed promising results, the reliability of OL was also demonstrated. Therefore, we still recommend the use of OL mainly due to its faster donning and doffing, since this is a matter of importance for the user acceptance of any rehabilitation systems.

Mechanical design and driving mechanism of an isokinetic functional electrical stimulation-based leg stepping trainer.

The mechanical design of a constant velocity (isokinetic) leg stepping trainer driven by functional electrical stimulation-evoked muscle contractions was the focus of this paper. The system was conceived for training the leg muscles of neurologically-impaired patients. A commercially available slider crank mechanism for elliptical stepping exercise was adapted to a motorized isokinetic driving mechanism. The exercise system permits constant-velocity pedalling at cadences of 1-60 rev x min(-1). The variable-velocity feature allows low pedalling forces for individuals with very weak leg muscles, yet provides resistance to higher pedalling effort in stronger patients. In the future, the system will be integrated with a computer-controlled neuromuscular stimulator and a feedback control unit to monitor training responses of spinal cord-injured, stroke and head injury patients.

Sleep and breathing on the first night after adenotonsillectomy for obstructive sleep apnea.

Adenotonsillectomy (T&A) has established effectiveness for the treatment of obstructive sleep apnea (OSA). However, more than 20% of children with OSA have respiratory compromise requiring medical intervention in the postoperative period. The reasons for this complication are not well-defined. We aimed to compare the nature and severity of sleep-disordered breathing in children with mild and severe OSA on the first night following adenotonsillectomy. Ten children were classified into groups of mild and severe OSA, based on preoperative testing. On the first night after T&A, they underwent polysomnography, including electroencephalograph, submental electromyography, bilateral electro-oculograms, monitoring of respiratory movements, heart rate, ECG, and oxygen saturation. Sleep-disordered breathing was assessed by the apnea-hypopnea index, the SaO(2) nadir, and the desaturation index, including dips in saturation below 90% (DI(90)). Sleep quality was assessed by sleep efficiency, time spent in each sleep state, and respiratory arousal index. Obstructive events occurred postoperatively in all children, but were more frequent in those with severe OSA preoperatively: the median (interquartile range) mixed/obstructive apnea/hypopnea indicies were 6.9 (2.2-9.8) events/hr and 21.5 (15.1-112.1) events/hr for the mild OSA group and the severe OSA group, respectively (P = 0.009). Obstructive events were the major cause of desaturation during sleep postoperatively. Sleep quality was severely disrupted in both groups, with reductions in both slow-wave sleep and rapid eye movement sleep. In conclusion, despite removal of obstructing lymphoid tissue, upper airway obstruction occurred on the first postoperative night in children with OSA. This study is the first to demonstrate the mechanism of respiratory compromise after adenotonsillectomy, a common postoperative complication in children with severe OSA.

Acoustic reflectance of pharyngeal structures in children.

The aim of this study was to examine whether Eccovision Reflectance Pharyngometer could assess the anatomical structure of the upper airway in young children. Secondary aims were to assess changes in pharyngeal volume in children with tonsillar (Group A, n=13) and adenoidal hypertrophy (Group B, n=17) at pre- and post- surgical procedures, respectively and further compare them to children who underwent myringotomy (Control Group C, n=10). In all 40 children (aged 3-9 years, median 6 years) enrolled in this pilot prospective study, six recordings (equally dispersed at pre- and 3 month post- operation per subject) of the pharyngeal cavity along with demographic (age, gender), somatic (standing and sitting height, body weight, head and neck circumference) and anatomic (bimaxilliary and bregma) characteristics, were captured. No significant intra-subject variability was noted within the multiple measurements of the pharyngeal volume at pre- as well as post-incision (ANOVA, P>0.1) in all groups. However, in Group A there was a marked increase from pre- to post-pharyngeal volumes in males (P=0.007), which was not observed in females (P=0.13). In Group B pharyngeal volumes decreased from pre- to post- in both males (P=0.87) and females (P=0.34). On the contrary, in Group C there was no change in pharyngeal volumes. These findings contradicted the visual evaluation of the size of the removed tonsillar and/or adenoidal mass in the first two groups and thus suggested that Eccovision Pharyngometer does not reliably assess pharyngeal volumes in a pediatric population.

Accuracy of bovine pregnancy detection using transrectal ultrasonography at 28 to 35 days after insemination.

OBJECTIVE: To estimate the accuracy of real-time ultrasonography to detect pregnancy in dairy cows at 28 to 35 days after insemination. METHODS: Cows that did not return to oestrus between 18 and 24 days after a first insemination (n = 526) were examined by transrectal ultrasonography from 28 to 35 days after insemination. Pregnancy was confirmed by the observation of a foetus, but fluid in the uterine horn and the presence of embryonic membranes were also noted. When pregnancy was not confirmed by the observation of a foetus, a second examination 7 days later, confirmed these remaining cows as pregnant or not pregnant to the first insemination. Detection of pregnancy at this early examination was compared with manual transrectal pregnancy examination performed 10 to 13 weeks after insemination (13-week examination). RESULTS: There were 44% of cows that were pregnant to the first service, 34% that had returned for a second service 18 to 24 days after the first insemination, and 20% of cows that were not pregnant, and had not returned normally for a second service (non-pregnant, non-return) within 24 days of their initial insemination. The presence of a foetus at 28 to 35 days after insemination was accurately predicted by a simplified method where uterine fluid accumulation and embryonic membranes were observed. Foetal loss between the early detection and the 13-week examination (9% of pregnancies) indicated that 28 to 35 days post insemination was too early to reliably detect pregnancy. CONCLUSION: Early examination of pregnancy with transrectal ultrasonography is an accurate method to identify non-pregnant, non-return cows. The examination can be simplified by the observation of uterine fluid accumulation and embryonic membranes, as opposed to the more involved process of observing the foetus.

Weaning infants with respiratory syncytial virus from mechanical ventilation through a fuzzy-logic controller.

We have previously developed a fuzzy logic controller for weaning adults with chronic obstructive pulmonary disease using pressure support ventilation (PSV). We used the core of our fuzzy logic-based weaning platform and further developed parametrizable components for weaning newborns of differing body size and disease-state. The controller was validated on neonates recovering from congenital heart disease (CHD) while receiving synchronous intermittent mandatory ventilation (SIMV). We wished to compare the efficacy of this controller versus the bedside weaning protocol in children with respiratory syncytial virus pneumonitis/bronchiolitis (RSV) in the pediatric intensive care unit (PICU). The fuzzy controller evaluated the "current" and "trend" weaning status of the newborn to quantitatively determine the change in the SIMV integrated ventilatory setting. For the "current" status it used heart rate (HR), respiratory rate (RR), tidal volume (VT) and oxygen saturation (SaO2), while for the "trend" status the differences of deltaRR/ deltat, deltaHR/ deltat, and deltaSaO2/ deltat recorded between two subsequent time points were utilized. The enumerated vital signs were fuzzified and then probability levels of occurrence were assigned. Individualized "golden" goals for SaO2 were set for each newborn. We retrospectively assessed the charts of 19 newborns, 113+/-128 days old, 5,546+/-2,321 gr body weight, weaning for 99+/-46 days, at 2-hour intervals. The SIMV levels proposed by the fuzzy controller were matched to those levels actually applied. In 60% of the time both values coincided. For the remaining 40%, the controller was more aggressive suggesting lower values of SIMV than the applied ones. The Area under the SIMV curves over time was 1,969+/-1,044 for the applied vs 1,886+/-978 for the suggested levels, respectively. The fuzzy controller adjusted for body size and disease-pattern can approximate the actual weaning course of newborns with RSV.

Fuzzy logic controller for weaning neonates from mechanical ventilation.

Weaning from mechanical ventilation is the gradual detachment from any ventilatory support till normal spontaneous breathing can be fully resumed. To date, we have developed a fuzzy logic controller for weaning COPD adults using pressure support ventilation (PS). However, adults and newborns differ in the pathophysiology of lung disease. We therefore used our fuzzy logic-based weaning platform to develop modularized components for weaning newborns with lung disease. Our controller uses the heart rate (HR), respiratory rate (RR), tidal volume (VT) and oxygen saturation (SaO2) and their trends deltaHR/deltat, deltaVT/deltat and deltaSaO2/deltat to evaluate, respectively, the Current and Trend weaning status of the newborn. Through appropriate fuzzification of these vital signs, Current and Trend weaning status can quantitatively determine the increase/decrease in the synchronized intermittent mandatory ventilation (SIMV) setting. The post-operative weaning courses of 10 newborns, 82+/-162 days old, were assessed at 2-hour intervals for 68+/-39 days. The SIMV levels, proposed by our algorithm, were matched to those levels actually applied. For 60% of the time both values coincided. For the remaining 40%, our algorithm suggested lower SIMV support than what was applied. The Area Under the Curve for integrated ventilatory support over time was 1203+/-846 for standard ventilatory strategies and 1152+/-802 for fuzzy controller. This suggests that the algorithm, approximates the actual weaning progression, and may advocate a more aggressive strategy. Moreover, the core of the fuzzy controller facilitates adaptation for body size and diversified disease patterns and sets the premises as an infant-weaning tool.

Effects of electrical stimulation-induced leg training on skeletal muscle adaptability in spinal cord injury.

Neuromuscular electrical stimulation has grown in popularity as a therapeutic device for training and an ambulation aid to human paralyzed muscle. Despite its current clinical use, few studies have attempted to concurrently investigate the functional and intramuscular adaptations which occur after electrical stimulation training. Six individuals with a spinal cord injury performed 10 weeks of electrical stimulation leg cycle training (30 min d(-1), 3 d week(-1)). The paralyzed vastus lateralis muscle showed significant alterations in skeletal muscle characteristics after the training, indicated by an improvement in total work output (52-112 kJ; P < 0.05), an increase in fiber cross-sectional area (18 to 41 x 10(2) microm(2); P < 0.05), a reduction in the percentage of type IIX fibers (75% to 12%; P < 0.05), a decrease in myosin heavy chain IIx (68% to 44%; P < 0.05), an increase in capillary density (2-3.5 capillaries around fiber; P < 0.05) and increases in activity levels of citrate synthase (7-16 mU mg(-1) protein) and hexokinase (1.2-2.4 mU mg(-1) protein). This study showed that 10 weeks of electrical stimulation training of human paralyzed muscle induces concurrent improvements in functional capacity and oxidative metabolism.