FES-rowing: a well-tolerated and highly beneficial exercise for a patient with Brown-Sequard syndrome.

CONTEXT: Brown-Séquard Syndrome (BSS) is a rare neurological condition associated with Spinal Cord Injury (SCI). Hemisection of the spinal cord causes paralysis of the homolateral side, and thermoalgesic dysfunction on the opposite side. Cardiopulmonary and metabolic alterations have been reported. For all these patients, regular physical activity is highly recommended and functional electrical stimulation (FES) may be a good option, especially for those with paraplegia. However, to our knowledge, the effects of FES have primarily been studied in those with complete SCI and data regarding application and effects in patients with incomplete lesions (with sensory feedback) is lacking. The present case report therefore evaluated the feasibility and effectiveness of a 3-month FES-rowing program in a patient with BSS. METHODS: Knee extensor muscle strength and thickness, walking and rowing capacities as well as quality of life were evaluated before and after 3 months of FES-rowing (two sessions per week) in a 54 year old patient with BSS. RESULTS: The individual had excellent tolerance and adherence to the training protocol. All measured parameters were greatly improved after 3 months: on average, + 30% rowing capacity, + 26% walking capacity, + 24.5% isometric strength, + 21.9% quadriceps muscle thickness, + 34.5% quality of life. CONCLUSION: FES-rowing appears to be well tolerated and highly beneficial for a patient with incomplete SCI and could therefore be considered as an appealing exercise option for these patients.

An Acute Dose of Specific Grape and Apple Polyphenols Improves Endurance Performance: A Randomized, Crossover, Double-Blind versus Placebo Controlled Study.

Polyphenols are thought to be an interesting ergogenic aid for exercise and recovery. However, most studies regarding the effects of polyphenols investigated several days of supplementations. The present work aimed to study the effects of an acute intake of grape and apple polyphenols on the capacity to maintain intense exercise, here named endurance performance. Forty-eight physically active men (31 ± 6 years) were included in this study. During the two testing sessions, volunteers completed an endurance test at a high percentage of their maximal aerobic power and time to exhaustion was measured. Respiratory and pain parameters were also monitored. The preceding evening and 1 h before testing, volunteers had to absorb either 500 mg of polyphenols or placebo according to randomization. In comparison with the placebo, the mean duration of the maximal endurance test was significantly increased with polyphenols (+9.7% ± 6.0%, p < 0.05). The maximal perceived exertion was reached later with polyphenols (+12.8% ± 6.8%, p < 0.05). Practically, the present study showed the beneficial effects of grape and apple polyphenols for athletes looking for endurance performance improvements. The specifically designed profile of polyphenols appeared to enhance the capacity to maintain intensive efforts and delay perceived exertion.

One year of training with FES has impressive beneficial effects in a 36-year-old woman with spinal cord injury.

CONTEXT: Reductions of muscular and cardiorespiratory functions are often observed in people with spinal cord injury (SCI) and several studies demonstrated the benefits of aerobic and strengthening exercise training for this population. Functional Electrical Stimulation (FES) of paralyzed muscles has been proposed as a strategy to assist patients in executing functional movement but its utilization during long durations has never been investigated. The purpose of the present study was to assess the effects of a one-year training program with FES (strengthening and rowing) in one subject with SCI. Evoked torque, quadriceps muscle thickness, aerobic exercise capacity and bone mineral density were tested. FINDINGS: All parameters increased after training: average evoked torque +151%, quadriceps muscle thickness +136%, thigh circumference +14%, bone density +19%, maximal oxygen uptake +76% and oxygen uptake at ventilatory threshold +111%. CONCLUSION: These impressive improvements demonstrate that FES training offers several interesting clinical benefits in a patient with SCI.

Functional electrical stimulation: cardiorespiratory adaptations and applications for training in paraplegia.

Regular exercise can be broadly beneficial to health and quality of life in humans with spinal cord injury (SCI). However, exercises must meet certain criteria, such as the intensity and muscle mass involved, to induce significant benefits. SCI patients can have difficulty achieving these exercise requirements since the paralysed muscles cannot contribute to overall oxygen consumption. One solution is functional electrical stimulation (FES) and, more importantly, hybrid training that combines volitional arm and electrically controlled contractions of the lower limb muscles. However, it might be rather complicated for therapists to use FES because of the wide variety of protocols that can be employed, such as stimulation parameters or movements induced. Moreover, although the short-term physiological and psychological responses during different types of FES exercises have been extensively reported, there are fewer data regarding the long-term effects of FES. Therefore, the purpose of this brief review is to provide a critical appraisal and synthesis of the literature on the use of FES for exercise in paraplegic individuals. After a short introduction underlying the importance of exercise for SCI patients, the main applications and effects of FES are reviewed and discussed. Major findings reveal an increased physiological demand during FES hybrid exercises as compared with arms only exercises. In addition, when repeated within a training period, FES exercises showed beneficial effects on muscle characteristics, force output, exercise capacity, bone mineral density and cardiovascular parameters. In conclusion, there appears to be promising evidence of beneficial effects of FES training, and particularly FES hybrid training, for paraplegic individuals.

Effects of electrical stimulation pattern on quadriceps isometric force and fatigue in individuals with spinal cord injury.

INTRODUCTION: Variable frequency trains (VFT) or train combinations have been suggested as useful strategies to offset the rapid fatigue induced by constant frequency trains (CFT) during electrical stimulation. However, most studies have been of short duration with limited functional application in those with spinal cord injury (SCI). We therefore tested force and fatigue in response to VFT, CFT, and combined patterns in strength training-like conditions (6-s contractions). METHODS: Ten SCI individuals underwent either CFT or VFT patterns until target torque was no longer produced and then switched immediately to the other pattern. RESULTS: Target torque was reached more times when VFT was used first (VFT: 6.7 ± 0.8 vs. CFT: 3.5 ± 0.2 contractions, P < 0.05) and when it was followed by the CFT pattern (VFT-CFT: 10.3 ± 1.2 vs. CFT-VFT: 6.9 ± 1.2 contractions, P < 0.05). CONCLUSIONS: These findings suggest that for the same initial forces the VFT pattern is less fatiguing than CFT and that when combining train types, VFT should be used first.

Hybrid functional electrical stimulation exercise training alters the relationship between spinal cord injury level and aerobic capacity.

OBJECTIVE: To test the hypothesis that hybrid functional electrical stimulation (FES) row training would improve aerobic capacity but that it would remain strongly linked to level of spinal cord lesion because of limited maximal ventilation. DESIGN: Longitudinal before-after trial of 6 months of FES row training. SETTING: Exercise for persons with disabilities program in a hospitaL. PARTICIPANTS: Volunteers (N=14; age range, 21-63y) with complete spinal cord injury (SCI) (T3-11) who are >2 years postinjury. INTERVENTION: Six months of FES row training preceded by a variable period of FES strength training. MAIN OUTCOME MEASURES: Peak aerobic capacity and peak exercise ventilation before and after 6 months of FES row training. RESULTS: FES row training significantly increased peak aerobic capacity and peak minute ventilation (both P<.05). Prior to FES row training, there was a close relation between level of SCI and peak aerobic capacity (adjusted R(2)=.40, P=.009) that was markedly reduced after FES row training (adjusted R(2)=.15, P=.10). In contrast, the relation between level of injury and peak minute ventilation was comparable before and after FES row training (adjusted R(2)=.38 vs .32, both P<.05). CONCLUSIONS: The increased aerobic capacity reflects more than increased ventilation; FES row training effectively circumvents the effect of SCI on peak aerobic capacity by engaging more muscle mass for training, independent of the level of injury.

Effects of electrical stimulation pattern on quadriceps force production and fatigue.

INTRODUCTION: Mixed stimulation programs (MIX) that switch from constant frequency trains (CFT) to variable frequency trains have been proposed to offset the rapid fatigue induced by CFT during electrical stimulation. However, this has never been confirmed with long stimulation patterns, such as those used to evoke functional contractions. The purpose of this study was to test the hypothesis that MIX programs were less fatiguing than CFTs in strength training-like conditions (6-s contractions, 30-min). METHODS: Thirteen healthy subjects underwent 2 sessions corresponding to MIX and CFT programs. Measurements included maximal voluntary isometric torque and torque evoked by each contraction. RESULTS: There were greater decreases of voluntary and evoked torque (P < 0.05) after CFT than MIX, and mean torque was 13 ± 1% higher during the MIX session (P < 0.05). CONCLUSIONS: These findings confirm that combining train types might be a useful strategy to offset rapid fatigue during electrical stimulation sessions with long-duration contractions.

Does electrical stimulation enhance post-exercise performance recovery?

Elite sport requires high-volume and high-intensity training that inevitably induces neuromuscular fatigue detrimental for physical performance. Improving recovery processes is, therefore, fundamental and to this, a wide variety of recovery modalities could be proposed. Among them, neuromuscular electrical stimulation is largely adopted particularly by endurance-type and team sport athletes. This type of solicitation, when used with low stimulation frequencies, induces contractions of short duration and low intensity comparable to active recovery. This might be of interest to favour muscle blood flow and therefore metabolites washout to accelerate recovery kinetics during and after fatiguing exercises, training sessions or competition. However, although electrical stimulation is often used for recovery, limited evidence exists regarding its effects for an improvement of most physiological variables or reduced subjective rating of muscle soreness. Therefore, the main aim of this brief review is to present recent results from the literature to clarify the effectiveness of electrical stimulation as a recovery modality.

Feasibility and efficacy of progressive electrostimulation strength training for competitive tennis players.

The purpose of this preliminary study was to show the feasibility of electrostimulation (ES) strength exercise incorporated into tennis sessions during the preparatory season of competitive players, and its impact on anaerobic performance. Twelve tennis players (5 men, 7 women) completed 9 sessions of quadriceps ES (duration: 16 minutes; frequency: 85 Hz; on-off ratio: 5.25-25 seconds) during 3 weeks. The ES sessions were integrated into tennis training sessions. Subjects were baseline tested and retested 1 (week 4), 2 (week 5), 3 (week 6), and 4 weeks (week 7) after the ES training program for maximal quadriceps strength, vertical jump height, and shuttle sprint time. Participants were able to progressively increase ES current amplitude and evoked force throughout the 9 training sessions, with an optimal treatment compliance of 100%. Maximal quadriceps strength significantly increased during the entire duration of the experiment (p < 0.001). Countermovement jump height at week 5 (+5.3%) and week 6 (+6.4%) was significantly higher than at baseline (p < 0.05). In addition, 2 x 10-m sprint time at week 6 was significantly shorter (-3.3%; p = 0.004) compared with pretraining. The 3-week ES strength training program was successfully incorporated into preseason tennis training with a linear progression in all training parameters. Throughout the study period, a delayed enhancement of anaerobic power and stretch-shortening cycle performance was observed. Progressive ES strength training may be safely included in the early tennis season and can lead to improvements in the anaerobic performance of men and women players.

Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial.

OBJECTIVE: To assess the effects of low-frequency electric muscle stimulation associated with usual physiotherapy on functional outcome after total hip arthroplasty (THA) for hip osteoarthritis (OA) in elderly subjects. DESIGN: Randomized controlled trial; pre- and posttreatment measurements. SETTING: Hospital rehabilitation department. PARTICIPANTS: Subjects (N=29) referred to the rehabilitation department after THA for hip OA. INTERVENTIONS: The intervention group (n=16; 78+/-8 y) received simultaneous low-frequency electric muscle stimulation of bilateral quadriceps and calf muscles (highest tolerated intensity, 1h session, 5 d/wk, for 5 weeks) associated with conventional physical therapy including resistance training. The control group (n=13; 76+/-10 y) received conventional physical therapy alone (25 sessions). MAIN OUTCOME MEASURES: Maximal isometric strength of knee extensors, FIM instrument, before and after; a six-minute walk test and a 200 m fast walk test, after; length of stay (LOS). RESULTS: Low-frequency electric muscle stimulation was well tolerated. It resulted in a greater improvement in strength of knee extensors on the operated side (77% vs 23%; P<.01), leading to a better balance of muscle strength between the operated and nonoperated limb. The low-frequency electric muscle stimulation group also showed a greater improvement in FIM scores, though improvements in the walk tests were similar for the 2 groups, as was LOS. CONCLUSIONS: Low-frequency electric muscle stimulation is a safe, well-tolerated therapy after THA for hip OA. It improves knee extensor strength, which is one of the factors leading to greater functional independence after THA.

Do low-frequency electrical myostimulation and aerobic training similarly improve performance in chronic heart failure patients with different exercise capacities?

OBJECTIVE: To confirm that electrical myostimulation is a good alternative to conventional aerobic training in patients with chronic heart failure and to compare the effects of both training programmes in patients with different exercise capacities. PATIENTS AND METHODS: A total of 44 patients with stable chronic heart failure underwent 5 weeks of exercise training, with electrical myostimulation or conventional aerobic training programmes. At baseline and after the training period, patients performed a symptom-limited cardiopulmonary exercise test and a 6-min walk test. RESULTS: Oxygen uptake at the end of exercise (V.O2 peak) and at ventilatory threshold (V.O2 VT) increased after electrical myostimulation (p< 0.001) and conventional aerobic training (p< 0.001) training programmes. The slope of the relationship between V.O2 and workload was reduced after electrical myostimulation (p< 0.05), but not after conventional aerobic training. Recovery was improved after both training programmes (p< 0.05), and the distance walked in 6 min was increased (p< 0.001). These improvements were not statistically different between electrical myostimulation and conventional aerobic training. Moreover, electrical myostimulation induced greater improvements in patients with low exercise capacity, whereas conventional aerobic training induced improved performance in patients with average exercise capacity. CONCLUSION: Five weeks of electrical myostimulation and conventional aerobic training exercise training produced similar improvements in exercise capacity in patients with chronic heart failure. However, electrical myostimulation appears to be more effective in patients with low exercise capacity than in those with average exercise capacity.

Comparison of low-frequency electrical myostimulation and conventional aerobic exercise training in patients with chronic heart failure.

BACKGROUND: Physical training is recommended as an efficient therapy in patients with chronic heart failure (CHF). Low-frequency electrical myostimulation (EMS) has recently been suggested as a good alternative to conventional aerobic training. The aim of this study was to compare the effects of EMS and conventional exercise training in patients with moderate to severe CHF. METHODS: Twenty-four patients with stable CHF (56.7+/-7.3 years, New York Heart Association grades II and III) underwent 5 weeks of exercise training, 5 h a week, using EMS (n=12) or conventional (n=12) training programmes. At baseline and after the training period, patients performed a symptom-limited cardiopulmonary test, a 6-min and a 200-m walk exercises and an evaluation of maximal knee extensor strength. RESULTS: Oxygen uptake (VO2) and workload at the end of exercise (peak values) and at ventilatory threshold increased after EMS (P< or =0.05) and conventional exercise (P<0.05) training programmes. The slope of the relationship between VO2 and workload was reduced after EMS (P<0.05). The time to recover half of peak VO2 decreased irrespective of the training programme (P<0.001). EMS and conventional exercise training programmes also increased the maximal knee extensor strength (P<0.05), the distance walked in 6 min (P<0.01) and decreased the time elapsed to cover 200 m (P<0.05). These improvements were not statistically different between EMS and conventional exercise. CONCLUSION: In patients with moderate to severe CHF, 5 weeks of EMS and conventional exercise training produce similar improvements to exercise capacity and muscle performance.