Efficacy of functional electrical stimulation alone and as an adjunct to exercise for improving respiratory function and aerobic capacity in spinal cord injury: a systematic review and meta-analysis.
Jiahao Xiangli, Binquan Ma, Yu Liang and 2 others
PMID 40820989WHAT IT FOUND
FES significantly improved expiratory function (FVC, PEF, MEP) in people with spinal cord injury, but did not improve inspiratory strength.
FES added to rowing improved peak oxygen uptake. Peak ventilation did not change.
Key findings
01FES significantly improved forced vital capacity, peak expiratory flow, and maximal expiratory pressure in people with SCI. The PEF improvement was about 0.8 L/s, exceeding the minimal important difference of 0.5 L/s, and the MEP effect was large (SMD 0.93).
02FES did not significantly improve maximal inspiratory pressure (MIP), and this finding was based on only 2 studies. The authors note the mechanism of abdominal FES targets expiratory muscles, so any effect on inspiration would be indirect.
03FES combined with rowing (7 studies) significantly improved VO2peak, and FES combined with cycling (2 studies) also showed a significant VO2peak improvement. However, peak ventilation (VEpeak) was not significantly improved for either rowing or cycling.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 2 studies contributed to the MIP analysis, so the null finding for inspiratory strength is very uncertain. Only 2 studies contributed to the cycling VO2peak analysis, making that positive result fragile. Publication bias was detected for PEF, MIP, and the rowing aerobic outcomes, so the positive results for those may be overestimated. Heterogeneity was high for VO2peak with rowing (I² = 69%), driven by differences in FES parameters, exercise protocols, and intervention durations across studies. Most individual studies were small (6 to 27 participants) and many were self-controlled or quasi-experimental rather than randomised. The FES protocols varied widely in frequency, intensity, duration, and stimulation parameters, making it hard to identify a single effective prescription.
Declared interests
No financial support was received for the research or publication of this article.
The easy way to misread this
Do not assume FES improves all respiratory function. The inspiratory measure (MIP) was not significant, and that finding was based on only 2 studies. A hurried reader of the title may conclude FES helps with both inspiration and expiration, but the evidence supports expiration only. In addition, publication bias was detected for PEF and the rowing VO2peak, so those positive results may be overestimated.
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