Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes.
Jan W van der Scheer, Victoria L Goosey-Tolfrey, Sydney E Valentino and 2 others
PMID 34118958WHAT IT FOUND
For adults with spinal cord injury, functional electrical stimulation cycling consistently improved lower-body muscle health across studies.
It also often increased leg power and aerobic fitness. Evidence for other health outcomes was weaker and less consistent.
Key findings
01Across 36 studies, 30 showed significant improvements in muscle health, but the one Level 1 study did not.
02Power output showed significant improvements in 34 out of 35 studies, and aerobic fitness in 20 out of 26 studies, but neither outcome had Level 1 or Level 2 studies.
03Adverse events were described in 21 studies involving 203 participants, with 18 participants experiencing suspected adverse reactions and one serious suspected reaction.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Most evidence came from lower-quality studies: of 92 studies, 65 were Level 3 and 18 were Level 4. No meta-analysis was possible because study designs, interventions, and outcome measures varied widely, and many studies did not report effect sizes, confidence intervals, or descriptive statistics. The review counted studies with statistically significant improvements, not clinically meaningful improvements. Women, adults older than 65, people with motor incomplete injuries, and people with high cervical or lumbar lesions were underrepresented. Participants were screened to be able to respond to FES cycling and were free of common exclusion problems, so the results may not apply to all patients with spinal cord injury. In 19 studies, FES cycling was combined with other lower-body strength exercise, so the contribution of cycling alone cannot be separated. Adverse events were not a primary outcome and were described in only 21 studies with 203 participants. The review did not identify the minimum or optimal dose, progression, or neuromuscular stimulation parameters.
Declared interests
The article metadata lists non-U.S. government research support. No author conflict-of-interest or funding declaration appears in the supplied text.
The easy way to misread this
Do not conclude that FES cycling alone has proven benefits for walking, independence, bone density, mood, or cardiovascular disease. The review gave high certainty only for lower-body muscle health, low or very low certainty for other outcomes, and 19 studies combined FES cycling with other lower-body strength exercise.