Importance of Exercise with FES in People with Spinal Cord Injury 
- Type 2 Diabetes - 

Justin Y. Jeon 

The Steadward Centre for Personal & Physical Achievement  University of Alberta, Edmonton AB

In my experience of working at the Steadward Centre (Formally known as Rick Hansen Centre) as a functional electrical stimulation (FES) - technician, I have had chanced to observe many people with spinal cord injury (SCI) with upper body obesity. Upper body obesity is one of the risk factors for developing Type 2 diabetes. Recent research showed that 22% of people with SCI had diabetes, compared to 6% in an able-bodied comparison group. It also showed that 56% of people with SCI had impaired carbohydrate metabolism (diabetes and glucose intolerance) compared to 20% in an able-bodied sample. In fact, it is estimated that people with SCI have about four to five times the risk of developing diabetes than the general population. This high incidence of impaired carbohydrate metabolism is due to physical inactivity, a large amount of paralyzed muscle tissue and changes in body composition (increased fat mass and decreased muscle mass) after SCI. 

Therefore, prevention and treatment of diabetes in people with SCI are very important. Aerobic exercise has been shown to decrease diabetes and cardiovascular disease (CVD). Aerobic exercise in people with SCI is possible with upper body exercise. However, due to the relatively small mass of upper body musculature, arm exercise may not elicit sufficient cardiopulmonary responses. Furthermore, prolonged and excessive upper body endurance exercise for individuals with SCI can be stressful on upper body joints and muscles particularly on shoulders and wrists, which are required for self-care and wheelchair mobility. Injuries to the upper body are commonly seen in the chronic phase of SCI and may negatively affect well being and quality of life. Therefore, recently another mode of aerobic exercise has been introduced in people with SCI such as FES-assisted cycling. 

Advanced computer technology has made it possible to apply an electrical current to muscles and to produce limb movements. This is known as FES and has resulted in the development of cycling and rowing devices for persons with lower and upper limb paralysis. The FES-cycling system is a computer-controlled bicycle, which applies electrical stimulation through surface electrodes to the buttocks, front and back of the thigh in a sequence to allow pedaling of the bicycle at 50 rpm for up to 30 minutes. FES-cycling is currently used to improve musculoskeletal and cardiovascular fitness for people with SCI, resulting in improved circulation of the lower limbs, improved cardiovascular fitness, decreased the incidence of pressure sore and blood clot. This may result in changes in body composition and consequently decrease cholesterol levels in blood. 

My Masters thesis demonstrated that eight weeks of exercise training with FES-cycling (30 min per day, 3 times per week at 50 rpm) decreased the risk of diabetes in subjects with SCI. Since I discovered that people with SCI have higher risk of developing diabetes and FES-cycling is beneficial to prevent diabetes in this population, I have educated people with SCI about the risk of diabetes and the importance of exercise. I contributed a number of articles to non-refereed journals targeting people with SCI and also lead a seminar co-hosted by the Steadward Centre, the Canadian Paraplegic Association and the Spinal Cord Injury Treatment Centre Society on the prevention of diabetes and CVD through diet and exercise. Now, I am trying to investigate more on why people with SCI have higher risk of developing diabetes so that I can provide answers on how to prescribe exercise prescription to prevent diabetes in people with SCI. I am also currently involved in a research project, which will determine the physiological effects of FES-Rowing in people with SCI. FES-Rowing could be another beneficial exercise for people with SCI to prevent diabetes and cardiovascular disease.

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