Functional Electrical Stimulation Assisted Exercise – Just how valuable is it and where are we heading?
Garry Wheeler PhD., C.Psych.
Introduction
The last quarter of a century has seen a remarkable growth in interest in the use of functional electrical stimulation as part of rehabilitation in persons with paralysis. Although, clinically uses have been confined to developing functional standing, grasping and even walking, it is becoming apparent that one of the most important potential uses of FES is in the area of exercise.
It is important to recognize that lack of physical activity among able bodied and those with spinal cord injury is becoming increasingly recognized as a major health issue. Recent National Data (CFLRI – Benchmarks 1997) suggests that the majority of adults and youth do not get enough physical activity for maintenance of optimal health. This has led the medical community to ask the question – “how much physical activity is sufficient to maintain health?” As a result, we have moved from a fitness and exercise model to a focus on physical activity and health-related benefits.
To date, much of the literature in the area of FES-assisted exercise has focused on exercise programs and fitness related benefits e.g. increased cardiovascular fitness or increased muscular strength and endurance. What is not clear is how FES-assisted exercise technology is associated with health related benefits. This would appear to be the next research question and direction for those working in this area.
The question facing scientists is therefore clear -
What is the principle health risks associated with spinal cord injury and how can FES-assisted exercise technology contribute to prevention?
Health-related issues and spinal injury
Spinal cord injury increases risk for a number of health related problems including: cardiovascular/coronary artery disease (including increased cholesterol and decreased HDL-cholesterol); diabetes; osteoporosis and circulatory disorders. As well as increasing functional fitness, it is clear that exercise solutions for persons with a spinal injury must address such issues if they are to be increasingly accepted by the medical and rehabilitation community.
How can FES contribute to the solution?
Early research using simple FES-assisted leg extension-flexion exercise and ERGYS-cycle exercise has demonstrated increased fitness, changes in peripheral blood flow and bone mass. As well, FES cycle exercise has been demonstrated to have an impact on glucose metabolism in spinal cord injured persons, which may have an impact on risk for diabetes. Such research suggests that FES exercise is a promising adjunct to health maintenance approaches in the spinal cord injured population. However, FES-assisted exercise technologies that have focused primarily on leg exercise are problematic in that only a relatively small amount of muscle mass is used during exercise and the exercise intensities are very low. Therefore, fitness and health-related changes are potentially limited.
So- called Hybrid exercise technologies in which FES leg exercise is combined with upper extremity exercise shows great promise in terms of producing the kind of workloads necessary to effect clinically relevant health changes. Some researchers have combined lower limb FES cycling with upper limb arm cycling to demonstrate significant changes in cardiovascular fitness. At the Steadward Centre, we have developed the ROWSTIM FES-assisted rowing system and have already demonstrated that this is an effective and reliable tool for increasing cardiovascular fitness in persons with spinal cord injury. At this time, we are on the third prototype of the ROWSTIM. Clearly, this device is a viable exercise system for persons with spinal injury and adaptable for use in the home by able-bodied partners. /spouses/family members. However, at this point we must now focus on answering health-related questions as we progress with the development of the ROWSTIM. These questions are:
- How does FES ROWING impact on risk for diabetes?
- How does FES ROWING impact on risk factors for heart disease such as elevated lipid levels – cholesterol and
LDL-C?
- How does FES ROWING impact on limb blood flow and therefore on risk for deep venous thrombosis for example?
- How does FES ROWING impact on seating pressure issues and the formation of decubitus ulcers?
These are the questions that the Steadward Centre, Edmonton, Stoke Mandeville, England, and Leuven, Belgium Research Groups will attempt to address in the near future. We hope to answer, some of the important health-related questions with regard to FES-exercise applications and contribute to better health for all persons with spinal injury.
Respectfully submitted
Garry Wheeler
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