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RCT·cardiology, internal medicine, neurology, research methods, clinical trial·PMC10556465

Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury. A randomized clinical trial

Frontiers in Neurology · 10 authors, 6 centres

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TL;DR

Neither intervention elicited significant changes in insulin sensitivity, glucose, or inflammatory biomarkers.

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Neither intervention elicited significant changes in insulin sensitivity, glucose, or inflammatory biomarkers. NMES-RT+FES produced robust hypertrophy of whole thigh muscle CSA, absolute thigh muscle CSA, and knee extensor CSA at post-intervention 1 compared to PMT+FES, while PMT+FES resulted in muscle hypertrophy at post-intervention 2. NMES-RT+FES also decreased total VAT CSA at post-intervention 1.

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RCT

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cardiology

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ORIGINAL PAPER

PMC10556465

Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury. A randomized clinical trial

Frontiers in Neurology

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ABSTRACT

Abstract Objective To examine the combined effects of neuromuscular electrical stimulation-resistance training (NMES-RT) and functional electrical stimulation-lower extremity cycling (FES-LEC) compared to passive movement training (PMT) and FES-LEC in adults with SCI on (1) oxygen uptake (VO 2 ), insulin sensitivity and glucose disposal in adults with SCI; (2) Metabolic and inflammatory biomarkers; (3) skeletal muscle, intramuscular fat (IMF) and visceral adipose tissue (VAT) cross-sectional areas (CSAs). Materials and methods Thirty-three participants with chronic SCI (AIS A-C) were randomized to 24 weeks of NMES-RT + FES or PMT + FES. The NMES-RT + FES group underwent 12 weeks of evoked surface NMES-RT using ankle weights followed by an additional 12 weeks of progressive FES-LEC. The control group, PMT + FES performed 12 weeks of passive leg extension movements followed by an additional 12 weeks of FES-LEC. Measurements were performed at baseline (BL; week 0), post-intervention 1 (P1; week 13) and post-intervention 2 (P2; week 25) and included FES-VO 2 measurements, insulin sensitivity and glucose effectiveness using the intravenous glucose tolerance test; anthropometrics and whole and regional body composition assessment using dual energy x-ray absorptiometry (DXA) and magnetic resonance imaging to measure muscle, IMF and VAT CSAs. Results Twenty-seven participants completed both phases of the study. NMES-RT + FES group showed a trend of a greater VO 2 peak in P1 [ p = 0.08; but not in P2 ( p = 0.25)] compared to PMT + FES. There was a time effect of both groups in leg VO 2 peak. Neither intervention elicited significant changes in insulin, glucose, or inflammatory biomarkers. There were modest changes in leg lean mass following PMT + FES group. Robust hypertrophy of whole thigh muscle CSA, absolute thigh muscle CSA and knee extensor CSA were noted in the NMES-RT + FES group compared to PMT + FES at P1. PMT + FES resulted in muscle hypertrophy at P2. NMES-RT + FES resulted in a decrease in total VAT CSA at P1. Conclusion NMES-RT yielded a greater peak leg VO 2 and decrease in total VAT compared to PMT. The addition of 12 weeks of FES-LEC in both groups modestly impacted leg VO 2 peak. The addition of FES-LEC to NMES-RT did not yield additional increases in muscle CSA, suggesting a ceiling effect on signaling pathways following NMES-RT. Clinical trial registration identifier NCT02660073 . Keywords: neuromuscular electrical stimulation, functional electrical stimulation, resistance training, spinal cord injury, rehabilitation

CITATION EXPORT

Ashraf S Gorgey, Refka E Khalil, William Carter et al.. Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury. A randomized clinical trial. Frontiers in Neurology. (2023). https://doi.org/10.3389/fneur.2023.1254760

AUTHORS

10 · 6 CENTRES

Ashraf S Gorgey, Refka E Khalil, William Carter, Boyd Ballance, Ranjodh Gill, Rehan Khan, Lance Goetz, Timothy Lavis, Adam P Sima, Robert A Adler

1Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
2Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
3Endocrinology Service, Richmond VA Medical Center, Richmond, VA, United States
4Endocrine Division, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
5Radiology Service, Richmond VA Medical Center, Richmond, VA, United States
6Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States