Ann Rehabil Med.  2013 Oct;37(5):619-627. 10.5535/arm.2013.37.5.619.

The Effects of Assisted Ergometer Training With a Functional Electrical Stimulation on Exercise Capacity and Functional Ability in Subacute Stroke Patients

Affiliations
  • 1Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea. clearblue10@naver.com
  • 2Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.
  • 3Department of Rehabilitation Medicine, Kwandong University College of Medicine, Gangneung, Korea.

Abstract


OBJECTIVE
To determine if assistive ergometer training can improve the functional ability and aerobic capacity of subacute stroke patients and if functional electrical stimulation (FES) of the paretic leg during ergometer cycling has additional effects.
METHODS
Sixteen subacute stroke patents were randomly assigned to the FES group (n=8) or the control group (n=8). All patients underwent assistive ergometer training for 30 minutes (five times per week for 4 weeks). The electrical stimulation group received FES of the paretic lower limb muscles during assistive ergometer training. The six-minute walk test (6MWT), Berg Balance Scale (BBS), and the Korean version of Modified Barthel Index (K-MBI) were evaluated at the beginning and end of treatment. Peak oxygen consumption (Vo2peak), metabolic equivalent (MET), resting and maximal heart rate, resting and maximal blood pressure, maximal rate pressure product, submaximal rate pressure product, submaximal rate of perceived exertion, exercise duration, respiratory exchange ratio, and estimated anaerobic threshold (AT) were determined with the exercise tolerance test before and after treatment.
RESULTS
At 4 weeks after treatment, the FES assistive ergometer training group showed significant improvements in 6MWT (p=0.01), BBS (p=0.01), K-MBI (p=0.01), Vo(2peak) (p=0.02), MET (p=0.02), and estimated AT (p=0.02). The control group showed improvements in only BBS (p=0.01) and K-MBI (p=0.02). However, there was no significant difference in exercise capacity and functional ability between the two groups.
CONCLUSION
This study demonstrated that ergometer training for 4 weeks improved the functional ability of subacute stroke patients. In addition, aerobic capacity was improved after assisted ergometer training with a FES only.

Keyword

Electrical stimulation; Ergometry; Bicycling; Stroke; Oxygen consumption

MeSH Terms

Anaerobic Threshold
Bicycling
Blood Pressure
Electric Stimulation*
Ergometry
Exercise Tolerance
Heart Rate
Humans
Leg
Lower Extremity
Metabolic Equivalent
Muscles
Oxygen Consumption
Stroke*

Reference

1. Bobath B. Adult hemiplegia: evaluation and treatment. 3rd ed. London: Butterworth-Heinemann;1990.
2. Gresham GE, Fitzpatrick TE, Wolf PA, McNamara PM, Kannel WB, Dawber TR. Residual disability in survivors of stroke: the Framingham study. N Engl J Med. 1975; 293:954–956. PMID: 1178004.
3. Brown DA, Kautz SA. Increased workload enhances force output during pedaling exercise in persons with poststroke hemiplegia. Stroke. 1998; 29:598–606. PMID: 9506599.
Article
4. Mayo NE, Wood-Dauphinee S, Ahmed S, Gordon C, Higgins J, McEwen S, et al. Disablement following stroke. Disabil Rehabil. 1999; 21:258–268. PMID: 10381238.
5. Szecsi J, Krewer C, Muller F, Straube A. Functional electrical stimulation assisted cycling of patients with subacute stroke: kinetic and kinematic analysis. Clin Biomech (Bristol, Avon). 2008; 23:1086–1094.
Article
6. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Stroke: neurologic and functional recovery the Copenhagen Stroke Study. Phys Med Rehabil Clin N Am. 1999; 10:887–906. PMID: 10573714.
7. Hwang IS, Lee HM, Cherng RJ, Chen JJ. Electromyographic analysis of locomotion for healthy and hemiparetic subjects: study of performance variability and rail effect on treadmill. Gait Posture. 2003; 18:1–12. PMID: 12855295.
8. Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, et al. Effects of electric stimulation-assisted cycling training in people with chronic stroke. Arch Phys Med Rehabil. 2008; 89:463–469. PMID: 18295624.
Article
9. Hunt KJ, Stone B, Negard NO, Schauer T, Fraser MH, Cathcart AJ, et al. Control strategies for integration of electric motor assist and functional electrical stimulation in paraplegic cycling: utility for exercise testing and mobile cycling. IEEE Trans Neural Syst Rehabil Eng. 2004; 12:89–101. PMID: 15068192.
Article
10. Takahashi T, Takazawa M, Nishiyama Y, Nakano E, Handa Y. FES cycling chair for the lower limbs disabled people with electric motor power assis. In : Proceedings of the 9th Annual International FES Society Conference; 2004 Sep 6-9; Bournemouth, UK. p. 247–249.
11. Raasch CC, Zajac FE. Locomotor strategy for pedaling:muscle groups and biomechanical functions. J Neurophysiol. 1999; 82:515–525. PMID: 10444651.
12. Hancock NJ, Shepstone L, Winterbotham W, Pomeroy V. Effects of lower limb reciprocal pedalling exercise on motor function after stroke: a systematic review of randomized and nonrandomized studies. Int J Stroke. 2012; 7:47–60. PMID: 22111955.
Article
13. Potempa K, Lopez M, Braun LT, Szidon JP, Fogg L, Tincknell T. Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. Stroke. 1995; 26:101–105. PMID: 7839377.
Article
14. Brown DA, Kautz SA, Dairaghi CA. Muscle activity adapts to anti-gravity posture during pedalling in persons with post-stroke hemiplegia. Brain. 1997; 120(Pt 5):825–837. PMID: 9183253.
Article
15. Holt R, Kendrick C, McGlashan K, Kirker S, Jenner J. Static bicycle training for functional mobility in chronic stroke: case report. Physiotherapy. 2001; 87:257–260.
16. Fujiwara T, Liu M, Tanuma A, Hase K, Tsuji T. Pedaling exercise for neuromuscular re-education: a review. Crit Rev Phys Rehabil Med. 2005; 17:163–178.
Article
17. Katz-Leurer M, Sender I, Keren O, Dvir Z. The influence of early cycling training on balance in stroke patients at the subacute stage: results of a preliminary trial. Clin Rehabil. 2006; 20:398–405. PMID: 16774090.
Article
18. Quaney BM, Boyd LA, McDowd JM, Zahner LH, He J, Mayo MS, et al. Aerobic exercise improves cognition and motor function poststroke. Neurorehabil Neural Repair. 2009; 23:879–885. PMID: 19541916.
Article
19. Katz-Leurer M, Carmeli E, Shochina M. The effect of early aerobic training on independence six months post stroke. Clin Rehabil. 2003; 17:735–741. PMID: 14606739.
Article
20. Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007; 35:562–590. PMID: 17299744.
Article
21. Lee SY, Im SH, Kim BR, Choi JH, Lee SJ, Han EY. The effects of neuromuscular electrical stimulation on cardiopulmonary function in healthy adults. Ann Rehabil Med. 2012; 36:849–856. PMID: 23342319.
Article
22. Kesar TM, Perumal R, Jancosko A, Reisman DS, Rudolph KS, Higginson JS, et al. Novel patterns of functional electrical stimulation have an immediate effect on dorsiflexor muscle function during gait for people poststroke. Phys Ther. 2010; 90:55–66. PMID: 19926681.
Article
23. Santos M, Zahner LH, McKiernan BJ, Mahnken JD, Quaney B. Neuromuscular electrical stimulation improves severe hand dysfunction for individuals with chronic stroke: a pilot study. J Neurol Phys Ther. 2006; 30:175–183. PMID: 17233925.
24. Petrofsky JS, Phillips CA. The use of functional electrical stimulation for rehabilitation of spinal cord injured patients. Cent Nerv Syst Trauma. 1984; 1:57–74. PMID: 6400201.
Article
25. Petrofsky JS, Laymon M. The effect of previous weight training and concurrent weight training on endurance for functional electrical stimulation cycle ergometry. Eur J Appl Physiol. 2004; 91:392–398. PMID: 14618331.
Article
26. Petrofsky JS, Stacy R. The effect of training on endurance and the cardiovascular responses of individuals with paraplegia during dynamic exercise induced by functional electrical stimulation. Eur J Appl Physiol Occup Physiol. 1992; 64:487–492. PMID: 1618183.
Article
27. Hooker SP, Scremin AM, Mutton DL, Kunkel CF, Cagle G. Peak and submaximal physiologic responses following electrical stimulation leg cycle ergometer training. J Rehabil Res Dev. 1995; 32:361–366. PMID: 8770800.
28. Skold C, Lonn L, Harms-Ringdahl K, Hultling C, Levi R, Nash M, et al. Effects of functional electrical stimulation training for six months on body composition and spasticity in motor complete tetraplegic spinal cord-injured individuals. J Rehabil Med. 2002; 34:25–32. PMID: 11900259.
29. Nash MS, Montalvo BM, Applegate B. Lower extremity blood flow and responses to occlusion ischemia differ in exercise-trained and sedentary tetraplegic persons. Arch Phys Med Rehabil. 1996; 77:1260–1265. PMID: 8976309.
Article
30. Raymond J, Schoneveld K, Van Kemenade CH, Davis GM. Onset of electrical stimulation leg cycling in individuals with paraplegia. Med Sci Sports Exerc. 2002; 34:1557–1562. PMID: 12370555.
Article
31. Raymond J, Davis GM, Climstein M, Sutton JR. Cardiorespiratory responses to arm cranking and electrical stimulation leg cycling in people with paraplegia. Med Sci Sports Exerc. 1999; 31:822–828. PMID: 10378909.
Article
32. Buchfuhrer MJ, Hansen JE, Robinson TE, Sue DY, Wasserman K, Whipp BJ. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol. 1983; 55:1558–1564. PMID: 6643191.
Article
33. Macko RF, Katzel LI, Yataco A, Tretter LD, DeSouza CA, Dengel DR, et al. Low-velocity graded treadmill stress testing in hemiparetic stroke patients. Stroke. 1997; 28:988–992. PMID: 9158639.
Article
34. Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. FES cycling treatment on hemiplegic patients: preliminary results. In : Proceedings of the 11th Annual International FES Society Conference; 2006 Sep 12-15; Miyagi-Zao, Japan. p. 77–79.
35. Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 Award Winner. Eur J Phys Rehabil Med. 2008; 44:159–167. PMID: 18418336.
36. Ambrosini E, Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial. Stroke. 2011; 42:1068–1073. PMID: 21372309.
37. Lo HC, Hsu YC, Hsueh YH, Yeh CY. Cycling exercise with functional electrical stimulation improves postural control in stroke patients. Gait Posture. 2012; 35:506–510. PMID: 22153770.
Article
38. Smart NA, Dieberg G, Giallauria F. Functional electrical stimulation for chronic heart failure: a meta-analysis. Int J Cardiol. 2013; 167:80–86. PMID: 22236510.
Article
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