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Background: Physical deconditioning and inactivity following spinal cord injury (SCI) are associated with multiple cardiometabolic risks. To mitigate cardiometabolic risk, exercise is recommended, but it is poorly established whether arm cycling exercise (ACE) or functional electrical stimulation (FES) leg cycling yields superior benefits. Objectives: To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI. Methods: Thirteen physically untrained individuals were randomly assigned to FES ( n = 6) or ACE ( n = 7) exercise 5 days/week for 16 weeks. Pre- and post-intervention EEE, peak oxygen consumption (absolute and relative VO 2Peak ), and work were assessed using indirect calorimetry, while body composition was measured by dual-energy x-ray absorptiometry. Results: Main effects were found for peak power ( p < .001), absolute ( p = .046) and relative ( p = .042) VO 2Peak , and peak work ( p = .013). Compared to baseline, the ACE group increased in EEE (+85%, p = .002), peak power (+307%, p < .001), VO 2Peak (absolute +21%, relative +22%, p ≤ .024), peak work (19% increase, p = .003), and total body fat decreased (-6%, p = .05). The FES group showed a decrease in percentage body fat mass (-5%, p = .008). The ACE group had higher EEE ( p = .008), peak power ( p < .001), and relative VO 2Peak ( p = .025) compared to postintervention values in the FES group. Conclusion: In the current study, ACE induced greater increases in EEE and CRF, whereas ACE and FES showed similar results on body fat. Exercise promotional efforts targeting persons with SCI should use both FES and ACE to reduce sedentary behavior and to optimize different health parameters after SCI., Competing Interests: Conflicts of Interest The authors declare no conflicts of interest., (© 2021 American Spinal Injury Association.)

Background: Functional electrical stimulation cycling is a common clinical treatment for individuals with spinal cord injury and other paralytic conditions, however, the long term effects of home-based functional electrical stimulation cycling remains unreported., Objective: To determine the effectiveness of a long-term home-based functional electrical stimulation lower extremities cycling (FES-LEC) program on body composition., Participant: An adult male 52.7 years of age at pre-intervention and 57.3 years of age at post-intervention with chronic C4 spinal cord injury and American Spinal Injury Association Impairment Scale C., Methods: Dual-energy X-ray absorptiometry scans were performed on the participant before and after the FES cycling program to determine body composition changes. An RT300 FES cycle was issued to the participant with the recommendation to cycle three times per week for general conditioning and the maintenance of physical health., Results: Total body lean mass (LM) increased from 39.13 kg to 46.35 kg, an 18.5% increase while total body fat mass (FM) increased by just 3.7% from 20.85 kg to 21.64 kg. Legs LM increased by 10.9% (10.93 kg to 12.12 kg). There was a negligible decrease in total body bone mineral content (BMC) with a pre-training measure of 2.09 kg compared to a post-training measure of 1.98 kg. Lower extremities FM increased by less than 1% from 3.51 kg to 3.54 kg., Conclusion: Natural limitations of a single subject case report disallow a causal conclusion. However, for this particular older adult with chronic tetraplegia, home-based FES-LEC appears to have resulted in cardio-metabolic protective body composition changes.

Study Design: Longitudinal design., Objectives: The study was undertaken to determine the effects of cessation of exercise interventions on body composition and metabolic profiles in men with chronic SCI., Settings: Clinical trials within a Medical Center., Methods: Eleven men with motor complete SCI were followed on average over a period of 2.5 years. Six men were involved in two different exercise interventions (functional electrical stimulation cycling versus arm cycling ergometer), 5 days/week for 16 weeks (exercise group), and five men served as a control (control group). Anthropometrics and dual energy X-ray absorptiometry (DXA) were captured to measure changes in lean mass (LM), fat mass (FM), percentage FM before, immediately after exercise, and after a period of 2.5 years. Basal metabolic rate (BMR) and lipid panel were also measured., Results: Thigh circumference increased by 8.5% following exercise (P = 0.042) and remained 6.4% greater than baseline measurements (P = 0.012). Leg LM increased by 9% following the exercise intervention (P = 0.03) and decreased by 16% in the follow-up visit (P = 0.02). Percentage trunk and total body FM increased by 4.5% (P = 0.008) and 3.5% (P = 0.019) in the follow-up visit, respectively, and whole body LM increased by 8.4% and decreased back by 5.4% following a 2.5 year-period. BMR significantly decreased by 15.5% following the exercise (P = 0.029) interventions., Conclusion: Exercise training is accompanied with positive changes in body composition as well as compensatory decrease in BMR, that regressed back following 2.5 years of exercise cessation. Participation in an exercise trial is unlikely to confound the measurements of a follow-up trial.

Background: Sedentarism is common among people with spinal cord injury (SCI). However, new technologies such as functional electrical stimulation cycles with internet connectivity may provide incentive by removing some of the limitations and external barriers., Objective: To determine the effectiveness of a long-term home-based functional electrical stimulation lower extremities cycling (FES-LEC) program on exercise adherence, body composition, energy expenditure, and quality of life (QOL) in an adult with chronic tetraplegia., Participant: A 53-year-old man, 33 years post-motor complete C4 SCI participated in FES-LEC in his home, three sessions per week for 24 weeks., Methods: Exercise adherence was calculated as the percentage of performed cycling sessions relative to the recommended number of cycling sessions. Body composition was measured by dual-energy X-ray absorptiometry. Energy expenditure was measured using a COSMED K4b2 and QOL via the World Health Organization Quality of Life (WHO-QOL) Brief Questionnaire. Testing was performed before and after the 24-week exercise program., Results: The participant cycled 59 out of a recommended 72 sessions which is an exercise adherence rate of 82%. Body composition displayed increases in total body lean mass (LM) with an increase of 3.3% and an increase in leg LM of 7.1%. Energy expenditure increased by 1.26 kcal/minute or greater than 200%. The physical and psychological domain scores of QOL increased by 25 and 4.5%, respectively., Conclusion: This case study provides encouragement concerning the practicality of a home-based FES-LEC program for those with SCI.