Background:

Spinal cord injury (SCI) is associated with both a state of chronic inflammation and an increased prevalence of cardiovascular disease (CVD). These disorders are closely linked and have been shown to negatively influence one another. Participation in regular exercise has been shown to be an effective intervention strategy in the treatment of each of these disorders. For individuals with SCI who may lack the lower limb motor capabilities to perform certain traditional exercise modalities, functional electrical stimulation (FES) cycling may provide an effective alternative.

Objective:

The purpose of this study was to examine the effects of 12 weeks of FES training performed 3 times per week on physiological indices of cardiovascular function as well as molecular indices of inflammation and cardiovascular health.

Methods:

Ten individuals with chronic SCI were included. Measures of central and peripheral cardiovascular function as well as hematological and immunological markers were assessed before and after the 12-week exercise program.

Results:

Enhancements in exercise performance as well as a corresponding increase in peripheral cardiovascular function were achieved, as shown by a significant 34% increase in pulse volume (P = .04) and trends toward increases in cross-sectional area (P = .09) and arterial inflow volume (P = .11) of the common femoral artery. Despite this, no change in any hematological or immunological markers was evident.

Conclusion:

Although the efficacy of FES exercise in enhancing exercise performance (time and distance to fatigue) and peripheral cardiovascular function has been reaffirmed, no alterations in any molecular indices of cardiovascular risk were achieved.

The authors declare no conflicts of interest.

1.
Myers
J
,
Lee
M
,
Kiratli
J
.
Cardiovascular disease in spinal cord injury
.
Am J Phys Med Rehabil.
2007
;
86
(
2
):
142
-
152
.
2.
Garshick
E
,
Kelley
A
,
Cohen
SA
, et al.
A prospective assessment of mortality in chronic spinal cord injury
.
Spinal Cord
.
2005
;
43
(
7
):
408
-
416
.
3.
Gorgey
AS
,
Gater
DR
.
Prevalence of obesity after spinal cord injury
.
Top Spinal Cord Inj Rehabil.
2007
;
12
(
4
):
1
-
7
.
4.
Cragg
JJ
,
Noonan
VK
,
Dvorak
M
,
Krassioukov
A
,
Mancini
GBJ
,
Borisoff
JF
.
Spinal cord injury and type 2 diabetes: Results from a population health survey
.
Neurology
.
2013
;
81
(
21
):
1864
-
1868
.
5.
Gregor
MF
,
Hotamisligil
GS
.
Inflammatory mechanisms in obesity
.
Annu Rev Immunol
.
2011
;
29
:
415
-
445
.
6.
Lee
MY
,
Myers
J
,
Hayes
A
, et al.
C-reactive protein, metabolic syndrome, and insulin resistance in individuals with spinal cord injury
.
J Spinal Cord Med.
2005
;
28
(
1
):
20
-
25
.
7.
Davies
AL
,
Hayes
KC
,
Dekaban
GA
.
Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury
.
Arch Phys Med Rehabil.
2007
;
88
(
11
):
1384
-
1393
.
8.
Hayes
KC
,
Hull
TCL
,
Delaney
GA
, et al.
Elevated serum titers of proinflammatory cytokines and CNS autoantibodies in patients with chronic spinal cord injury
.
J Neurotrauma
.
2002
;
19
(
6
):
753
-
761
.
9.
Knuefermann
P
,
Vallejo
J
,
Mann
DL
.
The role of innate immune responses in the heart in health and disease
.
Trends Cardiovasc Med.
2004
;
14
(
1
):
1
-
7
.
10.
Hansson
GK
.
Immune mechanisms in atherosclerosis
.
Arterioscler Thromb Vasc Biol
.
2001
;
21
(
12
):
1876
-
1890
.
11.
Pearson
TA
,
Mensah
GA
,
Alexander
RW
, et al.
Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association
.
Circulation
.
2003
;
107
(
3
):
499
-
511
.
12.
Warburton
D
,
Eng
J
,
Krassioukov
A
,
Sproule
S
.
Cardiovascular health and exercise rehabilitation in spinal cord injury
.
Top Spinal Cord Inj Rehabil.
2007
;
13
(
1
):
98
-
122
.
13.
Petersen
AMW
,
Pedersen
BK
.
The anti-inflammatory effect of exercise
.
J Appl Physiol
.
2005
;
98
:
1154
-
1162
.
14.
Gerrits
HL
,
de Haan
A
,
Sargeant
AJ
,
van Langen
H
,
Hopman
MT
.
Peripheral vascular changes after electrically stimulated cycle training in people with spinal cord injury
.
Arch Phys Med Rehabil.
2001
;
82
(June):
832
-
839
.
15.
Hooker
SP
,
Figoni
SF
,
Glaser
RM
,
Rodgers
MM
,
Ezenwa
BN
,
Faghri
PD
.
Physiologic responses to prolonged electrically stimulated leg-cycle exercise in the spinal cord injured
.
Arch Phys Med Rehabil.
1990
;
71
(
11
):
863
-
869
.
16.
Mutton
DL
,
Scremin
AM
,
Barstow
TJ
,
Scott
MD
,
Kunkel
CF
,
Cagle
TG
.
Physiologic responses during functional electrical stimulation leg cycling and hybrid exercise in spinal cord injured subjects
.
Arch Phys Med Rehabil.
1997
;
78
(
7
):
712
-
718
.
17.
Hooker
SP
,
Figoni
SF
,
Rodgers
MM
, et al.
Physiologic effects of electrical stimulation leg cycle exercise training in spinal cord injured persons
.
Arch Phys Med Rehabil.
1992
;
73
(
5
):
470
-
476
.
18.
Mohr
T
,
Andersen
JL
,
Biering-Sørensen
F
, et al.
Longterm adaptation to electrically induced cycle training in severe spinal cord injured individuals
.
Spinal Cord
.
1997
;
35
(
1
):
1
-
16
.
19.
Baldi
JC
,
Jackson
RD
,
Moraille
R
,
Mysiw
WJ
.
Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation
.
Spinal Cord
.
1998
;
36
(
7
):
463
-
469
.
20.
Gerrits
HL
,
de Haan
A
,
Sargeant
AJ
,
van Langen
H
,
Hopman
MT
.
Peripheral vascular changes after electrically stimulated cycle training in people with spinal cord injury
.
Arch Phys Med Rehabil.
2001
;
82
(
6
):
832
-
839
.
21.
Hopman
MTE
,
Groothuis
JT
,
Flendrie
M
,
Gerrits
KHL
,
Houtman
S
.
Increased vascular resistance in paralyzed legs after spinal cord injury is reversible by training
.
J Appl Physiol
.
2002
;
93
(
6
):
1966
-
1972
.
22.
Nash
MS
,
Bilsker
S
,
Marcillo
AE
, et al.
Reversal of adaptive left ventricular atrophy following electrically-stimulated exercise training in human tetraplegics
.
Paraplegia
.
1991
;
29
:
590
-
599
.
23.
Phillips
WT
,
Kiratli
BJ
,
Sarkarati
M
, et al.
Effect of spinal cord injury on the heart and cardiovascular fitness
.
Curr Probl Cardiol.
1998
;
23
(
11
):
641
-
716
.
24.
Jacobs
PL
,
Nash
MS
.
Exercise recommendations for individuals with spinal cord injury
.
Sports Med.
2004
;
34
(
11
):
727
-
751
.
25.
Hooker
SP
,
Wells
CL
.
Effects of low- and moderateintensity training in spinal cord-injured persons
.
Med Sci Sports Exerc
.
1989
;
21
(
1
):
18
-
22
.
26.
Chilibeck
PD
,
Jeon
J
,
Weiss
C
,
Bell
G
,
Burnham
R
.
Histochemical changes in muscle of individuals with spinal cord injury following functional electrical stimulated exercise training
.
Spinal Cord
.
1999
;
37
(
4
):
264
-
268
.
27.
DeVivo
MJ
,
Black
KJ
,
Stover
SL
.
Causes of death during the first 12 years after spinal cord injury
.
Arch Phys Med Rehabil.
1993
;
74
(
3
):
248
-
254
.
28.
Van Gaal
LF
,
Mertens
IL
,
De Block
CE
.
Mechanisms linking obesity with cardiovascular disease
.
Nature
.
2006
;
444
(
7121
):
875
-
880
.
29.
Manninen
V
,
Tenkanen
L
,
Koskinen
P
, et al.
Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment
.
Circulation
.
1992
;
85
(
1
):
37
-
45
.
30.
Kim
YK
,
Myint
AM
,
Lee
BH
, et al.
Th1, Th2 and Th3 cytokine alteration in schizophrenia
.
Prog Neuro-Psychopharmacology Biol Psychiatry
.
2004
;
28
:
1129
-
1134
.
31.
Kleiner
G
,
Marcuzzi
A
,
Zanin
V
,
Monasta
L
,
Zauli
G
.
Cytokine levels in the serum of healthy subjects
.
Mediat Inflamm.
2013
;
2013
:
434010
.
32.
Genest
J
,
McPherson
R
,
Frohlich
J
, et al.
2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult - 2009 recommendations
.
Can J Cardiol.
2009
;
25
(
10
):
567
-
579
.