Functional electrical stimulation elliptical stepping versus cycling in spinal cord-injured individuals.

BACKGROUND The cardiorespiratory responses and mechanical efficiencies of two modalities of functional electrical stimulation augmented leg exercises - isokinetic cycling and isokinetic elliptical stepping - were compared amongst individuals with spinal cord injury. METHODS Five subjects performed seated isokinetic evoked cycling and elliptical stepping leg exercise at 10, 20 and 30rev·min(-1) pedal cadences. 3-D motion analysis and force transducers attached onto the foot pedals quantified the external forces and power outputs developed by each lower extremity. Hip, knee and ankle joints power were derived via inverse dynamics analysis. The subjects' cardiorespiratory responses during exercise were measured by respiratory gas analysis. FINDINGS Ensemble-averaged oxygen uptakes across pedal cadences were higher during stepping (448 (75) ml·min(-1)) compared to cycling (422 (54) ml·min(-1)). External power outputs and metabolic efficiencies during stepping (9.9 (8.3) W, 2.9 (3.2) %) were double those observed during cycling (5.3 (6.3) W, 1.6 (1.9) %). Cumulative internal and external leg joint powers during stepping were twice higher than cycling, but the stepping mechanical efficiencies derived from inverse dynamics analysis were comparable to cycling (76.3 (21.2) % and 63.6 (12.3) % respectively). Heart rate responses were similar between cycling and stepping, while carbon dioxide production and expired ventilation were slightly higher during elliptical stepping. INTERPRETATION Both exercise modalities could deliver appropriate training stimuli for improving the aerobic fitness and leg pedalling strength of spinal cord-injured individuals. However electrical stimulation-enhanced elliptical stepping might provide greater exercise dose-potency for leg muscle strengthening than electrically-enhanced cycling due to the higher power outputs observed.