Bone changes in the lower limbs from participation in an FES rowing exercise program implemented within two years after traumatic spinal cord injury

Rebecca L Lambach; Nicole E Stafford; Julie A Kolesar; B Jenny Kiratli; Graham H Creasey; Robin S Gibbons; Brian J Andrews; Gary S Beaupre

doi:10.1080/10790268.2018.1544879

Bone changes in the lower limbs from participation in an FES rowing exercise program implemented within two years after traumatic spinal cord injury

J Spinal Cord Med. 2020 May;43(3):306-314. doi: 10.1080/10790268.2018.1544879. Epub 2018 Nov 26.

Authors

Rebecca L Lambach^{1

2}, Nicole E Stafford³, Julie A Kolesar^{1

4}, B Jenny Kiratli¹, Graham H Creasey^{1

2}, Robin S Gibbons⁵, Brian J Andrews^{6

7}, Gary S Beaupre^{1

4}

Affiliations

¹ Spinal Cord Injury & Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA.
² Department of Neurosurgery, Stanford University, Stanford, California, USA.
³ Department of Mechanical Engineering, Stanford University, Stanford, California, USA.
⁴ Bioengineering Department, Stanford University, Stanford, California, USA.
⁵ Aspire CREATe Centre for Rehabilitation Engineering and Assistive Technology, Division of Surgery & International Science, Royal National Orthopaedic Hospital, University College London, Stanmore, UK.
⁶ School of Engineering, University of Warwick, Coventry, UK.
⁷ Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.

Abstract

Objective: To determine the effect of a functional electrical stimulation (FES) rowing program on bone mineral density (BMD) when implemented within two years after SCI.Design: Prospective.Setting: Health Care Facility.Participants: Convenience sample; four adults with recent (<2 years) traumatic, motor complete SCI (C7-T12 AIS A-B).Intervention: A 90-session FES rowing exercise program; participants attended 30-minute FES training sessions approximately three times each week for the duration of their participation.Outcome Measures: BMD in the distal femur and tibia were measured using peripheral Quantitative Computed Tomography (pQCT) at enrollment (T₀) and after 30 (T₁), 60 (T₂), and 90 (T₃) sessions. Bone stimulus was calculated for each rower at each time point using the average number of weekly loading cycles, peak foot reaction force, and bone mineral content from the previous time point. A regression analysis was used to determine the relationship between calculated bone stimulus and change in femoral trabecular BMD between time points.Results: Trabecular BMD in the femur and tibia decreased for all participants in T_0-1, but the rate of loss slowed or reversed between T_1-2, with little-to-no bone loss for most participants during T_2-3. The calculated bone stimulus was significantly correlated with change in femoral trabecular BMD (P = 0.016; R²= 0.458).Conclusion: Consistent participation in an FES rowing program provides sufficient forces and loading cycles to reduce or reverse expected bone loss at the distal femur and tibia, at least temporarily, in some individuals within two years after SCI.Trial Registration: NCT02008149.

Keywords: Bone density; FES; FES rowing; Functional electrical stimulation; Paralysis; Rowing; SCI; Spinal cord injury; pQCT.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Bone Density*
Bone Diseases, Metabolic / diagnostic imaging
Bone Diseases, Metabolic / etiology
Bone Diseases, Metabolic / prevention & control*
Combined Modality Therapy
Electric Stimulation Therapy*
Exercise Therapy*
Female
Femur* / diagnostic imaging
Follow-Up Studies
Humans
Male
Middle Aged
Outcome Assessment, Health Care*
Paraplegia / complications
Paraplegia / diagnostic imaging
Paraplegia / rehabilitation*
Spinal Cord Injuries / complications
Spinal Cord Injuries / diagnostic imaging
Spinal Cord Injuries / rehabilitation*
Tibia* / diagnostic imaging
Time Factors
Tomography, X-Ray Computed
Water Sports

Associated data

ClinicalTrials.gov/NCT02008149

Grants and funding

I21 RX001410/RX/RRD VA/United States