Effects of cycling and/or electrical stimulation on bone mineral density in children with spinal cord injury

Abstract

Study design: Randomized clinical trial. Objectives: To determine the effect of cycling and/or electrical stimulation on hip and knee bone mineral density (BMD) in children with spinal cord injury (SCI). Setting: Children's hospital specializing in pediatric SCI. Methods: A total of 30 children, aged 5-13 years, with chronic SCI were randomized to one of three interventions: functional electrical stimulation cycling (FESC), passive cycling (PC), and non-cycling, electrically stimulated exercise (ES). Each group exercised for 1 h, three times per week for 6 months at home. The hip, distal femur and proximal tibia BMD were examined via dual-energy X-ray absorptiometry (DXA) pre-and post-intervention. Results: In all, 28 children completed data collection. The FESC group exhibited increases in hip, distal femur and proximal tibia BMD of 32.4, 6.62 and 10.3%, respectively. The PC group exhibited increases at the hip (29.2%), but no change at the distal femur (1.5%) or proximal tibia (À1.0%). The ES group had no change at the hip (À0.24%) and distal femur (3.3%), but a loss at the proximal tibia (À7.06%). There were no differences between groups or within groups over time. Significant negative correlations were found between baseline BMD and the amount of BMD change. Conclusion: Although not achieving statistical significance, hip BMD changes observed were greater than the reported 0.9-10% gains after exercise for children with and without disability. Thus, cycling with and without electrical stimulation may be beneficial for skeletal health in pediatric SCI, but further research is needed with a larger sample size.

Effects of electromyostimulation on muscle and bone in men with acute traumatic spinal cord injury: A randomized clinical trial

“…[15][16][17][18][19][20] A possible reason for this conflict may be the location of measured sites, since bone mineral adaptations are limited to the bone area under mechanical stress. 33 The study by Groah et al…”

“…34 Furthermore, EMS was suggested to be less effective than electrical stimulation cycling on BMD prevention after SCI. 20 The present protocol used stimulation patterns that acutely decrease the serum concentration of osteoclastic markers in men with recent SCI (i.e. CTx), 24 suggesting a positive effect on bone metabolism.…”

“…12 Shortly after SCI occurs, EMS was shown to be effective preventing muscle atrophy, 13,14 whereas benefits are more controversial in the treatment of osteoporosis resulting from neurological damage. [15][16][17][18][19][20] An early initiation of the EMS program under supervision of a physician following SCI has been postulated to maximize muscle benefits. 13 Similarly, the extensive destruction of the trabecular elements in patients with long-term SCI limits the available surface area for bone remodeling, limiting the potential for adaptation to mechanical loading interventions.…”

Effect of Progressive Locomotor Treadmill Compared to Conventional Training on Bone Mineral Density and Bone Remodeling in Paraplegia

“…In addition, Dolbow et al (29) illustrated that rehabilitation exercise interventions that provide enough stress are suitable for improving BMD. Some studies showed that functional electrical stimulation-cycling did not have significant effects on bone loss after SCI (30)(31)(32), But others illustrated that regular long-term FES cycle exercise can reverse loss of bone mass in SCI (26, 33).…”

Pediatric Spinal Cord Injury

“…Treatments such as electrical stimulation or medications to prevent low bone mass or osteoporosis in pediatric spinal cord injury have remained elusive. A comparative study of functional electrical stimulation (FES) cycling vs passive cycling vs electrical stimulation for 60 min a day, 3 days per week for 6 months did not reveal any differences in bone mineral density in the femur, hip or tibia either between or within groups over the course of the study [26]. In a sample of 82 children with spinal cord injury, 40 % had vitamin D insufficiency and 39 % had vitamin D deficiency [20].…”