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

Abstract

Objective: To study the effect of 14 weeks of electromyostimulation (EMS) training (47 minutes/day, 5 days/ week) on both muscle and bone loss prevention in persons with recent, complete spinal cord injury (SCI). Design: Prospective, experimental, controlled, single-blind randomized trial with external blind evaluation by third parties. Methods: Eight men with recent SCI (8 weeks from injury; ASIA Impairment Scale (AIS) "A") were randomized into the intervention or the control groups. Cross-sectional area of the quadriceps femoris (QF) muscle was quantified using magnetic resonance imaging. Bone mineral density changes were assessed with a dualenergy X-ray absorptiometry. Several bone biomarkers (i.e. total testosterone, cortisol, growth hormone, insulin-growth factor I, osteocalcin, serum type I collagen C-telopeptide), lipid, and lipoprotein profiles were quantified. A standard oral glucose tolerance test was performed before and after the 14-week training. All analyses were conducted at the beginning and after the intervention. Results: The intervention group showed a significant increase in QF muscle size when compared with the control group. Bone losses were similar in both groups. Basal levels of bone biomarkers did not change over time. Changes in lipid and lipoprotein were similar in both groups. Glucose and insulin peaks moved forward after the training in the intervention group. Conclusions: This study indicates that skeletal muscle of patients with complete SCI retains the ability to grow in response to a longitudinal EMS training, while bone does not respond to similar external stimulus. Increases in muscle mass might have induced improvements in whole body insulin-induced glucose uptake.

Effects of FES‐Rowing Exercise on the Time‐Dependent Changes in Bone Microarchitecture After Spinal Cord Injury: A Cross‐Sectional Investigation

“…Most studies have failed to find an effect of various exercise loading protocols on leg bone in SCI . However, our results support the few previous studies that found high exercise volume (magnitude × frequency) effective in improving bone health.…”

“…Bone remodels continuously in response to applied stresses and strains, and these adaptations are central to maintain bone mass and ensure sufficient bone strength. However, interventions that load sublesional bone in SCI (eg, standing frame, body‐weight‐supported treadmill walking, functional electrical stimulation‐ [FES‐] cycling) have rarely been shown to have even a modest effect, if any effect at all . This could be because of insufficient loading intensity (magnitude, number of cycles, and duration) to promote changes in bone density.…”

Neuromuscular Electrical Stimulation for Motor Restoration in Hemiplegia

“…Peripheral effects of NMES include increase in contractile force and fatigue resistance, 78,79 increase in muscle mass, 80 reduction of edema, 81 conversion of fast-twitch fast-fatiguing glycolytic type II muscle fibers to slow-twitch fatigue-resistant oxidative type I muscle fibers, 79 and enhanced hyperemic arterial response and endothelium-dependent cutaneous vasodilation. 82 These peripheral effects can reverse disuse atrophy and may explain in part some improvements stroke patients experience after various NMES treatments.…”

Musculoskeletal Outcomes from Chronic High-Speed, High-Impulse Resistance Exercise

“…Intuitively, this appears to be a reasonable goal, since as muscles accelerate and decelerate body segments to oppose the pull of gravity, bones adapt in accordance with the forces exerted [1,4,[14][15][16]]. Yet while muscle's plasticity allows it to adapt to various loading paradigms, bone is far less responsive [3,20,34,55]. This impacts the ability of resistive exercise to abate bone losses in disuse models (e. g. space flight, osteoporosis, geriatrics, etc.)…”