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Functional Electrical Stimulation Cycling Exercise for People with Multiple Sclerosis

  • Multiple Sclerosis and Related Disorders (J Graves, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

There has been substantial interest in the role of exercise for managing impairments, limitations, and disability progression among persons with multiple sclerosis (MS). Despite established benefits of exercise training for persons who have mild-to-moderate MS, the ability to deliver exercise to persons who experience higher disability remains challenging. One promising approach for exercise in this population is functional electrical stimulation (FES) cycling. This review provides a summary of the current evidence for FES cycling as an exercise training modality in persons with MS with respect to prescription, safety, tolerability, and acute and chronic effects.

Recent findings

We searched the literature for studies involving FES cycling exercise in persons with MS published in English up until July 2019. Eight studies were retrieved: two studies examined acute effects, two studies examined chronic effects, and four studies reported on both acute and chronic effects of FES cycling exercise. The overall quality of the studies was low, with only one, small, randomized controlled trial (RCT).

Summary

There is limited but promising evidence for the application of FES cycling exercise among persons with MS who have moderate-to-severe disability. Participants were capable of engaging in regular FES cycling exercise (~ 30 min, 2–3×/week), with few, mild adverse events experienced. Preliminary evidence from small, mostly uncontrolled trials supports the potential benefits of FES cycling on physiological fitness, walking mobility, and symptoms of fatigue and pain. High-quality RCTs of FES cycling exercise are necessary for providing recommendations for integrating exercise training in the management of advanced MS.

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References and Recommended Reading

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  1. Frohman EM, Racke MK, Raine CS. Multiple sclerosis - the plaque and its pathogenesis. N Engl J Med. 2006;354:942–55.

    Article  CAS  PubMed  Google Scholar 

  2. Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol. 2012;8:487–97.

    Article  PubMed  Google Scholar 

  3. Motl RW, Learmonth YC. Neurological disability and its association with walking impairment in multiple sclerosis: brief review. Neurodegener Dis Manag. 2014;4:491–500.

    Article  PubMed  Google Scholar 

  4. Pilutti LA, Sandroff BM, Klaren RE, Learmonth YC, Platta ME, Hubbard EA, et al. Physical fitness assessment across the disability spectrum in persons with multiple sclerosis: a comparison of testing modalities. J Neurol Phys Ther. 2015;39:241–9.

    Article  PubMed  Google Scholar 

  5. Amato MP, Ponziani G, Rossi F, Liedl CL, Stefanile C, Rossi L. Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler J. 2001;7:340–4.

    Article  CAS  Google Scholar 

  6. Bakshi R, Shaikh ZA, Miletich RS, Czarnecki D, Dmochowski J, Henschel K, et al. Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler J. 2000;6:181–5.

    Article  CAS  PubMed  Google Scholar 

  7. Flachenecker P, Henze T, Zettl UK. Spasticity in patients with multiple sclerosis - clinical characteristics, treatment and quality of life. Acta Neurol Scand. 2014;129:154–62.

    Article  CAS  PubMed  Google Scholar 

  8. Sandroff BM, Pilutti LA, Benedict RHB, Motl RW. Association between physical fitness and cognitive function in multiple sclerosis: does disability status matter? Neurorehabil Neural Repair. 2015;29:214–23.

    Article  PubMed  Google Scholar 

  9. Karampampa K, Gustavsson A, Miltenburger C, Kindundu CM, Selchen DH. Treatment experience, burden, and unmet needs (TRIBUNE) in multiple sclerosis: the costs and utilities of MS patients in Canada. J Popul Ther Clin Pharmacol. 2012;19:e11–25.

    PubMed  Google Scholar 

  10. Coleman CI, Sidovar MF, Roberts MS, Kohn C. Impact of mobility impairment on indirect costs and health-related quality of life in multiple sclerosis. PLoS One. 2013;8:e54756.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Confavreux C, Vukusic S, Adeleine P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain J Neurol. 2003;126:770–82.

    Article  Google Scholar 

  12. Motl RW, Sandroff BM, Kwakkel G, Dalgas U, Feinstein A, Heesen C, et al. Exercise in patients with multiple sclerosis. Lancet Neurol. 2017;16:848–56 This review provides an overview of current research involving exercise training in persons with MS.

    PubMed  Google Scholar 

  13. Kim Y, Lai B, Mehta T, Thirumalai M, Padalabalanarayanan S, Rimmer JH, et al. Exercise training guidelines for multiple sclerosis, stroke, and Parkinson disease: rapid review and synthesis. Am J Phys Med Rehabil. 2019;98:613–21 This review reports on current recommendations for exercise training for persons with MS.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Langeskov-Christensen M, Heine M, Kwakkel G, Dalgas U. Aerobic capacity in persons with multiple sclerosis: a systematic review and meta-analysis. Sports Med. 2015;45:905–23.

    Article  PubMed  Google Scholar 

  15. Hunt KJ, Fang J, Saengsuwan J, Grob M, Laubacher M. On the efficiency of FES cycling: a framework and systematic review. Technol Health Care. 2012;20:395–422.

    Article  CAS  PubMed  Google Scholar 

  16. Deley G, Denuziller J, Babault N. Functional electrical stimulation: cardiorespiratory adaptations and applications for training in paraplegia. Sports Med. 2015;45:71–82.

    Article  PubMed  Google Scholar 

  17. Shariat A, Najafabadi MG, Ansari NN, Cleland JA, Singh MAF, Memari A-H, et al. The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: a systematic review with meta-analysis. NeuroRehabilitation. 2019;44:389–412.

    Article  PubMed  Google Scholar 

  18. Aaron SE, Vanderwerker CJ, Embry AE, Newton JH, Lee SCK, Gregory CM. FES-assisted cycling improves aerobic capacity and locomotor function postcerebrovascular accident. Med Sci Sports Exerc. 2018;50:400–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ambrosini E, Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial. Stroke. 2011;42:1068–73.

    Article  PubMed  Google Scholar 

  20. Sköld C, Lönn L, Harms-Ringdahl K, Hultling C, Levi R, Nash M, et al. Effects of functional electrical stimulation training for six months on body composition and spasticity in motor complete tetraplegic spinal cord-injured individuals. J Rehabil Med. 2002;34:25–32.

    Article  PubMed  Google Scholar 

  21. Krause P, Szecsi J, Straube A. FES cycling reduces spastic muscle tone in a patient with multiple sclerosis. NeuroRehabilitation. 2007;22:335–7.

    PubMed  Google Scholar 

  22. Edwards T, Motl RW, Pilutti LA. Cardiorespiratory demand of acute voluntary cycling with functional electrical stimulation in individuals with multiple sclerosis with severe mobility impairment. Appl Physiol Nutr Metab. 2018;43:71–6.

    Article  CAS  PubMed  Google Scholar 

  23. Szecsi J, Schlick C, Schiller M, Pöllmann W, Koenig N, Straube A. Functional electrical stimulation-assisted cycling of patients with multiple sclerosis: biomechanical and functional outcome - a pilot study. J Rehabil Med. 2009;41:674–80.

    Article  PubMed  Google Scholar 

  24. Fornusek C, Hoang P. Neuromuscular electrical stimulation cycling exercise for persons with advanced multiple sclerosis. J Rehabil Med. 2014;46:698–702.

    Article  PubMed  Google Scholar 

  25. Backus D, Burdett B, Hawkins L, Manella C, McCully KK, Sweatman M. Outcomes after functional electrical stimulation cycle training in individuals with multiple sclerosis who are nonambulatory. Int J MS Care. 2017;19:113–21 This study reported that FES cycling exercise is safe for persons with MS who are nonambulatory, with potential benefits on symptoms of fatigue and pain.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Reynolds MA, McCully K, Burdett B, Manella C, Hawkins L, Backus D. Pilot study: evaluation of the effect of functional electrical stimulation cycling on muscle metabolism in nonambulatory people with multiple sclerosis. Arch Phys Med Rehabil. 2015;96:627–32.

    Article  PubMed  Google Scholar 

  27. Ratchford JN, Shore W, Hammond ER, Rose JG, Rifkin R, Nie P, et al. A pilot study of functional electrical stimulation cycling in progressive multiple sclerosis. NeuroRehabilitation. 2010;27:121–8. This study is the first trial of home-based FES cycling exercise for persons with MS. Home-based FES cycling exercise was safe with potential benefits for strength, mobility, cognitive function, and quality of life.

    PubMed  Google Scholar 

  28. Edwards T, Motl RW, Sebastião E, Pilutti LA. Pilot randomized controlled trial of functional electrical stimulation cycling exercise in people with multiple sclerosis with mobility disability. Mult Scler Relat Disord. 2018;26:103–11. This study is the first RCT of FES cycling exercise in persons with moderate-to-severe MS. FES cycling exercise was safe and feasible. Benefits of FES cycling exercise may include improved aerobic fitness and mobility.

    Article  PubMed  Google Scholar 

  29. Pilutti LA, Edwards T, Motl RW, Sebastião E. Functional electrical stimulation cycling exercise in persons with multiple sclerosis: secondary effects on cognition, symptoms, and quality of life. Int J MS Care. 2018. https://doi.org/10.7224/1537-2073.2018-048. This RCT reported secondary outcomes after 24 weeks of FES cycling exercise in persons with moderate-to-severe MS. Benefits of FES cycling exercise may include improved cognitive function, fatigue, and pain.

  30. Pilutti LA, Platta ME, Motl RW, Latimer-Cheung AE. The safety of exercise training in multiple sclerosis: a systematic review. J Neurol Sci. 2014;343:3–7.

    Article  PubMed  Google Scholar 

  31. Marrie RA. Comorbidity in multiple sclerosis: implications for patient care. Nat Rev Neurol. 2017;13:375–82.

    Article  PubMed  Google Scholar 

  32. Marrie R, Hanwell H. General health issues in multiple sclerosis: comorbidities, secondary conditions, and health behaviors. Continuum (Minneap Minn). 2013;19:1046–57.

    Google Scholar 

  33. Zhang T, Tremlett H, Zhu F, Kingwell E, Fisk JD, Bhan V, et al. Effects of physical comorbidities on disability progression in multiple sclerosis. Neurology. 2018;90:e419–27.

    Article  PubMed  PubMed Central  Google Scholar 

  34. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. Tenth ed. Philadelphia, PA: Wolters Kluwer; 2018.

  35. Langeskov-Christensen M, Langeskov-Christensen D, Overgaard K, Møller AB, Dalgas U. Validity and reliability of VO2-max measurements in persons with multiple sclerosis. J Neurol Sci. 2014;342:79–87.

    Article  PubMed  Google Scholar 

  36. Coleman CI, Sobieraj DM, Marinucci LN. Minimally important clinical difference of the timed 25-foot walk test: results from a randomized controlled trial in patients with multiple sclerosis. Curr Med Res Opin. 2012;28:49–56.

    Article  PubMed  Google Scholar 

  37. Morrow SA, Drake A, Zivadinov R, Munschauer F, Weinstock-Guttman B, Benedict RHB. Predicting loss of employment over three years in multiple sclerosis: clinically meaningful cognitive decline. Clin Neuropsychol. 2010;24:1131–45.

    Article  PubMed  Google Scholar 

  38. Morrow SA, Jurgensen S, Forrestal F, Munchauer FE, Benedict RHB. Effects of acute relapses on neuropsychological status in multiple sclerosis patients. J Neurol. 2011;258:1603–8.

    Article  CAS  PubMed  Google Scholar 

  39. Fox RJ, Bacon TE, Chamot E, Salter AR, Cutter GR, Kalina JT, et al. Prevalence of multiple sclerosis symptoms across lifespan: data from the NARCOMS registry. Neurodegener Dis Manag. 2015;5:3–10.

    PubMed  Google Scholar 

  40. Hadjimichael O, Kerns RD, Rizzo MA, Cutter G, Vollmer T. Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain. 2007;127:35–41.

    Article  PubMed  Google Scholar 

  41. Solaro C, Brichetto G, Amato MP, Cocco E, Colombo B, D’Aleo G, et al. The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology. 2004;63:919–21.

    Article  CAS  PubMed  Google Scholar 

  42. Taylor MJ, Fornusek C, Ruys AJ, Bijak M, Bauman AE. The Vienna FES interview protocol - a mixed-methods protocol to elucidate the opinions of various individuals responsible for the provision of FES exercise. Eur J Transl Myol. 2017;27:6604.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Taylor MJ, Ruys AJ, Fornusek C, Bijak M, Russold M, Bauman AE. Lessons from Vienna: stakeholder perceptions of functional electrical stimulation technology and a conceptual model for practice. Disabil Rehabil Assist Technol. 2018:1–8. This study reported stakeholder perceptions of FES technology for persons with muscle paralysis or weakness, and provides a model for increasing FES update.

  44. Common terminology criteria for adverse events (CTCAE) Version 5.0. National Institutes of Health, US Department of Health and Human Services; 2017.

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Authors and Affiliations

  1. Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada

    Lara A. Pilutti PhD

  2. Department of Physical Therapy, University of Alabama at Birmingham, 1716 9th Avenue South, Birmingham, AL, 35233, USA

    Robert W. Motl PhD

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  1. Lara A. Pilutti PhD
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Correspondence to Robert W. Motl PhD.

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This article is part of the Topical Collection on Multiple Sclerosis and Related Disorders

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Pilutti, L.A., Motl, R.W. Functional Electrical Stimulation Cycling Exercise for People with Multiple Sclerosis. Curr Treat Options Neurol 21, 54 (2019). https://doi.org/10.1007/s11940-019-0597-7

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