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

The Journal of Spinal Cord Medicine, 2020 · DOI: 10.1080/10790268.2018.1544879 · Published: May 1, 2020

Spinal Cord Injury Neurology Musculoskeletal Medicine

Simple Explanation

This study investigates whether using a special rowing machine with electrical stimulation can help prevent bone loss in people who have recently suffered a spinal cord injury. The researchers measured bone density in the legs of four participants before, during, and after a 90-session rowing program. The study found that consistent participation in the rowing program could reduce or even reverse the expected bone loss in the legs of some individuals with recent spinal cord injuries.

Study Duration

9- to 12-month

Participants

Four adults with recent (<2 years) traumatic, motor complete SCI (C7-T12 AIS A-B)

Evidence Level

Prospective case series

Key Findings

1
Trabecular BMD in the femur and tibia decreased for all participants in T0-1, but the rate of loss slowed or reversed between T1-2, with little-to-no bone loss for most participants during T2-3.
2
The calculated bone stimulus was significantly correlated with change in femoral trabecular BMD (P = 0.016; R2= 0.458).
3
The average number of weekly training sessions attended was also significantly correlated with the change in BMD in the distal femur (P < 0.001; R2= 0.700)

Research Summary

This study examined the impact of a functional electrical stimulation (FES) rowing program on bone mineral density (BMD) in individuals within two years of a spinal cord injury (SCI). The results suggest that consistent participation in an FES rowing program can reduce or reverse the expected rate of bone loss in the lower limbs, at least temporarily, in some individuals early after SCI. The study emphasizes the importance of considering both the magnitude of force and the number of loading cycles when evaluating interventions for bone health, as demonstrated by the significant correlation between calculated bone stimulus and BMD changes.

Practical Implications

Rehabilitation strategy

FES rowing can be considered as a rehabilitation strategy to mitigate bone loss in individuals with recent SCI.

Dose-dependent response

Consistent participation (2.5-3 sessions per week) is crucial for observing positive effects on bone density.

Personalized exercise prescription

Exercise prescriptions should consider both force magnitude and loading cycles to maximize bone stimulus.

Study Limitations

1
The primary limitation is the small number of subjects involved
2
it would have been ideal to compare results to an age- and injury-matched control population
3
Defining the FES rowing intervention by number of sessions rather than calendar time may also be con- sidered a limitation

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