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Scientific review

Several clinical studies have shown that individuals who followed a therapy using FES Cycling obtained a range of benefits, listed below according to type. The bibliographical reference is quoted in brackets on the right of the page.

Muscle performance in FES-induced exercises

Research clearly indicates that several weeks of progressive resistance FES-induced exercise of the quadricep muscles not only induces hypertrophy but also significantly improves their strength and endurance in carrying out FES-induced activity (ref. 1). FES Cycling training has shown to enormously improve the performance of the paralysed muscles for this activity, as indicated by the increase in power and levels of endurance to exercise. After between six weeks and six months of training, the power developed by FES Cycling generally increased from 6 to 30W, and the time of exercise increased from a few minutes to a target time of 30 minutes. Furthermore, greater isometric strength and increased endurance in the paralysed quadriceps, hamstring, and gluteal muscles – all activated during conventional FES Cycling exercise – have been observed.

Muscle size

FES Cycling training causes hypertrophy of the working muscles as indicated by an increased circumference of the thigh. Furthermore, given that it has been observed that the local adipose tissue is reduced considerably by FES-induced exercise, the degree of hypertrophy is much larger than the measured circumference reveals. This exercise appears, therefore, capable of making atrophy of the paralysed muscles regress, or of slowing down the rate of its progression (refs. 2 and 3).

Range of movement

The addition of FES-induced contractions to the traditional techniques of manual stretching of the antagonist muscle groups increases the stretching of the tight musculature, providing more effective results. FES-induced exercise, which is involved in FES Cycling, can increase the ROM of the lower limbs, reducing the contractions in patients with spinal lesions (refs. 45).

Skeletal system

FES Cycling training is capable of determining a delay in the reduction of osseous density compared to what was expected according to the regression curves calculated using the cross-section data, suggesting a potential osteoporosis delaying effect. Furthermore, some of the results observed suggest that the loss of osseous density in patients with recent lesions can be limited and the progression of osteoporosis delayed through isometric contractions pulsed at high-intensity and FES Cycling exercises (refs. 67).

Cardiopulmonary benefits

Exercise with FES Cycling induces significant aerobic, metabolic, and cardiopulmonary responses as well as favourable central and peripheral haemodynamic responses (refs. 8910). In general, after six weeks to six months of training using FES Cycling, improvements in performance can be seen, with an increased development of power and endurance. Increasing the opposing resistance from the cycle-ergometer leads with time to significant beneficial effects in training: increases in peak VO2, HR, SV, CO, and pulmonary ventilation (VE).

Cardiovascular risks

The degree of cardiovascular and metabolic responses, as well as of central and peripheral haemodynamic ones obtained during exercise using FES Cycling, can bring benefits in terms of a reduced risk of cardiovascular complications. The results observed include increased left ventricular mass and increased end-diastolic volume in the left ventricle in subjects with quadriplegia. This suggests that left ventricular atrophy resulting from the chronic reduced volume commonly observed in these patients can regress through this mode of FES-induced exercise (refs. 1112).

Peripheral circulation

The rhythmic patterns of isometric FES-induced contractions of the thigh and calf muscles can activate the musculo-skeletal pump, significantly increasing SV and CO, improving local circulation, decreasing peripheral vascular atrophy, and reducing the risk of Deep Vein Thrombosis and the incidence of circulatory disorders, especially during the acute phase of rehabilitation (ref. 13).

Integumentary system

FES-induced exercise can help reduce the risk of pressure ulcers, given that it favours the increase of muscle mass, capillary density, and blood flow of both the skin and muscles (ref. 13).

Immune system

Individuals with spinal lesions, above all those with affected by quadriplegia, are more predisposed to infections. Paralysis of the muscles in the ribcage can be related to a predisposition towards respiratory infections, while urinary infections can be caused by neurogenic dysfunctions in the bladder, but it is conceivable that the reduced function of the immune system can be added to this predisposition. Exercise using FES Cycling improves the immune response and hence reduces the risk of infections. Certain studies have found a significant increase in number, percentage, and cytotoxic activity of natural killer cells following FES Cycling sessions (ref. 14).

Diabetes Mellitus and insulin sensitivity

Subjects with spinal lesions are more predisposed to developing insulin resistance and type II Diabetes Mellitus. The training of the large muscle groups in healthy individuals increases sensitivity to insulin and can prevent type II Diabetes Mellitus. Training by electrically induced cycling three times a week increases sensitivity to insulin and tolerance to glucose in subjects with spinal cord injuries and hence has a role in preventing insulin resistance syndrome and Diabetes Mellitus in individuals with spinal lesions (refs. 1617).

Functional performance

Even if they may present notable improvements on the functional scale, individuals with a complete spinal lesion cannot return to voluntary function (ref.14). Individuals with incomplete lesions or paresis of the lower limbs can obtain an improvement in the voluntary muscle function and performance of ADLs through regular FES-induced training.

Psychological Benefits

Notable beneficial effects in patients with spinal cord lesions have been reported from FES cycling training, also from the psychological point of view. A great number of subjects undergoing a FES cycling training report that they feel stronger, more energetic, less tired, and generally manifest a greater feeling of wellbeing. Therefore, regular training can improve mental health disorders and the perception of health of subjects with spinal lesions (ref. 15).



Clinical Benefits of FES Cycling Exercise for Subjects with Central Neurological Impairments
FES Cycling Improves Motor Recovery in Postacute Hemiparetic Patients
A pilot study of FES Cycling in progressive multiple sclerosis
Cardiorespiratory, Metabolic, and Biomechanical Responses During FES Leg Exercise
Effects of training programs for spinal cord injury
Upper-limb Exercise in Tetraplegia using FES
Late recovery following spinal cord injury
 Spinal cord injury
Effects of FES on skeletal muscle adaptability in spinal cord injury
Insulin action and long-term FES training in individuals with spinal cord injuries
Peripheral vascular changes after FES Cycling in people with spinal cord injury
Altered contractile properties of quadriceps muscle in people with spinal cord injury after FES Cycling
FES Cycling may promote recovery of leg funcyion after incomplete spinal cord injury
FES: can it increase muscle strength and reverse osteopenia in spinal cord injuried individuals?
Increasing muscle mass in spinal cord injuried persons with FES
Improved body composition after 8 weeks of FES cycling in tetraplegic patients
Peak and submaximalphysiologic responses following FES
Metabolic and hemodynamic responses to concurrent voluntary arm crank and FES in quadriplegics
Training effects of FES on cardiorespiratory responses of spinal cord injuried subjects at rest and during submaximal exercise
Spasticity in spinal cord injuried: short-term effects of FES
Use of FES for rehabilitation of spinal cord injuried patients
Riferimenti bibiliografici studi clinici


  1. Baldi, J.C., Jackson, R.D., Moraille, R. and Mysiw, W.J. Muscle atrophy is prevented in patients with acute spinal cord injury using functional electric stimulation. Spinal Cord 1998. 336, 463-469.
  2. Chilibeck, J Jeon, C Weiss, G Bell, R Burnham : Histochemical changes in muscle of individuals with spinal cord injury following functional electrical stimulated exercise training. Spinal Cord 1999; 37: 264-268
  3. Donaldson N, Perkins TA, Fitzwater R, Wood DE & Middleton F: FES cycling may promote recovery of leg function after incomplete spinal cord injury. Spinal Cord 2000; 38: 680-682
  4. Petrofsky JS, Heaton HH and Phillips CA: Outdoor bicycle for exercise in paraplegics and quadriplegics. J Biomed Eng 1983; 5: 292-296
  5. Mohr T, Podenphant J, Biering-Sorensen F, Galbo H, Thamsborg G and Kjaer M: Increased bone mineral density after prolonged electrically induced cycle training of paralyzed limbs in spinal cord injured man. Calcified Tissue International 1997; 61: 22-25
  6. Ragnarsson KT: Physiologic effects of functional electrical stimulation-induced exercises in spinal-cord injured individuals. Clinical Orthopaedics 1988; Volume 233: 53-63
  7. Thomas W.J. Janssen, Roger M. Glaser, David B. Shuster: Clinical Efficacy of Electrical Stimulation Exercise Training: Effects on Health, Fitness, and Function. Topics in Spinal Cord Injury Rehabilitation 1998; 3(3): 33-49
  8. Hooker SP., Figoni SF., Rodgers MM., Glaser RM., et al.: Physiologic effects of electrical stimulation leg cycle exercise training in spinal cord injured persons. Arch Phys Med Rehabil 1992; 73: 470-6
  9. Faghri PD., Glaser RM., Figoni SF: Functional electrical stimulation leg cycle ergometer exercise: training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise. Arch Phys Med Rehabil 1992; 73: 1085-93
  10. Petrofsky JS., Stacy Ralph: The effect of training on endurance and the cardiovascular responses of individuals with paraplegia during dynamic exercise induced by functional electrical stimulation.
  11. Perkins TA, Donaldson N de N, Fitzwater R, Phillips GF & Wood DE: Leg powered paraplegic cycling system using surface functional electrical stimulation. Prog. 7th Vienna Internat Workshop on FES 2001
  12. Petrofsky JS & Stacy R: The effect of training on endurance and the cardiovascular responses of individuals with paraplegia during dynamic exercise induced by functional electrical stimulation. Eur J Appl Physiol 1992; 64: 487-492
  13. Gerrits, H.L., Haan, A. de, Sargeant, A.J., Langen, H. van & Hopman, M.T.E..Peripheral vascular changes after electrically stimulated cycle training in people with spinal cord injury. Archives of Physical Medicine & Rehabilitation 2001. 82: 832-839.
  14. John W. Mcdonald, Daniel Becker, Cristina L. Sadowsky, John A. Jane, Thomas E. Conturo, Linda M. Schultz: Late recovery following spinal cord injury - Case report and review of the literature. J Neurosurg (Spine 2) 2002; 97:252-265
  15. Janssen TWJ, Glaser RM and Shuster DB: Clinical efficacy of electrical stimulation exercise training: effects on health, fitness, and function. Topics in Spinal Cord Injury Rehabilitation 1998; 3: 33-49
  16. JY Jeon, et. Al. Improved glucose tolerance and insulin sensitivity after electrical stimulation-assisted cycling in people with spinal cord injury. Spinal Cord (2002) 40, 110 ± 117.
  17. Mohr T, et. Al. Insulin action and long-term electrically induced training in individuals with spinal cord injuries. Med Sci Sports Exerc. 2001 Aug;33(8):1247-52.