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Effects of Electrical Stimulation Training on Body Composition Parameters After Spinal Cord Injury: A Systematic Review

Journal

ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Volume 103, Issue 6, Pages 1168-1178

Publisher

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2021.09.004

Keywords

Body composition; Neurological rehabilitation; Rehabilitation; Spinal cord injury; Therapeutic electrical stimulation

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The objective of this study was to determine the effects of neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES), or both, training on different body composition parameters in individuals with spinal cord injury. The findings suggest that NMES/FES is an effective rehabilitation strategy for muscle hypertrophy and increasing lean mass (LM). Weekly training volumes are associated with muscle hypertrophy after NMES loading exercise. However, there is a lack of rationale for the selection of stimulation parameters.
Objective: To determine the effects of neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES), or both, training on different body composition parameters in individuals with spinal cord injury. Data sources: Three independent reviewers searched PubMed, Web of Science, Scopus, Cochrane Central, and Virtual Health Library until March 2020. Study selection: Studies were included if they applied NMES/FES on the lower limb muscles after spinal cord injury, reported stimulation parameters (frequency, pulse duration, and amplitude of current), and body composition parameters, which included muscle cross-sectional area (CSA), fat-free mass, lean mass (LM), fat mass, visceral adipose tissue, and intramuscular fat. Data synthesis: A total of 46 studies were included in the final analysis with a total sample size of 414 subjects. NMES loading exercise and FES cycling exercise were commonly used for training. Increases in muscle CSA ranged from 5.7-75%, with an average of 26% (n=33). Fifteen studies reported changes (both increase and decrease) in LM or fat-free mas ranged from -4% to 35%, with an average of less than 5%. Changes in fat mass (n=10) were modest. The effect on ectopic adipose tissue is inconclusive, with 2 studies showing an average reduction in intramuscular fat by 9.9%. Stimulation parameters ranged from 200-1000 ms for pulse duration, 2-60 Hz for the frequency, and 10-200 mA in amplitude. Finally, increase in weekly training volumes after NMES loading exercise resulted in a remarkable increase in percentage changes in LM or muscle CSA. Conclusions: NMES/FES is an effective rehabilitation strategy for muscle hypertrophy and increasing LM. Weekly training volumes are associated with muscle hypertrophy after NMES loading exercise. Furthermore, positive muscle adaptations occur despite the applied stimulation parameters. Finally, the included studies reported wide range of stimulation parameters without reporting rationale for such selection. (C) 2021 by the American Congress of Rehabilitation Medicine.

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