Recumbent stepping aerobic exercise in amyotrophic lateral sclerosis: a pilot study

  • Anjali Sivaramakrishnan
  • Sangeetha MadhavanEmail author
Original Article



Aerobic exercise can promote neuroplastic responses in the healthy and injured brain. Although the role of exercise in amyotrophic lateral sclerosis (ALS) is debated, new evidence suggests that exercise may reduce disease progression. While common exercise modalities such as the treadmill and cycle ergometer have been explored in ALS, the safety and feasibility of a total body recumbent stepper have not been investigated. Additionally, the functional and neurophysiological effects of recumbent stepping in ALS are still unknown. Here, we investigated the safety and feasibility of a 4-week recumbent stepping program to slow disease progression in ALS and possibly facilitate neuroplasticity.


Nine individuals with ALS performed moderate intensity recumbent stepping for four weeks. Outcomes included participation satisfaction questionnaire, ALS Functional Rating Scale Revised (ALSFRS-R), clinical tests of walking and endurance, fatigue severity scale, Beck depression inventory, SF-12, and transcranial magnetic stimulation-induced motor evoked potentials (MEPs). All measurements were collected at baseline, post-intervention, and at the 1-month follow-up.


Eight participants completed the study without any adverse events. The ALSFRS-R scores were similar at the end of the study and at follow-up. No significant differences were noted for any of the clinical outcomes. MEPs were present only in two participants and changes in corticomotor excitability after exercise were minimal.


Results from this preliminary study support the safety and feasibility of 12 sessions of total body recumbent stepping in individuals with ALS.


Aerobic exercise Corticomotor excitability Amyotrophic lateral sclerosis ALSFRS-R Recumbent stepping Neuroplasticity 



This work was supported by the UIC College of Applied Health Sciences Interdisciplinary Grant (SM).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All research procedures were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10072_2019_3736_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21.9 kb)


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Graduate Program in Rehabilitation Sciences, College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoUSA

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