Functional Electrical Stimulation Cycling Exercise for People with Multiple Sclerosis
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.
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).
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.
KeywordsMultiple sclerosis Functional electrical stimulation Exercise Cycling
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 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.CrossRefGoogle 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.CrossRefGoogle 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.CrossRefGoogle 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.PubMedGoogle 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.CrossRefGoogle 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.
- 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
- 34.American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. Tenth ed. Philadelphia, PA: Wolters Kluwer; 2018.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.Google Scholar
- 44.Common terminology criteria for adverse events (CTCAE) Version 5.0. National Institutes of Health, US Department of Health and Human Services; 2017.Google Scholar